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D Castaigne

Publications and source records attributed to D Castaigne.

At least 73 records · Page 4Linked to original sources
PubMed1997

Differentiation between recurrent tumor and benign conditions after treatment of gynecologic pelvic carcinoma: value of dynamic contrast-enhanced subtraction MR imaging.

PURPOSE: To compare dynamic contrast material-enhanced subtraction and T2-weighted spin-echo (SE) magnetic resonance (MR) imaging in the differentiation of fibrosis from tumor recurrence during the follow-up of treated gynecologic pelvic malignancy. MATERIALS AND METHODS: Thirty-four patients (aged 24-82 years) with 18 benign and 35 malignant lesions confirmed by means of surgery (n = 18), biopsy (n = 25), or 18-month follow-up examination (n = 10) underwent dynamic contrast-enhanced subtraction and T2-weighted SE MR imaging. Contrast material enhancement of an abnormal pelvic structure within the first 90 seconds on dynamic contrast-enhanced subtraction images or high signal intensity on T2-weighted SE images was considered indicative of malignancy. RESULTS: The sensitivity, specificity, accuracy, and positive and negative predictive values were 91%, 67%, 83%, 86%, and 86%, respectively, for dynamic contrast-enhanced subtraction imaging and 91%, 22%, 68%, 70%, and 57%, respectively, for T2-weighted SE imaging. More lesions were correctly classified with dynamic contrast-enhanced subtraction imaging than with T2-weighted SE imaging (P < .01). CONCLUSION: Dynamic contrast-enhanced subtraction imaging is more accurate than T2-weighted SE imaging for differentiating fibrosis from tumor recurrence during the follow-up of treated gynecologic pelvic malignancy. However, use of both sequences is recommended.

Adult↗
PubMed1997

[Current treatment of malignant epithelial tumors of the ovary].

Surgery is the essential element of staging and treatment of malignant ovarian tumours. Regardless of the stage, it must include peritoneal cytology, hysterectomy with bilateral adnexectomy, omentectomy, pelvic and lumbo-aortic lymphadenectomy, appendicectomy and multiple peritoneal biopsies. In stage I tumours, in young women desiring a subsequent pregnancy, preservation of the uterus and contralateral ovary can be proposed. In stages II, III and IV, the therapeutic strategy consists of primary surgery and systematic chemotherapy (6 cycles). Radical surgery is essential in these cases, as the size of the residual tumour at the end of operation constitutes the major prognostic factor. To optimize the quality of tumour debulking, the maximum of visible carcinomatous nodules must be resected with, if necessary, gastrointestinal resections. The value of second-look surgery, after 6 cycles of chemotherapy, is currently controversial: it is only indicated in the context of randomized trials. Borderline malignant ovarian tumours have a good prognosis regardless of their stage. Surgery can very often be conservative, particularly in young women. Adjuvant chemotherapy has been shown to be effective in these tumours. Many studies are underway to define the value of new cytostatic molecules and "interval" surgery (intercalated between several courses of chemotherapy).

Adult↗
PubMed1997

Extensive cytoreductive surgery in advanced ovarian carcinoma.

From June 1985 to June 1993, 152 patients with advanced ovarian cancer were treated with maximum cytoreductive surgery, and six to nine cycles of platinum-based chemotherapy. Six patients had stage IIIA-B disease, 101 stage IIIC, and 45 stage IV. Twenty-two tumors were grade 1. 58, grade 2. and 72, grade 3. Eighty-four patients (55%) presented with bulky tumors (> 10 cm in diameter). Optimal cytoreductive surgery (diameter of largest residual mass < 2 cm) was performed in 138 patients (91%). Fifty patients (33%) developed postoperative complications; 38 patients (25%) required a second laparotomy within a few days. Two postoperative deaths occurred. Overall 2-year and 4-year survival rates were 56% and 28%, respectively. There was a clear relationship between residual tumor and survival: the 2-year survival rate was 80% in the absence of residual tumor vs. 22% when the residuum exceeded 2 cm in diameter. The 2-year survival rate was 49% for tumor nodules < 2 cm in diameter. In a multivariate analysis of various risk factors (grade, stage, lymph node metastases, residual tumor, and age), the one that correlated most with survival was residual tumor. Despite a high morbidity rate, this modality of treatment, with the presence of optimal and aggressive perioperative measures in terms of intensive care unit and post-operative follow-up, offers an encouraging if not promising strategy for increased chances of survival in advanced ovarian cancer.

Adult↗
PubMed1997

[Negative second-look laparatomy in ovarian cancers. Survival analysis and prognostic factors from 64 cases treated at the Gustave Roussy Institute].

This study describes 64 cases of ovarian adenocarcinoma seen in the Gustave-Roussy Institut between 1978 and 1988 and who had a negative second-look laparotomy. The median age was 51 years (30-74). FIGO stages were: I: 7 (11%); II: 3 (5%); III: 39 (61%); IV: 3 (5%); and undetermined: 12 (19%). There were 53% of serous type, 14% of endometrioid type, 13% of undifferencied type, 8% of clear cells type, 3% of mucinous type, and 9% of mixed type tumors. There were 50% of grade 3 tumors. Initial debulking surgery was as complete as possible in 59 patients, with a residual tumor after surgery superior or equal to 2 cm in 25 patients. Post second-look surgery treatment (n = 57) consisted of chemotherapy (CT) alone in 22 patients (34%), radiotherapy (RT) alone in 31 patients (49%), and CT associated with RT in 4 patients (6%). Median follow-up is 100 months. The overall survival rates at 3 and 5 years were respectively 86 and 81%, and disease free survival rates 70 and 61%. Among the 64 patients, 26 relapsed (39%). Median time to relapse was 96 months. There is a statistical difference in the survival between patients who had no or inferior to 2 cm residual tumor and others. Residual tumor was the only factor to be significant in univariate and multivariate analysis of survival.

