Biomedical subjects

Aude Flechon

Publications and source records attributed to Aude Flechon.

7 recordsLinked to original sources

PubMed2006

Chemotherapy practices and perspectives in invasive bladder cancer.

Bladder cancer is the fifth most common cancer in adult patients. Two-thirds of patients have superficial tumors and their treatment is conservative. Nevertheless, 30% of superficial tumors become infiltrative and represent a third of tumors at initial diagnosis. Overall mortality from bladder cancer is 30%. Important molecular events may explain the carcinogenesis and evolution of these tumors. Infiltrating bladder cancers are currently treated by radical cystectomy. Neoadjuvant chemotherapy has demonstrated a positive impact on patients' outcomes before cystectomy. Adjuvant chemotherapy after cystectomy is currently being studied in an international randomized trial. Patients with advanced disease are treated by chemotherapy with palliative intentions. Two regimens are standard: the combination of methotrexate, vinblastine, adriamycin and cisplatin, and the combination of gemcitabine and cisplatin. The addition of paclitaxel to the latter regimen is the subject of ongoing study. Only a few patients have long-term nonevolutive disease. Research must be focused on the combination of chemotherapy and targeted drugs directed through gene methylation, cytokine-receptor activation and signaling pathways.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2003

[Metastatic prostate cancer].

Metastatic prostate cancer is an uncurable disease. Treatment is only palliative. Median survival of patients is 3 years. Prostate cancer is an hormonodependent cancer, androgen blockade is the most active treatment. However hormone resistance occurs after a median interval of 2 years. The major symptom is pain, others are urinary obstruction, neurological complications of bone metastases and hematological disorders. Androgen deprivation is the first-line treatment, impotency and osteoporosis being the main side effects. Other treatments are radiotherapy, radiopharmaceutics and chemotherapy. The most important treatment issue is quality of life.

Androgen Antagonists↗

PubMed2003

Management of clinical stage I nonseminomatous germ-cell testis tumors.

Nonseminomatous germ-cell tumors of the testis, the most common cancer in young adult males, are highly curable. Clinical Stage I disease represents almost a third of the patients. Three treatment strategies are currently available: surveillance, postorchiectomy chemotherapy and retroperitoneal lymph node dissection. Factors predictive of extratesticular involvement have been described, thus making it possible to tailor treatment to risk. New imaging procedures also permit staging and prediction of outcome. Decision-making is shared between the patient and his oncologist. Economic issues are better understood but should be further studied.

Chemotherapy, Adjuvant↗

PubMed2003

Management of vertebral metastases in prostate cancer: a retrospective analysis in 119 patients.

The objectives of this study were to define clinical problems and treatment strategies in vertebral metastases of prostate cancer. The clinical files of 634 patients with prostate cancer seen in a comprehensive cancer center during a 4-year period were retrospectively reviewed. One hundred nineteen patients (18.8%) had 212 significant episodes of osseous spinal metastases. Pain was nearly universal (93%), and motor and bladder impairment occurred in 25% and 3.1% of patients, respectively. Bone scan and magnetic resonance imaging (MRI) were performed in 197 and 64 episodes, respectively. Fifteen episodes of spinal cord compression were treated surgically. Other treatments included hormonal therapy (163 episodes), chemotherapy (70 episodes), and radiation therapy (103 episodes). Osteolytic lesions were observed alone and in combination with osteoblastic pattern in 18% and 26% of episodes, respectively. Bone scan was the most effective screening procedure of vertebral involvement, and MRI effectively showed epidural involvement. Overall treatment led to improvements in pain and motor impairment in 77% and 50% of patients, respectively. However, clinical episodes were recurrent (1.78 episodes per patient; range, 1-8). Median survival after vertebral metastasis episode was 14 months compared with only 4 months after surgery for spinal cord compression. Vertebral metastases strongly alter quality of life in patients with prostate cancer. Pain and neurologic complications are the major problems. Careful early screening with bone scan and MRI may help to define better treatment strategy. However, further prospective studies of clinical management are needed to determine the optimal timing of radiation therapy, medical treatments, and surgery.

