Dolz J., Massoptier L., Vermandel M.
Segmentation algorithms of subcortical brain structures On MRI for radiotherapy and radiosurgery: A survey.
Dolz J., Leroy H. A., Reyns N., Massoptier L., Vermandel M.
A Fast and Fully Automated Approach to Segment Optic Nerves on MRI and its Application to Radiosurgery.
Dhermain F., Reyns N., Colin P., Metellus P., Mornex F., Noel G.
Stereo tactic radiotherapy in brain metastases.
Stereotactic radiotherapy of brain metastases is increasingly proposed after polydisciplinary debates among experts. Its definition and modalities of prescription, indications and clinical interest regarding the balance between efficacy versus toxicity need to be discussed. Stereotactic radiotherapy is a 'high precision' irradiation technique (within 1mm), using different machines (with invasive contention or frameless, photons X or gamma) delivering high doses (4 to 25Gy) in a limited number of fractions (usually 1 to 5, ten maximum) with a high dose gradient. Dose prescription will depend on materials, dose constraints to organs at risk varying with fractionation. Stereotactic radiotherapy may be proposed: (1) in combination with whole brain radiotherapy with the goal of increasing (modestly) overall survival of patients with a good performance status, 1 to 3 brain metastases and a controlled extracranial disease; (2) for recurrence of 1-3 brain metastases after whole brain radiotherapy; (3) after complete resection of a large and/or symptomatic brain metastases; (4) after diagnosis of 3-5 asymptomatic new or progressing brain metastases during systemic therapy, with the aim of delaying whole brain radiotherapy (avoiding its potential neurotoxicity) and maintaining a high focal control rate. Only a strict follow-up with clinical and MRI every 3 months will permit to deliver iterative stereotactic radiotherapies without jeopardizing survival. Simultaneous delivering of stereotactic radiotherapy with targeted medicines should be carefully discussed.
Derrey S., Penchet G., Thines L., Lonjon M., David P., Bataille B., Emery E., Lubrano V., Laguarrigue J., Bresson D., Pelissou I., Irthum B., Lejeune J. P., Proust F.
French collaborative group series on giant intracranial aneurysms: Current management.
OBJECTIVES: Giant intracranial aneurysms represent a major therapeutic challenge for each surgical team. The aim of our study was to extensively review the French contemporary experience in treating giant intracranial aneurysms in order to assess the current management. PATIENTS AND METHODS: This retrospective multicenter study concerned consecutive patients treated for giant intracranial aneurysms (2004-2008) in different French university hospitals (Bordeaux, Caen, Clermont-Ferrand, Lille, Lyon, Nice, Paris-Lariboisiere, Rouen et Toulouse). Different variables were analyzed: the diagnostic circumstances, the initial clinical status based on the WFNS scale, aneurysmal features and exclusion procedure. At 6 months, the outcome was evaluated according to the modified Rankin Scale (mRS): favorable (mRS 0-2) and unfavorable (mRS 3-6). A multivariate logistic regression model included all the independent variables with P<0.25 in the univariate analysis (P<0.05). RESULTS: A total of 79 patients with a mean age of 51.5 +/- 1.6 years (median: 52 years; range: 16-79) were divided into two groups, with the ruptured group (n=26, 32.9%) significantly younger (P<0.05, Student's-t-test) than the unruptured group (n=53, 67.1%). After SAH, the initial clinical status was good in 12 patients (46.2%), and in the unruptured group, the predominant diagnosis circumstance was a pseudo-tumor syndrome occurring in 22 (41.5%). The first procedure of aneurysm treatment in the global population was endovascular in 42 patients (53.1%), microsurgical in 29 (36.7%) and conservative in 8 (10.2). An immediate neurological deterioration was reported in 38 patients (48.1%) after endovascular treatment in 19 (45.2% of endovascular procedures), after miscrosurgical in 15 (51.7% of microsurgical procedures) and after conservative in 4 (the half). At 6 months, the outcome was favorable in 45 patients (57%) and after multivariate analysis, the predictive factors of favorable outcome after management of giant cerebral aneurysm were the initial good clinical status in cases of SAH (P<0.002), the endovascular treatment (P<0.005), and the absence of neurological deterioration (P<0.006). The endovascular procedure was obtained as a predictive factor because of the low risk efficacy of indirect procedures, in particular a parent vessel occlusion. CONCLUSION: The overall favorable outcome rate concerned 57% of patients at 6 months despite 53.8% of poor initial clinical status in cases of rupture. The predictive factors for favorable outcome were good clinical status, endovascular treatment and the absence of postoperative neurological deterioration. Endovascular treatment should be integrated into the therapeutic armenmatarium against giant cerebral aneurysms but the durability of exclusion should be taken into account during the multidisciplinary discussion by the neurovascular team.
