Yvon Graic - Academia.edu (original) (raw)
Papers by Yvon Graic
Radiotherapy and Oncology, 2001
To assess the clinical and histological characteristics of breast cancer (BC) occurring after Hod... more To assess the clinical and histological characteristics of breast cancer (BC) occurring after Hodgkin's disease (HD) and give possible therapies and prevention methods. In a retrospective multicentric analysis, 117 women and two men treated for HD subsequently developed 133 BCs. The median age at diagnosis of HD was 24 years. The HD stages were stage I in 25 cases (21%), stage II in 70 cases (59%), stage III in 13 cases (11%), stage IV in six cases (5%) and not specified in five cases (4%). Radiotherapy (RT) was used alone in 74 patients (63%) and combined modalities with chemotherapy (CT) was used in 43 patients (37%). BC occurred after a median interval of 16 years. TNM classification (UICC, 1978) showed 15 T0 (11.3%), 44 T1 (33.1%), 36 T2 (27.1%), nine T3 (6.7%), 15 T4 (11.3%) and 14 Tx (10.5%). Ductal infiltrating carcinoma and ductal carcinoma in situ (DCIS) represented 81.2 and 11.3% of the cases, respectively. Among the infiltrating carcinoma, the axillary involvement rate was 50%. Seventy-four tumours were treated by mastectomy without (67) or with (ten) RT. Forty-four tumours had lumpectomy without (12) or with (32) RT. Another four received RT alone, and one CT alone. Sixteen patients (12%) developed isolated local recurrence. Thirty-nine patients (31.7%) developed metastases and 34 died; 38 are in complete remission whereas five died of intercurrent disease. The 5-year disease-specific survival rate was 65.1%. The 5-year disease-specific survival rates for the pN0, pN1-3 and pN>3 groups were 91, 66 and 15%, respectively (P<0.0001), and 100, 88, and 64% for the TIS, T1 and T2. For the T3 and T4, the survival rates decreased sharply to 32 and 23%, respectively. These secondary BC are of two types: a large number of aggressive tumours with a very unfavourable prognosis (especially in the case of pN>3 and/or T3T4), and many tumours with a 'slow spreading' such as DCIS and microinvasive lesions. These lesions developed especially in patients treated exclusively by RT. The young women and girls treated for HD should be carefully monitored in the long-term by clinical examination, mammography and ultrasonography. We suggest that a baseline mammography is performed 5-8 years after supradiaphragmatic irradiation (complete mantle or involved field) in patients who were treated before 30 years of age. Subsequent mammographies should be performed every 2 years or each year, depending on the characteristics of the breast tissue (e.g. density) and especially in the case of an association with other BC risk factors. This screening seems of importance due to excellent prognosis in our T(1S)T(1) groups, and the possibility of offering these young women a conservative treatment.
European Journal of Cancer, 1995
From 2/90 to 6/93, 195 adult patients (pts) with HD, CS lA-llIB without bulky tumor (nodes <10 cm... more From 2/90 to 6/93, 195 adult patients (pts) with HD, CS lA-llIB without bulky tumor (nodes <10 cm; mediastinal tumor/thoracic width ratio <0.45; no simultaneous lumbo-aortic and pelvic involvement) were randomized to receive 3 monthly courses (only I in peripheral CS lA) of ABVD-MP (DI and DIS, mg/m 2 : adriamycin 25, bleomycin (BLM) 10, vinblastin (VBL) 6, dacarbazin 375, methylprednisolone (MP) 120 = arm A, 101 pts) or EBVM-MP (DI and DIS, mg/m 2 : epirubicin 30, BLM 10, VBL 6, methotrexate 30, MP 120 = ann E, 94 pts). CTresponding pts were given (sub)total nodal and splenic RT (involved fields 40 Gy, non-involved 30 Gy). Pts characteristics: M llO, F 85; age <= 40 148, >4047; CS I 56, II ll7, ill 22; A 152, B 43; histology: LP 21, NS 128, MC 30, LD I, UN IS. Complete remission rates after CT and RT were 81 % (A 83 pts, E 74 pts) and 95% (A 96 pts, E 90 pts) (P = NS); 10 pts relapsed (A I, E 9, P < 0.05) and 4 pts died (A I, E 3).