Aged↗

PubMed2002

[Chemotherapy of neuroendocrine tumors].

Chemotherapy has few impact on neuroendocrine tumour patients outcome: it may decrease functional secretory symptoms and increase slightly median survival time. In islet-cell carcinoma of the pancreas the standard chemotherapy regimen is the combination of streptozotocin and doxorubicin. It induces 50% response rate and may increase by 50% the median survival. In enterochromaffin-cell tumours chemotherapy has modest impact and the combination of 5-fluorouracile and streptozotocin is the standard regimen. In undifferentiated enterochromaffin-cell tumours of unknown primary the standard chemotherapy regimen is the combination of etoposide and cisplatin which induces 50% response rate with probably no impact on overall survival. Chemotherapy must be indicated within the frame of a multidisciplinary approach and only in patients who have refractory and progressive disease. Indication of chemotherapy must be balanced with indications of biotherapies and embolization.

Antibiotics, Antineoplastic↗

PubMed2002

Management of post-chemotherapy residual masses in advanced seminoma.

PURPOSE: We studied the resection of post-chemotherapy residual masses (20% to 80%) of advanced seminoma complicated by extensive fibrosis, in which active disease appears in 10% to 20% of cases. MATERIALS AND METHODS: We retrospectively analyzed (1986 to 2000) residual mass evolution according to size in 79 platinum treated patients. RESULTS: There was an evaluable response in 78 patients, including toxic death in 1 after 1 chemotherapy cycle, a complete response in 34 (after chemotherapy in 15 and after complete residual mass resection in 19), a marker negative partial response in 42 (incomplete residual mass resection in 8), stable and progressive disease in 1 each. In 15 of 31 patients the resected residual mass was 3 cm. or greater, whereas in 12 of 29 it was less than 3 cm. No surgery was performed for 3 residual masses of unknown size. Of the 42 residual masses 21 disappeared at a median of 12.5 months. Progression occurred at the initial tumor site in 11 of 13 patients after a median of 3.5 months, including 3 with a complete response, 8 with a marker negative partial response (residual mass 3 cm. or greater in 3, less than 3 cm. in 4 and unknown size in 1) and treatment failure in 2 (residual mass 3 cm. or greater). At a median followup of 36.4 months 67 patients survived (no disease progression in 56 and nonevolving residual masses in 11), while 12 had died including 9 of progressive disease 1 of toxicity and 2 of other causes. CONCLUSIONS: In our study there was incomplete surgical resection in 30% of cases. Relapse in 16.6% of cases occurred rapidly after the end of chemotherapy. Viable cells were only noted in residual masses 3 cm. or greater (13%) and 50% of residual masses disappeared during surveillance. We intend to perform a prospective cohort study with close followup of patients with residual masses less than 3 cm. using an indication for surgery tailored to positron emission tomography findings in those with residual masses 3 cm. or greater.

Adult↗

PubMed2002

[Bladder cancer chemotherapy practice study].

OBJECTIVE: To study chemotherapy practice in invasive bladder cancer in a cancer centre (Centre Léon Bérard). MATERIAL AND METHODS: This retrospective study concerned all patients treated by chemotherapy between 1994 and 2000, either in the adjuvant setting (38) or for metastatic disease (66). RESULTS: Twenty four of the 38 patients receiving adjuvant chemotherapy were treated with MVAC, 21% developed febrile neutropenia and 60% relapsed. The median recurrence-free survival was 12 months. In patients treated for metastatic disease, the objective response rate was 36% and the median survival with advanced disease after chemotherapy was 10 months. These results are in line with those reported in large-scale randomized trials. The toxicity of chemotherapy was also fairly high (21% of febrile neutropenia). CONCLUSION: Prospective studies help to optimize chemotherapy protocols, but practice studies show the limited results and the high toxicity. The benefit/risk ratio must be carefully considered.

Antineoplastic Combined Chemotherapy Protocols↗