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J Genin

Publications and source records attributed to J Genin.

At least 19 recordsLinked to original sources
PubMed1999

Postoperative radiotherapy in the management of adult soft tissue sarcoma of the extremities: results with two different total dose, fractionation, and overall treatment time schedules.

PURPOSE: This retrospective study was performed to evaluate two postoperative radiotherapy schedules in terms of dose, fractionation, and overall treatment time in soft tissue sarcoma (STS) of the extremities. METHODS AND MATERIALS: Between January 1984 and December 1993, 62 patients with newly diagnosed localized STS of the extremities were treated with maximal conservative surgery and postoperative radiotherapy (RT). Forty-five patients received 50 Gy with conventional fractionation plus a boost dose (5 to 20 Gy). Seventeen patients had hyperfractionated accelerated radiotherapy (HFART) up to a dose of 45 Gy in 3 weeks. RESULTS: With a median follow-up of 72 months, the 5-year local failure rate was 25%, the 5-year disease-free and overall survival rates were respectively 42% and 62%. The 3-year local relapse, disease-free, and overall survival rates were respectively 16%, 44%, and 70% in the conventional radiotherapy group, and 36%, 47%, and 82% in the HFART group (NS). No factor significantly influenced local control with a trend, however, in favor of conventional RT (p = 0.10). CONCLUSION: HFART at the dose of 45 Gy does not seem to be superior to the standard RT schedule, neither in terms of local control, survival, nor in terms of long-term side effects. However this dose could be considered too low as well as the power of comparison between the two groups to draw definitive conclusions.

Adolescent↗
PubMed1999

[Primary cutaneous leiomyosarcoma: 32 cases].

BACKGROUND: Superficial leiomyosarcomas are rare tumors, which may be confined to the dermis or extend to subcutaneous tissues. PATIENTS AND METHODS: We report the results of a retrospective study of 32 patients treated for leiomyosarcomas through a twenty-two year period (from 1975 to 1997). RESULTS: Mean age was 45 years, with 50 p. 100 of patients less than 35 years of age. Forty seven percent of the tumors were located on the lower limbs and mean diameter was 2.8 cm. Three clinical types have been isolated: nodule beneath normal epidermis (50 p. 100), purple nodule ulcerated or not (28 p. 100), swelling tumor (22 p. 100). Sixteen percent were intradermal, whereas sixty nine percent involved subcutaneous tissues. With regard to tumor grade, 37 p. 100 of tumors were grade I, 44 p. 100 of tumors were grade II, and 19 p. 100 were grade III. Immunohistochemical staining showed positive reactions for all tumors with anti-vimentin and anti-alpha smooth muscle actin. Main treatment was complete surgical excision. Follow-up informations were available for all patients and 75 p. 100 of them had a follow up period longer than a year. Five patients with leiomyosarcomas involving the subcutis developed local recurrences, and two of them died of the disease. DISCUSSION: Leiomyosarcomas can occur at any age without predominant sex-ratio. Main prognostic factors are tumor size, distal location, depth of tumor invasion and pathological grade. Immunohistological staining with anti-alpha smooth muscle actin is more sensitive and specific than with anti-desmin or anti-HHF 35. Main treatment is surgical excision with wide margins.

Actins↗
PubMed1997

[Angiosarcoma of the breast. Apropos of 8 cases and review of the literature].

