PubMed Health⌕ Search

Biomedical subjects

M Ducreux

Publications and source records attributed to M Ducreux.

At least 163 records · Page 9Linked to original sources
PubMed1990

[Effect of alcohol and cirrhosis on the presence of Helicobacter pylori in the gastric mucosa].

The aim of this study was to determine whether there was any relationship between alcohol consumption, cirrhosis and Helicobacter pylori associated antral gastritis. One hundred and forty-four patients undergoing upper gastrointestinal endoscopy were prospectively included and classified in four groups. The first group of 23 patients had cirrhosis and an alcohol consumption below 80 g per day. The second group of 31 patients had cirrhosis and an alcohol consumption over 80 g per day. The third group of 34 patients had an alcohol consumption over 80 g per day without cirrhosis. The fourth group of 56 patients had an alcohol consumption below 80 g per day without any preexisting liver disease and underwent upper gastrointestinal endoscopy for non specific digestive symptoms. The diagnosis of Helicobacter pylori was made at histological examination using the hematoxylin and eosin stain and the Whartin-Starry stain in each case. Histopathological results were confirmed by a bacteriological study in 15 cases. One hundred and twelve of 144 patients (78 percent) had gastritis. Gastritis was more frequent (p less than 0.01) when Helicobacter pylori was present than when it was not (90 percent vs 68 percent). Gastritis was more frequent when alcohol consumption was high (86 percent vs 72 percent). Helicobacter pylori was found in 26 percent of the first group, 48 percent of the second group, 65 percent of the third group and 45 percent of the fourth group. These differences were significantly different (p less than 0.05). A statistically significant relationship between high alcohol consumption and the presence of Helicobacter pylori was noted, even in the presence of cirrhosis (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Intra-arterial hepatic chemotherapy for metastatic liver from colo-rectal carcinoma origin.

Loco-regional intra-arterial chemotherapy of hepatic metastases from colo-rectal cancer is one of the most effective non-surgical treatments in this clinical situation. In our experience of 58 cases treated during 3 years, in a non randomized study by either: 1) discontinuous perfusion of 5FU (using a subcutaneous access) or 2) by continuous infusion of FUDR (using an implantable pump), we observed an objective response rate of 52% and 53% with a 1 year survival of 73% and 90%, respectively. This technique, however, is limited in its application by loco-regional complications and in its long term efficacy by the development of extrahepatic metastases. The proof of its efficacy in terms of survival prolongation, is being studied within the framework of a prospective randomized trial with a control group.

Adenocarcinoma↗
PubMed1989

[Gastroduodenal complications of hepatic intra-arterial chemotherapy of hepatic metastases of colorectal origin].

Fifty-eight patients with colorectal liver metastases were treated by intra-arterial hepatic chemotherapy (IAHC) containing 5 FU (n = 42) or FUDR (n = 16). Twenty-three patients (39.6 p. 100) complained of abdominal pain. In three of these patients, the course was complicated by digestive hemorrhage. Endoscopic explorations and angioscintigraphy were normal in 4, showed oesophagitis in 3, superficial gastritis or duodenitis in 8 (34.7 p. 100) and gastric (2) or duodenal ulceration (6) in 8 (34.7 p. 100). The duodenal ulceration was extensive and considered to be cause of hemorrhage in two cases. Duodenal perforation due to the catheter was discovered in two other cases, one of which was secondary to tumoral extension revealed by forceps biopsy. This patient died 3 months later. Surgical treatment was mandatory in the other case due to digestive hemorrhage but did not prevent death. Angioscintigraphy performed in 15 patients with gastroduodenal inflammation or ulceration was normal in 7 patients, revealed arterial thrombosis in 5 and an extra-hepatic perfusion in the gastroduodenal area in 3 : this was related to a small pyloric artery which was occluded secondarily. IAHC was continued there after. This experience underlines the importance of exploring patients with digestive symptoms during IAHC so that it may be temporarily discontinued while an inadequately positioned infusion catheter may be corrected should gastroduodenal ulceration occur.

Antineoplastic Agents↗
PubMed1987

[Locoregional chemotherapy of hepatic metastases of colorectal cancer].

