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M Schlienger

Publications and source records attributed to M Schlienger.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Radiosurgery by linear accelerators in the treatment of 84 arteriovenous malformations].

We have treated in 1990 and 1991, 84 arteriovenous malformations (AVMs) by radiosurgery. Irradiation was realized by 5 to 7 arcs with 15 MV X rays circular minibeams of a GE-CGR Saturne 43 Linac diameter, at 100 cm 6 to 20 mm; the Betti arm chair and the Talairach frame. The prescribed peripheral dose containing the nidus was 25 Gy corresponding to the 60-70% isodose range (100% was the maximum dose). For the irradiation planning we used the 'associated targets methodology' and the ARTEMIS-3D TPS, both of which have been developped in the radiotherapy departement of the Tenon hospital. Evaluation was performed in February 1995, the follow-up range was 38 to 62 months. In 1990, 46 cases were treated for cure and were all evaluable, whereas in 1991, among the 38 irradiated cases one patient was not evaluable because of lack of arteriographic control. Thus this series consisted in 84 evaluable cases. The overall obliteration rate was 65/84 (78%), partial obliteration was seen in 18/84 (21%) and no change in 1 case. According to AVM volume, obliteration rate was: AVMs < 4200 mm3: 82% (46/56). For lesions > 4200 mm3 it was 68% (19/28). In one isocenter irradiation, the obliteration rate was 42/47 (89%); whereas it was 23/37 (62%) in multi-isocenters treatments. The obliteration rate was better for not previously treated cases: 39/44 (89%) than for previously treated nidus (mostly embolisation) 65% (26/40). In 23 spheroid AVMs obliteration rate was 87% (20/23) in 43 ellipsoid AVMs the obliteration rate was 77% (33/43); and in irregular rounded nidus, it was 67% (12/18). The peripheral dose of 25 Gys has been used in 78 cases (93%), the obliteration rate was 63/78 (81%); in 6 other cases treated with 15-23.5 Gy, it was 2/6 (33%). We observed two recurrences of haemorrhage at 4 and 6 months after radiosurgery (recurrent haemorrhage rate 2/84 = 2.4%) with total neurological recovery in one of the two patients. One patient died of myocardial infarctus 11 months after radiosurgery (there was a partial obliteration of his AVM at 8 months after radiosurgery). There was no AVM related death. One patient developed an epilepsy.

Aged↗
PubMed1994

Synchronous and metachronous head and neck carcinomas.

BACKGROUND: The incidence of head and neck cancer is increasing. To improve the survival of head and neck cancer patients, an effective program of screening and/or chemoprevention of second malignancies is essential. An analysis of the incidence, time to development, and risk factors of second malignant tumors in head and neck cancer patients can contribute to the design of effective screening and chemoprevention programs. METHODS: Eight hundred, fifty-one patients with initial squamous cell carcinoma of the larynx (n = 224), tonsils (n = 189), pyriform sinus (n = 165), oral cavity (n = 129), mobile tongue (n = 72), and base of tongue (n = 72) treated from 1978 to 1990 were analyzed for the presence of a second malignancy after initial therapy. Of these 851 patients, 544 (64%) were documented smokers and 35 (4%) were nonsmokers. No smoking information was available for 272 patients. Four hundred, fifty-four patients (53%) were consumers of alcohol and 64 patients (8%) were nondrinkers. Alcohol consumption information was not available for 333 patients. RESULTS: One hundred, sixty-two (19%) second head and neck carcinomas occurred in the original 851 patients. Sixty-six patients (41%) had synchronous tumors, and 96 patients (59%) had metachronous tumors. The probability of developing a second metachronous cancer 5-years after undergoing treatment for the initial head and neck cancer was 22%. Borderline statistical significance was observed in the 5-year second cancer incidence based on the site of the initial primary cancer (46% for the base of tongue, 34% for the pyriform sinus, 23% for the larynx, 18% for the oral cavity, 15% for the tonsils, and 10% for the mobile tongue). Tobacco smoking (3% for nonsmokers vs. 26% for < or = 20 pack-years vs. 42% for > 20 and < or = 40 packs/year vs. 30% for > 40 packs/year of smoking) and the consumption of alcohol (5% for non-drinkers vs. 32% for drinkers) were both statistically significant in predicting the likelihood of developing a second malignancy. Multivariate analysis revealed that the two independent variables that influenced the occurrence of a second metachronous cancer were the anatomic site of the original primary cancer and patient age. The survival rate after the second cancer was influenced significantly by the site of the second cancer (20% for a second head or neck cancer, 3% for a second esophageal cancer, and 2% for a second lung cancer). Continued smoking (20% for non-smokers vs. 5% for smokers) and continued alcohol consumption (27% for nondrinkers vs. 6% for drinkers) also adversely influenced the survival after the occurrence of a second cancer. CONCLUSIONS: This study confirms the high rate of second cancers in patients with initial head and neck malignancies. The development of a second malignancy is almost always fatal. Screening programs and chemoprevention trials should be directed toward cancer patients with initial head and neck cancers. Only the small subset of nonsmokers and nondrinkers should be excluded from such trials.