The 8 cases of primary breast angiosarcoma which were diagnosed, treated and had their follow-up at the Gustave-Roussy Institute between 1954 and 1995 are reported. The age at presentation ranged from 32 to 68 years. In 4 patients the vascular nature of their mammary lesion was conspicuous by a violaceous discolorations of the overlying skin. No patient had enlarged ipsilateral axillary lymph nodes. One patient had metastases. In 2 out of 5 patients who had a partial surgical or fine-needle biopsy before treatment, the diagnosis was missed, and adequate treatment was unduly delayed. The tumor most often presents as an ill defined area made of dense endothelium-lined papillae. A remarkable picture of "soap bubbles" has been identified in 4 cases. The "meshes" of fatty areas appear to be reinforced as they are infiltrated by tumor cells. This appearance may be specific of mammary angiosarcoma. By the French Cancer Centers' grading system for soft tissue sarcomas in general, grade is III in 3 tumors, II in 2 tumors, I in 3 tumors. Five tumors were treated by total mastectomy only. In 3 cases a total mastectomy was followed by radiation therapy to the chest wall. At diagnosis a chemotherapy was administered only to the patient who had metastases. Median disease-free survival was 9 months. Median overall survival was 13 months. From a review of the literature a simple mastectomy appears to be necessary as well as enough for local treatment. Patients with a grade III angiosarcoma of the breast should be included into a therapeutical trial of adjuvant chemotherapy for soft tissue sarcomas in general.

Adult↗
PubMed1997

[Asynchronous sequential stimulation. A new signal treatment for cochlear implants].

Cochlear implants use a fixed or FO dependent stimulation rate, whatever the sound analysed (vowel or consonant) and its analysis procedure (fixed filters or FFT). We present a procedure which varies as a function of the nature of the input signal. This method is based on FFT analysis using a variable with analysis window. Short windows are applied on the transient part of the signal, providing poor frequency resolution but good time resolution; they accurately permit to follow the speech signal in time during its fast temporal variations. Large windows are applied on the stationary parts of the signal, providing better frequency resolution, but poor time resolution. Transient parts of the speech order this window switching; they are detected using the statistical properties of the FFT; moreover the narrow windowing is coupled with an increase of the stimulation frequency. This strategy has been implemented using the Digisonic cochlear implant software, and clinically assessed on 6 regular cochlear implant users, owing to a consonant-vowel-consonant test. This Asynchronous-Interleaved-Stimulation (AIS) strategy provides the patients with better discrimination than fixed window FFT analysis. The coding protocol are described and results presented.

Acoustic Stimulation↗
PubMed1995

High-dose ifosfamide: circumvention of resistance to standard-dose ifosfamide in advanced soft tissue sarcomas.

PURPOSE: The study was designed to assess the toxicity and activity of high-dose ifosfamide (HDI) administered by continuous infusion at a dose of 4 g/m2/d over 3 days every 4 weeks in adult patients with advanced soft tissue sarcomas (ASTS) pretreated with doxorubicin and/or a standard-dose ifosfamide (SDI)-containing regimen. PATIENTS AND METHODS: Between January 1991 and November 1993, 40 patients with progressive ASTS were entered onto the study. Twenty-eight patients had been pretreated with a multidrug regimen that contained SDI and were classified as follows: SDI-refractory (n = 21), SDI-resistant (n = 2), and indeterminate SDI-sensitive (n = 5). Patients were treated until progression or major toxicity. RESULTS: One hundred forty-seven cycles of HDI were administered. Neutropenia was dose-limiting, with 100% of patients experiencing grade 3 to 4 toxicity and 12 admissions for febrile neutropenia (30% of patients). Neurotoxicity (17% of patients) was significantly associated with acute renal failure (n = 4) (P < .001), grade 4 thrombocytopenia (P < .01) and febrile neutropenia (P = .048). Chronic renal toxicity (n = 4) was significantly associated with retroperitoneal masses and/or prior nephrectomy (P = .008). Partial responses (PRs) were observed in 12 of 36 assessable patients (33%) and eight patients (22%) experienced disease stabilization. All but one response occurred in patients pretreated with SDI, with five PRs among SDI-refractory patients. Leiomyosarcomas appear resistant to HDI. The median response duration was 8 months (range, 6 to 13+) and the median overall survival time was 12 months. CONCLUSION: The activity of HDI in these pretreated ASTS patients and the apparent circumvention of SDI resistance suggest a real dose-response relationship for ifosfamide and deserve further evaluation. Although toxic, this treatment appears feasible and manageable using routine clinical support. Since prophylaxis of ifosfamide-induced renal damage remains unknown, frequent monitoring of renal and tubular functions during therapy is highly recommended.

