PubMed Health⌕ Search

Biomedical subjects

M Mercier

Publications and source records attributed to M Mercier.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Prognostic factors in operable epidermoid esophageal cancers].

OBJECTIVE: The aims of the study were to determine the prognostic factors on overall survival in patients with resectable squamous cell esophageal carcinoma. POPULATION: Two hundred and ninety three patients with stage I and II tumor were included in a phase III clinical trial that compared surgery alone to preoperative chemoirradiation. Eighteen parameters issued from clinical, biological radiological and pathological characteristics were included in univariate and multivariate analysis. RESULTS: The overall survival was influenced by: quality of surgical resection tumor response, nodal involvement on the CT-scan, tumor length and tumor location. Three groups of patients could be identified on two simple clinical preoperative variables. The first group: patients without dysphagia with or without nodal involvement on the CT-scan. The second group: patients with dysphagia and without nodal involvement on the CT-scan. The third group: patients with dysphagia and with nodal involvement with CT-scan. The 5 years survival rates were 34% for the first group, 23% for the second group and 0% for the third group. CONCLUSION: The identification of prognostic factors is valuable for the stratification of patients in future therapeutic studies.

Carcinoma, Squamous Cell↗
PubMed1997

Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus.

BACKGROUND: We conducted a multicenter, randomized trial to compare preoperative chemoradiotherapy followed by surgery with surgery alone in patients with stage I and II squamous-cell cancer of the esophagus. METHODS: The preoperative combined therapy consisted of two one-week courses; each involved radiotherapy, in a dose of 18.5 Gy delivered in five fractions of 3.7 Gy each, and 80 mg of cisplatin per square meter of body-surface area, administered 0 to 2 days before the first day of radiotherapy. The surgical plan included one-stage en bloc esophagectomy and proximal gastrectomy by the abdominal and right thoracic routes, to be performed immediately after randomization in the group assigned to surgery alone and two to four weeks after the completion of preoperative chemoradiotherapy in the group assigned to combined therapy. RESULTS: A total of 297 patients entered the study; 11 were found to be ineligible, and 4 were lost to follow-up. Of the remaining 282, 139 were assigned to surgery alone and 143 to combined therapy. After a median follow-up of 55.2 months, no significant difference in overall survival was observed; the median survival was 18.6 months for both groups. As compared with the group treated with surgery alone, the group treated preoperatively had longer disease-free survival (P=0.003), a longer interval free of local disease (P=0.01), a lower rate of cancer-related deaths (P=0.002), and a higher frequency of curative resection (P=0.017). However, there were more postoperative deaths (P=0.012) in the group treated preoperatively with chemoradiotherapy. Three prognostic factors were found to influence survival in a multivariate analysis: the disease stage, based on computed tomography; the location of the tumor; and whether the surgical resection was curative. CONCLUSIONS: In patients with squamous-cell esophageal cancer, preoperative chemoradiotherapy did not improve overall survival, but it did prolong disease-free survival and survival free of local disease.

Antineoplastic Agents↗
PubMed1997

Antibodies against Echinococcus multilocularis alkaline phosphatase as markers for the specific diagnosis and the serological monitoring of alveolar echinococcosis.

The immunological properties of the purified alkaline phosphatase (pAP) of Echinococcus multilocularis metacestodes have been investigated using alveolar echinococcosis (AE) patient sera in ELISA tests. A comparative study was done with EmC-Ag (crude antigen) and pAP-Ag (purified antigen). When the parasite purified enzyme pAP was used as antigen, the specificity of the ELISA was markedly increased since it reached 100% without any decrease of its sensitivity (100%). The serologic follow-up of AE patients was conducted during several months with these two antigens in three categories of patients: cured, stabilized and aggravated. There was a good correlation between clinical and serologic data when the pAP was used as antigen in ELISA tests. The anti-pAP antibodies titres did change more rapidly than anti-EmC antibodies titres when a recurrence occurred. Modifications of the anti-pAP antibodies levels were also observed during the patient's therapy: mebendazole, albendazole and Isoprinosine. These results suggest that pAP-Ag should be used for the diagnosis and the follow-up of AE patients.

