The aim of this study was to assess the outcome and the prognosis factors of uterine and ovarian carcinosarcomas.
From January 1993 to January 2010, data from 68 consecutively treated patients with ...uterine (n=59) and ovarian (n=9) carcinosarcomas were retrospectively analyzed in a single French comprehensive cancer center.
The median follow-up was 24.2 months (interquartile range IQR: 13.5 to 54.6). The median age was 69 years (IQR: 63 to 77). Patients were classified as FIGO stage I (n=28; 41%) and FIGO stage II to IV (n=40; 59%), respectively. There were 33 (49%) and 29 (43%) homologous and heterologous type, respectively. The median disease-free survival and overall survival were 21.9 months (IQR: 7.9 to 22.3) and 27.1 months (IQR: 14.5 to 72), respectively. No statistical differences of survival were reported concerning the initial location of the carcinosarcoma (uterine vs. ovarian). Radiation therapy (hazards ratio HR=0.3; 95% confidence interval CI, 0.16-0.67) and FIGO stage I (HR=0.4; 95% CI, 0.17-0.9) were associated with an increased disease-free survival. Homologous type (HR=3; 95% CI, 1.4-6.3) and FIGO stage II to IV (HR=2.64; 95% CI, 1.3-5.4) were associated with a decreased overall survival. There was no survival improvement for the 12% of patients receiving a multimodal adjuvant therapy.
Uterine and ovary carcinosarcomas present a worse prognosis. On the basis of the present study data, although it should be prospectively confirmed, a sequential or multimodal adjuvant therapy should be proposed to patients with early-stage uterine and ovary carcinosarcomas.
The objective of the European research project NOVIWAM (2010-2013), involving four types of partners (research institutes, business entities, water managers, and other stakeholders) for five regions ...or countries (Cyprus, Albania, Poitou Charentes Region, Northern Hydrological Region in Portugal, Andalusia), was to harmonize research planning, and to make consistent and complementary the approaches used to solve the problems related to the water resource management, from the quantitative and the qualitative points of view. We indicate here the approach we followed, and we give some indications about the research priorities. We also succinctly describe an example of a feasibility study undertaken in order to illustrate these issues, aiming at lowering the water consumption (a decrease of 25%) for irrigation, while maintaining the farmers' income and the volumes of agricultural goods produced; and also while ensuring the stability of the water management company's budget.
Ancrée initialement dans le domaine des études littéraires et linguistiques, la notion de genre a fait, depuis les années 1980, l’objet de nombreuses recherches en didactique du français. Dans ce ...domaine, les genres ont d’abord fait l’objet de classements conçus essentiellement comme des outils de guidage de la lecture et de l’écriture. Des recherches plus récentes se sont également interrogées sur les situations de production et réception langagières ainsi que les différentes transformations que connaissent les genres lorsqu’ils deviennent des outils ou des objets d’enseignement et d’apprentissage de la classe de français. Dans ce volume de la collection « Recherches en didactique du français », nous avons voulu prolonger la réflexion critique et didactique sur les rôles des genres dans l’enseignement du français selon deux axes. Le premier axe regroupe des contributions visant à établir un état des lieux concernant la place et le statut accordés aux genres dans la recherche en didactique et, plus spécifiquement encore, dans les instructions officielles et programmes actuels de français des différents pays francophones. Le deuxième axe est consacré aux travaux portant sur les genres et leur statut dans la formation et/ou dans les pratiques enseignantes. Il rassemble des recherches qui thématisent la notion de genre comme outil et/ou objet d’enseignement dans différents contextes scolaires, du primaire à l’université.
The objective of the European research project NOVIWAM (2010-2013), involving four types of partners (research institutes, business entities, water managers, and other stakeholders) for five regions ...or countries (Cyprus, Albania, Poitou Charentes Region, Northern Hydrological Region in Portugal, Andalusia), was to harmonize research planning, and to make consistent and complementary the approaches used to solve the problems related to the water resource management, from the quantitative and the qualitative points of view. We indicate here the approach we followed, and we give some indications about the research priorities. We also succinctly describe an example of a feasibility study undertaken in order to illustrate these issues, aiming at lowering the water consumption (a decrease of 25%) for irrigation, while maintaining the farmers' income and the volumes of agricultural goods produced; and also while ensuring the stability of the water management company's budget.
