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Biomedical subjects

A Laugier

Publications and source records attributed to A Laugier.

At least 19 recordsLinked to original sources
PubMed1995

Epidermoid carcinoma of the anal margin: 17 cases treated with curative-intent radiation therapy.

Between 1973 and 1991, 17 patients with epidermoid carcinoma of the anal margin without evidence of distant metastasis were treated with curative-intent radiation therapy (RT). There were nine T1-tumors, six T2-, one T3- and one T4-tumor; two patients presented with inguinal node involvement: one N1 and one N3. Nine patients underwent prior incomplete local excision (six with microscopic involvement of surgical margins and two with macroscopic residual disease). The radiation dose to the tumor was 60-70 Gy; the radiation dose to the inguinal lymph nodes was 40-45 Gy in N0, and 50-60 Gy for involved inguinal nodes. The 5- and 10-year cancer-specific survival rates were 86.2% and 77.5%, respectively. The same probabilities were 100% and 100% for T1-tumors, 60% and 40% for T2-tumors. Severe complications occurred in two patients, one anal radionecrosis requiring a colostomy and one permanent anal incontinence after local excision, which was non-related to irradiation. For the cured patients, the sphincter preservation rate after 5 years was 82% (9/11). In univariate analysis and in Cox multivariate analysis, the cancer-specific survival rate was influenced by one factor: the tumor size.

Adult↗
PubMed1994

Synchronous and metachronous head and neck carcinomas.

BACKGROUND: The incidence of head and neck cancer is increasing. To improve the survival of head and neck cancer patients, an effective program of screening and/or chemoprevention of second malignancies is essential. An analysis of the incidence, time to development, and risk factors of second malignant tumors in head and neck cancer patients can contribute to the design of effective screening and chemoprevention programs. METHODS: Eight hundred, fifty-one patients with initial squamous cell carcinoma of the larynx (n = 224), tonsils (n = 189), pyriform sinus (n = 165), oral cavity (n = 129), mobile tongue (n = 72), and base of tongue (n = 72) treated from 1978 to 1990 were analyzed for the presence of a second malignancy after initial therapy. Of these 851 patients, 544 (64%) were documented smokers and 35 (4%) were nonsmokers. No smoking information was available for 272 patients. Four hundred, fifty-four patients (53%) were consumers of alcohol and 64 patients (8%) were nondrinkers. Alcohol consumption information was not available for 333 patients. RESULTS: One hundred, sixty-two (19%) second head and neck carcinomas occurred in the original 851 patients. Sixty-six patients (41%) had synchronous tumors, and 96 patients (59%) had metachronous tumors. The probability of developing a second metachronous cancer 5-years after undergoing treatment for the initial head and neck cancer was 22%. Borderline statistical significance was observed in the 5-year second cancer incidence based on the site of the initial primary cancer (46% for the base of tongue, 34% for the pyriform sinus, 23% for the larynx, 18% for the oral cavity, 15% for the tonsils, and 10% for the mobile tongue). Tobacco smoking (3% for nonsmokers vs. 26% for < or = 20 pack-years vs. 42% for > 20 and < or = 40 packs/year vs. 30% for > 40 packs/year of smoking) and the consumption of alcohol (5% for non-drinkers vs. 32% for drinkers) were both statistically significant in predicting the likelihood of developing a second malignancy. Multivariate analysis revealed that the two independent variables that influenced the occurrence of a second metachronous cancer were the anatomic site of the original primary cancer and patient age. The survival rate after the second cancer was influenced significantly by the site of the second cancer (20% for a second head or neck cancer, 3% for a second esophageal cancer, and 2% for a second lung cancer). Continued smoking (20% for non-smokers vs. 5% for smokers) and continued alcohol consumption (27% for nondrinkers vs. 6% for drinkers) also adversely influenced the survival after the occurrence of a second cancer. CONCLUSIONS: This study confirms the high rate of second cancers in patients with initial head and neck malignancies. The development of a second malignancy is almost always fatal. Screening programs and chemoprevention trials should be directed toward cancer patients with initial head and neck cancers. Only the small subset of nonsmokers and nondrinkers should be excluded from such trials.

Adult↗
PubMed1994

Epidermoid carcinoma of the anal canal. Results of curative-intent radiation therapy in a series of 270 patients.