Adenocarcinoma↗
PubMed1997

[Surgical strategy for peritoneal carcinosis of ovarian origin].

Cancer of the ovary is usually discovered in an advanced stage after development of peritoneal carcinosis. Surgery is a fundamental element for diagnosis and treatment. Therapeutic strategy for cancer of the ovary discovered in an advanced stage includes first-line surgery and systematic postoperative chemotherapy. The essential prognostic factor is the quality of the initial surgical resection and the size of the residual tumoral tissue. Hysterectomy with adnexectomy, omentectomy, lumbo-ovarian and pelvic node dissection and extensive excision of visible carcinosis nodules, with if need digestive resection, are required for optimal tumor reduction. This aggressive surgery should be performed by well trained surgical teams.

Adnexa Uteri↗
PubMed1996

[Krukenberg tumors. Analysis of a series of 28 cases].

We report a retrospective series of 28 patients with Krukenberg tumors treated at the Gustave Roussy Institute from 1973 to 1990. Mean age of these women was 42 years. The patients were classed into two groups: depending on whether the ovarian metastasis (group 1) or the primary cancer (group 2) was discovered first. The primary tumor was identified in 20 cases (18 cases of linitis, 1 tumor of the cecum, 1 tumor of the appendix). The primary tumor remained unknown in 8 cases. Twenty-seven patients underwent radical total hysterectomy or bilateral adnexectomy. Gastrectomy was possible for 11 of the 18 cases of linitis; hemicolectomy and appendectomy were performed for the cecal and appendicular tumors respectively. Diagnosis of a primary tumor of the appendix was made after systematic appendectomy and of two Krukenberg tumors after systematic bilateral adnexectomy. In the first group of patients, both localizations were treated in 6 cases, one in 12 including 4 because gastrectomy was not initially possible and in 8 because the primary tumor was unknown. In the second group, the two localizations were treated in 7 cases, and one in 2 cases because gastrectomy was not possible. Surgery was not performed in one patient due to diffuse carcinosis. Bilateral ovarian metastases were seen in 26 out of the 28 cases and 26/28 had chemotherapy without any appreciable effect. Bone metastasis predominated (9 cases), followed by pleuropulmonary (5 cases) and liver (3 cases) metastasis. Overall median survival was 20 months; 14 months in the first group and 29 months in the second. Appendectomy and exploration of the colon and the stomach were performed in all cases in which the Krukenberg tumor was discovered intraoperatively. An endosonographic exploration of the stomach is recommended if the primary tumor is not localized. Bilateral adnexectomy should always be performed in patients with linitis whatever the age. Surgical treatment of the two localizations is not always sufficient for cure.

Adult↗
PubMed1994

A phase II study of high-dose cisplatin, vinblastine, bleomycin, and etoposide (PVeBV regimen) in malignant nondysgerminomatous germ-cell tumors of the ovary.

Fourteen patients with malignant nondysgerminomatous germ-cell tumors of the ovary were treated with a combination of high-dose cisplatin, vinblastine, bleomycin, and etoposide (PVeBV regimen). Nine patients received PVeBV as primary postoperative therapy, of whom four had no residual disease. Four patients received PVeBV for recurrent disease. One patient underwent PVeBV therapy as second-line treatment. Three patients with initial poor prognostic features were treated with early high-dose chemotherapy with autologous bone marrow rescue as consolidation therapy after two cycles of PVeBV. Ten of 14 patients (71%) are progression-free with a median follow-up of 6 year. Equal efficacy and less toxicity favor the combination of bleomycin, etoposide, and cisplatin (BEP) as standard treatment of ovarian germ-cell tumors in the 1990s.

Adolescent↗
PubMed1992

Arterioureteral fistula after extended resection of pelvic tumors: report of three cases and review of the literature.

Arterioureteral fistulas are rare. Three patients with arterioureteral fistulas complicating extended resection of pelvic tumors associated with bilateral cutaneous ureterostomy in the right lower quadrant are reported. In one case, the fistula involved the left ureter, the right common iliac artery, and the inferior mesenteric artery. Pathological iliac artery, pelvic cancer, or operated ureteral stones are often incriminated in the genesis of ureteroarterial fistulas. Insertion of a ureteral catheter has been found to be the main promoting factor. The common iliac artery is involved frequently. Clinical presentation is often limited to gross hematuria, whereas complementary investigations have not proved to be sensitive. Surgical treatment is often complex, but must be undertaken early, even in the absence of absolute proof of diagnosis, in order to preclude uncontrollable massive hemorrhage.

Female↗
PubMed1992

[Contribution of expert systems in clinical practice: apropos of the Penelope experience, an expert system in assisted diagnosis and therapy of ovarian adenocarcinoma].

An expert system (ES) for Diagnosis and Therapy of ovarian adenocarcinoma has been developed at the Institut Gustave-Roussy. From surgical and histological results, clinical examination and additional investigative reports, the system presents a synthesis and then determines the stage of the disease. The system than proposes therapeutic indications adapted to the characteristics of the illness and of the patient, and edits a report at the end of the ES consultation. This experience allowed us to specify the field of ES applications in oncology. As tools for diagnosis and therapy, they cannot act as a substitute for the know-how of the physician, as too many medical decisions remain difficult to formalize in the ES. On the other hand the use of artificial intelligence techniques appears to be useful for establishing coherent data bases, which are necessary pre-requisites for clinical research in oncology. The integration of the system in the Hospital Information System is the guarantee of its use in current clinical practice.

Adenocarcinoma↗