Jean-Marie Dilhuydy

DNA topoisomerase IIα expression and the response to primary chemotherapy in breast cancer

The α isoform of Topoisomerase IIα (Topo IIα) is a proliferation marker as well as a target for several chemotherapeutic agents such as anthracyclines. In vitro studies have demonstrated the relationship between the Topo IIα expression level and chemosensitivity of target cancer cells. To verify this effect in vivo, we selected 125 patients presenting with T2>3 cm and T3 N0–1 M0 breast tumours who were treated by six cycles of primary chemotherapy, including epirubicin before any surgery. Therapy response was assessed by clinical and X-ray mammogram measurements of tumour shrinkage. The pretherapeutic core biopsies were immunostained with a monoclonal antibody (Ki-S7) against Topo IIα. Ki-S7 positivity ranged from 0 to 50% (median, 15%). A high percentage of Ki-S7-positive cells (>15%) was associated with tumour regression under chemotherapy (OR=2.88, CI: 1.3–6.4, P=0.004). Ki-S7 further emerged as an independent predictor of tumour regression (OR=3.34, CI: 1.41–7.93, P=0.006), together with tumour size of less than 40 mm (OR=3.82, CI: 1.58–9.25, P=0.002) and negative oestrogen receptor (ER) status (OR=3.35, CI: 1.43–7.86, P=0.005), in a multivariate analysis including tumour size, SBR grade, ER and PR status, Ki-67, p53 and Her-2/neu. Our clinical results confirm in vitro data on the relationship between Topo IIα expression and tumour chemosensitivity and thus may have important practical implications.

Parcours de femmes 2001

Résumé:Le but de l’enquête d’opinion «Parcours de femmes 2001» était d’évaluer la prise en charge globale et les besoins de patientes atteintes d’un cancer féminin. Les femmes incluses dans cette étude transversale et observationnelle, présentaient un cancer du sein ou un cancer gynécologique (ovaires, utérus), de tout stade avec un traitement ayant débuté depuis au moins 3 mois et/ou terminé depuis moins d’un an. De février à novembre 2001, 2 839 questionnaires ont été distribués: 1 870 patientes l’ont retourné (soit 66 %), 87 % d’entre elles présentaient un cancer du sein. Au total, 92 % des femmes déclarent avoir reçu des informations/explications au moment du diagnostic; cependant un déficit en informations était rapporté chez 34 % des patientes présentant une récidive; 18 % seulement des patientes ont été associées à la décision thérapeutique et 60 % des femmes ont cherché des informations complémentaires soit auprès des médias, soit auprès d’autres patientes ou du milieu médical. La fatigue représente le principal problème, rapporté par 78 % des patientes, cette fatigue n’est pas suffisamment prise en charge par les soignants en raison des difficultés diagnostiques et thérapeutiques. D’autres difficultés liées à la vie familiale, affective et socioprofessionnelle sont difficilement identifiées et insuffisamment prises en considération par les soignants. En conclusion, l’information donnée aux patientes atteintes de cancers mammaires ou gynécologiques doit être plus complète au moment de la récidive notamment sur les effets secondaires liés aux traitements. La prise en charge psychosociale doit faire l’objet d’une nouvelle approche plus globale nécessitant une coordination entre les différentes structures existantes.Abstract:The aim of the survey ‘Parcours de femmes 2001’ was to evaluate the overall management and care of patients with female cancers and to determine their needs. Women with breast or gynecological cancer, who had either received at least 3 months of treatment or had completed treatment less than 1 year before the study, were enrolled in this cross-sectional, observational study. From February to November 2001, 2,839 questionnaires were distributed; 1,870 were returned (66% response rate), mainly by breast cancer patients (87%). While 92% of women reported having received information at diagnosis, a lack of information was reported in 34% of relapsed patients. Only 18% of patients were included in the treatment decision process; and 60% of women obtained complementary information from the media, patients and care professionals. Fatigue was the most severe problem quoted (78% of cases) and was poorly managed by caregivers due to diagnostic and treatment difficulties. Problems relating to family and to affective and socio-professional life were poorly identified and remained largely unmanaged. Information given to female cancer patients must be improved in relapsed patients particularly regarding the adverse effects of treatment. Psychosocial management requires a more holistic approach through new channels together with the coordination of existing structures.

DNA topoisomerase IIα expression and the response toprimary chemotherapy in breast cancer

The α isoform of Topoisomerase IIα (Topo IIα) is a proliferation marker as well as a target for several chemotherapeutic agents such as anthracyclines. In vitro studies have demonstrated the relationship between the Topo IIα expression level and chemosensitivity of target cancer cells. To verify this effect in vivo, we selected 125 patients presenting with T2>3 cm and T3 N0–1 M0 breast tumours who were treated by six cycles of primary chemotherapy, including epirubicin before any surgery. Therapy response was assessed by clinical and X-ray mammogram measurements of tumour shrinkage. The pretherapeutic core biopsies were immunostained with a monoclonal antibody (Ki-S7) against Topo IIα. Ki-S7 positivity ranged from 0 to 50% (median, 15%). A high percentage of Ki-S7-positive cells (>15%) was associated with tumour regression under chemotherapy (OR=2.88, CI: 1.3–6.4, P=0.004). Ki-S7 further emerged as an independent predictor of tumour regression (OR=3.34, CI: 1.41–7.93, P=0.006), together with tumour size of less than 40 mm (OR=3.82, CI: 1.58–9.25, P=0.002) and negative oestrogen receptor (ER) status (OR=3.35, CI: 1.43–7.86, P=0.005), in a multivariate analysis including tumour size, SBR grade, ER and PR status, Ki-67, p53 and Her-2/neu. Our clinical results confirm in vitro data on the relationship between Topo IIα expression and tumour chemosensitivity and thus may have important practical implications.

