SYSTEMIC TREATMENT OF BONE SARCOMA, SOFT TISSUE SARCOMA, GIST. In osteosarcomas and Ewing sarcomas, the interest of systemic treatments is established in neo-adjuvant and adjuvant setting. Effective molecules are doxorub...SYSTEMIC TREATMENT OF BONE SARCOMA, SOFT TISSUE SARCOMA, GIST. In osteosarcomas and Ewing sarcomas, the interest of systemic treatments is established in neo-adjuvant and adjuvant setting. Effective molecules are doxorubicin, alkyls, vinca-alkaloids and etoposide in Ewing's sarcomas, and methotrexate, doxorubicin, cisplatin, ifosfamide and etoposide in osteosarcoma. Several ongoing clinical studies raise the question of the value of maintenance treatment, including anti-angiogenic tyrosine kinase inhibitors. In soft tissue sarcomas, anthracyclines remain the reference molecules, either in the adjuvant (neo) or metastatic setting. Other anti-angiogenic chemotherapy molecules or tyrosine kinase inhibitors are authorized whose effectiveness differs depending on the histological subtype. In the adjuvant setting, many questions remain about the optimal use of chemotherapy and the selection of patients who could benefit from such a strategy. In high-risk gastro intestinal stromal tumor (GIST), the standard is 3 years adjuvant treatment with imatinib; a recent study asks whether treatment should continue for up to 6 years. In metastatic GIST, patients are treated with 4 successive lines of more or less specific tyrosine kinase inhibitors: imatinib, sunitinib, regorafenib, riprenib.
SURGICAL MANAGEMENT OF BONE SARCOMAS. Bone sarcoma surgery must be carried out by a specialized team, often multidisciplinary, integrated into the NetSarc+ network. Its main objective is to obtain appropriate margins to...SURGICAL MANAGEMENT OF BONE SARCOMAS. Bone sarcoma surgery must be carried out by a specialized team, often multidisciplinary, integrated into the NetSarc+ network. Its main objective is to obtain appropriate margins to limit the risk of recurrence. Technical advances made in the resection and reconstruction of bone sarcomas have improved the quality of life of patients and reduced the amputation rate. Complications (infection, failure of reconstruction) are numerous, and surgical revisions are frequent. Functional after-effects (neurological deficits, chronic pain) are omnipresent and responsible for a disability that is sometimes difficult for the patient to accept. Collaboration between the surgical oncologist and the attending physician is an essential tool during the long-term follow-up of these patients.
Bonvalot S, Tzanis D, Bouhadiba T
… +1 more, Meeus P
Rev Prat
· 2025 Nov · PMID 41575113
SURGERY OF SOFT TISSUE SARCOMA IN ADULTS. Medical strategy and surgery of soft tissue sarcoma are decided within the multidisciplinary tumor board with an appropriate imaging assessment, multiple percutaneous core needle...SURGERY OF SOFT TISSUE SARCOMA IN ADULTS. Medical strategy and surgery of soft tissue sarcoma are decided within the multidisciplinary tumor board with an appropriate imaging assessment, multiple percutaneous core needle biopsies to confirm diagnosis and a correct staging and risk assessment. Surgery must be carried out by a surgeon specifically trained in the treatment of this disease in an expert center. The standard surgical procedure is an one bloc excision with clear margins, which implies removing the tumour with a rim of normal tissue around it.
THE DIAGNOSIS OF SARCOMA REQUIRES TEAM EXPERTISE. Sarcoma is the prototype of the "rare cancer" which suff ers from a sometimes complicated diagnostic pathway. This is all the truer for soft tissue sarcomas for which the...THE DIAGNOSIS OF SARCOMA REQUIRES TEAM EXPERTISE. Sarcoma is the prototype of the "rare cancer" which suff ers from a sometimes complicated diagnostic pathway. This is all the truer for soft tissue sarcomas for which the clinical signs are not very specific or even falsely reassuring. The key message is that any patient with a suspected sarcoma must be referred as soon as possible to an expert "sarcoma" center belonging to the NetSarc+ network to benefit from the expertise both diagnostically and therapeutically. In the centers of this expert network, the diagnostic phase begins with radiological expertise both on the analysis of tumor semiology and on the taking of specific samples for diagnostic purposes. This precious sample allows the expert pathologist to apply the most accurate techniques to off er a precise diagnosis and determine the grade of malignancy, paving the way for personalized treatment.
A PLURAL ENTITY. Sarcoma are a heterogeneous group of 150 different histopathological entities, developed from soft tissues or bone of any anatomical location.Their estimated incidence is around 70 cases for 100 000 peop...A PLURAL ENTITY. Sarcoma are a heterogeneous group of 150 different histopathological entities, developed from soft tissues or bone of any anatomical location.Their estimated incidence is around 70 cases for 100 000 people. They can occur in patients of any age, including children, the median age of onset being around 60 years. Most sarcomas are sporadic, since predisposing factors are rare. In France, the treatment of patiens with sarcomas must be carried out, within a center belonging to Netsarc+ networt as soon as a diagnosis is suspected, to offer them a better prognosis, mostly explained by the quality of the surgery, a major prognostic factor in these diseases.
Peiffer G, Lajzerowicz N, Galera O
… +3 more, Perriot J, Ricard E, Gallopel-Morvan K
Rev Prat
· 2025 Nov · PMID 41575108
TOBACCO IN FILMS AND SMOKING AMONG YOUNG PEOPLE. The presence of tobacco in films and TV series remains widespread, despite its proven impact on the initiation of smoking among young people. In addition to films, platfor...TOBACCO IN FILMS AND SMOKING AMONG YOUNG PEOPLE. The presence of tobacco in films and TV series remains widespread, despite its proven impact on the initiation of smoking among young people. In addition to films, platforms massively distribute these images, influencing adolescents, whose risk of starting to smoke is multiplied by two to three after exposure. Social media amplifies this phenomenon. In response to this observation, measures have been proposed: film classification, health warnings, and awareness-raising among film professionals and platforms. However, total censorship is contested in the name of artistic freedom. The challenge is to reconcile public health and creative freedom to achieve the goal of a tobacco-free generation by 2032.
