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Romuald Wernert

Bio: Romuald Wernert is an academic researcher. The author has contributed to research in topics: Hyperthermic intraperitoneal chemotherapy & Medicine. The author has an hindex of 5, co-authored 8 publications receiving 181 citations.

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Journal ArticleDOI
TL;DR: Compared with CRSa, CRS-HIPEC improved OS and recurrence-free survival, without additional morbidity or mortality, and may be considered a valuable therapy for strictly selected patients with limited PMs from GC.
Abstract: PURPOSEGastric cancer (GC) with peritoneal metastases (PMs) is a poor prognostic evolution. Cytoreductive surgery (CRS) yields promising results, but the impact of hyperthermic intraperitoneal chem...

184 citations

Journal ArticleDOI
01 Jun 2016-Ejso
TL;DR: This application offers computer-assistance to produce simple, quick but precise and standardized pre, intra and postoperative reports of the extent of peritoneal metastases and may help specialized and non-specialized institutions in their current practice but also facilitate research and multicentre studies on peritoneAL surface malignancies.
Abstract: Based on the importance of assessing the true extent of peritoneal disease, PeRitOneal MalIgnancy Stage Evaluation (PROMISE) internet application (www.e-promise.org) has been developed to facilitate tabulation and automatically calculate surgically validated peritoneal cancer index (PCI), and other surgically validated scores as Gilly score, simplified peritoneal cancer index (SPCI), Fagotti and Fagotti-modified scores. This application offers computer-assistance to produce simple, quick but precise and standardized pre, intra and postoperative reports of the extent of peritoneal metastases and may help specialized and non-specialized institutions in their current practice but also facilitate research and multicentre studies on peritoneal surface malignancies.

49 citations

Journal ArticleDOI
01 Apr 2019
TL;DR: The timing and patterns of recurrence of Pseudomyxoma peritonei are defined to provide a basis for modifying follow-up of these patients.
Abstract: Background Pseudomyxoma peritonei (PMP) is a rare clinical condition characterized by mucinous ascites, typically related to appendiceal or ovarian tumours. Current standard treatment involves cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), but recurrences occur in 20-30 per cent of patients. The aim of this study was to define the timing and patterns of recurrence to provide a basis for modifying follow-up of these patients. Methods This observational study examined a prospectively developed multicentre national database (RENAPE working group) to identify patients with recurrence after optimal CRS and HIPEC for PMP. Postoperative complications, long-term outcomes and potential prognostic factors were evaluated. Results Of 1411 patients with proven PMP, 948 were identified who had undergone curative CRS and HIPEC. Among these patients, 229 first recurrences (24·2 per cent) were identified: 196 (20·7 per cent) occurred within the first 5 years (early recurrence) and 30 (3·2 per cent) occurred between 5 and 10 years. Three patients developed a first recurrence more than 10 years after the original treatment. The mean(s.d.) time to first recurrence was 2·36(2·21) years. Preoperative chemotherapy and high-grade pathology were significant factors for early recurrence. Overall survival for the entire group was 77·9 and 63·1 per cent at 5 and 10 years respectively. The principal site of recurrence was the peritoneum. Conclusion Recurrence of PMP was rare after 5 years and exceptional after 10 years.

