Des études cliniques récentes confirment l’intérêt de la musicothérapie dans la prise en charge de la douleur, de l’anxiété, de l’humeur et dans l’amélioration de la qualité de vie des patients atteints de cancer. Elle permettrait une réduction des nausées et de la souffrance physique et morale. Évaluer l’intérêt de la musicothérapie sur la douleur et l’anxiété chez des patients atteints de cancer hospitalisés et/ou suivis en service d’oncologie. Étude prospective chez 24 patients atteints de cancer hospitalisés et/ou suivis en service d’oncologie présentant des échelles visuelles analogiques (EVA de 0 à 10) douleur et/ou anxiété supérieures ou égales à 3. Les patients ont bénéficié de séances hebdomadaires de musicothérapie réceptive réalisées par une musicothérapeute selon le protocole adapté de la méthode en U standardisée. Ils ont quantifié leur niveau de douleur et d’anxiété sur deux EVA avant, après et 30 minutes après chaque séance. La musicothérapie réceptive permet des réductions significatives de la douleur (p < 0,001) pendant la séance (−58,3 %) et jusqu’à 30 minutes après (−59,7 %). Une réduction de l’anxiété (p < 0,001) a été observée pendant la séance (−74,3 %) et jusqu’à 30 minutes après (−72,6 %). Les résultats de cette étude de faisabilité démontrent que la musicothérapie réceptive selon le protocole adapté de la méthode en U standardisée contribue à réduire la douleur et l’anxiété chez les patients atteints de cancer hospitalisés et/ou suivis en oncologie. De plus, la musicothérapie s’intègre parfaitement dans une prise en charge pluridisciplinaire et globale. Une étude contrôlée randomisée sera nécessaire afin de valider ces premiers résultats. Recent clinical studies have confirmed the benefits of music therapy in the management of pain, anxiety, mood and improving the quality of life of cancer patients. It would further reduce nausea and physical and psychological suffering. To assess the value of receptive music therapy on pain and anxiety in hospitalized cancer patients and/or followed in oncology. Prospective study in 24 patients hospitalized with cancer and/or followed on an outpatient basis with the Visual Analogic Scale (VAS 0 to 10) pain and/or anxiety greater or equal to 3. Patients received weekly sessions of receptive music therapy according to the protocol adapted from the U-based music therapy method by a trained music therapist. They quantified their level of pain and anxiety on two visual analogue scales before, after and 30 minutes after each session. The receptive music therapy allows significant reductions in pain (P < 0.001) during the session (−58.3%) until 30 minutes after (−59.7%). A reduction in anxiety (P < 0.001) was observed during the session (−74.3%) until 30 minutes after (−72.6%). The results of this feasibility study demonstrate that receptive music therapy according to the protocol adapted from the U-based music therapy method helps to reduce pain and anxiety in hospitalized cancer patients and/or followed in oncology. In addition, music therapy fits perfectly into a multidisciplinary management and overall patient and is well accepted by patients and teams. A randomized controlled study is needed to validate these initial results.

Neuroendocrine carcinoma is a rare and agressive malignant tumor, mainly developing at the expense of the respiratory and of the digestive tract. Among the digestive tract, appendix, small bowel, and pancreas are the preferential sites of involvement, other locations have been more rarely reported. Neuroendocrine digestive tumors may present with various symptoms in relationship with their localization and a complex pathophysiology. Diagnosis is often made at an advanced stage, explaining partly the bad prognosis of these tumors. The optimal management of digestive neuroendocrine tumors is rendered difficult by their rarity and by a low number of randomized trials. We review the literature regarding epidemiologic and prognostic features of these rare tumors, their diagnostic and therapeutic care. Potential complications are also discussed. (C) 2013 Societe nationale francaise de medecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

