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Biomedical subjects

J L Lefebvre

Publications and source records attributed to J L Lefebvre.

At least 55 records · Page 3Linked to original sources
PubMed1991

Randomised EORTC head and neck cooperative group trial of preoperative intra-arterial chemotherapy in oral cavity and oropharynx carcinoma.

Between February 1978 and January 1984, 222 eligible patients were randomised in a multicentre trial of preoperative intra-arterial chemotherapy in the treatment of oral cavity and oropharynx carcinoma. Patients were randomised between either surgery or preoperative chemotherapy. This latter group received vincristine and bleomycin for 12 days. Patients were stratified according to the primary site: floor of the mouth (FM) versus posterior oral cavity or oropharynx (POC) and institution. The FM group received postoperative radiotherapy depending upon quality of the margins and lymph-node pathological involvement, when it was systematically applied in the POC group. Tumour regression after chemotherapy either complete (CR) or partial (PR greater than 50%) was observed in 48% in the FM group and 41% in the POC group, and lymph-node regression (CR + PR) was respectively 15% and 23%. Some discrepancies appeared between clinical regression and pathological response, and the number of cases without histological response was clearly higher than the number of cases without clinical response. The overall survival showed a statistically significant difference (P = 0.048) between FM and POC groups. In the FM group, median survival in the chemotherapy arm was estimated at 7 years compared with 3 years in the surgery arm. In the POC group, median survival was estimated at 3 years in both treatment arms. Chemotherapy lowered the uncontrolled disease and local recurrence in the FM group. These differences do not exist in the POC group, which may be due to the systematically postoperative radiotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Cervical lymph nodes from an unknown primary tumor in 190 patients.

Over 10 years, 475 patients with isolated lateral neck masses were evaluated: 190 with lymph nodes from an unknown primary tumor (LNUP), 188 with neck lymphomas, 78 with benign tumors, 10 with sarcomas, and 9 with chemodectomas. This study focused on the patients with LNUP. Only 86 patients were treated with surgery (plus radiotherapy). Other patients were treated with radiotherapy (84) or chemotherapy (13) or had no treatment (7). For the overall population, failures in the neck occurred in 51% of the patients and distant metastases in 27%, while primary tumors appeared in 16%. Survival rates at 3, 5, and 10 years were 27%, 19%, and 7%, respectively, for the overall population and 45%, 35%, and 19%, respectively, for the surgical group. The diagnosis and therapeutic approach had a direct effect on neck control; failure in the neck occurred in 7 of 47 patients (15%) when fine needle aspiration and radical neck dissection with radiotherapy were performed, in 5 of 12 patients (42%) when fine needle aspiration and modified neck dissection with radiotherapy were used, in 5 of 12 patients (42%) when adenectomy diagnosis and radiotherapy treatment were performed, and in 6 of 11 patients (54%) when diagnosis by incisional biopsy was performed prior to admission, despite subsequent radical neck dissection and radiotherapy treatment. In our opinion, panendoscopy and fine needle aspiration should be the first-line diagnostic approach. When cytologic diagnosis proves impossible, the second-line approach must consist of cervical exploration with frozen section examination and excisional biopsy, followed by immediate appropriate treatment. In cases of LNUP, radical neck dissection seems to be preferable.

Female↗
PubMed1990

Occupational risk factors for upper respiratory tract and upper digestive tract cancers.

A case-control study was conducted to investigate occupational risk factors for upper respiratory and digestive tract cancers (nose, lips, buccal cavity, pharynx, and larynx) in the north of France. Two hundred and eighty three cases of histologically confirmed cancer in men treated during the first semester of 1983 at the Regional Cancer Institute were included in the study. Two controls per case were chosen from patients in the medical wards of the local general hospitals in the same geographical area as the case, who did not have cancer. Controls were individually matched for sex, age (+/- 18 months), ethnic group, area of residence, and smoking and alcohol drinking history. All subjects were questioned about occupations in which they had worked for at least 15 years. Odds ratios for major occupational categories were estimated using conditional logistic regression for matched samples. Significant associations were found between wood work and nasal cancer (four cases, no control) and farming and lip cancer (odds ratio 5.3, 95% confidence interval 1.1-26.8). Pharyngeal cancer was associated with the textile industry (OR 2.4, 95% CI 1.0-5.7) and the building industry (OR 2.0, 95% CI 1.1-3.9). Coal miners showed a threefold excess risk for cancer of the lip (4 cases, no control), buccal cavity (OR 3.5, 95% CI 1.1-11.8), and larynx (OR 3.2, 95% CI 1.1-9.7).

