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Melanoma: HELP
Articles by Juliette Thariat
Based on 20 articles published since 2008
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Between 2008 and 2019, J. Thariat wrote the following 20 articles about Melanoma.
 
+ Citations + Abstracts
1 Guideline [Locoregional treatments of brain metastases for patients with metastatic cutaneous melanoma: French national guidelines]. 2014

Lubrano, V / Derrey, S / Truc, G / Mirabel, X / Thariat, J / Cupissol, D / Sassolas, B / Combemale, P / Modiano, P / Bedane, C / Dygai-Cochet, I / Lamant, L / Mourrégot, A / Rougé Bugat, M-È / Siegrist, S / Tiffet, O / Mazeau-Woynar, V / Verdoni, L / Planchamp, F / Leccia, M-T / Anonymous610807. ·Service de neurochirurgie, hôpital de Rangueil, CHU de Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse, France. · Département de neurochirurgie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France. · Département de radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, BP 77980, 21079 Dijon, France. · Département de radiothérapie-curiethérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, BP 307, 59020 Lille, France. · Pôle de radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France. · Service d'oncologie médicale, ICM, institut du cancer de Montpellier Val-d'Aurelle, 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier, France. · Service de dermatologie, hôpital Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France. · Unité onco-dermatologie, centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France. · Service de dermatologie, hôpital Saint-Vincent-de-Paul, boulevard de Belfort, BP 387, 59020 Lille, France. · Service de dermatologie, hôpital Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France. · Service de médecine nucléaire, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, BP 77980, 21079 Dijon, France. · Service d'anatomie pathologique, hôpital Purpan, place Baylac, 31059 Toulouse, France. · Service de chirurgie oncologique, ICM, institut du cancer de Montpellier Val-d'Aurelle, 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier, France. · Cabinet médical, 59, rue de la Providence, 31500 Toulouse, France. · Cabinet médical, 3, rue Saint-Sigisbert, 57050 le Ban-Saint-Martin, France. · Service de chirurgie générale et thoracique, centre hospitalier universitaire, 42055 Saint-Étienne, France. · Direction des recommandations et de la qualité de l'expertise, Institut national du cancer, 52, avenue André-Morizet, 92513 Boulogne-Billancourt, France. · Direction des recommandations et de la qualité de l'expertise, Institut national du cancer, 52, avenue André-Morizet, 92513 Boulogne-Billancourt, France. Electronic address: recommandations@institutcancer.fr. · Clinique de dermatolo-vénéréologie, photobiologie et allergologie, pôle pluridisciplinaire de médecine, hôpital Michallon, 38043 Grenoble, France. ·Neurochirurgie · Pubmed #25241016.

ABSTRACT: INTRODUCTION: The management of metastatic cutaneous melanoma is changing, marked by innovative therapies. However, their respective use and place in the therapeutic strategy continue to be debated by healthcare professionals. OBJECTIVE: The French national cancer institute has led a national clinical practice guideline project since 2008. It has carried out a review of these modalities of treatment and established recommendations. METHODS: The clinical practice guidelines development process is based on systematic literature review and critical appraisal by experts. The recommendations are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines are reviewed by independent practitioners in cancer care delivery. RESULTS: This article presents the results of bibliographic search, the conclusions of the literature and the recommendations concerning locoregional treatments of brain metastases for patients with metastatic cutaneous melanoma.

2 Guideline [Management of patients with metastatic cutaneous melanoma: French national guidelines. French National Cancer Institute]. 2014

Leccia, M-T / Planchamp, F / Sassolas, B / Combemale, P / Modiano, P / Bedane, C / Cupissol, D / Derrey, S / Dygai-Cochet, I / Lamant, L / Lubrano, V / Mirabel, X / Mourrégot, A / Rougé Bugat, M-E / Siegrist, S / Thariat, J / Tiffet, O / Truc, G / Verdoni, L / Mazeau-Woynar, V. ·Pôle pluridisciplinaire de médecine, clinique de dermatolo-vénéréologie, photobiologie et allergologie, hôpital Michallon, 38043 Grenoble, France. · Direction des recommandations et de la qualité de l'expertise, Institut national du cancer, 52, avenue André-Morizet, 92513 Boulogne-Billancourt, France. Electronic address: recommandations@institutcancer.fr. · Service de dermatologie, hôpital Cavale Blanche, boulevard Tanguy-Prigent, 29609 Brest, France. · Unité onco-dermatologie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France. · Service de dermatologie, hôpital Saint-Vincent-de-Paul, boulevard de Belfort, BP 387, 59020 Lille, France. · Service de dermatologie, hôpital Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France. · Service d'oncologie médicale, ICM, institut du cancer de Montpellier Val-d'Aurelle, parc Euromédecine, 208, avenue des Apothicaires, 34298 Montpellier, France. · Département de neurochirurgie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France. · Service de médecine nucléaire, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, BP 77980, 21079 Dijon, France. · Service d'anatomie pathologique, hôpital Purpan, place Baylac, 31059 Toulouse, France. · Service de neurochirurgie, hôpital de Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse, France. · Département de radiothérapie-curiethérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, BP 307, 59020 Lille, France. · Service de chirurgie oncologique, ICM, institut du cancer de Montpellier Val-d'Aurelle, parc Euromédecine, 208, avenue des Apothicaires, 34298 Montpellier, France. · Cabinet médical, 59, rue de la Providence, 31500 Toulouse, France. · Cabinet médical, 3, rue Saint-Sigisbert, 57050 Le Ban-Saint-Martin, France. · Pôle de radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France. · Service de chirurgie générale et thoracique, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne, France. · Département de radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, BP 77980, 21079 Dijon, France. · Direction des recommandations et de la qualité de l'expertise, Institut national du cancer, 52, avenue André-Morizet, 92513 Boulogne-Billancourt, France. ·Ann Dermatol Venereol · Pubmed #24507205.

