PubMed Health⌕ Search

Biomedical subjects

J P Pilleron

Publications and source records attributed to J P Pilleron.

At least 19 recordsLinked to original sources
PubMed1988

[Nipple discharge without palpable tumor. Experience of the Institut Curie from 1970 to 1984].

Four hundred and ten women with serous or bleeding nipple discharge without palpable mass were treated by surgery in the Curie Institute between 1970 and 1984. The cancer rate in this group was 12.2 per cent. Galactography was of anatomical interest as it showed the canal at the origin of the discharge. Malignant cells were observed at cytological examination in only 17 per cent of intragalactophoric cancers. Surgical excision is necessary if the nipple discharge is uniporous and easily reproducible by areolar pressure, particularly in the post-menopausal period when the frequency of cancer is highest (17.7 per cent).

Breast↗
PubMed1988

Desmoid tumors in adults: the role of radiotherapy in their management.

Twenty-six adult patients with the pathologic diagnosis of desmoid tumor were treated between 1964 and 1983 at the Institut Curie in Paris with megavoltage irradiation. Twenty of these patients (76 percent) had extraabdominal tumors. Definitive surgical resection was performed on nine patients (one received preoperative radiotherapy). At last follow-up 1 1/2 to 10 years after treatment, all of the patients had no evidence of disease. Seven of the nine had follow-up examinations from 5 to 10 years after treatment. Seven patients had postoperative radiotherapy with doses from 4,700 to 6,500 rads (47 to 65 Gy) for either microscopic (three patients) or gross (four patients) residual disease. All but one patient had no evidence of disease from 2 to 8 years after treatment. Nine patients had radiotherapy for recurrent inoperable tumors and six had no evidence of disease from 3 to 20 years after treatment. Recurrences developed in three patients; outside the treatment portal in one, and the other two had received less than 5,000 rads (50 Gy). Clinical regression of tumors after treatment was slow, with complete regression taking up to 2 years. Postoperative radiotherapy with doses of at least 5,000 to 6,000 rads (50 to 60 Gy) was effective in achieving local control of inoperable or incompletely resected tumors, thus the need for repeated resections was avoided. Computerized tomography has greatly improved the assessment of tumor extension and should be used routinely before either operation or radiotherapy to obtain adequate margins and minimize the chance of missing disease.

Adolescent↗
PubMed1988

[Lymphoceles and peritonization following lymphadenectomy for cancer of the uterus].

Pelvic lymphocysts following lymphadenectomy in the management of cervical and corporeal uterine carcinoma are recorded in one third of the cases and require surgery in 2-3% of cases. In order to prevent these lymphocysts, peritoneal suturing in front of the lymph node dissection area was progressively abandoned in order to allow peritoneal resorption of the lymph. A retrospective study analysed 226 iliac lymphadenectomies between 1982-1986 for uterine cancer treated at the Institut Curie. 220 patients received peritoneal suturing, while 46 patients were not sutured. The incidence of lymphocysts was respectively 35.9% and 17.4%. The difference is statistically significant (p = 0.01). The "no suture" technique lowered the incidence and the severity of lymphocysts. No side effect of the "no suture" technique was recorded. Multivariate analysis demonstrated that lymphocysts were significantly related to the side of the cancer in the cervix (p = 0.0001), to the preventive use of heparin (p = 0.0025) and to suturing the peritoneum with suction drainage (p = 0.004). We conclude that after pelvic lymphadenectomy the "no suture" technique for the peritoneum reduces the incidence of lymphocysts in the majority of patients.

Drainage↗
PubMed1987

[Conservative surgery after preoperative radiotherapy in the treatment of breast cancer. Indications and results].

From 1969 to 1983, 122 patients with unifocal breast cancer, equal or more than 3 centimeters in diameter, NON1a or N1b, were treated at the Institut Curie with conservative surgery after pre-operative external irradiation. Among them were 68% T2NON1a, and 26% N1b (with 21% T2N1b); 80% of the tumors were located in the upper part of the breast. Initial radiotherapy with a moderate dose (50 to 55 Gy for the breast and the lower axillary area) was followed 6 weeks later by a lumpectomy either alone (42 cases) or associated to an axillary node resection (80 cases). Five year survival rate with non evident disease T2NON1a cases is 79%, similar to the radical surgery rate in this group. We noted 8% local recurrences with no axillary recurrences. Post operative courses were a little more troubled than with initial lumpectomy. We noted 8% of upper limb oedema, only in patients who received both radiotherapy and surgery in the axilla. Cosmetic results are good in 65% of the cases, while they are good in 80% for initial lumpectomy. So this therapeutic method gives satisfactory results, but we need more cases with a longer follow-up to draw definitive conclusions.

Adult↗
PubMed1985

[Prevention of postoperative lymphocele after breast amputation].

