Biomedical subjects

Jean-Pierre Droz

Publications and source records attributed to Jean-Pierre Droz.

26 records · Page 2Linked to original sources

PubMed2003

Management of clinical stage I nonseminomatous germ-cell testis tumors.

Nonseminomatous germ-cell tumors of the testis, the most common cancer in young adult males, are highly curable. Clinical Stage I disease represents almost a third of the patients. Three treatment strategies are currently available: surveillance, postorchiectomy chemotherapy and retroperitoneal lymph node dissection. Factors predictive of extratesticular involvement have been described, thus making it possible to tailor treatment to risk. New imaging procedures also permit staging and prediction of outcome. Decision-making is shared between the patient and his oncologist. Economic issues are better understood but should be further studied.

Chemotherapy, Adjuvant↗

PubMed2003

Management of vertebral metastases in prostate cancer: a retrospective analysis in 119 patients.

The objectives of this study were to define clinical problems and treatment strategies in vertebral metastases of prostate cancer. The clinical files of 634 patients with prostate cancer seen in a comprehensive cancer center during a 4-year period were retrospectively reviewed. One hundred nineteen patients (18.8%) had 212 significant episodes of osseous spinal metastases. Pain was nearly universal (93%), and motor and bladder impairment occurred in 25% and 3.1% of patients, respectively. Bone scan and magnetic resonance imaging (MRI) were performed in 197 and 64 episodes, respectively. Fifteen episodes of spinal cord compression were treated surgically. Other treatments included hormonal therapy (163 episodes), chemotherapy (70 episodes), and radiation therapy (103 episodes). Osteolytic lesions were observed alone and in combination with osteoblastic pattern in 18% and 26% of episodes, respectively. Bone scan was the most effective screening procedure of vertebral involvement, and MRI effectively showed epidural involvement. Overall treatment led to improvements in pain and motor impairment in 77% and 50% of patients, respectively. However, clinical episodes were recurrent (1.78 episodes per patient; range, 1-8). Median survival after vertebral metastasis episode was 14 months compared with only 4 months after surgery for spinal cord compression. Vertebral metastases strongly alter quality of life in patients with prostate cancer. Pain and neurologic complications are the major problems. Careful early screening with bone scan and MRI may help to define better treatment strategy. However, further prospective studies of clinical management are needed to determine the optimal timing of radiation therapy, medical treatments, and surgery.

Aged↗

PubMed2003

[Current views in geriatric oncology].

Geriatric oncology represents a novel specialty which can be defined as specific older cancer patients management. It includes a validated geriatric procedure, the comprehensive geriatric assessment, which is the best way of approaching the complex interacting medical problems of frail older patients. Geriatric assessment of elderly cancer patients is actually a subject for discussion among geriatric oncology community. Geriatric assessment may provide either guidelines for anti-cancer treatment in the elderly, or guidelines for the management of older patients with cancer. Two clinical research ways are now developed : firstly the definition of the most relevant geriatric variables allowing clinical trials in such a heterogeneous population; secondly, the determination and the validation of a specific tool to screen frail and vulnerable older patients, and the study of the geriatric assessment impact on the quality of life of older cancer people.

Aged↗

PubMed2002

[Kidney tumors].

Explore the source record for details and available documents.

Diagnosis, Differential↗

PubMed2002

[Chemotherapy of neuroendocrine tumors].

Chemotherapy has few impact on neuroendocrine tumour patients outcome: it may decrease functional secretory symptoms and increase slightly median survival time. In islet-cell carcinoma of the pancreas the standard chemotherapy regimen is the combination of streptozotocin and doxorubicin. It induces 50% response rate and may increase by 50% the median survival. In enterochromaffin-cell tumours chemotherapy has modest impact and the combination of 5-fluorouracile and streptozotocin is the standard regimen. In undifferentiated enterochromaffin-cell tumours of unknown primary the standard chemotherapy regimen is the combination of etoposide and cisplatin which induces 50% response rate with probably no impact on overall survival. Chemotherapy must be indicated within the frame of a multidisciplinary approach and only in patients who have refractory and progressive disease. Indication of chemotherapy must be balanced with indications of biotherapies and embolization.

Antibiotics, Antineoplastic↗

PubMed2002

Management of post-chemotherapy residual masses in advanced seminoma.