European Journal of Cancer, 1999
Diagnosis is suggested by the functional symptoms and digital rectal examination and must be conf... more Diagnosis is suggested by the functional symptoms and digital rectal examination and must be confirmed by histological examination. The second step is to evaluate the patient's condition, the extent of the cancer and the consequences on the urinary system; the choice of the treatment depends on this evaluation. The most common tumors are adenocarcinomas with a histological grading strongly correlated to the lymphatic involvement and frequency of metastases. Lymphatic involvement is closely related to the local clinically demonstrable involvement, histological grade, serum acid phosphatase concentrations and results of lymphography. Upon diagnosis of cancer of the prostate more than half the patients already harbour metastases, usually of the bone. This percentage is correlated to the size of the primary tumor, involvement of the seminal vesicles, histological grade and lymphatic involvement. The authors propose a series of investigations adapted to each case.
Bulletin du cancer
From October 1977 to December 1983, estrogen receptor (ER) and progesterone receptor (PR) levels ... more From October 1977 to December 1983, estrogen receptor (ER) and progesterone receptor (PR) levels were measured in 645 tumors from women with primary, unilateral, nonmetastatic breast cancer. All of them were treated surgically. Some received adjuvant radiotherapy, adjuvant chemotherapy, or adjuvant hormonotherapy. A level of greater than 5 fmol/mg cytosolic protein was considered as positive for both ER and PR. Unifactorial analysis, using Kaplan and Meier estimates and the log-rank test, revealed that disease-free survival (DFS) and overall survival (SV) were both strongly related to age, tumor size, nodal status, nodal effraction, histopathologic grading (SBR), ER, and PR. Menopausal status and number of intramammary tumor foci were not significant. Multifactorial analysis, using Cox's model, revealed a strong relationship between SV and age (poor prognosis [pp]: less than or equal to 37 years old), menopausal status (pp: postmenopausal) tumor size, nodal status (pp: N+ greater than 3), nodal effraction, ER (pp: less than or equal to 5 fmol/mg), histopathologic grading (pp: SBR = 3), and PR (pp: less than or equal to 5 fmol/mg). Similarly, multifactorial analysis revealed a strong correlation between DFS and age, tumor size, nodal status, nodal effraction, histopathologic grading, and PR. A prognostic score taking into account these prognostic factors was calculated for DFS and SV. Analysis of this score allowed us to divide our patients into four significantly different (P less than 0.0001) groups with high, intermediate, and low risk of relapse. Our procedure was then validated using the sample test technique. These results show that both ER and PR have their own prognostic weight and should be considered, among other classic prognostic factors, when adjuvant therapies are indicated after surgical treatment of breast cancer.
Bulletin du cancer
Between October 1977 and December 1983, 379 consecutive patients have been treated for unilateral... more Between October 1977 and December 1983, 379 consecutive patients have been treated for unilateral, non metastatic breast cancer, either with conservative (n = 205) or radical surgery (n = 174), with axillary dissection in all the cases. None of them had histologically proved lymph node involvement. Adjuvant radiotherapy was given in 268 cases. Estrogen receptor (ER) and progesterone receptor (PR) levels were measured on each tumor. Levels greater than 5 fmoles/mg cytosolic protein were considered as positive for both ER and PR. At 5 years, overall survival (OS) and disease-free survival (DFS) are respectively 88% and 79%. Unifactorial analysis using KAPLAN and MEIER estimates and Logrank test revealed that OS was significantly related to age, tumor size, histopathological grading, ER and PR. DFS was significantly related to the same factors. Menopausal status, number of intra mammary tumor foci, previous familial history of breast cancer were not significant. Multifactorial analysis revealed that DFS was significantly related to age (bad prognosis [bp]: less than or equal to 37 years old), tumor size, histopathological grading (bp: SBR = 3) and that OS was significantly related to tumor size and PR (bp: PR less than or equal to 5 fmoles/mg protein). A prognostic score was obtained which sampled our patients into 3 significantly different (P less than 0.0001) groups with high, intermediate and low risk of relapse. These results suggest that tumor size, histopathological grading and PR have their own prognostic weight in histologically node negative breast cancer. Grouping these factors together allows to define a high risk relapse group that could benefit from adjuvant treatment.
La Presse Médicale
The so-called inflammatory carcinoma of the breast is a rare condition characterized, in almost e... more The so-called inflammatory carcinoma of the breast is a rare condition characterized, in almost every case, by metastatic diffusion in numerous organs. Clinical criteria are indispensable to establish a diagnosis which is not ruled out by a negative skin biopsy. Radiotherapy or surgery, or both, gives disappointing results with a median survival of about 18 months and a 5-year survival rate of 5%. It is unanimously agreed that adding chemotherapy to these methods improves local control and increases the 5-year survival rate. The optimal treatment remains to be determined by co-operative studies.
