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Biomedical subjects

G Calais

Publications and source records attributed to G Calais.

At least 73 records · Page 4Linked to original sources
PubMed1990

Prognostic significance of breast relapse after conservative treatment in node-negative early breast cancer.

The prognostic significance of local relapse after conservative treatment of early stage breast carcinoma has been controversial. To determine the incidence and the prognostic value of a breast relapse, we analyzed the results obtained in a series of patients with pT1pN0 presentation of breast carcinoma treated conservatively without adjuvant medical treatment. From 1976 to 1986, 202 patients with invasive breast carcinoma of less than 2 cm without lymph node involvement were treated with surgery and radiation therapy. The overall survival rate was 97.2% at 5 years. Locoregional relapses occurred in 16 patients (7.9%). In these patients, the overall survival rate was significantly decreased as compared to that of patients without local relapse (87.5% versus 98.3% at 5 years, p less than 0.001). The probability of remaining metastasis-free was also significantly decreased (80.2% vs 91.3%, p less than 0.001). Most relapses (94%) appeared at or close to the primary site. Salvage local treatment was possible in 14/16 patients (87.5%). Age, menopausal status, size and site of primary tumor, histological grade, and boost technique did not influence significantly the risk of local relapse occurrence. We concluded that the occurrence of a breast relapse after a successful local conservative treatment is a pejorative prognostic factor predictive of a high risk of distant metastasis development. There is a need to individualize factors that could allow discrimination of patients with a high probability of local relapse and subsequent metastasis.

Adult↗
PubMed1990

Preoperative or postoperative brachytherapy for patients with endometrial carcinoma stage I and II.

In endometrial carcinoma, vaginal vault brachytherapy is performed to improve the local control rate and to decrease vaginal recurrences. To assess the best chronology of this brachytherapy compared to surgery, we have retrospectively analyzed results of treatment of patients treated either with preoperative brachytherapy (60 Gy) and then radical hysterectomy with bilateral salpingo oophorectomy (RH-BSO) (Group 1), or with RH-BSO and then postoperative brachytherapy (60 Gy) (Group 2). There were one hundred twenty-one patients in Group 1 and 63 in Group 2. The mean age was 61.8 years in Group 1 and 64.3 in Group 2. In Group 1, 73% of the patients were Stage I, and 77.6% were in Group 2. The two groups were comparable for histological grading and depth of tumoral invasion into the myometrium. Brachytherapy was delivered with one uterine and two vaginal sources in Group 1 and with three vaginal sources in Group 2. Doses to the reference volume and to reference points were calculated according to ICRU recommendations. Brachytherapy data were similar in the two groups except reference volume, which was smaller in Group 2. Local control rate was 87% in Group 1 and 91% in Group 2. Distant metastasis occurred in 12% of patients in Group 1 and 9% in Group 2. The 5-year actuarial survival rate was 84% in Group 1 and 89% in Group 2. Regarding stage, histological grading, and depth of tumoral invasion, no differences were observed between the two therapeutic groups. The only prognostic factor in the entire population was Stage. The 5-year actuarial survival rate was 91% for Stage I patients and 69% for Stage II (p value less than 0.03). The late severe complication rate was 14% in Group 1 and 7.9% in Group 2, a difference which was not statistically significant. We concluded that since no differences were observed between the two techniques, vaginal brachytherapy should be performed postoperatively when surgery is the first treatment (Stage I or II, grade 1 or 2, and no deep tumoral invasion into the myometrium).

Brachytherapy↗
PubMed1990

Lymphadenectomy in the management of endometrial carcinoma stage I and II. Retrospective study of 155 cases.