Adult↗
PubMed1994

MR imaging in the follow-up of malignant and aggressive soft-tissue tumors: results of 511 examinations.

PURPOSE: To present magnetic resonance (MR) imaging findings from 511 follow-up examinations of aggressive soft-tissue tumors. MATERIALS AND METHODS: One hundred eighty-two patients with aggressive soft-tissue tumours underwent postoperative T1- and T2-weighted imaging; 41 also underwent 51 gadolinium-enhanced T1-weighted examinations, and five underwent dynamic gadolinium-enhanced subtraction imaging. RESULTS: Twenty-four of 25 patients (101 of 102 examinations) without high signal intensity (HSI) at T2-weighted imaging had no recurrence. Among 79 patients (321 examinations) who demonstrated HSI without a mass, only two tumors recurred within 1 year. An HSI mass was found in 88 studies of 78 patients and represented recurrence (n = 60), hygroma (n = 24), or a radiation-induced pseudomass (n = 4). Hygromas did not enhance, while recurrences enhanced at 1-3 minutes and postirradiation change enhanced at 4-7 minutes. CONCLUSION: T2-weighted imaging can be used to identify possible recurrence of aggressive soft-tissue tumors, while gadolinium-enhanced imaging can be used to differentiate recurrences from hygromas and inflammatory change.

Adolescent↗
PubMed1993

[Desmoid tumors or intra-abdominal fibromatoses].

Intraabdominal desmoid tumour or fibromatosis, recurrent but non-metastatic, invasive, fibroblastic proliferations, are rare tumours. From 1968 to 1989, 16 patients were treated at Gustave Roussy Institute. They were associated with familial adenomatous polyposis in 10% of cases. These tumours, observed mainly in young women (70 to 85% of cases), are aggravated by pregnancy, and spontaneous regression can occur at menopause, proving their hormonal dependence. Although histologically benign, they are serious lesions due to their invasive character; their excision is complete in only 50% of cases. They recur in 30% to 75% of cases and cause death of the patient in 30% of cases. Treatment is surgical but due to their often very slow course, and their spontaneous stabilisation in some cases, a mutilating surgical treatment (extensive small intestine resection) does not seem to be justified. Radiotherapy is effective only at doses incompatible with the site of these tumours (35 to 60 Gy). Chemotherapy has never been shown to be effective.

Adult↗
PubMed1992

Clinical results of a 15-filter digital auditory prosthesis using selective amplification and compression.

Classical hearing aid efficiency was compared with that of a 15-filter digital auditory prosthesis in 23 patients suffering from partial sensorineural hearing loss. This device contains a microprocessor 320C25 from TEXAS Instruments. The sound signal is analysed at a sampling rate of 16 kHz. With the use of a Fast Fourier Transform (FFT), it provides the system with 15 energy levels at frequencies ranging from 0 to 8 kHz. The energy of each frequency band is multiplied by a coefficient stored in the device memory and directly dependent on the patient's audiometric specificities. The 15 signals are then synthesized by inverse FFT and mixed in a loudspeaker. The prosthesis is a rechargable battery powered 4 x 10 x 15 cm box programmable through a PC. The clinical results obtained with this 15-filter digital prosthesis are discussed and compared with the performances of present classical hearing aids.

Auditory Threshold↗
PubMed1992

Imaging in the follow-up of soft tissue tumors.

Local recurrences of aggressive soft tissue tumors are frequent and very difficult to detect clinically after surgery and radiation therapy. Ultrasound is limited because the skin is thick. On contrast-enhanced CT, both scars and recurrences increase their signal. MRI is the best technique, and the only one we presently use in the detection of recurrent tumors. We are reporting 511 follow-up examinations in 182 patients after tumor removal. All patients had histologic confirmation or at least 6 months follow-up. There were 164 malignant tumors and 18 cases of aggressive fibromatosis.

