超选择动脉插管化疗在治疗妇科中晚期恶性肿瘤中的应用

目的:评价选择动脉插管化疗(SIAC)在妇科中晚期恶性肿瘤治疗中的价值。方法:对128例中晚期妇科恶性肿瘤患者采用Seldinger法行超选择动脉插管化疗,主要药物有DDP、MMC、EPIA、ADM、5蛳Fu、DACT、CTX、MTX等。SIAC治疗患者2 ~ 4疗程后手术。结果:128例行SIAC的中晚期恶性肿瘤患者,116例获得再次手术机会,再次手术时术中见大部分肿瘤体积明显缩小,粘连程度明显好转,腹水不同程度消退。完全有效33例,部分有效75例,轻微有效13例,无效7例。经SIAC治疗,患者生存率较以往未行SIAC治疗的患者生存率明显提高,其2 a、5 a生存率分别为57.6 %、24.4 %。结论:超选择动脉插管化疗治疗妇科中晚期恶性肿瘤可使肿瘤缩小甚至消退,提高手术成功率,延长患者生存期。     

选择性动脉插管化疗在晚期鼻咽癌综合治疗中的应用

目的 探讨动脉插管化疗在晚期鼻咽癌综合治疗中的价值。方法 对Ⅲ、Ⅳ期鼻咽癌20例,进行股动脉穿刺,选择性上颌动脉插管化疗,用BLM8mg、DDP60mg、5—Fulg灌注。1周后进行常规放疗,对3例放疗后病灶残留的病人也进行了插管化疗。结果 放疗前插管的20例患者,CR16例,占80％,PR4例,占20％。放疗后插管的3例中,CR1例,PR2例。无严重毒副反应。结论 对放疗前或放疗后病灶残留的晚期鼻咽癌进行选择性上颌动脉插管化疗是安全、可靠的。可使肿瘤缩小,起到局部降期及预防远处转移的作用,并对放疗起到增敏的作用。远期疗效有待进一步研究。     

介入联合三维适形放疗治疗中晚期肝癌的临床研究

目的：通过单纯介入治疗中晚期肝癌与介入联合三维适形放疗对比,来研究介入联合三维适形放疗治疗中晚期原发肝癌的疗效。方法：2001年3月至2006年5月对确诊的57例中晚期原发肝癌患者,随机分为单纯介入组及介入联合三维适形放疗组。介入组30例,联合组27例。介入组采用经导管动脉化疗及栓塞,经皮股动脉穿管,根据肿瘤部位插管至肝固有动脉或左、右肝动脉。灌注化疗药物包括5-FU、顺铂、丝裂霉素、蒽环类药物等,灌注后使用碘油栓塞,4-6周重复,共3-6次。联合组先TACE治疗2次后再局部三维适形放疗（3D-CRT）,一般在第二次介入后一周左右开始放疗。放疗为1次/日,2-2.5GY/次,5次/周,放疗总剂量为Dt52GY-62GY。治疗3个月后影像学复查疗效。结果：介入组CR 0例,PR 20例,NC 8例,PD 2例,CR＋PR为有效,有效率为66.7%;联合治疗组CR2例,PR18例,NC6例,PD1例,有效率为74.1%,P=0.049。远期观察：介入组及联合组0.5,1,2年生存率分别为66.7%,53.3%,43.3%;88.9%,70.7%,55.5%（P=0.023）。所有病例均顺利治疗结束,未出现治疗中断退出。结论：介入联合三维适形放疗治疗能提高中晚期原发肝癌疗效,没有明显增加不良反应。     

肝动脉灌注LAK／IL—2及化疗药物治疗晚期肝癌

目的：观察经皮肝动脉插管化疗药物灌注，栓塞术联合LAK／IL－2灌注治疗中晚期肝癌的疗效、T淋巴细胞改变及副反应。方法：96例经确诊的中晚期肝癌，随机分为动脉化疗栓塞联合LAK／IL－2观察组及单纯介入化疗栓塞组各48例，两组均采用经皮穿刺肝动脉插管灌注化疗药物及栓塞。化疗药物5－Fu1000mg＋卡铂300mg 表阿霉素30mg或丝裂霉素10－20mg，栓塞剂为碘化油和明胶海绵，介入治疗3－4周1次，2次1疗程，观察组栓塞后沿导管灌注同种异体LAK细胞1×10^9100ml及IL－240万U。两次介入间隔期间观察组每周3次静滴1×10^9/100mlLAK细胞及每日肌注IL－210万U结果：观察组总有效率（CR＋PR）为72．9％（35／48），对照组总有效率（CR＋PR）淡57．3％（28／48），两组比较有显性差异（P＜0．05）。观察组T淋巴细胞治疗前后变化有统计学意义（P＜0．01），而对照组无统计学意义，结论：同种异体LAK细胞联合化疗及栓塞治疗中晚期肝癌较单纯介入化疗栓塞疗效明显提高，是安全可行的一种治疗方法。     

