Ces dernières années, des nouvelles variétés visant à répondre aux enjeux environnementaux et sociétaux ont été créées dans différents pays européens. Certaines de ces variétés résistantes au mildiou ...et/ou à l'oïdium ont récemment été classées en France mais leur caractérisation sensorielle reste méconnue des vignerons. Pour les guider dans leurs choix de plantation, trois études ont été conduites afin de définir soit 1) la proximité sensorielle des vins de variétés résistantes par rapport aux vins de cépages emblématiques connus, et/ou 2) l'impact sensoriel d'un assemblage avec les cépages traditionnels. Deux méthodes sensorielles innovantes ont été utilisées: le positionnement sensoriel polarisé (PSP) et le tri libre. Le PSP a permis de déterminer si les vins issus de variétés résistantes se rapprochaient des caractéristiques sensorielles des vins de cépages français de référence dans deux études. Le tri libre a permis d'évaluer l'impact de différents niveaux d'assemblage de vins de variétés résistantes sur la perception de différents vins de cépage dans une troisième étude. Cette communication montre à la fois, l'intérêt d'appliquer ces deux méthodes sensorielles innovantes aux vins et des informations sensorielles conduisant à une meilleure appropriation de ces différentes variétés à travers les vignobles et leurs contextes régionaux.
In the last few years, new grape varieties have emerged in Europe to address environmental and societal challenges by reducing pesticide use. Some of these resistant grape varieties to mildew and/or powdery mildew have recently been classified in France, but their sensory characterization remains unknown for the wine professionals. To respond to this need, three studies were conducted in order to determine either 1) the sensory proximity between resistant grape varietal and well-known emblematic grape varietal wines, or 2) the sensory impact of blending them with our traditional grape varieties. Two innovative sensory methods were used: the polarized sensory positioning (PSP) and the free sorting. The PSP allowed to determine whether wines from resistant grape varieties have similar sensorial characteristics of French reference grape varietal wines in two studies. The free sorting evaluated the impact of different levels of blending with resistant varietal wines on the perception of different grape varietal wines in a third study. This communication showed both the interest of applying these innovative sensory methods to wines and information about the sensory characteristics of resistant grape varietal wines by leading to a better appropriation of these various resistant grape varieties across the vineyards and their regional contexts.
Abstract The peritoneal cavity must be oncologically considered as an organ in its own right and peritoneal metastases (PM) must be treated with the same curative intent (and the same results) as ...liver metastases. The package combining complete cytoreductive surgery (CCRS) (treating the visible disease) plus hyperthermic intraoperative peritoneal chemotherapy (HIPEC) (treating the remaining non-visible disease) achieves cure in many patients. Twenty years of publication allow us to assemble sufficient background information and data to point out the good and poor indications for CCRS + HIPEC. HIPEC is the standard of care for the treatment of peritoneal pseudomyxomas and peritoneal mesotheliomas and also, recently for the treatment of colorectal PM with limited peritoneal extension. HIPEC is in the evaluation phase for gastric PM and ovarian PM after initially disappointing results, but it is highly probable that it will be useful in particular settings. PM from neuroendocrine tumours are in the same situation. HIPEC is not currently indicated for the treatment of PM from sarcomas, from GIST, and for small round-cell desmoplastic tumours, given the poor results obtained. HIPEC can be useful, on a case-by-case basis, to treat rare tumours complicated by isolated peritoneal diffusion (e.g. Frantz’s tumours). HIPEC can be used in the prophylactic setting to prevent PM in patients with a high risk of developing PM, and the first results of the ‘second-look’ approach are promising. Finally, CCRS + HIPEC appear to be indispensable tools in the oncologist’s armentarium.
To analyze the impact of systematic second-look surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) performed 1 year after resection of the primary tumor in asymptomatic patients at high ...risk of developing peritoneal carcinomatosis (PC).
From 1999 to 2009, 41 patients without any sign of recurrence on imaging studies underwent second-look surgery aimed at treating limited PC earlier and more easily. They were selected based on 3 primary tumor-associated criteria: resected minimal synchronous macroscopic PC (n = 25), synchronous ovarian metastases (n = 8), and perforation (n = 8).
PC was found and treated with complete surgery plus HIPEC in 23 of the 41 (56%) patients. The other patients underwent complete abdominal exploration plus systematic HIPEC. Median follow-up was 30 (9-109) months. One patient died postoperatively at day 69. Grade 3-4 morbidity was low (9.7%). The 5-year overall survival rate was 90% and the 5-year disease-free survival rate was 44%. Peritoneal recurrences occurred in 7 patients (17%), 6 of whom had macroscopic PC discovered during the second-look (26%), and one patient had no macroscopic PC (6%). In the univariate analysis, the presence of PC at second-look surgery was a significant risk factor for recurrence (P = 0.006).
Selection criteria for high-risk patients appear to be accurate. In these patients, the second-look strategy treated peritoneal carcinomatosis preventively or at an early stage, yielding promising results. This study has allowed us to design a multicentric randomized trial (comparing the second-look + HIPEC approach versus standard follow-up alone), which is beginning.
NETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation ...to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry.
Patients’ characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N=35784) and in the subgroup of incident patient population (N=29497).
Among the 35784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li–Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29497 incident patients, 25851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS P<0.001 for all, with a hazard ratio of 0.681 (95% CI 0.618–0.749) for OS.
This nationwide registry of sarcoma patients shows that surgical treatment in a reference center reduces the risk of relapse and death.
Abstract Background To analyse the natural history of extra-abdominal wall desmoid-type fibromatosis (DF) and compare outcome in patients who underwent initial surgery with those who did not. ...Patients and methods All consecutive patients affected by primary sporadic extra-abdominal wall DF observed between January 1992 and December 2012 were included. Patients were divided into surgical (SG) or non-surgical groups (NSG) according to initial treatment. Relapse free survival was calculated for SG, and crude cumulative incidence (CCI) of switching to surgery or other treatments for NSG. Results 216 patients were identified, 94 in SG (43%), 122 in NSG (57%). A shift towards a more systematic use of a conservative approach (78% of all comers) was observed in the latter years (2006–2012), although a small proportion of patients (28%) had been offered the conservative strategy even in the early period (1992–2005). Median follow-up (FU) was 49 mo. (interquartile (IQ), 20–89 mo.), 76 months for SG and 39 months for NSG. 5-year relapse-free survival (RFS) for SG was 80% (95% confidence interval (CI), 72–89%). For the NSG, 5-year CCI of switching to surgery was 5% (95% CI: 1.7%, 14%), and 51% to other treatments (95% CI: 41%, 65%). 27 (20%) NSG patients underwent spontaneous regression. Conclusion A non-surgical approach to extra-abdominal wall DF allowed surgery to be avoided in the majority of patients. This approach can be safely proposed and surgery offered as an option in selected cases.
Summary Four thousand new cases of soft tissue sarcomas are diagnosed each year in France, 23% of which are localized in the abdomen and pelvis; the treatment of non-metastatic tumor is based on wide ...surgical resection, the quality of which determines the long-term outcome. To ensure appropriate care, the European Society of Medical Oncology (ESMO) recommends that any patient with an unexplained soft tissue mass (of any size for deep lesions or of >5 cm for superficial lesions) be referred to a specialized center with capacities for multidisciplinary team decision; appropriate imaging should be performed prior to treatment and a percutaneous image-guided needle biopsy should be routinely performed. In France, clinical and pathology networks (NetSarc and RRePS) currently offer patients a structured means to make a systematic diagnosis of soft tissue sarcoma and help to provide access to appropriate treatment in a specialized center.
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