ABSTRACT: BACKGROUND: Recent years have seen the emergence of new molecules for the treatment of patients with metastatic cutaneous melanoma, with significant benefits in terms of survival and the opening of new therapeutic perspectives. In addition, many techniques are currently being developed for locoregional treatment of metastatic sites. Management of metastatic melanoma is thus fast-changing and is marked by innovative therapeutic approaches. However, the availability of these new treatments has prompted debate among healthcare professionals concerning their use and their place in therapeutic strategy. AIMS: Since 2008, the French National Cancer Institute (INCa) has been leading a project to define and diffuse national clinical practice guidelines. It has performed a review of these treatment methods, which it aims to circulate, and it is seeking to develop recommendations in order to allow nationwide implementation of innovative approaches while promoting good use thereof. METHODS: The clinical practice guidelines development process is based on systematic literature review and critical appraisal by experts within a multidisciplinary working group, with feedback from specialists in cancer care delivery. The recommendations are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines are reviewed by independent practitioners in cancer care delivery. RESULTS: This article presents the national recommendations for first- and second-line systemic treatment and for locoregional treatment of metastatic sites in patients presenting metastatic cutaneous melanoma.

3 Guideline [Loco-regional treatments of the metastatic sites for patients with pauci-metastatic cutaneous melanoma (without brain metastasis): French national guidelines]. 2014

Sassolas, Bruno / Mourrégot, Anne / Thariat, Juliette / Tiffet, Olivier / Dygai-Cochet, Inna / Mirabel, Xavier / Truc, Gilles / Cupissol, Didier / Modiano, Philippe / Combemale, Patrick / Bedane, Christophe / Derrey, Stéphane / Lamant, Laurence / Lubrano, Vincent / Siegrist, Sophie / Rougé-Bugat, Marie-Ève / Mazeau-Woynar, Valérie / Verdoni, Laëtitia / Planchamp, François / Leccia, Marie-Thérèse. ·Hôpital Cavale Blanche, boulevard Tanguy-Prigent, 29609 Brest, France. · Institut du Cancer de Montpellier Val-d'Aurelle, parc Euromédecine, 208, avenue des Apothicaires, 34298 Montpellier, France. · Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France. · Centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne, France. · Centre Georges-François-Leclerc, 1, rue du Professeur-Marion, BP 77980, 21079 Dijon, France. · Centre Oscar-Lambret, 3, rue Frédéric-Combemale, BP 307, 59020 Lille, France. · Hôpital Saint-Vincent-de-Paul, boulevard de Belfort, BP 387, 59020 Lille, France. · Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France. · Hôpital Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoge, France. · Hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France. · Hôpital Purpan, place Baylac, 31059 Toulouse, France. · Hôpital de Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse, France. · Cabinet médical, 3, rue Saint-Sigisbert, 57050Le Ban-Saint-Martin, France. · Cabinet médical, 59, rue de la Providence, 31500 Toulouse, France. · Institut national du cancer, 52, avenue André-Morizet, 92513 Boulogne-Billancourt, France. · Hôpital Michallon, 38043 Grenoble, France. ·Bull Cancer · Pubmed #24369290.

ABSTRACT: INTRODUCTION: The last years are marked by the emergence of new molecules for the treatment of metastatic cutaneous melanoma with a significant benefit on the survival. Besides, some techniques are in development for the loco-regional treatment of the metastatic sites, bringing new therapeutic perspectives. However, their respective use and place in the therapeutic strategy are debated by healthcare professionals. OBJECTIVE: The French National Cancer Institute leads a national clinical practice guidelines project since 2008. It realized a review of these modalities of treatment and developed recommendations. METHODS: The clinical practice guidelines development process is based on systematic literature review and critical appraisal by a multidisciplinary expert workgroup. The recommendations are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines are reviewed by independent practitioners in cancer care delivery. RESULTS: This article presents recommendations for loco-regional treatments of the pulmonary, bone, cutaneous, hepatic and digestive metastatic sites for patients with pauci-metastatic cutaneous melanoma.

4 Review [Management of uveal melanomas, guidelines for oncologists]. 2018

Mathis, Thibaud / Cassoux, Nathalie / Tardy, Magali / Piperno, Sophie / Gastaud, Lauris / Dendale, Rémi / Maschi, Celia / Nguyen, Anh-Minh / Meyer, Laurent / Bonnin, Nicolas / Baillif, Stephanie / Tick, Sarah / Mouriaux, Fréderic / Jaspart, Franck / Dellis, Josette / Rosier, Laurence / Desjardins, Laurence / Herault, Joel / Caujolle, Jean Pierre / Thariat, Juliette. ·Hôpital de la Croix-Rousse, 103 grande rue de la Croix-Rousse, 69004 Lyon, France. · Institut Curie, 26, rue de l'ulm, 75248 Paris cedex 05, France. · Hôpital Pasteur, 30, voie romaine, 06000 Nice, France. · Hôpitaux civils de Colmar, 39, avenue de la liberté, 68024 Colmar, France. · Centre d'ophtalmologie du Zénith, 63800 Cournon D'auvergne, France. · CHNO des XV-XX, 28, rue de Charenton, 75012 Paris, France. · Centre hospitalier universitaire Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes, France. · Polyclinique du Parc, route d'Assevent, 59600 Maubeuge, France. · Association nationale des patients atteints du cancer de l'œil, ANPACO, 5, rue de Fontfrède, 15230 Pierrefort, France. · Centre Retine Gallien, 68, rue du palais-Gallien, 33000 Bordeaux, France. · Centre Lacassagne, 227, avenue Valombrose, 06200 Nice, France. · Centre François Baclesse, ARCHADE, service de radiothérapie, 3, avenue du général-Harris, 14000 Caen, France. Electronic address: jthariat@gmail.com. ·Bull Cancer · Pubmed #30217336.

ABSTRACT: Uveal melanomas are the most frequent primary malignant eye tumor. Enucleation was historically the gold standard. Since then, several studies showed that conservative treatments did not increase the risk of metastasis or survival. Choroidal melanomas are both radioresistant and located close to visual structures (the optic nerve and macula) of the eye, which may be preserved in some settings without compromising tumor control, as this is the first priority. Different types of radiation therapy may be used for such tumors: brachytherapy and charged particles, including proton beam therapy. If visual prognosis is dependent to the local treatment, the vital prognosis is dependent on the metastatic risk, with a risk of liver involvement in 20 to 50% of patients, depending on tumor size and genomics. Median survival after the discovery of liver metastases is about 15 months. The management of these patients is often complex. Systemic therapies (chemotherapy, targeted therapies, immunotherapy, etc.) yield limited response rates and although local treatments of liver metastases are promising, they are only feasible in selected patients. The mission of the MELACHONAT national network is to improve the management of patients regardless of the stage of the disease. The patient association ANPACO is dedicated to help uveal melanoma patients in their health care path and to promote knowledge dissemination within the patient community. The aim of this review is to focus on the local treatments of uveal melanomas as well as the management of their metastatic evolution.