38 citations

Journal ArticleDOI
S. Valmary-Degano, Prudence Colpart, Laurent Villeneuve1, F. Monnien, L. M'Hamdi, G. Lang Averous, M. Capovilla, Frédéric Bibeau2, M. H. Laverrière3, V. Verriele-Beurrier, H. Ben Rejeb, Peggy Dartigues4, J. Hommell-Fontaine5, François-Noël Gilly5, S. Isaac5, E. Mery, Julio Abba3, Karine Abboud6, Mohammad Alyami5, Catherine Arvieux3, Naoual Bakrin5, G. Balague, V. Barrau, J.M. Bereder, I. Berton-Rigaud, I. Bonnefoy5, D. Bouzard, I. Bricault3, Cécile Brigand, S. Carrere, C. de Chaisemartin, M. Chassang, A. Chevallier, Thomas Courvoisier, A. Dohan, Clarisse Dromain4, Julien Dubreuil5, Frédéric Dumont, Clarisse Eveno, M. Faruch-Bilfeld, G. Ferron, Laure Fournier, Johan Gagnière, D. Geffroy, L. Ghouti, Laurence Gladieff, Olivier Glehen, Diane Goéré4, A. Guibal, Jean-Marc Guilloit, Frédéric Guyon, Bruno Heyd, Christine Hoeffel7, C. Hordonneau, P. Jourdan-Enfer5, R. Kaci, R. Kianmanesh7, C. Labbé-Devilliers, J. Lacroix, B. Lelong, A. Leroux-Broussier, Yoann Lherm, R. Lo Dico, Gérard Lorimier, Caroline Malhaire8, Frédéric Marchal, Pascale Mariani8, E. Mathiotte, Pierre Meeus, S. Msika, Cédric Nadeau9, Pablo Ortega-Deballon, Guillaume Passot, O. Pellet, P. Peyrat, Denis Pezet, Nicolas Pirro, Marc Pocard, F. Poizat, Jack Porcheron, A. Poulet5, François Quenet, P. Rat, P. Rousselot, H. Senellart, M. Serrano5, Vincent Servois8, O. Sgabura, Andrea Skanjeti5, Magali Svrcek, R. Tetreau, Emilie Thibaudeau, Y. Touchefeu, Jean-Jacques Tuech, Delphine Vaudoyer5, S. Velasco, Romuald Wernert, Franck Zinzindohoué 
01 Oct 2017-Ejso
TL;DR: PD-L1 expression by immune cells evaluated with E1L3N was an independent prognostic factor in EPMM and Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy predicted better prognosis than other treatments.
Abstract: Background Epithelioid peritoneal malignant mesothelioma (EPMM) is the most common subtype of this aggressive tumor. We compared two antibodies against PD-L1, a recent theranostic biomarker, and evaluated the prognostic value of PD-L1 expression by mesothelial and immune cells in EPMM. Methods Immunohistochemistry was performed on 45 EPMM. Clinical and pathological data were extracted from the RENAPE database. Using E1L3N and SP142 clones, inter-observer agreement, PD-L1 expression by mesothelial and immune cells and inter-antibody agreement were evaluated. The prognostic relevance of PD-L1 expression was evaluated in 39 EPMM by univariate and multivariate analysis of overall survival (OS) and progression-free survival (PFS). Results Inter-observer agreement on E1L3N immunostaining was moderate for mesothelial and immune cells, and fair for mesothelial and poor for immune cells using SP142. Using E1L3N, 31.1% of mesothelial and 15.6% of immune cells expressed PD-L1, and 22.2% of mesothelial and 26.7% of immune cells using SP142. Inter-antibody agreement was moderate. In most positive cases, 1–5% of tumor cells were positive. Using E1L3N, PD-L1 expression by lymphocytes was associated with better OS and PFS by both univariate and multivariate analysis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy predicted better prognosis than other treatments. Solid subtype was an independent prognostic factor for worse OS. Conclusion E1L3N appeared easier to use than SP142 to evaluate PD-L1 expression. A minority of EPMM expressed PD-L1, and only a few cells were positive. PD-L1 expression by immune cells evaluated with E1L3N was an independent prognostic factor in EPMM.

19 citations

Journal ArticleDOI
TL;DR: In this article, the impact of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on the prognosis of gastric poorly cohesive carcinoma (PCC) was investigated.
Abstract: BACKGROUND The incidence of gastric poorly cohesive carcinoma (PCC) is increasing. The prognosis for patients with peritoneal metastases remains poor and the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is controversial. The aim was to clarify the impact of gastric PCC with peritoneal metastases treated by CRS with or without HIPEC. METHODS All patients with peritoneal metastases from gastric cancer treated with CRS with or without HIPEC, in 19 French centres, between 1989 and 2014, were identified from institutional databases. Clinicopathological characteristics and outcomes were compared between PCC and non-PCC subtypes, and the possible benefit of HIPEC was assessed. RESULTS In total, 277 patients were included (188 PCC, 89 non-PCC). HIPEC was performed in 180 of 277 patients (65 per cent), including 124 of 188 with PCC (66 per cent). Median overall survival (OS) was 14.7 (95 per cent c.i. 12.7 to 17.3) months in the PCC group versus 21.2 (14.7 to 36.4) months in the non-PCC group (P < 0.001). In multivariable analyses, PCC (hazard ratio (HR) 1.51, 95 per cent c.i. 1.01 to 2.25; P = 0.044) was associated with poorer OS, as were pN3, Peritoneal Cancer Index (PCI), and resection with a completeness of cytoreduction score of 1, whereas HIPEC was associated with improved OS (HR 0.52; P < 0.001). The benefit of CRS-HIPEC over CRS alone was consistent, irrespective of histology, with a median OS of 16.7 versus 11.3 months (HR 0.60, 0.39 to 0.92; P = 0.018) in the PCC group, and 34.5 versus 14.3 months (HR 0.43, 0.25 to 0.75; P = 0.003) in the non-PCC group. Non-PCC and HIPEC were independently associated with improved recurrence-free survival and fewer peritoneal recurrences. In patients who underwent HIPEC, PCI values of below 7 and less than 13 were predictive of OS in PCC and non-PCC populations respectively. CONCLUSION In selected patients, CRS-HIPEC offers acceptable outcomes among those with gastric PCC and long survival for patients without PCC.