Locoregional, intra-arterial chemotherapy of liver metastases secondary to colo-rectal cancers is the least damaging among non-surgical treatments. In our experience of 58 cases treated during three years either with intermittent perfusions of 5 FU, or with continuous perfusion of FUDR (by pump), we observed 52% and 53% of objective responses with a survival rate at one year, of 73% and 90% respectively. However, this technique is limited because of locoregional complications and less effective, due to the development of extra-hepatic metastases. The proof of its effectiveness, in terms of survival, is currently being studied in the scope of a prospective and randomized trial with control group.

Adenocarcinoma↗
PubMedDate not supplied

CPT-11 (irinotecan) in the treatment of colorectal cancer.

Colorectal cancer is one of the most common cancers in the Western World. Although 50% of patients are cured by surgery alone, the outcome is poor in high-risk patients (Dukes stages B2 and C) despite adjuvant chemotherapy with 5-fluorouracil (5-FU)-based regimens. CPT-11 (irinotecan) is a promising new agent for the treatment of colorectal cancer with a unique mechanism of action. CPT-11 is a DNA topoisomerase I inhibitor, which has not demonstrated susceptibility to the P-glycoprotein-mediated multidrug-resistant phenotype. Phase II studies with CPT-11 have demonstrated definite activity against colorectal cancer in both chemotherapy-naive and pretreated patients (response rates of 15-32% observed) even with clinical evidence of resistance to 5-FU. The response rate appears to be consistent, reproducible and equivalent to that achieved with 5-FU plus folinic acid in chemotherapy-naive patients.

Antineoplastic Agents, Phytogenic↗
PubMedDate not supplied

Hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis of digestive and peritoneal origin: rationale.

Up to a few years ago peritoneal carcinomatosis was considered as an "incurable" disease. The aim of this paper is to review the surgical approach with curative intent to carcinomatosis: it consists of complete resection of macroscopic disease (R1), associated with hyperthermic intraperitoneal chemotherapy (HIPEC) to treat residual microscopic disease, and to evaluate its indications. Overall 5-year survival of patients with peritoneal carcinomatosis treated by HIPEC is similar to that of patients with hepatic metastases treated with curative intent. Those patients should no longer be considered as patients with a terminal disease but as patients with a potentially treatable localized disease.

Antineoplastic Agents↗
PubMedDate not supplied

Evaluation of clinical efficacy of new medical treatments in advanced colorectal cancer. Results of a workshop organized by the EORTC GITCCG. European Organization for Research and Treatment of Cancer. Gastrointestinal Tract Cancer Cooperative Group.

During the last few years several factors have contributed to an increasing change in the medical treatment of advanced colorectal cancer. Among them are the more general acceptance of the impact of chemotherapy on quality of life and survival in first as well as in second-line treatment, the introduction of new drugs and the definition of novel endpoints which can roughly be defined as "patient benefit". For this reason the European Organization for Research and Treatment of Cancer (EORTC) Gastrointestinal Tract Cancer Cooperative Group (GITCCG) felt it was appropriate to organize a workshop with experts from different countries and national groups to discuss in depth several aspects concerning the treatment of patients with advanced colorectal cancer.

Clinical Trials as Topic↗
PubMedDate not supplied

[Muir-Torre syndrome and familial colorectal cancer: 2 families with molecular genetic analysis].

INTRODUCTION: The Muir-Torre Syndrome is a rare genodermatosis, defined by the occurrence of cutaneous tumors (such as sebaceous adenomas, epitheliomas, or carcinomas, and/or keratoacanthomas), and internal malignancies. Recently, molecular analysis in hereditary non polyposis colorectal cancer demonstrated a common genetic basis, linking these two disorders, with the observation of germline mutations in the hMSH2 gene (one of the DNA mismatch repair system genes) in both syndromes. Such molecular demonstration of a single nosological entity should be clinically used to improve the indications of molecular testings in oncogenetics, still restricted to highly stringent criteria for hereditary non polyposis colorectal cancer. CLINICAL CASES: We identified three patients from two different families, who fulfilled the criteria for both Muir-Torre Syndrome and hereditary non polyposis colorectal cancer. The search of a germline mutation of the hMSH2 gene was performed on an affected member from each family, and their relatives with their informed consent. Within each family, all individuals with colorectal cancer were carriers of the same mutation. In the first family, this mutation was a pathogenic microinsertion, usable for predictive testing. In the second family, a missense mutation was identified, requesting further demonstration of its pathogenicity before its use in a predictive purpose. CONCLUSIONS: The diagnosis of cutaneous tumors compatible with Muir-Torre syndrome should lead the dermatologist to suspect an hereditary non polyposis colorectal cancer that should bring to an oncogenetic approach: personnal and familial history of colorectal cancer, molecular analysis, recommendations for colonoscopic screening in at-risk relatives. In the case of a colorectal cancer at a young age, or in the case of familial cases, the gastroenterologist should screen for cutaneous lesions of Muir-Torre syndrome, which could add a criteria for an hereditary syndrome, and lead to molecular oncogenetic analysis.