5 Review [Focus on clinical and pathological management of conjunctival melanocytic tumors]. 2018

Lassalle, Sandra / Caujolle, Jean-Pierre / Leger, François / Maschi, Célia / Gastaud, Lauris / Nahon-Esteve, Sacha / Thariat, Juliette / Baillif, Stéphanie / Hofman, Paul. ·Laboratoire de pathologie clinique et expérimentale, pavillon J, hôpital Pasteur, CHU de Nice, 30, voie Romaine, CS 51069, 06001 Nice cedex 1, France; Institute of research on cancer and aging de Nice (IRCAN), Inserm U1081/CNRS UMR7284, UFR de médecine, 28, avenue Valombrose, 06107 Nice cedex 2, France; FHU OncoAge Nice, 30, avenue de la voie Romaine, CS 51069, 06001 Nice cedex 1, France. Electronic address: lassalle.s@chu-nice.fr. · Service d'ophtalmologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, CS 51069, 06001 Nice cedex 1, France. · Service de pathologie, hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France. · Département d'oncologie médicale, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice, France. · Département de radiothérapie, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice, France. · Laboratoire de pathologie clinique et expérimentale, pavillon J, hôpital Pasteur, CHU de Nice, 30, voie Romaine, CS 51069, 06001 Nice cedex 1, France; Institute of research on cancer and aging de Nice (IRCAN), Inserm U1081/CNRS UMR7284, UFR de médecine, 28, avenue Valombrose, 06107 Nice cedex 2, France; FHU OncoAge Nice, 30, avenue de la voie Romaine, CS 51069, 06001 Nice cedex 1, France. ·Ann Pathol · Pubmed #29803361.

ABSTRACT: Conjunctival-pigmented tumors are rare, but they are one of the most commonly encountered by the pathologist working with the department of ophthalmology. Nevus and melanoma can be encountered and have some histological difference compared to their cutaneous counterpart. Primary acquired melanosis (PAM) is a conjunctival specific entity. This clinical term includes several histological lesions ranging from benignity to melanoma precursor lesion. Histologic examination determines the therapy and the risk of progression to melanoma. We present here a histopathological, clinical and therapeutic synthesis of conjunctival-pigmented lesions, emphasizing the importance of a good understanding between clinicians and pathologists.

6 Review [Operative therapy and irradiation of conjunctival melanoma]. 2015

Westekemper, H / Meller, D / Darawsha, R / Scholz, S L / Flühs, D / Steuhl, K-P / Hérault, J / Thariat, J / Sauerwein, W. ·Klinik für Erkrankungen des vorderen Augenabschnitts, Zentrum für Augenheilkunde, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland. henrike.westekemper@uk-essen.de. · Klinik für Erkrankungen des vorderen Augenabschnitts, Zentrum für Augenheilkunde, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland. · Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland. · Cyclotron Biomédical, Centre Antoine-Lacassagne, Nice, France. ·Ophthalmologe · Pubmed #26475337.

ABSTRACT: BACKGROUND: Radiotherapy of conjunctival melanoma has gained in importance in recent years compared to less invasive therapeutic approaches. This is due to the high recurrence rates achieved by omitting adjuvant therapy and to the increasing availability of suitable radiotherapeutic methods, so that tumors formerly not amenable to organ-preserving therapy can now be treated. OBJECTIVE: This article presents the current radiotherapeutic options for conjunctival melanoma. The aim is to describe the diagnostic and therapeutic strategies and the course of therapy of malignant conjunctival melanoma. It is the authors' intention to justify the necessity of the adjuvant therapy of conjunctival melanoma and to emphasize the need for interdisciplinary cooperation during the course of tumor therapy. METHODS: The article is based on results published in the literature as well as on data collected and experience gained in our centre.

7 Article Radiosurgery or hypofractionated stereotactic radiotherapy for brain metastases from radioresistant primaries (melanoma and renal cancer). 2018

Lesueur, Paul / Lequesne, Justine / Barraux, Victor / Kao, William / Geffrelot, Julien / Grellard, Jean-Michel / Habrand, Jean-Louis / Emery, Evelyne / Marie, Brigitte / Thariat, Juliette / Stefan, Dinu. ·Radiotherapy department, Centre François Baclesse, Caen, France. Paul.LESUEUR89@gmail.com. · Laboratoire d'accueil et de recherche avec les ions accélérés, CEA-CIMAP, Caen, France. Paul.LESUEUR89@gmail.com. · Medical university of Caen, Caen, France. Paul.LESUEUR89@gmail.com. · Clinical research department, Centre François Baclesse, Caen, France. · Medical physics department, Centre François Baclesse, Caen, France. · Radiotherapy department, Centre François Baclesse, Caen, France. · Medical university of Caen, Caen, France. · Neurosurgery department, CHU Côte de Nacre, Caen, France. · Imaging department, Centre François Baclesse, Caen, France. ·Radiat Oncol · Pubmed #30055640.

