IgG subclass deficiency and vaccination antibody titers : a paediatric study

Date du colloque&nbsp;: 10/2008</p

Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review

<p>Abstract</p> <p>Background</p> <p>Thoracic spine pain (TSP) is experienced across the lifespan by healthy individuals and is a common presentation in primary healthcare clinical practice. However, the epidemiological characteristics of TSP are not well documented compared to neck and low back pain. A rigorous evaluation of the prevalence, incidence, correlates and risk factors needs to be undertaken in order for epidemiologic data to be meaningfully used to develop evidence-based prevention and treatment recommendations for TSP.</p> <p>Methods</p> <p>A systematic review method was followed to report the evidence describing prevalence, incidence, associated factors and risk factors for TSP among the general population. Nine electronic databases were systematically searched to identify studies that reported either prevalence, incidence, associated factors (cross-sectional study) or risk factors (prospective study) for TSP in healthy children, adolescents or adults. Studies were evaluated for level of evidence and method quality.</p> <p>Results</p> <p>Of the 1389 studies identified in the literature, 33 met the inclusion criteria for this systematic review. The mean (SD) quality score (out of 15) for the included studies was 10.5 (2.0). TSP prevalence data ranged from 4.0–72.0% (point), 0.5–51.4% (7-day), 1.4–34.8% (1-month), 4.8–7.0% (3-month), 3.5–34.8% (1-year) and 15.6–19.5% (lifetime). TSP prevalence varied according to the operational definition of TSP. Prevalence for any TSP ranged from 0.5–23.0%, 15.8–34.8%, 15.0–27.5% and 12.0–31.2% for 7-day, 1-month, 1-year and lifetime periods, respectively. TSP associated with backpack use varied from 6.0–72.0% and 22.9–51.4% for point and 7-day periods, respectively. TSP interfering with school or leisure ranged from 3.5–9.7% for 1-year prevalence. Generally, studies reported a higher prevalence for TSP in child and adolescent populations, and particularly for females. The 1 month, 6 month, 1 year and 25 year incidences were 0–0.9%, 10.3%, 3.8–35.3% and 9.8% respectively. TSP was significantly associated with: concurrent musculoskeletal pain; growth and physical; lifestyle and social; backpack; postural; psychological; and environmental factors. Risk factors identified for TSP in adolescents included age (being older) and poorer mental health.</p> <p>Conclusion</p> <p>TSP is a common condition in the general population. While there is some evidence for biopsychosocial associations it is limited and further prospectively designed research is required to inform prevention and management strategies.</p

Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review

<p>Abstract</p> <p>Background</p> <p>Thoracic spine pain (TSP) is experienced across the lifespan by healthy individuals and is a common presentation in primary healthcare clinical practice. However, the epidemiological characteristics of TSP are not well documented compared to neck and low back pain. A rigorous evaluation of the prevalence, incidence, correlates and risk factors needs to be undertaken in order for epidemiologic data to be meaningfully used to develop evidence-based prevention and treatment recommendations for TSP.</p> <p>Methods</p> <p>A systematic review method was followed to report the evidence describing prevalence, incidence, associated factors and risk factors for TSP among the general population. Nine electronic databases were systematically searched to identify studies that reported either prevalence, incidence, associated factors (cross-sectional study) or risk factors (prospective study) for TSP in healthy children, adolescents or adults. Studies were evaluated for level of evidence and method quality.</p> <p>Results</p> <p>Of the 1389 studies identified in the literature, 33 met the inclusion criteria for this systematic review. The mean (SD) quality score (out of 15) for the included studies was 10.5 (2.0). TSP prevalence data ranged from 4.0–72.0% (point), 0.5–51.4% (7-day), 1.4–34.8% (1-month), 4.8–7.0% (3-month), 3.5–34.8% (1-year) and 15.6–19.5% (lifetime). TSP prevalence varied according to the operational definition of TSP. Prevalence for any TSP ranged from 0.5–23.0%, 15.8–34.8%, 15.0–27.5% and 12.0–31.2% for 7-day, 1-month, 1-year and lifetime periods, respectively. TSP associated with backpack use varied from 6.0–72.0% and 22.9–51.4% for point and 7-day periods, respectively. TSP interfering with school or leisure ranged from 3.5–9.7% for 1-year prevalence. Generally, studies reported a higher prevalence for TSP in child and adolescent populations, and particularly for females. The 1 month, 6 month, 1 year and 25 year incidences were 0–0.9%, 10.3%, 3.8–35.3% and 9.8% respectively. TSP was significantly associated with: concurrent musculoskeletal pain; growth and physical; lifestyle and social; backpack; postural; psychological; and environmental factors. Risk factors identified for TSP in adolescents included age (being older) and poorer mental health.</p> <p>Conclusion</p> <p>TSP is a common condition in the general population. While there is some evidence for biopsychosocial associations it is limited and further prospectively designed research is required to inform prevention and management strategies.</p