En imagerie TEP, la quantification des données acquises peut être assurée en utilisant une série de techniques de correction pour minimiser les effets inhérents au processus d’imagerie par émission de positons. Des images quantitatives peuvent ainsi être reconstruites après avoir corrigé les données d’émission détectées de la présence de coïncidences aléatoires et diffusées, des effets d’atténuation, des effets associés aux différentes sensibilités des détecteurs, des effets liés à la géométrie de l’appareil et des effets du temps-mort. Tous ces effets sont bien pris en compte dans les imageurs TEP commercialisés. Néanmoins, d’autres effets viennent entacher d’erreurs les images TEP, comme la résolution spatiale finie engendrant des effets de volume partiel ou encore les mouvements du patient et, notamment, les mouvements respiratoires et cardiaques. Au niveau thoraco-abdominal, les effets du mouvement respiratoire sur les images d’émission tomographiques se caractérisent par une perte de sensibilité dans la détection en raison du flou qui lui est associé. De nombreuses méthodes ont été développées pour corriger ces effets, mais sans réellement encore trouver une légitimité en routine clinique. Ces domaines de recherche sont ainsi toujours très actifs.In PET imaging, quantification of the acquired data can be achieved by using a series of correction techniques to minimize the effects inherent in the imaging process of emission tomography. Quantitative images can be reconstructed after correcting the detected emission data for the presence of random and scattered coincidences, attenuation effects, effects associated with the variable detectors sensitivity, effects related to the geometry of the device and the effects of dead-time. All these effects are well accounted for in the PET imaging market. However, other effects can degrade the quality of the PET images, such as the finite spatial resolution generating partial volume effects, or the patient movements including respiratory and cardiac physiological movements. In the thoracic field, the effects of respiratory motion on PET images are characterized by a loss of detection sensitivity due to the associated blur. Several methods have been developed to correct for these effects, but still without a wide acceptance in clinical routine. These research areas are therefore still very active.

ABSTRACT Background Folate antimetabolite pemetrexed was approved for treatment of patients with metastatic non small-cell lung carcinoma (NSCLC). Its activity on brain metastases makes it attractive in combination with whole brain radiation therapy (WBRT), but this regimen could also potentially increase toxicity. Patients and treatment We retrospectively assessed the use of pemetrexed concurrently with WBRT in 12 consecutive patients with brain metastases from NSCLC. Patients received pemetrexed 500 mg/m2, either alone (n = 4) or combined with cisplatin 75mg/m2 (n = 6) or carboplatin AUC5 (n = 2). Median total number of pemetrexed-based chemotherapy cycles was 3.5 (range: 1–8). In the course of chemotherapy, patients received WBRT delivering 30 Gy in 10 fractions (n = 8) or 20 Gy in 5 fractions (n = 4). Results Six patients improved neurologically with treatment (five complete and one partial responses). Four patients had their neurological symptoms stable. Best radiological response was complete response lasting until last follow-up in one patient. Five patients experienced partial response. One patient had stable disease. Progressions were identified in four patients, within a median time interval of 17 weeks (range: 6–58 weeks). Three patients were not analyzable for tumor response because of rapid systemic progression leading to death. Two of them had improved neurologically. No high-grade WBRT-toxicity was reported but one patient developed symptoms suggestive of a limbic encephalopathy five weeks after WBRT completion. Conclusion The combination of pemetrexed with WBRT was associated with a substantial improvement of neurological deficits and tumor responses in most patients. However, survival remained disappointing and there were concerns about toxicity in one patient. A clinical trial is required for better analyzing the potential synergistic effects of drug with radiation and evaluating neurological toxicity. Disclosure All authors have declared no conflicts of interest.

ABSTRACT Background Approximately 20% of breast cancer diagnoses are made in women younger than 45 years of age. Anticancer treatments are associated with serious problems in the sexual functioning of breast cancer patients. We assessed the sexual functioning of breast cancer patients treated with mastectomy. Patients and methods We performed a prospective study in 110 women who had been treated with mastectomy for a breast cancer using a self-administered questionnaire on how the mastectomy had changed their sexual life since the primary diagnosis of breast cancer. Results All patients expressed not having received sufficient information about how the disease and treatment including surgery might affect their sexual life. Sixty eight percent reported being still sexually active, but 62% revealed that the cancer treatment had affected their sexual desire or possibility to reach orgasm; 25% observed that their partner was afraid of sexual intercourse and 18% felt an emotional separation in the couple during the course of the disease. Conclusion Problems related to body image and sexuality were identified in all women post mastectomy. It is time to better take into account quality of life, and more particularly the sexual function in breast cancer survivors. Disclosure All authors have declared no conflicts of interest.

