Aboukaïs R., Quidet M., Baroncini M., Bourgeois P., Leclerc X., Vinchon M., Lejeune J. P.   Grade 1 Spetzler and Martin cerebral ruptured arteriovenous malformations treated by microsurgery: Poor functional outcome is related to injury from haemorrhage.  Neurochirurgie.  2017 ;63 :69-73

INTRODUCTION: Ruptured arteriovenous malformations (rAVM) are life-threatening diseases. OBJECTIVE: To evaluate the outcome of patients with grade 1 SPM rAVM after microsurgical treatment. MATERIALS AND METHOD: We retrospectively included 64 consecutive operated patients with a grade 1 SPM rAVM in our institution between 2002 and 2012. Complications related to the surgical procedure were recorded. All patients were re-evaluated 3months after treatment using the modified Rankin Scale score (mRS). Persistent neurological disorders were evaluated 1year after bleeding. Conventional cerebral angiography was performed for each patient immediately after surgical treatment and 1year later. RESULTS: The mean age at diagnosis was 30.8 years. Initial WFNS score was grade 1 in 25 patients, grade 2 in 11 patients, grade 3 in 10 patients, grade 4 in 9 patients and grade 5 in 9 patients. No remnant was left and a new surgery was performed only in a single patient who was initially operated-on under emergency conditions with limited preoperative investigations due to a poor clinical grade. Early postoperative complications related to the surgical procedure were recorded in 7 patients. The mRS score 3months after treatment was 2) and the hydrocephalus were significantly associated (P<0.05) to a bad functional outcome (mRS>2). CONCLUSION: Grade 1 rAVM is a life-threatening disease concerning in most cases young patients. Long-term morbidity is often related to the hemorrhagic brain damage and rarely to the AVM resection.

Philipp C., Mordon S.   TREATMENT OF FACIAL VASCULAR LESIONS WITH A NOVEL 589nm SOLID-STATE LASER - FIRST CLINICAL OBSERVATIONS.  Lasers Surg. Med..  2017 ;49 :411-412
Fizazi K., Tran N., Fein L., Matsubara N., Rodriguez-Antolin A., Alekseev B. Y., Özgüroğlu M., Ye D., Feyerabend S., Protheroe A., De Porre P., Kheoh T., Park Y. C., Todd M. B., Chi K. N.   Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer.  N. Engl. J. Med..  2017 ;377 :352-360

BACKGROUND: Abiraterone acetate, a drug that blocks endogenous androgen synthesis, plus prednisone is indicated for metastatic castration-resistant prostate cancer. We evaluated the clinical benefit of abiraterone acetate plus prednisone with androgen-deprivation therapy in patients with newly diagnosed, metastatic, castration-sensitive prostate cancer. METHODS: In this double-blind, placebo-controlled, phase 3 trial, we randomly assigned 1199 patients to receive either androgen-deprivation therapy plus abiraterone acetate (1000 mg daily, given once daily as four 250-mg tablets) plus prednisone (5 mg daily) (the abiraterone group) or androgen-deprivation therapy plus dual placebos (the placebo group). The two primary end points were overall survival and radiographic progression-free survival. RESULTS: After a median follow-up of 30.4 months at a planned interim analysis (after 406 patients had died), the median overall survival was significantly longer in the abiraterone group than in the placebo group (not reached vs. 34.7 months) (hazard ratio for death, 0.62; 95% confidence interval [CI], 0.51 to 0.76; P<0.001). The median length of radiographic progression-free survival was 33.0 months in the abiraterone group and 14.8 months in the placebo group (hazard ratio for disease progression or death, 0.47; 95% CI, 0.39 to 0.55; P<0.001). Significantly better outcomes in all secondary end points were observed in the abiraterone group, including the time until pain progression, next subsequent therapy for prostate cancer, initiation of chemotherapy, and prostate-specific antigen progression (P<0.001 for all comparisons), along with next symptomatic skeletal events (P=0.009). These findings led to the unanimous recommendation by the independent data and safety monitoring committee that the trial be unblinded and crossover be allowed for patients in the placebo group to receive abiraterone. Rates of grade 3 hypertension and hypokalemia were higher in the abiraterone group. CONCLUSIONS: The addition of abiraterone acetate and prednisone to androgen-deprivation therapy significantly increased overall survival and radiographic progression-free survival in men with newly diagnosed, metastatic, castration-sensitive prostate cancer. (Funded by Janssen Research and Development; LATITUDE ClinicalTrials.gov number, NCT01715285 .).