ABSTRACT: BACKGROUND: Until 50% of patients with renal cancer or melanoma, develop brain metastases during the course of their disease. Stereotactic radiotherapy has become a standard of care for patients with a limited number of brain metastases. Given the radioresistant nature of melanoma and renal cancer, optimization of the fractionation of stereotactic radiotherapy is needed. The purpose of this retrospective study was to elucidate if hypofractionated stereotactic radiotherapy (HFSRT) impacts local control of brain metastases from radioresistant tumors such as melanoma and renal cancer, in comparison with radiosurgery (SRS). METHODS: Between 2012 and 2016, 193 metastases, smaller than 3 cm, from patients suffering from radioresistant primaries (melanoma and renal cancer) were treated with HFSRT or SRS. The primary outcome was local progression free survival (LPFS) at 6, 12 and 18 months. Overall survival (OS) and cerebral progression free survival (CPFS) were secondary outcomes, and were evaluated per patient. Objective response rate and radionecrosis incidence were also reported. The statistical analysis included a supplementary propensity score analysis to deal with bias induced by non-randomized data. RESULTS: After a median follow-up of 7.4 months, LPFS rates at 6, 12 and 18 months for the whole population were 83, 74 and 70%, respectively. With respect to fractionation, LPFS rates at 6, 12 and 18 months were 89, 79 and 73% for the SRS group and 80, 72 and 68% for the HFSRT group. The fractionation schedule was not statistically associated with LPFS (HR = 1.39, CI95% [0.65-2.96], p = 0.38). Time from planning MRI to first irradiation session longer than 14 days was associated with a poorer local control rate. Over this time, LPFS at 12 months was reduced from 86 to 70% (p = 0.009). Radionecrosis occurred in 7.1% for HFSRT treated metastases to 9.6% to SRS treated metastases, without any difference according to fractionation (p = 0.55). The median OS was 9.6 months. Six, 12 and 18 months CPFS rates were 54, 24 and 17%, respectively. CONCLUSION: Fractionation does not decrease LPFS. Even for small radioresistant brain metastases (< 3 cm), HFSRT, with 3 or 6 fractions, leads to an excellent local control rate of 72% at 1 year with a rate of 7.1% of radionecrosis. HFSRT is a safe and efficient alternative treatment to SRS.

8 Article Cataract Avoidance With Proton Therapy in Ocular Melanomas. 2017

Thariat, Juliette / Jacob, Sophie / Caujolle, Jean-Pierre / Maschi, Celia / Baillif, Stéphanie / Angellier, Gaelle / Mathis, Thibaud / Rosier, Laurence / Carnicer, Adela / Hérault, Joel / Salleron, Julia. ·Institution, Department of Radiation Oncology-Proton Therapy, Nice, France. · Centre Francois Baclesse, Department of Radiation Oncology, Normandie Universite - Unicaen, Caen, France. · Laboratory of Epidemiology, Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-HOM, SRBE, LEPID, Fontenay-aux-Roses, France. · Department of Ophthalmology, University Hospital Pasteur 2, Nice, France. · Department of Ophthalmology, Eye University Clinic la Croix Rousse, Lyon, France. · Eye Clinic, Centre d'Exploration et de Traitement de la Retine et de la Macula, Bordeaux, France. · Department of Biostatistics, Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France. ·Invest Ophthalmol Vis Sci · Pubmed #29049739.

ABSTRACT: Purpose: The lens is a radiosensitive organ. Any dose of cephalic irradiation can give rise to radiation-induced cataracts. Contrary to other forms of radiotherapy, proton therapy (PT) can spare all or part of the lens due to accurate dose deposition. We investigated whether a lens-sparing approach was relevant to avoid cataracts in uveal melanoma patients. Methods: Patients were referred for PT from onco-ophthalmologists of private and academic institutions. Patients without preexisting cataracts or implants were entered in a prospective database. Dose thresholds responsible for cataracts were investigated in volumes of lens or lens periphery. Lens opacifications and de novo vision-impairing cataracts (VICs) had biannual follow up by ophthalmologists blinded to lens dose. Correlations between dose-volume relationships and VICs were assessed using univariate/multivariate regressions. Results: Between 1991 and 2015, 1696 uveal melanoma patients were consecutively treated with PT. After a median follow up of 48 months, 14.4% and 8.7% of patients had cataracts and VIC within median times of 19 and 28 months, respectively. Median values of mean lens and lens periphery doses were 1.1 (radiobiologically effective [RBE] dose in photon-equivalent grays [GyRBE]) and 6.5 GyRBE, respectively. The lens received no dose in 25% of the patients. At an irradiated lens volume of ≤5%, there was no significantly increased risk for VIC below a dose of 10 GyRBE. Conclusions: A lens-sparing approach is feasible and results not only in reduced need for cataract surgery but also in better fundus-based tumor control. Reassessment of radioprotection rules for lens dose thresholds may follow.

9 Article Dry Eye Syndrome After Proton Therapy of Ocular Melanomas. 2017

Thariat, Juliette / Maschi, Celia / Lanteri, Sara / Peyrichon, Marie Laure / Baillif, Stephanie / Herault, Joel / Salleron, Julia / Caujolle, Jean Pierre. ·Proton Therapy Unit, Department of Radiation Therapy, Centre Antoine Lacassagne, Nice, France. Electronic address: jthariat@gmail.com. · Department of Ophthalmology, Pasteur 2 Hospital, Eye University Clinic, Nice, France. · Proton Therapy Unit, Department of Radiation Therapy, Centre Antoine Lacassagne, Nice, France. · Department of Biostatistics, Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France. ·Int J Radiat Oncol Biol Phys · Pubmed #28586953.

ABSTRACT: PURPOSE: To investigate whether proton therapy (PT) performs safely in superotemporal melanomas, in terms of risk of dry-eye syndrome (DES). METHODS AND MATERIALS: Tumor location, DES grade, and dose to ocular structures were analyzed in patients undergoing PT (2005-2015) with 52 Gy (prescribed dose, not accounting for biologic effectiveness correction of 1.1). Prognostic factors of DES and severe DES (sDES, grades 2-3) were determined with Cox proportional hazard models. Visual acuity deterioration and enucleation rates were compared by sDES and tumor locations. RESULTS: Median follow-up was 44 months (interquartile range, 18-60 months). Of 853 patients (mean age, 64 years), 30.5% had temporal and 11.4% superotemporal tumors. Five-year incidence of DES and sDES was 23.0% (95% confidence interval [CI] 19.0%-27.7%) and 10.9% (95% CI 8.2%-14.4%), respectively. Multivariable analysis showed a higher risk for sDES in superotemporal (hazard ratio [HR] 5.82, 95% CI 2.72-12.45) and temporal tumors (HR 2.63, 95% CI 1.28-5.42), age ≥70 years (HR 1.90, 95% CI 1.09-3.32), distance to optic disk ≥5 mm (HR 2.71, 95% CI 1.52-4.84), ≥35% of retina receiving 12 Gy (HR 2.98, 95% CI 1.54-5.77), and eyelid rim irradiation (HR 2.68, 95% CI 1.49-4.80). The same risk factors were found for DES. Visual acuity deteriorated more in patients with sDES (0.86 ± 1.10 vs 0.64 ± 0.98 logMAR, P=.034) but not between superotemporal/temporal and other locations (P=.890). Enucleation rates were independent of sDES (P=.707) and tumor locations (P=.729). CONCLUSIONS: Severe DES was more frequent in superotemporal/temporal melanomas. Incidence of vision deterioration and enucleation was no higher in patients with superotemporal melanoma than in patients with tumors in other locations. Tumor location should not contraindicate PT.

