Biomedical subjects
Publications and source records attributed to G Calais.
We report a case of chronic cervical myelopathy which developed after radiotherapy for differentiated carcinoma of the buccal cavity. The myelopathy was diagnosed by the finding of severe cervical cord atrophy at MRI.
Seven to eight percent of cervix carcinomas are carcinomas of the cervical stump. The prognosis for these tumors has sometimes been considered more unfavourable than that for carcinomas on intact uterus. From 1976 to 1986 we treated 43 patients with carcinoma of the cervical stump. The mean age was 63.6 years. Staging system used was FIGO classification modified according to the criteria of Institut Gustave Roussy in Villejuif. There were 12 stage IB, 12 early stage II, 5 late stage II and 14 stage III. Twenty-four centropelvic tumors (IB and early stage II) were treated with radiotherapy and surgery, 2 with surgery alone and one with radiotherapy alone. Late stage II and stage III tumors were treated with radiotherapy alone (+ hysterectomy for two patients). Local control rate was 83% for centropelvic tumors and 53% for late stage II and stage III. Seven patients developed distant metastases. Uncorrected 5-year actuarial survival rate was 78% for centro-pelvic tumors and 46% for late stage II and stage III. Three patients developed severe complications (grade 3). Prognostic factors were: stage, nodal status and pathological status of the cervix after radiotherapy. For the same stage the results were similar to those observed for carcinomas on intact uterus treated at our institution during the same time period.
In order to better assess the place of abdominopelvic irradiation after chemotherapy in the treatment of advanced ovarian carcinoma, the survival times in 25 patients treated from 1976 to 1986 were examined. 2 stage IIc, 18 stage III and 4 stage IV were treated. Treatment included chemotherapy (with cisplatin in 16/25 cases) and a second-look laparotomy. 12 patients had only microscopic residual tumor, 5 had macroscopic tumor less than 2 cm, and 8 patients had no detectable residual tumor. A whole abdomen irradiation of 22.50 Gy with a pelvic boost to 45 Gy was also performed. Actuarial 3-year survival was 58% for the entire population. 10 loco-regional relapses were observed. The 3-year-actuarial survival was 71% for stage III patients. Haematologic tolerance of irradiation was poor with only 17 patients (68%) receiving the complete dose of irradiation. One late grade 3 intestinal complication was observed. These results and others previously published, suggest that abdominal irradiation is valuable in the treatment of advanced ovarian carcinoma for stage IIc or III patients without macroscopic residual disease after chemotherapy and second-look laparotomy.
In our centre, the vast majority of patients with oropharyngeal tumours are treated by irradiation. Over a period of 10 years, between 1976 and 1986 we treated 305 patients with squamous carcinomas of the oropharynx. The mean age was 58.2 years. There were 24 women and 281 men. 59% of the patients had advanced tumours, classified as T3 or T4, 54% of the patients showed the presence of adenopathy at the first examination. All patients received radiation therapy. 69 patients had surgical treatment of the tumour or glands. 21 patients had implant therapy (most often combined with transcutaneous irradiation). 165 patients had induction chemotherapy. Local tumour control was obtained in 124 patients (41%), i.e. 82, 56, 31 and 4% for T1, T2, T3 and T4 respectively. The 5 years survival rate of the overall population was 28%. The principle causes of failure were local progression for T3 and T4 tumours and metastases and second cancers in patients with T1 or T2 tumours. The prognostic factors were gland involvement and general health. The site of the tumour, sex and histological type were not prognostic factors. Induction chemotherapy did not improve the results of treatment.
Between 1976 and 1986, we have treated 115 patients with base of the tongue carcinomas. The mean age was 53.8 years. Staging system used was the UICC TNM classification of 1979. 70% of the tumors were T3 or T4 and 42% had N2 or N3 lymph nodes. Loco-regional treatment was irradiation alone (98/115) or surgery and post-operative radiotherapy (17/115). 67 patients received an induction chemotherapy. 3 and 5 years actuarial survival was 25% and 23%, and 42, 48, 20 and 17% at 3 years for T1, T2, T3 and T4 lesions respectively. Local control rate at the primary sites was 55%, local control rate in the neck was 78%. Distant metastases occurred for 10% and 8% had a second primary. Nodal status was the only other prognostic factor. Local control rate obtained with irradiation alone was not good. For limited tumors T1 and T2, a better local control rate can be obtained with interstitial therapy or surgery.
