Ploussard G., Almeras C., Briganti A., Giannarini G., Hennequin C., Ost P., Renard-Penna R., Salin A., Lebret T., Villers A., Soulié M., Taille A., Flamand V.   Management of Node Only Recurrence after Primary Local Treatment for Prostate Cancer: A Systematic Review of the Literature.  J. Urol..  2015 ;194 :983-988

PURPOSE: We analyzed all available studies assessing the management of node only recurrence after primary local treatment of prostate cancer. MATERIALS AND METHODS: We systematically reviewed the literature in January 2015 using the PubMed, Web of Sciences and Embase databases according to PRISMA guidelines. Studies exclusively reporting visceral or bone metastatic disease were excluded from analysis. Eight radiotherapy and 12 salvage lymph node dissection series were included in our qualitative study. RESULTS: All 248 radiotherapy and 480 salvage lymph node dissection studies were single arm case series including a total of 728 patients. Choline positron emission tomography/computerized tomography was the reference imaging technique for nodal recurrence detection. Globally 50% of patients remained disease-free after short-term followup. Nevertheless, approximately two-thirds of patients received adjuvant hormone therapy, leading an overestimation of prostate specific antigen-free survival rates obtained after salvage treatment. Combining radiotherapy with salvage lymph node dissection may improve oncologic control in the treated region without improving the outfield relapse risk or the prostate specific antigen response. Great heterogeneity among series in adjuvant treatments, endpoints, progression definitions and study populations made it difficult to assess the precise impact of salvage treatment on the prostate specific antigen response and compare outcomes between radiotherapy and salvage lymph node dissection series. Toxicity after radiotherapy or salvage lymph node dissection was acceptable without frequent high grade complications. The benefit of early hormone therapy as the only salvage treatment remains unknown. CONCLUSIONS: Although a high level of evidence is currently missing to draw any strong conclusion, published clinical series show that in select patients salvage treatment directed to nodal recurrence could lead to good oncologic outcomes. Although the optimal timing of androgen deprivation therapy in this setting is still unknown, such an approach could delay time to systemic treatment with an acceptable safety profile. Future prospective trials are awaited to better clarify this potential impact on well-defined endpoints.

Pignot G., Mejean A., Bernhard J. C., Bigot P., Timsit M. O., Ferriere J. M., Zerbib M., Villers A., Mouracade P., Lang H., Bensalah K., Couapel J. P., Rigaud J., Salomon L., Bellec L., Soulie M., Vaessen C., Roupret M., Baumert H., Gimel P., Patard J. J.   The use of partial nephrectomy: results from a contemporary national prospective multicenter study.  World J. Urol..  2015 ;33 :33-40

PURPOSE: Despite benefits in functional renal outcome and favorable oncological efficacy, previous studies show marked underuse of partial nephrectomy (PN). We investigated national utilization of partial and radical nephrectomy (RN) using a contemporary, prospective population-based cohort. METHODS: Between June and December 2010, 1,237 patients were treated by PN or RN for renal cell carcinoma in 56 French centers. Data were prospectively collected, and statistical analyses were performed. RESULTS: Overall, 667 (53.9 %) and 570 patients (46.1 %) underwent RN and PN, respectively. In case of PN, surgical approach was an open PN in 63.3 % of cases, a laparoscopic PN in 21.0 % of cases and a robot-assisted PN in 15.7 % of cases. PN was used in T1a, T1b, T2 and T3 tumors in 395 (76.7 %), 131 (38.2 %), 29 (14.7 %) and 7 (4.6 %), respectively. Median ischemia time was 16 min [0-60], and mean blood loss was 280.4 ml (+/-339.9). Tumor characteristics and operative features were significantly different according to the surgical approach. Warm ischemia time was significantly higher in case of laparoscopic or robot-assisted procedure (p < 0.001). There was no statistical significant difference in blood loss and transfusion rate according to surgical approach. Postoperative medical and surgical complications occurred in 8.2 and 10.0 % of PN, respectively, with no significant difference according to surgical approach. CONCLUSIONS: Partial nephrectomy for renal cell carcinoma is commonly used in this French centers sample. Mini-invasive approaches represent also a significant part of all partial nephrectomies with no difference in terms of complication rates.