In our institution endometrial carcinomas Stage I and II were treated with initial uterovaginal brachytherapy 60 Gy followed by modified radical hysterectomy with pelvic lymphadenectomy. We have studied the results in order to assess the value of lymphadenectomy in the treatment strategy. Between 1976 and 1986, 155 patients were treated (107 Stage I, 48 Stage II mean age 60.2 years). Twenty-six patients also received postoperative pelvic external beam irradiation on account of lymph node involvement and/or deep tumour invasion into the myometrium. Fourteen patients (9%) had lymph node involvement. External iliac lymph nodes were involved in 78.5% of these cases. Lymph node involvement rate was higher for stage II, grade 3 tumours and when there was deep tumour invasion of the myometrium. The rate of local (pelvic) treatment failure was 12% for node-negative patients and 36% for node-positive patients and the 5-year actuarial survival rates for the two groups were 83% and 41% respectively. As a consequence of our interpretation of the findings and influenced by the high complication rate which we attribute to lymphadenectomy and the information given by other prognostic indicators, we have changed to a policy of carrying out pelvic external radiotherapy for all Stage II, grade 2 or 3 cases and those with deep myometrial invasion. Lymphadenectomy is not performed in these cases. For patients with Stage I grade 1 tumours without deep tumour invasion only external iliac node sampling is performed. If this shows tumour, external irradiation is given in addition to vaginal vault brachytherapy.

Adenocarcinoma↗
PubMed1990

Oropharynx carcinoma: irradiation alone versus induction chemotherapy plus irradiation--5 year results.

Induction chemotherapy (CT) has demonstrated overall response rates of 80% for oropharynx carcinomas, but no overall survival benefit has been reported. In order to determine the value of induction CT for such patients, we conducted a retrospective study: 121 patients were treated with CT and radiotherapy (RT) (Group 1). This group was compared with a historical group of 84 patients treated by RT alone (Group 2). The CT used was Cisplatinum associated with Bleomycin and Vincristin or Vindesin and with 5 Fluoro-uracil. An objective response to CT was observed for 41% of patients. The 5 year actuarial survival rate was 19% for Group 1 and 24% for Group 2. Patterns of failure were identical in the two groups. The only difference observed was for patients with N3 nodes (26% of 5 year survival rate in Group 1 versus 9% in Group 2) (p = 0.05). The results did not depend on the histological differentiation, the tumour site or the type of CT. We conclude that this retrospective study failed to demonstrate an advantage for induction CT in oropharynx carcinoma except for patients with N3 nodes.

Actuarial Analysis↗
PubMed1990

[Inner canthus--anatomical junction. A surgical entity].

The medial canthus is a surgical entity. The anatomical features are defined from a dissection of eight orbital regions. The pathways of carcinological invasion and the anatomical barriers are considered. The conclusions are discussed in the light of the data reported in the literature.

Dissection↗
PubMed1990

[Breast recurrence after conservative treatment of cancers of the breast: predictive factors and prognostic significance].

The prognostic significance of local relapse after conservative treatment of early stage breast cancer has been controversial. To determine the prognostic value of breast relapse occurrence and the factors predisposing to local failure, we analysed the results obtained in a series of 324 patients conservatively treated for breast invasive carcinomas of 2 cm or less. All patients were treated by tumorectomy and axillary dissection, radiation therapy, and adjuvant medical treatment in 85 of 109 patients with involved nodes. The overall 5-yr survival rate was 91.5%. The actuarial 5-yr local control rate was 91.9%. Local relapses occurred in 25 patients. In these patients, the overall 5-yr survival rate was significantly decreased as compared to that of patients without local relapse (76.9% versus 93.4%, P less than 0.001). Recurrence in the breast within 2 yr of initial treatment of severely affected the risk of metastasis occurrence as compared to later relapses (metastasis-free survival rate of 14.3% versus 63.9% at 3-yr from local relapse, P less than 0.01). Local relapse occurred more frequently in premenopausal patients, in patients with low bodymass index, and in patients with small breast size. Local control was not significantly affected by age, tumor size or node involvement. We conclude that the occurrence of a breast relapse after a local conservative treatment has a negative significance and is predictive of a high risk of distant metastasis development, especially when local relapse occurred within 2 yr of initial treatment. There is a need to determine individual factors that could allow discrimination of patients with a high probability of local relapse and subsequent metastasis.

Adult↗
PubMed1990

[Epithelial cancer of the ovary in adults: prognostic and therapeutic study of 95 cases].

