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Biomedical subjects

F Bladou

Publications and source records attributed to F Bladou.

At least 19 recordsLinked to original sources
PubMed2004

European collaborative group on prostate brachytherapy: preliminary report in 1175 patients.

OBJECTIVE: To establish a multi-centre database of a large number of patients treated with brachytherapy across Europe. METHODS: A total of 1175 patient files were registered in the database and the completeness of the data on these patients resulted in the majority being included in the analysis. RESULTS: The database of patients treated with brachytherapy across Europe indicates that optimal patient selection for this procedure has been made, both in terms of outcome and side-effects, which will be subject of future analyses. This should enable refinement of the treatment choice and administration as well as provide useful guidance to other centres that want to establish this procedure for their patients. It will also set the ground for prospective studies. CONCLUSIONS: The established database indicates that brachytherapy as a treatment option for prostate cancer is well established in many centres.

Aged↗
PubMed2004

Major complications of urinary diversion after pelvic exenteration for gynecologic malignancies: a 23-year mono-institutional experience in 124 patients.

OBJECTIVE: The objective of this study was to analyze the postoperative outcome of patients undergoing urinary diversion at the time of pelvic exenteration. METHODS: Between January 1980 and December 2002, 232 pelvic exenterations for gynecologic malignancies were performed in our hospital. One hundred and twenty-four included a urinary diversion. There were locally advanced or recurrent cancers including 101 cervical, 11 endometrial, 5 vagina, 2 ovarian malignancies and 5 pelvic sarcoma. RESULTS: Ninety patients (72.5%) had a history of previous irradiation. Exenterations were 69 anterior and 55 total. Urinary diversion included 14 bilateral ureterostomies, 62 trans-intestinal diversion and 48 continent diversion using distal ileum and right colon. Pelvic filling was performed in 56 patients (45%). Low colorectal anastomosis was performed in 42 of 48 supralevator pelvic exenteration (87.5%). Postoperative mortality rate was 8% (10/124). Overall 12-week postoperative morbidity rate was 52% (65/124) and appears to be significantly higher in irradiated patients and after total exenteration. In trans-intestinal noncontinent group, eight patients were reoperated for a complication directly related to urinary diversion procedure. No reoperation for such a complication was performed in the continent urinary diversion group. CONCLUSIONS: Ileocolic continent pouch seems to be the safer urinary diversion procedure after exenteration for gynecological malignancies especially in irradiated patients and after total exenteration.

Adult↗
PubMed2003

[Iodine-125 transperineal prostate brachytherapy with preplanning technique: pre and post-implant dosimetry results analysis].

PURPOSE: Post-implant CT-based dosimetry is the only method of assessing the quality of permanent prostate brachytherapy. As a consequence of our permanent feedback with the preplanned technique, geometric and dosimetric criteria for optimal seed implantation are proposed and pre and post-implantation dosimetric results are presented. PATIENTS AND METHODS: In 2000 and 2001, one hundred and twenty patients with early stage prostate cancer were treated with transperineal I-125 preplanned brachytherapy (RAPID Strand, Amersham Health). The prescription dose was 145 Gy to the planning target volume. For the pre-planning and post-implant dosimetry the Variseed 6.7 version software was used (Varian Medical Systems). The D90, V100 and V150 values, the position of the dose peak [Dose] peak) and the full width at half maximum (FWHM) on differential dose volume histogram from both planned and post-implant dosimetry were compared for all patients. RESULTS: For preplanned dosimetry, the mean values for D90, V100, V150, [Dose] peak, FWMH were respectively of 199Gy, 100%, 70%, 220Gy, 113Gy. For post-implantation, these values became respectively of 157Gy, 90%, 62%, 220Gy, 194Gy. CONCLUSION: In our practice, differences are noted between preplanned and post-implant dosimetry parameters that should be anticipated to assure optimal definitive result. A working methodology both for performing the preplanned dosimetry and for evaluating the post-implantation dosimetric results is proposed.

Brachytherapy↗
PubMed2003

Expression of a model gene in prostate cancer cells lentivirally transduced in vitro and in vivo.

In a preclinical model for prostate cancer gene therapy, we have tested lentiviral vectors as a practical possibility for the transfer and long-term expression of the EGFP gene both in vitro and in vivo. The human prostate cancer cell lines DU145 and PC3 were transduced using experimental conditions which permitted analysis of the expression from a single proviral vector per cell. The transduced cells stably expressed the EGFP transgene for 4 months. After injection of the transduced cell populations into Nod-SCID mice a decrease in EGFP was only observed in a minority of cases, while the majority of tumors maintained transgene expression at in vitro levels. In vivo injection of viral vector preparations directly into pre-established subcutaneous or orthotopic tumor masses, obtained by implantation of untransduced PC3 and DU145 cells led to a high transduction efficiency. While the efficiency of direct intratumoral transduction was proportional to the dose of virus injected, the results indicated some technical limitations inherent in these approaches to prostate cancer gene therapy.