Adult↗
PubMed1994

Epidermoid carcinoma of the anal canal. Results of curative-intent radiation therapy in a series of 270 patients.

BACKGROUND: Epidermoid carcinoma of the anal canal is an uncommon disease, and most institutions have only a small series of patients. The current study of a large series of patients treated with radiation therapy in a single institution evaluates the outcome, prognostic factors, and the late complications for these patients. METHODS: From 1972 to 1991, 270 patients with anal canal epidermoid carcinoma without evident distant metastasis were irradiated with curative intent in the Radiotherapy Department of Tenon Hospital. The sex ratio was 1 man/5.7 women, with a mean age of 67.5 years. The histology included 59.6% well-differentiated epidermoid carcinoma, 32.2% moderately or poorly differentiated epidermoid carcinoma, and 8.2% cloacogenic. The T-classification was: T1: 8.5%; T2: 51.1%; T3: 30.4%; T4: 10%. Abnormal inguinal lymph nodes were present in 12.5% of the patients. Patients were irradiated by external beam. They received a first course of photon irradiation consisting of (mostly 18 mV or 25 mVl; some Co60 or 6 mV) 40-45 Gy (box technique) in the pelvis for 4-5 weeks. After a rest of 4-6 weeks, a second course of 15-20 gy in 2 weeks was given through a perineal field by an electron beam of suitable energy. When rectal involvement was important, a four-field, small box technique was used. Fourteen patients were given a booster irradiation of 30 Gy by interstitial brachytherapy (Iridium 192 sources), and four patients were treated with interstitial brachytherapy alone, to a mean dose of 62.5 Gy. RESULTS: At 5 and 10 years, determinate survival rates were: T1: 86% and 86%; T2: 86.2% and 82.5%; T3: 60.1% and 56.8%; T4: 45% and 45%, respectively. The overall local control rate was 80%. The overall anal conservation rate was 67%. In 154 patients (57%), the anus had maintained its normal function. At 5 and 10 years, determinate survival was 76% and 73.7%, respectively, for N0 and 53.5 and 53.5% for clinically involved inguinal lymph nodes. According to the log-rank test, survival comparisons between T2 and T3 classifications and of tumor sizes less than or equal to 4 cm in length and greater than or equal to 5 cm in length were significant (P = 0.0001 and P < 0.0001, respectively). The presence of clinical abnormal inguinal lymph nodes had a significant negative influence on survival rates (P = 0.047). Multivariate analysis indicated that T-classification and tumor size in centimeters were the only predictive variables. Nonpredictive variables included nodal status, histology, age, total dose, overall treatment time, and irradiation technique. The grade 3 complication rate requiring surgical treatment was 27/270 (10%), considering all patients (27/190 represents a 14% rate for patients who had local tumor control after radiation therapy alone without secondary salvage amputation). There was no significant relationship between complication rate and the aforementioned variables. Because of the homogeneity of the irradiation doses, no significant relationship was found between dose, local control rate, or complication rate. CONCLUSIONS: After radiation therapy, recognizing the distinction between tumor sizes of less than or equal to 4 cm in length and more than 4 cm in length (which is not considered in TNM Classification criteria [International Union Against Cancer, 1987]) could help to improve treatment strategies. For tumors more than 4 cm in length and/or with clinically involved lymph nodes, the treatment should be more extensive with combined chemotherapy and radiation therapy, but the increased local control with the addition of cytotoxic chemotherapy to irradiation has not been proven.

Adult↗
PubMed1994

Kidney mobility during respiration.

