Marie Larochelle

Local Failure Is Responsible for the Decrease in Survival for Patients With Breast Cancer Treated With Conservative Surgery and Postoperative Radiotherapy

PURPOSE The aim of the present study was to evaluate the role of local failure (LF) in the survival of patients treated with lumpectomy and postoperative radiotherapy and to investigate whether LF is not only a marker for distant metastasis (DM) but also a cause. METHODS Charts of patients treated with breast conservative surgery between 1969 and 1991 were reviewed retrospectively. There were 2,030 patients available for analysis. The median duration of follow-up was 6 years. A Cox regression multivariate analysis was performed using LF as a time-dependent covariate. RESULTS Local control (LC) was 87% at 10 years. Local failure led to poorer survival at 10 years than local control (55% v 75%, P < .00). In a Cox model, local failure was a powerful predictor of mortality. The relative risk associated with LF was 3.6 for mortality and 5.1 for DM (P < .00). In patients with LF, the rate of DM peaked at 5 to 6 years, whereas it peaked at 2 years for patients with LC. The mean time between surgery and DM was 1,050 days for patients without LF and 1,650 days for patients with LF (P < .00). CONCLUSION Our results show that local failure is associated with an increase in mortality. The difference in the time distribution of distant metastasis for LF and LC could imply distinct mechanisms of dissemination. Local failure should be considered not only as a marker of occult circulating distant metastases but also as a source for new distant metastases and subsequent mortality.

The impact of skin washing with water and soap during breast irradiation: a randomized study.

BACKGROUND The effect of washing the irradiated skin during radiotherapy for breast cancer is uncertain. The purpose of this study was to evaluate the impact of washing the breast skin with water and soap during radiotherapy on the intensity of acute skin toxicity. MATERIALS AND METHODS Ninety-nine patients treated for breast cancer were prospectively randomized prior to receiving radiotherapy to the breast into two groups: (1), no washing was allowed during radiotherapy (49 patients); and (2), washing was allowed with water and soap (50 patients). Acute toxicity was recorded according to the Radiation Therapy Oncology Group (RTOG) acute skin toxicity scale for each patient every week during radiotherapy and 1 month after the end of radiotherapy. Symptoms related to skin toxicity were scored by visual analogue scales at the same time intervals. Other data collected included sociodemographic data, characteristics related to the tumor and previous treatments, radiation technique, necessity for a second simulation due to loss of skin marks and treatment interruptions. RESULTS In the non-washing group, the following maximum acute toxicity scores were observed: grade 0, 2%; grade 1, 41%; grade 2, 57%; grades 3 and 4, 0%. For the washing group, the scores were: grade 0, 0%; grade 1, 64%; grade 2, 34%; grade 3, 2%; and grade 4, 0%. Moist desquamation was seen in 33% of non-washing patients, but in only 14% of washing patients. The median scores of pain, itching and burning of the treated skin were higher in the non-washing group, although this was not statistically significant. In a multivariate analysis using logistic regression, acute skin toxicity was associated with the patients weight, concomitant radiochemotherapy and hot spots on dosimetry, and there was a trend toward more acute skin toxicity in the non-washing group. CONCLUSION Washing the irradiated skin during the course of radiotherapy for breast cancer is not associated with increased skin toxicity and should not be discouraged.

‘Of course, it's just obvious’: adolescents’ ideas of scientific knowledge

What is scientific knowledge? What criteria are relevant to its production? What is scientific observation? Scientific experimentation? These are some of the key questions answered by a group of twenty‐five secondary adolescents in a research programme concerned with the representation of science. A detailed analysis of individual interviews identified the naively realistic and empiricist postulates underlying their representation of scientific knowledge and its production. Why are we interested in students’ notions of scientific knowledge? The first reason is didactic in nature: knowledge acquired about these notions provides clues as to why our students do not understand. The second reason is ideological: it seems legitimate to ask if students have been made aware of the contemporary questions that come from epistemological reflection. The third reason is also ideological: even though many people in society do not understand modern scientific theories, it is even more bothersome that they cannot render ...

Constructivism and education: Constructivism and education: beyond epistemological correctness

For several years now, research conducted within the perspective of epistemological constructivism has allowed us to develop other, fruitful ways of conceiving the problem of knowledge and, with this, the problem of learning. For instance, as constructivism implies that knowledge is always knowledge that a person constructs, it has prompted the development of didactic situations which stress the need to encourage greater participation by students in their appropriation of scholarly knowledge. But how has this basic precept of constructivism contributed to the renewal of day-to-day teaching practices? What sort of participation, construction, and forms of knowledge are involved … and valued? Most often, it is a “softer” version of constructivism which is favorably considered. Indeed, taking students’ knowledge into account seems to have scarcely modified the usual teaching modus vivendi at any level of instruction one chooses to examine. No doubt students’ points of view are elicited with greater frequency. That is, in fact, the major effect of so-called constructivism on educational practices, as Morf has emphasized in this book. However, such elicitation appears to obey no other end than to identify “whats wrong” with the students’ points of view. Wrong, that is, from the perspective of the knowledge which is to be taught; no account is made of how potentially this sanctioned form of knowledge may present major divergences with student knowledge in terms of nature, scope, and viability. When this is the case, two major issues go by the board: the complexification of students’ knowledge, and the development of a shared, reflexive kind of understanding of the subject and task at hand.

