Évaluation des résultats d’une radiothérapie de rattrapage à visée curative dans le cadre du traitement des rechutes pelviennes isolées de cancers du col utérin.
Quatorze patientes atteintes d’une ...rechute pelvienne d’un cancer du col utérin ont été prises en charge dans notre service de 1982 à 2009. Cinq rechutes étaient centropelviennes, quatre vaginales et cinq ganglionnaires pelviennes. Quatre patientes ont eu une exérèse chirurgicale première de la rechute. Les 14 patientes ont reçu une radiothérapie pelvienne de dose médiane de 55Gy en fractionnement classique. Une chimiothérapie concomitante a été administrée à 13 patientes. Une curiethérapie vaginale de complément de bas débit de dose médiane de 20Gy a été réalisée chez trois patientes. Le recul médian était de 39mois.
La tolérance de la radiothérapie était acceptable avec 29 % de cas de toxicité aiguë digestive ou urinaire de grade 3. Le contrôle tumoral a été obtenu chez dix patientes (71 %). Quatre patientes ont présenté une poursuite évolutive locorégionale. Au moment de l’analyse, trois patientes étaient décédées de leur cancer. Les taux de survie globale à deux et cinq ans étaient respectivement de 84 % et 74 %. Huit patientes ont souffert d’effets secondaires tardifs, sévères dans trois cas (21 %).
Dans notre expérience, une chimioradiothérapie permet d’obtenir un taux élevé de rémission chez les patientes atteintes d’une rechute pelvienne isolée d’un cancer du col utérin. Celle-ci n’est réalisable qu’en l’absence de radiothérapie externe pelvienne lors du traitement initial de la tumeur ou en cas de rechute tumorale localisée en dehors du volume précédemment irradié.
Evaluation of the results of salvage radiation therapy with curative intent in the treatment of recurrent cervical carcinoma.
Fourteen patients with a recurrence of a cervical cancer were treated in our department between 1982 and 2009. Five patients had a pelvic relapse, four a vaginal relapse and five a pelvic lymph node relapse. Four patients had first a surgical resection of the relapse, which was incomplete in two patients. All patients had pelvic radiotherapy with a median dose of 55Gy in conventional fractionation. Concurrent chemotherapy was administered to 12 patients. A vaginal brachytherapy with a median dose of 20Gy was performed in addition in 3 patients. The median follow-up was 39months.
Safety of radiation therapy was correct with 29% of grade 3 acute or intestinal toxicity. Tumor control was observed in 10 patients (71%). Four patients presented a locoregional tumor progression. At the time of analysis, three patients had died from their cancer. From the date of relapse, the rate of overall survival at 2 and 5year was respectively 84% and 74%. Three patients (21%) had severe late effects.
In our experience, chemoradiotherapy can achieve a high rate of remission in patients with isolated pelvic recurrence of cervical cancer. This treatment is feasible only if the patient had not received radiation therapy before or if the relapse is out of the previously irradiated volume.
Iron deficiency anemia represents a public health issue which is usually managed by midwives. Because it is associated with maternal and fetal risks, a treatment is warranted. Oral iron represents ...the main option for treating this condition. Despite the existence of national and international guidelines no consensus about its modality of use has emerged so far. The primary objective of this study was to analyze midwives'practice with regards to iron deficiency anemia treatment using oral iron formulations.
We conducted an observational and descriptive cross-sectional in a sample of midwives from the Gironde administrative region using a questionnaire.
We obtained 85 questionnaires from midwives working in private or public health facilities. Doses of iron and duration of treatment seem insufficient for a majority of responders. Folic acid and vitamin C are often associated with oral iron. Most midwives assess the efficacy of oral iron at one month with hemoglobin and ferritin levels. A significant fraction of these midwives shares similar practices which are in good accordance with the literature such as patient counselling with regards to drug intake, management of gastrointestinal side effects and inefficacity of oral iron. Noticeably, some of these midwives don't follow any guidelines.
The majority of participants demonstrated practices in accordance with various national guidelines although no precise therapeutic algorithm is available as reference. Larger studies on the management of iron deficiency anemia in pregnancy by health professionals and harmonization of practices are necessary.
Évaluer les techniques d’irradiation et leur toxicité dans les traitements des lymphomes hodgkinien et non hodgkinien avec atteinte médiatisnale durant une période de 10ans
Entre 2003 et 2015, ...173 patients traités pour un lymphome de stade I à III ont été traité dans le centre. Certains de ces patients ont été pris en charge pour une atteinte médiatisnale, soit par irradiation conformationelle tridimensionnelle soit par RCMI.
