Individual patient data meta-analysis of neoadjuvant chemotherapy followed by surgery versus upfront surgery for carcinoma of the oesophagus or the gastro- oesophageal junction

Introduction Which neoadjuvant treatment for locally advanced thoracic oesophagus (TE) or gastro-oesophageal junction carcinoma is best remains an open question. Randomised controlled trials variously accrued patients with adenocarcinoma and squamous cell carcinoma, making strong conclusions hard to obtain. The primary objective of this individual participant data meta-analysis was to investigate the effect of neoadjuvant chemotherapy on overall survival (OS). Patients and methods Eligible trials should have closed to accrual before 2016 and compared neoadjuvant chemotherapy and surgery (CS) to surgery alone. All relevant published and unpublished trials were identified via searches of electronic databases, conference proceedings and clinical trial registers. The main end-point was OS. Investigators were contacted to obtain the individual patient data, which was recorded, harmonised and checked. A random-effects Cox model, stratified by trial, was used for meta-analysis and subgroup analyses were preplanned. Results 16 trials were identified as eligible. Individual patient data were obtained from 12 trial and 2478 patients. CS was associated with an improved OS versus surgery, hazard ratio (HR) = 0.83 [0.72–0.96], p < 0.0001, translating to an absolute benefit of 5.7% at 5-years from 16.8% to 22.5%. Treatment effects did not vary substantially between adenocarcinoma (HR = 0.73 [0.62–0.87]) and squamous cell carcinoma (HR = 0.91 [0.76–1.08], interaction p = 0.26). A somewhat more pronounced effect was observed in gastro-oesophageal junction (HR = 0.68 [0.50–0.93]) versus TE (HR = 0.87 [0.75–1.00], interaction p = 0.07). CS was also associated with a greater disease-free survival (HR = 0.74 [0.64–0.85], p < 0.001). Conclusions Neoadjuvant chemotherapy conferred a better OS than surgery alone and should be considered in all anatomical location and histological subtypes

Individual Participant Data Network Meta-Analysis of Neoadjuvant Chemotherapy or Chemoradiotherapy in Esophageal or Gastroesophageal Junction Carcinoma

PURPOSE: The optimal neoadjuvant treatment for resectable carcinoma of the thoracic esophagus (TE) or gastroesophageal junction (GEJ) remains a matter of debate. We performed an individual participant data (IPD) network meta-analysis (NMA) of randomized controlled trials (RCTs) to study the effect of chemotherapy or chemoradiotherapy, with a focus on tumor location and histology subgroups. PATIENTS AND METHODS: All, published or unpublished, RCTs closed to accrual before December 31, 2015 and having compared at least two of the following strategies were eligible: upfront surgery (S), chemotherapy followed by surgery (CS), and chemoradiotherapy followed by surgery (CRS). All analyses were conducted on IPD obtained from investigators. The primary end point was overall survival (OS). The IPD-NMA was analyzed by a one-step mixed-effect Cox model adjusted for age, sex, tumor location, and histology. The NMA was registered in PROSPERO (CRD42018107158). RESULTS: IPD were obtained for 26 of 35 RCTs (4,985 of 5,807 patients) corresponding to 12 comparisons for CS-S, 12 for CRS-S, and four for CRS-CS. CS and CRS led to increased OS when compared with S with hazard ratio (HR) = 0.86 (0.75 to 0.99), P = .03 and HR = 0.77 (0.68 to 0.87), P &lt; .001 respectively. The NMA comparison of CRS versus CS for OS gave a HR of 0.90 (0.74 to 1.09), P = .27 (consistency P = .26, heterogeneity P = .0038). For CS versus S, a larger effect on OS was observed for GEJ versus TE tumors (P = .036). For the CRS versus S and CRS versus CS, a larger effect on OS was observed for women (P = .003, .012, respectively). CONCLUSION:Neoadjuvant chemotherapy and chemoradiotherapy were consistently better than S alone across histology, but with some variation in the magnitude of treatment effect by sex for CRS and tumor location for CS. A strong OS difference between CS and CRS was not identified.</p

Les verres au natron et les verres aux cendres du Wadi Natrun (Egypte)