Impact of locoregional radiotherapy in node-positive patients treated by breast-conservative treatment.

PURPOSE The aim of this study is to evaluate the impact of locoregional radiation in node-positive patients treated by tumorectomy and radiation therapy. METHODS A retrospective study including all our 1368 T1-2 node-positive patients was conducted. Conservative surgery was followed by breast irradiation. Axillary and supraclavicular irradiation was left to the discretion of the treating radiation oncologist. RESULTS In the group receiving locoregional radiation (472 patients), the 10-year regional control was 97% vs. 91% for the group receiving radiation to the breast only (896 patients) (p = 0.004). In a Cox model analysis, locoregional radiation is associated with a better regional control rate (hazard ratio: 0.27; 95% confidence interval: 0.13-0.54, p = 0.0001). Locoregional radiotherapy is associated with a better rate of locoregional control (hazard ratio: 0.56; 95% confidence interval: 0.38-0.8, p = 0.002). In particular, for the N>3 group, the substantial 10-year locoregional failure rate (26% with breast irradiation only) is cut by 50%. Locoregional radiotherapy, however, is not associated with a lower rate of distant metastases. CONCLUSION Locoregional radiation decreases the rate of locoregional failure by nearly 50%. Locoregional radiotherapy should be considered for node-positive patients, especially if they have more than 3 positive nodes.

On Peers, Those 'Particular Friends'.

As an outgrowth of the institutionalisation of science, peers have come to enjoy a prerogative making them key actors in the configuration of the exercise of science. Indeed, as referees, they have been endowed with an enormous political power in that their function no longer restricts them to merely certifying or attesting: they have to assess. Scholarly writing, as conceived of by Robert Boyle, coupled with its transformation into writing bearing an imprimatur, serves as the starting point of our discussion of this aspect which is also part and parcel of science education.

Les enjeux socioéthiques des désaccords entre scientifiques: Un aperçu de la construction discursive d'étudiants et étudiantes

RésuméCette recherche avait pour objectif d’explorer comment des groupes d’étudiants et étudiantes du collège appréhendent et structurent les désaccords entre scientifiques et, plus particulièrement, les enjeux socioéthiques qui les sous-tendent. En vue de simuler un contexte qui se rapproche de celui que des jeunes peuvent instaurer lorsqu’ils conversent entre eux sur le clonage, par exemple, nous avons aménagé un contexte de délibération en petit groupe de trois à quatre étudiants et étudiantes à propos d’une autre délibération, si l’on peut dire. Les étudiants et étudiantes ont ainsi été invités a se prononcer sur une conversation (écrite) d’une quinzaine de minutes entre deux scientifiques qui adoptent des positions contrastées en regard, dans un cas, de l’utilisation des travaux des médecins nazis dans la recherche sur l’hypothermie et, dans l’autre cas, de la manipulation du matériel génétique des êtres vivants, en particulier des êtres humains. Nous présentons ici un aperçu des stratégies et ressources discursives mobilisées par les étudiants et étudiantes pour exprimer et justifier leurs positionnements et repositionnements tout au long de leur propre conversation, ainsi que de l’≪ agir éthique ≫ que les uns les autres ont spontanément énacté.AbstractThis study was designed to explore how groups of students at a CÉGEP (a type of two-year pre-university college specific to Quebec) framed not only disagreements among scientists but also, and particularly, the underlying socio-ethical stakes of these disagreements. As part of simulating a context comparable to that which might arise among young people when they discuss cloning, for example, we devised a deliberative context involving small groups of three to four students on the subject of another sort of deliberation, so to speak. Students were asked to express their point of view about an adversarial conversation (presented in written form), lasting approximately 15 minutes, between two scientists who had adopted opposing positions with respect, in the first case, to the use of hypothermia research performed by Nazi physicians and, in the second, to the manipulation of genetic material among living beings, and humans in particular.The corpus of our materials was made up of tape-recorded conversations among eight groups of students. The average length of conversations was approximately 1½> hours. With the exception of one student who had a concentration in literature, participating students were all enrolled in science programs; most planned to continue in the same field once they reached university. The average age of the students was 18, with the exception of three students who had returned to school and whose ages varied between 23 and 31. We used a range of tools deriving from the methodology of discourse analysis and argumentation to elucidate how students give shape and meaning to the disagreements among scientists and co-construct one or more group positions. We thus investigated not only the discursive strategies and resources activated by students to justify the initial and revised positions they adopted over the course of their own conversation but also the forms of ‘ethical action-taking’ spontaneously enacted by them.Among other findings, we were able to show that students were quite capable of tackling the ‘problematic subjects’ with which we presented them. Indeed, they demonstrated a certain agility in terms of their deliberative capacities. We were also able to show that the stability of this ‘tackling’ process could be likened to the equilibrium characterizing recursive systems. Once the debate was fully underway, tensions emerged, classifications that had previously gone unquestioned lost some of their certainty, and new options took shape.In short, the very act of taking a position stood out as being more dynamic, more controversial—or at least less quiescent—than is the case during one-on-one interviews. On that point, we believe we have touched on a useful methodological advance, for it suggests that the rather undifferentiated epistemological portrait emerging from individual interviews perhaps represents only half the story. In that connection, group deliberation holds out much conceptual, methodological, and educational promise because it tends to foster the complexification of participants* points of view.In addition, we have shown that whenever the discussion explicitly draws on the world of science, the discursive achievement of the participants becomes more quiescent, somewhat as though the school rhetoric of science that they brought into play constrained and indeed inhibited their deliberative activities and oriented the debate. It is also worth noting that the various groups whom we met tended to dissociate epistemology from ethics, as if the latter were not an integral part of science production but instead represented some sort of ‘supplement of soul’ that scientists may display after the fact—that is, once the production of science is over and done with.

