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J L Lefebvre

Publications and source records attributed to J L Lefebvre.

63 records · Page 4Linked to original sources
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Interstitial brachytherapy and early tongue squamous cell carcinoma management.

The results of treatment of 341 previously untreated patients with early squamous cell carcinoma (SCC) of the anterior two thirds of the tongue using iridium 192 implants (January 1974-December 1983) are presented. Furthermore, 265 patients underwent neck dissection, followed, in 102 cases, by radiotherapy. Incidence of local treatment complications was 19% (66 patients; however, only 3% (11 patients) needed more than a single medical treatment. Two months after completion of overall treatment, 326 patients (96%) were free of disease. Local failures occurred in 18% of cases; however, after successful salvage surgery this rate was reduced to 11%. Neck failures occurred in 18% of cases, but after successful salvage were reduced to 12%. Distant metastases were rare (1.5%), whereas metachronous cancers were frequent (102 patients). Survival rates were 61% (56% to 66%) at 3 years, 46% (41% to 51%) at 5 years, and 26% (23% to 34%) at 10 years. Deaths due to tongue cancer evolution (20%) equalled those due to metachronous cancers (18.5%) and intercurrent diseases (21%).

Adult↗
PubMedDate not supplied

Epilarynx: pharynx or larynx?

BACKGROUND: As a general rule, epilarynx is studied as a part of supraglottis. On the contrary, in France, due to its particular natural history, it is often studied separately. METHODS: To assess the value of this French classification, we compared from an epidemiologic point of view, in one study, 86 cases of epilarynx squamous cell carcinoma (SCC) with 431 oropharynx, 339 hypopharynx, and 89 vestibule SCC. In another study, we compared, from a clinical point of view, 232 epilarynx SCC with 1351 oropharynx, 652 hypopharynx, and 372 vestibule SCC. RESULTS: Epilarynx patients appeared to be much heavier drinkers than larynx patients and similar to pharynx patients but tobacco consumption did not differ. The patterns of nodal involvement were similar for pharynx and epilarynx SCC. For stages I and II, patterns of failures were similar, but for stages III and IV, there were fewer locoregional failures in vestibule patients; distant metastases were equally frequent for these tumors. From the standpoint of multiple primaries, epilarynx SCC appeared to be more akin to pharynx than to larynx SCC with a much lower incidence of lung cancers. Finally, the outcome after treatment was different for vestibule, epilarynx, and pharynx SCC, with a 5-year survival of 43%, 27%, and 13%, respectively. CONCLUSIONS: These data support the identification of epilarynx as a real entity that should be taken into account for stratification in clinical trials.

Actuarial Analysis↗
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Lymph node invasion in hypopharynx and lateral epilarynx carcinoma: a prognostic factor.

Hypopharynx (HC: pyriform fossa, postcricoïd area, and posterior wall) and lateral epilarynx carcinomas (LEC: aryepiglottic fold, pharyngoepiglottic fold, and arytenoïd) have a high tendency to cervical lymph node invasion. Such nodal extension is a well-known prognostic factor. This study is based on a retrospective review of 884 clinical records of previously untreated HC or LEC. Seventy percent of patients revealed palpable nodes at their first examination, with a higher percentage for HC (73%) than LEC (62%). The 5-year survival rate was divided by three in the presence of contralateral, bilateral, or fixed nodes, or in cases of nodes exceeding 3 cm. Multiple positive nodes, extracapsular spread, or lower-neck positive nodes significantly decreased survival, doubled the number of neck recurrences, and tripled the number of distant metastases while control at the primary site remained unvaried.

Adult↗
PubMedDate not supplied

[Organ preservation in ORL oncology: myth or reality. The case for laryngeal preservation].

The conservation of a functional larynx is an important goal in the various attempts to improve the treatment of locally-advanced pharyngo-laryngeal cancers. Several axes have been followed: conservative surgery (subtotal laryngectomy), exclusive irradiation (with conventional or non-conventional fractionation), initial chemotherapy (followed by surgery or irradiation) or concomitant chemotherapy-radiotherapy. The numerous studies, including some major randomised trials, dealing with the issue of larynx preservation are reviewed in the present article. A critical comparison of their results and its integration in a consistent approach are difficult, especially because the different options are aimed at different patients. Total laryngectomy and its psychological and social consequences can be avoided in a significant number of patients, although the long term functional outcome is poorly known and the choice of the optimal treatment modality is largely dependent on the expertise and experience of the medical team.

Combined Modality Therapy↗
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A randomized EORTC study on the effect of preoperative polychemotherapy in pyriform sinus carcinoma treated by pharyngolaryngectomy and irradiation. Results from 5 to 10 years.

226 patients with an operable epidermoid carcinoma of the pyriform sinus were entered in this clinical trial; 187 cases were considered evaluable, they were distributed as follows: 16 T2, 171 T3, 44 N0, 103 N1 and 40 N3 (UICC TNM Classification 1979). The 89 patients of the chemotherapy group received a 3 day course of Vincristine (1.5 mg/m2), Bleomycin (15 mg), Methotrexate (80 mg). Both the chemotherapy group and the 98 patients of the control group went through the surgical procedure of total laryngectomy with pharyngectomy and radical neck dissection. Radiotherapy was administered postoperatively according to tumor margins and nodal involvement. On examination of the surgical specimen, no evidence of tumor regression was observed in the chemotherapy group. The 3 and 5 year survivals are respectively 45% and 35% in both groups. Node metastasis was studied after N size, N status, capsular rupture (PR +) and revealed early and extensive nodal involvement with 25% capsular ruptures in N0 patients, up to 70% rate in N3. Capsular rupture is also associated with a significantly lower survival and a higher incidence of distant metastases.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Hypopharyngeal cancer in the Northern region and Pas-de-Calais. Epidemiological factors].

Authors report results of two epidemiological studies concerning hypopharynx cancer. The first one is a part of the head and neck cancer registry of Northern France from 1984 to 1987. Hypopharynx tumors represent 18% of the 6019 registered tumors, 99% are squamous cell carcinoma; the annual european standardized incidence rate is 17.0 per 100,000 males and 0.5 per 100,000 females. The second one is a prospective study of 339 hypopharynx cancer patients: 1 out of 3 lives alone and 1 out 3 works at the moment of diagnosis. The average daily tobacco and alcohol consumption are 24 g and 128 g respectively, without any difference regarding professional exposures.

Adult↗