BACKGROUND: Epidermoid carcinoma of the anal canal is an uncommon disease, and most institutions have only a small series of patients. The current study of a large series of patients treated with radiation therapy in a single institution evaluates the outcome, prognostic factors, and the late complications for these patients. METHODS: From 1972 to 1991, 270 patients with anal canal epidermoid carcinoma without evident distant metastasis were irradiated with curative intent in the Radiotherapy Department of Tenon Hospital. The sex ratio was 1 man/5.7 women, with a mean age of 67.5 years. The histology included 59.6% well-differentiated epidermoid carcinoma, 32.2% moderately or poorly differentiated epidermoid carcinoma, and 8.2% cloacogenic. The T-classification was: T1: 8.5%; T2: 51.1%; T3: 30.4%; T4: 10%. Abnormal inguinal lymph nodes were present in 12.5% of the patients. Patients were irradiated by external beam. They received a first course of photon irradiation consisting of (mostly 18 mV or 25 mVl; some Co60 or 6 mV) 40-45 Gy (box technique) in the pelvis for 4-5 weeks. After a rest of 4-6 weeks, a second course of 15-20 gy in 2 weeks was given through a perineal field by an electron beam of suitable energy. When rectal involvement was important, a four-field, small box technique was used. Fourteen patients were given a booster irradiation of 30 Gy by interstitial brachytherapy (Iridium 192 sources), and four patients were treated with interstitial brachytherapy alone, to a mean dose of 62.5 Gy. RESULTS: At 5 and 10 years, determinate survival rates were: T1: 86% and 86%; T2: 86.2% and 82.5%; T3: 60.1% and 56.8%; T4: 45% and 45%, respectively. The overall local control rate was 80%. The overall anal conservation rate was 67%. In 154 patients (57%), the anus had maintained its normal function. At 5 and 10 years, determinate survival was 76% and 73.7%, respectively, for N0 and 53.5 and 53.5% for clinically involved inguinal lymph nodes. According to the log-rank test, survival comparisons between T2 and T3 classifications and of tumor sizes less than or equal to 4 cm in length and greater than or equal to 5 cm in length were significant (P = 0.0001 and P < 0.0001, respectively). The presence of clinical abnormal inguinal lymph nodes had a significant negative influence on survival rates (P = 0.047). Multivariate analysis indicated that T-classification and tumor size in centimeters were the only predictive variables. Nonpredictive variables included nodal status, histology, age, total dose, overall treatment time, and irradiation technique. The grade 3 complication rate requiring surgical treatment was 27/270 (10%), considering all patients (27/190 represents a 14% rate for patients who had local tumor control after radiation therapy alone without secondary salvage amputation). There was no significant relationship between complication rate and the aforementioned variables. Because of the homogeneity of the irradiation doses, no significant relationship was found between dose, local control rate, or complication rate. CONCLUSIONS: After radiation therapy, recognizing the distinction between tumor sizes of less than or equal to 4 cm in length and more than 4 cm in length (which is not considered in TNM Classification criteria [International Union Against Cancer, 1987]) could help to improve treatment strategies. For tumors more than 4 cm in length and/or with clinically involved lymph nodes, the treatment should be more extensive with combined chemotherapy and radiation therapy, but the increased local control with the addition of cytotoxic chemotherapy to irradiation has not been proven.

Adult↗
PubMed1993

[Cancer of the anal canal; role of radiotherapy and combinations of chemotherapy and radiotherapy].

Carcinoma of the anal canal is a rare disease, more common in women than in men. The mean age distribution at presentation is about 60 years. The natural history is mainly loco-regional, distant metastases being uncommon. Histologically, most cancer are of the squamous cell type of different keratinization. The pre treatment evaluation is mainly performed by methodical clinical examination. There is no widely accepted staging system for these tumours. Three statistically significant prognostic factors are admitted: tumour size, regional nodal involvement and histological grade. The french school (Tenon, Institut Gustave Roussy, Institut Curie, Lyon) and the experience at the "Princess Margaret Hospital" at Toronto have shown that irradiation of these tumours is an adequate therapy. In Europe, irradiation has always played a more important role in the therapy of these tumours, than in North America where surgery was often preferred as the initial therapy. With the introduction of combined modality treatment, the use of pre-operative concomitant radiochemotherapy, in North America, has again changed the treatment policy towards a conservative radiotherapeutic approach. The present study analyses the modalities and the results from radiation therapy alone and the preliminary results from concomitant irradiation and chemotherapy.

Anus Neoplasms↗
PubMed1992

Multidisciplinary treatment approach to locally advanced non-inflammatory breast cancer using chemotherapy and radiotherapy with or without surgery.