ABSTRACT Introduction Germ-cell tumors (GCTs) are highly curable with cisplatin-based chemotherapy. The BEP chemotherapy (Indianapolis) has become a standard in the management of GCT. The aim of this study was to evaluate the long-term side effects of a modified BEP regimen, with of bleomycin as a continuous infusion. Patients and methods The military hospital of Val de Grâce has developed a modified BEP regimen with the aim of reducing bleomycin-induced toxicity in patients with GCTs: bleomycin 15mg/d (d1-5) as an IV continuous injection, etoposide 100mg/m2 (d1-5) and cisplatin 20mg/m2 (d1-5), repeated every 3 weeks. Survivors were asked in 2011 to participate to this study on late toxicity, including assessment of laboratory tests, pulmonary function tests (PFT) and a semen analysis. Results Between March 1998 and January 2009, 68 patients with GCTs received first line chemotherapy with this modified BEP. Distribution of patients' was as following: Good prognosis (GP): 42, Intermediate and Poor-prognosis (IPP): 20, stage I with High risk factors (HP): 6. The median follow-up was 75 months. The 2-years overall survival was 90%. The relapse rate was 13%. The main immediate adverse events reported grade III-IV were neutropenia (25%), anemia (1%), thombopenia (1%), digestive (6%), infection (4%), decreased DLCO (4%) and tromboembolic events (3%). Thirty four patients were assessable for the late toxicity of this regimen (18 patients in GP, 14 patients in IPP and 2 patients in HP).The 5-years overall survival was 82%. The analysis of late side effects revealed one patient developed a haematologic malignancy (myelodysplasia).Abnormal PFT was observed in 4 patients, and only 1 patient was clinically symptomatic. In post-treatment analysis, we evaluated the fertility of 30 patients. The fertility was preserved in 22 patients (73%). Twenty patients have realized a semen analysis after the chemotherapy, and azoospermia was observed in only 3 pts (15%). Among 10 patients remaining, 5 patients had children after the treatment. Conclusion Using bleomycin as a continuous infusion is feasible and seems to produce similar results in terms of response rates and overall survival compared to the classic BEP chemotherapy regimen, with a total dose less important than standard. These results will be compared with those of conventional BEP Disclosure All authors have declared no conflicts of interest.

Le diagnostic précoce de cancer du testicule permet d’offrir au patient toutes ses chances de guérison et de le rendre éligible à une stratégie de désescalade thérapeutique afin de ne pas hypothéquer inutilement son avenir. L’objectif est donc double : réduire la mortalité spécifique et la morbidité des traitements. Dans les armées, les médecins des services médicaux d’unité sont en première ligne pour établir ce diagnostic précoce. Leur action doit reposer essentiellement sur l’information médicale concernant, notamment, les facteurs de risque et les signes d’appel du cancer du testicule, conduisant le cas échéant à proposer une palpation testiculaire. La visite systématique annuelle est de fait un cadre propice à cet échange, comme nous l’avons démontré dans cette première étude épidémiologique interventionnelle dont nous présentons ici les conclusions principales et les recommandations qui en découlent

Les carcinomes des sinus maxillaires constituent des tumeurs rares de la face, caractérisées par un taux élevé de récidive locale. Leur prise en charge n’est pas consensuelle et les rôles respectifs de la radiothérapie et de la chirurgie ont souvent été débattus. Compte tenu d’un diagnostic souvent tardif alors qu’elles sont localement évoluées, la radiothérapie est fréquemment proposée de première intention chez des patients inopérables d’emblée. Cependant, la chirurgie s’inscrit en traitement princeps des tumeurs plus localisées, associée à une radiothérapie adjuvante systématique, optimisée par une meilleure définition des volumes cibles. Il reste à mieux évaluer le bénéfice à attendre d’une radiothérapie de première intention en cas de tumeur inopérable, à définir la place du traitement des aires ganglionnaires, ainsi que celle de la chimiothérapie d’induction ou concomitante dans une prise en charge de plus en plus souvent conjuguée de ces tumeurs de pronostic défavorable.

