Martine Berlière

Histologic study of peritoneal endometriosis in infertile women

The present study included 118 patients undergoing a laparoscopy for infertility. In 86 patients with laparoscopically diagnosed endometriosis (group I), biopsies were taken from areas of apparent endometriosis (n = 86) and from a visually normal peritoneum (n = 52). Histology reveals the presence of endometriosis in 93% of positive sites and in 13% of negative sites. In 32 patients without endometriosis at laparoscopy (group II), biopsies were taken from normal uterosacral ligaments (n = 32). Endometriosis was observed in 6% of cases. Despite the increased ability to detect pigmented and nonpigmented endometriotic lesion, histological study revealed the presence of endometriosis in normal peritoneum in 13% (group I) and 6% (group II) of cases.

Uterine side effects of tamoxifen: a need for systematic pretreatment screening

Objective To evaluate the relationship between the time elapsed from the administration of ampicillin prophylaxis to delivery and its efficacy in interrupting intrapartum transmission of group B streptococcus. Methods During the 12-month study period, all women who came to the Virgen de las Nieves Hospital (Granada, Spain) for delivery were screened for group B streptococcus vaginal carriage by a pigment-detection culture-based procedure. Colonized women were treated with ampicillin (2 g intravenously), and the interval between ampicillin administration and delivery was recorded. Newborns from colonized mothers also were screened to detect group B streptococcus colonization. Results During the study period, 4525 women were admitted to the hospital for delivery and screened for group B streptococcus vaginal colonization. Group B streptococcus was detected in 543 women (12%), of whom 454 gave birth vaginally to 454 liveborn infants. Intrapartum ampicillin was given to 201 of these 454 women (44%), and 10% of the newborns from mothers who received intrapartum ampicillin prophylaxis were colonized by group B streptococcus. The relationship between timing of ampicillin administration and rate of neonatal group B streptococcal transmission was as follows: less than 1 hour before delivery, 46%; 1–2 hours, 29%; 2–4 hours, 2.9%; and more than 4 hours, 1.2%. Among the 253 mothers who received no intrapartum prophylaxis, colonization was found in 120 of their newborns (47%). Conclusion When the time between the start of ampicillin prophylaxis and delivery is at least 2 hours, vertical transmission of group B streptococcus is minimized.

Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy in patients with primarily unresectable, advanced-stage ovarian cancer

OBJECTIVE The aim of this review is to report our experience and the feasibility of neoadjuvant chemotherapy in patients with advanced-stage ovarian cancer. METHODS Forty-five patients with primarily unresectable advanced-stage epithelial ovarian cancer were treated in our center between 1995 and 2002 by platinum-based neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy. Their files were reviewed retrospectively. RESULTS At the end of neoadjuvant chemotherapy, according to RECIST criteria, 1 patient (2.2%) had achieved a clinical complete response (CR), 33 (73.4%) a partial response (PR), and 8 (17.8%) had stable disease (SD). Only 3 (6.6%) patients showed disease progression (PD). Surgery was performed in patients with objective response or SD after a median number of 4 courses (range: 2-6) of induction chemotherapy. A complete macroscopic debulking was achieved in 24 (53.3%) out of 39 patients in whom cytoreductive surgery was performed. For the entire group, median overall survival was 29 months. Survival was significantly improved in patients with optimal debulking compared to patients with persistent tumor after surgery: 41 months versus 23 months (P = 0.0062). Median survival for patients responding to neoadjuvant chemotherapy (CR and PR) was 44 months compared to 27 months for patients with SD or PD after initial chemotherapy (P = 0.01). Neither treatment-related deaths nor significant toxicities were observed. CONCLUSION Neoadjuvant chemotherapy followed by optimal debulking may be a safe and valuable treatment alternative in patients with primarily unresectable advanced-stage bulky ovarian cancer. Patients with an objective response to chemotherapy or absence of macroscopic residual tumor after surgery have a better outcome. This approach is currently being tested in large, prospective randomized clinical trials.

Focal Expression and Final Activity of Matrix Metalloproteinases May Explain Irregular Dysfunctional Endometrial Bleeding

Irregular dysfunctional bleeding of the endometrium (ie, metrorrhagia without organic lesion) is common in women, whether treated or not with ovarian hormones. Several matrix metalloproteinases (MMPs) become normally expressed and/or activated at menstruation and cause extracellular matrix breakdown. We therefore explored whether episodes of irregular dysfunctional bleeding could be associated with untimely MMP activity. By histology, foci of stromal breakdown were exclusively found in the endometrium of metrorrhagic women at bleeding. In these foci, 1) expression of estrogen receptor-alpha and progesterone receptor was altered; 2) collagenase-1 (MMP-1), stromelysin-1 (MMP-3), and gelatinase B (MMP-9) became detected in stromal cells, together with MMP-9 in neutrophils; and 3) gelatinase A (MMP-2) was more expressed and immunolocalized at the membrane of stromal cells. By biochemistry, endometrial lysates from nonbleeding metrorrhagic patients contained more latent and active MMP-2 and -9 than age-matched controls; at bleeding, collagenase activity, MMP-9, and active MMP-2 were strikingly increased whereas tissue inhibitor of metalloproteinases-1 (TIMP-1) was considerably decreased. As a functional assay, in situ gelatin zymography revealed large areas of gelatinolytic activity only in endometrium of bleeding patients. Altogether, these results strongly suggest that inappropriate focal expression and activation of several MMPs, combined with decreased inhibition, trigger irregular dysfunctional endometrial bleeding.