Risk factors for development of non-specific musculoskeletal pain in preteens and early adolescents: a prospective 1-year follow-up study

Background Musculoskeletal pain symptoms are common in children and adolescents. These symptoms have a negative impact on children's physical and emotional well-being, but their underlying aetiology and risk factors are still poorly understood. Most of the previous cohort studies were conducted among mid and/or late adolescents and were mainly focused on a specific pain location (e.g. low back pain or neck pain). The purpose of this study is to estimate occurrence of new-onset pain symptoms, in all musculoskeletal locations, in preteens and early adolescents and investigate risk factors for development of these symptoms. Methods 1756 schoolchildren (mean age 10.8) were recruited from schools in southern Finland. Information was extracted as to whether they experienced musculoskeletal pain and a total of 1192 children were identified as free of musculoskeletal pain symptoms. Information was collected on factors which could potentially predict the development of musculoskeletal pain: headache, abdominal pain, sadness/feeling down, day-time tiredness, difficulty in falling asleep, waking up during nights, level of physical activity and hypermobility. These children were followed-up 1-year later and those with new episodes of non-traumatic and traumatic musculoskeletal pain symptoms were identified. Results A total of 1113 schoolchildren (93% of baseline pain-free children) were found at one-year follow-up. New episodes of musculoskeletal pain were reported by 21.5% of these children. Of them 19.4% reported non-traumatic pain and 4.0% reported traumatic pain. The neck was the most commonly reported site with non-traumatic pain, while the lower limb was the most common site for traumatic pain. The independent risk factors for non-traumatic musculoskeletal pain were headache (OR = 1.68, [95% CI 1.16–2.44]) and day-time tiredness (OR = 1.53, [95% CI 1.03–2.26]). The risk factors for traumatic musculoskeletal pain were vigorous exercise (OR = 3.40 [95% CI 1.39–8.31]) and day-time tiredness (OR = 2.97 [95% CI 1.41–6.26]). Conclusion This study highlights that there may be two types of pain entities with both distinct and common aspects of aetiology. For primary prevention purposes, school healthcare professionals should pay attention to preteens and early adolescents practicing vigorous exercise (predictor of traumatic pain), reporting headache (predictor of non-traumatic pain) and reporting day-time tiredness (predictor of both types of pain).BioMed Central Open acces

Place de la radiothérapie stéréotaxique dans le cancer du poumon non à petites cellules en oligoprogression [Place of stereotactic radiotherapy in oligoprogressive non-small cell lung cancer]

This review of the literature provides an overview of the combination of stereotactic radiotherapy (SBRT) with immune checkpoint inhibitors (ICI) and tyrosine kinase inhibitors (TKI) in oligo-progressive non-small cell lung neoplasia. This combination showed local control of 76-100% and distant response rates of 8-60%. They reported progression-free survival of 2.7-24 months and overall survival of 13.4-41.2 months. All-grade toxicity rates ranged from 0% to 42%, with grade≥3 toxicity ranging from 0% to 14%. The combination of SBRT with ICI or TKIs exhibits a safe profile with high rates of local control with this combination. This could delay the use of a new line of systemic therapy in these patients with often limited therapeutic resources

Impact du curage ganglionnaire cervical dans la prise en charge par chimioradiothérapie exclusive des cancers de l’oropharynx de stade N2-3 : étude observationnelle en vie réelle