介入化疗联合放射治疗原发性巨块型肝癌的研究

目的观察介入治疗联合三维适形放疗治疗原发性巨块型肝癌的临床疗效及毒副作用。方法对58例患者介入治疗1～2次后，应用治疗计划系统（treatment planning system，TPS）制定治疗计划，行三维适形放疗。结果治疗后完全缓解（CR）4例，占6．89％，部分缓解（PR）31例，占53．44％，无变化（NC）19例，占32．76％，总有效率CR＋PR为60．34％；1、2年的生存率分别为70．1％，50％。介入治疗后部分患者出现恶心、呕吐、纳差、上腹部不适、腹胀等胃肠道反应。放疗后18例出现右上腹痛，9例出现肝功能损伤，但程度较轻。结论介入化疗联合三维适形放疗能提高原发性巨块型肝癌的临床疗效，延长生存期，毒副作用可耐受。     

盆腔恶性肿瘤动脉内化疗及栓塞治疗(附10例报告)

目的探讨动脉内化疗及栓塞治疗中晚期盆腔恶性肿瘤的方法及治疗效果.方法对10例由于年龄大,体质差,发现较晚,不能耐受手术的中晚期盆腔恶性肿瘤采用动脉药盒植入治疗6例,肿瘤供血动脉超选择插管化疗栓塞治疗4例.结果10例患者治疗后效果满意,症状明显缓解,病灶缩小或消失.其中CR1例,PR4例,4例患者经治疗后行Ⅰ期手术.不良反应轻微.结论动脉内化疗及栓塞治疗中晚期盆腔肿瘤是一种较好的治疗方法.     

瘤体内注射平阳霉素治疗浅表恶性肿瘤(附36例报告)

目的:评价瘤体内注射平阳霉素治疗浅表恶性肿瘤的临床疗效,探讨局部治疗浅表恶性肿瘤的有效方法.方法:采用平阳霉素行浅表恶性肿瘤瘤体内注射,观察肿瘤消退情况及毒副反应.结果:局部浅表肿瘤完全消退(CR)16例,部分消退(PR)10例,局部控制有效率为72.2%;副反应轻,主要有发热、恶心、局部疼痛、脱发等.结论:瘤体内注射平阳霉素是治疗浅表恶性肿瘤的有效方法,主要适宜已行手术、放疗、全身化疗后原发灶消退而仅出现浅表转移且不愿再做上述治疗者,以及已出现给病人带来直观、过重精神负担的浅表转移瘤块而又拒绝或不宜手术、放疗、全身化疗者,还可配合全身化疗、放疗,以达到全身治疗与局部处理的有机配合,有利于提高肿瘤总的控制率.     

介入联合三维适形放疗治疗中晚期肝癌的临床研究

目的:通过单纯介入治疗中晚期肝癌与介入联合三维适形放疗对比,来研究介入联合三维适形放疗治疗中晚期原发肝癌的疗效。方法:2001年3月至2006年5月对确诊的57例中晚期原发肝癌患者,随机分为单纯介入组及介入联合三维适形放疗组。介入组30例,联合组27例。介入组采用经导管动脉化疗及栓塞,经皮股动脉穿管,根据肿瘤部位插管至肝固有动脉或左、右肝动脉。灌注化疗药物包括5-FU、顺铂、丝裂霉素、蒽环类药物等,灌注后使用碘油栓塞,4-6周重复,共3-6次。联合组先TACE治疗2次后再局部三维适形放疗(3D-CRT),一般在第二次介入后一周左右开始放疗。放疗为1次/日,2-2.5GY/次,5次/周,放疗总剂量为Dt52GY-62GY。治疗3个月后影像学复查疗效。结果:介入组CR 0例,PR 20例,NC 8例,PD 2例,CR+PR为有效,有效率为66.7%;联合治疗组CR2例,PR18例,NC6例,PD1例,有效率为74.1%,P=0.049。远期观察:介入组及联合组0.5,1,2年生存率分别为66.7%,53.3%,43.3%;88.9%,70.7%,55.5%(P=0.023)。所有病例均顺利治疗结束,未出现治疗中断退出。结论:介入联合三维适形放疗治疗能提高中晚期原发肝癌疗效,没有明显增加不良反应。     