Alcohol Drinking↗
PubMed1989

[Cancer of the upper aerodigestive tract. Global study of 2418 cases].

The authors present the general results of a retrospective study on 2418 patients treated between 1976 and 1980. Primaries were located on buccopharynx in 51% of cases, pharyngolarynx in 45% and nasopharynx or nasal and paranasal cavities in 4%. Two out of 3 tumours were classified T3 T4 (UICC 1979) and 1 out of 2 patients presented with palpable cervical lymph nodes. Taking into account persistent diseases and recurrences, failure at primary sites occurred in 40% of patients, in the neck in 20%, distant metastases in 10%. Synchronous and/or metachronous cancers were observed in 1 out of 3 patients. Actuarial survival rates were 2/3 at 1 year, 1/3 at 3 years, 1/4 at 5 years and 1/7 at 8 years. Endolaryngeal tumours had the best prognosis while hypopharyngeal tumours had the worst prognosis.

Adult↗
PubMed1988

[Registry of cancers of the upper respiratory and digestive tract at the Northern and Pas-de-Calais departments from 1984 to 1986].

Northern France is known to have the highest mortality rate for cancers of the upper aerodigestive tract (UADT); a UADT cancer registry was therefore set up in this region in January 1984. Three years of meticulous registration provided some significant information. The incidence of UADT cancer was alarming: 4538 UADT cancers in 4403 patients. Most of the patients were males (93.5%). The annual average incidence was 74 per 100,000 males as against 4.8 per 100,000 females. Comparisons with adjusted rates for the European population (91.3 per 100,000 males, 4.8 per 100,000 females) and the world population (68.3 per 100,000 males and 3.6 per 100,000 females) further justified this conclusion. The accuracy of histopathological diagnosis was high (precise diagnosis in 99.2% of the patients). Squamous cell cancers were the commonest form of tumours (97.8%). Oropharynx (27%), larynx (24%) and the hypopharynx (18%) were the most frequent localizations.

Adolescent↗
PubMed1987

Comparison of platinum concentrations in human head and neck tumours following administration of carboplatin, iproplatin or cisplatin.

Tumour tissue levels of platinum were determined in patients with head and neck tumours receiving carboplatin (11 patients, 400 mg/m2) and iproplatin (5 patients, 360 mg/m2). The platinum concentrations ranged from 1.1 +/- 0.4 ng Pt/mg tissue (iproplatin administration) to 1.4 +/- 0.3 ng Pt/mg tissue (carboplatin administration). These results were compared with published platinum levels after cisplatin administration. Although the administered dose of carboplatin (1.08 mmol/m2) and iproplatin (0.86 mmol/m2) was higher than the cisplatin one (0.33 mmol/m2), no significant statistical differences were observed in the resulting platinum tissue levels. The constancy of tumour platinum level after treatment with different platinum complexes could be explained, at least for carboplatin and cisplatin, by both the tumour diffusion properties and the reactivity of the drugs.

Adult↗
PubMed1987

[Cervical adenopathies of unknown primary site. Apropos of 190 cases].

From 1974 to 1983 a total of 190 patients with metastatic cervical adenopathy from an undetected epidermoid cancer were treated, this group representing 3% of total cervicofacial tumors seen. In half the cases the lymph node had evolved over more than 3 months and measured 6 cm or more. Prognosis was poor (27% survival at 3 years and 19% at 5 years). The presumed primary tumor was detected in 16% of cases and 27% of patients developed distant metastases, whereas the 86 patients treated by neck dissection and irradiation showed cervical evolution in only 23% of cases. The therapy proposed includes total radical neck dissection followed by pharyngeal and bilateral cervical irradiation, the value of chemotherapy remaining to be determined during controlled trials.

Aged↗
PubMed1987

[Different modalities of the radiosurgical combination in the treatment of tumors of lateral buccopharyngeal junction].