International audiencePurposeThe purpose of this study was to assess the efficacy in terms of neck failure of an initial neck dissection before definitive chemoradiotherapy in N2-3 oropharyngeal squamous cell carcinomas, as well as the dosimetric impact and the acute and delayed morbidity of this approach.Materials and methodsAll patients consecutively treated between 2009 and 2018 with definitive chemoradiotherapy using intensity-modulated conformal radiotherapy (IMRT) for a histologically proven N2-3 oropharyngeal squamous cell carcinomas were retrospectively included. The therapeutic approach consisted of induction chemotherapy, followed by cisplatine-based chemoradiotherapy preceded or not by neck dissection. Neck dissection was discussed on a case-by-case basis in a dedicated multidisciplinary tumour board for patients with a dissociated response to induction chemotherapy, defined as a better response on the primary than on the node. Chemoradiotherapy without neck dissection was systematically performed in case of a major lymph node response to induction chemotherapy (decrease in size of 90% or more). Intensity-modulated radiotherapy using a simultaneous-integrated boost delivered 70 Gy in 35 fractions on macroscopic tumour volumes, 63 Gy on intermediate-risk levels or extra-nodal extension and 54 Gy on prophylactic lymph node areas.ResultsTwo groups were constituted: 47 patients without an initial neck dissection (62.7%), and 28 patients with a neck dissection prior to definitive chemoradiotherapy (37.3%). Initial patient characteristics were not statistically different between the two groups. The median follow-up was 60.1 months (range: 3.2–119 months). Incidence of neck failure was higher in patients without neck dissection (P = 0.015). The neck failure rate at 5 years was 19.8% (95% confidence interval: 7.4–30.6%; P = 0.015) without neck dissection versus 0% following neck dissection. All lymph node failures occurred in the planned target volume at 70 Gy. Upfront neck dissection suggested a decrease in the mean dose received by the homolateral parotid gland (P = 0.01), mandible (P = 0.02), and thyroid gland (P = 0.02). Acute toxicity of chemoradiotherapy after neck dissection suggested a reduction in grade ≥ 3 adverse events (P = 0.04), early discontinuation of concomitant chemotherapy (P = 0.009) and feeding tube-dependence (P = 0.008) in univariate analysis. During follow-up, there was no difference between the two groups in terms of xerostomia, dysgeusia, dysphagia or gastrostomy dependence in univariate analysis.ConclusionNeck dissection prior to definitive chemoradiotherapy in N2-3 oropharyngeal squamous cell carcinoma was associated with high neck control without additional mid and long-term morbidity.Objectif de l’étudeIl s’agissait d’évaluer l’efficacité en termes d’échec ganglionnaire du curage ganglionnaire cervical initial dans les carcinomes épidermoïdes de l’oropharynx de stade N2-3 pris en charge par chimioradiothérapie exclusive, ainsi que l’impact dosimétrique et la tolérance aiguë et tardive de cette approche.Matériels et méthodesTous les patients consécutivement pris en charge entre 2009 et 2018 par chimioradiothérapie exclusive à l’aide d’une radiothérapie conformationelle avec modulation d’intensité (RCMI) pour un carcinome épidermoïde de l’oropharynx de stade N2-3 selon la septième édition de la classification TNM American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) ont été rétrospectivement inclus. La stratégie thérapeutique consistait en une chimiothérapie d’induction, suivie d’une chimioradiothérapie exclusive à base de cisplatine précédée ou non d’un curage ganglionnaire cervical. Le curage ganglionnaire cervical a été discuté au cas par cas en réunion de concertation multidisciplinaire dédiée chez les patients en situation de réponse dissociée à la chimiothérapie d’induction, à savoir une réponse de meilleure qualité sur la tumeur primitive que sur les ganglions. Une chimioradiothérapie sans curage ganglionnaire cervical a été systématiquement réalisée en cas de réponse ganglionnaire majeure à la chimiothérapie d’induction (diminution en taille de 90 % ou plus). La RCMI délivrait en boost intégré une dose de 70 Gy en 35 fractions dans les volumes tumoraux macroscopiques, 63 Gy dans les aires ganglionnaires à risque intermédiaire ou en rupture capsulaire et 54 Gy dans celles irradiées à visée prophylactique.RésultatsDeux groupes ont été constitués : 47 (62,7 %) patients sans curage ganglionnaire cervical initial, et 28 (37,3 %) patients avec un curage ganglionnaire cervical avant la chimioradiothérapie. Les caractéristiques initiales des patients n’étaient pas statistiquement différentes entre les deux groupes. Le recul médian était de 60,1 [3,2–119] mois. L’incidence des échecs ganglionnaires était plus élevée chez les patients n’ayant pas eu de curage ganglionnaire cervical (p = 0,015). Le taux d’échec ganglionnaire à 5 ans était de 19,8 % (intervalle de confiance à 95 % : 7,4–30,6) en l’absence de curage ganglionnaire cervical contre aucune rechute (0 %) après curage ganglionnaire cervical. Tous les échecs ganglionnaires se trouvaient dans le volume cible prévisionnel à 70 Gy. Le curage ganglionnaire cervical a permis une diminution de la dose moyenne reçue par la parotide homolatérale (p = 0,01), la mandibule (p = 0,02) et la thyroïde (p = 0,02). La tolérance aiguë de la chimioradiothérapie avait tendance à être meilleure chez les patients ayant eu un curage ganglionnaire avec une réduction des événements indésirables de grade ≥ 3 (p = 0,04), de l’arrêt précoce de la chimiothérapie concomitante (p = 0,009) et du recours à une gastrostomie (p = 0,008) en analyse unifactorielle. Au cours du suivi, il n’existait aucune différence entre les deux groupes en termes de xérostomie, de dysgueusie, de dysphagie ou de dépendance à la gastrostomie en analyse unifactorielle.ConclusionLe curage ganglionnaire cervical avant la chimioradiothérapie exclusive dans les carcinomes épidermoïdes de l’oropharynx de stade N2-3 était associé à un très bon taux de contrôle ganglionnaire sans morbidité supplémentaire à moyen et long termes

Efficacy and safety of helical tomotherapy with daily image guidance in anal canal cancer patients.