Between 1976 and 1986 we have treated 396 patients with carcinoma of the uterine cervix, stages Ib, II and III. The mean age was 54.2 years. The staging system used was the FIGO classification, modified according to the Institut Gustave-Roussy criteria. There were in stage Ib 117 cases, in early stage II 124 cases, in late stage II 63 cases and in stage III 92 cases. Treatment methods used were radiotherapy and surgery combined for localised pelvic lesions (stage Ib and stage II) and radiotherapy alone for those cases that were central and going out to the side wall of the pelvis (late stage II and stage III). The actuarial five-year survival rate was 91% for stage Ib, 67% for early stage II, 48% for late stage II and 28% for stage III. The main causes of failure were recurrence in the pelvis in 15% of treated areas and distant metastases in 13%. The state of the lymph nodes was another prognostic factor but the histological subtype and age were not. 7% of cases had severe complications (urinary, digestive and lymphatic).
In order to better assess the place of radiotherapy in the treatment of ovarian carcinoma, the length of survival in 44 patients treated with irradiation has been examined. 44 patients, with nil or minimal (less than 2 cm) residual disease, were found among 92 patients with invasive ovarian carcinoma treated consecutively in our center from 1976 to 1986. Treatment included laparotomy for 42 patients. Debulking surgery was complete in 9 stage I and 10 stage II patients. Those patients also received abdominopelvic (16 cases) or pelvic (3 cases) irradiation. Residual tumour was left in the 25 remaining patients (2 with stage IIc, 18 with stage III, and 5 with stage IV) who further underwent various regimes of polychemotherapy (9 without and 16 with cisplatin) followed by second-look laparotomy. 25 patients had no (8 patients) or minimal (17 patients) residual disease after this second laparotomy and they underwent abdominopelvic irradiation. Overall 3-year survival was 68%, 3-year survival was 80% for stage I and II patients treated by radiotherapy after initial complete debulking surgery, and 58% for advanced stages treated by radiotherapy after chemotherapy and second-look laparotomy, 3-year survival was 71% for 18 patients with stage III. Tolerance for irradiation was significantly decreased after chemotherapy and this prevented a complete dose being delivered to 32% of the patients. A late severe complication was noted in only one case. For stage I or II our results are close to those already published by others.(ABSTRACT TRUNCATED AT 250 WORDS)
At the C. G. F. Leclerc, Dijon, 91 early rectal tumors were treated with intracavitary contact radiotherapy alone or in combination with interstitial brachytherapy. The median age of the patients was 70 years. Most of them were referred because of poor surgical risk. Preservation of the sphincter was obtained in 85% (77/91). The actuarial local relapse-free survival rate at 5 years was 74% (67/91). No significant difference was seen between the 72 adenocarcinomas and 19 villous adenomas (p = 0.12). For the middle rectum the rate was 94% compared to 54% for the upper and 77% for the lower rectum. Anterior primaries fared better than posterior and lateral tumors (100%, 63%, and 67% respectively). After salvage therapy the local control rate raised to 91% (83/91). The clinical and endoscopic staging system of Dijon was of prognostic significance: T1A adenocarcinomas (purely exophytic tumors of less than 3 cm) had a better 5-year local relapse-free survival rate (97%) than T2A, T1B or T2B (p less than 0.01).
The treatment of carcinomas of the soft palate most often involves radiotherapy. In order to assess the value of irradiation, notably in the treatment of limited T1 or T2 tumours, a retrospective study was carried out of 76 case records suitable for analysis of patients treated in our hospital for this type of tumour between 1974 and 1987. There were 70 men and 6 women. The mean age was 54 years. Fifty-four patients had limited T1 or T2 tumours (including 40 without lymphadenopathy). Treatment methods varied but 48/76 were treated by radiotherapy only (transcutaneous irradiation and/or local interstitial implant). Local tumour control was obtained in 87% of patients with T1 tumours, in 77% with T2 and in 50% with T3 tumours. Lymph node control was obtained in 68% of patients. None of the patients initially classified NO showed any subsequent lymph node involvement. The actuarial five-year survival rate was 67% for T1, 38% for T2 and 22% for T3. Lymph node involvement was the only other prognostic factor. Fourteen patients developed distant metastases and 13% had at least one other tumour site. Radiotherapy as tumour treatment is thus felt to be the method most widely used apart from tumours strictly limited to the uvula, where surgery is preferred. Cervical lymph nodes are treated surgically when there is a palpable lymphadenopathy and by radiotherapy for N0 patients. Induction chemotherapy before radiotherapy is used in addition at stages T3 and T4.
Induction chemotherapy in oropharynx carcinomas had demonstrated overall response rates of 80%, but no overall survival benefit have been reported. In order to determine the value of induction chemotherapy for these patients, we conducted a retrospective study: 86 patients were treated with chemotherapy (CT) and RT (group 1) and 52 patients were treated by radiotherapy (RT) alone (group 2). All patients had T3 or T4 tumors. CT used was cisplatinum based associated with bleomycin and vincristine or vindesine and actually with 5 fluoro-uracil. Objective response to the CT was observed for 34% patients. Five years actuarial survival rate was 18% for group 1 and 17% for group 2. Patterns of failure were identical in the 2 groups. A difference was observed only for patients with N3 nodes (24% 5 years survival rate in group 1 versus 6% in group 2) (P = 0.05). According to the histologic differentiation, the tumor site or the type of CT, no difference was observed. We concluded that this study failed to demonstrate an advantage for induction chemotherapy in advanced oropharynx carcinoma excepted for patients with N3 nodes.