Between April 1982 and December 1987, 82 locally advanced non-metastatic and non-inflammatory breast cancers were treated (42 stage IIIA, 40 stage IIIB). The median follow-up is 70 months from the beginning of the treatment. The initial treatment consisted of 4 courses of chemotherapy (doxorubicin, vincristine, cyclophosphamide, 5-fluorouracil) followed by irradiation (45 Gy to the breast and nodal area). A fifth course of chemotherapy was given after radiation therapy. Three different locoregional approaches were proposed depending on the tumoral response. In 32 patients (39%) with residual tumor larger than 3 cm in diameter or located behind the nipple or with multifocal tumors, mastectomy and axillary dissection were performed. Fifty other patients (61%) benefited from conservative treatment: 32 patients (39%) achieved complete remission and received a boost to the initial tumor bed; 18 patients (22%) who had a residual mass less than or equal to 3 cm in diameter were treated by tumorectomy and axillary dissection followed by a boost to the tumorectomy site. After completion of local therapy, all patients received a sixth course of chemotherapy. A maintenance adjuvant chemotherapy regimen without anthracycline was prescribed (12 monthly cycles). Three- and 5-year disease-free survival rates were 81.7% and 72% respectively. Five-year locoregional relapse rate (with or without other sites of failure) was 8.8%. In a multivariate analysis, disease-free survival was significantly influenced by the N-stage (p < 0.0001), initial tumor size (p = 0.01), and tumor response after initial chemotherapy (p = 0.02). Five-year breast conservation probability was 58.4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Preoperative radiation therapy and surgery in the treatment of "bulky" squamous cell carcinoma of the uterine cervix (stage Ib, IIa, and IIb operable tumors).

Forty-two women with "bulky" squamous cell carcinoma of the uterine cervix, larger than 5 cm, were treated between 1982 and 1988. The median follow-up was 5 years (from 37 to 106 months). The age range was from 25 to 77 years (mean: 49). There were 14 stage Ib, 5 stage IIa, and 23 stage IIb operable patients. Forty grays were delivered at mid-plane of the pelvis (23 fractions in 31 days) using the four-field technique (6-18 MV). External beam radiation therapy was followed by 20 Gy of intracavitary radiation therapy. Forty-eight days later total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) and bilateral pelvic lymphadenectomy were performed. The 3- and 5-year disease-free survival was 83 and 81%, respectively. The 5-year locoregional control rate was 83%. Thirteen patients suffered from mild to severe complications (31%) but there were only two long-term (5%) complications.

Brachytherapy↗
PubMed1992

[Synovial sarcoma. A study of a series of 46 cases].

Synovial sarcoma is a rare malignant soft tissue tumor. The histological diagnosis remains sometimes difficult. The authors report 46 cases, treated in different hospitals in Paris. The medium survival rate of this group (which includes cases treated long ago) is of 30 per cent at 5 years. But only 24 per cent are disease free at this time. At the last follow up, the patients deceased after the fifth year included, the survival rate drops down to 12 per cent. Local recurrences and metastasis are analysed with reference to the different treatments applied. It seems that the association of polychimiotherapy and wide surgical excision might increase the survival rate, but this has to be confirmed in future. Radiotherapy is still a valuable treatment when excision is only limited, or when excision is impossible, due to localisation or extension of the tumor.

Adolescent↗
PubMed1992

[Review of results and clinical analysis of conservative partial surgery associated with postoperative radiotherapy in operable breast cancers stages I amd II].

Over the last 25 years, conservative forms of treatment have been used for the locoregional treatment of early breast cancer, stages I and II (< 3 cm in diameter). At present, the same carcinological results are obtained with conservative surgery and radiation therapy as with radical surgery, and the aesthetic and functional results have improved. Several parameters should be taken into account, ie tumour volume, breast volume, multifocal nature and histologic type. A number of questions still remain unanswered namely: what is the most appropriate conservative surgery (quadrantectomy, tumourectomy or local excision)? What is the most appropriate total irradiation dose (50 Gy over 5 weeks: or 45 Gy over 4.5 weeks)? What is the value of radiation boost in patients with negative resection margins? What is the value of radiation boost in patients with a high local risk of recurrence? What is the most appropriate radiation technique for boost in the primary tumour bed (electrons or iridium implants)? Does the external irradiation of regional lymph nodes improve survival rate? Is it possible to extend conservative treatment to a 4-cm diameter tumour? What is the impact of adjuvant systemic chemotherapy and/or hormonotherapy on the risk of isolated breast cancer recurrence?