肝动脉灌注LAK/IL-2及化疗药物治疗晚期肝癌

目的观察经皮肝动脉插管化疗药物灌注、栓塞术联合LAK／IL－2灌注治疗中晚期肝癌的疗效、T淋巴细胞改变及副反应。方法96例经确诊的今晚期肝癌,随机分为动脉化疗栓塞联合LAK/IL－2观察组及单纯介入化疗栓塞组各48例。两组均采用经皮穿刺肝动脉插管灌注化疗药物及栓塞。化疗药物5-Fu1000mg＋卡铂300mg＋表阿霉素30mg或丝裂霉素10～20mg,栓塞剂为碘化油和明胶海绵,介入治疗3～4周1次,2次1疗程。观察组检室后沿导管灌注同种异体LAK细胞1×109/100ml及IL－240万U,两次介入间隔期观察组每周3次静滴1×109／100mlLAK细胞及每日从注IL－210万U。结果观察组总有效率（CR＋PR）为72．9％（35／48）,对照组总有效率（CR＋PR）为58．3％（28／48）,两组比较有显著性差异（P＜0．05）。观察组T淋巴细胞治疗前后变化有统计学意义（P＜0．01）,而对照组无统计学意义。结论同种异体LAK细胞联合化疗及栓塞治疗中晚期肝癌较单纯介入化疗栓塞疗效明显提高,是安全可行的一种治疗方法。     

介入化疗加放射治疗30例晚期难治性肿瘤

 目的 试图通过应用多学科，多靶点综合治疗难治性肿瘤以希望提高疗效。方法 针对30 例晚期肿瘤广泛术后复发，无再次手术机会，而单纯放疗存在对放射线不敏感等诸多因素、放疗困难的患者采用介入并放疗，先行2 ~ 3个周期的介入化疗，再行局部的放疗。结果 CR13例（40 %），PR 15例（50 %），NC1例（3 %），PD1例（3 %），CR+PR23例（90 %）。结论 介入化疗加放射治疗晚期难治性肿瘤疗效比较明显，效果满意。是对晚期难治性肿瘤治疗的一种较好手段之一。     

The medically important dematiaceous fungi and their identification

Dematiaceous fungi include a large group of organisms that are darkly pigmented (dark brown, olivaceous, or black). In most cases the pigment is melanin, and specifically, dihydroxynaphthalene melanin. The diseases produced include chromoblastomycosis, eumycotic mycetoma, and phaeohyphomycosis. Phaeohyphomycosis is a new classification for a diverse group of previously known entities grouped together on the basis of finding dematiaceous hyphal and/or yeast-like forms in tissue; tissue involvement may be superficial, cutaneous and corneal, subcutaneous, or systemic. Identification of these fungi is based mostly upon morphology. Important structures include annellides (Phaeoannellomyces, Exophiala), phialides (Phialophora, Wangiella), adelophialides (Phialemonium without collarettes, Lecythophora with collarettes), differentiation of conidiophores (Xylohypha versus Cladosporium) and conidial hilum, septation and germination (Bipolaris, Drechslera, Exserohilum). Useful laboratory tests include the 12% gelatin test (controversial), nitrate assimilation (W. dermatitidis is negative, most other species are positive), and determination of temperature maxima (especially 37 degrees C for E. jeanselmei, 40 degrees C for W. dermatitidis and B. spicifera, 42 degrees C for X. bantiana, and 45 degrees C for Dactylaria constricta var. gallopava and Scedosporium inflatum).     

