Sur le théorème locale des cycles invariants

Si on considère une famille de variétés projectives complexes non singulières, c"est un fait aujourd'hui bien connu que les possibles variétés singulières vers lesquelles peut dégénerer cette famille doivent vérifier certaines contraintes, parmi lesquelles une importante relation entre la cohomologie de la fibre singulière, la cohomologie de la fibre générique et la monodromie de la famille, qui est precise par le théorème local des cycles invariants prouvé par Clemens, Deligne et Steenbrink ([1], [4], [13]) : tous les cocycles de la fibre générique qui sont invariants par la monodromie autour d¡une fibre singulière proviennent par spécialisation de la cohomologie de cette fibre singulière.

Final results of the SAKK 16/00 trial: a randomized phase III trial comparing neoadjuvant chemoradiation to chemotherapy alone in stage IIIA/N2 non-small cell lung cancer (NSCLC).

Aim: One standard option in the treatment of stage IIIA/N2 NSCLC is neoadjuvant chemotherapy followed by surgery. We investigated in a randomized trial whether the addition of neoadjuvant radiotherapy would improve the outcome. Here we present the final results of this study. Methods: Patients (pts.) with pathologically proven, resectable stage IIIA/N2 NSCLC, performance status 0-1, and adequate organ function were randomized 1:1 to chemoradiation (CRT) with 3 cycles of neoadjuvant chemotherapy (cisplatin 100 mg/m2 and docetaxel 85 mg/m2 d1, q3weeks) followed by accelerated concomitant boost radiotherapy (RT) with 44 Gy in 22 fractions in 3 weeks, or neoadjuvant chemotherapy alone (CT), with subsequent surgery for all pts. The primary endpoint was event-free survival (EFS). Results: 232 pts. were randomized in 23 centers, the median follow-up was 53 months. Two thirds were men, median age was 60 years (range 37-76). Histology was squamous cell in 33%, adenocarcinoma in 43%. Response rate to CRT was 61% vs. 44% with CT. 85% of all pts. underwent surgery, 30-day postoperative mortality was 1%. The rate of complete resection was 91% (CRT) vs. 81% (CT) and the pathological complete remission (pCR) rate was 16% vs. 12%. The median EFS was 13.1 months (95% CI 9.9 - 23.5) for the CRT group vs. 11.8 months (95% CI 8.4 - 15.2) in the CT arm (p 0.665). The median overall survival (OS) with CRT was 37.1 months (95% CI 22.6 -50), with CT 26.1 months ( 95% CI 26.1 - 52.1, p 0.938). The local failure rate was 23% in both arms. In the CT arm 12 pts. were given postoperative radiotherapy (PORT) for R1 resection, 6 pts. received PORT in violation of the protocol. Pts. with a pCR, mediastinal downstaging to ypN0/1 and complete resection had a better outcome. Toxicity of chemotherapy was substantial, especially febrile neutropenia was common, whereas RT was well tolerated. Conclusions: This is the first completed phase III trial to evaluate the role of induction chemoradiotherapy and surgery, in comparison to neoadjuvant CT alone followed by surgery. RT was active, it increased response, complete resection and pCR rates. However, this failed to translate into an improvement of local control, EFS or OS. Notably, surgery after induction treatment was safe, including pneumonectomy. The overall survival rates of our neoadjuvant regimen are very encouraging, especially for a multicenter setting. Disclosure: M. Pless: Advisory Board for Sanofi; R. Cathomas: Advisory Board Sanofi D.C. Betticher: Advisory Board Sanofi. All other authors have declared no conflicts of interest.

Aplicação de um protocolo de espectroscopia por ressonância magnética das adrenais: experiência com mais de 100 casos

Objetivo: Avaliar um protocolo de espectroscopia por ressonância magnética (ERM) do próton de hidrogênio (1H) bidimensional (2D) disponível comercialmente (Siemens Medical Systems; Erlangen, Alemanha), aplicado para nódulos adrenais e diferenciação das massas (adenomas, feocromocitomas, carcinomas e metástases). Materiais e Métodos: Um total de 118 pacientes (36 homens e 82 mulheres), apresentando-se com 138 nódulos/massas adrenais, foi avaliado prospectivamente (média de idade: 57,3 ± 13,3 anos). Uma sequência de ERM-1H-PRESS-CSI (espectroscopia por resolução de ponto-imagem por desvio químico) multivoxel foi utilizada. Análise espectroscópica foi realizada da esquerda-direita, sentido crânio-caudal, usando três sequências sagitais, além de sequências axiais e coronais T2-HASTE. Os seguintes índices foram calculados: colina (Cho)/creatina (Cr), 4,0–4,3 ppm/Cr, lipídio (Lip)/Cr, Cho/Lip e lactato (Lac)/Cr. Resultados: ERM-1H-2D foi bem sucedida em 123 (89,13%) lesões. Os valores de sensibilidade e especificidade encontrados para as proporções e pontos de corte avaliados foram: Cho/Cr ≥ 1,2, sensibilidade de 100% e especificidade de 98,2% (diferenciação de adenomas e carcinomas de feocromocitomas e metástases); 4,0–4,3 ppm/Cr ≥ 1,5, 92,3% de sensibilidade, especificidade de 96,9% (diferenciação de carcinomas e feocromocitomas de adenomas e metástases); Lac/Cr ≤ –7,449, sensibilidade de 90,9% e especificidade de 77,8% (diferenciação de feocromocitomas contra carcinomas e adenomas). Conclusão: Os dados da ERM-1H-2D foram eficazes e permitiram a diferenciação entre massas adrenais e nódulos na maioria das lesões com diâmetro > 1,0 cm.

Studies of Eu- and Yb-induced Reconstructions on the Si(100) Surface

This thesis presents experimental studies of rare earth (RE) metal induced structures on Si(100) surfaces. Two divalent RE metal adsorbates, Eu and Yb, are investigated on nominally flat Si(100) and on vicinal, stepped Si(100) substrates. Several experimental methods have been applied, including scanning tunneling microscopy/spectroscopy (STM/STS), low energy electron diffraction (LEED), synchrotron radiation photoelectron spectroscopy (SR-PES), Auger electron spectroscopy (AES), thermal desorption spectroscopy (TDS), and work function change measurements (Δφ). Two stages can be distinguished in the initial growth of the RE/Si interface: the formation of a two-dimensional (2D) adsorbed layer at submonolayer coverage and the growth of a three-dimensional (3D) silicide phase at higher coverage. The 2D phase is studied for both adsorbates in order to discover whether they produce common reconstructions or reconstructions common to the other RE metals. For studies of the 3D phase Yb is chosen due to its ability to crystallize in a hexagonal AlB2 type lattice, which is the structure of RE silicide nanowires, therefore allowing for the possibility of the growth of one-dimensional (1D) wires. It is found that despite their similar electronic configuration, Eu and Yb do not form similar 2D reconstructions on Si(100). Instead, a wealth of 2D structures is observed and atomic models are proposed for the 2×3-type reconstructions. In addition, adsorbate induced modifications on surface morphology and orientational symmetry are observed. The formation of the Yb silicide phase follows the Stranski-Krastanov growth mode. Nanowires with the hexagonal lattice are observed on the flat Si(100) substrate, and moreover, an unexpectedly large variety of growth directions are revealed. On the vicinal substrate the growth of the silicide phase as 3D islands and wires depends drastically on the growth conditions. The conditions under which wires with high aspect ratio and single orientation parallel to the step edges can be formed are demonstrated.