Bulletin du cancer
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This article offers a retrospective overview of 25 years of implementation of psycho-oncology at the Memorial Sloan Kettering Memorial Cancer Center. It shows the ways and means used to obtain a progressive development of this sub-specialty for the purpose of improving patients' quality of life and helping professional teams wishing to offer integrated care to patients and families. ⋯ This has enabled the determination of the prevalence psycho-pathologies in the field of cancer, and demonstrated the need for early screening, and the instatement and evaluation of various specific interventions. Today, psycho-oncology is considered as a natural component of supportive care, but it should continue to develop alongside other specialities in order to help patients and families to cope with cancer better, both during and after treatment.
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The microarray technology has enabled scientists to simultaneously investigate the expression of thousands of genes. Regarding breast cancer, this technology has provided a molecular classification into clinically relevant subtypes, new tools to predict disease outcome and response to treatment and new insights into carcinogenesis and metastatic progression pathways. Here we describe the state of the art of gene expression profiling for breast cancer, and we discuss the potential impact on breast cancer patient management considering its limits and promises.
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In this brief review we describe the general principles of the antigenicity of human tumor cells, which can be recognized by T lymphocytes and particularly by cytolytic T lymphocytes. This antigenicity of tumor cells lead to the development of therapeutic anticancer vaccines that should induce tumor regressions or prevent the development of metastases in the vaccinated patients. ⋯ Detailed immunological analyses with some of these vaccinated patients showed strong anti-tumor T cell responses and suggested that the main limiting factor for clinical efficacy is a phenomenon of resistance of the tumor to T lymphocyte attack. Current research projects aim at elucidating the mechanisms of this resistance and to develop new vaccination strategies that circumvent this roadblock.
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Malignant gliomas of which glioblastomas represent the ultimate grade of malignancy are characterized by dismal prognoses because malignant glioma cells present both important proliferation and neoangiogenesis processes and can actively migrate through the narrow extra-cellular spaces in the brain, often travelling relatively long distances, making them elusive targets for effective surgical management. Invasive malignant glioma cells show a decrease in their proliferation rates and a relative resistance to apoptosis (type I programmed cell death) as compared to the highly cellular centre of the tumour, and this may contribute to their resistance to conventional proapoptotic chemotherapy and radiotherapy. The multidisciplinary up to date treatment for glioblastoma patients combined maximal surgical removal of the tumor with postoperative radiotherapy and concomitant chemotherapy with temozolomide. ⋯ It is a ligand of the alpha1 subunit of the pump which impairs the proliferation and migration of glioblastoma cells by disorganizing the actin cytoskeleton and inducing severe autophagic process in glioblastoma cells. Collectively, these data suggests that the novel cardenolide is an attractive candidate for preclinical and clinical development, at least in the area of glioblastoma. This compound should reach phase I clinical trials in the summer of 2008.
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Review Meta Analysis
[Systematic review 2007: Primary treatments of testicular germ cell tumors after radical orchydectomy].
The "Standards, Options and Recommendations" (SOR)program in oncology, has been initiated in 1993 by the Federation of French Cancer Centres and is realised in collaboration with public and private clinicians,professional federations, scientific societies and since 2005 with National cancer institute. Its aims are to develop clinical practice guidelines (CPG), health technologic assessment reports and systematic reviews. By preparing the latter, it provides support to the scientific societies for the update of their CPG. In this context, the SOR, in collaboration with the French Association of Urology (AFU), has developed a systematic review on the management of nonseminomatous (NSTGC) or seminomatous(STGC) testicular germ cell cancer treated with primary radiotherapy (RT), chemotherapy (CT) or surveillance (SV) after radical orchidectomy. Today, 80 % of patients with testicular germ cell cancer, including metastatic stage, can be cured. Actual challenges are to limit morbidity and late sequels of treatments while maintaining their therapeutic efficacy. Following this goal, surveillance, considered as a therapeutic option, is being broadly developed particularly for localised tumours. ⋯ The choice of risk-adapted treatment for patients with locally NSTGC of the testis seems to be appropriate: SV for low risk patients and CT for others. For advanced stage, the suppression of bleomycine remains questionable. For local STGC, the choice of SV or CT versus RT needs to be confirmed by RCT with prolonged follow-up according to promising results in term of toxicity obtained with carboplatine or lower irradiation dose (20 Gy instead of 30 Gy). Finally, for advanced STGC, the utility of carboplatine single agent treatment versus cisplatin-based combination chemotherapy has not been proved.