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Prise en charge du cancer epidermoide du canal anal

Conflits d'int?r?tsAmgenRoche. Journ?es Francophones d'H?pato-gastroent?rologie et d'Oncologie Digestive 2011 . Enum?rer Principales classifications (atteinte tumorale) Bilan pr?-th?rapeutique D?tailler Modalit?s th?rapeutiques non chirurgicales La place de la chirurgie Identifier et

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Prise en charge du cancer epidermoide du canal anal

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    9. Role of human papillomavirus (HPV) integration in the progression from normal epithelium to invasive carcinoma. L-SIL, low-grade squamous intraepithelial lesion; H-SIL, high-grade squamous intraepithelial lesion.Role of human papillomavirus (HPV) integration in the progression from normal epithelium to invasive carcinoma. L-SIL, low-grade squamous intraepithelial lesion; H-SIL, high-grade squamous intraepithelial lesion.

    27. RT + MMC + 5-FU UKCCR ACT I RT + MMC + 5-FU > RT UKCCR et al., Lancet 348:1049-54, 1996 EORTC RT + MMC + 5-FU > RT Bartelink et al., J Clin Oncol 15:2040-9, 1997 RTOG 87-04/ECOG 1289 RT + MMC + 5-FU > RT + 5-FU Flam et al., J Clin Oncol 14:2527-2539, 1996

    31. Amélioration des toxicités

    33. ACT II: The second UK phase III Anal Cancer Trial « A randomized trial of chemoradiation using MMC or cisplatin with or without maintenance (cisplatin/5-FU) in squamous cell carcinoma of the anus »

    34. Factorial design I. Chemoradiation comparison

    35. CRT Comparison Complete Response at 6 months

    38. Results: Grade 3 & 4 Acute Toxicity During Chemoradiation 1 cardiac 5-FU death 1 neutropaenic sepsis – not picked up and acted on in time – subject of internal enquiry – cross sites1 cardiac 5-FU death 1 neutropaenic sepsis – not picked up and acted on in time – subject of internal enquiry – cross sites

    39. Comment faire pour améliorer ? Modifier la technique (tissus sains) Augmenter la dose de radiothérapie ACCORD 03 Modifier la stratégie de la CT Neoadjuvante ACCORD 03 RTOG 98-11 Maintenance ACT II Thérapies ciblées ACCORD 16

    40. Toxicités tardives

    42. Chirurgie de sauvetage? ?Rôle de la qualité de la résection Rouqie, J Chir, 2008 95 AAP suivi 5 ans ?Seul facteur pronostique : résection R0 (n=76) versus R1 (n=9) ou R2 (n=9) ?Survie médiane : R0 > 10 ans versus 1 an pour R1 et R2 (p=0.001)

    43. Surveillance

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