Orale Langzeitbehandlung von Onychomykosen mit Ketoconazol

Zusammenfassung: An der Studie zur Wirksamkeit und Anwendungssicherheit von Ketoconazol nahmen 27 Männer im Alter von 20 bis 80 (Median: 57) Jahre, davon 18 mit Onychomykosen und 9 als KontroUen bei den Laborwertbestimmungen, teil. Während des ersten Behandlungsmonats erhielten je 9 Patienten 200 mg und 400 mg Ketoconazol täglich. Danach wurden beide Gruppen 6 Monate mit 200 mg/d weiterbehandelt. Die klinische Beurteilung sowie hämatologische, biochemische und Plasmaspiegeluntersu-chungen erfolgten mindestens monafich, mykologische Untersuchungen wurden vor Aufnahme und bei Beendigung der Therapie vorgenommen. Erne letzte klinische Unter-suchung erfolgte 1 Jahr nach Beginn der Studie. Nach 7 Monaten Behandlung wurden 23 von 30 Nägeln mit “gebessert” bis “stark gebessert” beurteilt, nach dem behandlungsfreien Intervall galt dies für 28 von 30 Nägeln. Die Plasmaspiegel waren mit 200 mg/d ausreichend und uber den Behandlungszeit-raum konstant. Dies spricht für gute orale Resorption und Abwesenheit von Enzyminduktion. Die Laborwerte zeigten im Vergleich zu den Kontrollen und den Werten vor Behandlung keine signifikanten Abweichungen, so daß myelo-, nephro- und hepatotoxische Wirkungen von 400 bzw. 200 mg/d ausgeschlossen werden können. Der Lipidhaushalt wurde nicht beeinfluat und es trat unter Therapie als Folge der Ketoconazolwirkung lediglich Lanosterin im Serum auf. Nach Beendigung der Therapie ging der Lanosteringehalt schnell zurück. Damit erweist sich Ketoconazol in den angewandten Dosen als ein gut verträgliches und zur Langzeitbehandlung von Onychomykosen geeignetes Antimykotikum. Summary: Twenty-seven males with a median age of 57 (range: 20 to 80) years took part in this study on the efficacy and safety of ketoconazole. Eighteen men suffered from onychomycosis; nine served as controls in the safety evaluation. During the first month of treatment, nine patients received 200 mg and the nine other 400 mg ketoconazole daily. Then the treatment was uniformly continued with 200 mg/d for 6 months. Clinical evaluation and haematological, biochemical and plasma level investigations were carried out at least at monthly intervals; mycological controls were performed at the start and end of therapy. A final clinical evaluation was carried out one year after the start of the study. After 7 months of treatment, moderate or definite clinical improvement was obtained in 23 out of 30 nails. After 5 more months without antimycotic treatment this was the case in 28 of 30 nails. Plasma levels obtained with 200 mg ketoconazole daily were adequate and constant during the entire treatment period. This indicates a good oral resorption as well as the absence of induction of hepatic enzymes. The laboratory values did not show significant deviations as compared with the controls or with the pretreatment values. This excludes myelo-, nephro- and hepatotoxic effects of 400 and 200 mg ketoconazole daily. The lipid metabolism was not influenced, the only difference was the occurrence of lanosterol in the serum, which is a result of the mechanism of action of ketoconazole. After the medication period the lanosterol levels subsided rapidly. In the applied doses ketoconazole is a well-tolerated and effective drug for the systemic long-term treatment of onychomycosis.     

Laboratory Techniques Alternative to In Vivo Experiments for Studying the Liberation, Penetration and Fungicidal Action of Topical Antimycotic Agents in the Skin, Including Ciclopiroxolamine