de Boysson H., Aide N., Liozon E., Lambert M., Parienti J. J., Monteil J., Huglo D., Bienvenu B., Manrique A., Aouba A.   Repetitive F-18-FDG-PET/CT in patients with large-vessel giant-cell arteritis and controlled disease.  Eur. J. Intern. Med..  2017 ;46 :66-70

OBJECTIVE: (18)F-FDG PET/CT can detect large-vessel involvement in giant-cell arteritis (GCA) with a good sensitivity. In patients with clinically and biologically controlled disease, we aimed to assess how vascular uptakes evolve on repetitive FDG-PET/CT. PATIENTS AND METHODS: All included patients had to satisfy the 4 following criteria: 1) diagnosis of GCA was retained according to the criteria of the American College of Rheumatology or based on the satisfaction of 2 criteria associated with the demonstration of large-vessel involvement on FDG-PET/CT; 2) all patients had a positive PET/CT that was performed at diagnosis before treatment or within the first 10days of treatment; 3) another FDG-PET/CT was performed after at least 3months of controlled disease without any relapse; 4) patients were followed-up at least for 12months. RESULTS: Twenty-five patients (17 [68%] women, median age: 69 [65-78]) with large-vessel inflammation on a baseline FDG-PET/CT and with repetitive imaging during the period with controlled disease were included and followed-up for 62 [25-95] months. Four repeated procedures revealed total extinction of vascular uptakes at 11.5 [8-12] months after the first FDG-PET/CT. Eight PET/CT revealed decreased numbers of vascular uptakes, and 10 procedures revealed no changes. The 3 remaining procedures indicated worsening of the numbers of vascular uptakes in the absence of relapse. CONCLUSIONS: Our study revealed long-term persistent vascular uptake on repeated FDG-PET/CT in >80% of our GCA patients with large-vessel inflammation and clinical-biological controlled disease. Prospective studies are required to confirm these findings.

Oinino S., Rodrigues I., Boulanger T., Andre C., Bonneterre J., Zairi F., Mortier L., Desmedt E., Templier C., Le Rhun E.   Prognosis of leptomeningeal metastases from melanoma: A case series of 28 patients.  J. Clin. Oncol..  2017 ;35
Fenoll C., Jabbour S., Leclere F. M., Pessis R., Lkah C., Atlan M.   Should a Preoperative Testicular Exam Be Mandatory for Abdominal Body Contouring Patients?.  Aesthet. Surg. J..  2017 ;37 :NP36-NP37
Dupont C., Betrouni N., Mordon S. R., Reyns N., Vermandel M.   5-ALA Photodynamic Therapy in Neurosurgery, Towards the Design of a Treatment Planning System: A Proof of Concept.  IRBM.  2017 ;38 :34-41
Guénot M., Lebas A., Devaux B., Colnat-Coulbois S., Dorfmuller G., McGonigal A., Reyns N., Gilard V., Derrey S., Sol J. C., Clémenceau S.   Surgical technique.  Neurophysiol Clin.  2017 ;48 :39-46

In SEEG, as for any surgical procedure, the benefit/risk ratio is a key-point. This implies rigorous clinical practice in terms of indication, information delivered to the patient, and surgical technique. Numerous technical options may be used to achieve this goal. All are valuable, as long as they are executed with rigor and consistency. Intracranial bleeding represents the main risk of the procedure (1-4% of cases). The procedure also carries a risk of infection (0.8%), death (total of 6 reported cases in all the literature, <0.002%), and of minor and transient side effects. SEEG is performed under general anesthesia. MRI is the gold standard morphological imaging, used for targeting and for trajectory calculations. It is strictly necessary to use some form of vascular imaging to minimize the peroperative bleeding risk. SEEG can be performed on a frame-based, or frameless, basis, using stereotactic instrumentation, or a neurosurgical robot. Literature does not provide any data in favour of one of these techniques compared to the other. The minimal acceptable bone thickness is considered to be 2mm. Postoperatively, as soon as any non-preexisting neurological deficit is noticed, neuroimaging must immediately be performed. It is recommended to perform a postoperative imaging during the 24hours after implantation. The numerous current possibilities, in terms of imaging and technology, give rise to many possible stereotactic strategies for performing SEEG implantation. None of these strategies can be considered as superior to the other. The guarantee of the best possible result is provided by the care with which these procedures are done.

