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Pierre-Yves Marcy

Publications and source records attributed to Pierre-Yves Marcy.

12 recordsLinked to original sources
PubMed2006

French multicenter phase III randomized study testing concurrent twice-a-day radiotherapy and cisplatin/5-fluorouracil chemotherapy (BiRCF) in unresectable pharyngeal carcinoma: Results at 2 years (FNCLCC-GORTEC).

BACKGROUND: Unresectable carcinomas of the oropharynx and hypopharynx still have a poor long-term prognosis. Following a previous phase II study, this phase III multicenter trial was conducted between November 1997 and March 2002. METHODS: Nontreated, strictly unresectable cases were eligible. Twice-daily radiation: two fractions of 1.2 Gy/day, 5 days per week, with no split (D1-->D46). Total tumor doses: 80.4 Gy/46 day (oropharynx), 75.6 Gy/44 day (hypopharynx). Chemotherapy (arm B): Cisplatin 100 mg/m2 (D1, D22, D43); 5FU, continuous infusion (D1-->D5), 750 mg/m2/day cycle 1; 430 mg/m2/day cycles 2 and 3. RESULTS: A total of 163 evaluable patients. Grade 3-4 acute mucositis 82.6% arm B/69.5% arm A (NS); Grade 3-4 neutropenia 33.3% arm B/2.4% arm A (p < 0.05). Enteral nutrition through gastrostomy tube was more frequent in arm B before treatment and at 6 months (p < 0.01). At 24 months, overall survival (OS), disease-free survival (DFS), and specific survival (SS) were significantly better in arm B. OS: 37.8% arm B vs. 20.1% arm A (p = 0.038); DFS: 48.2% vs. 25.2% (p = 0.002); SS: 44.5% vs. 30.2% (p = 0.021). No significant difference between the two arms in the amount of side effects at 1 and 2 years. CONCLUSION: For these unresectable cases, chemoradiation provides better outcome than radiation alone, even with an "aggressive" dose-intensity radiotherapy schedule.

Adult↗
PubMed2005

Cardiac toxicity assessment in locally advanced breast cancer treated neoadjuvantly with doxorubicin/paclitaxel regimen.

BACKGROUND: The psychological difficulty of accepting a mastectomy for locally advanced breast cancer (LABC) justifies the use of chemotherapy as neoadjuvant primary treatment. The aim of this prospective study was to assess the efficacy of the doxorubicin/paclitaxel (AT) schedule neoadjuvantly administered in terms of response rates and survival in patients with LABC, with a special focus on cardiac toxicity. PATIENTS AND METHOD: All patients were treated by doxorubicin (60 mg/m2 i.v.) bolus followed by paclitaxel (200 mg/m2) as a 3-h infusion. Treatment was repeated every 3 weeks for four or six courses and followed by surgery, radiotherapy, and hormonotherapy for patients with positive hormonal receptors. Patients with significant cardiovascular history or ECG abnormalities were not eligible for the study. Measurements of left ventricular ejection fraction (LVEF) were performed at baseline and at the end of chemotherapy. RESULTS: From 1998 to 2001, 34 consecutive patients followed up in our institution were entered into this study. Median age was 49 years (range, 32-68 years). Seventeen patients had stage IIB, 5 patients stage IIIA, and 12 patients stage IIIB disease. Twenty-one patients underwent conservative surgery, 7 radical surgery, and 6 patients no surgery due to metastatic disease occurring during treatment. An objective clinical response was noted in 22 (65%) of 34 patients (6 patients with histological complete response, 10 patients with rare malignant cells, and 6 patients with a partial response), 6 patients presented a progressive disease, and 8 patients a stable disease. Twenty-four patients have kept normal cardiac function, 7 patients had a cardiac toxicity as defined by the institution [4 (24%) of 17 patients received 360 mg/m2 of doxorubicin (A), 2 of 4 presented congestive heart failure (CHF), and 3 (21%) of 14 patients received 240 mg/m(2) of A without CHF]. Three patients did not receive four or six cycles as initially planned due to the progressive disease during the chemotherapy courses. These patients were excluded from the final analysis, particularly cardiac toxicity analysis. At time of median follow-up (42 months), 28 of 34 patients were alive (one death due to CHF, five others due to progressive disease). CONCLUSION: The AT regimen in neoadjuvant treatment for LABC remains efficient, but cardiac toxicity reported in this study underlies the necessity to optimize the schedule of AT combination.

Adult↗
PubMed2005

Atlas-based automatic segmentation of MR images: validation study on the brainstem in radiotherapy context.

