Benefit of surgery after chemoradiotherapy in stage IIIB (T4 and/or N3) non–small cell lung cancer

AbstractObjective: The purpose of this study was to evaluate postchemoradiotherapy surgery in stage IIIB non–small cell lung cancer. Methods: Forty patients with stage IIIB non–small cell lung cancer were included in this phase II study. A preoperative diagnosis of stage IIIB cancer was based on mediastinoscopy or a thoracotomy in all patients. Induction treatment included two cycles of cisplatin (100 mg/m2, day 1), 5-fluorouracil (1 g/m2, days 1-3), and vinblastine (4 mg/m2, day 1) combined with 42 Gy of hyperfractionated radiotherapy delivering 21 Gy in two sessions. Patients with a clinical response were offered surgery. Results: The minimum follow-up for survivors was 48 months. Thirty patients had a T4 lesion and 18 had N3 disease. Twenty-nine patients (73%) had a clinical objective tumor response after induction treatment. These 29 patients underwent thoracotomy, and a complete resection was performed in 23 (58%). Two postoperative deaths occurred (7%). Four patients had a pathologic complete response at the time of surgery (10%). The 5-year survival is 19% for the overall population. When only patients who had persistent viable tumor cells at surgery are considered (n = 25), the 5-year survival is 28%. The 5-year survival is 42% for patients having no mediastinal lymph node involvement at the time of surgery and being treated with complete resection. Conclusion: This study shows that surgery, when feasible, is associated with a 28% long-term survival for patients in whom chemoradiotherapy alone fails to control disease

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Les groupes de prospective maritime et littorale sur les façades françaises. Les perspectives offertes par le CIAT de Troyes en matière d’aménagement du littoral / Façade groups for maritime and coastal forward planning. Prospects presented by the Troyes 1CLP regarding coastal planning

During the national debate regarding the elaboration of a Law for land planning and development, the sea and coastal zone have been generally forgotten. During the meeting of Troyes in September 1994, the Interministerial Committee for Land Planning decided to set up working groups for Maritime and Coastal forward planning. Composed of State departments representatives and scientists, these groups will suggest, to the Govement before March 1997, some major guidelines for decision-making.Dans le cadre du débat national concernant l’élaboration d’une loi d’orientation pour l’aménagement et le développement du territoire, la mer et le littoral ont été trop souvent oubliés. Le Comité interministériel d’aménagement du territoire, réuni à Troyes en septembre 1994, décide alors de mettre en place des Groupes de prospective maritime et littorale par façade, rassemblant des représentants des services de l’État et des scientifiques, afin de proposer, pour mars 1997, un certain nombre de grandes orientations d’action au Gouvernement.Le Lamer Christian. Les groupes de prospective maritime et littorale sur les façades françaises. Les perspectives offertes par le CIAT de Troyes en matière d’aménagement du littoral / Façade groups for maritime and coastal forward planning. Prospects presented by the Troyes 1CLP regarding coastal planning. In: Cahiers du Centre nantais de recherche pour l'aménagement régional, n°47-48, 1997. Littoral 95 - Actes du Colloque International Continuités et ruptures sur les littoraux européens. pp. 331-338

Chapitre IX. Economie et finances locales

Freville Yves, Guengant Alain, Le Lamer Christian, Uhaldeborde Jean-Michel. Chapitre IX. Economie et finances locales. In: Annuaire des collectivités locales. Tome 2, 1982. pp. 543-599

Chapitre IX. — Économie et finances locales — Sous la direction scientifique d'Yves Freville

Guengant Alain, Le Lamer Christian, Moine Gérard, Uhaldeborde Jean-Michel. Chapitre IX. — Économie et finances locales — Sous la direction scientifique d'Yves Freville. In: Annuaire des collectivités locales. Tome 1, 1981. pp. 399-473

Chapitre VIII. — Innovations et gestion

Fixari Daniel, Garnier Patrick, Bouinot Jean, Demeestere René, Le Lamer Christian. Chapitre VIII. — Innovations et gestion. In: Annuaire des collectivités locales. Tome 4, 1984. pp. 415-450

Chapitre X. — Innovations et gestion

Bouinot Jean, Demeestere René, Fixari Daniel, Garnier Patrick, Le Lamer Christian. Chapitre X. — Innovations et gestion. In: Annuaire des collectivités locales. Tome 3, 1983. pp. 491-522

Chapitre X. Innovation et gestion

Bouinot Jean, Fixari Daniel, Garnier Patrick, Izebe Guy, Le Lamer Christian, Muzio Jacqueline, Schmitt Dominique. Chapitre X. Innovation et gestion. In: Annuaire des collectivités locales. Tome 2, 1982. pp. 601-644