10 Article Conservative Treatments of Ocular Melanomas: Technology Used Wisely. 2017

Thariat, Juliette / Herault, Joel / Mouriaux, Frederic. ·Department of Radiation Oncology, Centre Francois Baclesse, University of Nice, Sophia Antipolis, France. Electronic address: jthariat@gmail.com. · Department of Radiation Oncology and Physics, Centre Francois Baclesse, University of Nice, Sophia Antipolis, France. · Department of Ophthalmology, University Hospital, Rennes, France. ·Int J Radiat Oncol Biol Phys · Pubmed #28454734.

ABSTRACT: -- No abstract --

11 Article Practice Patterns Analysis of Ocular Proton Therapy Centers: The International OPTIC Survey. 2016

Hrbacek, Jan / Mishra, Kavita K / Kacperek, Andrzej / Dendale, Remi / Nauraye, Catherine / Auger, Michel / Herault, Joel / Daftari, Inder K / Trofimov, Alexei V / Shih, Helen A / Chen, Yen-Lin E / Denker, Andrea / Heufelder, Jens / Horwacik, Tomasz / Swakoń, Jan / Hoehr, Cornelia / Duzenli, Cheryl / Pica, Alessia / Goudjil, Farid / Mazal, Alejandro / Thariat, Juliette / Weber, Damien C. ·Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland. Electronic address: Jan.hrbacek@psi.ch. · Ocular Tumor Proton Therapy Program, University of California San Francisco, San Francisco, California. · National Proton Therapy Centre, Clatterbridge Cancer Centre, Bebington, United Kingdom. · Centre de Protonthérapie d'Orsay, Institut Curie, Orsay, France. · Centre Lacassagne, Nice, France. · F. H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Protons for Therapy, Helmholtz-Zentrum Berlin, Berlin, Germany. · BerlinProtonen am HZB, Charité - Universitätsmedizin Berlin, Berlin, Germany. · Institute of Nuclear Physic, Polish Academy of Sciences, Krakow, Poland. · BC Cancer Agency - TRIUMF, Vancouver, Canada. · Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland. ·Int J Radiat Oncol Biol Phys · Pubmed #27084651.

ABSTRACT: PURPOSE: To assess the planning, treatment, and follow-up strategies worldwide in dedicated proton therapy ocular programs. METHODS AND MATERIALS: Ten centers from 7 countries completed a questionnaire survey with 109 queries on the eye treatment planning system (TPS), hardware/software equipment, image acquisition/registration, patient positioning, eye surveillance, beam delivery, quality assurance (QA), clinical management, and workflow. RESULTS: Worldwide, 28,891 eye patients were treated with protons at the 10 centers as of the end of 2014. Most centers treated a vast number of ocular patients (1729 to 6369). Three centers treated fewer than 200 ocular patients. Most commonly, the centers treated uveal melanoma (UM) and other primary ocular malignancies, benign ocular tumors, conjunctival lesions, choroidal metastases, and retinoblastomas. The UM dose fractionation was generally within a standard range, whereas dosing for other ocular conditions was not standardized. The majority (80%) of centers used in common a specific ocular TPS. Variability existed in imaging registration, with magnetic resonance imaging (MRI) rarely being used in routine planning (20%). Increased patient to full-time equivalent ratios were observed by higher accruing centers (P=.0161). Generally, ophthalmologists followed up the post-radiation therapy patients, though in 40% of centers radiation oncologists also followed up the patients. Seven centers had a prospective outcomes database. All centers used a cyclotron to accelerate protons with dedicated horizontal beam lines only. QA checks (range, modulation) varied substantially across centers. CONCLUSIONS: The first worldwide multi-institutional ophthalmic proton therapy survey of the clinical and technical approach shows areas of substantial overlap and areas of progress needed to achieve sustainable and systematic management. Future international efforts include research and development for imaging and planning software upgrades, increased use of MRI, development of clinical protocols, systematic patient-centered data acquisition, and publishing guidelines on QA, staffing, treatment, and follow-up parameters by dedicated ocular programs to ensure the highest level of care for ocular patients.

12 Article Visual Outcomes of Parapapillary Uveal Melanomas Following Proton Beam Therapy. 2016

Thariat, Juliette / Grange, Jean-Daniel / Mosci, Carlo / Rosier, Laurence / Maschi, Celia / Lanza, Francesco / Nguyen, Anh Minh / Jaspart, Franck / Bacin, Franck / Bonnin, Nicolas / Gaucher, David / Sauerwein, Wolfgang / Angellier, Gaelle / Hérault, Joel / Caujolle, Jean-Pierre. ·Department of Radiation Therapy, Cancer Center Antoine Lacassagne-Nice Sophia Antipolis University Hospital, Nice, France. Electronic address: jthariat@gmail.com. · Department of Ophthalmology, Eye University Clinic la Croix Rousse, Lyon, France. · Department of Ophthalmology, National Institute for Cancer Research, Mura Delle Cappucine, Genova, Italy. · Eye Clinic, Centre d'Exploration et de Traitement de la Retine et de la Macula, Bordeaux, France. · Department of Ophthalmology, Eye University Clinic Pasteur 2, Nice, France. · Department of Ophthalmology, Eye University Clinic Gabriel Montpied, Clermont Ferrand, France. · Department of Ophthalmology, Eye University Clinic, Hopital Civil, Strasbourg, France. · Department of Radiation Therapy, NCTeam, Strahlenklinik, Universitätsklinikum Essen, Essen, Germany. · Department of Radiation Therapy, Cancer Center Antoine Lacassagne-Nice Sophia Antipolis University Hospital, Nice, France. ·Int J Radiat Oncol Biol Phys · Pubmed #27084650.

