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Biomedical subjects

B Pierquin

Publications and source records attributed to B Pierquin.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Conservative treatment of bladder epitheliomas by partial cystectomy and iridium-192 curietherapy].

From 1971 to 1979, 55 patients were treated for bladder cancer at the Henri-Mondor Hospital using a treatment protocol combining low dose pre-operative external beam radiation followed by iliac node dissection, limited partial cystectomy (or sometimes for T1 tumors, a trans-urethral resection) and curietherapy with iridium 192. The 5 year disease free survival was 37/55 (67%). The rate of local recurrences plus second tumors within the bladder was 16% (9/55). These results are compared with other conservative modalities of treatment of bladder cancer.

Adult↗
PubMed1987

[Salvage irradiation of epidermoid carcinoma of the oropharynx by iridium 192].

Between May 1971 and March 1982, 73 patients with either recurrent or subsequent squamous cell carcinomas arising in a previously irradiated oropharynx were treated using iridium 192 wires. Although local control was achieved in 72% of these patients, only 10 remained alive at 5 years (14%). Local control was best for tonsillar arch lesions (96%), while base of tongue and glosso-tonsillar sulcus tumors were controlled in only 60%. One of the two patients with a posterior pharyngeal wall lesion is alive and well at 5 years, while the other died of an unknown cause at 20 months. Salvage implantation produced soft tissue necrosis in 36% of base of tongue implants, but only 18% of those involving the tonsillar arch. Although one necrosis was fatal, the others were successfully managed medically. Since these results compare favorably with those of previously published series, we recommend re-irradiation with iridium 192 for recurrent or new malignancies arising in a previously irradiated oropharynx. For tonsillar arch lesions, brachytherapy is the treatment of choice while in the base of tongue, it is reasonable option.

Adult↗
PubMed1987

[Curietherapy of the eustachian tube with Ir-192].

An essential success factor for tympanoplasties is effective aeration of middle ear, lack of tubular permeability being a factor for failure. The anti-inflammatory effect of curietherapy with Iridium 192 introduced into the tube during middle ear surgery was studied in 38 patients. Tubular dysfunction was evaluated by clinical and manometric examinations. During operation, a sealed plastic tube 1.6 mm in diameter was introduced into the Eustachian tube, an Iridium wire inserted on the following day, and a dose of 1.5 and 3 Gy applied to two groups respectively. Tubular function was assessed as normal or almost normal in 61% of cases. Results were compared with a group of 30 patients not receiving curietherapy.

Adolescent↗
PubMed1987

[Update on exclusive radiotherapy of T1 and T2 of the faucial arch].

From April 1971 to October 1984, 71 patients with T1 or T2 tumors of the faucial arch were treated according to the following protocol: Telecobalt therapy to the primary site and to the neck nodes to a dose of 45 Gy. Brachytherapy to the primary site to a dose of 25 to 30 Gy using iridium 192. For node positive patients, boost dose to involved neck nodes with electrons, or radical neck dissection. Seven patients with T1N0 tumors were treated exclusively by 60 Gy iridium implantation. The crude disease free survival is 66% for the group of patients with tumors of the tonsillar region and 41% for those with tumors of the soft palate or uvula. Local control of tonsillar tumors was 98% while that of tumors of the soft palate was 85%. Regional control was 98% for the N0 group and 87% for the N1-3 group. Five cases of soft tissue ulceration were observed, all of which healed spontaneously within a few months. Less salivary impairment was seen than after treatment by external irradiation alone. While these promising results have encouraged the use of this protocol, the introduction of the plastic tube technique has expanded the indications to include almost all T1 and T2 tumors of the faucial arch without obvious extension to the base of tongue or retromolar trigone.

Adult↗
PubMed1987

[Evaluation of low-dose cobalt teletherapy in the treatment of oropharyngeal cancers of moderate extension].

Comparative efficacy of treatment with irradiation of 20 Gy, either conventionally fractionated (33 cases) or by semi-continuous low-dose irradiation (32 cases) was studied in 65 patients with oropharyngeal cancer with moderate extension (T2b and T3a). Survival rate was 44% in the low-dose group as against 24% in the conventionally treated group at 2-year follow up review. More particularly, however, there were 4 times fewer recurrences in the low-dose group (16% as against 61% in conventional group). This suggests the need for continuing study of the time factor in radiotherapy, although a few cases of necrosis (16%) were observed in the low-dose group.

Cobalt Radioisotopes↗
PubMed1986

[Conservative treatment of breast cancer. Results after 10 years].