Contrast Media↗
PubMed1992

[Neurosarcoma associated with Von Recklinghausen disease: apropos of 25 cases observed at the Gustave Roussy Institute from 1967 to 1990].

In the absence of systematic immunohistochemistry investigations, only 25 cases (out of 69) clearly diagnosed as neurosarcoma due to the association with Von Recklinghausen disease (ie, neurofibromatosis type 1) and treated at the Institut Gustave Roussy were included in the present study. Neurosarcoma consists of a neurocristopathy whose cells migrate to several parts of the body in order to constitute neuroglia, Schwann cells, pigmented and endocrinal tissues. From 1967 to 1990, 25 cases of such neurosarcomas associated with a neurofibromatosis type 1 were seen at our institute. Three different histological terms exist for this tumour: malignant schwannoma, neurosarcoma, and more recently, malignant peripheral nerve sheath tumours (MPNST). The median age (23 years) of the patients with neurofibromatosis type 1 is lower than that of patient with isolated neurosarcoma. Their sex ratio is 2/1. Primary tumour surgical exeresis was performed in all cases, with poor results in 7. Post-operative radiation therapy was not systematically used in this series. It was administered only in cases with incomplete surgical exeresis or when a local recurrence occurred. Adjuvant CYVADIC (doxorubicin, procarbazine, cyclophosphamide, vincristine) chemotherapy was administered in 5 cases, of in cases of relapse (8). All cases but 2 (the most recent ones) relapsed within 1 to 226 months (median 7 months). In addition, 13 patients developed metastases. Overall, the 2-year and 4-year survival rates were 41% and 18%, respectively. Our observations confirm the very poor prognosis for the association of neurofibromatosis type 1 and neurosarcoma. This finding should lead to systematically associate radical surgical exeresis, post-operative irradiation and adjuvant chemotherapy in the treatment of these patients.

Adolescent↗
PubMed1992

[Elastofibroma dorsi. Apropos of 5 cases].

Elastofibroma is a rare tumor mainly found under the scapula. Based on a recent study of five cases, we would like to stress the importance of making the diagnosis of elastofibroma, as this lesion simply consists of dysplasia of the elastic fibres and is not malignant as could be suggested by clinical examination.

Aged↗
PubMed1991

Twenty years experience of interstitial iridium brachytherapy in the management of soft tissue sarcomas.

From February 1968 to February 1988, 50 patients above 10 years of age with a soft tissue sarcoma were treated with interstitial brachytherapy, combined with a wide excision. After pathologic review, 48 were included in the final analysis. A pathological grading was made possible in 41, which showed a majority of high grades (2 + 3 = 86%). Patients presented mainly with small (less than 5 cm: 36) or mid-size lesions (greater than 5 cm: 12). The tumor was located in the limbs (32), trunk (9), and head and neck (7). Four patients had metastases at the time of treatment. Brachytherapy was part of the initial treatment in 22 cases, and of a salvage procedure after previous excision(s) combined or not with another form of treatment in 26. A uniform technique of iridium 192 wires after-loaded in plastic tubing was used. Sixty Gy median doses were delivered with brachytherapy alone (44) or combined with external beam (4). Sixteen patients also received an adjuvant chemotherapy. Follow up ranged from 16 months to 20 years (median 82 months). At the time of analysis, two patients (4%) only had failed in the irradiated volume, but the marginal failures rate (14:31%) was unexpectedly high. Seven of the patients who failed (43%) were salvaged by a second similar procedure. The 5-year survival was 62% in non-previously treated patients and 56.5% in previously treated ones (pNS). By multivariate analysis, only the tumor location appeared predictive of LF (p less than 0.01), which in turn was strongly correlated with the metastatic outcome (p less than 0.01). Necroses were observed in 17 cases (35%) and associated with a benign course in most of them. High dose brachytherapy combined with conservative surgery is highly effective in small and mid-size soft tissue sarcomas located in the extremities and head and neck, whereas in trunk and in recurrent tumors, the adjunction of large fields external radiotherapy and/or possibly polychemotherapy appears necessary.