Vingt-six hommes et 43 femmes ont été inclus dans cette étude. Le suivi médian était de 43mois. Quarante-neuf patients ont été pris en charge par irradiation conformationelle tridimensionnelle et 20 par RCMI. La dose médiane reçue lors d’une irradiation d’un lymphome non hodgkinien était de 40Gy (36–44). La dose médiane reçue lors d’une irradiation d’un lymphome hodgkinien était de 30Gy (30–36). Entre 2003 et 2006, 16 patients ont été pris en charge par irradiation conformationelle tridimensionnelle et aucun par RCMI. Entre 2007 et 2009, 16 patients ont pris en charge par irradiation conformationelle tridimensionnelle et un par RCMI. Entre 2010 et 2015, 19 patients pris en charge par RCMI et aucun par irradiation conformationelle tridimensionnelle. Onze des 20 (55 %) patients pris en charge par RCMI et 35 des 49 (71 %) traités par pris en charge par irradiation conformationelle tridimensionnelle ont souffert d’au moins un symptôme de toxicité aiguë. Parmi les patients traités par irradiation conformationelle tridimensionnelle, un patient a été atteint d’une pneumopathie grade 1 séquellaire. Aucun patient pris en charge par RCMI n’a souffert de toxicité tardive.
L’amélioration des techniques d’irradiation des lymphomes hodgkinien et non hodgkinien semble diminuer la toxicité aiguë et tardive. Un suivi plus long est nécessaire pour mieux évaluer la toxicité tardive.
Evidence-based medicine is considered as mandatory especially in the field of drugs evaluation but is expanding to other fields such as surgery and medical devices. There is a general perception that ...EBP is not well developed in rehabilitation professions. Although needed, little is known about clinical research in rehabilitation professions: Are they any publication? What kind of research is published? Are publications indexed in the main database? RECLIP study therefore proposed to answer these questions through a bibliometric overview for 6 rehabilitation professions. A literature search was performed in Pubmed, Cochrane, Pedro, Pascal, Web of Sciences and OTseeker by rehabilitation professionals. The inclusion criteria were the following: originating from Europe, reporting clinical research, in the field of one of the 6 rehabilitation professions (audiology, occupational therapy, physiotherapy, speech therapy, orthoptics, psychomotricity), and published between 2007 and 2011. When the search resulted in more than 300 references, a sample of 300 references was drawn. After verification of inclusion criteria, articles were assessed for the publication language, indexation on Pubmed, impact factor and methodology. Among the retrieved references, 25% truly reported European clinical research in the rehabilitation field. The 5 European countries that published the most in rehabilitation field were United Kingdom, Sweden, Netherlands, Germany and France. Concerning methodology, repartition between descriptive, analytic and interventional studies varied greatly according to professions (
p
value <0.0001). Speech therapy had the most interventional pattern with 89% of publication being interventional followed by physiotherapy and audiology, on the opposite orthoptics was at less than 20%. This first bibliometric overview highlights the fact that there might be a lack of comparative research and that bibliographic searches are not adapted for rehabilitation professions, meaning that practices might not always be based on evidence, but rather on experience. Efforts should be made on indexation, and rehabilitation schools should focus on highlighting research to their students.
The treatment of rectal carcinoma is based on multidisciplinary strategy and multimodal approaches including gastrointestinal tract specialists, medical oncologists, radiation oncologists and ...surgery. The different objectives should be declined according to the characteristics of the tumours. The aim of the therapist would be to select the best strategy offering to the patient to be cured with as less as possible late adverse toxicity. The challenge of the treatment of small tumours is to maintain a functional anal sphincter while minimizing the risk of local recurrence. The standard treatment of locally advanced disease is aiming firstly to cure the patient and secondly to prevent late complications. Each of these clinical presentations of the disease has to be considered as a whole taking into account the new surgical techniques and a personalized approach adapted to the tumour. Nowadays they should be studied with dedicated clinical trials.
Le traitement des cancers du rectum repose sur une prise en charge pluridisciplinaire et le plus souvent sur une approche multimodale comprenant la gastro-entérologie, l’oncologie médicale, ...l’oncologie–radiothérapie et la chirurgie. Les différents objectifs qui doivent être discriminés dépendent des caractéristiques de la tumeur. Le défi de la prise en charge des petites tumeurs repose sur la conservation d’un sphincter fonctionnel sans risque de récidive locale. Le traitement standard des maladies localement évoluées vise, par ordre de priorité, à guérir le malade en minimisant les séquelles tardives de la prise en charge. Chacune de ces situations cliniques se trouve désormais démembrée grâce aux progrès de la chirurgie et d’une approche personnalisée au patient à la caractéristique clinique de la maladie. Elles sont désormais l’objet d’études thérapeutiques spécifiques.
The treatment of rectal carcinoma is based on multidisciplinary strategy and multimodal approaches including gastrointestinal tract specialists, medical oncologists, radiation oncologists and surgery. The different objectives should be declined according to the characteristics of the tumours. The aim of the therapist would be to select the best strategy offering to the patient to be cured with as less as possible late adverse toxicity. The challenge of the treatment of small tumours is to maintain a functional anal sphincter while minimizing the risk of local recurrence. The standard treatment of locally advanced disease is aiming firstly to cure the patient and secondly to prevent late complications. Each of these clinical presentations of the disease has to be considered as a whole taking into account the new surgical techniques and a personalized approach adapted to the tumour. Nowadays they should be studied with dedicated clinical trials.
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