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Biomedical subjects

M Spielmann

Publications and source records attributed to M Spielmann.

At least 109 records · Page 6Linked to original sources
PubMed1988

Early metastatic cancer of unknown primary origin at presentation. A clinical study of 302 consecutive autopsied patients.

We studied 302 consecutive autopsied patients who presented with carcinoma of unknown primary origin. The most frequent metastatic sites were the nodes, lung, and bone. The primary site was identified while patients were alive in 27% and at autopsy in 57%; the site remained unidentified in 16%. The pancreas (26.5%), lung (17.2%), kidney (4.6%), and colorectum (3.6%) were the most frequent primary sites, but the reliability of diagnostic tests used in the search for this site was disappointing. Survival was identical in patients whose primary site was discovered while alive, at autopsy, or remained unknown. The number of metastases at presentation was the major prognostic factor. Analysis of autopsy data demonstrated that patients with carcinoma of unknown primary origin pursue a different course than expected when the primary site is the first manifestation of the disease. On the basis of these results and the results of other modern series, we suggest an approach consisting of a limited initial workup but with greater emphasis on modern histochemistry studies and immunohistopathologic and other kinetic and morphologic parameters to understand the patient tumor characteristics better and base the clinical management on an individual basis.

Actuarial Analysis↗
PubMed1988

[Epidermoid cancers of the esophagus: combined chemotherapy, surgery and radiotherapy. Preliminary results in 50 cases].

Fifty operable epidermoid esophageal carcinomas were treated by combined chemotherapy, surgery and radiotherapy. The post-operative mortality was 5.4% and the severe post-operative morbidity was 29%. The vindesine-5FU-platinum association and the vindesine-endoxan-platinum association gave respectively 55% and 35% objective responses (OR) after two preoperative courses without increasing the operative mortality. The patients who showed an OR had a less important tumoral extension. Thus, an objective response to the pre-operative chemotherapy is in fact a new prognostic factor. Survival without recurrence seems to be increased when chemotherapy is efficient in the curative resection group. These findings incite to promote prospective randomized studies with this kind of combined therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

[Initial chemotherapy in the treatment of inflammatory breast cancers. 230 cases].

The results of 2 chemotherapeutic regimens used in 170 cases of inflammatory breast cancer were compared with those obtained in 60 historical controls treated with radiotherapy and hormonal therapy. Inflammatory breast cancers could be divided into evolutive phase 2 with limited signs of inflammation and evolutive phase 3 where inflammation involved the whole breast. The 60 controls had been treated between 1967 and 1974 with radiotherapy (45 Gy plus an extra dose of 20 or 30 Gy); premenopausal patients underwent ovarian irradiation. The 91 patients treated with regimen A between 1976 and 1980 received a DVM-type induction chemotherapy (doxorubicin 40 mg/m2 on day 1, vincristin 1 mg/m2 on day 2, and methotrexate 6 mg/m2 on days 3, 4, 5) every 3 or 4 weeks, and a VCF-type maintenance chemotherapy (vincristin 1 mg/m2 on day 1, cyclophosphamide 200 mg/m2 on days 2, 3, 4 and 5-fluorouracil 300 mg/m2 on days 2, 3, 4) every 4 weeks. Premenopausal patients had their ovaries irradiated; postmenopausal patients received tamoxifen. The therapeutic sequence was: 3 DVM - 45 Gy - DVM - 15 Gy - 4 DVM - 4-12 VCF. The 79 patients treated between 1980 and 1982 with regimen B received a DVCMF-type induction therapy (doxorubicin 50 mg/m2 on day 1, vincristin 0.6 mg/m2 on day 2, 5-fluorouracil 300 mg/m2 on days 3, 4, 5, cyclophosphamide 200 mg/m2 on days 3, 4, 5 and methotrexate 10 mg/m2 on days 3, 4, 5) every 4 weeks. Hormonal therapy was the same as with regimen A. The sequence was 3 DVCMF - 45 Gy - DVM - 20-25 Gy - 4 DVM - 4-12 VCF. The survival rate at 3 years was 42% in controls, 53% in regimen A patients and 74% in regimen B patients (P less than 0.05). The relapse-free survival rates in these three groups at 3 years were 15%, 32% and 54% respectively (P less than 0.0008). These results suggest that a multidisciplinary approach and initial chemotherapy are useful in this type of breast cancer. The value of prolonged maintenance treatment is discussed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Musculoskeletal tumors: follow-up with MR imaging after treatment with surgery and radiation therapy.

Magnetic resonance (MR) imaging was used as a follow-up technique in 60 patients who underwent surgery and/or radiation therapy for primary malignant musculoskeletal tumors. MR imaging was performed on a 1.5-T imager with T1- and T2-weighted imaging sequences; MR imaging findings were confirmed by means of posttreatment surgery and histologic analysis or follow-up for at least 1 year. If a low-signal-intensity lesion was seen on T2-weighted images in a patient who had undergone radiation therapy or surgery, the patient usually did not have active tumor (sensitivity, 96%). If a high-signal-intensity lesion was seen after a patient had undergone only surgery, the patient had active tumor (six of six such cases). In patients who had undergone only radiation therapy, however, the presence of a high-signal-intensity lesion may indicate either active tumor or radiation-induced inflammatory changes. Thus, in such cases, differential diagnosis of active tumor may be difficult, if not impossible, to make from MR images.