Patient information about radiation therapy: a survey in Europe

BACKGROUND AND PURPOSE We performed a survey to evaluate the present status and means of information given to patients treated by radiotherapy. A short questionnaire was sent, with the help of ESTRO, to 746 European heads of department with a request to send specific documents used for informing the patient. Within 2 months (March and April 1996) we received 290 answers (39%) and 97 centres sent documents. MATERIALS AND METHODS Analysis of the questionnaire and the documents was performed quantitatively with usual statistical methods and qualitatively with a socio-anthropological method of content analysis. RESULTS Analysis of the questionnaire shows the major role of the radiation oncologist in giving information and writing documents. The 298 different samples sent from 97 centres represent a wide panel with a booklet of general information (59 booklets/57 centres), practical advice and specific explanations (177 documents/49 centres) and informed consent (36 documents/28 centres). The anthropological study was centred on the way information was given, evaluation of the patients understanding and analysis of documents sent. CONCLUSION This preliminary survey needs to be completed by a study, including the patients point of view and needs, about the information given.

apports de l'anthropologie appliquée au champ de la cancérologie =: interests of applied anthropology to oncology

From now on the introduction of social and human sciences studies in the field of oncology has not always been conclusive. This article aims to analyze the bounds that border the meeting and the understanding between physicians, patients and anthropologists. It also treats the problems due to the introduction of applied anthropology in the field of oncology and points up the interests and practical contributions that this disciplinary bring and could bring.

Que peuvent apporter l’anthropologie et la sociologie à la pratique en cancérologie ? Apport des sciences humaines à la cancérologie

RésuméDepuis les débuts des sciences humaines en cancérologie, la recherche sociologique et anthropologique, dans les établissements de soins, s’est largement développée sans toujours convaincre de son intérêt. Cet article vise à aborder les freins qui entravent la rencontre et la compréhension mutuelles entre soignants et chercheurs en sciences humaines, les problématiques qu’engendre l’introduction des sciences humaines en cancérologie, ainsi que les intérêts et les apports pratiques que peut apporter un véritable partenariat soignant-chercheur.AbstractFrom now on, the introduction of human sciences studies in the field of oncology has not always been conclusive. This article aims to analyze the bounds that border the meeting and the understanding between physicians and human sciences researchers. It also treats the problems due to the introduction of human sciences in the field of oncology and points up the interests and practical contributions that a partnership between physicians and researchers could bring.

Prise en compte de l’entourage des patients atteints de cancer: un aperçu mondial des programmes et des actions d’information et de soutien

Résumé:Une étude bibliographique sur les publications concernant la prise en compte de l’entourage des patients, montre que ce sont les pays scandinaves et anglosaxons qui ont le plus avancé dans cette réflexion et dans la mise en place de programmes évalués destinés à apporter soutien, conseils et aide aux proches de malades atteints de cancer. L’entourage concerne les proches, c’est-à-dire la famille et les amis, et dans certains cas, l’équipe soignante. Il s’agit d’une vision très large dans le cadre d’une prise en charge globale.Nous assistons en France depuis les premiers États Généraux des malades du cancer organisés par La Ligue Nationale contre le Cancer en 1998 et en 2000 à une évolution irréversible des mentalités qui ne peut que déboucher, grâce aussi au Plan Cancer, à un meilleur soutien non seulement des patients mais encore de leur entourage.Abstract:A survey of published studies and programs concerning the family and friends of cancer patients shows that Scandinavian and Anglo-Saxon countries are well ahead in the development of evaluated programs for information and help, considering the patient and their close relations, as well as the medical team as a whole, in a global approach to treatment and follow-up. In France, since the first «États Généraux des malades» (National meeting of patients) for cancer patients organised by the Ligue Nationale contre le Cancer in 1998 and 2000 and the establishment of the «Cancer Plan», we witness an irreversible evolution of attitudes and mental process leading to a better support of patients and their families and friends.

1011 - Structured patient information in radiotherapy departments in Europe

With the help of ESTRO, we performed a survey to evaluate the present status and means in information given to patients treated by radiotherapy. A short questionnaire was sent to 746 European heads of departments with a request to send specific documents used for informing the patients. Within 2 months (march and april 1996), we received 290 answers (39%) and 97 centers send 298 documents. Methods : analysis of the questionnary and the documents was performed quantitatively with uusual statistical methods and qualitatively with a socio-anthropological method of content analysis. Results : Analysis of the questionnaire shows the major role of the radiation oncologist in giving information and writing documents. The 298 different samples sent from 97 centres represent a wide panel with a booklet of general information (59 booklets /57 centers), practical advice and specific explanations (177 documents/ 49 centers) and informed consent (36 documents/28 centers). the anthropological study was centred on the way information was given, evaluation of the patientsunderstanding and qualitative analysis of documents sent. Conclusion : the high rate of response (40 %) of this survey shows the general interest for radiation therapy staffs on patient information. However, this preliminary survey needs to be completed by a study, including the patients point of view and needs, about the information given.