Adolescent↗
PubMed1991

[Large resection of the sacroiliac joint. Technique, reconstruction, anatomical and functional results].

The surgical treatment of tumors close to the sacro-iliac joint is made uneasy due to the thinness of the posterior skin cover and the proximity of anterior vascular and nerve elements. A complete, pre-operative appreciation of the extent of the lesion is necessary. 12 patients were operated on and reviewed after a 34 months average follow-up. Complications were frequent, particularly on the cutaneous and neurological standpoint. The surgical technique varied according to a greater extension of the lesion toward the iliac or sacral bone. Extension to the acetabulum was particularly distressing. The functional results depended on extent of muscular resection nerve resections, volume of resected bone. However the surgical treatment is the only one possible in some tumors non-sensible to conservative treatments.

Adolescent↗
PubMed1991

[Presentation of a 16-filter hearing aid with selective amplification and compression].

The hearing aid device is a 4 X 10 X 15 cm box. It is battery operated and monitored by a PC computer. The Texas 320C25 microprocessor performs real-time signal analysis at 16 kHz and gives 16 energy levels ranging from 0 to 8 kHz by Fourier transform. For each frequency band, the energy received is multiplied by a gain determined according to the patient's audiometric characteristics stored in the device's memory. The signal is then synthesized by reverse Fourier transform and sent to the earphone. The performances of this device are discussed and compared with present hearing aid devices.

Amplifiers, Electronic↗
PubMed1990

["Monosonic" one canal digital implant].

In order to decrease the gap between the single and multichannel cochlear implant efficacy we tried to improve the speech coding strategy of the Monomac, the constant current single channel system which we designed in 1987. Owing to a research computerized system, different strategies have been successively studied in the laboratory on 12 new implanted patients during the first weeks of the post-operative period to avoid habituation differences. Results led us to design a miniaturized digital emitter, the Monosonic. This emitter allows the speech therapist to program the frequency band wideness (80-1000 Hz) of the transmitted information, and the threshold level and dynamic range of the stimulating square wave as a function of its frequency. Other strategies are discussed, which have not been yet studied, but may be also programmed.

Acoustic Stimulation↗
PubMed1989

[The value of magnetic resonance imaging in the surveillance of fibromatosis. A study of 10 cases].

Retrospective study of 10 patients followed for fibromatosis after initial treatment by magnetic resonance imaging. There is a close correlation between an intense signal on weighted T2 images and tumour recurrence. Inversely, a low signal on the weighted T2 image indicated fibrotic sequelae without tumour recurrence. The examination should commence with the weighted T2 sequence. The injection of contrast medium may be an alternative.

Adult↗
PubMed1988

Importance of tumor cells in axillary node sinus margins ('clandestine' metastases) discovered by serial sectioning in operable breast carcinoma.

The prognostic implications of small emboli of carcinoma cells in the sinus margins of axillary lymph nodes ('clandestine' metastases) discovered by serial node sectioning at 2 mm intervals was analysed. All patients, previously untreated, were admitted between 1967 and 1978 and underwent mastectomy and axillary node dissection. Our study examined the risk of distant metastases of 1153 patients with from 0 to 3 involved axillary lymph nodes. A Cox multivariate analysis was performed, taking into account the classical prognostic factors (menopausal status, histoprognostic grade, and anatomic tumor size), and for nodal status including the notion of clandestine (CM) or parenchymal metastases (PM). Compared to patients without axillary metastases, patients with one node involved with CM had a relative risk of distant metastases of 1.7, identical to the risk for patients with one node with PM; and patients with one node containing PM and a second CM, had a relative risk of 2.2. Serial node sectioning discovers nodal metastases that would otherwise not be detected. These CM have important clinical implications and should be taken into account when considering adjuvant manipulations.

Axilla↗