National audienc

Le manganèse comme impureté, décolorant et colorant des verres au natron

National audienc

Les verres au natron et les verres aux cendres du Wadi Natrun (Egypte)

National audienc

Note sur le recyclage du verre dans l’Antiquité et sur les groupes de recyclage

National audienc

La situation de l’artisanat verrier à Augustodunum dans le contexte des découvertes effectuées en Gaule

Il est rappelé d’abord que les cartes de répartition des ateliers de verriers en Gaule, aux premiers siècles de notre ère, écartent de nombreux sites de transformation de verre brut importé du Proche-Orient, au motif qu’on n’y a pas retrouvé de déchets exploitables d’un point de vue typologique. Mais les traces d’activités verrières de cette époque semblent bien plus nombreuses que ne le montrent ces cartes, à l’instar de ce qu’on observe à Autun.Malgré le caractère bien incomplet de nos connaissances sur la répartition des ateliers de verriers anciens de Gaule romaine, cette répartition constitue dès à présent un solide argument en faveur de la prépondérance pour le verre d’un commerce de proximité. Celui-ci semble de règle, contrairement à ce qu’on observe pour de nombreux ateliers de céramiques, et mériterait que soit entreprise une étude extensive en laboratoire des déchets mineurs d’ateliers anciens, tels que gouttes et fils de verre, analogue à celle qui est en cours à Autun.Readers are reminded that the maps showing the distribution of glass-working workshops in Gaul during the early centuries AD have ignored many sites where unrefined glass imported from the Near East was transformed, on the grounds that no typologically conformant waste has been discovered there. However, traces of glass-working activities in this period seem much more numerous than the maps show, after the fashion of what we see in Autun.Despite the very incomplete state of knowledge of the distribution of glass-working workshops in Roman Gaul, this distribution currently provides a very solid argument in favour of a local trade in glassware. Unlike what is seen for many ceramics workshops, this would seem to be the rule for glaziers, and there is a case to be made for a wide-ranging laboratory study to be made of smaller pieces of waste from ancient workshops, such as beads or threads of glass, similar to what is being undertaken in Autun.Es wird zunächst daran erinnert, dass zahlreiche Produktionsstätten, an denen aus dem Vorderen Orient importiertes Rohglas weiterverarbeitet wurde, auf den Verteilungskarten der Glaswerkstätten der ersten Jahrhunderte unserer Zeitrechnung nicht berücksichtigt werden. Als Begründung wird angegeben, daß keine Produktionsabfälle gefunden wurden, die typologisch eingeordnet werden könnten. Insbesondere die Beobachtungen in Autun legen jedoch nahe, dass die Spuren der Aktivitäten der Glasherstellung aus dieser Zeit sehr viel zahlreicher sind, als es die Karten vermuten lassen.Zwar sind unsere Kenntnisse über die Verbreitung der antiken Glaswerkstätten im römischen Gallien noch lückenhaft, doch die Verbreitungskarte ist bereits jetzt ein gut fundiertes Argument für die Vorrangstellung des Nahhandels im Vertrieb der Glasproduktion. Im Gegensatz zu den Beobachtungen zahlreicher Keramikwerkstätten scheint er die Regel zu sein. Es wäre wünschenswert, dass als unbedeutend angesehene Abfälle der antiken Glaswerkstätten, wie z.B. Glastropfen und-fäden im Labor einer umfassenden Untersuchung unterzogen werden, der Art, wie sie momentan in Autun im Gang ist

Le manganèse comme impureté, décolorant et colorant des verres au natron

National audienc

Note sur le recyclage du verre dans l’Antiquité et sur les groupes de recyclage

National audienc

Lʼatelier de verrier de Beyrouth et la diffusion du verre syro-palestinien en Méditerranée occidentale à la fin de lʼépoque hellénistique

Foy Danièle, Picon Maurice, Thirion Merle Valérie. Lʼatelier de verrier de Beyrouth et la diffusion du verre syro-palestinien en Méditerranée occidentale à la fin de lʼépoque hellénistique. In: Topoi. Orient-Occident. Supplément 8, 2007. Productions et échanges dans la Syrie grecque et romaine (Actes du colloque de Tours, juin 2003