Animals↗
PubMed2002

Effect of nonsteroidal anti-inflammatory agents and finasteride on prostate cancer risk.

PURPOSE: We examine the relationship of nonsteroidal anti-inflammatory drugs and finasteride on the risk of prostate cancer. MATERIALS AND METHODS: Participants in this case control study using a prospective collection of data were drawn from consecutive patients who underwent prostate biopsy at 12 different departments of urology from January 1999 to June 2000. Medication use was assessed by self-questionnaire as well as questions about dietary and lifestyle factors that might be relevant for prostate cancer risk. RESULTS: The study included 639 patients with prostate cancer and 659 cancer-free controls. Univariate analysis showed no significant impact of aspirin and finasteride on prostate cancer risk while the nonaspirin nonsteroidal anti-inflammatory drug users had a lower risk (OR 0.80, 95% CI 0.64-0.99). After adjusting for potential confounders, the protective effect of nonaspirin nonsteroidal anti-inflammatory drugs was no longer significant (OR, 0.84, 95% CI 0.66-1.07), while finasteride showed a significant protective effect (OR 0.58, 95% CI 0.37-0.92). CONCLUSIONS: The results suggest that finasteride could have a chemopreventive role in prostate cancer. While aspirin did not show any impact on prostate cancer risk, the role of nonaspirin nonsteroidal anti-inflammatory drugs warrants further studies.

Aged↗
PubMed2002

A Nod Scid mouse model to study human prostate cancer.

Prostate cancer is the second cause of cancer mortality in men in Western countries. To study new therapeutic approaches such as gene therapy, animal models of human prostate cancer with metastatic behavior are mandatory. We used the Nod Scid mouse strain to develop an orthotopic animal model. Two androgen-independent cell lines (PC-3 and DU 145) were used. Local tumor growth and metastases were analyzed. The tumor take rates were close to those reported in the literature. However, a high frequency of various metastatic sites has been observed (liver, lung, spleen, adrenal, kidney, lymph node, and diaphragm). It can be concluded that the Nod Scid mouse is a relevant preclinical animal model to study human prostate cancer. Metastatic sites seem more numerous in comparison to other orthotopic mice models described.

Adenocarcinoma↗
PubMed2001

[Correlation between Gleason score of prostatic biopsies and the one of the radical prostatectomy specimen].

UNLABELLED: The Gleason score obtained on prostatic biopsies is an essential element in the treatment decision for localized prostate cancer. The objective of this study was to evaluate the correlation between the biopsy Gleason score and the definitive Gleason score and to propose a classification into 3 groups in order to improve this correlation. MATERIAL AND METHODS: One hundred radical prostatectomies were performed between 1995 and 1998. Eighty four of these patients underwent 6 biopsies. The Gleason score of the biopsies and operative specimens were compared. The concordance between the biopsy Gleason score and the operative specimen Gleason score was initially analysed score by score. The concordance was then established according to three groups, well differentiated tumours (score 2-4), moderately differentiated tumours (score 5-7), poorly differentiated tumours (score 8-10). RESULTS: The concordance between the biopsy Gleason score and the operative specimen Gleason score was perfect in only 37% of cases. A 1-point difference of the score was observed in 35.7% of cases and a 2-point or greater difference was observed in 27.3% of cases. By classifying patients into 3 groups, the concordance increased from 37% to 72.6%. CONCLUSION: The classification of patients into three distinct groups (well, moderately and poorly differentiated tumours) increases the concordance between the biopsy Gleason score and the definitive Gleason score. However, the limitations of the biopsy Gleason score must be kept in mind, particularly in the case of low-grade tumours.

Biopsy, Needle↗
PubMed1999

[What is the role of the correspondence of free PSA/total PSA in the staging of local prostate cancer? Series of 50 radical prostatectomy cases].