ABSTRACT: PURPOSE: In parapapillary melanoma patients, radiation-induced optic complications are frequent and visual acuity is often compromised. We investigated dose-effect relationships for the optic nerve with respect to visual acuity after proton therapy. METHODS AND MATERIALS: Of 5205 patients treated between 1991 and 2014, those treated using computed tomography (CT)-based planning to 52 Gy (prescribed dose, not accounting for relative biologic effectiveness correction of 1.1) in 4 fractions, with minimal 6-month follow-up and documented initial and last visual acuity, were included. Deterioration of ≥0.3 logMAR between initial and last visual acuity results was reported. RESULTS: A total of 865 consecutive patients were included. Median follow-up was 69 months, mean age was 61.7 years, tumor abutted the papilla in 35.1% of patients, and tumor-to-fovea distance was ≤3 mm in 74.2% of patients. Five-year relapse-free survival rate was 92.7%. Visual acuity was ≥20/200 in 72.6% of patients initially and 47.2% at last follow-up. A wedge filter was used in 47.8% of the patients, with a positive impact on vision and no impact on relapse. Glaucoma, radiation-induced optic neuropathy, maculopathy were reported in 17.9%, 47.5%, and 33.6% of patients, respectively. On multivariate analysis, age, diabetes, thickness, initial visual acuity and percentage of macula receiving 26 Gy were predictive of visual acuity. Furthermore, patients irradiated to ≥80% of their papilla had better visual acuity when limiting the 50% (30-Gy) and 20% (12-Gy) isodoses to ≤2 mm and 6 mm of optic nerve length, respectively. CONCLUSIONS: A personalized proton therapy plan with optic nerve and macular sparing can be used efficiently with good oncological and functional results in parapapillary melanoma patients.

13 Article Outcomes After Proton Beam Therapy for Large Choroidal Melanomas in 492 Patients. 2016

Bensoussan, Elsa / Thariat, Juliette / Maschi, Célia / Delas, Jérôme / Schouver, Elie Dan / Hérault, Joël / Baillif, Stéphanie / Caujolle, Jean-Pierre. ·Department of Ophthalmology, Pasteur Hospital, Nice Teaching Hospital, Nice, France. · Department of Radiation Oncology, Protontherapy Center, Centre Antoine Lacassagne, Nice, France. · Department of Cardiology, Pasteur Hospital, Nice Teaching Hospital, Nice, France. · Department of Ophthalmology, Pasteur Hospital, Nice Teaching Hospital, Nice, France. Electronic address: jeanpierre.caujolle@neuf.fr. ·Am J Ophthalmol · Pubmed #26940166.

ABSTRACT: PURPOSE: To evaluate proton beam therapy (PBT) as a means to preserve the eye and spare some vision while not deteriorating survival in patients with large choroidal melanomas. DESIGN: This is a retrospective, consecutive cohort study of patients with T3-4 choroidal melanomas according to the 7th edition of the American Joint Cancer Classification treated with PBT over a 24-year period. RESULTS: A total of 492 patients were included. Mean (range) tumor thickness and diameter were 8.77 (2-15) mm and 14.91 (7-24.1) mm, respectively. Mean macular and optic disc distance were 4.56 (0-19.9) mm and 4.59 (0-22.1) mm, respectively. Mean follow-up was 61.9 months. Rates of neovascular glaucoma (NVG) and enucleation (mainly for local recurrence or NVG) were 27.0% and 19.5%, respectively. Enucleation rates decreased over time. The 5-year local control was 94%. Mean baseline visual acuity was 20/63, and visual acuity ≥20/200 was preserved in 20% of patients. At 5 years, 25% of T3 patients presented with metastasis; overall and specific survival rates were 65% and 75%, respectively. CONCLUSION: Local control after PBT remained good with increasingly manageable complications and fewer secondary enucleations over time for these large melanomas. As PBT does not seem to deteriorate survival in these patients having a high risk of metastasis, PBT may be considered as a safe and efficient alternative to enucleation in patients with large choroidal melanoma, and may help to spare some vision.

14 Article Tumour Response in Uveal Melanomas Treated with Proton Beam Therapy. 2016

Maschi, C / Thariat, J / Herault, J / Caujolle, J-P. ·Department of Ophthalmology, Pasteur 2 Hospital, Nice Teaching Hospital, Nice, France. Electronic address: celia.maschi@gmail.com. · Department of Radiation Oncology, Centre Lacassagne, Proton Therapy Center, Nice, France. · Department of Ophthalmology, Pasteur 2 Hospital, Nice Teaching Hospital, Nice, France. ·Clin Oncol (R Coll Radiol) · Pubmed #26385821.

ABSTRACT: AIMS: Post-proton therapy surveillance of uveal melanomas relies on decreased thickness on repeat ultrasound B every 6 months for 2 years and yearly thereafter. Earlier pseudoprogression, a phenomenon described in other tumour types within the first months of irradiation, can also be observed in uveal melanomas and may lead to inappropriate enucleation. The Collaborative Ocular Melanoma Study (COMS) has defined ultrasound criteria to identify tumour progression after brachytherapy. We aimed to determine the reliability of ultrasound as a means to measure tumour height after proton therapy and predict local relapse. MATERIALS AND METHODS: All 1992-2012 consecutive patients with at least three ultrasound B measurements during follow-up were included. RESULTS: There were 55 local relapses of 886 patients (6.2%). Ultrasound B reliability was highest at 24 months, with specificity higher than 95% starting at 18 months. CONCLUSION: Before 18 months post-proton therapy, the risk of falsely concluding in favour of a relapse exceeds 5% and should prompt repeat measurements 3 and 6 months later but should not prompt enucleation without further clinical assessment.

