L'objectif du registre des cancers de Guyane est de collecter l ensemble des tumeurs invasives et/ou in situ survenues depuis le 1er janvier 2003 chez des patients vivant en Guyane, quels que soient la localisation de la tumeur, le lieu de diagnostic et de traitement. Cette thèse a pour but de décrire la population atteinte d un cancer afin d améliorer les connaissances sur cette maladie et ainsi de permettre aux actions de santé publique d être plus efficaces.De 2003 à 2009, le taux d incidence des cancers standardisé sur l âge était, dans les deux sexes, 30% inférieur en Guyane par rapport à la France métropolitaine et n était pas différent de celui d Amérique du Sud.Nous avons comparé l incidence, la mortalité et la survie relative des patientes atteintes d un cancer invasif du sein (CIS) et des patientes atteintes d un cancer invasif du col de l utérus (CIC) entre la Guyane et la métropole.Le ratio incidence/mortalité indiquait que les cancers du sein étaient de plus mauvais pronostic en Guyane par rapport à la métropole.La survie relative des femmes atteintes d un CIS était inférieure en Guyane par rapport à la France métropolitaine.En Guyane, le taux standardisé d incidence du cancer du col de l utérus était 4 fois plus élevé qu en métropole. Les femmes vivant dans l intérieur de la Guyane semblaient être diagnostiquées à un stade plus tardif et plus souvent sur symptômes que les femmes du littoral. L accès aux soins des migrants est un challenge et une source d inégalité de santé. La détection précoce des cancers à travers des programmes de prévention est cruciale pour améliorer la survie par cancer et notamment chez les patients étrangers. / The objective of the cancer registry of French Guiana is to compile all patients living in French Guiana with malignant invasive pathology and/or in situ lesions starting January 1st 2003 in persons living in French Guiana, whatever the tumoral location and the place of diagnosis and care. This study aimed to describe the population with invasive cancer to improve the knowledge about this disease in order to target public health interventions more effectively.The age standardised incidence rate was 30% times lower than in France in both sexes and the same than in South America.We compared incidence and relative survival of patients with invasive breast cancer (IBC) and patients with invasive cervical cancer (ICC) between women from French Guiana and metropolitan France.The ratio between incidence and mortality showed that the prognosis of IBC in French Guiana was worse than in metropolitan France.The relative survival rate among women with IBC in French Guiana was lower than among women in metropolitan France.In French Guiana, the age-standardized incidence rate of cervical cancer was four times higher than in France. Women living in remote areas seemed to be diagnosed later and more often following symptoms.Access to care for migrants is challenging and sustains health inequalities. Early detection through prevention programs is crucial for increasing cancer survival notably for foreign-born patients. Further studies with more patients and other variables could improve the knowledge about these diseases

Objectifs : Notre travail avait pour objectifs (i) d’évaluer le bénéfice dosimétrique et de prédire le bénéfice clinique d’une radiothérapie adaptative pour des cancers des voies aéro‐digestives supérieures, à la fois en termes de toxicité et de contrôle local, (ii) d’identifier les patients bons candidats à une stratégie de radiothérapie adaptative, et (iii) d’identifier le meilleur schéma de radiothérapie adaptative pour épargner les parotides. Matériels et méthodes : Le bénéfice dosimétrique a été évalué en utilisant les données de patients inclus dans une étude de phase III évaluant le bénéfice clinique d’une radiothérapie adaptative. La dose cumulée sans et avec radiothérapie adaptative a été estimée par des méthodes de recalage élastique. Une évaluation des différents algorithmes de recalage a été faite à la fois en termes de précision spatiale et d’impact sur la dose estimée. Des modèles de prédiction du risque de surdosage ont été développés en utilisant des modèles linéaires généralisées mixtes et une validation croisée par leave‐one‐out. L’évaluation de différents schémas de radiothérapie