OBJECTIVE: To refine the pretreatment staging of localized prostate cancers. MATERIAL AND METHOD: Prospective study on 50 total prostatectomy specimens from men with apparently prostate-confined adenocarcinoma. Preoperative assay of the free PSA/total PSA ratio and analysis of this ratio according to the presence of capsular effraction, capsular invasion and positive margins. RESULTS: Significant difference of this ratio according to the presence or absence of capsular effraction (13.2% versus 18.9%), capsular invasion (12.4% versus 17.5%) and positive margins (11.6% versus 16.3%). CONCLUSION: The free PSA/total PSA ratio can be useful for staging of prostate cancer, but this needs to be confirmed by a large-scale prospective study.

Adenocarcinoma↗
PubMed1998

[Value of surgery in the treatment of advanced cervical cancers].

Surgical resection of advanced nonmetastatic forms of cervical cancers is controversial, but improve local control. The local and regional staging assessment, comprising an examination under general anaesthesia, endocavitary ultrasonography, computed tomography (CT) and/or magnetic resonance imaging (MRI) allows staging, evaluation of the main prognostic factors and selection of the therapeutic strategy. Pelvic and lumboaortic lymph nodes can be investigated by CT, MRI or laparoscopic lymphadenectomy. Surgical resections consist of colpohysterectomy possibly combined with radical lymphadenectomy or pelvic exenteration, followed by pelvic reconstruction using various procedures: low colorectal anastomosis, continent urinary diversion, and vaginal reconstruction with pelvic filling. The mortality and morbidity of pelvic exenteration remain high. It is therefore important to prevent the most frequent complications as effectively as possible. The local control, overall survival and recurrence-free survival can be improved by combining concomitant radiotherapy-chemotherapy and large surgical resection. Some unfavourable local situations can justify palliative pelvic exenteration in highly selected indications designed to improve local control and comfort of survival.

Combined Modality Therapy↗
PubMed1997

Preliminary results of a phase I/II study of post-operative high-dose rate brachytherapy for advanced or recurrent pelvic tumours.

Electron beam intraoperative radiation therapy (EB-IORT) and intraoperative low-dose rate brachytherapy (IOLB) seem able to improve the local control of advanced or recurrent pelvic tumours (ARPT). We report the usefulness, technical considerations and potential advantages of employing post-operative high-dose rate brachytherapy (POHB) as a treatment for ARPT. From February 1995 to February 1997, 14 patients underwent POHB for ARPT. The mean age was 58 years (range: 37-74). Six patients presented with recurrent rectal carcinoma, three with cervix carcinoma (one primary T3; two recurrences), two with bladder carcinoma (one primary T4; one recurrence), one with prostate carcinoma, one with recurrent pre-sacral lymphoma and one with undifferentiated carcinoma. At the time of resection, blind-end HDR catheters were implanted in a single plan in the tumour bed and stabilized by absorbable sutures. Eight days later, POHB delivered 20Gy in 5 fractions or 40Gy in 10 fractions for advanced and recurrent tumours, respectively. To decrease the incidence of late side-effects, a change was made after the tenth patient to deliver 2 Gy per fraction twice a day, with an interval of 6 h between each fraction. With a median follow-up of 8 months (range: 1-22), local control was achieved in all cases. Six patients developed metastatic disease. One patient presented a perineal wound dehiscence requiring surgery 2 months after POHB. POHB is feasible for patients with recurrent or advanced pelvic diseases, and appears more cost-effective than EB-IORT for dosimetric and radiobiological considerations. Compared with IOLB, POHB allows the total radioprotection of the medical staff, and, in the context of cost reduction, a reduction of the overall time of hospitalization.

Adult↗
PubMed1997

Clinical experience with 80 inflatable penile prostheses.

OBJECTIVES: Prosthetic surgery for impotence has been transformed by the use of inflatable prostheses, superseding the old semi-rigid designs. Our objective is to report the functional results and the complications of this type of surgery. METHODS: 80 inflatable prostheses were implanted between October 1987 and October 1994. The mean follow-up was 3 years and assessment of the objective (mechanical functioning of the prosthesis and complications) and subjective results (sexuality of the patients) was made in 68 patients. RESULTS: There were: 54.5% functional disturbances, 7% infections, and 27.5% prosthesis removals. Most of the patients were satisfied, although only 65% returned to regular sexual activity. CONCLUSIONS: The choice between an inflatable and a semi-rigid prosthesis should be carefully discussed because of the frequent mechanical complications that have been reported for the sophisticated designs. Inflatable penile prostheses nevertheless remain the design of choice. Their reliability has been increasing since the manufacture of monobloc designs. Such a device is costly, and should be compared with that of intracavernous injections.

Adult↗
PubMed1997

[In vitro and in vivo models developed from human prostatic cancer].