The authors report 95 cases of ovarian carcinoma treated between 1st January 1975 and December 1986 in the department of gynecology and radiotherapy of hospital Bretonneau in Tours. The overall actuarial 5-year survival was 37.5%, for stage I 100%, stage II 51%, stage III 36%, stage IV 5%, grade I 88%, grade II 51%, grade III 18%. The authors stress the prognostic importance of histologic grade and the bad prognosis of small cell ovarian carcinoma with hypercalcemia. The authors propose a therapeutic attitude based on the results and a review of the literature.

Actuarial Analysis↗
PubMed1990

[Primary non-Hodgkin's high grade malignant lymphoma of the digestive system. A prospective study of the combination of surgery-chemotherapy-radiotherapy].

We report a prospective study concerning the association of surgery-chemotherapy and radiotherapy in the treatment of primary high grade digestive non-Hodgkin's lymphomas in 19 patients. The analysis of 11 stages IE, 5 stages II1E and 3 stages II2E allowed us to evaluate the efficacy and the tolerance of this triple therapeutic association. Fifteen patients are alive and well with a median follow-up of 54 months. One of these patients relapsed, but after autologous bone marrow transplantation is in second unmaintained complete remission. Four patients died of intercurrent aetiology although one death was related to treatment morbidity. Our results and the analysis of literature data lead us to recommend the triple association in the treatment of stage II2E high grade primary digestive lymphomas (PDL) and for PDL without complete resection. However, surgery and chemotherapy appear to be sufficient in the treatment of stages IE and II1E with complete resection.

Adult↗
PubMed1990

[Epithelioma of the medial canthus. Retrospective study of 47 surgically treated cases].

The authors report a retrospective study of 47 cases of carcinoma of the medial canthal area which were operated on between 1982 and 1987. Patient age and the histological frequency of basal cell carcinoma were similar to those of studies previously reported. Local extension must be evaluated at the initial clinical examination and computed tomography can be very useful. Frozen section for histopathologic study should be done if there is the least doubt. The surgical treatment and different methods of local reconstruction are discussed.

Adult↗
PubMed1990

[Pure primary retroperitoneal seminoma in a woman. Apropos of a case].

The authors report a case of a stage IV retroperitoneal seminoma in a patient of 43 years of age diagnosed after histological examination of a biopsy specimen from the left sub clavicular lymph mode showed metastatic seminomatosis. After complete assessment including and abdominal and pelvic ultrasound, a CT scan of the abdomen and pelvis, an intravenous urogram, a lymphogram and serial estimations of tumour markers (alpha feta protein and beta HCG) a laparotomy was carried out. This made it possible to take a retroperitoneal biopsy as well as to carry out a total hysterectomy without conservation of the ovaries. From all this we concluded that we were dealing with a straightforward very large retroperitoneal seminoma. The treatment was continued with large doses of chemotherapy using Vinblastin, Cisplatin and Bleomycin (V.C.B.). She received 5 treatments of this and then had radiotherapy. The authors report this first case described in the literature (because they found no other in women) and what made them decide on the therapy.

Adult↗
PubMed1990

[Results of radiotherapy of carcinomas of the tonsillar area. Study of 137 cases].

In our center, carcinomas of the tonsillar region are most often treated by radiotherapy. The aim of this retrospective study was to assess the therapeutical results obtained for such tumors over a period of ten years. From 1976 to 1986, 137 patients with carcinoma of the tonsillar area were exclusively treated by radiotherapy. The mean age of the patients was 54.3 years. 120 male and 17 female patients were included in the study. 63% of the patients had T3 or T4 tumors, while 53% had N2 or N3 adenopathies at enrollment (1979 TNM classification). All the patients had transcutaneous irradiation done either exclusively (121 cases) or in combination with curietherapy (16 cases). 61 patients had induction chemotherapy. Local control of the tumor was obtained in 59% of patients (79/137), and attained 92%, 71%, 58% and 16% for the T1, T2, T3 and T4 groups, respectively. The 5 year survival rate was 34%. 12 patients developed distal metastases. 9 patients developed another type of cancer. Elements of prognosis were tumor size and nodal status. Age, sex and histological differentiation were not determinant prognostic factors.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

[Radiotherapy of inoperable esophageal cancer. Retrospective analysis apropos of 108 cases].