Grob J. J., Mortier L., D'Hondt L., Grange F., Baurain J. F., Dréno B., Lebbe C., Robert C., Dompmartin A., Neyns B., Gillet M., Louahed J., Jarnjak S., Lehmann F. F.   Safety and immunogenicity of MAGE-A3 cancer immunotherapeutic with dacarbazine in patients with MAGE-A3-positive metastatic cutaneous melanoma: an open phase I/II study with a first assessment of a predictive gene signature.  ESMO Open.  2017 ;2 :e000203

Background: We assessed safety, immunogenicity and clinical activity of recombinant MAGE-A3 antigen combined with AS15 immunostimulant (MAGE-A3 immunotherapeutic) in association with dacarbazine in patients with metastatic melanoma. Methods: In this open-label, phase I/II, uncontrolled multicentre trial conducted in Belgium and France, patients with MAGE-A3-positive melanoma received up to 24 doses of MAGE-A3 immunotherapeutic (four cycles) coadministered with eight doses of dacarbazine. Adverse events (AE) were recorded until 31 days postvaccination, and serious AEs (SAE), until 30 days following the last dose. MAGE-A3-specific antibodies were measured by ELISA. Clinical activity of MAGE-A3 immunotherapeutic was assessed in patients positive/negative for previously identified gene signature (GS) associated with clinical outcome. Results: Forty-eight patients were enrolled and treated (32 GS+, 15 GS-, 1 unknown GS status); two patients completed the study. All patients reported AEs, the most common were 'general disorders and administration site conditions' (94%). Treatment-related AEs were reported by 85% of patients; the most common was pain at injection site (38%). Sixteen SAEs were reported by 21% of patients; two were considered as treatment related (neutropenia and thrombocytopenia; grade 4). Postdose 4, all patients were seropositive for MAGE-A3-specific antibodies, with a geometric mean titre of 2778.7 ELISA units (EU)/mL (95% CI 1638.3 to 4712.8). One complete and three partial responses were reported (only in GS+ patients). Median overall survival was 11.4 months for GS+ and 5.3 months for GS- patients. Conclusion: Although this trial shows poor results compared with the new results with checkpoint inhibitors, it gives an interesting insight in rapidly developing fields like combinations of immunotherapy and chemotherapy, new generation vaccines and the use of gene profile as a predictive marker. Trial registration number: NCT00849875.

Lear J. T., Basset-Seguin N., Kaatz M., Jouary T., Mortier L., Fabrizio T., Herd R., Leverkus M., Revil C., Page D. R., Grob J. J.   Treatment patterns and outcomes for patients with locally advanced basal cell carcinoma before availability of Hedgehog pathway inhibitors: a retrospective chart review.  Eur. J. Dermatol..  2017 ;27 :386-392

Understanding the molecular basis of basal cell carcinoma (BCC) has led to development of Hedgehog pathway inhibitors (HPIs) for patients with advanced forms of BCC (aBCC). A practical definition of aBCC as a distinct disease entity is unavailable, and epidemiological information is limited. To conduct the RONNIE study to describe characteristics, treatment patterns, and outcomes of patients with aBCC during the period preceding HPI introduction, as well as results from patients with locally advanced BCC (laBCC). A retrospective chart review was conducted using data from adult patients with a new diagnosis of laBCC between 1(st) January 2005 and 31(st) December 2010. The study period was 1(st) January 2005 to 31(st) December 2011 to allow for inclusion of at least 12 months of follow-up information for all patients. RESULTS: Treatment data were available for 106/117 patients. Radiation and excisional surgery were the most common first-line treatment options (43.4% and 23.5% of patients, respectively). Patients typically received multiple subsequent treatments; no apparent trend or pattern was observed. Complete visual response, partial visual response, and stable disease were obtained in 51.9%, 25.9%, and 11.1% of patients, respectively, after first-line surgery, and in 53.7%, 22.0%, and 9.8%, respectively, after first-line radiation. Median progression-free survival after first-line treatment was 32.1 months. Median overall survival was 78.8 months. These data represent a baseline for laBCC before HPIs became part of the treatment algorithm. The observed heterogeneity of treatment patterns highlights the lack of an established standard treatment for laBCC before HPIs were available.