adaptative (en termes de fréquence et de nombre) a été réalisée en se basant sur l’épargne des parotides. La valeur prédictive de paramètres quantitatifs issus de la TEP a été évaluée à travers une revue systématique de la littérature. La valeur prédictive de paramètres intensité issue de la TEP a été analysée dans 2 cohortes indépendantes. Résultats : Nos travaux ont confirmé qu’en l’absence de radiothérapie adaptative pour des cancers des VADS, il existe un risque de surdosage des parotides de plus de 2 Gy pour les 2/3 des patients. Il s’y associe un risque de sous dosage de la tumeur de plus de 1 Gy pour 50 % des patients. Une radiothérapie adaptative permet de corriger à la fois le surdosage des parotides (bénéfice clinique estimée de 10 % de diminution du risque de xérostomie) et le sous dosage de la tumeur. Basés sur des paramètres issus de la planification et de la première semaine de traitement, des modèles de prédiction du risque de sur dosage des parotides ou de sous dosage de la tumeur ont été développés. Les paramètres TEP prédictifs du risque de récidive ont été identifiés. Un nomogramme a pu être développé et validé dans une 2nd cohorte de patients. Conclusion : Nos travaux confirment le bénéfice d’une radiothérapie adaptative pour épargner les parotides et maintenir la couverture tumorale. Ce bénéfice dosimétrique devrait permettre une diminution de la toxicité et une amélioration du contrôle local. Des paramètres anatomiques et dosimétriques simples permettent l’identification des patients à risque de surdosage des parotides ou de sous dosage de la tumeur. L’utilisation de la TEP permet d’identifier précocement les patients à haut risque de récidive, candidats potentiels à une intensification thérapeutique. Ces résultats justifient la poursuite des travaux sur une cohorte de patients plus importante, idéalement dans le cadre d’études cliniques de phase III. / Objectifs: The aims of this work were (i) to evaluate the dosimetric benefit and to predict the clinical benefit of adaptive radiotherapy for head and neck cancer, regarding both toxicities and local control, (ii) to identify patients whose good candidate for an adaptive strategy, and (iii) to identify the best adaptive strategy to spare the parotid glands. Materials and methods: The dosimetric benefit was assessed using data from a phase III study evaluating the clinical benefit of an adaptive radiotherapy. Cumulated dose with and without adaptive was estimated using deformable image registration. Different methods of deformable image registration were evaluated regarding both spatial and dose estimation accuracy. Predictive model of the risk of parotid gland overdose was computed using generalized linear mixed model and cross validation by leave‐one‐out. The dosimetric benefit of numerous replanning strategies, defined by various numbers and timing of replanning, with regard to parotid gland sparing, was quantified. We performed a systematic review to evaluate the predictive value of quantitative PET parameters. The predictive value of PET intensity parameters was assessed using two independent cohorts of patients. Résultats: Without adaptive radiotherapy, 65% of the patients had a PG overdose of more than 2 Gy and 50% of the patients had a tumor underdose of more than 1 Gy. Adaptive radiotherapy allows to correct both parotid gland overdose and tumor underdose. Based on parameters calculated at the planning and at the first week of treatment, predictive models of PG overdose and tumor underdose were computed. PET parameters correlated with overall survival were identified. Using two independent cohorts of patients, a nomogram to predict survival was build and externally validated. Conclusion: Our studies showed the benefit of adaptive radiotherapy to spare the parotid glands while increasing tumor coverage. These benefits should allow to decrease the toxicities while increasing local control. Early anatomical and dosimetric parameters allow identifying patients at risk of tumor underdose or parotid gland overdose. PET performed before the treatment allows identifying patients with a high‐risk of locoregional failure and death, potentially candidates for treatment. These results justify further studies on a larger cohort of patients, ideally in phase III clinical trials.