Between 1976 and 1986, we treated with curative intent, 108 patients with inoperable esophageal cancer. Eighty-three patients (77%) were treated with radiation therapy alone with a mean total dose of 61 Gy and 25 (23%) patients were treated with induction chemotherapy followed by radiotherapy. Actuarial survival, site of failure, sequellae of treatment, and prognostic factors were analysed in this retrospective study. Survival rates at 2, 3 and 5 years were 23, 16 and 9%, respectively. Local failure occurred in more than 61% of documented failures. Patients with tumor located in the upper third of the esophagus, or with total tumor stenosis or poor performance status had low results, but the difference was not statistically significant. Patients treated according to CT scan plans had a 43% 3-year survival rate; this difference is statistically significant (P = 0.0001). Induction chemotherapy improved one year local control and survival rate (60%), but no long term survival benefit was observed. We conclude that inoperable esophageal cancer can be treated successfully by radiotherapy with a curative intent. We also discuss the role that CT scan planning can play in the effective treatment of these patients.

Actuarial Analysis↗
PubMed1989

Carcinoma of the uterine cervix stage IB and early stage II. Prognostic value of the histological tumor regression after initial brachytherapy.

In our center limited centro pelvic invasive carcinomas of the uterine cervix (less than 4 cm) are treated with brachytherapy and surgery. With these therapeutic modalities no residual carcinoma was observed for 80% of the patients. The purpose of this study was to evaluate our results with this treatment, and to evaluate the prognostic value of the pathological status of the cervix. From 1976 to 1987 we have treated 115 patients with these modalities. Staging system used was the FIGO classification modified for Stage II (divided in early Stage II and late Stage II). Patients were Stage IB (70 cases) and early Stage II (45 cases); 60 Gy were delivered with utero vaginal brachytherapy before any treatment. Six weeks later a radical hysterectomy with pelvic lymphadenectomy was performed. Twenty-one patients with positive nodes received a pelvic radiotherapy (45 to 55 Gy). Local control rate was 97% (100% for Stage IB and 93% for early Stage II). Uncorrected 10-year actuarial survival rate was 96% for Stage IB and 80% for early Stage II patients. No treatment failure was observed for Stage IB patients. Ninety-two patients (80%) had no residual carcinoma in the cervix (group 1) and 23 patients (20%) had a residual tumor (group 2). The sterilization rate of the cervix was 87% for Stage IB tumors versus 69% for early Stage II, and was 82% for N- patients versus 68% for N+ patients. Ten year actuarial survival rate was 92% for group 1 and 78% for group 2 (p = 0, 1). Grade 3 complications rate was 6%. We conclude that brachytherapy + surgery is a safe treatment for limited centro pelvic carcinomas of the uterine cervix (especially Stage IB) and that pathological status of the cervix after brachytherapy is not a prognostic factor.

Adenocarcinoma↗
PubMed1989

Prognostic factors in limited rectal cancer treated with intracavitary irradiation.

At the Centre Georges-François Leclerc of Dijon, 91 limited rectal tumors received a complete intracavitary 50 kV contact radiotherapy alone or associated with interstitial brachytherapy according to the guidelines of J. Papillon. Nineteen had a villous adenoma and 72 a well or moderately differentiated rectal adenocarcinoma. The majority of patients had contra-indications for major surgical procedures. The median age was 70 years. Seventy-six percent (69/91) of the rectal tumors remained free from local recurrence. After salvage therapy, the local control was 91% (83/91). Sphincter preservation was obtained in 85% (77/91). "De novo" adenocarcinomas developed on pre-existing benign pathology and villous adenomas were not significantly different with regard to local control (76% resp. 75% versus 59.5%; p = 0.22). According to the Dijon clinical staging system, the local relapse-free survival at 5 years was 97% for CS T1A, 77% for CS T1B, 65% for CS T2A, and 60% for CS T2B. Tumors of the anterior rectal wall had a better local control rate than lateral and posterior primaries (100% versus 63% versus 67%). For the middle rectum, the local relapse-free survival was 94% compared to 54% of the upper and 77% of the lower rectum. Four additional patients had a preoperative intracavitary therapy and salvage surgery for incomplete tumor regression; the complete remission rate is 96% (91/95). Intracavitary radiotherapy alone is an effective treatment for limited rectal cancers. Contact X ray therapy can be used alone in CS T1A whereas a combination of contact X ray therapy and interstitial brachytherapy is often the optimal approach in CS T1B and CS T2A. In CS T2B, our data do not support the use of intracavitary techniques alone. In these cases, the sequence external irradiation followed by an interstitial implant seems of interest and deserves further evaluation with more patients and follow-up.