Alkaline Phosphatase↗
PubMed1996

Phase II study of alternating doses of vinorelbine in combination with cisplatin for non-small cell lung cancer (NSCLC): a disappointing experience.

UNLABELLED: In both Phase III trials of vinorelbine-cisplatin (VP) versus single-agent vinorelbine, the received vinorelbine dose intensities were 18.8 and 21.1 mg/m2 per week in the VP arms. Vinorelbine was administered at the weekly dose of 30 mg/m2. A new structure of the vinorelbine-cisplatin regimen delivering alternating doses of vinorelbine (35 mg/m2 on weeks 1, 3, 5 and 17.5 mg/m2 on weeks 2 and 4) was reported to increase the vinorelbine dose intensity in patients with non-small cell lung cancer (NSCLC). To further analyze the ability of such an alternating vinorelbine schedule to enhance vinorelbine delivery, a Phase II study of VP was conducted in NSCLC patients using the previously published alternating doses of vinorelbine for 6 cycles. Cisplatin was administered on weeks 1, 5 and every 6 weeks thereafter, at a dose of 75 mg/m2 in the first 14 patients and at a dose of 100 mg/m2 in the 18 remaining patients. The intended vinorelbine dose intensity was 26.25 mg/m2 per week. The median delivered dose intensities of vinorelbine calculated during the first 8-week period were: all patients, 17.9 mg/m2 per week; patients treated with cisplatin 75 mg/m2, 18.1 mg/m2 per week; patients receiving cisplatin 100 mg/m2, 17.9 mg/m2 per week; naive patients 18.2 mg/m2 per week and previously treated patients. 13.2 mg/m2 per week. Reductions and delays in the vinorelbine treatment mostly occurred on weeks 3 and 7, which are times of high-dose treatments (35 mg/m2) according to the protocol. The partial response rate was 34% (95% C.I. = 26-42%). Median survival was 21 weeks. The main toxicities were febrile neutropenia (nine patients, including two septic deaths) and constipation Grades 3 and 4 (five patients). CONCLUSION: The use of alternating doses of vinorelbine within the VP regimen did not lead to higher vinorelbine delivered dose intensities than those reported with a standard weekly 30 mg/m2 administration.

Adult↗
PubMed1996

The effect of Saccharomyces cerevisiae and Aspergillus oryzae on fermentations in the rumen of faunated and defaunated sheep; protozoal and probiotic interactions.

We measured the effect of the direct addition to the rumen of Saccharomyces cerevisiae (SC 50 mg/day) and Aspergillus oryzae (AO 3 g/day) on the fermentation processes in fistulated sheep. The measurements were carried out on animals whose rumens were first defaunated and then refaunated. The animals received a ration composed of hay (600 g/day), barley (600 g/day) and soybean meal (150 g/day), fed twice daily in two equal meals. The number of fungi and total, viable or cellulolytic bacteria were lower after the inoculation of protozoa in defaunated rumens. The probiotics stimulated the development of total bacteria but reduced the population of cellulolytic bacteria. The addition of the probiotics and the presence of protozoa each incurred a decrease in the redox potential values. The association of both treatments had an additive effect on this parameter. The two probiotics and the protozoa stabilized the rumen pH after the meal, maintaining it above the value of 6 for a longer period of time. The positive effects on pH were accumulated in the refaunated animals receiving probiotics. The ammonia nitrogen concentration was considerably increased by the presence of the protozoa; the probiotics increased the ammonia concentration only in the refaunated sheep. The methane and hydrogen proportions in the fermentation gases were invariably higher in the refaunated animals. The probiotics had no clear effect either on the gas composition or the concentration and the composition of the mixture of volatile fatty acids; only the concentration of isovalerate was significantly increased by probiotics and only in refaunated animals. The protozoa did, however, considerably increase the concentrations of acetate, butyrate and isoacids and decreased the concentration of caproate.

Ammonia↗
PubMed1996

Quality of life as an outcome in breast cancer. Clinical application.