Adenoma↗
PubMedDate not supplied

Results of lymphadenectomy for obvious lateroaortic lymph node metastases from colorectal primaries.

BACKGROUND/AIMS: To analyze the results of surgery for macroscopically or radiologically obvious (i.e., easily detectable by computed tomography scan or by palpation) synchronous or metachronous lateroaortic lymph node metastases from colorectal primaries. METHODOLOGY: Thirty-one highly selected patients who underwent a lateroaortic lymphadenectomy for obvious lateroaortic lymph node metastases from January 1989 to January 1999 were analyzed retrospectively. An associated metastatic lesion was present in 68% of the cases before or concomitantly with the lateroaortic lymph node metastases. Ten lateroaortic lymph node metastases were synchronous with the primary, and 21 were metachronous. Decision for lymphadenectomy was taken after a multidisciplinary meeting and a period of observation. Median follow-up after lymphadenectomy was 24.2 months (range: 6-120). All the patients received at least two systemic lines of chemotherapy before or after the lateroaortic lymphadenectomy. RESULTS: There was no postoperative mortality. Resection was macroscopically complete (R0-1 of UICC) in 26 cases (84%). Twenty-six (83.8%) patients developed recurrent lesions or had progressive residual disease. The most frequent first site of recurrence was intrathoracic (54.8%) for the entire series, except for the subgroup of isolated lateroaortic lymph node metastases in which recurrent lesions were mainly lateroaortic. Three-year global and disease-free survival rates were, respectively, 39% and 9.6%. No significant difference was noted in survival between lateroaortic lymph node metastases that were synchronous or metachronous with the primary. However, the most important prognostic factor was the presence of associated metastases. Indeed 3-year survival attained 30% when lateroaortic lymph node metastases were isolated but 0% when lateroaortic lymph node metastases were associated with another metastatic site (P = 0.006). CONCLUSIONS: Obvious lateroaortic lymph node metastasis is rarely isolated. However, when it is isolated, in selected cases (objective response to systemic chemotherapy, good general status), resection can be beneficial whatever its synchronous or metachronous appearance.

Adenocarcinoma↗
PubMedDate not supplied

[Assessment of the cost of first line chemotherapy in metastatic colorectal cancer. Preliminary results in the FFCD 9601 trial].

AIM: The objective of the study was to estimate the cost of first line chemotherapy in metastatic colorectal cancer treated in the Gustave-Roussy Institute. Patients were randomized in the study FFCD 9601 with four schedules of treatment: Tomudex(R), 5FU weekly, LV5FU2 with low dose of folinic acid and LV5FU2 with high dose of folinic acid. PATIENTS AND METHODS: Thirty three patients were included prospectively from March 1997 to April 1999. Healthcare costs took into account drug-regimen related costs (cost of the drugs and its preparation, drug administration, laboratory tests, transport from and to hospital), non-drug-regimen related hospitalization costs (treatment of chemotherapy related side effects, radiologic tests, hospital outpatient visits, transport from and to hospital) and surgery costs. Costs were derived from the accounting system in the Gustave-Roussy Institute. Non medical costs were not taken into account in this study. RESULTS: The median overall cost per 4 weeks was 6,343 FF with LV5FU2 low dose, 9,968 FF with LV5FU2 high dose, 15,340 FF with 5FU weekly and 28,810 FF with Tomudex(R). This overcost is explained by a more expensive price and greater toxicity: 12 grade 3-4 toxicity and 9 hospitalizations (including one in intensive care unit for the 8 treated patients) for Tomudex(R) despite a lower cost for the administration of the drug. Weekly 5FU was the most expensive among the 5FU schedules because of its dose and frequency of administration. CONCLUSIONS: The cost of first line chemotherapy in metastatic cancer colorectal is high (6,000 FF minimum per 4 weeks of treatment). Tomudex, a recent and expensive drug, seems to be more toxic. In this study, toxicity was probably overestimated due to the small number of patients. More patients are necessary in order to better estimate the cost of toxicity of these chemotherapies.