Results are presented of combined transmaxillary buccopharyngectomy-radiotherapy treatment of 290 tumors of lateral buccopharyngeal junction. Post-therapeutic course was uncomplicated but 8 postoperative deaths are reported. Secondary extension of tumor was noted in 109 patients and another cancer in 64. Actuarial survival at 3 years was 54%, at 5 years 39% and at 10 years 17%. Lingual and muscle extensions were the most difficult to control and first intention excision is therefore performed when bone invasion has occurred. In contrast, total dose radiotherapy should probably precede surgery for forms with lingual and/or muscle extension.

Adult↗
PubMed1986

Uptake of platinum compounds in human tumors. In vitro study.

The kinetics of intratumoral uptake of cisplatin, carboplatin (CBDCA) and TNO-6 were studied in vitro in fragments of tumors of the head and neck maintained in culture medium under conditions simulating therapeutic conditions of chemo-embolization. Cisplatin and TNO-6 are more rapidly taken up than CBDCA (carboplatin). With each of these compounds, after 24 hours a fraction of the platinum taken up is not irreversibly bound to the tissue. The rate of uptake and the proportion of platinum irreversibly bound depends a great deal on the tumor under study. The characteristics of the diffusion indicate that TNO-6 is better used with chemo-embolization than with systemic injection. The opposite finding is seen with carboplatin. Cisplatin appears to to be about equally well-suited for either method of injection.

Aged↗
PubMed1986

[Registry of cancers of the upper aero-digestive tract in departments of the North and Pas-de-Calais. Report for the year 1984].

The authors give the results of the head and neck carcinoma registry in the Northern France at the end of the first registration year. This registration was easily carried out with a pathologic diagnosis known in 99% cases. The carcinoma incidence is rather high in this French country: 1 636 new cases, i.e. an incidence about 79.5/100 000 males. The most frequent are buccopharyngeal carcinoma. It seems to exist some differences between different Northern districts which shows the necessity of epidemiologic studies and of such a registry.

Adult↗
PubMed1985

Platinum concentration in human tumors of head and neck, uterine cervix, and breast following treatment with cisplatin.

Intratumoral platinum concentrations were measured in three tumor sites (head and neck, uterine cervix, and breast) 48 h after cisplatin administration according to the same protocol. The platinum levels were in the same order of magnitude in all tumors, but the concentration in breast tumors was found to be higher than that in tumors of the head and neck and of the uterine cervix.

Breast Neoplasms↗
PubMed1984

[Our experience with the pectoralis major musculocutaneous flap. Apropos of 57 cases].

One of the most important technical advances in cervicofacial plastic surgery over the last few years is undoubtedly the use of the musculocutaneous flap from pectoralis major. A review of its application in 57 cases showed the flap to be of excellent viability (5% total necrosis of flap), and to offer multiple possibilities during primary surgery or that following radiation. Indications and excision limits can be extended, particularly in buccopharyngeal surgery, providing and appreciable functional gain (particularly disappearance of pain), even though long-term carcinologic advantages are deceiving.

Adult↗
PubMed1984

[The use of the pectoralis major myocutaneous flap in cervicofacial and particularly buccopharyngeal, surgery. Apropos of 42 cases].

During the last two years, we have used a pectoralis major myocutaneous flap in 42 cases (28 after radiotherapy). The immediate post-operative periods were very simple and the flap reliability was remarkable: only three partial necrosis and no total necrosis were observed. This technique seems to be an important contribution in the field of buccopharyngeal surgery, especially in the case of extensive tumors involving the tongue. In that case, initial radiotherapy followed by extensive surgery with myocutaneous flap reconstruction seems to be the best therapeutic strategy. It is the authors' feelings that local control will probably be better but long term results will be still poor. Effectively, in case of extended tumors general prognosis has to be taken in account as well as local prognosis.

Adult↗
PubMed1983

[Nasopharyngeal epitheliomas: experience of the Regional Cancer Control Center in Lille (79 cases 1970-1982)].

From 1970 to 1982, 79 cases of nasopharyngeal carcinomas were treated at the Regional Cancer Center of Lille (France). At the term of the study, it appears that patients of Central Europe origin have a rather high risk of NPC (17% of cases, that ethnic population representing about 8% of all superior aerodigestive tract carcinomas). The classical differences between well and undifferentiated tumors are founded, the first presenting local spread the other general involvement.

Adolescent↗