Radiotherapy treatment planning needs optimum definition of the target volume in its relative position to normal tissue. The motion of the kidneys during respiration has not been well quantified. They move in a tilted coronal and sagittal plane. Using fast MRI while patients held their breath we quantified the movements of the kidneys. Fourteen patients volunteered for the study. Nine MRI images of the kidneys for one volunteer were done: three in the axial plane (all in deep inspiration) and six in the coronal plane (three in deep inspiration, three in deep expiration). The maximal vertical motion of the superior pole from its end-expiratory to its end-inspiratory position is 39 mm (43 mm for the inferior pole). In deep inspiration or deep expiration the positions of the right and left kidneys appear reproducible. The mean deviation of kidney movement is less than 4 mm in all three dimensions (range, 0-6.9). For tumors close to the kidney, we advocate respiration gated radiation therapy so as to minimize the movement of this very radiosensitive structure.

Adult↗
PubMed1994

The associated targets methodology and the multi-isocenters radiosurgery treatment planning system Artemis-3D.

A new radiosurgical methodology, the "associated targets methodology" has been developed and tested by our group for the irradiation of complex cerebral arteriovenous malformations using our treatment planning system Artemis-3D. For the treatment of the arteriovenous malformations we used 15 MV photons generated by a Saturne 43 Linac, eight additional collimators (6-20 mm in diameter), the Betti fixation seat and the Talairach stereotactic frame. The successive steps of the associated targets' methodology are: -the prescription of a peripheral minimal therapeutic effective dose corresponding to the 60-70% cumulated isodose range; -the compartmentalization of the target volume into several sub-volumes, each of them having its own isocenter, collimator, irradiation space and isocenter dose weight; -the 3-dimensional computation and graphics requirements, and dose volume analysis; -the optimization evaluation criteria taking into account the dose inside and outside of the lesion. Two treatment planning software versions of Artemis-3D exist; the first one was developed for the sitting position and later for the supine treatment position, the second version is a multi-modalities imagery radiosurgical treatment planning system based on more powerful computers. Different types of stereotactic frames have been integrated. Three-dimensional visualization, stereotactic CT imaging, and angiography can be used for the sitting or supine position. We started using this methodology in 1990, and treated 44 patients during that year. For 26 single isocenter arteriovenous malformations, the obliteration rate was 22/26 (85%). In the 18 multi-isocenters irradiation cases, the overall obliteration rate was 11/18 = 61%. An example of successfully irradiated complex arteriovenous malformation is discussed to illustrate the methodology. With this three-dimensional methodology we have improved the results obtained during the first period (1986 to 1989) of our radiosurgical practice in which we used a two dimensional planification approach.

Dose-Response Relationship, Radiation↗
PubMed1994

[Radiosurgical irradiation of 49 cerebral arteriovenous malformations using linear accelerator].

During 1990 we treated 49 cases of arterio-veinous malformations (AVMs) using radiosurgery. We employed 15 MV X-Ray minibeams of a Saturne 43 Linac, eight additional collimators, 6-20 mm, the O Betti armchair and the Talairach stereotactic frame. Irradiation consisted of delivering 25 Gy at the periphery of the nidus corresponding to the 60-70% peripheral isodose range. We used the "Associated Target Methodology" and the three-dimensional treatment planning system Artemis-3D, both of which have been developed in our radiotherapy department. In December 1992, 44 out of 49 patients who had been treated were available for analysis with a 2-3-year follow-up. The overall obliteration rate was 33/44 (75%). According to the number of isocenters the obliteration rate was: 22/26 (85%) for one isocenter. In 18 multi-isocenters irradiation cases overall obliteration rate was 11/18 (61%). Two isocenters were used in nine of these 18 cases, the obliteration rate was 6/9; while when three isocenters were used it was 2/4 and in five cases of four isocenters irradiation the obliteration rate was 3/5. Obliteration rate for lesions < or = 4200 mm3 was 31/37 (84%). For greater volumes (5500 mm3 to 19000 mm3; median 9200 mm3) the obliteration rate was 2/7 whereas three others were partially (75 to 90%) obliterated and two remained inchanged. Before radiosurgery 21 cases received other treatment (mostly embolizations), the obliteration rate in this group was 15/21 (71.5%) while in previously untreated AVMs it was 18/23 (78%). A control arteriography was performed between 6 to 18 months after radiosurgery in 44 patients; three others refused the arteriography but are alive and well; two others had palliative irradiation, one of whom is dead. Out of 28 AVMs checked between 6 to 12 months 17/28 were obliterated (61%). In four cases, epilepsy was the first symptom; one has not suffered a further crisis whereas three others experienced a decrease in the number of crises. Two patients had recurrence of bleeding four and six months after irradiation (recurrence rate 2/44 = 5%). There were no lasting neurological consequences.