Incidence of reversible amenorrhea in women with breast cancer undergoing adjuvant anthracycline-based chemotherapy with or without docetaxel

BackgroundTo determine the incidence of reversible amenorrhea in women with breast cancer undergoing adjuvant anthracycline-based chemotherapy with or without docetaxel.MethodsWe studied the incidence and duration of amenorrhea induced by two chemotherapy regimens: (i) 6 cycles of 5-fluorouracil 500 mg/m2, epirubicin 100 mg/m2 and cyclophosphamide 500 mg/m2 on day 1 every 3 weeks (6FEC) and (ii) 3 cycles of FEC 100 followed by 3 cycles of docetaxel 100 mg/m2 on day 1 every 3 weeks (3FEC/3D). Reversible amenorrhea was defined as recovery of regular menses and, where available (101 patients), premenopausal hormone values (luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estradiol) in the year following the end of chemotherapy.ResultsOne hundred and fifty-four premenopausal patients were included: 84 treated with 6FEC and 70 with 3FEC/3D. The median age was 43.5 years (range: 28–58) in the 6FEC arm and 44 years (range: 29–53) in the 3FEC/3D arm. Seventy-eight percent of patients were treated in the context of the PACS 01 trial. The incidence of chemotherapy-induced amenorrhea at the end of chemotherapy was similar in the two groups: 93 % in the 6FEC arm and 92.8 % in the 3FEC/3D arm. However, in the year following the end of chemotherapy, more patients recovered menses in the 3FEC/3D arm than in the 6FEC arm: 35.5 % versus 23.7 % (p = 0.019). Among the 101 patients for whom hormone values were available, 43 % in the 3FEC/3D arm and 29 % in the 6FEC arm showed premenopausal levels one year after the end of chemotherapy (p < 0.01). In the 3FEC/3D group, there was a statistically significant advantage in disease-free survival (DFS) for patients who were still amenorrheic after one year, compared to patients who had recovered regular menses (p = 0.0017).ConclusionOur study suggests that 3FEC/3D treatment induces more reversible amenorrhea than 6FEC. The clinical relevance of these findings needs to be investigated further.

Papillomatose juvénile mammaire

The authors report a patient with juvenile papillomatosis of the breast presenting with a palpable mass and illustrate the correlation between mammographic, sonographic and pathologic features.

The Place of Extensive Surgery in Locoregional Recurrence and Limited Metastatic Disease of Breast Cancer: Preliminary Results

The aims of this study were first to clearly define two different entities: locoregional recurrences and limited metastatic disease and secondly to evaluate the place of extensive surgery in these two types of recurrence. Material and Methods. Twenty-four patients were followed from June 2004 until May 2014. All patients underwent surgery but for 1 patient this surgery was stopped because the tumour was unresectable. Results. The median interval between surgery for the primary tumour and the locoregional recurrence or metastatic evolution was 129 months. Eight patients had pure nodal recurrences, 4 had nodal and muscular recurrences, 5 had muscular + skin recurrences, and 8 had metastatic evolution. Currently, all patients are still alive but 2 have liver metastases. Disease free survival was measured at 2 years and extrapolated at 5 years and was 92% at these two time points. No difference was observed for young or older women; limited metastatic evolution and locoregional recurrence exhibited the same disease free survival. Conclusion. Extensive surgery has a place in locoregional and limited metastatic breast cancer recurrences but this option must absolutely be integrated in the multidisciplinary strategy of therapeutic options and needs to be planned with a curative intent.

A systematic encounter with a psycho-oncologist: Longitudinal study in women with breast cancer

Introduction: Cancer patients usually will not ask for psychological support. To increase the proportion of patients who may benefit from psychological support, an encounter was implemented in our hospital, within days following the announcement of a breast cancer diagnosis. In the current study the interest and the efficiency of such an intervention on the distress across the stages of the oncological treatment was assessed. Methods: A longitudinal design with an intervention group and a control group that did not receive the visit of the psychologist was performed. Sociodemographic and disease information, distress, coping, and patients’ needs were assessed on three occasions (diagnosis, treatment and end of treatment). Results: A significant decrease in depression (p < .05), in needs of medical information (p < .05) and a mobilization of distractive coping (p < .05) was found only in the encounter group. Conclusion: Current research indicates that an encounter with the psycholog... Document type : Article de périodique (Journal article) Référence bibliographique OGEZ, David ; Zech, Emmanuelle ; Van Maanen, Aline ; Brison, Céline ; Meulemans, Sylviane ; et. al. A systematic encounter with a psycho-oncologist: Longitudinal study in women with breast cancer. In: British Journal of Medicine and Medical Research, Vol. 20, no.9, p. 1-12 (2017) DOI : 10.9734/BJMMR/2017/32251

Abstract P2-18-03: Potential benefits of hypnosis sedation on different modalities of breast cancer treatment

Background: In oncology, hypnosis has been used for pain relief in metastatic patients but rarely for induction of anaesthesia. Material and methods: Between January 2010 and February 2014, 220 patients from our breast clinic (Cancer Center - Cliniques universitaires Saint-Luc - Universite catholique de Louvain) were included in an observational, non randomized study approved by our local ethics committee. 110 consecutive patients underwent breast surgery (lumpectomy or mastectomy +/- axillary lymph node dissection or sentinel lymph node biopsy) while on general anaesthesia (group I) and 110 consecutive patients underwent the same surgical procedures while on hypnosis sedation (group II). The stages and the tumor characteristics were well balanced between the two groups. After surgery, 28 patients received chemotherapy in group I and 27 patients in group II. Radiotherapy was administered to 96 patients of group I and 95 patients of group II. Currently, 83 patients of group I and 82 patients of group II are receiving endocrine therapy. Different parameters were studied for each treatment modality. Results: Duration of hospitalization was statistically significantly reduced in group II vs. group I (3.3 days vs. 4.4 days) (CI 95% range: -1.48 -0,72, p=0,0000000578) for all surgical procedures. The same results were observed for mastectomies alone (3.1 vs. 5.3 days) (CI 95 % range: -3,19 -1,31, p=0,0002 ) and for lumpectomies (3.1 vs. 4.3 days) (CI 95 % range: -1,024 -0,364, p=0,00065). The number of post-mastectomy lymph punctures was reduced in group II (1 to 3 (median value n=1.6) vs. group I (2 to 5 (median value n=3.1, p=0.01), as was the quantity of lymph removed (103 ml versus 462.7 ml) (p=0,0297) in the group of mastectomies. Concerning chemotherapy, the incidence of asthenia was statistically decreased (p=0.015) in group II. There was a statistically non significant trend towards a decrease in the incidence of nausea/vomiting and muscle pain in group II (respectively p=0.1 and p=0.2). The frequencey of severe radiodermitis (p=0.01) and post-radiotherapy asthenia (p=0.01) were significantly reduced in group II. Finally, compliance to endocrine therapy was improved in group II (p=0.05), while incidence of hot flashes (p=0,00029), joint or muscle pain (p=0,000139) and asthenia (p=0,00002) were statistically significantly decreased in group II. Discussion: Hypnosis sedation exerts beneficial effects on nearly all modalities of breast cancer treatment. The absence of a significant benefit for chemotherapy-induced nausea/vomiting and muscle pain observed is probably due to the small number of patients receiving chemotherapy in our study. Conclusion: Benefits of hypnosis sedation on breast cancer treatment are very encouraging and further promote the concept of integrative oncology. Citation Format: Martine Berliere, Sarah Lamerant, Philippe Piette, Aurore Lafosse, Laurence Delle Vigne, Fabienne Roelants, Christine Watremez, Marie-Agnes Docquier, Lafita Fellah, Isabelle Leconte, Francois Duhoux. Potential benefits of hypnosis sedation on different modalities of breast cancer treatment [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-18-03.

Chemotherapy-Related Amenorrhea in Breast Cancer: Review of the Main Published Studies, Biomarkers of Ovarian Function and Mechanisms Involved in Ovarian Toxicity

Breast carcinoma is the most common cancer in women of reproductive age. In Europe and in the United States, approximately 30% of all breast cancers occur before menopause and 15% of women are diagnosed in the reproductive age (age of 45 or younger). Adjuvant chemotherapy prolongs disease-free survival (DFS) and overall survival (OS), especially in young women, but also induces long-term and severe side effects such as temporary or definitive ovarian function suppression which results in potential loss of fertility and premature exposure to the risks of menopause including cardiovascular diseases, osteoporosis, hot flashes and genitourinary dysfunctions Bines et al. (1996). The probability of menopause with chemotherapy depends on the type of regimen used and on the age of the patient. In the literature, the estimated risk of amenorrhea varies between 0% and 60% in women younger than 40 years and between 40% and 100% in women older than 40 years. Beyond age and the type of regimen used, important variations reflect different durations of follow-up and variable definitions of menopause and of chemotherapy-related amenorrhea Bines et al. (1996).