De Wolf J., Fournier C., Surmei E., Bellier J., Porte H. L.
Conservatively Treated Extended Tracheal Necrosis Complicating Pharyngolaryngectomy.
Ann. Thorac. Surg..
Tracheal necrosis is a rare life-threatening phenomenon that most often occurs after thyroid operations or prolonged intubation. Conservative treatment can be one choice in extensive tracheal necrosis. We report the case of a 59-year-old man, with tracheal necrosis that developed after pharyngolaryngectomy, that we treated conservatively using hyperbaric oxygen therapy and antibiotic therapy. The follow-up was assured by tracheobronchoscopy. A year after his discharge, the trachea was totally healed.
De Montalembert M., Ribeil J. A., Brousse V., Guerci-Bresler A., Stamatoullas A., Vannier J. P., Lahary A., Touati M., Bouabdallah K., Cavazzana M., Chauzit E., Baptiste A., Lefebvre T., Puy H., Elie C., Karim Z., Ernst O., Rose C.
Assessment of Cardiac Iron Overload in Chonically Transfused Patients with Thalassemia, Sickle Cell Anemia, and Myelodysplastic Syndromes.
Classe M., Malouf G., Gregoire V., Villers A., Leroy X.
Ismolecular analysis the key for translocation renal cell carcinoma?: An extensive study of 23 cases.
Chuzel P., Mansour A., Ognard J., Gentric J., Bressollette L., Hamad D., Betrouni N.
Automatic Clustering for MRI Images, Application on Perfusion MRI of Brain.
Chowdhury S., Heidenreich A., Villers A., Klotz L., Siemens D. R., Phung D., Wang F., Forer D., Van Os S., Shore N. D.
J. Clin. Oncol..
Carpentier O., Selvaggi L., Jegu J., Purohit A., Prim N., Velten M., Quoix E.
Modern Treatments in Advanced Non-Small-Cell Lung Cancer: Temporal Trends and Effect on Survival. A French Population-Based Study.
Clin. Lung Cancer.
UNLABELLED: Extrapolation of clinical trials results to the general population is always challenging. We analysed 1047 patients diagnosed with an advanced stage disease between 1998 and 2005 in a french administrative department and found a good spread of modern chemotherapy since 1998 and targeted therapy since 2002. Moreover, the outcomes in patients treated according to guidelines are very proximal from those obtained in clinical trials. BACKGROUND: Management of metastatic non-small-cell lung cancer has considerably evolved during the past 2 decades. In this study we aimed to assess how treatments have spread at a population-based level and their effect on survival. PATIENTS AND METHODS: Medical records of patients diagnosed from 1998 to 2005 in the French department of Bas-Rhin were checked to collect data on patient characteristics and treatments received. Multivariate analysis of survival was performed using pretherapeutic and therapeutic factors including targeted therapies received as third-line treatment. RESULTS: We included 1047 patients with stage IIIB to IV non-small-cell lung cancer. The proportion of patients who underwent chemotherapy increased from 373/471 (79.2%) to 491/576 (85.2%) over the 1998 to 2001 and 2002 to 2005 periods, and there was an increased use of third-generation drugs associated with platin. Third-line treatment was gefitinib or erlotinib in 73/155 (47.1%) of the cases among patients diagnosed from 2002 to 2005. Compared with older agents, targeted therapy administered as third-line treatment was associated with a longer survival but there was no significant difference in survival with recent chemotherapy agents in multivariate analyses (hazard ratio, 0.773; 95% confidence interval, 0.445-1.343). CONCLUSION: Results of our study showed a good spread of modern chemotherapy and targeted therapy use at a population-based level. However, even if the general outcomes were improved along the years, the results observed in real clinical practice were slightly different from those reported in clinical trials.