Le cancer du sein inflammatoire (CSI) est l’une des formes la plus agressive en raison de son potentiel métastatique élevé. Le diagnostic est basé sur des signes cliniques avec une émergence rapide, mais en réalité ces signes sont subjectifs et non spécifiques. Malgré le traitement multidisciplinaire, le pronostic reste mauvais avec une survie à 5 ans inférieure à 50% vs 90% dans le cancer du sein non inflammatoire (CSNI). Les CSI sont rares en Europe et aux Etats-Unis, représentant moins de 2% du CS. En Afrique du Nord et en particulier en Tunisie, ils représentent plus de 5% des CS. Notre équipe a trouvé des gènes significativement plus sur-exprimés dans CSI dans une signature moléculaire indépendante des sous-types moléculaires et était composé de 79 gènes. Nous nous sommes intéressés particulièrement à MARCKS qui code pour le substrat majeur de la protéine kinase C. Dans le cadre de cette thèse, nous avons tenté de mieux comprendre les aspects épidémiologiques et cliniques des CSI associés à une distribution géographique différente. Nous analyserons les caractéristiques histo-cliniques et de pronostic sur une série de 219 patientes de CSI traitées à l'Institut Salah Azaiez (Tunis) de 2008 à 2013. Les résultats de cette série historique tunisienne ont été comparés à ceux de la littérature. Évaluer si la protéine MARCKS pourrait être un nouveau marqueur spécifique du CSI par une analyse IHC sur des échantillons de tumeurs CSI et CSNI de patientes française et tunisiennes (N = 502). Les corrélations entre l'expression de MARCKS et les critères cliniques et biologiques ont été établies. / Inflammatory Breast Cancer (IBC is one of the most aggressive breast cancers due its high metastatic potential. The diagnostic is based on clinical signs with rapid emergence but in reality these signs are subjective and non-specific. Despite the multi-modality treatment, the prognosis remains poor with survival in 5-year inferior to 50% vs 90% in non-Inflammatory Breast Cancers (non-IBC). IBC were rare in Europe and USA, represented at least 2% of breast cancer (BC), more frequent in North Africa and particularly in Tunisia which they present more than 5% of BC. Our team has found genes most significantly over-expressed in IBC given a molecular signature independent from the molecular subtypes and was composed of 79 genes. We were interested particularly to MARCKS gene that encodes for the major substrate of protein kinase C. As part of this thesis, we have attempted to better understand the epidemiological and clinical aspects of IBCs associated with a different geographical distribution. We will analyze the histo-clinical characteristics and the prognosis on a series of 219 patients with IBC treated at the Salah Azaiez Institute (Tunis) from 2008 to 2013. The results of this historical Tunisian series were compared with those of literature. Evaluate whether MARCKS protein could be a new specific marker for IBC by an IHC analysis on IBC and non-IBC tumor samples of French and Tunisian patients (N=502). Correlations between the expression of MARCKS and clinical and biological criteria were established.

Please read the abstract in the thesis. / Thesis (PhD)--University of Pretoria, 2013. / gm2013 / Internal Medicine / unrestricted

A naphthoquinone, 7-methyljuglone and some of its 5-hydroxy, 5-acetoxy-, 5-alkoxy- and 1,2,4,5-tetra-O-acetate derivatives were tested for their activity in four human cancer cell lines: breast adenocarcinoma, cervical epithelial carcinoma, oesophageal carcinoma and prostate epithelial carcinoma. Compound 2,5-dihydroxy-7-methyl-1,4-naphthoquinone was found to be the most effective one (exhibited a fifty percent inhibitory concentration (IC50) in the range of 5.3 to 14.7 μM), while the parent compound 7-methyljuglone was less active than several of these derivatives. The IC50 values of 5-hydroxy-6-methyl-1,4-naphthoquinone were found to be between 19.1 and 15.4 μM on the four cell lines. However this compound showed toxicity on peripheral blood mononuclear cells. Six derivatives were selected for mechanistic studies. Considering the findings from cell cycle analysis, caspase 3/7 activation and annexinV-FITC dual labelling, 5-hydroxy-6-methyl-1,4-naphthoquinone was found to have antitumour effect by inducing apoptosis. Two derivatives namely, ‘8-fluoro-5-hydroxy-7- methyl-1,4-naphthoquinone’ and ‘2,5-dihydroxy-7-methyl-1,4-naphthoquinone’ were found to be not toxic on peripheral blood mononuclear cells suggesting their action is specific for tumour cells. Compound 2,5-dihydroxy-7-methyl-1,4-naphthoquinone was found to induce apoptosis through caspase 3/7 activation. In view of the enhanced potencies associated with these derivatives, these analogues may hold considerable therapeutic potential for the treatment of leukaemia cancers. The ethanol extracts of seven plant species (ethnobotanically selected) were also tested for their cytotoxicity, assayed by the XTT assay, against four human cancer cell lines at concentrations ranging from 0.78 to 100 μg/ml. Of all the ethanol extracts, Foeniculum vulgare