Hamid Hocini

2008 french national guidelines for the treatment of venous thromboembolism in patients with cancer: Report from the working group

Venous thromboembolism (VTE) is a major therapeutic issue in cancer patients. Advances in this field and heterogeneities in clinical practices prompted us to establish guidelines in the management of VTE in cancer patients according to the SOR (Standards, Options and Recommendations) methodology. A literature review of the studies published on this topic between 1999 and 2007 was performed. The guidelines were developed from the analysis of 38 out of 418 publications selected. They were peer-reviewed by 65 independent experts. The treatment of VTE in patients with cancer, including those with intracranial malignancies, should be based on low-molecular-weight heparins administered at therapeutic doses for at least 3 months. In the event of recurrent VTE, pulmonary embolism with hemodynamic failure or contra-indication to anticoagulant treatment, the indications and usages of vena cava filters and thrombolytic drugs should be the same as in non-cancer patients.

Anti-Müllerian hormone in breast cancer patients treated with chemotherapy: a retrospective evaluation of subsequent pregnancies.

Few studies have reported reproductive outcomes after breast cancer chemotherapy. The relationship between anti-Müllerian hormone (AMH) concentrations and the occurrence of subsequent pregnancies in women after chemotherapy for breast cancer was investigated. Women aged 18-43 years treated with chemotherapy for invasive breast cancer between May 2005 and January 2011 were retrospectively identified. Exclusion criteria were previous gonadotoxic treatment, oophorectomy or hysterectomy. Measurement of AMH took place before, during chemotherapy and at distant time points after the end of chemotherapy (4 months to 5.5 years). Seventeen out of 134 patients experienced 28 spontaneous pregnancies (median follow-up: 59 months). Neither baseline AMH (divided into quartiles) nor end-of-chemotherapy AMH (detectable versus undetectable) were significantly associated with the occurrence of pregnancy. Chemotherapy regimen with anthracyclines was associated with a greater probability of pregnancy compared with a taxane-containing regimen (hazard ratio 4.75; (95% CI 1.76 to 12.8); P = 0.002). Five-year disease-free survival and overall survival rates were 60% (95% CI: 51 to 70; relapse, n = 48) and 88% (95% CI 82 to 95; deaths, n = 21), respectively. AMH did not predict the occurrence of pregnancy. Additional studies assessing ovarian reserve and reproductive outcomes after breast cancer are required.

Cancer lobulaire infiltrant du sein : particularités diagnostiques et évolutives☆

Invasive lobular carcinoma accounts for 4 to 10% of breast cancers. The clinical and radiological diagnosis is difficult to make. Its progression is slower than that of ductal cancer, and the prognostic factors are more favourable. Its metastases are more frequently located in the digestive tract and the ovaries. It is more frequently bilateral. Its prognosis is not different from that of infiltrating ductal carcinomas. The choice of therapies depends on the individual characteristics of each patient and of the biological features of each tumour. However, lobular carcinomas seem to be less responsive to chemotherapy.

Contraception after breast cancer: Results of a survey among French gynecologists.

9044 Background: Due to the frequency of breast cancer, and to the high proportion of premenopausal women, contraception in survivors is a major concern. In contrast, literature data are dramatically nonexistent. Classical options included local methods, copper or hormonal (LNG) intrauterine devices (IUD). Little is known about the use of estroprogestins or progestative only contraception. The aim of this survey is to describe French current practice regarding contraception after breast cancer. Methods: A retrospective study was conducted between 1 June 2002 and 1 January 2003. Premenopausal patients with previous history of breast cancer, still menstruating, and consulting for contraception desire were included. 2,500 forms were sent to French gynecologist members of the GERM, FNCGM, and SFG, and 197 responses were obtained. Results: Median age was 38,6 years old. Tumor characteristics were invasive carcinoma (88%) versus in situ carcinoma (11.9%), N+ disease (18.9%) versus N-(48.6%), HR + (51.8%), HR- (...

Nonpalpable Breast Lesions in a Breast Care Unit: Prospective Analysis on 2708 Consecutive Cases.

Background: Breast cancer screening increases the detection of nonpalpable breast lesions, These lesions raise specific concerns, involving radiological imaging, biopsy techniques, and pathological analysis. The objective of the study is to evaluate the management of nonpalpable breast lesions in a breast disease unit.Material and Methods: From 2001 to 2007, 2708 nonpalpable breast lesions were prospectively evaluated by a multidisciplinary team. Radiologic lesions were detected by mammography alone (71,5%), ultrasonography (27,90%), MRI (0,20%). All lesions were classified according to the BI RADS classification. Three hundred and nine (309) core needle biopsies were performed, 807 vacuum assisted biopsies, and 521 open breast biopsies. The pathologic results were correlated with surgery, rebiopsy or long-term imaging follow up.Results: The pathologic results showed 33 % of malignant lesions (DCIS, invasive carcinoma), 9 % of high risk lesions (atypical ductal or lobular hyperplasia, lobular carcinoma in situ) and 58 % of benign lesions. The prevalence of cancer as a function of BI-RADS was: BI-RADS 0 : 2,6% (4/152), BI-RADS 2: 0% (0/55), BI-RADS 3: 2,3% (17/740), BI-RADS 4: 23,4% (352/1502) et BI-RADS 5 : 78,7% (185/235). Twelve of 152 (7,9 %) high risk lesions were upgraded to malignant lesions and 34/211 DCIS (16,1%) were upgraded to invasive carcinoma after surgery. Diagnostic performance rates exhibited the following results: agreement rate=96,6%, sensibility=96,2%, overall underestimation rate=12,6%, and false-negative rate=1,6%.After vacuum assisted biopsy, one-step surgery was performed in 82,9% and after core needle biopsy in 68,4%.Conclusion: This kind of quality evaluation in community practice should be encouraged. Management of those lesions continuously evolves with the widespread of RMI and new biopsy techniques. Efforts should be made in exploring imaging-pathologic discrepancies, and in identifying predictive factors of invasion on biopsies. We currently perform a focused analysis on lesions that required two surgical steps despite a prior biopsy, in order to point out new ways to improve our practices. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6020.