In clinical trials of anticancer agents, the assessment of objective effects has historically been the primary end-point. However, because of the limited impact of these agents on survival, the study of quality of life (QOL) has become increasingly important. QOL evaluation is difficult and the approaches of physicians and reimbursors of healthcare are quite different. In addition, QOL is not a simple concept and several different methods have been used to evaluate it. These methods can be divided into the following 2 groups: experimental methods [the best known is the quality-adjusted life-year (QALY), which utilise some kind of experimentation; and observational methods, which use questionnaires and are often multifactorial. Some of these questionnaires are used for patients with all types of pathologies, while others are cancer-specific; all questionnaires must be validated. We conducted 3 QOL studies in patients with breast cancer using the Functional Living Index-Cancer (FLIC) questionnaire. In the first, a French translation of the FLIC questionnaire was validated. The FLIC and Functional Living Index-Emesis (FLIE) questionnaires were used to assess QOL in a second study comparing 2 different antiemetics for the control of nausea and vomiting. Finally, QOL was evaluated in patients with breast cancer during adjuvant chemotherapy. Several other studies employing different questionnaires in patients with breast cancer have been published. Clinical applications for QOL evaluation in oncology may be the prognostic implications of QOL, evaluation of toxicity and duration of treatment, and evaluation of utility and QOL. However, although assessment of QOL is important for both physicians and funders, there is no gold standard method available, and the results of QOL studies have to be interpreted cautiously.

Breast Neoplasms↗
PubMed1996

A prospective randomized trial of idarubicin vs daunorubicin in combination chemotherapy for acute myelogenous leukemia of the age group 55 to 75.

A prospective randomized study was conducted comparing the efficacy and toxicity of two anthracyclines for the treatment of patients with acute myeloid leukemia (AML) between 55 and 75 years. A total of 220 patients were randomized to receive as induction chemotherapy cytosine arabinoside (Ara-C: 100 mg/m2/day; continuous infusion for 7 days) combined with either daunorubicin (DNR: 50 mg/m2/day, i.v. bolus for 3 days) (n=108) or idarubicin (IDA: 8 mg/m2/day, i.v. bolus for 5 days) (n=112). The complete remission (CR) rate was similar (P=0.296) after IDA (76/112; 68%) and DNR (66/108; 61%) (P=0.3). For patients aged 55-65, the CR rate was significantly higher after IDA (39/47; 83%) than after DNR (29/50; 58%) (P=0.007). Persistent leukemia was more frequent after DNR (26/108) than after IDA (13/112; P=0.015). Hematological and extra-hematological toxicities were similar. The CR patients were given a consolidation course of chemotherapy with Ara-C: 50 mg/m2/12 h, subcutaneously for 5 days, combined with either DNR:30 mg m2/day, i.v. bolus for 3 days or IDA:8 mg/m2/day i.v. bolus for 3 days according to the initial randomization, and then received a continuous maintenance treatment for 2 years. The survival and disease-free survival (DFS) were similar in both groups; there was no difference in the risk of relapse. However, there was a trend for a longer event-free survival (EFS) in the IDA group than for the DNR patients (P=0.07). Our results seem to indicate that IDA is probably more efficient than DNR for AML patients between 55 and 75 years, and confirm the data published in other studies comparing prospectively IDA and DNR in adults.

Aged↗
PubMed1996

[An improved quality of life self-questionnaires specific for head and neck tumors].

The assessment of quality of life is an element that is now taken into account in the evaluation of therapies in oncology and especially for treatments connected with important sequellae. The lack of a specific tool measuring the quality of life of patients with head and neck cancers (H&N), validated in French, leads us to develop and to validate a self-questionnaire. The construction of this questionnaire has been realised following a strict procedure (identification of aspects to explore, formulation and selection of items) conducting to a specific module of 17 questions with 4 modes of reply. The validation of the questionnaire has been undertaken on 116 patients that filled the specific module H&N and the general self-questionnaire QLQ-C30 of the EORTC. The acceptability is excellent since only 4% of the patients have refused to participate to this study and that the number of missing data is very low. The value of the Cronbach alpha coefficient with the global score equal to 0.85, reflects a good reliability of the questionnaire. Global score correlation of the module H&N with the different scales (functional and symptoms) of the QLQ-C30 are coherent. Global scores are correlated to the nature of the treatment (p < 0.001), to the evolution of the disease (p = 0.01), to the tumour site (p = 0.015) but not to the code WHO neither to the performance of a laryngectomy. The whole results indicate that we have a specific tool, reliable, and validated. Associated to a general quality of life questionnaire, this specific tool will be useful to complete the evaluation of therapies, especially during of comparative clinical trials.