Adenocarcinoma↗
PubMed1989

Squamous cell carcinoma of the base of the tongue: results of treatment in 115 cases.

Between 1976 and 1986, we treated 115 patients (mean age 53.8 years) with base of tongue carcinomas. The staging system used was the UICC TNM classification of 1979. Seventy per cent of the tumours were T3 or T4 and 42% had N2 or N3 lymph node. Locoregional treatment was irradiation alone (98/115) or surgery and post-operative radiotherapy (17/115). Sixty-seven patients received induction chemotherapy. Actuarial survival of the entire group at 3 and 5 years was 25 and 23%, respectively, and 3-year actuarial survival rates for T1, T2, T3 and T4 lesions were 42, 48, 20 and 17%, respectively. The local control rate at the primary site was 55% and 78% in the neck. Distant metastases occurred in 10% of patients and 8% had a second primary. Nodal status was the only other prognostic factor. The local control rate obtained with irradiation alone was not good. For limited T1 and T2 tumours, interstitial therapy or surgery should improve the local control rate.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[Sarcoma of the endometrium. Epidemiology and prognostic factors. Apropos of a study of 22 cases].

Endometrial sarcomas (sarcomas of the endometrial stroma and mixed mullerian tumors) are rare tumors with a bad prognosis. Because of our experience in treating these tumors we have been able to make an analysis of epidemiology and the prognostic factors. We have treated 22 patients. The mean age was 61 years. There were 15 stage I, 3 stage II, 2 stage III, and 2 stage IV. 21/22 patients had a surgical resection of the primary tumor, 19/22 had pelvic irradiation after surgery with vaginal radiotherapy given for 14 patients. The actuarial survival rates at 3 and 5 years were 51 and 34%. 5/22 patients had pelvic recurrence, 6/22 had distant metastasis. In our study the prognostic factors were the stage and the histological subtype. Pelvic radiotherapy seems to improve the rates for survival. The main points for discussion are the need to have a definite histological diagnosis done after initial surgery. A CT scan of the lungs and a lymphangiogram must be performed before treatment. After surgery it appears necessary to give pelvic and vaginal radiotherapy. At the present time chemotherapy did not appear to improve survival.

Adult↗
PubMed1989

[Cancer of the tonsillar region. Role of irradiation in treatment].

In our center, carcinomas of the tonsillar region are usually treated by radiotherapy. This study presents the results of our treatment experience over ten years. Between 1976 and 1986, we treated 137 patients with carcinoma of the tonsillar area. The mean age was 54.3 years. The UICC TNM staging of 1979 was used: 63% of the patients had T3 and T4 tumours and 53% had lymph nodes at the first examination. All patients were treated by radiotherapy, alone for 121 patients and associated with brachytherapy for 16 patients. 61 patients received induction chemotherapy with Cisplatinum. Local control rate at the primary site was 56%, and was respectively 92%, 71%, 57% and 11% for T1, T2, T3 and T4 tumours. Local control rate in the neck was 72%. The 5-year actuarial survival rate was 34%. Distant metastasis occurred in 12 patients. 9 patients had a second primary tumor. Node status and stage were the main prognostic factors. Age, sex, histological subtype were not prognostic factors.

Carcinoma, Squamous Cell↗