Maxillary sinus carcinomas are rare malignancies of the face, characterized by high local relapsing rate. Modalities of treatment are without consensus and respective roles of radiation therapy and surgery remain controversial. As those malignancies are often diagnosed at locally advanced stage, radiation therapy may frequently be used for patients having unresectable advanced disease. Nevertheless, surgery remains treatment of choice for more localized malignancies, in association with systematic postoperative radiotherapy. For those patients whose prognosis remains pejorative, it is necessary to precise the role of radiotherapy in first intention for inoperable tumors, to define necessity for nodal treatment performing and evaluate the place of neoadjuvant or concomitant chemotherapy in a multimodal strategy. (C) 2008 Elsevier Masson SAS. All rights reserved.

The authors report a case of stage N3 pure testicular seminoma associated with paradoxical elevation of alphafoetoprotein (AFP). Despite the absence of histological arguments after review of the slides, this lesion was considered to be a stage pT1 N3 M0 S3 non seminomatous germ cell tumour with a poor prognosis. Simple surveillance was proposed following normalization of tumour markers, regression of retroperitoneal masses and negative PET scan. Laboratory and then clinical relapse at three months was treated by salvage chemotherapy followed by retroperitoneal lymph node dissection. The presence of embryonic carcinoma in one of the residual masses led to a revision of the initial histological diagnosis. The rare data of the literature indicate a variable approach according to alphafoetoprotein levels.

La survenue d’une coagulation intravasculaire disséminée est une complication rare au cours de l’évolution des cancers de prostate. Survenant dans la majorité des cas lors de la phase d’hormonorésistance, elle est le plus souvent infraclinique. La découverte d’une coagulation intravasculaire disséminée inaugurale d’un cancer de prostate peut engager le pronostic vital à court terme, en raison des risques de complications hémorragiques et thromboemboliques associés, imposant une prise en charge urgente. À travers une revue de la littérature, nous insisterons sur les données épidémiologiques, la physiopathologie et les différents moyens thérapeutiques disponibles pouvant contribuer à obtenir dans certains cas une rémission prolongée, malgré un pronostic initial péjoratif.

Recurrent meningiomas constitute an uncommon but significant problem after standard therapy failure. Speculation that meningiomas may be subject to endocrine influence was supported by both immunohistochemical analyses and epidemiological data. Therefore, alternative strategies such as endocrine therapy have been suggested. Although evidence of consistent findings for the role of specific hormonal exposures is mounting, there are numerous discrepancies about the mitogenic effect of hormonal manipulation on meningioma cells. A better understanding of the molecular mechanisms involved in meningioma pathogenesis may not only lead to the identification of novel diagnostic and prognostic markers but may also facilitate the development of new pathogenesis-based targeted strategies. This review of literature aims to summarize the present state of the art of endocrine therapy in the management of meningiomas, in order to establish whether hormonotherapy could be included in the therapeutic strategy for unresectable and/or progressive tumours in previously irradiated meningioma patients.

The authors report a case of stage N3 pure testicular seminoma associated with paradoxical elevation of alphafoetoprotein (AFP). Despite the absence of histological arguments after review of the slides, this lesion was considered to be a stage pT1 N3 M0 S3 non seminomatous germ cell tumour with a poor prognosis. Simple surveillance was proposed following normalization of tumour markers, regression of retroperitoneal masses and negative PET scan. Laboratory and then clinical relapse at three months was treated by salvage chemotherapy followed by retroperitoneal lymph node dissection. The presence of embryonic carcinoma in one of the residual masses led to a revision of the initial histological diagnosis. The rare data of the literature indicate a variable approach according to alphafoetoprotein levels. (C) 2008 Elsevier Masson SAS. Tous droits reserves

Disseminated intravascular coagulation is a rare complication of prostatic cancer evolution. Occurring on hormonorefractory phase, it remains most often infraclinic. Cases of acute, severe intravascular disseminated coagulation at first presentation are life-threatening because of hemorragic and thrombotic complications, justifying emergency medical treatment. In the light of a review of literature, we insist on epidemiological features, physiopathology and therapeutics of intravascular disseminated coagulation. In spite of a pejorative prognosis, this could help to achieve a period of remission.