Bulletin du cancer
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The management of gliomas in daily clinical practice is challenging. It requires a multidisciplinary and coordinated approach involving neurosurgery, radiotherapy and, finally, chemotherapy. Important progress has been made during the last years with the introduction of a combined treatment associating standard radiotherapy with concomitant chemotherapy using temozolomide, a novel alkylating agent. ⋯ In this "Practical Guide", we describe the daily practice and aim at answering some common questions in the management of patients suffering from glioblastoma, astrocytoma, oligodendroglioma and low grade glioma. The therapeutic options presented here are based on evidences from the literature. In the absence of documented evidence, the empirical choices from our local practice are explained and justified.
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Compared to conventional radiotherapy, proton beam therapy provides a superior distribution of radiation dose due to the physical characteristics of protons. Protons administer a uniform dose across the target and then virtually zero deep to the target and lower dose proximal to the target (for non-superficial lesions). The result is a smaller treatment volume, and therefore a lower incidence and frequency of treatment-related morbidity. ⋯ This means an improved local control probability and lower normal tissue complication probability. Evidence-based medicine has demonstrated that clinical gains have been realized in the treatment of patient with uveal melanoma, skull-base or spinal sarcoma and prostate cancer. In the future, more extensive prospective studies are required to assess more completely the potential clinical benefit of proton beam therapy in many anatomical sites in children and adults.
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Due to its life threatening character, a cancer diagnosis represents an existential rupture, disturbing an individual's life trajectory perceived beforehand as a continuum. As a consequence, a patient's physical, psychological, social and spiritual equilibrium may be disturbed, calling for a support by clinicians, which surpasses biomedical treatment. ⋯ This article summarizes main aspects of patient-physician communication and our experience as teachers of the so-called Communication Skills Training. It provides a review on research in progress in this field and finally indicates other elements of support, which contribute to the < narrative reconstruction > of the patient facing the rupture induced by cancer.
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In the past decades, prognosis of head and neck squamous cell carcinoma (HNSCC) has not improved even though treatment has made substantial progress. Since the description of immune response against some cancers, antitumoral immunotherapy has been studied to be used as adjunctive treatment in various cancer types. ⋯ Among various TAAs, cancer testis antigens family may be promising candidates for specific immune therapy in HNSCC. Ongoing studies will confirm whether expression CTAs generate an immune response in clinical vaccine trials.
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Trastuzumab (Herceptin), a recombinant, humanised, monoclonal-antibody that targets human epidermal growth factor receptor 2 (HER2), has been approved as an adjuvant therapy for HER2-positive early breast cancer. The aim of this study was to assess the incremental cost-effectiveness ratio of this treatment compared with adjuvant therapy alone in the French setting. A cost-effectiveness analysis was performed using a Markov state transition model. ⋯ For 1 000 patients with a 10-year follow-up, an adjuvant therapy with trastuzumab would avoid 49.7 loco-regional recurrences, 179.5 distant recurrences and 133.4 deaths. The incremental discounted cost of trastuzumab therapy over a lifetime horizon was estimated at 27594 euro per patient in association with a discounted gain of 2.27 life-years. In accordance with the techniques of economical evaluation, the utilization of trastuzumab as an adjuvant therapy in patients with early HER2 positive breast cancer improves patient survival with an acceptable cost-effectiveness ratio in the French setting (incremental cost-effectiveness ratio of 12,148 euros /LYG).