Pauwels X., Azahaf M., Lassailly G., Sergent G., Buob D., Truant S., Boleslawski E., Louvet A., Gnemmi V., Canva V., Mathurin P., Pruvot F. R., Leteurtre E., Ernst O., Dharancy S.   Drug-Eluting Beads Loaded With Doxorubicin (DEBDOX) Chemoembolisation Before Liver Transplantation for Hepatocellular Carcinoma: An Imaging/Histologic Correlation Study.  Cardiovasc. Interv. Radiol..  2015 ;38 :685-692

PURPOSE: Most transplant centers use chemoembolisation as locoregional bridge therapy for hepatocellular carcinoma (HCC) before liver transplantation (LT). Chemoembolisation using beads loaded with doxorubicin (DEBDOX) is a promising technique that enables delivery of a large quantity of drugs against HCC. We sought to assess the imaging-histologic correlation after DEBDOX chemoembolisation. MATERIALS AND METHODS: All consecutive patients who had undergone DEBDOX chemoembolisation before receiving liver graft for HCC were included. Tumour response was evaluated according to Response Evaluation Criteria in Solid Tumours (RECIST) and modified RECIST (mRECIST) criteria. The result of final imaging made before LT was correlated with histological data to predict tumour necrosis. RESULTS: Twenty-eight patients underwent 43 DEBDOX procedures for 45 HCC. Therapy had a significant effect as shown by a decrease in the mean size of the largest nodule (p = 0.02) and the sum of viable part of tumour sizes according to mRECIST criteria (p < 0.001). An objective response using mRECIST criteria was significantly correlated with mean tumour necrosis >/=90 % (p = 0.03). A complete response using mRECIST criteria enabled accurate prediction of complete tumour necrosis (p = 0.01). Correlations using RECIST criteria were not significant. CONCLUSION: Our data confirm the potential benefit of DEBDOX chemoembolisation as bridge therapy before LT, and they provide a rational basis for new studies focusing on recurrence-free survival after LT. Radiologic evaluation according to mRECIST criteria enables accurate prediction of tumour necrosis, whereas RECIST criteria do not.

Ouzzane A., Renard-Penna R., Marliere F., Mozer P., Olivier J., Barkatz J., Puech P., Villers A.   Magnetic Resonance Imaging Targeted Biopsy Improves Selection of Patients Considered for Active Surveillance for Clinically Low Risk Prostate Cancer Based on Systematic Biopsies.  J. Urol..  2015 ;194 :350-356

PURPOSE: Current selection criteria for active surveillance based on systematic biopsy underestimate prostate cancer volume and grade. We investigated the role of additional magnetic resonance imaging targeted biopsy in reclassifying patients eligible for active surveillance based on systematic biopsy. MATERIALS AND METHODS: We performed a study at 2 institutions in a total of 281 men with increased prostate specific antigen. All men met certain criteria, including 1) prebiopsy magnetic resonance imaging, 12-core transrectal systematic biopsy and 2 additional magnetic resonance imaging targeted biopsies of lesions suspicious for cancer during the same sequence as systematic biopsy, and 2) eligibility for active surveillance based on systematic biopsy results. Criteria for active surveillance were prostate specific antigen less than 10 ng/ml, no Gleason grade 4/5, 5 mm or less involvement of any biopsy core and 2 or fewer positive systematic biopsy cores. Patient characteristics were compared between reclassified and nonreclassified groups based on magnetic resonance imaging targeted biopsy results. RESULTS: On magnetic resonance imaging 58% of the 281 patients had suspicious lesions. Magnetic resonance imaging targeted biopsy was positive for cancer in 81 of 163 patients (50%). Of 281 patients 28 (10%) were reclassified by magnetic resonance imaging targeted biopsy as ineligible for active surveillance based on Gleason score in 8, cancer length in 20 and Gleason score plus cancer length in 9. Suspicious areas on magnetic resonance imaging were in the anterior part of the prostate in 15 of the 28 men (54%). Reclassified patients had a smaller prostate volume (37 vs 52 cc) and were older (66.5 vs 63 years) than those who were not reclassified (p < 0.05). CONCLUSIONS: Magnetic resonance imaging targeted biopsy reclassified 10% of patients who were eligible for active surveillance based on systematic biopsy. Its incorporation into the active surveillance eligibility criteria may decrease the risk of reclassification to higher stages during followup.