was found to have the best activity on HeLa cells, which exhibited an IC50 value of 19.97± 0.048 μg/ml. Therefore, it was selected for isolation of the bioactive principles. The extract of Foeniculum vulgare was fractionated using column chromatography with hexane and ethyl acetate at different ratios as eluent. Two known compounds, ‘4-methoxycinnamyl alcohol’ and ‘syringin’ were isolated. The IC50 values of ‘4-methoxycinnamyl alcohol’ and ‘syringin’ were found to be 7.82 ± 0.28 μg/ml and 10.26 ± 0.18 μg/ml respectively on HeLa cells. Both compounds were tested for their cytotoxicity against U937 cells and also on peripheral blood mononuclear cells. At the concentrations of 10 and 100 μg/ml ‘4- methoxycinnamyl alcohol’ showed similar cell proliferation as that of the positive control ‘cisplatin’. ‘Syringin’ however, had much lower cytotoxicity on the U937 cells than ‘4- methoxycinnamyl alcohol’. IC50 was found to be 91.14 ± 0.63 μg/ml. Both ‘syringin’ and ‘4- methoxycinnamyl alcohol’ were not cytotoxic at concentrations of 1 and 10 μg/ml on the PBMCs as compared to cisplatin. ‘4-Methoxycinnamyl alcohol’ was selected based on its activity on the cancer cells, for further investigation with regard to its mechanism of action. On gel electrophoresis it did not show a typical ladder pattern, instead a characteristic smear resulted which indicated necrosis. Two best derivatives of 7-methyljuglone (‘8-fluoro-5-hydroxy-7-methyl-1,4-naphthoquinone’ and ‘2,5-dihydroxy-7-methyl-1,4-naphthoquinone’) and the ethanol extract of F. vulgare warrant further investigation to be considered for their potential as anticancer agents. / Dissertation (MSc)--University of Pretoria, 2011. / Plant Science / unrestricted

Glioblastoma (GBM) is a deadly, malignant brain tumor with a poor long-term prognosis. The current median survival is approximately fifteen to seventeen months with the standard of care therapy which includes surgery, radiation, and chemotherapy. An important factor contributing to recurrence of GBM is high resistance of GBM cancer stem cells (CSCs), for which a systematically delivered single drug approach will be unlikely to produce a viable cure. Therefore, multi-drug therapies are needed. Currently, only temozolomide (TMZ), which is a DNA alkylator, affects overall survival in GBM patients. CSCs regenerate rapidly and over-express a methyl transferase which overrides the DNA-alkylating mechanism of TMZ, leading to drug resistance. Idasanutlin (RG7388, R05503781) is a potent, selective MDM2 antagonist that additively kills GBM CSCs when combined with diagnostics in a truly theranostic manner for enhancing personalized medicine against GBM. The goal of this thesis was to develop a multi-drug therapy using mutli-functional nanoparticles (NPs) that preferentially target the GBM CSC subpopulation and provide in vivo preclinical imaging capability. Polymer-micellar NPs composed of poly(styrene-<i>b</i>-ethylene oxide) (PS-<i>b</i>-PEO) and poly(lactic-<i>co</i>-glycolic) acid (PLGA) were developed investigating both single and double emulsion fabrication techniques as well as combinatinos of TMZ and RG7388. The NPs were covalently bound to a 15 base-pair CD133 aptamer in order to target a specific epitope on the CD133 antigen expressed on the surface of GBM CSC subpopulation. For theranostic functionality, the NPs were also labelled with a positron emission tomography (PET) radiotracer, zirconium-89 (⁸⁹Zr). The NPs maintained a small size of less than 100 nm, a relatively neutral charge and exhibited the ability to produce a cytotoxic effect on CSCs. There was a slight increase in killing with the aptamer-bound NPs compared to those without a targeting agent. This work has provided a potentially therapeutic option for GBM specific for CSC targeting and future in vivo biodistribution

Mesocestoides corti and Taenia crassiceps are tapeworms, larvae of which are characterized by their ability to reproduce asexually. In this work, the effect of infection by M. corti and T. crassiceps in BALB/c, C57BL/6J and ICR mice on the growth and metastasis of B16F10 melanoma tumors was investigated. Although an increase in metastatic activities was observed after intravenous administration of melanoma cells to M. corti-infected mice, both tapeworms showed a strong suppressive effect on the size and number of tumors and metastases formed when the cells were administered intraperitoneally. This, in some cases, led to a complete elimination of tumor cells. In vitro cultivation of B16F10 cells in the presence of larval excretory-secretory products led to a decrease in their viability but an increase in their migration ability. Flow cytometry proved that M. corti infection has an effect on the increased number and proportion of macrophage populations in the peritoneum of ICR mice. Our work confirmed the anti-tumor effect of T. crassiceps infection in mice and introduced M. corti as a new helminth species capable of influencing cancer. Key words: helminths, cestodes, cancers, Mesocestoides corti, Taenia crassiceps

No description available.