The diagnostic value of mammography was evaluated retrospectively in 23 recurrent carcinomas in p... more The diagnostic value of mammography was evaluated retrospectively in 23 recurrent carcinomas in patients previously treated by partial mastectomy with or without adjuvant radiotherapy. Mammography established accurate diagnosis in 11 of the 23 patients. Mammography should always be performed in addition to clinical and cytological examinations and results must be evaluated jointly. Confrontation of these three investigations may be inconclusive as a result of changes produced by radiotherapy or surgery. The authors recall the necessity of surgical control of any nodular lesion developed in the area of the initial operation, particularly during the first three years.
Bulletin du cancer
This retrospective study shows the advantage of the CA 15.3 assay for the early detection of rela... more This retrospective study shows the advantage of the CA 15.3 assay for the early detection of relapse in breast cancer. It involved 473 women with invasive canalar carcinoma who had local recurrence or metastasis and/or an elevation of CA 15.3 (> 35 kU/l). The positive predictive value is excellent (97.7%). Sensitivity is poor for local relapse (13.7%), but a marker elevation at this time is a good prognostic factor of further distant metastasis (88%). It is better in the case of distant metastasis (74%), especially in bone and and liver localizations. CA 15.3 measurement at two month intervals may allow an early detection in 40% of distant metastasis. These results confirm the need of trials to test the benefits in terms of survival of early treatment of breast cancer metastasis only proved by CA 15.3 elevation, without any clinical or radiological finding.
Cancer/Radiothérapie, 1997
Immuno-analyse & Biologie Spécialisée, 1998
Cancer/Radiothérapie, 1997
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 1997
Though Hodgkin's disease (HD) is one of the malignancies in which considerable progress has b... more Though Hodgkin's disease (HD) is one of the malignancies in which considerable progress has been made, long-term side effects have been observed, second primary cancer being the most significant. Several recent reports have indicated an increased risk of breast cancer (BC) in girls and young women among HD patients. In a retrospective multicenter analysis, 63 women treated for HD subsequently developed BC. Results that were obtained in 13 women (21%) who developed either synchronous (five cases) or metachronous (eight cases) BC were analyzed. The median age at diagnosis of HD was 19 years. Seven patients underwent exclusive radiotherapy (RT) (including "mantle" supradiaphragmatic irradiation) and six received concomittant radiation therapy and chemotherapy. The first breast tumor occurred after a median delay of 16 years. According to the TNM classification, we showed nine stage T0 (non palpable lesions), four stage T1, five stage T2, one stage T3, two stage T4 and fiv...
British journal of cancer, 1993
One hundred and seventy-eight patients with non metastatic inflammatory breast cancer (IBC) have ... more One hundred and seventy-eight patients with non metastatic inflammatory breast cancer (IBC) have been treated at the Centre H. Becquerel. Median follow up is 67 months (6-178). Every patient received neoadjuvant chemotherapy (mean number of cycles = 4; range: 2-8), followed by a loco regional treatment (radiotherapy = XRT or modified radical mastectomy = S), followed by adjuvant chemotherapy. During this period, the types of chemotherapy and locoregional treatment have been the following: Study I: 64 patients treated with CMF or AVCF and XRT; Study II: 83 patients, treated with either AVCF, FAC or VAC followed by S (n = 38) or XRT (n = 22) in case of complete or partial response, or followed by XRT (23) in case of initial supraclavicular lymph node involvement or lack of response after chemotherapy; Study III: 31 patients treated with FEC-HD + Estrogenic recruitment followed by S and XRT after adjuvant chemotherapy, except seven patients who received XRT (refusal of surgery). Althou...
JAMA, 2005
A NTHRACYCLINES ARE AMONG the most widely used agents for breast cancer treatment, followed by ta... more A NTHRACYCLINES ARE AMONG the most widely used agents for breast cancer treatment, followed by taxanes, which were gradually introduced during the last decade. Combinations of these drug classes have proven superior to anthracyclines alone in advanced or metastatic breast cancer, 1,2 while taxanes are still under evaluation in early breast cancer. 3 Uncertainties regarding the optimal schedule of administration in combination with anthracyclines, as well as safety and cost issues, are fueling a debate on whether the use of taxanes is justified outside of clinical trials. 4 Febrile neutropenia is a common adverse effect of chemotherapy, the severity of which depends both on the types and doses of drugs administered and on individual risk factors. Several groups have tested combinations of docetaxel with anthracy-clines in adjuvant and neoadjuvant settings, and the data were recently reviewed. 3 Higher rates of febrile neutro-penia are reported with these combinations, including various docetaxel schedules, than with more traditional Context Adjuvant chemotherapy with new cytotoxic agents for breast cancer must be properly assessed for toxicity.
International Journal of Radiation Oncology*Biology*Physics, 2006
To compare concomitant and sequential adjuvant chemoradiotherapy regimens in node-positive, opera... more To compare concomitant and sequential adjuvant chemoradiotherapy regimens in node-positive, operable breast cancer patients. This was a randomized, French, multicenter, phase III trial enrolling 638 eligible women with prior breast surgery and positive axillary dissection. Patients in Arm A received 500 mg/m2 5-fluorouracil, 12 mg/m2 mitoxantrone, and 500 mg/m2 cyclophosphamide, with concomitant radiotherapy (50 Gy +/- 10-20-Gy boost). Patients in Arm B received 500 mg/m2 5-fluorouracil, 60 mg/m2 epirubicin, and 500 mg/m2 cyclophosphamide, with subsequent radiotherapy. Chemotherapy was administered on Day 1 every 21 days for 4 cycles. Median treatment durations were 64 and 126 days (Arms A and B, respectively), with no significant difference in overall or disease-free survival. Five-year locoregional relapse-free survival favored patients with conservative surgery (two thirds of the population), with less local and/or regional recurrence in Arm A than in Arm B (3% vs. 9%; p = 0.01). Multivariate analysis in this subgroup showed a 2.8-fold increased risk of locoregional recurrence with sequential chemoradiotherapy, independent of other prognostic factors (p = 0.027). Febrile neutropenia and Grade 3-4 leukopenia were significantly more frequent in Arm A. Subclinical left ventricular ejection fraction events at 1 year were more frequent with concomitant radiotherapy (p = 0.02). Concomitant radiotherapy with adjuvant fluorouracil, mitoxantrone, and cyclophosphamide has significantly better locoregional control in node-positive breast cancer after conservative surgery and 50% shorter treatment, albeit with slightly more acute toxicity. With mitoxantrone no longer available for adjuvant breast cancer treatment, alternative concomitant chemoradiotherapy studies are needed.
European Journal of Cancer, 1995
European Journal of Cancer, 1997
In a retrospective multicentric analysis, 63 women treated between 1941 to 1988 for Hodgkin&#... more In a retrospective multicentric analysis, 63 women treated between 1941 to 1988 for Hodgkin's disease (HD) subsequently developed 76 breast cancers (BC). The median age at diagnosis of HD was 26 years (range 7-67), and 22 women (35%) were 20 years old or less. Exclusive radiotherapy (RT) was used in 36 women (57%) and combined modalities with chemotherapy (CT) in 25 (39%). Breast cancer occurred after a median interval of 16 years (range 2-40) and the median age at diagnosis of the first BC was 42 years (range 25-73). TNM classification (UICC, 1978) showed 10 T0 (non-palpable lesions) (13%), 20 T1 (26%), 22 T2 (29%), 8 T3 (11%), 7 T4 (9%) and 9 Tx (12%), giving altogether a total of 76 tumours, including, respectively, 5 and 8 bilateral synchronous and metachronous lesions. Among the 68 tumours initially discovered, 53 ductal infiltrating, one lobular infiltrating and two medullary carcinomas were found. Moreover, two fibrosarcomas and 10 ductal carcinoma in situ (DCIS) were also found. Among 50 axillary dissections for invasive carcinomas, histological involvement was found in 31 cases (62%). 45 tumours were treated by mastectomy, without (n = 35) or with (n = 10) RT. 27 tumours had lumpectomy, without (n = 7) or with RT (n = 20). 2 others received RT only, and one only CT. 7 patients (11%) developed isolated local recurrence. 20 patients (32%) developed metastases and all died; 38 are in complete remission, whereas 5 died of intercurrent disease. The 5-year disease-specific survival rate by the Kaplan-Meier method was 61%. The 5-year disease-specific survival rate for pN0, pN1-3 and pN > or = 3 groups were 91%, 66% and 0%, respectively (P < 0.0001) and 100%, 88%, 64% and 23% for the T0, T1, T2 and T3T4 groups, respectively. These secondary BCs seem to be of two types: a large number of aggressive tumours with a very unfavourable prognosis (especially in the case of pN > 3 and/or T3T4); and many tumours with a 'slow development' such as DCIS and microinvasive lesions, especially in patients treated exclusively by RT. Moreover, a very unusual rate of bilateral tumours (21%) was observed. These secondary BC could be 'in field', in 'border of field' or 'out of field'. However, a complete analysis of doses delivered by supradiaphragmatic irradiation was often very difficult, due to large variations in several parameters. We conclude that young women and girls treated for HD should be carefully monitored by clinical examination, mammography and ultrasonography.
