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Biomedical subjects

J Papillon

Publications and source records attributed to J Papillon.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Role of preoperative radiotherapy in preservation of the anal sphincter in cancer of the lower rectum].

Short term preoperative irradiation of rectal cancer (30 Gy in 12 days) followed by a two-month rest before surgery has proven to be more efficient than most usual protocols of radiotherapy. In a series of 136 tumors T2, T3 or T4, tumor-free specimens and Duke'A lesions were found at surgery in 17% and 36% respectively. Surgeons took advantage of the tumor regression and performed sphincter-saving surgery in 41 patients with T2, T3 or T4 tumors of the lower third of the rectum. Of 30 patients followed from 2 to 6 years, the disease-free survival rate is 86%. Only one local failure was observed and subsequently controlled by abdomino-perineal resection.

Amputation, Surgical↗
PubMed1989

Interstitial curietherapy in the conservative treatment of anal and rectal cancers.

Conservative treatment has become a valid alternative to radical surgery in most cases of cancer of the anal canal and in selected cases of cancer of the low rectum. In this strategy interstitial curietherapy has an appreciable role to play. The results of a series of 369 patients followed more than 3 years indicate that implantation of Iridium-192 is effective not as sole treatment but as a booster dose 2 months after a course of external beam or intracavitary irradiation. The dose delivered did not exceed 20 to 30 Gy and the implantations were always performed in one plane using either a plastic template or a steel fork. Three groups of cases must be considered: (a) among 221 patients with epidermoid carcinoma of the anal canal, the rate of death related to treatment failures was 20% and among the patients cured more than 90% retained normal sphincter function. (b) In 90 patients with T1-T2 invasive adenocarcinoma of the rectum, Iridium-192 was carried out after four applications of contact X ray therapy. The rate of control was 84%. (c) In 62 elderly, poor risk patients with T2-T3 tumor of the low rectum initially suitable for an abdomino-perineal resection, a tentative extension of the field of conservation was made using a split-course protocol combining a short course of external beam irradiation at a dose of 30-35 Gy in 10 fractions over 12 days and an Iridium-192 implant. The rate of death due to treatment failures was 14.5% and among the patients controlled 97% had a normal anal function. These results show that implantations of Iridium-192 may contribute to the control of anal and rectal cancers and may spare many patients a permanent colostomy, but the treatment requires great care in patient selection, treatment protocol, technical details, and follow-up. This treatment policy must be conceived as a team work of radiation oncologists and surgeons.

Adenocarcinoma↗
PubMed1987

The future of external beam irradiation as initial treatment of rectal cancer.

Several trials have demonstrated that pre-operative irradiation for rectal cancer decreases significantly the incidence of pelvic recurrence. However, this method is far from being generally accepted. It is now possible to enhance the effectiveness of external beam irradiation and to use it to extend the field of sphincter-saving and conservative procedures. Our protocol consists of a split-course regimen with a short course of cobalt-60 arc rotation (3000 cGy in 12 days). After 2 months rest, the second stage of treatment depends upon the pressure of residual disease and the site of the tumour. It consists of either radical surgery (82 cases) or conservative treatment by intracavitary irradiation in the event of a favourable initial response or in the case of poor risk patients (73 cases). In the radiotherapy-surgical group, the subsequent operative specimens were tumour free in 17 per cent of cases and assigned to Dukes' A category in 32 per cent of cases. Of 91 patients with T2 or T3 tumour involving the lower third of the rectum (followed up for more than 3 years) 72 (84 per cent) had no recurrence. Thirty-three of these patients (46 per cent) underwent a colostomy while 39 (54 per cent) had normal anal function. These results demonstrate the major place that a properly planned external beam irradiation can have in the curative management of cancers of the low rectum.

Adenocarcinoma↗
PubMed1987

Epidermoid carcinoma of the anal canal. A series of 276 cases.