Première cause de mortalité en France, la pathologie cancéreuse est aussi l’un des principaux facteurs des inégalités sociales devant la mort. La responsabilité du travail dans sa survenue demeure largement sous-estimée, en lien notamment avec l’importance du non-recours au droit de la réparation des maladies professionnelles par les personnes atteintes de cancer, évoqué institutionnellement par les termes de « sous déclaration » et de « sous reconnaissance ». Profitant d’un dispositif d’alerte et d’accompagnement s’exerçant depuis 2002 sur le territoire de la Seine-Saint-Denis (GISCOP93), cette recherche s’est attelée à suivre au long cours des salariés ou anciens salariés atteints de cancer broncho-pulmonaire, et leurs proches, dans leur parcours d’accès au droit à réparation, pour identifier les facteurs de l’exercice de ce droit.Nourrie de ce matériau ethnographique, de fonds d’archives et d’observations dans une Caisse primaire d’assurance maladie, la thèse se partage en trois séquences. La première, après avoir précisé le dispositif de recherche mis en place, s’intéresse aux conditions nécessaires à l’exercice du droit : il s’agit pour ces salariés et anciens salariés de parvenir à se concevoir « victimes » de leur travail passé et à trouver les ressources pour s’engager dans de telles démarches. La deuxième s’attache à reconstituer l’histoire de la catégorie médico-légale des cancers professionnels, qui apparaît au début du XXe siècle et, plus particulièrement, celle des cancers broncho-pulmonaires : elle témoigne des conditions de fabrication de la « présomption d’origine » – au fondement du système de réparation des maux du travail – dans le cas de cette pathologie. En suivant la trajectoire d’un tableau de maladie professionnelle du début des années 1920 jusqu’au début des années 1990, elle donne à voir la fragilité de cette catégorie. La troisième séquence permet d’observer ce qu’il advient de ce droit au moment où il est appliqué par l’organisme en charge d’instruire les dossiers. Elle donne à voir les coulisses de l’instruction et les conditions de qualification d’un cancer en maladie professionnelle. / Cancerous pathologies, currently the leadingcause of death in France, are also one of the main causes of social inequalities before death. The importance of occupational factors in the onset of the disease remains largely under-estimated, particularly because very few cancr patients exercise their right to compensation for occupational diseases, a phenomenon officially described as "under-reporting" and "under-recognition". This research, which has benefited from data collected by a program designed to identify and support occupational-cancer patients implemented since 2002 in the French département of Seine-Saint-Denis by the the French "Groupement d'Intérêt Scientifique sur les Cancers d'Origine Professionnelle" (ie GISCOP93, a scientific association for occupational cancers), set out to monitor current and former workers and employees who have been diagnosed with broncho-pulmonary cancer as well as their families, as they go through the process of seeking and obtaining compensation, in order to identify the factors that determine whether they do or do not exercise their rights. This research, based on the data gathered during this phase of ethnographical research, on archival holdings and on observations in a French "Caisse primaire d'assurance maladie" (CPAM, ie local healthcare insurance office), comprises three parts. After describing the research protocol that was implemented, the first part focuses on identifying the conditions required for occupational-cancer patients, to exercise their rights: they need to learn to perceive themselves as "victims" of their occupational history and to find the resources necesary to start the compensation-seeking process. The second part focuses on retracing the history of the medical and legal category of occupational cancer, which was first defined in the early 20th century, and more specifically, on the history of broncho-pulmonary cancers. This part describes the conditions which led to creating the notion of "presumed origin" - a cornerstone of the occupational-harm reparation system - in the case of this specific type of cancer. By retracing the stages of evolution of a table of occupational diseases from the early 1920s to the early 1990s, it illustrates how fragile this last category can be. The third section records what happens when the right to compensation is enforced by the institution in charge of investigating claims, revealing what takes place behind the scènes during the investigation of a claimand the conditions that define whether and when a case of cancer is recognized as an occupational disease.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24516号 / 医博第4958号 / 新制||医||1064(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊藤 貴浩, 教授 岩田 想, 教授 武藤 学 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM