Bulletin du cancer
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Treatment of high-risk prostate cancer - localized or locally advanced - is based on the combination of external irradiation and hormonal treatment by LHRH analogue (aLHRH) according to the results of phases III randomized trials RTOG and/or EORTC trials. These trials show a significant improvement of overall or specific survival. Localized prostate cancer require 6-month complete androgen blockade, while locally advanced prostate cancer need a long-term hormonal treatment for a duration ranging from 2,5 to 3 years. Some trials, which have a long follow-up show that the risk of cardiovascular death is not significantly increased by hormonal treatment.
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Based on the observation of a high incidence of breast cancer in the upper outer quadrant adjacent to the usual area of application of deodorants and/or antiperspirants, several scientific teams have advanced the hypothesis of a possible link between antiperspirants and breast cancer. The possibility of the involvement of parabens and aluminium salts, traditional components of a number of cosmetic products, has been advanced by the same teams. In order to ascertain whether this hypothesis could or could not be confirmed, a group of clinical experts in oncology was set up to search and analyse the literature data relating to the problem raised with the aim of answering three predefined questions: 1) does it exist experimental or biological arguments supporting a potential link between the use of deodorants/antiperspirants and breast cancer? 2) Does the use of deodorants/antiperspirants have any effect on the increase in the risk of breast cancer? 3) Could a causal relationship between the use of deodorants/antiperspirants and breast cancer be accepted? The scientific data were searched systematically in the PubMed database (http://www.ncbi.nlm.nih.gov/sites/entrez) using standardised search equations. ⋯ Among these nineteen articles, many are methodologically unsound, do not answer to the questions posed or deal with the question of parabens and were therefore discarded by the reflection group. The expert group's conclusion coincides with those of the French, European and American health authorities. After analysis of the available literature on the subject, no scientific evidence to support the hypothesis was identified and no validated hypothesis appears likely to open the way to interesting avenues of research.
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Identification of sentinel node (SN) involvement predictive factors, non-sentinel node involvement predictive factors, selective prognosis of each group of patients by study of breast surgery cases with sentinel node sampling. ⋯ First, 72.1% of T0 or T1 tumors, avoid adverse axillary dissection effects. Second, micrometastatic involvement predictive factors do not differ from macrometastatic ones and those of positive secondary axillary dissection among micrometastatic SN do not appear clearly : the risk of axillary recurrence is low: at the very most, it seems possible to propose a safe guideline, avoiding secondary axillary dissection only for selected group of lower risk patients: tumoral size < 10 mm, grade I, monocentric SN involvement. Third, it is not possible to differentiate a selective prognosis between negative, CTI, micrometastatic and macrometastatic SN subgroups probably because of a short follow-up. Fourth, teaching through companionship is fully valided by the secondary minimal rate of axillary recurrence.
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Life expectancy increasing and cancer incidence rising with age, geriatric and cancer care will become a significant medical, public health, challenge. It is possible that the lack of efficacy of cancer therapies in the elderly may simply be due to the fact that physicians reduce anticancer drug doses empirically, in order to avoid "putative" toxicities that might arise as a result of alterations of physiological functions or as a result of co-morbidities generally present within this population. However, many authors have demonstrated that some patients over 70 years old could tolerate and obtain same benefit from therapies as younger adults, when some who are frail need less aggressive therapies. ⋯ Such studies have been successfully conducted in the elderly, some of them leading to dose recommendations. This paper detail the different sources of PK-PD variability in the elderly, some practical considerations regarding the design of studies using the population approach, as well as some examples of studies performed in the elderly. We conclude with some recommendations in this population at risk.
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The optimal management of elderly patients with cancer includes, besides the tumour assessment, a geriatric evaluation procedure. To date, comprehensive geriatric assessment (CGA) remains the gold standard of evaluation in older patients. ⋯ This approach has been developed to help oncologists differentiate the healthy elderly from other older patients whose problems would possibly interfere with cancer treatment and who require a pre-treatment CGA. Studies have shown that healthy older patients derive no advantage from CGA, but benefit from cancer treatment as much as younger patients.