Radiotherapy and Oncology, 2001
To assess the clinical and histological characteristics of breast cancer (BC) occurring after Hod... more To assess the clinical and histological characteristics of breast cancer (BC) occurring after Hodgkin's disease (HD) and give possible therapies and prevention methods. In a retrospective multicentric analysis, 117 women and two men treated for HD subsequently developed 133 BCs. The median age at diagnosis of HD was 24 years. The HD stages were stage I in 25 cases (21%), stage II in 70 cases (59%), stage III in 13 cases (11%), stage IV in six cases (5%) and not specified in five cases (4%). Radiotherapy (RT) was used alone in 74 patients (63%) and combined modalities with chemotherapy (CT) was used in 43 patients (37%). BC occurred after a median interval of 16 years. TNM classification (UICC, 1978) showed 15 T0 (11.3%), 44 T1 (33.1%), 36 T2 (27.1%), nine T3 (6.7%), 15 T4 (11.3%) and 14 Tx (10.5%). Ductal infiltrating carcinoma and ductal carcinoma in situ (DCIS) represented 81.2 and 11.3% of the cases, respectively. Among the infiltrating carcinoma, the axillary involvement rate was 50%. Seventy-four tumours were treated by mastectomy without (67) or with (ten) RT. Forty-four tumours had lumpectomy without (12) or with (32) RT. Another four received RT alone, and one CT alone. Sixteen patients (12%) developed isolated local recurrence. Thirty-nine patients (31.7%) developed metastases and 34 died; 38 are in complete remission whereas five died of intercurrent disease. The 5-year disease-specific survival rate was 65.1%. The 5-year disease-specific survival rates for the pN0, pN1-3 and pN>3 groups were 91, 66 and 15%, respectively (P<0.0001), and 100, 88, and 64% for the TIS, T1 and T2. For the T3 and T4, the survival rates decreased sharply to 32 and 23%, respectively. These secondary BC are of two types: a large number of aggressive tumours with a very unfavourable prognosis (especially in the case of pN>3 and/or T3T4), and many tumours with a 'slow spreading' such as DCIS and microinvasive lesions. These lesions developed especially in patients treated exclusively by RT. The young women and girls treated for HD should be carefully monitored in the long-term by clinical examination, mammography and ultrasonography. We suggest that a baseline mammography is performed 5-8 years after supradiaphragmatic irradiation (complete mantle or involved field) in patients who were treated before 30 years of age. Subsequent mammographies should be performed every 2 years or each year, depending on the characteristics of the breast tissue (e.g. density) and especially in the case of an association with other BC risk factors. This screening seems of importance due to excellent prognosis in our T(1S)T(1) groups, and the possibility of offering these young women a conservative treatment.
European Journal of Cancer, 1995
From 2/90 to 6/93, 195 adult patients (pts) with HD, CS lA-llIB without bulky tumor (nodes <10 cm... more From 2/90 to 6/93, 195 adult patients (pts) with HD, CS lA-llIB without bulky tumor (nodes <10 cm; mediastinal tumor/thoracic width ratio <0.45; no simultaneous lumbo-aortic and pelvic involvement) were randomized to receive 3 monthly courses (only I in peripheral CS lA) of ABVD-MP (DI and DIS, mg/m 2 : adriamycin 25, bleomycin (BLM) 10, vinblastin (VBL) 6, dacarbazin 375, methylprednisolone (MP) 120 = arm A, 101 pts) or EBVM-MP (DI and DIS, mg/m 2 : epirubicin 30, BLM 10, VBL 6, methotrexate 30, MP 120 = ann E, 94 pts). CTresponding pts were given (sub)total nodal and splenic RT (involved fields 40 Gy, non-involved 30 Gy). Pts characteristics: M llO, F 85; age <= 40 148, >4047; CS I 56, II ll7, ill 22; A 152, B 43; histology: LP 21, NS 128, MC 30, LD I, UN IS. Complete remission rates after CT and RT were 81 % (A 83 pts, E 74 pts) and 95% (A 96 pts, E 90 pts) (P = NS); 10 pts relapsed (A I, E 9, P < 0.05) and 4 pts died (A I, E 3).
European Journal of Cancer, 1999
Diagnosis is suggested by the functional symptoms and digital rectal examination and must be conf... more Diagnosis is suggested by the functional symptoms and digital rectal examination and must be confirmed by histological examination. The second step is to evaluate the patient's condition, the extent of the cancer and the consequences on the urinary system; the choice of the treatment depends on this evaluation. The most common tumors are adenocarcinomas with a histological grading strongly correlated to the lymphatic involvement and frequency of metastases. Lymphatic involvement is closely related to the local clinically demonstrable involvement, histological grade, serum acid phosphatase concentrations and results of lymphography. Upon diagnosis of cancer of the prostate more than half the patients already harbour metastases, usually of the bone. This percentage is correlated to the size of the primary tumor, involvement of the seminal vesicles, histological grade and lymphatic involvement. The authors propose a series of investigations adapted to each case.
Bulletin du cancer
From October 1977 to December 1983, estrogen receptor (ER) and progesterone receptor (PR) levels ... more From October 1977 to December 1983, estrogen receptor (ER) and progesterone receptor (PR) levels were measured in 645 tumors from women with primary, unilateral, nonmetastatic breast cancer. All of them were treated surgically. Some received adjuvant radiotherapy, adjuvant chemotherapy, or adjuvant hormonotherapy. A level of greater than 5 fmol/mg cytosolic protein was considered as positive for both ER and PR. Unifactorial analysis, using Kaplan and Meier estimates and the log-rank test, revealed that disease-free survival (DFS) and overall survival (SV) were both strongly related to age, tumor size, nodal status, nodal effraction, histopathologic grading (SBR), ER, and PR. Menopausal status and number of intramammary tumor foci were not significant. Multifactorial analysis, using Cox's model, revealed a strong relationship between SV and age (poor prognosis [pp]: less than or equal to 37 years old), menopausal status (pp: postmenopausal) tumor size, nodal status (pp: N+ greater than 3), nodal effraction, ER (pp: less than or equal to 5 fmol/mg), histopathologic grading (pp: SBR = 3), and PR (pp: less than or equal to 5 fmol/mg). Similarly, multifactorial analysis revealed a strong correlation between DFS and age, tumor size, nodal status, nodal effraction, histopathologic grading, and PR. A prognostic score taking into account these prognostic factors was calculated for DFS and SV. Analysis of this score allowed us to divide our patients into four significantly different (P less than 0.0001) groups with high, intermediate, and low risk of relapse. Our procedure was then validated using the sample test technique. These results show that both ER and PR have their own prognostic weight and should be considered, among other classic prognostic factors, when adjuvant therapies are indicated after surgical treatment of breast cancer.
Bulletin du cancer
Between October 1977 and December 1983, 379 consecutive patients have been treated for unilateral... more Between October 1977 and December 1983, 379 consecutive patients have been treated for unilateral, non metastatic breast cancer, either with conservative (n = 205) or radical surgery (n = 174), with axillary dissection in all the cases. None of them had histologically proved lymph node involvement. Adjuvant radiotherapy was given in 268 cases. Estrogen receptor (ER) and progesterone receptor (PR) levels were measured on each tumor. Levels greater than 5 fmoles/mg cytosolic protein were considered as positive for both ER and PR. At 5 years, overall survival (OS) and disease-free survival (DFS) are respectively 88% and 79%. Unifactorial analysis using KAPLAN and MEIER estimates and Logrank test revealed that OS was significantly related to age, tumor size, histopathological grading, ER and PR. DFS was significantly related to the same factors. Menopausal status, number of intra mammary tumor foci, previous familial history of breast cancer were not significant. Multifactorial analysis revealed that DFS was significantly related to age (bad prognosis [bp]: less than or equal to 37 years old), tumor size, histopathological grading (bp: SBR = 3) and that OS was significantly related to tumor size and PR (bp: PR less than or equal to 5 fmoles/mg protein). A prognostic score was obtained which sampled our patients into 3 significantly different (P less than 0.0001) groups with high, intermediate and low risk of relapse. These results suggest that tumor size, histopathological grading and PR have their own prognostic weight in histologically node negative breast cancer. Grouping these factors together allows to define a high risk relapse group that could benefit from adjuvant treatment.
La Presse Médicale
The so-called inflammatory carcinoma of the breast is a rare condition characterized, in almost e... more The so-called inflammatory carcinoma of the breast is a rare condition characterized, in almost every case, by metastatic diffusion in numerous organs. Clinical criteria are indispensable to establish a diagnosis which is not ruled out by a negative skin biopsy. Radiotherapy or surgery, or both, gives disappointing results with a median survival of about 18 months and a 5-year survival rate of 5%. It is unanimously agreed that adding chemotherapy to these methods improves local control and increases the 5-year survival rate. The optimal treatment remains to be determined by co-operative studies.
The diagnostic value of mammography was evaluated retrospectively in 23 recurrent carcinomas in p... more The diagnostic value of mammography was evaluated retrospectively in 23 recurrent carcinomas in patients previously treated by partial mastectomy with or without adjuvant radiotherapy. Mammography established accurate diagnosis in 11 of the 23 patients. Mammography should always be performed in addition to clinical and cytological examinations and results must be evaluated jointly. Confrontation of these three investigations may be inconclusive as a result of changes produced by radiotherapy or surgery. The authors recall the necessity of surgical control of any nodular lesion developed in the area of the initial operation, particularly during the first three years.
Bulletin du cancer
This retrospective study shows the advantage of the CA 15.3 assay for the early detection of rela... more This retrospective study shows the advantage of the CA 15.3 assay for the early detection of relapse in breast cancer. It involved 473 women with invasive canalar carcinoma who had local recurrence or metastasis and/or an elevation of CA 15.3 (> 35 kU/l). The positive predictive value is excellent (97.7%). Sensitivity is poor for local relapse (13.7%), but a marker elevation at this time is a good prognostic factor of further distant metastasis (88%). It is better in the case of distant metastasis (74%), especially in bone and and liver localizations. CA 15.3 measurement at two month intervals may allow an early detection in 40% of distant metastasis. These results confirm the need of trials to test the benefits in terms of survival of early treatment of breast cancer metastasis only proved by CA 15.3 elevation, without any clinical or radiological finding.
Cancer/Radiothérapie, 1997
Immuno-analyse & Biologie Spécialisée, 1998
Cancer/Radiothérapie, 1997
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 1997
Though Hodgkin's disease (HD) is one of the malignancies in which considerable progress has b... more Though Hodgkin's disease (HD) is one of the malignancies in which considerable progress has been made, long-term side effects have been observed, second primary cancer being the most significant. Several recent reports have indicated an increased risk of breast cancer (BC) in girls and young women among HD patients. In a retrospective multicenter analysis, 63 women treated for HD subsequently developed BC. Results that were obtained in 13 women (21%) who developed either synchronous (five cases) or metachronous (eight cases) BC were analyzed. The median age at diagnosis of HD was 19 years. Seven patients underwent exclusive radiotherapy (RT) (including "mantle" supradiaphragmatic irradiation) and six received concomittant radiation therapy and chemotherapy. The first breast tumor occurred after a median delay of 16 years. According to the TNM classification, we showed nine stage T0 (non palpable lesions), four stage T1, five stage T2, one stage T3, two stage T4 and fiv...
British journal of cancer, 1993
One hundred and seventy-eight patients with non metastatic inflammatory breast cancer (IBC) have ... more One hundred and seventy-eight patients with non metastatic inflammatory breast cancer (IBC) have been treated at the Centre H. Becquerel. Median follow up is 67 months (6-178). Every patient received neoadjuvant chemotherapy (mean number of cycles = 4; range: 2-8), followed by a loco regional treatment (radiotherapy = XRT or modified radical mastectomy = S), followed by adjuvant chemotherapy. During this period, the types of chemotherapy and locoregional treatment have been the following: Study I: 64 patients treated with CMF or AVCF and XRT; Study II: 83 patients, treated with either AVCF, FAC or VAC followed by S (n = 38) or XRT (n = 22) in case of complete or partial response, or followed by XRT (23) in case of initial supraclavicular lymph node involvement or lack of response after chemotherapy; Study III: 31 patients treated with FEC-HD + Estrogenic recruitment followed by S and XRT after adjuvant chemotherapy, except seven patients who received XRT (refusal of surgery). Althou...
JAMA, 2005
A NTHRACYCLINES ARE AMONG the most widely used agents for breast cancer treatment, followed by ta... more A NTHRACYCLINES ARE AMONG the most widely used agents for breast cancer treatment, followed by taxanes, which were gradually introduced during the last decade. Combinations of these drug classes have proven superior to anthracyclines alone in advanced or metastatic breast cancer, 1,2 while taxanes are still under evaluation in early breast cancer. 3 Uncertainties regarding the optimal schedule of administration in combination with anthracyclines, as well as safety and cost issues, are fueling a debate on whether the use of taxanes is justified outside of clinical trials. 4 Febrile neutropenia is a common adverse effect of chemotherapy, the severity of which depends both on the types and doses of drugs administered and on individual risk factors. Several groups have tested combinations of docetaxel with anthracy-clines in adjuvant and neoadjuvant settings, and the data were recently reviewed. 3 Higher rates of febrile neutro-penia are reported with these combinations, including various docetaxel schedules, than with more traditional Context Adjuvant chemotherapy with new cytotoxic agents for breast cancer must be properly assessed for toxicity.