Summary: Short-term experiments on excised skin (human, pig) gave the following results: 1. In the tissue activity test with direct inoculation (D-TAT) commercial preparations of the non-azole antimycotics ciclopiroxolamine, tolnaftate and naftifine, produced higher inhibitory activity against Trichophyton mentagrophytes (standard strain) in various levels of the horny layer than were produced by the azole antimycotics econazole, miconazole, clotrimazole, oxiconazole and bifonazole. Fast drying solutions of antimycotics invariably gave higher inhibitory activities than creams. In the ultrafiltration tissue activity test (UFT- TAT) against Candida albicans (2 strains), antimycotic agents ranked in order of effectiveness as follows: ciclopiroxolamine – most of the azole antimycotics – bifonazole and naftifine. 2. In tests of fungicidal activity against T. mentagrophytes (2 strains) and Microsporum gypseum (1 strain) the first step was to inoculate the skin surface. After the horny layer had been penetrated by fungal mycelia, antimycotic agents of documented fungicidal potency, chiefly in the form of creams, were applied to the skin surface and left to act for up to 18 hours. The horny layer and epidermis were then scraped off and the concentration of viable fungi was determined. Ciclopiroxolamine cream and lotion produced by far the greatest diminution in viable fungi; creams containing oxiconazole and naftifine were moderately effective and those containing tioconazole and bifonazole produced a relatively small decrease in viable fungi. To avoid erroneous results it is important to homogenize and dilute the skin scrapings; if this is not done certain antimycotics will give misleadingly high fungal killing rates. At this early stage the scatter of results is still wide and minor differences in efficacy cannot as yet be detected with certainty. 3. From the results of various comparative tests it is evident that pig skin can be used as a substitute for human skin in the tests listed under 1. and 2. above. This discovery may make a valuable contribution towards limiting the need for experiments on living animals and trials on human beings. Zusammenfassung: In Kurzzeitversuchen an exzidierter Haut (Mensch, Schwein) wurde gefunden: 1. Im Gewebeaktivitätstest mit direkter Inokulation (D-GAT) wurde mit Handelspräparaten der Nichtazol-Antimykotika Ciclopiroxolamin, Tolnaftat und Naftifin in verschiedenen Hornschichtniveaus eine höhere Hemmaktivität gegenüber Trichophyton mentagrophytes (Standard-Stamm) erzielt als mit solchen der Azol-Antimykotika Econazol, Miconazol, Clotrimazol, Oxiconazol und Bifonazol. Rasch trocknende Lösungen von Antimykotika ergaben durchweg höhere Hemmaktivitäten als Cremes. Im Ultrafiltrations-Gewebeaktivitätstest (UFT-GAT) gegenüber Candida albicans (2 Stämme) ergab sich nach erzielter Wirksamkeit die Rangfolge Ciclopiroxolamine – Mehrzahl der Azolantimykotika – Bifonazol und Naftifin. 2. In Fungizidie-Testen gegenüber T. mentagrophytes (2 Stämme) und Microsporum gypseum (1 Stamm) wurde zunächst die Hautoberfläche inokuliert. Nach Durchdringung der Hornschicht mit Pilzmyzelien wirkten auf die Hautoberfläche bis zu 18 Stunden lang überwiegend Cremes von als fungizid publizierten Antimykotika ein. Während sich in abgeschabter Hornschicht und Epidermis der so bearbeiteten Hautoberflächen mit Ciclopiroxolamin-Creme und -Lotion die weitaus höchste Verminderung lebensfähiger Keime ergab, bewirkten Cremes mit Oxiconazol und Naftifin eine mittlere und solche mit Tioconazol und Bifonazol eine relativ niedrige Keimeliminierung. Zur Vermeidung von fehlerhaften Ergebuissen mußten Homogenisierung und Verdünnung der Hautschabsel erfolgen, anderenfalls bei mehreren Antimykotika eine zu hohe Keimabtötung vorgetäuscht worden wäre. Wegen der vorerst noch hohen Streuung der Ergebnisse können kleinere Wirksamkeitsunterschiede noch nicht sicher erfaßt werden. 3. Nach dem Ergebnis verschiedener Vergleichstests kann in den Testen zu 1. und 2. Schweinehaut als Ersatz für Haut vom Menschen dienen und dürfte damit wesentlich zur Einschränkung von Versuchen am lebenden Tier und von Prüfungen am Menschen beitragen.     

Efficiency of crude and purified fungal antigens in serodiagnosis to discriminate mycotic from other respiratory diseases

Mycotic immunodiagnosis was performed in 186 hospitalized patients with different respiratory diseases, mostly considered as tuberculosis and others with a doubtful diagnosis. Crude histoplasmin, coccidioidin, paracoccidioidin, blastomycin, candidin, aspergillin, and sporotrichin, as well as purified polysaccharide-protein complexes (PPC) of Histoplasma capsulatum, Coccidioides immitis, and Paracoccidioides brasiliensis were used as antigens. Immune tests used included skin test (ST), gel immunodiffusion (ID), counterimmunoelectrophoresis (CIE), complement fixation (CF), and ELISA. A possible association with candidosis was observed in 17% of patients with tuberculosis and diabetes; one presumptive paracoccidioidomycosis, one confirmed aspergillosis, and six cases of active histoplasmosis were determined. Candidin ST showed 29% of positive reactions with an increased frequency in patients between 31 and 55 years of age. CF test showed the highest positivity percentages with crude antigens, specially for Candida antigen (26.3%) and histoplasmin (18.2%). Cross reactions were evident with crude antigens but decreased when PPC's were used in ELISA.     