Improved accessibility and resolution of remote sensing data has many potential applications for monitoring habitats and species for conservation. The aim of this study was to develop a methodology ...to identify suitable habitat for the umbrella species
Tetrao urogallus in a large area in the French Pyrénées. The focus of this study was on factors affecting
T. urogallus distribution which can be identified accurately using earth observation data; the vegetation mosaic and the forest cover ratio which describe the forest fragmentation level. A landcover map was derived from SPOT-5 images (10
m spatial resolution) using a fuzzy classification combined with a knowledge-based classification. Using ground truth data two different vegetation mosaics were identified, the first corresponding to the nesting habitat and the second to the winter habitat of
T. urogallus. An aggregative method using the software CLAPAS was employed to derive from the original landcover map a map of vegetation mosaics and a forest cover ratio map using a moving window of 10
ha. These two maps were combined and suitable habitat for
T. urogallus was considered as: all the areas where the mosaic of vegetation types is similar to the composition of the
T. urogallus reference habitat (winter or nesting), where the forest cover ratio is between 10% and 80%, and where they fall within the altitudinal range of 1200–2300
m. Validation was carried out using ground truth species distribution data which showed that the areas indicated as suitable for
T. urogallus covered 95% of the reference habitats of the species. Results of habitat suitability modelling, such as in the current study, indicate that conservation strategy must aim to tackle habitat fragmentation, both by maintaining connectivity within the metapopulation system, but also through active management to re-establish connectivity between spatially distinct populations.
There is a plea for the development of tools allowing the screening of fragile patients under oral chemotherapy. Such tools would identify patients with difficulties for being adherent or for having ...low side effects management skills. The aim of this study is to validate psychometric characteristics of a questionnaire assessing patients' adherence and skill level of management for oral capecitabine treatment.
Questionnaire's psychometric validation study. Prospective monocentric cohort. Cases-simulated questionnaire was constructed, according to recommendations, from the results of a socio-anthropological study. Validation phases included: a pre-testing and a field-testing including acceptability, scale reliability and internal consistency were conducted involving experts and patients sample.
Pre-testing excluded 1 item. Acceptability phase included 15 patients, who did not change any of the questions. Reliability and internal consistency were tested with 67 patients. Cancer site did not statistically influence questionnaire answers. No correlation was identify with the analyse performed for the internal consistency testing.
This questionnaire has shown to be a valid tool for the assessment of the adherence and side effect management skill for patients with capecitabine treatment. It can easily be uses as a screening tool for prescribers. It can also be used as an evaluation tool for a therapeutic education programme in this field.
Une étude sur le potentiel de discrimination des surfaces brûlées de six indices spectraux (« normalized difference vegetation index » NDVI, « soil adjusted vegetation index » SAVI, « global ...environment monitoring index » GEMI, « burn area index » BAI, Albedo et « brightness index » BI) a été conduite sur une zone de savane dans la région de Marovoay (Nord-ouest de Madagascar). L'objectif était de déterminer, dans un environnement caractérisé par un couvert végétal épars et par une analyse de séparabilité, l'indice spectral le plus adapté à détecter les surfaces brûlées à partir d'images MODIS. Les résultats montrent que l'indice de brillance est le plus performant, d'autant plus qu'il est utilisé avec une méthode basée sur l'utilisation de deux images de référence, pré- et post-feu.