On the sovereignty of school rhetoric: Representations of science among scientists and guidance counsellors

This article sheds light on views held by actors who enjoy a certain degree of institutional legitimacy for “talking about science,” either as practitioners in the field of science or as guidance counsellors working with youths interested in having a science-related career. One hundred and seven scientists and technologists who worked either in a university or industrial research centre and 182 guidance counsellors working in high school settings participated in our survey; the main instrument for data collection was a questionnaire developed using the bank of items from “VOSTS.” Excepting a few aspects of the production of scientific knowledge, the predominant tendency suggests that both professional groups share a relatively similar discursive outlook on science—an outlook which presents a “family resemblance” with the usual school rhetoric on the exceptional status of science.

Les paradoxes de Peter

RésuméSous plusieurs aspects, le texte de Fensham (2002) ne livre pas la rupture annoncée dans l’intitulé. Tout au plus, comme je tente de l’illustrer brièvement, se révèle-t-il une variation sur un même thème ou, diraient les sociologues de l’éducation, sur une même «forme scolaire». C’est d’ailleurs sur ce concept de forme scolaire que je me suis appuyée pour jauger le projet de Fensham et montrer que ce projet, loin de mettre en péril ladite forme, reconduit au contraire ses prérogatives et le rapport à l’impersonnel qui la caractérise: le mode de socialisation à la cité savante continue à se décliner en termes de contenus d’enseignement, et les conditions d’appropriation de ceux-ci à se dérouler dans l’enclos disciplinaire et sous le parrainage de l’école. En d’autres termes, si rupture il y a, elle ne semble guère s’adresser à la forme scolaire et à la politique qui lui est consubstantielle. C’est un paradoxe d’autant plus étonnant que Fensham déplore lui-même la courte vue en matière de changements «éduco-politiques» d’une étude qui lui paraît pourtant comporter des pistes prometteuses pour renouveler les pratiques d’alphabétisation dite scientifique.AbstractIn many respects, Fensham’s (2002) text does not make good on the break announced in the title. At most, as I have attempted to briefly show, it turns out to be a variation on the same theme—or, as sociologists of education would put it, on the same ‘school form.’ Moreover, this concept of school form (in French, forme scolaire: what endows a particular historical configuration with unity or consistency) has provided me with a basis for assessing Fensham’s project and showing that it is far from imperilling the current ‘form.’ On the contrary, it perpetuates this form’s prerogatives and characteristic relationship with the impersonal. In practical terms, the mode of socialization into the res publica of scholars and experts continues to be formulated in terms of learning contents, and the conditions under which such contents are appropriated continue to unfold both within the territory delimited by disciplines and under the patronage of schools. All in all, to whatever degree the notion of a break applies, it seems scarcely concerned with the school form and the politics that is of a piece with this form. This paradox is all the more astonishing because Fensham himself deplores the short-sightedness of the ‘educopolitical’ changes that were proposed in a study that, in his view, has nevertheless offered some promising avenues for renewing the practices of so-called scientific literacy.