During the past ten years, substantial progress has been made in the knowledge of the natural history of epidermoid carcinoma of the anal canal and of the response of the disease to radiotherapy alone or combined with chemotherapy. At the present time, the main problem in the management of this tumor concerns identification of the best modalities to achieve local control and preservation of anal function. From a series of 276 cases, followed for more than three years, the necessity for a careful pretreatment evaluation was stressed. This included a systematic search for pelvic metastatic lymph nodes by palpation and CT scan. All patients were treated initially by irradiation except those who underwent groin dissection for inguinal node metastasis or colostomy for complete anal obstruction. Three groups of patients have been identified: unresectable or disseminated tumors (33 cases), resectable tumors but not suitable for sphincter conservation (21 cases) treated by radiochemotherapy and delayed surgery, and resectable tumors suitable for sphincter conservation (222 cases) which were treated by a split-course regimen combining a short course of carefully planned external beam irradiation (19 days) followed by an iridium 192 implant after a two-month rest. In this group, which represents 80 percent of the whole series, 80 percent of patients have had their cancer controlled and 90 percent of controlled patients have retained normal anal function. The use of chemotherapy during the first days of irradiation is advisable in all cases to reinforce the efficacy of treatment and increase the chance of anal preservation. Results of the split-course regimen, combining external beam and interstitial irradiation, demonstrate a clear superiority over external beam irradiation alone, especially for large infiltrating tumors, which represent the majority of cases.

Adult↗
PubMed1987

Outcome of mammary capsulotomies.

We reviewed the outcome of capsulotomies, both open and closed, in 134 patients with fibrous capsular contractures surrounding mammary implants. The rate of occurrence of fibrous capsules is given, along with other percentages for each type of augmentation. The study shows that the first attempt at a capsulotomy, either closed or open, gives a better result than the following attempts. After the third attempt, successful capsulotomies are either very rare or nonexistent. We therefore advise that after two or at most three unsuccessful closed capsulotomies, one should opt for an open capsulotomy. After two or at most three unsuccessful open capsulotomies, one should change to another approach.

Breast↗
PubMed1986

Radiation therapy in the conservative management of cancers of the low rectum and anal canal.

Radiotherapy has gained a prominent place in the management of cancer of the rectum and anus. In 221 cases of epidermoid carcinoma of the anal canal not involving more than three quarters of the circumference of the anal canal or the vaginal mucosa combined external beam using 60 Cobalt (30 Gy over 19 days) with an iridium implant boost (10-20 Gy) 2 months later resulted in a 5-year survival rate of 65%. Ninety percent of patients had normal anal function. A series of 281 patients with "early" adenocarcinoma of the rectum was treated by intracavitary irradiation (50 Kv energy, 100-150 Gy in 3-4 applications over 6 weeks). They were selected as being confined to the bowel wall without evidence of lymphadenopathy or anaplasia. Five-year survival and local recurrence rates were 78% and 5% respectively. A further series of 64 patients with more extensive "intermediate" type adenocarcinoma of the lower third of the rectum selected on the basis of age and poor surgical risk were treated by external beam 60 Cobalt irradiation (30 Gy over 12 days) followed by intracavitary and 192 iridium inplant after a two month interval. Of 44 patients treated more than 3 years previously the local control rate was 79.5% and survival 83%. These results suggest that radiotherapy might be applied to more extensive rectal carcinomas which otherwise would require total rectal excision.

Adenocarcinoma↗
PubMed1986

[Seminoma of testis. Analysis of failures and development of therapeutic strategies. Apropos of a Lyons series of 117 cases].