PURPOSE: Brain tumor radiotherapy requires the volume measurements and the localization of several individual brain structures. Any tool that can assist the physician to perform the delineation would then be of great help. Among segmentation methods, those that are atlas-based are appealing because they are able to segment several structures simultaneously, while preserving the anatomy topology. This study aims to evaluate such a method in a clinical context. METHODS AND MATERIALS: The brain atlas is made of two three-dimensional (3D) volumes: the first is an artificial 3D magnetic resonance imaging (MRI); the second consists of the segmented structures in this artificial MRI. The elastic registration of the artificial 3D MRI against a patient 3D MRI dataset yields an elastic transformation that can be applied to the labeled image. The elastic transformation is obtained by minimizing the sum of the square differences of the image intensities and derived from the optical flow principle. This automatic delineation (AD) enables the mapping of the segmented structures onto the patient MRI. Parameters of the AD have been optimized on a set of 20 patients. Results are obtained on a series of 6 patients' MRI. A comprehensive validation of the AD has been conducted on performance of atlas-based segmentation in a clinical context with volume, position, sensitivity, and specificity that are compared by a panel of seven experimented physicians for the brain tumor treatments. RESULTS: Expert interobserver volume variability ranged from 16.70 cm(3) to 41.26 cm(3). For patients, the ratio of minimal to maximal volume ranged from 48% to 70%. Median volume varied from 19.47 cm(3) to 27.66 cm(3) and volume of the brainstem calculated by AD varied from 17.75 cm(3) to 24.54 cm(3). Medians of experts ranged, respectively, for sensitivity and specificity, from 0.75 to 0.98 and from 0.85 to 0.99. Median of AD were, respectively, 0.77 and 0.97. Mean of experts ranged, respectively, from 0.78 to 0.97 and from 0.86 to 0.99. Mean of AD were, respectively, 0.76 and 0.97. CONCLUSIONS: Results demonstrate that the method is repeatable, provides a good trade-off between accuracy and robustness, and leads to reproducible segmentation and labeling. These results can be improved by enriching the atlas with the rough information of tumor or by using different laws of deformation for the different structures. Qualitative results also suggest that this method can be used for automatic segmentation of other organs such as neck, thorax, abdomen, pelvis, and limbs.

Algorithms↗
PubMed2005

[Role of an exclusive concomitant radio-chemotherapy treatment in non operable esophageal cancer: results of a 10-year experience in Antoine-Lacassagne Center].

Treatment of non operable esophageal cancer still remains debatable. To date, radio-chemotherapy treatment could be considered as a standard, offers to the patients real hope and a new area of management in this unfavourable cancer. The aim of the present study was to report retrospectively a 10 year experience in concomitant radio-chemotherapy primary treatment in non operable esophageal cancer patients in Antoine Lacassagne anti cancer Center. Between January 1989 and June 1997, 63 consecutive, previously untreated patients with squamous cell carcinoma of the esophagus and who were inoperable for various reasons were majoritably treated with cisplatin (70 mg/m2) at J1 plus 5-fluorouracil (800 mg/m2/d) from J1 to J5 every 3 weeks (78% of patients) concomitantly with external beam radiotherapy (2 types). Two other chemotherapy regimens has been also used. Seventy-five percent (47/63) of the patients received the stipuled concomitant radio-chemotherapy dose. Neutropenia in the form of WHO grade 3-4 : 27% (17/63) was observed, grade 3-4 anemia and thrombopenia in 16 (26 %) and in 9 (15%) patients, respectively, grade 3-4 emesis in 6 % (4/63), grade 3-4 mucositis in 10 % (6/63). On 47 patients with accessible responder status, 18 of them presented a complete response, 20 a partial response, 6 a stable disease and 3 a progressive disease. The median follow up was 7 years. The median overall survival was 9.6 months with 11% estimated to be alive after 5 years. Combined treatment with cisplatin 5-fluorouracil and radiotherapy for inoperable cancer of the esophageal is relatively well tolerated and reasonably efficacious in a very selected group of patients.

Adult↗
PubMed2004

Is routine triple endoscopy for head and neck carcinoma patients necessary in light of a negative chest computed tomography scan?

BACKGROUND: The objective of the current study was to analyze the results obtained by triple endoscopy during the initial evaluation of a primary carcinoma of the head and neck. METHODS: A total of 487 patients with a squamous cell carcinoma of the head and neck was studied. None of the patients had evidence of metastasis or a second primary tumor on the thoracic computed tomography (CT) scan or chest X-ray. All patients underwent a triple endoscopy including nasopharyngoscopy, laryngoscopy, pharyngoscopy, bronchoscopy, and esophagoscopy. RESULTS: A synchronous primary invasive carcinoma of the lung and esophagus was diagnosed in 5 patients (1%) and 10 patients (2%), respectively. In addition, nine lesions were considered to be a regional extension of the primary tumor to the esophagus, and nine in situ carcinomas were observed. It is interesting to note that a significant correlation was found between the risk of a second synchronous esophageal carcinoma and the initial location of the primary head and neck carcinoma (P = 0.002, chi-square test). Esophageal carcinoma was observed in 1.3% of the patients with an oropharyngeal tumor, 2% of the patients with a laryngeal tumor, none of the patients with a tumor of the oral cavity, and 9.2% of the patients with a hypopharyngeal tumor. CONCLUSIONS: The role of bronchoscopy and esophagoscopy in the presence of a normal thoracic CT scan has been questioned because of the relatively low incidence of a second esophageal and/or lung primary tumor. Nonetheless, based on the same incidence criterion, it appears reasonable to schedule a routine esophagoscopy for those patients with a squamous cell carcinoma of the hypopharynx.