The possibility of maintaining and studying human prostatic cancers in an in vitro and in vivo environment has allowed the development of rare but essential tools to study many aspects of the biology of these cancers. Although none of the available models is perfect, the sum of the studies conducted with these models over more than 20 years constitutes the basis for major progress in our understanding of this disease. The most widely used cell lines (cultured in vitro) are PC-3, DU-145 and LNCaP. They are limited by the fact that they are essentially androgen-independent cell lines, derived from metastatic sites. Due to the slow growth of prostatic cancers, it is very difficult to obtain cancer cell lines which can be transplanted in immunodeficient animals (such as athymic mice) and only a few xenografts are currently available, some of which, like PCV-82, LuCaP 23, CWR-22, are androgen-dependent or sensitive. These models can be used to study host-tumour interactions as well as endocrinological interactions, stroma-tumour cell interactions, and to analyse molecular phenomena related to stages of hormone dependence and hormone resistance. In vitro and in vivo models of metastatic prostatic cancer have also been developed and appear to have a crucial impact on the understanding of metastatic mechanisms and new therapeutic approaches. This paper describes the main experimental models developed from human prostatic cancers, their main characteristics, their value compared to clinical cancers and some of the major studies conducted with these models. Due to the exponential progress in molecular biology techniques and oncogenetics, it appears essential to increase the number and diversity of experimental models of prostatic cancer in order to advance research concerning the crucial phenomena occurring during the course of this disease, from oncogenesis to currently incurable metastatic stages.

Androgens↗
PubMed1997

[Clear cell sarcoma of the kidney relapsing after 10 years of asymptomatic evolution].

We report the case of a kidney tumor occurring in a thirteen year-old girl. This tumor was first diagnosed and treated as a benign one. After ten years without recurrence, a relapse occurred. The diagnosis was recurrent clear cell sarcoma of the kidney. The course in our case is uncommon because clear cell sarcoma of the kidney is a rare and aggressive pediatric neoplasm, usually characterized by a predilection for bone metastases, and a mid survival rate of 30 months without treatment.

Adolescent↗
PubMed1997

[Drug-resistant genito-urinary rhabdomyosarcoma in children with primary psoas abscess. Apropos of a case].

We report an unusually uncommon case of genitourinary rhabdomyosarcoma in a child which was chemoresistant and complicated by a primary psoas abscess which presented as a pelvic mass associated with an abscess of the right iliac fossa. Ultrasound and CT investigations suggested the diagnosis of a centropelvic tumor which was confirmed at puncture-aspiration. MRI was most contributive giving a precise description of the local extension. Intensive multi-drug chemotherapy would appear to have improved outcome in patients with poor-prognosis Maurer group III tumors. In exceptional cases when no tumor response is obtained, carcinological surgery with large dissection, possibly with adjuvant radiotherapy, is indicated. Percutaneous drainage of the deep psoas abscess is as effective as classical surgery and spares the abdominal wall, particularly important if a second operation should be needed. Multidisciplinary management is required for the treatment of this highly malignant tumor.

Adolescent↗
PubMed1996

Cell proliferation and apoptosis during prostatic tumor xenograft involution and regrowth after castration.

The biological mechanisms involved in androgen-dependent and -independent prostate cancer growth after castration were analyzed in the LuCaP 23.1 human prostate cancer xenograft model. Athymic mice (n = 82) bearing LuCaP 23.1 xenograft were castrated and tumors were harvested at different time points from day 0 to day 112 post castration. In each group of mice, tumor growth rate (TGR), serum PSA concentration, percentage of tumor cells incorporating bromodeoxyuridine (BUdR index), percentage of apoptotic tumor cells assessed by morphological analysis (apoptotic index), and presence of apoptosis-related DNA "ladder" were analyzed. Castration induced a significant decrease in TGR and serum PSA from day 1 to day 7, and a progressive increase in the 2 parameters from day 14 to day 112, heralding androgen-independent tumor relapse. Meanwhile the BUdR and apoptotic indexes varied as follows after castration: an increase was noted for both at day 3, a significant increase in apoptotic index with a decrease in BUdR index from day 5 to day 14, and a progressive decrease in apoptotic index while BUdR index remained at 50% of the pre-castration value from day 28 to day 112. DNA ladder was present sparsely in tumors grown in non-castrated hosts, universally present in tumors from day 1 to day 28 post castration, and frequent in tumors from day 56 to 112. Castration-induced effects in LuCaP 23.1 tumors were characterized by an increase in number of apoptotic cells and a decrease in proliferative activity. The androgen-independent tumor relapse after castration was associated with a low apoptotic index with no increase in proliferative activity.

Animals↗