Antimetabolites, Antineoplastic↗
PubMedDate not supplied

Prognostic factors for chemoembolization in liver metastasis from endocrine tumors.

BACKGROUND/AIMS: The aims of this study were to assess response rates, evaluate side effects and determine prognostic factors for both response and toxicity in patients with liver metastasis from endocrine tumors treated with chemoembolization. METHODOLOGY: Data concerning 64 patients who underwent a total of 186 sessions of chemoembolization were retrospectively evaluated and correlated with response and toxicity after chemoembolization. RESULTS: Overall clinical, morphological and biological response rates were 93%, 74% and 52% respectively. Complete control of hormone-related symptoms was obtained in 59% of patients with a mean duration of response of 15 months. Transient major complications occurred after 5.9% of sessions and 3 patients died. In the univariate and multivariate analyses, a non-pancreatic primary and chemoembolization as first-line non-surgical treatment were prognostic factors for clinical response, and <30% of liver involvement for morphological response. A significant increase in morbidity was noted in patients with more than 70% of liver involvement. CONCLUSIONS: Hormone-related symptoms were controlled in the majority of patients with a non-pancreatic primary and in those treated with chemoembolization as first-line therapy. Morphological response and toxicity were respectively correlated with liver involvement of less than 30% and greater than 70%.

Adult↗
PubMedDate not supplied

[Control of perfusion by angioscintigraphy during hepatic intra-arterial chemotherapy].

Intra-arterial hepatic chemotherapy is effective in the treatment of liver metastases, and it has been used at the Gustave Roussy Institute since 1983. During laparotomy, arterial catheters are introduced usually into the gastroduodenal artery, and they are connected either to a subcutaneous access or to an implantable pump. Seventy-one patients with liver metastases from colorectal adenocarcinoma were examined by angioscintigraphy to evaluate the quality of liver perfusion. Our technique uses three radioactive compounds and makes it possible to obtain a standard liver scintigram with technetium 99-colloidal rhenium sulphur, a dynamic view of liver arterial perfusion by injection of pure technetium 99 pernechtate, and a static mapping of well-perfused territories after injection of technetium 99-labelled macroaggregated albumin. This technique is reliable to explain most of the problems encountered during intra-arterial hepatic chemotherapy. In our experience, the quality of perfusion was highly variable and had a prognostic value. Objective responses were more frequent in well-vascularized metastases (64 percent) than in metastases with hypoperfusion (36 percent). Survival was also better in the former case, with a median survival of 18 months as against 12 months (p = 0.028).

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Treatment of hepatocellular carcinoma in the presence of liver cirrhosis].

Hepatocellular carcinoma accounts for 90% of the primary malignant liver tumours. Most cases occur in cirrhotic livers. Management decisions should not be based on the stage of the tumour extension but rather on the functional situation of the liver. The first therapeutic option which should be considered is surgical resection if the case presents with a single tumour (or less than 4 tumours for some teams) without detectable metastasis nor intraportal thrombosis and if the liver remaining after surgery will be sufficient for normal hepatic functions. The disadvantage of resection is the high risk of recurrence in the long term. Liver transplantation cannot be proposed if the hepatocellular carcinoma has produced clinical signs but it can be a possibility in case of a resectable tumour in the framework of a prospective protocol comparing transplantation and resection. Intra-arterial injection of 131-iodine linked lipiodol is the only effective treatment in case of portal thrombosis. Chemoembolization of nonresectable hepatocellular carcinoma has led to spectacular tumour response but its effect on survival has not been demonstrated by randomized studies. For tumours less than 3 cm in diameter, even multifocal alcoholization has proved encouraging results. Although a randomized study of questionable quality suggested tamoxifen could be effective, there is no current indication for this drug. External radiotherapy may be a possibility in the future, especially with proton irradiation. Thus the current management of hepatocellular carcinoma is in a difficult, even paradoxical, situation since there is a wide therapeutic choice (resection, alcoholization, transplantation) for the rare cases with small tumours but almost no possibilities for the more severe cases most frequently encountered.

Adult↗