Adult↗
PubMed1989

Advanced Hodgkin disease (clinical stages IIIB and IV): low relapse rate after brief chemotherapy followed by high-dose total lymphoid irradiation.

From January 1980 to September 1986, 50 patients with Hodgkin disease, clinical stages (CS) IIIB (26 cases) and IVB (24 cases) were treated by three cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy, followed by high-dose (40 Gy) (sub)total lymphoid irradiation, including the spleen. Ten patients (2 CS IIIB, 8 CS IVB) were in failure, and seven (4 CS IIIB, 3 CS IVB) died during their first complete remission (2 from treatment-related complications, 1 from unknown cause, 4 from insufficient supportive care and/or a shortage of health supplies); three patients (CS IIIB) relapsed (2 alive in second complete remission, 1 deceased). After 7 years, actuarial survival and relapse-free duration were, respectively, 64% for the 50 patients and 89% for the 40 patients in complete remission. Unfavourable outcome was observed in patients with pelvic nodal involvement. The low relapse rate (none in CS IVB) was the most striking result after brief chemotherapy followed by total lymphoid irradiation.

Adolescent↗
PubMed1989

Gallbladder carcinoma: role of radiation therapy.

Gallbladder carcinoma continues to be a discouraging disease. Prognosis after resection still remains poor. Radiation therapy has been used in an attempt to improve the prognosis but only a few series of less than ten cases have been reported. Since 1977 we have treated 20 patients with gallbladder carcinoma with postoperative radiotherapy (mean total dose 4200 radiation absorbed dose). In four patients all the tumour was resected with the intent of cure. In 12 patients, the lesion was partially resected and in four patients no resection was performed. Seven patients in whom the tumour was partially resected or not resected also had chemotherapy. Our evaluation was retrospective and we compared our results with historical control groups comparable with respect to surgical procedures and pathological staging. In patients operated on for cure, one patient is alive at 84 months, the others died at 7, 8 and 33 months. In patients in whom the tumour was partially resected the mean survival time was 8.1 months and two patients are still alive 7.0 months after treatment. According to the Nevin classification the mean survival time in stage IV and V patients was respectively 9.2 and 7.2 months. There was no difference in survival between patients treated or not treated with chemotherapy. This experience is the largest published and suggests that radiotherapy may increase survival after no resection or palliative resection of gallbladder carcinoma.

Adenocarcinoma↗
PubMed1985

Interim analysis of a phase III study on preoperative radiation therapy in resectable rectal carcinoma. Trial of the Gastrointestinal Tract Cancer Cooperative Group of the European Organization for Research on Treatment of Cancer (EORTC).

To improve surgical results of potentially operable rectal cancer (T2, T3, T4, Mo), the European Organization for Research on Treatment of Cancer (EORTC) conducted a two-arm randomized clinical trial to evaluate the effect of administering radiotherapy before radical surgery. Four hundred ten patients were allocated to be treated either by surgery alone or by 34.5 Gy of radiotherapy (in 19 days overall) followed by surgery. The tolerance of the adjuvant radiation therapy was fairly good. The 5-year survival rate was 65% overall and showed no difference between both therapeutic regimens. Similarly, the metastases-free rate was the same in both groups. In contrast, the preoperative radiation therapy showed a marked effect on local control of the disease, the comparison of the time to local recurrence being highly significant between the two treatment groups (P = 0.001). The proportion of patients free of local recurrence at 5 years was 85% in the combined treatment versus 65% in the group of patients treated by surgery alone.

Adult↗
PubMed1985

[Primary pseudo-ovarian peritoneal carcinosis. 4 cases].

Primary papillary carcinosis of the peritoneum is a rare disease seen in elderly women in whom no digestive or ovarian carcinoma could be detected. Its histological structure is identical with that of papillary carcinoma of the ovary. The 4 cases reported here were treated as advanced ovarian carcinomas, with multiple chemotherapy including doxorubicin and cis-platinum. Three patients were re-operated upon after 6 courses. Complete remission was obtained in all 4 cases, but the patients relapsed under maintenance therapy. The diagnosis must be suspected in elderly women presenting with unexplained carcinosis. This is particularly important since effective treatments can now be proposed, as for advanced ovarian carcinomas.

Adenocarcinoma, Papillary↗