18 citations


Cited by
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Journal ArticleDOI
TL;DR: Gastric cancer is not a top-10 malignancy in the United States but represents one of the most common causes of cancer death worldwide as mentioned in this paper, therefore, multidisciplinary treatment is paramount to treatment selection.
Abstract: Gastric cancer is not a top-10 malignancy in the United States but represents one of the most common causes of cancer death worldwide. Biological differences between tumors from Eastern and Western countries add to the complexity of identifying standard-of-care therapy based on international trials. Systemic chemotherapy, radiotherapy, surgery, immunotherapy, and targeted therapy all have proven efficacy in gastric adenocarcinoma; therefore, multidisciplinary treatment is paramount to treatment selection. Triplet chemotherapy for resectable gastric cancer is now accepted and could represent a plateau of standard cytotoxic chemotherapy for localized disease. Classification of gastric cancer based on molecular subtypes is providing an opportunity for personalized therapy. Biomarkers, in particular microsatellite instability (MSI), programmed cell death ligand 1 (PD-L1), human epidermal growth factor receptor 2 (HER2), tumor mutation burden, and Epstein-Barr virus, are increasingly driving systemic therapy approaches and allowing for the identification of populations most likely to benefit from immunotherapy and targeted therapy. Significant research opportunities remain for the less differentiated histologic subtypes of gastric adenocarcinoma and those without markers of immunotherapy activity.

515 citations

Journal ArticleDOI
TL;DR: Treatment of gastric cancer is rapidly evolving in an effort to combat this challenging disease.
Abstract: Gastric adenocarcinoma is the fifth most common and the third most lethal cancer worldwide. Surgery is the only chance of cure, but recurrence is common, even with complete resection. Advances in diagnosis and staging, genomic classification, surgical resection and treatment of peritoneal disease, systemic chemotherapy and chemoradiation, and targeted and immune therapies have led to the current multidisciplinary approach to gastric adenocarcinoma. Treatment of gastric cancer is rapidly evolving in an effort to combat this challenging disease.

235 citations

Journal ArticleDOI
TL;DR: From the findings, PIPAC has been shown to be feasible and safe and can be considered as a treatment option for refractory, isolated peritoneal metastasis of various origins, however, its use in further indications needs to be validated by prospective studies.
Abstract: Summary Pressurised intraperitoneal aerosol chemotherapy (PIPAC) was introduced as a new treatment for patients with peritoneal metastases in November, 2011. Reports of its feasibility, tolerance, and efficacy have encouraged centres worldwide to adopt PIPAC as a novel drug delivery technique. In this Review, we detail the technique and rationale of PIPAC and critically assess its evidence and potential indications. A systematic search was done to identify all relevant literature on PIPAC published between Jan 1, 2011, and Jan 31, 2019. A total of 106 articles or reports on PIPAC were identified, and 45 clinical studies on 1810 PIPAC procedures in 838 patients were included for analysis. Repeated PIPAC delivery was feasible in 64% of patients with few intraoperative and postoperative surgical complications (3% for each in prospective studies). Adverse events (Common Terminology Criteria for Adverse Events greater than grade 2) occurred after 12–15% of procedures, and commonly included bowel obstruction, bleeding, and abdominal pain. Repeated PIPAC did not have a negative effect on quality of life. Using PIPAC, an objective clinical response of 62–88% was reported for patients with ovarian cancer (median survival of 11–14 months), 50–91% for gastric cancer (median survival of 8–15 months), 71–86% for colorectal cancer (median survival of 16 months), and 67–75% (median survival of 27 months) for peritoneal mesothelioma. From our findings, PIPAC has been shown to be feasible and safe. Data on objective response and quality of life were encouraging. Therefore, PIPAC can be considered as a treatment option for refractory, isolated peritoneal metastasis of various origins. However, its use in further indications needs to be validated by prospective studies.

197 citations

Journal ArticleDOI
TL;DR: This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy, as well as future perspectives for heating technology for the treatment of tumors.
Abstract: The therapeutic application of heat is very effective in cancer treatment Both hyperthermia, ie, heating to 39-45 °C to induce sensitization to radiotherapy and chemotherapy, and thermal ablation, where temperatures beyond 50 °C destroy tumor cells directly are frequently applied in the clinic Achievement of an effective treatment requires high quality heating equipment, precise thermal dosimetry, and adequate quality assurance Several types of devices, antennas and heating or power delivery systems have been proposed and developed in recent decades These vary considerably in technique, heating depth, ability to focus, and in the size of the heating focus Clinically used heating techniques involve electromagnetic and ultrasonic heating, hyperthermic perfusion and conductive heating Depending on clinical objectives and available technology, thermal therapies can be subdivided into three broad categories: local, locoregional, or whole body heating Clinically used local heating techniques include interstitial hyperthermia and ablation, high intensity focused ultrasound (HIFU), scanned focused ultrasound (SFUS), electroporation, nanoparticle heating, intraluminal heating and superficial heating Locoregional heating techniques include phased array systems, capacitive systems and isolated perfusion Whole body techniques focus on prevention of heat loss supplemented with energy deposition in the body, eg, by infrared radiation This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy Proven and experimental clinical applications of thermal ablation and hyperthermia are listed Methods for temperature measurement and the role of treatment planning to control treatments are discussed briefly, as well as future perspectives for heating technology for the treatment of tumors

153 citations