Bone Neoplasms↗
PubMed1986

Conservative management of breast cancer.

Between 1970 and 1982, 592 patients with T1 and small T2 breast cancers were treated at the Institut Gustave-Roussy by a combination of conservative surgery and radiotherapy. Mean follow-up was 78 months. The actuarial survival rate at 5 and 10 years was 92 per cent and 80 per cent respectively. There were 36 locoregional relapses of which 26 were within the treated breast. The actuarial relapse rate within the breast was 5 per cent at 5 years. If operable, a relapse within the breast did not significantly affect overall survival. The efficacy of conservative management of small breast tumours is confirmed.

Adult↗
PubMed1986

Primary chemotherapy in the treatment of inflammatory breast carcinoma: a study of 230 cases from the Institut Gustave-Roussy.

We report the largest series of induction chemotherapy for inflammatory breast carcinoma (IBC). Results of two chemotherapy protocols with radiation therapy (RT) (170 patients) are compared with results with radiation alone (60 patients) in the treatment of this disease. From 1973 to 1975, 60 patients (control, group C) received RT (45 Gy and 20 to 30 Gy boost) and hormonal manipulation. From 1976 to 1980, 91 patients (group A) were treated with induction chemotherapy: Adriamycin (Adria Laboratories, Columbus, Ohio), vincristine, and methotrexate (AVM) and RT on a cyclical schedule; and maintenance chemotherapy: vincristine, cyclophosphamide, and 5-fluorouracil (5-FU) (VCF). From 1980 to 1982, 79 patients (group B) received induction chemotherapy, Adriamycin, vincristine, cyclophosphamide, methotrexate, and 5-FU (AVCMF) and RT on a cyclical schedule and VCF maintenance. Hormonal manipulation was performed in all groups. Disease-free survival at 4 years was 15% for group C, 32% for group A, and 54% for group B (P less than .005 group C v group A, less than .00001 group C v group B, and less than .01 group A v group B). Total survival at 4 years was 42% for group C, 53% for group A, and 74% for group B (P = .17 group C v group A, less than .00001 group C v group B, and less than .001 group A v group B). Clinical assessment of tumor aggressiveness, nodal status, type of chemotherapy administered, and early response to chemotherapy (by third course) were all prognostic factors. There is an important, highly statistically significant benefit in terms of both disease-free survival and total survival observed in patients treated with the addition of chemotherapy compared with radiation alone in IBC.

Aged↗
PubMed1985

[Chemotherapy by ambulatory continuous infusion using a portable pump: a feasibility trial].

43 metastatic cancer patients received 190 portable infusors over 24 hours or more. This portable infusor is a disposable material made by Travenol which operates without outside energy. The drug in an elastomere balloon reservoir is injected about 24 hours at a rate of 2 ml/hour. We used various drugs: CDDP, bleomycin, 5 fluorouracil, aracytine, velbe, voltarene. The patients were under hospital observation and received their treatment without any incident due to the pump itself. The patients who had already been perfused with the usual technique greatly appreciated the comfort of this light portable device. Our next step will permit us to estimate the use of these infusors by patients at home.

Ambulatory Care↗
PubMed1985

[Mesenchymal breast sarcomas. Apropos of 25 cases].

Breast sarcoma are rare, representing 1% of all malignant breast tumours. This is a retrospective study of 25 patients with a breast sarcoma, treated at Institut Gustave Roussy from 1954 to 1981. Thirty six per cent of these arose in a cystosarcoma phyllodes. A variety of histologies were found, the main one being malignant fibrohistiocytoma (44%). Nodal involvement was rare (4%) and, as in other sarcoma, hematogenous spread of metastases was more usual. Local recurrence occurred in 44% of cases and distant metastases (usually pulmonary) in 24%. The 3 year disease-free survival was 60% and the major prognostic factor was the mitotic index. Surgery is the treatment of choice of these tumours, supplemented by local irradiation in those cases where only a tumorectomy has been performed. The role of adjuvant chemotherapy remains undefined.

Adolescent↗
PubMed1985

[Medical treatment of soft-tissue sarcomas in adults].

Soft tissue sarcomas are rare tumors. There is a lot of histologic varieties but the natural history and the prognosis are very similar. Surgery remains the first step of the treatment policy. Radiotherapy, given additionally, can prevent local relapse. Till now, chemotherapy was given to patientes with advanced diseases. Except doxorubicine and ifosfamide much drugs act poorly in the solft tissue sarcomas. CYVADIC is the best combination available. One randomized study has established the value of adjuvant chemotherapy in soft tissue sarcomas of the extremities. The real place of chemotherapy, probably will be in the next years, beside surgery and radiotherapy, in a multidisciplinary combined approach.