Adolescent↗
PubMed1993

A 3-D radiosurgical methodology for complex arteriovenous malformations.

A 3-D methodology, the associated targets methodology, for planning radiosurgical irradiations of complex arteriovenous malformations (AVMs) is presented. It uses the ARTEMIS-3D treatment planning system and has been devised and adopted by our group since January 1990. Its main features are: (a) prescription and delivery of a minimal target dose on the surface of the lesion, corresponding to a 60-70% isodose range. The dose to adjacent functional neurological structures is taken into account as well as the maximum dose to the lesion; (b) An optimisation approach consisting of obtaining the optimal superimposition of the isodose surface and the 3-D contour of the lesion and sharp fall-offs by interactive manipulation of the treatment parameters. The clinical choice of the treatment plan is based on a compromise between the optimal reference isodose surface encompassing the lesion and the minimisation of the volumetric dose fall-off. In complex AVMs the angiographic results have been significantly improved in comparison with our previous experience because of the better achieved lesion encompassing.

Humans↗
PubMed1993

[Cancer of the anal canal; role of radiotherapy and combinations of chemotherapy and radiotherapy].

Carcinoma of the anal canal is a rare disease, more common in women than in men. The mean age distribution at presentation is about 60 years. The natural history is mainly loco-regional, distant metastases being uncommon. Histologically, most cancer are of the squamous cell type of different keratinization. The pre treatment evaluation is mainly performed by methodical clinical examination. There is no widely accepted staging system for these tumours. Three statistically significant prognostic factors are admitted: tumour size, regional nodal involvement and histological grade. The french school (Tenon, Institut Gustave Roussy, Institut Curie, Lyon) and the experience at the "Princess Margaret Hospital" at Toronto have shown that irradiation of these tumours is an adequate therapy. In Europe, irradiation has always played a more important role in the therapy of these tumours, than in North America where surgery was often preferred as the initial therapy. With the introduction of combined modality treatment, the use of pre-operative concomitant radiochemotherapy, in North America, has again changed the treatment policy towards a conservative radiotherapeutic approach. The present study analyses the modalities and the results from radiation therapy alone and the preliminary results from concomitant irradiation and chemotherapy.

Anus Neoplasms↗
PubMed1992

Multidisciplinary treatment approach to locally advanced non-inflammatory breast cancer using chemotherapy and radiotherapy with or without surgery.

Between April 1982 and December 1987, 82 locally advanced non-metastatic and non-inflammatory breast cancers were treated (42 stage IIIA, 40 stage IIIB). The median follow-up is 70 months from the beginning of the treatment. The initial treatment consisted of 4 courses of chemotherapy (doxorubicin, vincristine, cyclophosphamide, 5-fluorouracil) followed by irradiation (45 Gy to the breast and nodal area). A fifth course of chemotherapy was given after radiation therapy. Three different locoregional approaches were proposed depending on the tumoral response. In 32 patients (39%) with residual tumor larger than 3 cm in diameter or located behind the nipple or with multifocal tumors, mastectomy and axillary dissection were performed. Fifty other patients (61%) benefited from conservative treatment: 32 patients (39%) achieved complete remission and received a boost to the initial tumor bed; 18 patients (22%) who had a residual mass less than or equal to 3 cm in diameter were treated by tumorectomy and axillary dissection followed by a boost to the tumorectomy site. After completion of local therapy, all patients received a sixth course of chemotherapy. A maintenance adjuvant chemotherapy regimen without anthracycline was prescribed (12 monthly cycles). Three- and 5-year disease-free survival rates were 81.7% and 72% respectively. Five-year locoregional relapse rate (with or without other sites of failure) was 8.8%. In a multivariate analysis, disease-free survival was significantly influenced by the N-stage (p < 0.0001), initial tumor size (p = 0.01), and tumor response after initial chemotherapy (p = 0.02). Five-year breast conservation probability was 58.4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Preoperative radiation therapy and surgery in the treatment of "bulky" squamous cell carcinoma of the uterine cervix (stage Ib, IIa, and IIb operable tumors).