PURPOSE: We studied the resection of post-chemotherapy residual masses (20% to 80%) of advanced seminoma complicated by extensive fibrosis, in which active disease appears in 10% to 20% of cases. MATERIALS AND METHODS: We retrospectively analyzed (1986 to 2000) residual mass evolution according to size in 79 platinum treated patients. RESULTS: There was an evaluable response in 78 patients, including toxic death in 1 after 1 chemotherapy cycle, a complete response in 34 (after chemotherapy in 15 and after complete residual mass resection in 19), a marker negative partial response in 42 (incomplete residual mass resection in 8), stable and progressive disease in 1 each. In 15 of 31 patients the resected residual mass was 3 cm. or greater, whereas in 12 of 29 it was less than 3 cm. No surgery was performed for 3 residual masses of unknown size. Of the 42 residual masses 21 disappeared at a median of 12.5 months. Progression occurred at the initial tumor site in 11 of 13 patients after a median of 3.5 months, including 3 with a complete response, 8 with a marker negative partial response (residual mass 3 cm. or greater in 3, less than 3 cm. in 4 and unknown size in 1) and treatment failure in 2 (residual mass 3 cm. or greater). At a median followup of 36.4 months 67 patients survived (no disease progression in 56 and nonevolving residual masses in 11), while 12 had died including 9 of progressive disease 1 of toxicity and 2 of other causes. CONCLUSIONS: In our study there was incomplete surgical resection in 30% of cases. Relapse in 16.6% of cases occurred rapidly after the end of chemotherapy. Viable cells were only noted in residual masses 3 cm. or greater (13%) and 50% of residual masses disappeared during surveillance. We intend to perform a prospective cohort study with close followup of patients with residual masses less than 3 cm. using an indication for surgery tailored to positron emission tomography findings in those with residual masses 3 cm. or greater.

Adult↗

PubMed2002

[Management of advanced seminoma: retrospective study of 96 patients].

AIM OF THE STUDY: We report the results of a retrospective study in 96 patients with advanced seminoma, who received first line chemotherapy at the centre Léon-Bérard from 1980 to 2000. PATIENTS AND METHODS: The primary site of disease was gonadonal in 88 patients and extragonadal in 8 others. Among the 96 patients, 8 patients had an atypic seminoma and 88 a classical seminoma. Extranodal metastases were present in 25 patients, metastatic site was unique in 69 patients. Except 9 patients, all had a good prognosis according to the IGCCCG. All patients had normal serum AFP level at diagnosis. Ten and 38 patients had elevated hCG and LDH serum marker level respectively. RESULTS: After first line chemotherapy, 18 patients achieved a complete response (CR) and 73 a marker negative partial response (PR-). Two presented a marker positive partial response (PR+), and two others, a progressive disease (PD). One toxic death occurred after first cycle of chemotherapy. Seventy-seven patients had residual masses. Resection was performed in 27 patients with PR- and led to 18 CR. Only two of the 27 residual mass contained active tumor. After chemotherapy and additional treatment as surgery or radiotherapy, a residual mass was still present in 55 patients but disappeared spontaneously for 23 of them. Relapse occurred in 18 patients, 16 of whom received salvage chemotherapy. A favourable response was observed in 9 patients with 6 complete responses. Despite this treatment, 14 patients eventually died. No adverse prognostic factor such as primary extragonodal site, prior radiotherapy, number of metastastic sites, international classification, serum markers levels (hCG, LDH) was found. The 5-years overall survival rate was 78%. CONCLUSION: This study show the poor outcome of patients with advanced seminoma after relapse. Renewed efforts are required to identify specific markers in seminoma in order to optimize treatment at initial presentation. Spontaneous regression of residual mass is frequent, thus an observation can be proposed without indication of immediate additional treatment, as surgery.

Adolescent↗

PubMed2002

[Bladder cancer chemotherapy practice study].

OBJECTIVE: To study chemotherapy practice in invasive bladder cancer in a cancer centre (Centre Léon Bérard). MATERIAL AND METHODS: This retrospective study concerned all patients treated by chemotherapy between 1994 and 2000, either in the adjuvant setting (38) or for metastatic disease (66). RESULTS: Twenty four of the 38 patients receiving adjuvant chemotherapy were treated with MVAC, 21% developed febrile neutropenia and 60% relapsed. The median recurrence-free survival was 12 months. In patients treated for metastatic disease, the objective response rate was 36% and the median survival with advanced disease after chemotherapy was 10 months. These results are in line with those reported in large-scale randomized trials. The toxicity of chemotherapy was also fairly high (21% of febrile neutropenia). CONCLUSION: Prospective studies help to optimize chemotherapy protocols, but practice studies show the limited results and the high toxicity. The benefit/risk ratio must be carefully considered.

Antineoplastic Combined Chemotherapy Protocols↗