Isoconazole nitrate in the treatment of tropical dermatomycoses

Summary. A total of 54 patients with culturally proven tropical dermatomycoses, comprising 23 with various types of dermatophytoses, one with foot infection due to Trichosporon beigelii and one with foot infection due to Geotrichum candidum , two with candidoses of the groin and 27 with pityriasis versicolor, were included in a clinical trial of efficacy of 1% isoconazole cream (Travogen^R, Schering, Berlin, Germany). Five patients were not evaluable. A clinical and mycological cure was achieved in 29 cases in 3–4 weeks. In 15 (31%) of the remaining patients treatment was required for 5–6 weeks, while another three patients required treatment for 8 weeks. In two patients the disease proved to be resistant to treatment with the drug.
Zusammenfassung. Insgesamt 54 Patienten mit kulturell gesicherter Dermatomykose, (23 unterschiedliche Dermatophytosen, eine Trichosporon beigelii - und eine Geotrichum candidum -Fußinfektion, 2 Candidosen der Leistengegend und 27 Pityriasis versicolor) wurden in einer klinischen Wirksamkeits-studie mit 1% iger Isoconazol-Creme (Travogen^R, Schering, Berlin, Deutschland) behandelt. Fünf Patienten waren nicht auswertbar. Eine klinische und mykologische Heilung wurde bei 47 von 49 Patienten (96%) erreicht. Bei 29 patienten (59%) wurde die Heilung bereits nach 3–4 Wochen Behandlung erreicht. Weitere 15 Patienten (31%) benötigten 5–6 Wochen und drei Patienten 8 Wochen Behandlungsdauer. Zwei Mykosesituationen erwiesen sich als therapieresistent.     

Large-scale molecular characterization and analysis of gastric cancer

The recent effort by The Cancer Genome Atlas （TCGA） Network has revealed that gastric cancer, which is a leading cause of cancerrelated deaths worldwide with a 5-year survival rate less than 25%, is a much more heterogeneous disease than previously thought. And yet, conventional treatment approaches and clinical trials have assumed it is a single disease. Although it is well known that under the microscope, gastric cancer cells appear quite different, the current classification scheme recognizes two main categories of gastric cancer： diffuse and intestinal.     

A conceptually new treatment approach for relapsed glioblastoma: Coordinated undermining of survival paths with nine repurposed drugs (CUSP9) by the International Initiative for Accelerated Improvement of Glioblastoma Care

To improve prognosis in recurrent glioblastoma we developed a treatment protocol based on a combination of drugs not traditionally thought of as cytotoxic chemotherapy agents but that have a robust history of being well-tolerated and are already marketed and used for other non-cancer indications. Focus was on adding drugs which met these criteria: a) were pharmacologically well characterized, b) had low likelihood of adding to patient side effect burden, c) had evidence for interfering with a recognized, well-characterized growth promoting element of glioblastoma, and d) were coordinated, as an ensemble had reasonable likelihood of concerted activity against key biological features of glioblastoma growth. We found nine drugs meeting these criteria and propose adding them to continuous low dose temozolomide, a currently accepted treatment for relapsed glioblastoma, in patients with recurrent disease after primary treatment with the Stupp Protocol. The nine adjuvant drug regimen, Coordinated Undermining of Survival Paths, CUSP9, then are aprepitant, artesunate, auranofin, captopril, copper gluconate, disulfiram, ketoconazole, nelfinavir, sertraline, to be added to continuous low dose temozolomide. We discuss each drug in turn and the specific rationale for use- how each drug is expected to retard glioblastoma growth and undermine glioblastoma''s compensatory mechanisms engaged during temozolomide treatment. The risks of pharmacological interactions and why we believe this drug mix will increase both quality of life and overall survival are reviewed.     

Endometrial cancers and predisposition

As nearly 5% of all endometrial cancers occur because of a predisposition, this possibility has systematically to be explored. The hallmarks of predisposition, a young age at diagnosis, a personal or a familial history of cancer, have to be searched systematically. The identification of a predisposition in a family has a major impact on the management of the proband or his relatives. The endometrial cancer main predisposition is Lynch's syndrome. In this review, we will focus on this condition and describe its clinical manifestations, the underlying molecular mechanisms, the cancer risks and the management guidelines. We will also get onto some far less frequent other predispositions.