From Jan.61 to Dec.81, 117 patients with seminoma of testis were treated in the Leon Berard Centre, Lyon. All had undergone lymphography during investigation of possible extension, 19 were treated with 200 KV up 1966, 64 with Cobalt up to 1978 and 29 with photons x of 18 MV since that date. From 1979 adjuvant chemotherapy has always included cisplatinum. The 5 years survival rate was 95% of stage I (51/54 cases), 72% of stage II (26/36 cases) and 1/7 of stage III. Unsuccessful treatment of neoplasm was noted in 23 patients, in 80% of cases during the first two years and involving mainly pulmonary metastases. Three patients had mediastinal metastases while recovery surgery was possible in 4 cases. Three fatal iatrogenic complications were observed. Since the use of high energies, particularLy x beams of 18 MV there has been almost total absence of radic complications. Therapy now proposed is as follows: stage I: surgery plus radiotherapy; stage II A-B: surgery and irradiation avoiding mediastinum; stage II C and III: primary chemotherapy.

Adult↗
PubMed1985

Reduction mammoplasty by the total dermoglandular pedicle.

The use of a total dermoglandular pedicle in 700 cases of reduction mammoplasty are described by this team of authors. They emphasize that their modification of the dermoglandular pedicle provides an extremely reliable blood supply to the areola and is quick and easy to perform. There is no anesthesia of the nipple postoperatively, and the shape of the breast is favorable both in the immediate postoperative period and over the long-term follow-up observation between the years 1979 and 1984.

Adolescent↗
PubMed1985

Conservative treatment of early carcinoma of the breast: significance of axillary dissection and iridium implant.

One hundred and ninety five patients with T1T2 less than 3 cm N0 infiltrating carcinomas of the breast have been treated between 1973 and 1982 with local excision followed by cobalt irradiation and iridium boost. One hundred and sixty five underwent an elective axillary dissection. The overall survival at 5 years is 87% and the NED survival 81%. The size of the tumor on the mammogram and on the operative specimen is of significant prognostic value. At 5 years the probability of local relapse in the breast is 4% and the probability of axillary recurrence is 1.2% after axillary dissection. Comparison of these results with those of an historical group of 300 patients treated between 1950 and 1973 indicates an improvement in the local control with good cosmetic results and no obvious change in axillary recurrence and overall survival.

Adolescent↗
PubMed1984

New prospects in the conservative treatment of rectal cancer.

Conservative treatment of rectal cancer is applicable only to limited tumors that are assumed to have no lymphatic spread; these are well or moderately well differentiated adenocarcinomas confined to the bowel wall, without palpable pararectal metastatic lymph nodes. The experience of intracavitary irradiation (contact x-ray therapy often combined with iridium 192 implant), based on 245 patients followed for more than five years, shows a low rate of local failure (5.3 per cent). The rate of death from cancer is 8.9 per cent and the five-year survival rate is 76 per cent. In patients under 60 years, a perirectal lymphadenectomy should be considered a safety measure. A new approach, based on a combination of external beam irradiation (3000 rads in 12 days), followed by iridium 192 implant two months later, allows the field of conservative treatment in poor-risk surgical patients to be extended without jeopardizing their chance of cure.

Adenocarcinoma↗
PubMed1984

The Gordon Richards Memorial Lecture 1983: radiotherapy and proctology.

Radiation treatment is playing an increasing role in the management of patients with ano-rectal carcinoma. This role may be categorized as a) adjuvant therapy of rectal cancer, b) definitive irradiation of rectal cancer, and c) radiotherapy of carcinoma of the anal canal. Preoperative irradiation according to a well-planned protocol is able not only to decrease the incidence of local failures but also to convert some tumors, initially suitable for AP resection, into a conservative procedure. Applied to selected cases, intracavitary irradiation can control limited rectal cancer with a rate higher than other conservative methods (series of 231 cases followed more than five years). Carcinoma of the anal canal should not be treated by radical surgery or by external beam irradiation alone. New approaches based on combined procedures such as cobalt-60 and iridium-192 implant, with or without chemotherapy, demonstrated a substantial improvement in five-year survival rates in a series of 100 cases. Proctology represents for the radiation oncologist an experience which is both gratifying and full of promise.

Adenocarcinoma↗