Forty-two women with "bulky" squamous cell carcinoma of the uterine cervix, larger than 5 cm, were treated between 1982 and 1988. The median follow-up was 5 years (from 37 to 106 months). The age range was from 25 to 77 years (mean: 49). There were 14 stage Ib, 5 stage IIa, and 23 stage IIb operable patients. Forty grays were delivered at mid-plane of the pelvis (23 fractions in 31 days) using the four-field technique (6-18 MV). External beam radiation therapy was followed by 20 Gy of intracavitary radiation therapy. Forty-eight days later total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) and bilateral pelvic lymphadenectomy were performed. The 3- and 5-year disease-free survival was 83 and 81%, respectively. The 5-year locoregional control rate was 83%. Thirteen patients suffered from mild to severe complications (31%) but there were only two long-term (5%) complications.

Brachytherapy↗
PubMed1992

[Review of results and clinical analysis of conservative partial surgery associated with postoperative radiotherapy in operable breast cancers stages I amd II].

Over the last 25 years, conservative forms of treatment have been used for the locoregional treatment of early breast cancer, stages I and II (< 3 cm in diameter). At present, the same carcinological results are obtained with conservative surgery and radiation therapy as with radical surgery, and the aesthetic and functional results have improved. Several parameters should be taken into account, ie tumour volume, breast volume, multifocal nature and histologic type. A number of questions still remain unanswered namely: what is the most appropriate conservative surgery (quadrantectomy, tumourectomy or local excision)? What is the most appropriate total irradiation dose (50 Gy over 5 weeks: or 45 Gy over 4.5 weeks)? What is the value of radiation boost in patients with negative resection margins? What is the value of radiation boost in patients with a high local risk of recurrence? What is the most appropriate radiation technique for boost in the primary tumour bed (electrons or iridium implants)? Does the external irradiation of regional lymph nodes improve survival rate? Is it possible to extend conservative treatment to a 4-cm diameter tumour? What is the impact of adjuvant systemic chemotherapy and/or hormonotherapy on the risk of isolated breast cancer recurrence?

Adult↗
PubMed1991

[Primary lymphoma of the central nervous system. Review of recent literature data].

Primary CNS lymphoma is a rare entity. In the last few years, increasing numbers of reports have focused on the clinical, radiological and biological aspects of this tumor. The problem of the therapy of this particular localisation of lymphoma remains mostly unsolved. Radiotherapy still remains the standard approach. However, recent trials combining chemo and radiotherapy have shed promising light on a dark prognosis. These aspects are reviewed based on recent reports in the literature.

Brain Neoplasms↗
PubMed1990

Primary lymphoma of the central nervous system. An unresolved therapeutic problem.

From January 1979 to December 1987, 35 cases of primary central nervous system lymphoma (CNS-L) were treated. We recently reviewed these cases focusing on treatment results, treatment modalities, and radiotherapy (RT) or chemotherapy-radiotherapy (CT-RT). Variables such as age, risk factors, presenting symptoms, and histologic condition (all were high-grade or intermediate-grade non-Hodgkin's lymphomas [NHL]) and radiologic data were similar to those of series reported previously. The median survival time was 36 months (+/- 0.2 months) and the disease-free survival (DFS) time was 16 months (+/- 0.12 months). Twelve of 32 patients evaluable for treatment results experienced a recurrence (all but one occurred in the CNS). The DFS rate was 70% for the CT-RT group and 50% for the RT group (median follow-up time, 24 months). Therapeutic results in CNS-L are discussed with special emphasis on a putative role of CT in the management of this rare type of tumor.

Adolescent↗
PubMed1990

[Intraoperative radiotherapy of cancer of the pancreas].

Intra-operative irradiation could overcome some of the problems of conventional "external" radiotherapy, allowing an increase of the tumor dose and better sparing of the normal tissues. The present study reports 14 cases of patients treated by such a technique; 8 cases were pancreatic cancers (only one being surgically removed). The first conventional surgical step was performed in the operating room. The patient, still under general anaesthesia, was then taken to the irradiation room. A linear accelerator (Saturne CGR 20) was utilized to deliver 15-20 Gy to the tumor volume. Three weeks later, the patients received a 40 Gy complementary irradiation by external beams, and 5 Fluorouracil. There were no early post-operative complications. Three patients suffered from painful lesions; pain disappeared in all 3 cases after the intra-operative irradiation. All patients (with the exception of one who was still alive 9 months later) died 4-10 months after treatment. No definitive conclusion can be drawn from this limited case study. However, encouraging results reported by other groups should lead to further studies regarding this possibly promising procedure.

Aged↗