Closed suction drainage is widely used after modified radical mastectomy to prevent accumulation of serum or lymph and to promote adherence of the skin flaps to the chest wall. However, between 5 and 35% of the patients develop seroma, which may prolong their stay in hospital and require more frequent post-operative outpatient visits. The prospective study reported demonstrate a significant correlation between the incidence of post-operative seromas, the duration of suction drainage and the amounts of fluid drained. The incidence of seroma also correlated significantly with the patient's age, the size of the breast removed, the presence of arterial hypertension and the post-operative use of heparin. Pre-operative radiotherapy and the TNM type of the tumour had no effect on the duration and volume of drainage nor on the occurrence of seromas. A drainage of short duration and a short stay in hospital are advocated for most mastectomy patients. Delayed mobilization of the shoulder should decrease the volume of accumulated fluid and the incidence of seromas.

Adult↗
PubMed1985

[Amputation of the rectum by the perineosacral approach for anorectal cancer. Indications, results. Apropos of 27 cases].

Twenty seven patients were operated on by perineo-sacral route for anal or rectal cancer. This technique used between 1965-1982 at the Institut Curie was selected because the patients were very old and/or presented with major visceral disease, where the abdomino-perineal resection was not indicated. There was no post-operative death. The margin were free of disease in every patients. 6/27 died within the 6 post-operative months mainly from cardiovascular disease. While most patients were irradiated pre operatively perineal healing was obtained within 6 months in 18/21 cases. 5 patients died of cancer during the two years following surgery. 16/21 are NED with a follow up 1-12 years. Perineo-sacral route is a good alternative from APR in old patients with cardio-vascular disease.

Age Factors↗
PubMed1984

Wide excision of the tumor, axillary dissection, and postoperative radiotherapy as treatment of small breast cancers.

A retrospective study was carried out on 265 patients with small cancers of the breast who were subjected to wide excision of the tumor, axillary dissection, and postoperative radiotherapy. In the group of patients with T1, T2 less than 3 cm, N0, N1a (which represents 90% of all patients in the study), axillary lymph node involvement was found in 27% of cases, and in 11% three nodes or more were affected. Only five cases of recurrences occurred during the follow-up, and 19 patients presented distant metastases. The survival for all patients T1, T2 less than 3 cm, N0, N1a in the study was of 93% at 3 years and 93% at 5 years. Morbidity was minimal and the cosmetic results were generally good.

Adenocarcinoma↗
PubMed1984

Treatment of epidermoid anal canal cancer.

Between 1968 and 1979, 183 patients with invasive epidermoid cancer of the anal canal were treated at Institut Curie. There was 156 women, 27 men with a mean age of 67 +/- 11 years (range 40 to 85 years). The initial height of the tumor was less than 4 cm (65 patients), 4 to 6 cm (98 patients), and more than 6 cm (20 patients). All the patients received radiotherapy, either preoperatively or as curative procedure. Twenty-five patients received preoperative radiotherapy, and there was no residual tumor in 9 biopsies obtained at operation. Four local recurrences were observed. One hundred fifty-eight patients received curative radiotherapy, 115 of whom did not undergo operation. Eighty were alive with no evidence of disease and good anal function with a minimum of 3 years follow-up. We observed 15 local recurrences, 4 inguinal recurrences, and 8 visceral metastases. In addition, eight patients initially had such a big tumor that radiotherapy was only a palliative procedure. Forty-three patients required a surgical procedure after this curative radiotherapy. Colostomy (12 patients) or abdominoperineal amputation (25 patients) was required for local recurrence and colostomy was required for necrosis related to radiotherapy. Five year survival was 59 percent. The survival was related to the size of the tumor (p less than 0.0001). The likelihood of retaining normal anal function with local control of the tumor was also closely related to the initial size of the tumor.

Adult↗
PubMed1984

[Angiosarcoma of the breast].

Since angiosarcoma of the breast was first reported in 1907 fewer than one hundred cases have been reported. They are primary malignant vascular mesenchymal tumors occurring in young females. Their prognosis is very bad. We report here six new cases treated at the Institut Curie between 1972-1983. The mean age was 33, range 27-40. One tumor was a low grade one and the five others of breast, were high grade tumors. We carried out four amputations three associated with radiotherapy and/or chemotherapy and the fourth one did not received adjuvant treatment. In the two others cases the diagnosis was made when the patients were already suffering from polymetastatic disease. The mean survival was 17 months, the range 5-44 months. Recent reviews of the pathologic material made it possible to differentiate three grades in these tumors. The prognosis was correlated to the degree of differentiation. Recently hormonal receptors have been described in soft tissue sarcomas. The value of levels of these receptors in breast angiosarcoma Is discussed.

Adult↗
PubMed1983

[Prognosis of breast epithelioma detected by microcalcifications in the absence of a palpable tumor].