Adult↗
PubMed2003

[2003 Update of Standards, Options and Recommendations for management of patients with salivary gland malignant tumors (excluding lymphoma, sarcoma and melanoma) (summary report)].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVES: To update clinical practice guidelines for the management of patients with salivary gland malignant tumors previously validated in 1997. These recommendations cover diagnosis, classification, treatment and follow-up of patients with these tumors. METHODS: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPG s according to the definitions of the Standards, Options and Recommendations project. Once the guidelines has been defined, the document is submitted for review by independent reviewers. RESULTS: This article is a summary version of the full document presenting the updated clinical practice guidelines with algorithms. The main questions addressed by the expert group in this update concern the place of fine needle aspiration biopsy in preoperative diagnosis, the place of cervical lymph node area surgical treatment, the place of postoperative irradiation and neutron therapy in the treatment of unresectable tumors and also the place of medical imaging, especially RMI, for the diagnosis of these tumors.

Antineoplastic Agents↗
PubMed2002

Cost-benefit assessment of inferior vena cava filter placement in advanced cancer patients.

We retrospectively collected data recorded between 1994 and 2000, with the aim of evaluating the cost and benefits of IVCFP (inferior vena cava filter placement) in advanced cancer patients treated in our institution alone from the radio-diagnosis department's point of view. A total of 30 procedures were performed. The benefits were represented by the efficacy and the safety of the filter. The costing procedure consisted in multiplying the value of the unit index by the number of relative complexity indices. Eighty percent (24/30) of the patients were dead at the time of the study. Twenty percent (6/30) of the patients died before even being discharged from hospital. Three of them died from renal failure, owing to complete renal vein thrombosis (n=2) or hydronephrosis (n=1), and 1 from pulmonary embolism because it was exceptionally severe; the other 2 patients were cachectic, i.e., in poor general condition. The individual cost of the procedures represented only 2% of the mean entire cost of hospitalization. Seventy-six percent, 56% and 40% of the patients, were still alive at 1 month; 3 months and 6 months, respectively, with an improved quality of survival in at least 53% of the patients. The low complication rate and the low cost relative to the mean cost of hospitalization (2%) are factors in favor of using IVCFP if it is medically indicated.

Adult↗
PubMed2002

Controlled transperitoneal percutaneous cecostomy as a therapeutic alternative to the endoscopic decompression for Ogilvie's syndrome.

Acute colonic pseudo-obstruction, the so-called Ogilvie's syndrome, results in massive colonic dilation without mechanical obstruction. In most cases, a conservative treatment with or without endoscopic decompression is sufficient. In rare cases of relapses or failures, a cecostomy has to be performed. A surgical cecostomy is associated with high morbidity and mortality. However, a percutaneous cecostomy could be an interesting alternative treatment. We report the case of a 67-yr-old male with colonic pseudoobstruction for which both the conservative and the endoscopic treatments were unsuccessful. A percutaneous cecostomy was performed, and for the first time in this indication, a transperitoneal access was used with the help of nylon T-fasteners.

Aged↗
PubMedDate not supplied

Burst fracture of the spine involving vertebrae presenting no other lesions: the role of vertebroplasty.

We report our experience on percutaneous vertebroplasty performed on five patients who presented with history of trauma to the spine and secondary burst fracture, but with stable fractures, and on whom the medical and orthopedical therapies had been unsuccessful in the relief of the intractable pain and in the treatment of their functional status. Four cases have benefitted from the intervention, with complete disappearance of the symptomatology in two and incomplete in the other two. In one case, the improvement in the persistent painful symptoms was of no significance. Controls by computed tomography (CT). Which were performed after 3 months showed a satisfactory consolidation of the fractured vertebrae.

Adult↗
PubMedDate not supplied

[Brachial fluoroscopically guided implantation of venous port devices in oncology patients].

Access to the central venous circulation for chemotherapy infusion has traditionally been achieved surgically via the subclavian or jugular routes. With ongoing improvements in technical management, alternative means of central venous access have been developed such as arm-port or forearm-port implantation under imaging guidance. Venous arm port devices implantation was attempted in 200 cancer patients under fluoroscopic guidance, after arm venography. The 4% failure rate was due to the inability to perform the arm venogram, venous spasm or presence of a large contrast medium hematoma (rolling vein). Median follow-up was 180 days (range 4-671) and the complication rate was 13.3% (0.7/1,000 patients-day). Twenty-six complications occurred and were due to venous thrombosis (n = 3), large brachial hematoma (n = 1), local (n = 7) and systemic sepsis (n = 1), skin dehiscence (n = 4), fissuration (n = 4), dislocation (n = 2), obstruction (n = 2), and twist of the port (n = 2), leading to a 8.5% removal rate. Main indications for arm port implantation may be breast cancer, previous arm or cervical venous thrombosis, morbid obesity, respiratory insufficiency, previous surgical failure and the irradiated neck.

Adult↗