15 Article [Malignant tumours of the eye: Epidemiology, diagnostic methods and radiotherapy]. 2015

Jardel, P / Caujolle, J-P / Gastaud, L / Maschi, C / Sauerwein, W / Thariat, J. ·Service d'oncologie radiothérapie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France. Electronic address: jardelpauline@yahoo.fr. · Service d'ophtalmologie, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France. · Service d'oncologie médicale, centre Antoine-Lacassagne, 33, avenue de la Lanterne, 06189 Nice, France. · NC Team, Strahlenklinik, hôpital universitaire, 45122 Essen, Allemagne. · Unité CyberKnife et protonthérapie, service d'oncologie radiothérapie, centre Antoine-Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France. ·Cancer Radiother · Pubmed #26508321.

ABSTRACT: Malignant tumours of the eye are not common, barely representing 1 % of all cancers. This article aims to summarise, for each of the main eye malignant diseases, aspects of epidemiology, diagnostic methods and treatments, with a focus on radiation therapy techniques. The studied tumours are: eye metastasis, intraocular and ocular adnexal lymphomas, uveal melanomas, malignant tumours of the conjunctive, of the lids, and retinoblastomas. The last chapter outlines ocular complications of radiation therapy and their management.

16 Article [Mucosal melanomas of the head and neck: State of the art and current controversies]. 2015

Troussier, Idriss / Baglin, Anne-Catherine / Marcy, Pierre-Yves / Even, Caroline / Moya-Plana, Antoine / Krengli, Marco / Thariat, Juliette. ·CHRU de Poitiers, oncologie radiothérapie, 2, rue de la Milétrie, 86000 Poitiers, France. Electronic address: idriss.troussier@me.com. · Hôpital Lariboisière, department of pathology, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France. · Centre Lacassagne, department of radiology, 33, avenue de la Lanterne, 06189 Nice, France. · Institut Gustave-Roussy, department of medical oncology, rue Camille-Desmoulins, 94000 Villejuif, France. · Institut Gustave-Roussy, department of head and neck surgery, rue Camille-Desmoulins, 94000 Villejuif, France. · University Hospital "Maggiore della Carità", division of radiotherapy, via Solaroli, 17, 28100 Novara, Italie. · Centre Lacassagne, département de radiothérapie, 227, avenue de la Lanterne, 06200 Nice, France. ·Bull Cancer · Pubmed #26022288.

ABSTRACT: Mucosal melanomas of the head and neck (sinonasal and oral cavity) account for 1% of neoplasms, 4% of all melanomas and over 50% of all mucosal melanomas. They have a high metastatic potential. Five-year overall survival does not exceed 30%. Diagnosis may be difficult and includes adequate immunohistochemical staining. Risk factors, presentation and molecular biology are different from those of cutaneous melanomas. The mainstay of treatment is surgery and postoperative radiotherapy. Endoscopic surgery should be evaluated prospectively. Neck dissection is recommended for N0 oral cavity melanomas, while it can generally be omitted for sinonasal melanomas. Inoperable tumors can be treated with exclusive radiotherapy. Molecular guidance for metastatic cases is a relevant option despite low level of evidence, based on the rarity of disease and low response rates to chemotherapy. c-KIT inhibitors and immunotherapy appear promising.

17 Article Proton beam therapy for presumed and confirmed iris melanomas: a review of 36 cases. 2014

Rahmi, Ahmed / Mammar, Hamid / Thariat, Juliette / Angellier, Gaelle / Herault, Joel / Chauvel, Pierre / Kodjikian, Laurent / Denis, Philippe / Grange, Jean Daniel. ·Department of Ophthalmology, Croix-Rousse University Hospital, University Claude Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France. ·Graefes Arch Clin Exp Ophthalmol · Pubmed #25038910.

ABSTRACT: BACKGROUND: To report the clinical features and outcomes of iris melanomas treated by proton beam therapy. MATERIALS AND METHODS: A retrospective study was conducted at the Croix-Rousse University Hospital of Lyon, Department of Ophthalmology, in 36 patients treated by proton beam therapy for presumed (n = 29) and confirmed (n = 7) iris melanomas between July 1997 and October 2010. Ciliary body melanomas with iris involvement were excluded. The patients' mean age was 54.4 years (range, 22-82 years). The average tumor diameter was 3.8 mm (range, 2.5-8.0). The iridocorneal angle was invaded by the tumor in 47% of cases (n = 17), the ciliary body in 17% of cases (n = 6), and the sclera in 3% (n = 1). Raised intraocular pressure was present before treatment in 11.1 % of cases (n = 4). Tumor biopsy was performed in 19% of cases (n = 7). Four patients had undergone an initial incomplete surgical excision of tumor before radiotherapy. Surgical preparation of the eye with tantalum ring positioning had been performed in all cases 3-4 weeks before irradiation. The prescribed dose was 60 Cobalt Gray Equivalent (CGE) of proton beam radiotherapy delivered in four fractions on four consecutive days. RESULTS: The median follow-up was 50 months (mean 60.5, range 15-136). One patient (2.7%) was lost to follow-up. None of the patients showed tumor progression, local recurrence, or metastasis. None of the patients required secondary enucleation. Cataract was developed in 62% of patients, glaucoma in two cases (6%) after irradiation, and hyphema with the aggravation of pre-existing glaucoma in one patient. No patients developed neovascular glaucoma. CONCLUSIONS: Proton beam therapy appears to be the treatment of choice for the conservative treatment of iris melanomas with excellent tumor control and an acceptable rate of complications. Longer follow-up studies on a larger series is necessary to consolidate these results.

18 Article Effect of surgical modality and hypofractionated split-course radiotherapy on local control and survival from sinonasal mucosal melanoma. 2011

Thariat, J / Poissonnet, G / Marcy, P-Y / Lattes, L / Butori, C / Guevara, N / Dassonville, O / Santini, J / Bensadoun, R-J / Castillo, L. ·Department of Radiation Oncology/IBDC CNRS UMR 6543, Anti-Cancer Centre Antoine-Lacassagne, University Nice Sophia-Antipolis, Nice, France. jthariat@hotmail.com ·Clin Oncol (R Coll Radiol) · Pubmed #21621990.