Activities of Daily Living↗
PubMed1996

[Surgical health care patterns and cancer cost: two studies using population registry data].

The goal of the first study was to analyze the surgical health care patterns for operated cases colorectal cancer. The role of surgery was analyzed for 732 cases diagnosed between 1988 and 1991 and recorded by the Doubs Cancer Registry, France. Young patients were more inclined to surgery than the older patients: 41% before 65 years and 27% after 65 (p < 0.02). Age was the only variable related to the type of activity of the surgeon (public or private sector): 65.9% of patients younger than 65 years were treated by a private surgeon but only 56.6% of patients older than 65 (p < 0.02). The goal of the second study was to analyze direct costs induced by cancer from the point of view of the "Mutualité Sociale Agricole", the rural branch of the French Social Security. A 3-year follow-up was the minimum required to be able to isolate costs in function of the different clinical steps of the disease. This study was performed on 24 breast cancers, 16 lung cancers, 22 prostatic cancers and 36 colorectal cancers diagnosed between 1988 and 1991 in patients insured by the Doubs MSA (the rural branch of the French Social Security). The average cost of a cancer varied from 53,800 FF to 82,600 FF, according to cancer site. Transportation costs represented from 7% to 15% of the total cost. These two studies outline the usefulness of cancers registries as a tool for health authorities looking for a better efficiency of the health care system.

Aged↗
PubMed1995

[Surveillance and rehabilitation of cancers of upper respiratory and digestive tracts].

Follow-up of head and neck cancers after treatment is usually done by specialists every 2 to 3 month during an indeterminate period. The aim of this follow up is to detect a recurrence or a complication due to the treatment. Xerostomia, endolaryngeal and cutaneous modifications are the most frequent sequelae of irradiation. Major surgery of the larynx require a speech rehabilitation which gives correct results in 70% of the cases. Professional rehabilitation is possible for few patients: only 50% of the patients who had jobs before treatment were able to go back to work. The return to work was more often seen among civil servants, and workers than among craftsmen. Laryngectomised people resume their work less often than other head and neck cancer patients. There is no problem with social rehabilitation.

Disability Evaluation↗
PubMed1995

Serum secretory IgA and secretory component in patients with non-cirrhotic alcoholic liver diseases.

Elevated levels of secretory IgA in serum have been demonstrated in several liver dysfunctions such as hepatic cytolysis and cholestasis. However, these possible alterations at an early stage of liver diseases have not yet been investigated. We studied a cohort of chronic alcoholic patients without cirrhosis in order to assess the changes in serum secretory IgA and other forms of secretory component, the split product of the polymeric Ig-receptor of epithelial cells. The possible diagnostic value of these measurements in the assessment of alcoholic disease was compared to that of serum gamma-glutamyl transpeptidase activity. Serum levels of secretory IgA and IgM and free secretory component, were quantified by an enzyme-linked immunosorbent assay in 71 patients with chronic alcoholic liver disease without cirrhosis and in 45 healthy controls. Patients were divided into two groups according to the severity of the liver abnormalities. In addition, the reversibility of serum secretory IgA, IgM and free secretory component abnormalities after alcohol withdrawal was evaluated in 15 patients. Serum levels of the three molecular forms of secretory component were significantly higher than those measured in control subjects, both in the whole population of patients and in the two groups of alcoholic patients without cirrhosis. In all groups, serum secretory IgA levels were correlated to free secretory component but not to total IgA levels. Serum secretory IgA levels were as discriminative as gammaglutamyl transferase activity in distinguishing between chronic alcoholic patients without cirrhosis and non-alcoholic subjects. The abnormalities of serum secretory IgA concentrations were reversible after alcohol withdrawal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Phase I study of vinorelbine and carboplatin in advanced non-small cell lung cancer.