Alkylating Agents↗
PubMed1985

Phase II study of elliptinium in advanced breast cancer.

A group of 74 patients with advanced breast cancer received elliptinium as second- or third-line treatment (100 mg/m2/week). The objective response rate was 19% (30% in soft tissue metastases), lasting from 3 to 12 months. This drug appears to have no marrow toxicity. Mild to moderate nausea and mouth dryness were the most frequently encountered side effects. Hemolysis occurred in five patients who had an IgM antibody and represents the dose-limiting toxicity. Cumulative renal toxicity (World Health Organization, grade 2) was observed in one of ten patients who had received greater than 2000 mg of elliptinium.

Acute Kidney Injury↗
PubMed1985

[Combination vindesine, cyclophosphamide, cis-platinum and CCNU in esophageal epidermoid cancer. Preliminary analysis of 64 cases].

We have treated 64 patients with esophageal squamous cell carcinoma using a combination of Vindesine 1.4 mg/m2 on day 1-2, Cyclophosphamide 200 mg/m2 on day 2-3-4, Cis-Platin 100 mg/m2 on day 3 and CCNU. 28 of the 37 patients considered to be inoperable were evaluable. We observed three complete responses and three partial responses in this group (overall response rate 21,5%). Twenty seven patients considered to be operable received the same chemotherapy without CCNU, owing to the risk of thrombopenia. 23 of these patients were evaluable in whom we observed 35% partial responses and no complete responses. No severe toxicity related to the chemotherapy protocol was observed. The mediocre results among the group of inoperable patients suggest that other chemotherapy protocols need to be tested. On the other hand, in the group of operable patients, the preliminary results encourage us to continue this study.

Adult↗
PubMed1983

[Malignant lymphomas and other hematosarcomas with initial breast localization. Retrospective study of 20 cases].

A review of 20 cases of malignant lymphomas and other hematopoietic sarcomas initially localized in the mammary gland permitted us to determine some main clinical and morphologic features. Ages range from 14 to 74 years. Clinical features consist of two principal aspects: a radiologically homogeneous, well circumscribed mass or an inflammatory tumor. After staging, one half of the cases remain localized only in the mammary gland (extranodal stage I). Granulocytic sarcoma, monoblastic sarcoma and Hodgkin's disease are very rare. Non Hodgkin's lymphomas are the most frequent. In 40 per cent of the cases, it is a diffuse, large non cleaved cell type, according to the working formulation for clinical usage (centroblastic in the Kiel classification). These are probably B cell derived malignant lymphomas. Eleven per cent of the cases fall into the large cell with multilobated nuclei type according to Pinkus, which probably is a T cell derived malignant lymphoma. Treatment consists of radiotherapy and/or chemotherapy, mastectomy is not advisable. Like any malignant lymphoma localized in other sites, prognosis depends on two main data: clinical stage of the disease and histologic type. Ten patients are in complete remission, the median survival being 3.5 years.

Adolescent↗
PubMed1982

[Salvage chemotherapy in resistant malignant lymphomas (author's transl)].

A salvage chemotherapy was used in advanced malignant lymphomas resistant to previous chemotherapy. The chemotherapy schedule consisted by the monthly administration of vindesine and continuous infusions of bleomycins, associated with cis-diammine-dichloro-platinum in Hodgkin's disease (patients resistant to MOPP and ABVD protocols) and with DTIC in non-Hodgkin lymphomas (patients resistant to CHOP or equivalent protocol). In 10 patients with advanced Hodgkin's disease (stages III and IV), one complete remission and four partial regressions were achieved. Five patients are still alive after 6 and 14 months. In 15 non-Hodgkin lymphoma patients, two complete remissions and seven partial regressions were achieved. Eight patients are still alive after 4 to 12 months. Severe toxicities related to the chemotherapy protocol have never been observed. These results demonstrate the efficiency of the described chemotherapy schedules in advanced malignant lymphomas resistant to visual therapy.

Adolescent↗
PubMed1982

[Cellular immunity in breast cancer patients].

84 breast cancer patients were examined prior to surgery regarding cellular immunity. 47 patients were free from secondary tumors, 37 already had axillary lymph node metastases, but no other secondary growth. 37 healthy women formed a control group. With reference to the total leukocyte count and to the percentage of T cells in the total lymphocyte count, there was no difference between the control group and the cancer patients. The latter, however, showed a significantly increased lymphocyte count compared with that of the control group. Despite an increase in the number of lymphocytes in cancer patients, there was a significant decrease in their ability to be stimulated by concanavalin A. In breast cancer patients with regional metastases the ability to be stimulated by phytohemagglutinin was decreased, too.

Adult↗
PubMed1982

[Factors of severity in placental choriocarcinoma].

A retrospective study has been carried out on the poor prognostic features of a group of 57 patients. These are: the existence of extra-pelvic and extra-pulmonary metastases and a level of serum HCG above 200000. The most favourable prognostic signs are absence of these two factors in pregnancy that is not normal and a delay between the onset of the first diagnostic elements and treatment of less than 6 months.

Adolescent↗