ABSTRACT: AIMS: To assess the efficacy of surgery and high-dose split-course radiotherapy in sinonasal head and neck mucosal melanoma (SHNMM). MATERIAL AND METHODS: Between 1991 and 2006, 23 patients (median age 73 years, male:female ratio 0.4) with non-metastatic SHNMM underwent surgery and postoperative radiotherapy, two had exclusive radiotherapy. Radiotherapy consisted of three series of 18Gy (3×6Gy every other day for 1 week) with 3 week planned treatment breaks. Chi-squared tests, Kaplan-Meyer method and Log-rank test were used to assess prognostic factors for survival and local control. RESULTS: There were 20 nasal cavity tumours; 12 of these involved more than one sinonasal site. One patient (4%) had lymphadenopathies at diagnosis. Six SHNMMs (24%) were amelanotic. The median follow-up was 39 months. Fourteen patients had en bloc surgery, 16 underwent radiation (14 postoperative, two exclusive). Eleven patients had local relapse, three had regional relapse and three had bone or liver metastases. Five year local control was 49±12%. Five year overall and SHNMM-specific survival was 38±12% and 62±12%, respectively. Five patients were alive without disease after 5 years and three after 10 years. En bloc excision (tumour removed in one piece) was prognostic for survival. CONCLUSIONS: En bloc surgery was a prognostic factor on outcomes for local control and survival in this series. Data from the literature have shown that postoperative radiation therapy improves local control. Most series were carried out with conventional fractionation. The effect of planned breaks (split-course radiotherapy) may be deleterious, as suggested in this series. Therefore, split-course radiotherapy cannot be recommended for SHNMM.

19 Article Postoperative radiotherapy in head and neck mucosal melanoma: a GETTEC study. 2010

Benlyazid, Adil / Thariat, Juliette / Temam, Stephane / Malard, Olivier / Florescu, Carmen / Choussy, Olivier / Makeieff, Marc / Poissonnet, Gilles / Penel, Nicolas / Righini, Christian / Toussaint, Bruno / Lacau St Guily, Jean / Vergez, Sebastien / Filleron, Thomas. ·Department of Head and Neck Surgery, Claudius Regaud Institute, 20-24 rue du pont Saint Pierre, Toulouse 31052, France. adil.benlyazid@gmail.com ·Arch Otolaryngol Head Neck Surg · Pubmed #21173371.

ABSTRACT: OBJECTIVE: to report patterns of failure according to treatment modality, with an emphasis on the role of postoperative radiotherapy in patients with localized head and neck mucosal melanoma (HNMM) treated during a 28-year period in a multi-institutional setting. DESIGN: retrospective review. SETTING: french medical institutions. PATIENTS: a total of 160 patients with nonmetastatic HNMM treated from 1980 through 2008. INTERVENTIONS: treatment modality consisted of surgery alone (hereinafter, S group) (n = 82 patients) or with postoperative radiotherapy (hereinafter, SRT group) (n = 78). Patients and tumor characteristics were similar in the 2 groups. There was a nonsignificant trend (P = .11) for more locally advanced tumor stage (38.9%) in the SRT group compared with the S group (24.5%). RESULTS: patients in the S group had an increased probability of locoregional recurrence as a first event (55.6%) compared with those in the SRT group (29.9%; P < .01). After adjusting for tumor stage (T1/T2 vs T3/T4), the subdistribution hazard ratio of locoregional relapse was 0.31, (95% confidence interval [CI], 0.15-0.61; P < .01).The rate of distant metastasis as a first event was significantly higher in the SRT group (40.6%) compared with the S group (19.9%; P = .01). Regardless of their treatment, patients who had a locoregional relapse during follow-up had an increased risk of subsequent distant metastasis (hazard ratio, 3.07; 95% CI, 1.65-5.67) and death (hazard ratio, 3.01; 95% CI, 1.91-4.78). CONCLUSIONS: this large retrospective study suggests that postoperative radiotherapy improves the locoregional control of HNMM. The higher rate of distant metastasis was due to more advanced disease in the SRT group.

20 Article Primary cancer of the sphenoid sinus--a GETTEC study. 2009

Vedrine, Pierre Olivier / Thariat, Juliette / Merrot, Olivier / Percodani, Josiane / Dufour, Xavier / Choussy, Olivier / Toussaint, Bruno / Dassonville, Olivier / Klossek, Jean-Michel / Santini, José / Jankowski, Roger. ·Department of Otolaryngology-Head and Neck Surgery, University Hospital, Nancy, France. ·Head Neck · Pubmed #18972425.

ABSTRACT: BACKGROUND: Primary involvement of the sphenoid sinus occurs in 2% of all paranasal sinus tumors and is associated with dismal prognosis. Optimal management remains debatable. METHODS: A total of 23 patients were treated for a primary cancer of the sphenoid sinus from 1988 to 2004. Charts were reviewed for patient-, tumor-, and treatment-related parameters. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional control and survival. RESULTS: Cranial neuropathies were present in 12 patients. Pathologic findings included adenoid cystic carcinoma, adenocarcinoma, lymphoma, squamous cell carcinoma, sarcoma, neuroendocrine carcinoma, melanoma, and malignant hemangiopericytoma. All but 2 patients had stages III to IV cancer. Radiotherapy was performed in 18 patients and chemotherapy in 12. Of 10 patients undergoing surgery, total excision with grossly negative margins was achieved in 4 patients and subtotal resection in 6. Median locoregional control and overall survival were 12 and 41 months, respectively. On multivariate analysis, cranial neuropathy was associated with worse locoregional control and survival. Surgery was rarely complete because of advanced stages at presentation, but it yielded better outcomes than other treatments without surgery in non lymphoma-cases. CONCLUSION: Early CT and MRI should be performed when facing aspecific, rhinological, or neuro-ophtalmological symptoms. Cranial neuropathies indicate a worse prognosis. Surgery, including debulking surgery, may be preferred to combined modality treatments without surgery. Its apparently favorable impact on prognosis would need to be tested in homogenous histological groups of patients, which is impossible because of the rarity of the disease. Highly conformal radiotherapy (adjuvant or definitive) should be encouraged and optimized with concurrent chemotherapy in advanced stages. Aggressive multidisciplinary management including surgery, chemotherapy, and radiotherapy should be encouraged and adapted on histology and tumor extensions. Progress is still warranted to improve outcomes.