NEW TECHNIQUES OF PROSTATE IRRADIATION. Radiotherapy is a leading treatment in the management of prostate cancer. Technological developments and experience have made it possible to develop innovative techniques, to carry...NEW TECHNIQUES OF PROSTATE IRRADIATION. Radiotherapy is a leading treatment in the management of prostate cancer. Technological developments and experience have made it possible to develop innovative techniques, to carry out shorter treatments, with fewer sessions and similar effectiveness, with a good control of toxicity. Historical treatments involving 40 sessions have been replaced by much shorter cycles of 20 sessions and even as few as 5 sessions in carefully selected cases. The hindsight seems sufficient, and ongoing studies suggest the installation of new treatment standards, and in the goal for the future is one session treatments.
Sabé M, Seragnoli F, Penzenstadler L
… +1 more, Thorens G
Rev Prat
· 2025 Oct · PMID 41575100
A TRUE THERAPEUTIC REVOLUTION OR A TREND? Psychedelics, long marginalized, are now gaining renewed interest in psychiatry for their therapeutic potential. Substances like psilocybin, LSD, and MDMA are being studied for t...A TRUE THERAPEUTIC REVOLUTION OR A TREND? Psychedelics, long marginalized, are now gaining renewed interest in psychiatry for their therapeutic potential. Substances like psilocybin, LSD, and MDMA are being studied for treating conditions such as treatment-resistant depression, post-traumatic stress disorder (PTSD), and anxiety in palliative care. The FDA granted psilocybin "breakthrough therapy" status for certain indications in psychiatry, and progress has been made in Phase 3 clinical trials. However, the use of psychedelics carries risks, especially with non-medical use, including side effects. Stigmatization, their illegal status in many countries, and high costs limit accessibility. Despite promising results, the integration of these substances in psychiatry remains uncertain and raises ethical and societal concerns.
FROM HEPARIN-INDUCED THROMBOCYTOPENIA TO THE EMERGENCE OF VITT LIKE SYNDROMES. Heparin-induced immune-allergic thrombocytopenia (HIT) and vaccine-induced thrombotic immune thrombocytopenia (VITT) first described in 2021,...FROM HEPARIN-INDUCED THROMBOCYTOPENIA TO THE EMERGENCE OF VITT LIKE SYNDROMES. Heparin-induced immune-allergic thrombocytopenia (HIT) and vaccine-induced thrombotic immune thrombocytopenia (VITT) first described in 2021, share pathophysiological mechanisms involving anti-PF4 antibodies. HIT results from the formation of anti-PF4/heparin antibodies, leading to thrombocytopenia associated with a hypercoagulable state. VITT, which occurs following adenoviral vector vaccination, exhibits similarities with HIT but arises without prior heparin exposure and often involves anti-PF4 antibody reactivity that is independent of heparin. The diagnosis of both HIT and VITT relies on specific biological tests conducted in expert centers to confirm the pathogenicity of anti-PF4 antibodies. Since 2022, the discovery of a new acquired autoimmune thrombotic disease, referred to as "VITT-like", has been reported in infectious or hematological contexts, further expanding the spectrum of immune-thrombotic disorders associated with anti-PF4 antibodies.
CYSTIC LESIONS OF THE PANCREAS. The practice of every gastroenterologist is daily punctuated by the management of patients with pancreatic cystic lesions (PCL). The discovery is usually fortuitous and the lesions in majo...CYSTIC LESIONS OF THE PANCREAS. The practice of every gastroenterologist is daily punctuated by the management of patients with pancreatic cystic lesions (PCL). The discovery is usually fortuitous and the lesions in majority are small (less than 10mm). The prevalence of PCL in the general population of adults is very high and probably greater than 40% if we consider lesions of 2 mm. Some PCL are precancerous lesions, (as intraductal papillary mucinous neoplasm [IPMN]) with a real risk of pancreatic adenocarcinoma and others cystic lesions have a risk of metastases such as pseudopapillary and solid tumors or cystic neuroendocrine tumors. The follow-up protocol, recommended by international experts, is highly debated because it is expensive, potentially invasive (in case of repeated use of endoscopic ultrasound) and not perfect. Only a few patients will develop aggressive and potentially invasive lesions. However, the lack of specific diagnostic tools for the grade of dysplasia and the mortality rate of pancreatic cancer leads European experts to recommend regular monitoring.
HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS. Hemophagocytic lymphohistiocytosis (HLH) is an uncontrolled, life-threatening inflammation caused by immune dysregulation and excessive activation of macrophages and T lymphocytes. HLH...HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS. Hemophagocytic lymphohistiocytosis (HLH) is an uncontrolled, life-threatening inflammation caused by immune dysregulation and excessive activation of macrophages and T lymphocytes. HLH is characterized by persistent fever, hepatosplenomegaly, hyperferritinemia, cytopenia, coagulopathy, and hemophagocytosis. A distinction is made between the primary (genetic/familial) form (HLHp), which is caused by mutations in genes involved in the T and NK cells cytotoxicity pathway, and the secondary (acquired) form (HLHs), which usually occurs in the setting of an immunodeficiency associated with a neoplastic, infectious or autoimmune pathology. Early diagnosis and prompt treatment of the triggering factor, combined with HLH control thanks to corticosteroid therapy and sometimes immunosuppressants (etoposide, biotherapies), are the basis of management.