Induction chemotherapy is now frequently included in therapeutic protocol for carcinoma of oral cavity and oropharynx. Frequency of objective responses and predictive factors for favorable responses to therapy were evaluated in 135 patients. In 45% of cases an objective tumoral regression was noted (with 6% total regression). Combined CDDP-5 FU produced responses in 65% of cases, whereas the combinations of CDDP-BLM-VCR-MTX and of CDDP-BLM-VDS produced values of 35 and 41% respectively. Small tumors (T1, T2) regressed better during chemotherapy than extensive tumors (T3, T4) (16 and 34% respectively). The tumor implantation site was a predictive factor: tumors of the tonsillar region not extending to base of tongue regressed in 74% of cases as against 35% for lesions of base of tongue. In contrast, histologic type and degree of glandular involvement were not important predictive factors. These findings suggest that induction chemotherapy for carcinoma of oropharynx or oral cavity is feasible and that predictive factors of response to treatment are size and site of tumor and type of chemotherapy.
We are reporting a localised skin angiosarcoma of the breast. As far as we can tell this is only the fourth time this condition has been published. The tumour appeared 6 years after a conservative lumpectomy with removal of lymphatics and follow-up radiotherapy had been carried out for an adenocarcinoma of the breast. This tumour was characterised by the presence of several round blue-coloured nodules in the skin with some inflammation surrounding them. The glandular tissue underneath was normal, as was the opposite breast, and there was no spread. The patient was pyrexial and a syndrome of inflammation persisted until the tumour had been removed by a simple mastectomy. We have discussed the clinical and histological aspects of this case and compared them with those found in the literature. Differential diagnosis with in particular Stewart-Treves syndrome has been emphasized. The treatment consists in wide excision and sometimes followed by radiotherapy or chemotherapy. The prognosis is very poor, survival never having been more than 22 months. Finally the role of irradiation in the causation of this tumour has been discussed. (Our patient is alive after 2 years without any sign of a recurrence).
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PURPOSE: To evaluate the relationship between the number of positive nodes and probabilities of locoregional control and survival in patients with invasive squamous cell carcinomas of the oral cavity and oropharynx. MATERIAL AND METHODS: Between 1976 and 1993, we treated with curative intent 183 patients (median age: 56 years; standard deviation: 10 years). Seventy-nine patients (43%) had oropharyngeal primary invasive carcinoma and 104 (57%) had oral cavity (excluding the lip) primary invasive carcinoma. Patients with simultaneous primary lesion or visceral metastases were excluded from the analysis. All the patients had neck dissection with at least six nodes to analyse. One-hundred fifty-nine patients (87%) underwent resection of the primary lesion and 158 (86%) were treated postoperatively with external beam irradiation alone or combined with interstitial implant (median dose: 60 Gy; standard deviation: 10 Gy). Average follow-up was 52 months. RESULTS: The overall 5-year survival rate using the Kaplan-Meier method was 42.6%. The 5-year survival rates were 60.0% when lymph nodes were histologically negative, 39.5% when one lymph node was positive, 28.0% when two lymph nodes were positive and 24.4% when three or more lymph nodes were positive (P = 0.0004). The number of positive nodes did not significantly influence the specific disease-free survival and locoregional control rates. CONCLUSION: Patients with one or more positive neck nodes must have postoperative treatment.
In breast cancer postoperative radiation therapy improves local control rate and survival. When chemotherapy and radiation are indicated, the sequencing of the two treatments is still controversial. Several studies have suggested that adjuvant radiotherapy could be safely delayed until adjuvant chemotherapy was completed. Other studies, most of them retrospective, pointed out that a delay in the initiation of radiotherapy in order to give chemotherapy first may result in an increased rate of local recurrence. Concomitant administration of the two treatments is an attractive alternative. Pilot studies have demonstrated its feasibility. A randomised phase III trial is presently in progress, comparing sequential treatment with chemotherapy first followed by irradiation and radiation versus concomitant treatment. Four-hundred and five patients have been included in 24 months. Toxicity and compliance to the treatment are reported in this evaluation.
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The bone metastases of a malignant, non-secreting paraganglioma were treated with [131I]metaiodobenzylguanidine (131I-MIBG) over a 10-year period. Initial treatment (131I-MIBG: 9.6 GBq) resulted in a decrease in the number of bone metastases from 16 to 2. At three years, a relapse with primary tumor regrowth and liver metastasis was again treated with 131I-MIBG (22.2 GBq). A decrease in the number of bone metastases and MIBG uptake was again observed.
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