Bulletin du cancer
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Magnetic resonance spectroscopy (MRS), that may be added to conventional magnetic resonance imaging (MRI) exam exhibit an increasing role in the management of brain tumors. These technique allow quantitative analysis of metabolites, either cell specific, either reflecting physiological and/or pathological process. ⋯ Positive diagnosis of brain tumor, differential diagnosis between infiltrative glioma (grade II) and gliomatosis, determination of the limits of tumor infiltration, and distinction between tumor and post-therapeutic images are some of the potential applications of MRS. Ongoing and future studies may also precise the place of MRS in the differential diagnosis between high grade glioma, metastasis and CNS lymphoma, as well as in monitoring therapy in glioma.
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Glioblastoma multiforme still remains, at present, the most frequent and deadly primary malignant glioma in adult. Despite safer and larger neurosurgical resections, patients almost always relapse very close or inside the tumor bed. Since more than 20 years, radiation therapy (RT) continue delivering the same dose of 60 Gy in 6 weeks, more precisely guided with CT-scanner and magnetic resonance imaging (MRI) in the treatment position. ⋯ It is therefore highly possible that, using it complementary to conventional CT and MRI for RT treatment planning, they add some precious informations; consequently, the very limited efficacy/toxicity ratio could be increased. This hypothesis will only be confirmed by prospective studies registering in parallel both functional and morphological abnormalities, linking them with sites of local recurrence. Once "targeted" the real microscopically invaded areas, one can speculate on new escalating dose studies, delivering RT in "adequate" volumes, combining it with new "targeted" drugs, as already recently demonstrated in head and neck cancers.
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Peritoneal carcinomatosis represent an advanced form of colorectal cancer but different of others metastatic pathways. However carcinomatosis was associated with stage M in the TNM classification, because of a very poor prognosis, actually resulting despite new chemotherapeutic agents of a single year of survival. In an estimated 30% of patients, no other tumour location can be found. ⋯ This study had include 24 patients with an overall survival of 65% at 3 years. These survival result was the most prolonged never reported in the treatment of peritoneal colorectal carcinomatosis. HIPEC can be considered as a new standard even the exact place in clinical practice had to be more define because of alls recent progress are publish giving an important number of publications during the 2003-2004 years, some of them coming from French groups.
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Estrogen is the main hormone involved in the development and growth of hormone-dependent breast cancer. Endocrine adjuvant treatment in recent years focused primarily on the use of SERMs, mainly tamoxifen. Tamoxifen actions are complex. ⋯ Recently, the results of clinical trials comparing aromatase inhibitors to tamoxifen in post menopausal women with hormone-dependent breast cancer showed a benefit in favor of aromatase inhibitors in reducing the risk of recurrence. These trials were either comparative (for anastrozole) or sequential (for anastrozole, letrozole and exemestane). The issues of long term adverse effects (bone) and hormone treatment sequence remain to be addressed.