Background and purpose Intensity-modulated radiotherapy (IMRT), also using volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) techniques, has been only recently introduced for treating anal cancer patients. We report efficacy and safety HT, and daily image-guided RT (IGRT) for anal cancer. Materials and methods We retrospectively analyzed efficacy and toxicity of HT with or without chemotherapy for anal cancer patients. Local control (LC) and grade 3 or more toxicity rate (CTC-AE v.4.0) were the primary endpoints. Overall (OS), disease-free (DFS), and colostomy-free survival (CFS) are also reported. Results Between October 2007 and May 2014, 78 patients were treated. Fifty patients presented a stage II or stage IIIA (UICC 2002), and 33 presented a N1-3 disease. Radiotherapy consisted of 36 Gy (1.8 Gy/fraction) delivered on the pelvis and on the anal canal, with a sequential boost up to 59.4 Gy (1.8 Gy/fraction) delivered to the anal and to nodal gross tumor volumes. Concomitant chemotherapy was delivered in 73 patients, mainly using mitomycin C and 5-fluorouracil (n = 30) or mitomycin C and capecitabine combination (n = 37). After a median follow-up period of 47 months (range 3-75), the five-year LC rate was 83.8% (95% CI 76.2-91.4%). Seven patients underwent a colostomy because of local recurrence (n = 5) or pretreatment dysfunction (n = 2). Overall incidence of grade 3 acute toxicity was 24%, mainly as erythema (n = 15/19) or diarrhea (n = 7/19). Two patients presented a late grade 3 gastrointestinal toxicity (anal incontinence). No grade 4 acute or late toxicity was recorded. Conclusions HT with daily IGRT is efficacious and safe in the treatment of anal canal cancer patients, and is considered in our department standard of care in this clinical setting

Management of locally advanced anal canal carcinoma with intensity-modulated radiotherapy and concurrent chemotherapy.

The best curative option for locally advanced (stages II-III) squamous-cell carcinomas of the anal canal (SCCAC) is concurrent chemo-radiotherapy delivering 36-45 Gy to the prophylactic planning target volume with an additional boost of 14-20 Gy to the gross tumor volume with or without a gap-period between these two sequences. Although 3-dimensional conformal radiotherapy led to suboptimal tumor coverage because of field junctions, this modality remains a standard of care. Recently, intensity-modulated radiotherapy (IMRT) techniques improved tumor coverage while decreasing doses delivered to organs at risk. Sparing healthy tissues results in fewer severe acute toxicities. Consequently, IMRT could potentially avoid a gap-period that may increase the risk of local failure. Furthermore, these modalities reduce severe late toxicities of the gastrointestinal tract as well as better functional conservation of anorectal sphincter. This report aims to critically review contemporary trends in the management of locally advanced SCCAC using IMRT and concurrent chemotherapy

Radiotherapy of salivary gland tumours

International audiencePrimary tumours of the salivary glands account for about 5 to 10% of tumours of the head and neck. These tumours represent a multitude of situations and histologies, where surgery is the mainstay of treatment and radiotherapy is frequently needed for malignant tumours (in case of stage T3-T4, nodal involvement, extraparotid invasion, positive or close resection margins, histological high-grade tumour, lymphovascular or perineural invasion, bone involvement postoperatively, or unresectable tumours). The diagnosis relies on anatomic and functional MRI and ultrasound-guided fine-needle aspiration for the diagnostic of benign or malignant tumors. In addition to patient characteristics, the determination of primary and nodal target volumes depends on tumor extensions and stage, histology and grade. Therefore, radiotherapy of salivary gland tumors requires a certain degree of personalization, which has been codified in the recommendations of the French multidisciplinary network of expertise for rare ENT cancers (Refcor) and may justify a specialised multidisciplinary discussion. Although radiotherapy is usually recommended for malignant tumours only, recurrent pleomorphic adenomas may sometimes require radiotherapy based on multidisciplinary discussion. An update of indications and recommendations for radiotherapy for salivary gland tumours in terms of techniques, doses, target volumes and dose constraints to organs at risk of the French society for radiotherapy and oncology (SFRO) was reported in this article