International Journal of Radiation Oncology*Biology*Physics, 2006
To compare concomitant and sequential adjuvant chemoradiotherapy regimens in node-positive, opera... more To compare concomitant and sequential adjuvant chemoradiotherapy regimens in node-positive, operable breast cancer patients. This was a randomized, French, multicenter, phase III trial enrolling 638 eligible women with prior breast surgery and positive axillary dissection. Patients in Arm A received 500 mg/m2 5-fluorouracil, 12 mg/m2 mitoxantrone, and 500 mg/m2 cyclophosphamide, with concomitant radiotherapy (50 Gy +/- 10-20-Gy boost). Patients in Arm B received 500 mg/m2 5-fluorouracil, 60 mg/m2 epirubicin, and 500 mg/m2 cyclophosphamide, with subsequent radiotherapy. Chemotherapy was administered on Day 1 every 21 days for 4 cycles. Median treatment durations were 64 and 126 days (Arms A and B, respectively), with no significant difference in overall or disease-free survival. Five-year locoregional relapse-free survival favored patients with conservative surgery (two thirds of the population), with less local and/or regional recurrence in Arm A than in Arm B (3% vs. 9%; p = 0.01). Multivariate analysis in this subgroup showed a 2.8-fold increased risk of locoregional recurrence with sequential chemoradiotherapy, independent of other prognostic factors (p = 0.027). Febrile neutropenia and Grade 3-4 leukopenia were significantly more frequent in Arm A. Subclinical left ventricular ejection fraction events at 1 year were more frequent with concomitant radiotherapy (p = 0.02). Concomitant radiotherapy with adjuvant fluorouracil, mitoxantrone, and cyclophosphamide has significantly better locoregional control in node-positive breast cancer after conservative surgery and 50% shorter treatment, albeit with slightly more acute toxicity. With mitoxantrone no longer available for adjuvant breast cancer treatment, alternative concomitant chemoradiotherapy studies are needed.
European Journal of Cancer, 1995
European Journal of Cancer, 1997
In a retrospective multicentric analysis, 63 women treated between 1941 to 1988 for Hodgkin&#... more In a retrospective multicentric analysis, 63 women treated between 1941 to 1988 for Hodgkin's disease (HD) subsequently developed 76 breast cancers (BC). The median age at diagnosis of HD was 26 years (range 7-67), and 22 women (35%) were 20 years old or less. Exclusive radiotherapy (RT) was used in 36 women (57%) and combined modalities with chemotherapy (CT) in 25 (39%). Breast cancer occurred after a median interval of 16 years (range 2-40) and the median age at diagnosis of the first BC was 42 years (range 25-73). TNM classification (UICC, 1978) showed 10 T0 (non-palpable lesions) (13%), 20 T1 (26%), 22 T2 (29%), 8 T3 (11%), 7 T4 (9%) and 9 Tx (12%), giving altogether a total of 76 tumours, including, respectively, 5 and 8 bilateral synchronous and metachronous lesions. Among the 68 tumours initially discovered, 53 ductal infiltrating, one lobular infiltrating and two medullary carcinomas were found. Moreover, two fibrosarcomas and 10 ductal carcinoma in situ (DCIS) were also found. Among 50 axillary dissections for invasive carcinomas, histological involvement was found in 31 cases (62%). 45 tumours were treated by mastectomy, without (n = 35) or with (n = 10) RT. 27 tumours had lumpectomy, without (n = 7) or with RT (n = 20). 2 others received RT only, and one only CT. 7 patients (11%) developed isolated local recurrence. 20 patients (32%) developed metastases and all died; 38 are in complete remission, whereas 5 died of intercurrent disease. The 5-year disease-specific survival rate by the Kaplan-Meier method was 61%. The 5-year disease-specific survival rate for pN0, pN1-3 and pN > or = 3 groups were 91%, 66% and 0%, respectively (P < 0.0001) and 100%, 88%, 64% and 23% for the T0, T1, T2 and T3T4 groups, respectively. These secondary BCs seem to be of two types: a large number of aggressive tumours with a very unfavourable prognosis (especially in the case of pN > 3 and/or T3T4); and many tumours with a 'slow development' such as DCIS and microinvasive lesions, especially in patients treated exclusively by RT. Moreover, a very unusual rate of bilateral tumours (21%) was observed. These secondary BC could be 'in field', in 'border of field' or 'out of field'. However, a complete analysis of doses delivered by supradiaphragmatic irradiation was often very difficult, due to large variations in several parameters. We conclude that young women and girls treated for HD should be carefully monitored by clinical examination, mammography and ultrasonography.