Between 1961 and 1975, 300 women with cancer of the breast (T1:72; T2:167; T3:61) were treated conservatively with radiotherapy alone (T3) or with partial or predominant radiotherapy combined with tumorectomy without axillary dissection (T1 or T2). The results, normalized at 10 years, confirmed that the survival rate (crude or NED) was exactly the same as with other conservative treatments or mutilating surgical treatments. Relapses were few (8%) in T1 cases and acceptable in T2 and T3 cases (13% and 18% respectively); in almost every patient they were amenable to surgery, with good local postoperative course. The prevalence of metastases was directly proportional to the size of the tumour; it was neither more nor less frequent than after radical surgery. Complications were rare and not very severe. Cosmetic results were either excellent (T1) or satisfactory (T2, T3). Finally, the proportions of breasts preserved at 10 years among patients alive and NED was very high, ranging from 96% (T1) to 91% (T2) and 87% (T3). These good results were associated with the possibility of high dosage additional endocurietherapy of the tumoral area with iridium 192, particularly in extensive forms where tumorectomy was cosmetically precluded. Since 1975, we have been using the conservative treatment in closer association with non mutilating surgery.

Breast Neoplasms↗
PubMed1986

Radiation therapy for carcinoma of the pinna using iridium 192 wires: a series of 70 patients.

From January 1970 to November 1982, 70 patients with carcinoma of the pinna were treated by interstitial irradiation. An afterloading technique with Iridium 192 wires was used. One patient recurred and had a total pinnectomy followed by 60 Gy external radiation. This patient was alive without evidence of disease at 134 months. Three patients who had tumors greater than 4 cm in size at presentation developed late necrosis which required subsequent total pinnectomy. Cosmetic results were assessed in 55 patients and were good with few late sequelae (in 78% of cases (36/46) when the tumor measured less than 4 cm, but only in 1/9 when the tumor measured more than 4 cm). We advocate interstitial Iridium 192 irradiation for treatment of pinna tumors smaller than 4 cm. None of 39 patients with squamous cell carcinoma had biopsy proven cervical lymph node metastasis at the time of diagnosis. Four patients with squamous cell carcinoma (4/39: 10%) later developed a regional nodal metastasis after treatment of the pinna. All four relapsed in the parotid region and were managed by partial parotidectomy and neck dissection followed by external irradiation. One of these four patients died from uncontrolled cervical node disease. In our opinion, when regular follow-up is dependable, it is reasonable to save treatment of the cervical nodes for those patients who relapse with involved metastatic cervical nodes.

Adult↗
PubMed1986

Interstitial radiation therapy for squamous cell carcinoma of the tonsillar region: the Creteil experience (1971-1981).

From July 1971 to December 1981, 33 selected patients with T1, T2 tumors of the tonsillar region were treated according to the following protocol: 1. Telecobalt therapy to the primary site and to neck nodes to a dose of 45 Gy. 2. Brachytherapy to the primary site to a dose of 30 Gy using iridium 192. 3. Boost dose to involved neck nodes with electrons, or radical neck dissection, whether N1, N2, or N3. The actuarial disease-free survival was 76% when all patient groups were included and 80% for the N0 patients. The local control rate was 100%. Disease control in the neck was 94% overall and 100% for the N0 group. These results favor the use of this protocol for superficial, minimally infiltrating tumors less than 4 cm in diameter, without obvious extension to the base of the tongue or retromolar trigone.

Adult↗
PubMed1986

Locoregional recurrences following radical external beam irradiation and interstitial implantation for operable breast cancer--a twenty three year experience.

Locoregional recurrences are reported in 493 consecutive with T1 T2 N0 N1 breast cancer patients who were treated with radical external beam irradiation and interstitial 192 Ir. implant between 1961 and 1979. Follow-up ranges from 5-23 years (mean 10 years) with 195 patients having 10-23 years follow up (mean 12 years). Tumorectomy was performed in 130/158 (88%) T1 and 73/335 (22%) T2 patients. There were 51 (10%) locoregional recurrences with 34 mammary, 14 combined mammary/axillary and 3 isolated axillary recurrences. The 10 year relapse rate was 20/195 (10%). The risk, timing and site of relapse varied according to TNM stage and tumorectomy. The risk was higher for T2 (42/335, 12.5%) than T1 (9/158, 5.5%) due to a larger number of recurrences occurring in the first 5 years (T2 32/335, 9.5% vs T1 4/158, 2.5%). Between 5-10 years, risk of relapse equalized to around 3% for both groups and only 1 relapse was seen after 10 years. Of the 48 mammary recurrences, 25 (52%) occurred in the implant volume, 7 (14%) occurred on the margin of the implant, 12 (25%) occurred at sites remote from the primary and in 4 (9%), the exact site could not be defined. 14/48 mammary recurrences were accompanied by axillary relapse, there were 3 isolated axillary recurrences and supraclavicular metastases accompanied axillary relapse in 3 cases. The overall risk, of axillary relapse was 3% (17/493) and there was significant correlation with initial N stage. Salvage surgery generally mastectomy and axillary dissection, was possible in 45/51 (90%) recurrences. 23/45 (50%) survive NED 0.2-9 years (mean 3 years) after salvage. 8/23 (35%) followed longer than 5 years after salvage survive NED. Our results have been compared with other series in the literature and changes in our current protocol are described.

Brachytherapy↗
PubMed1986

Conservative treatment of breast cancer in Europe: report of the Groupe Européen de Curiethérapie.