Ouzzane A., Helfrich O., Le Nobin J., Puech P., Betrouni N., Villers A.   Understanding the pathological implications of MRI: application to focal therapy planning.  Curr. Opin. Urol..  2015 ;25 :198-204

PURPOSE OF REVIEW: The current challenge in prostate cancer (PCa) focal therapy indication and planning is how to accurately estimate tumor parameters such as volume, extent and grade. In addition to biopsy results, MRI provides an estimation of PCa contour, volume and histopathological characteristics such as presence of high Gleason grade. Among MRI sequences, diffusion-weighted imaging with apparent diffusion coefficient map is the sequence that showed the best results for cancer aggressiveness characterization. RECENT FINDINGS: It was shown that the higher the Gleason score, the lower the apparent diffusion coefficient value. However, accuracy is not sufficient for peripheral zone cancers to be validated for clinical decision and it was not enough investigated for transition zone cancers. Analysis of tumor extent showed a significant underestimation of tumor volume by imaging and this finding should be taken into consideration when planning focal therapy procedures. SUMMARY: Pathological implications of MRI for focal therapy planning are significant but not mature enough to be validated. Future research should aim to quantify cellularity and architectural patterns of PCa Gleason system in correlation with signal abnormalities for better assessment of tumor aggressiveness and extent, and to compare the boundaries of tumors between MRI and histopathological evaluation in order to define an optimal treatment margin.

Nivaggioni G., Baillet C., Beron A., Truant S., Duhamel A., Pruvot F. R., Huglo D.   Reproducibility evaluation of Tc-99m-mebrofenin hepatobiliary scintigraphy using SPECT for future remnant liver functional assessment before major hepatectomy.  Med. Nucl.-Imag. Fonct. Metab..  2015 ;39 :182-191
Nieboer D., Vergouwe Y., Roobol M. J., Ankerst D. P., Kattan M. W., Vickers A. J., Steyerberg E. W.   Nonlinear modeling was applied thoughtfully for risk prediction: the Prostate Biopsy Collaborative Group.  J Clin Epidemiol.  2015 ;68 :426-34

OBJECTIVES: We aimed to compare nonlinear modeling methods for handling continuous predictors for reproducibility and transportability of prediction models. STUDY DESIGN AND SETTING: We analyzed four cohorts of previously unscreened men who underwent prostate biopsy for diagnosing prostate cancer. Continuous predictors of prostate cancer included prostate-specific antigen and prostate volume. The logistic regression models included linear terms, logarithmic terms, fractional polynomials of degree one or two (FP1 and FP2), or restricted cubic splines (RCS) with three or five knots (RCS3 and RCS5). The resulting models were internally validated by bootstrap resampling and externally validated in the cohorts not used at model development. Performance was assessed with the area under the receiver operating characteristic curve (AUC) and the calibration component of the Brier score (CAL). RESULTS: At internal validation models with FP2 or RCS5 showed slightly better performance than the other models (typically 0.004 difference in AUC and 0.001 in CAL). At external validation models containing logarithms, FP1, or RCS3 showed better performance (differences 0.01 and 0.002). CONCLUSION: Flexible nonlinear modeling methods led to better model performance at internal validation. However, when application of the model is intended across a wide range of settings, less flexible functions may be more appropriate to maximize external validity.

Narducci F., Merlot B., Bresson L., Katdare N., Le Tinier F., Cordoba A., Fournier C., Leblanc E.   Occult Invasive Cervical Cancer Found After Inadvertent Simple Hysterectomy: Is the Ideal Management: Systematic Parametrectomy With or Without Radiotherapy or Radiotherapy Only?.  Ann. Surg. Oncol..  2015 ;22 :1349-1352

BACKGROUND: After the diagnosis of occult cervical cancer during simple hysterectomy, is the best treatment option for the patient surgery with or without radiotherapy or radiation therapy only? Our study aims to answer this question. MATERIALS AND METHODS: We retrospectively analyzed 29 patients with occult cervical cancer found after inadvertent simple hysterectomy and who were referred to our cancer center between 2000 and 2010. All of the patients were discussed by the tumor board. Thirteen patients underwent surgery (radical parametrectomy and pelvic lymphadenectomy) using the minimally invasive approach (surgical group), and 16 patients underwent pelvic lymphadenectomy and radiation therapy or concurrent chemoradiation (radiation group). RESULTS: Age, BMI, and the tumor diameter were not statistically different between the surgical and radiation group: 44 and 49 (+/- 11) years (p = .23), 24.6 (+/- 6.2) and 26.7 (+/- 5) (p = 0.33), and 22 (+/- 13) and 31 (+/- 11) mm (p = .09), respectively. The 5-year overall and disease-free survivals for the surgical and radiation groups were: 100 and 77 % (p = .04), and 86 and 37 % (p = .02), respectively. These results were statistically significant. CONCLUSIONS: In the case of occult cervical cancer found after simple hysterectomy, radical parametrectomy with pelvic lymphadenectomy using minimally invasive surgery seems to be more efficient than radiation therapy or concurrent chemoradiation, with acceptable minimal morbidity being observed.

Munck C., Mordon S. R., Scherpereel A., Porte H., Dhalluin X., Betrouni N.   Intrapleural Photodynamic Therapy for Mesothelioma: What Place and Which Future?.  Ann. Thorac. Surg..  2015 ;99 :2237-2245

In the surgical multimodal management of malignant pleural mesothelioma, it seems crucial to proceed with an efficient local adjuvant treatment to kill residual tumor cells. Intrapleural photodynamic therapy has recently emerged as a potential candidate in this goal. In this review, we analyzed and classified 16 articles in which patients with malignant pleural mesothelioma received intrapleural photodynamic therapy after maximal surgical resection. The toxicity, effect on survival, and development of the technique were assessed. After two decades of clinical studies, intrapleural photodynamic therapy after surgical resection became a safe treatment that significantly improved the survival of patients.

Mortier L., Lepesant P., Saiag P., Robert C., Sassolas B., Grange F., Lhomel C., Lebbe C.   Comparison of sun protection modalities in parents and children.  J. Eur. Acad. Dermatol. Venereol..  2015 ;29 :16-19

BACKGROUND: Routine sun protection is recommended to prevent skin cancer. The aims of the present analysis were to assess and compare modalities of sun protection in parents and their children. METHODS: EDIFICE Melanoma is a French nationwide observational survey. It was conducted through phone interviews among a representative sample of 1502 individuals aged >/=18 years, using the method of quotas. The survey took place shortly after the summer, from 28 September to 20 October 2011. RESULTS: Of the 1502 subjects interviewed, 1067 reported sun exposure (SE) at least 10 days per year, 748 were parents and 319 had no children. Sun protection measures seemed adequate in both the 'parents' and 'non-parents' groups: 74% used clothing and 43% used sunscreen, which was reapplied regularly in 57% of cases. Sun protection measures used by SE parents for SE children were superior, both qualitatively and quantitatively, to those used for themselves, i.e., 50% of parents reported using clothing, sunglasses and hats for their children vs. 23% for themselves. In 87% of cases, parents reported regular re-application of sunscreen for their children vs. 44% for themselves. The sunscreen SPF (Sun Protection Factor) was significantly lower for parents than for their children. CONCLUSIONS: Sun protection awareness appears to be globally satisfactory in the French population, with no difference between adults who are parents and those who are not. From both qualitative and quantitative standpoints, French parents use sun protective measures more efficiently for their children than for themselves.