Breast cancer remains a potentially lethal disease, which requires aggressive treatments and is associated with long-term consequences. Its prognosis is linked to both tumor biology and burden at ...diagnosis. Although treatments have allowed important improvements in prognosis over the past 20 years, breast cancer screening remains necessary. Mammographic screening allows earlier stage diagnoses and a decrease of breast cancer specific mortality. However, breast cancer screening modalities should be revised with the objective to address demonstrated limitations of mammographic screening (limited benefit, imperfect sensitivity and specificity, overdiagnoses, radiation-induced morbidity). Furthermore, both objective and perceived performances of screening procedures should be improved. Numerous large international efforts are ongoing, leading to scientific progresses that should have rapid clinical implications in this area. Among them is improvement of imaging techniques performance, development of real time diagnosis, and development of new non radiological screening techniques such as the search for circulating tumor DNA, development of biomarkers able to allow precise risk evaluation and stratified screening. As well, overtreatment is currently addressed by biomarker-based de-escalation clinical trials. These advances need to be associated with strong societal support, as well as major paradigm changes regarding the way health and cancer prevention is perceived by individuals.
Rapporter et discuter notre expérience monocentrique de la prise en charge du cancer primitif du vagin chez les patientes âgées.
L’ensemble des données sur la prise en charge des patientes de plus de ...70ans traitées pour un cancer primitif du vagin à l’institut de cancérologie Lucien-Neuwirth a été recueilli de manière rétrospective.
D’août 1999 à janvier 2009, 9/24 patientes traitées pour un cancer primitif du vagin étaient âgées de 70ans ou plus. L’âge médian était de 81ans (70–94ans). La majorité des patientes avaient un indice de performance inférieur ou égal à 1 (n=6), un carcinome épidermoïde (n=7) et un stade FIGO≤II (n=6). Toutes ont été traitées par radiothérapie externe, 3 ont eu une chimiothérapie concomitante, 3 une curiethérapie complémentaire et 6 ont été opérées (colpohystérectomie). Parmi les 7 patientes évaluables, il y a eu 4 réponses complètes, 2 réponses partielles et une progression. Les principales toxicités aiguës ont été digestives (n=5), urinaires (n=3), générales (n=3) et cutanées (n=2). Trois patientes ont eu des toxicités tardives. Quatre patientes ont eu une récidive locale après un délai moyen de 10,8 mois. Quatre patientes étaient vivantes à la date des dernières nouvelles et 4/5 décès étaient liés au cancer. Toutes les patientes ayant reçu l’association radiothérapie–curiethérapie étaient vivantes sans maladie (n=3). La survie globale médiane a été de 18 mois.
Les cancers primitifs du vagin sont des tumeurs rares et agressives. Nos résultats suggèrent la faisabilité de l’association radiothérapie et curiethérapie chez les patientes âgées. Des essais prospectifs demeurent nécessaires pour mieux préciser et valider la stratégie optimale, en particulier chez la personne âgée.
Report and discuss the management of the primitive vaginal cancer in elderly adults at a single institute.
Data from patients more than 70 year-old treated for a primitive vaginal cancer at the Institut de Cancérologie de la Loire Lucien-Neuwirth was retrospectively collected.
From August 1999 to January 2009, 9/24 patients treated for a primitive vaginal cancer had more than 70 year-old. The median age was 81 years (7–94 years). Most patients had a performance status less or equal to 1 (n=6), a squamous cell carcinoma (n=7) and a FIGO stage less or equal to II (n=6). All patients were treated with 3D external beam radiation, 3 received concurrent chemotherapy, 3 had a supplementary brachytherapy, and 6 had a colpohysterectomy. Among 7 evaluable patients, there were 4 complete responses, 2 partial responses and one progression. Main acute toxicities were gastrointestinal (n=5), urinary (n=3), general (n=3) and cutaneous (n=2). Three patients experienced late toxicities. Four patients had a local recurrence after a mean delay of 10.8 months. At last news, 4 patients were still alive and 4/5 deaths were related to the cancer. All (n=3) patients who received the combination of radiotherapy - brachytherapy were alive and disease-free. Median overall survival was 18 months.
Primitive vaginal cancers are rare and aggressive tumours. Our results suggested the feasibility of the combination of radiotherapy and brachytherapy for elderly patients. Prospective trials remain needed to better define and validate the optimal strategy, especially in elderly adults.