Thirty-one patients with previously untreated advanced non-small cell lung cancer were included in a Phase I study to determine the optimal dose of Carboplatin (CBDCA) which preserves the best Navelbine (NVB) dose-intensity. NVB was administered at a 30-mg/m2 fixed-dose on days 1-8/q 3 weeks, whereas CBDCA doses were planned to be escalated from 275 to 400 mg/m2 on day 1/q 3 weeks for six successive groups of patients. The toxicity limiting dose of CBDCA in the combination was 350 mg/m2 on day 1/q 3 weeks because of repetitive Grade IV neutropenia, and the optimal dose of CBDCA was 325 mg/m2 on day 1/q3 weeks, offering a 86.4% NVB and a 92.6% CBDCA relative dose-intensity for the first 9 weeks. Responses were observed at each step. This study demonstrates the feasibility and the efficacy of the NVB-CBDCA combination. It suggests that dose-intensity calculation can be helpful to determine the recommended dose for Phase II studies of new drug combinations.

Aged↗
PubMed1995

Role of alcohol and tobacco in the aetiology of head and neck cancer: a case-control study in the Doubs region of France.

A case-control study conducted from 1986 to 1989 using the Doubs Cancer Registry included 299 cases of head and neck cancer and 645 controls from the general population. The results provide an indicator of the respective roles of alcohol and tobacco in all these cancers and on the tumour site. The people who smoked more than one packet of cigarettes a day have a risk that is 13 times higher than that of non-smokers and those who drink more than one and a half litres of wine per day have a risk that is 34 times higher of developing head and neck cancer. The combined exposure of alcohol and tobacco is characterised by a high risk and can be described by a multiplicative model without interaction. The age at onset (below 18 years of age) and the duration of smoking (over 35 years) are high risk factors. The risk decreases after stopping smoking, but only casual smokers (less than 7 cigarettes per day) can hope to have the same risk as non-smokers within a period of 15 years. Subjects smoking only non-filter cigarettes have a higher risk (OR = 1.98) than those who smoke filter cigarettes. The same applies to those who roll their own cigarettes (OR = 1.93) or inhale the smoke (OR = 1.51).

Adult↗
PubMed1995

Differences in treatment and survival rates of non-small-cell lung cancer in three regions of France.

Treatment and survival rates of patients with non-small-cell lung cancer (NSCLC) were compared between three French Cancer Registries (Calvados, Doubs, Tarn). The methodological issues in such comparisons are discussed. The treatments for NSCLC differed between the regions: radiotherapy tended to be preferred in Calvados (73% vs 21.3% surgery), whereas surgery was more frequently employed in Doubs and Tarn (27.7% and 37% respectively). The percentage of cases receiving no therapeutic treatment ranged from 7.8% (Calvados) to 26% (Tarn). Despite the differences in treatment, the overall survival rates were similar in the three regions. Adjustment for treatment in such a descriptive study may be misleading since different therapeutic strategies in different regions may lead to selection of patients of systematically better or poorer prognosis in the various treatment groups.

Adult↗
PubMed1995

[Psychosocial aspects of cancer screening].

Psychosocial reluctance is a major obstacle to the success of mass screening. In France, several opinion polls demonstrated that the fear of cancer as a disease, the fear of a positive result and the fear of the possible therapeutic consequences were the major determinants opposed to screening despite information often known to the public. The psychological obstacles appear less important in the US population, except for minorities. Age seems to be a discriminating factor, indeed after 50 years, reluctance to screening is increased probably due to a generation effect influencing the meaning of the disease and the interest of screening. Site specific constraints also exist, in colorectal cancer, 30% of the people feel as an embarrassment the manipulation of the stools. If false positives are responsible for a supplementary anxiety, it doesn't last long and it doesn't influence the observation of future campaign. These psychosocial obstacles as a whole justify the need of converging information that must take into account cultural problems. The favourable influence of the general practitioner explains his essential role for the success of mass screening.

Adolescent↗