A retrospective study of 65 patients with unpalpable breast cancer revealed by microcalcifications on mammography showed that 18 had presented with infiltrating epithelioma. The contralateral epithelioma was revealed by mammography. Three deaths from metastases had occurred in this group. The 65 carcinomas discovered by mammography were treated by excision of the microcalcified area. This was followed by mammectomy in 34 cases and by irradiation in 25. Close surveillance only was suggested in 6 cases. Histological studies showed 6 lobular carcinomas in situ and 59 duct epitheliomas, 26 of which were infiltrating. The prognosis of isolated duct epitheliomas is highly favourable, and no dissemination was observed. The 2 local recurrences observed after secondary irradiation concerned infiltrating epitheliomas; these patients are now alive without sign of recurrence after mammectomy. After conservative treatment (tumorectomy followed by irradiation), no recurrence was observed among patients with non-infiltrating duct carcinomas.

Adult↗
PubMed1983

[Phyllodes tumors of the breast. Apropos of 83 cases].

Twelve recurrences after surgical treatment of 83 cystosarcoma phyllodes of the breast were reported. The histology of the initial tumor was benign (n = 73), borderline (n = 6), sarcoma (n greater than 4). Nine recurrences were observed at the initial site of the tumor (2 in another quadrant of the same breast and I in the contralateral breast). The cause of local recurrence is related to incomplete tumorectomy (n = I), pseudo-capsule infiltration (n = 3), micro-nodules satellites (n = 2). No etiology for recurrence was defined in 3 cases. The importance of a careful microscopic examination of the initial tumor is emphasized because the infiltration of the pseudo-capsule and the presence of micro-nodules satellites can only be recorded on correctly prepared slides.

Adolescent↗
PubMed1983

[Glandular cancer of the cervix in the initial stages. Treatment and results at the Curie Institute].

102 patients were treated for adenocarcinoma of the cervix, stage 1 and 2, by radiotherapy and surgery at the Curie Institute between the years 1955 and 1974. Glandular carcinoma represents about 10% of cancers of the uterine cervix. The survival rate is: at five years 81%, at ten years 78%, at fifteen years 74%. This is similar to the survival rate for squamous carcinoma of the same stages. 48% of adenocarcinomata are found to be sterilised on the surgical specimen as compared with 78% in squamous cell carcinomata. This justified the even more frequent use of radiotherapy with surgery in this type of tumour.

Adenocarcinoma↗
PubMed1983

[Operable cancers of the rectum: preoperative radiotherapy. Retrospective study of 192 cases treated at the Curie Institute].

Pre-operative irradiation in operable cancer of the rectum remains controversial. This is a report of a retrospective study about 192 patients treated between 1958 and 1980 at the Institut Curie (Paris) for a rectal cancer. An abdomino-perineal resection was done in 144 patients, 83 as a primary procedure and 61 after a pre-operative irradiation. During the same period 48 patients had an anterior resection. We put in this study the only patients who underwent curative surgery. Irradiation was given with high voltage by a four field "box technique". The tumour received 40 to 50 grays in 5 to 6 weeks. The operation was done at least 6 weeks after the end of the irradiation. There was no difference for the sex, and age of the patients, and in the size of the tumour before treatment, between the patients irradiated and those operated on as a primary procedure. There was no difference in the operative mortality as well as the 3, 5, and 10 year survival in the two groups. Pre-operative irradiation did not change the number of perineal recurrences or the number of visceral metastases. The healing of the perineum was significantly longer in the irradiated patients (p less than 0.001). The survival was closely related to the Dukes classification. The number of Dukes A patients was significantly higher (p = 0.02) after irradiation: 26/61 (43%) vs 19/83 (23%) when the patients were not irradiated. In our experience pre-operative irradiation can shrink some large tumours helping the surgical act.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

[Estrogenic paradox: treatment of ulcerated or atrophic scirrhous carcinoma of the breast in elderly women. A method not to be forgotten].

The authors report their experience in the treatment of advanced scirrhous carcinoma of the breast with estrogens only at the Curie Institute. Patients were elderly women in whom other forms of treatment were contraindicated because of local tumor extension or a poor general condition related to age. 32.5% of the patients responded favorably (out of a total of 40 patients). Mean duration of treatment was 21.5 months. Dosage varied according to efficacy and side-effects. Both dienestrol and diethylstilbestrol were used with no preference for one or the other. Serious side-effects were relatively infrequent and minor side-effects either resolved or improved significantly when dosage was reduced or treatment discontinued. Considering the present widespread use of antiestrogens and the systematic detection and dosage of intratumoral hormone receptors, the authors stress the advantages of this seemingly paradoxical effect of estrogens and underline the need for comparative studies.

Adenocarcinoma, Scirrhous↗