These two meetings organised successively to discuss the conservative methods of treatment of breast cancer, made it possible to gather data on a substantial number of patients from an important number of European centers. It is encouraging to note that there is a general consensus among the various European centers concerning the basic principles of treatment and that long years of experience have led to the use of well defined technical protocols which are relatively similar from one center to another. Since serious complications have now become exceptional, we foresee that the conservative treatment of breast cancer will continue to evolve on a technical level as the indications for this approach continue to develop within the overall plan of patient care with the assurance that optimum results may be maintained. However, we must point out that the lack of a unified system of reporting irradiation doses in volumes corresponding to the possible and/or real extension of the tumor remains an obstacle in developing a truly unified attitude in the application of these techniques. Each center defines the radiation dose given by wide field techniques and the dose given by cone-down (boost) techniques in a relatively arbitrary way without true anatomic correlations. These correlations must be found and defined, so that a specified dose has a universal meaning. The role of the surgeon in the successful application of breast conserving techniques is far from negligible. Now that our colleagues who wield the scalpel have begun to gain confidence in the curative powers of irradiation, we may hope that a close collaboration between radiotherapist and surgeon will lead to the application of conservative techniques under optimal conditions in the breast, with the development of minimal tumorectomy and minimal curative cone-down dose; and in the axilla, with the development of axillary dissection limited to the lower border of the pectoralis minor and followed by radiation therapy only if more than two nodes show tumor involvement. However, it is important to point out that while it is possible to use radiation therapy alone to treat breast cancer and conserve the breast at all stages of the development of the disease, it is not possible to use conservative surgical techniques alone as a substitute for adequate irradiation. The development of protocols which routinely apply breast conserving methods in synonymous with the development and routine use of the best radiation therapy techniques. This article presents two separate and complementary studies of two different sets of data presented at two successive meetings.(ABSTRACT TRUNCATED AT 400 WORDS)

Axilla↗
PubMed1986

The past and future of conservative treatment of breast cancer.

Since 1961 more than 1,200 patients with breast cancer were treated conservatively at the Institut Gustave Roussy (Villejuif) and, since 1970, at the Hôpital Henri Mondor (Créteil). This group included approximately 25% T1 tumors, 55% T2 tumors, and 20% T3 tumors. All of these patients were staged, according to the U.I.C.C. Tumor Classification System. This paper presents the results of treatment of 330 patients who were followed for a minimum of 10 years and 59 patients who were followed for a minimum of 15 years. We also present our most recent protocol, which has been in use since 1983.

Breast Neoplasms↗
PubMed1985

A comparison between low dose rate radiotherapy and conventionally fractionated irradiation in moderately extensive cancers of the oropharynx.

We report the comparative results for local tumor control between two groups of patients treated by radiotherapy fractionated in a conventional manner at normal high dose rate (29 patients with 2 years minimum follow-up and 24 patients with 3 years minimum follow-up) and by low dose rate radiotherapy (19 patients with 2 years minimum follow-up, 14 patients with 3 years minimum follow-up) with moderately extensive cancers of the oropharynx (T2b-T3a, 3-5 cm in diameter). At 2 and 3 years follow-up, the number of local recurrences in the patients treated with low dose rate radiotherapy is half (26 and 21%) that for those treated with conventionally fractionated radiation at normal high dose rates (52 and 54%). These results require more rigorous confirmation.

Carcinoma, Squamous Cell↗
PubMed1985

Comparative dosimetry between iridium wires and seed ribbons.

We have undertaken a computer study that explores the conditions under which seed ribbons may replace iridium 192 wires in the Paris System. Compared with continuous iridium 192 wires, seed ribbons demonstrate greater inhomogeneity and loss of flexibility, simplicity, and other advantages. Nonetheless, we have defined the conditions where seed ribbons may be used in the Paris System to give satisfactory dose distributions and acceptable levels of heterogeneity within any given implant volume. These conditions include seed length, spacing between seeds, number of seeds per ribbon, and geometric arrangement of ribbons.

Brachytherapy↗
PubMed1985

The guide gutter or loop techniques of interstitial implantation and the Paris system of dosimetry.

The predictive dosimetry system for implants known as the Paris system can be used with either loops or hairpins. When using the guide gutter technique, implant geometry is predetermined by the inherent spacing and parallelism of the branches of the hairpins. When using loops, their branches should not be spaced too widely apart and should be parallel over an adequate distance to obtain a fairly regular dose distribution between them. The basic principles of implantation are the same as for rectilinear sources. Branches must be rectilinear, parallel, arranged so that their centers are located in the same plane (central plane). Adjacent branches must be equidistant from each other and the reference linear kerma rate (or the linear activity) must be uniform and identical for all sources. When these conditions are met, the dimensions of the treated volume (volume encompassed by the reference isodose surface with a value equal to 85% of the basal dose rate) can be estimated at the time of the implantation procedure. In practice, only a few relationships presented in this paper, with examples of application, must be known. Although, the Paris system permits forecasting the final dosimetry, the geometry of the implant must be verified and the dose calculated according to the implantation as actually achieved. The best method of checking the exact position of radioactive sources in an implant and determining the dose rate at any desired point is a reconstruction by computer program although alternative methods are occasionally appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)

Brachytherapy↗