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Biomedical subjects

R A Guérin

Publications and source records attributed to R A Guérin.

At least 19 recordsLinked to original sources
PubMed1995

Adjuvant radiotherapy versus combined sequential chemotherapy followed by radiotherapy in the treatment of resected nonsmall cell lung carcinoma. A randomized trial of 267 patients. GETCB (Groupe d'Etude et de Traitement des Cancers Bronchiques).

BACKGROUND: The effect of adjuvant chemotherapy after resection of nonsmall cell lung cancer (NSCLC) remains an unresolved question. METHODS: From October, 1982, to November, 1986, 267 patients with resected NSCLC were included in a randomized trial. The adjuvant allocated treatments were either postoperative radiotherapy, 60 Gy in 6 weeks (radiotherapy group = 129 patients), or three courses of postoperative COPAC (cyclophosphamide, doxorubicin, cisplatin, vincristine, lomustine) chemotherapy followed by a similar radiotherapy schedule (chemotherapy/radiotherapy group = 138 patients). RESULTS: The sex ratio (M:F) was 19/1; mean age was 57 +/- 9 years. According to postoperative staging, 8 patients were Stage I, 70 were Stage II, and 189 were Stage III. The histologic type was squamous cell carcinoma in 175 patients, adenocarcinoma in 57, and large cell carcinoma in 35. The minimum follow-up was 6 years. Four patients were lost to follow-up. Death was recorded in 233 patients. No significant difference was observed in terms of disease free interval (P = 0.47, log-rank test), or overall survival (P = 0.68, log-rank test). With respect to the first site of relapse, distant metastasis occurred more frequently in the radiotherapy group (P = 0.09, log-rank test) whereas local relapse occurred similarly in both groups (P = 0.27). An interaction was observed between lymph node involvement and treatment in terms of overall survival. CONCLUSIONS: The COPAC chemotherapy as postoperative treatment failed to improve overall survival in patients with resected NSCLC receiving postoperative radiotherapy but decreased the pattern of metastatic progression, mainly in the N2 patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[Medical treatment of inoperable malignant glioma. Non-superselective intra-arterial chemotherapy with HECNU followed by conventional radiotherapy].

Forty-six cases of non-surgical malignant glioma were treated by several repeated infusion of non-superselective intra-arterial chemotherapy using HECNU, followed by conventional radiotherapy. Chemotherapy was well tolerated immediately. Good responses rate was 46% for the whole group, but was higher in anaplastic astrocytomas (71%) than in glioblastomas (43%). The median survival for responders was 17 months, and clinical improvement was observed in a large majority of them. Later, neurological or ophthalmological ipsilateral complications of varying severity were observed in 8.7% and 15% of the cases respectively. Despite these complications the treatment was generally well tolerated and gave in responders a longer survival with better comfort.

Adult↗
PubMed1989

[Primary tumors of the spine. Initial oncologic aspects: epidemiology, anatomo-prognostic and therapeutic classification].

Primary tumors of the vertebral column are rare: 20 per cent of all primary tumors of the spinal column. The distribution by type of tumor shows that the three most frequent primary tumors considered to be "radio and/or chemo resistant lesions" are the chordoma (15.5 to 24.5%), the chondrosarcoma (20%) and the giant cell tumor (10%). A second group with "chemo and/or radiosensitive lesions" include the Ewing sarcoma, primary lymphoma and plasmocytoma (5%). We consider a third group with the benign tumor: osteochondroma, chondroma, osteoid osteoma, osteoblastoma, aneurysmal bone cyst, hemangioma and eosinophilic granuloma (2 to 3%). The last tumoral group agrees with sarcomatous tumors: osteogenic sarcoma, fibrosarcoma, malignant fibro-histiocytoma, angiosarcoma and hemangio-pericytoma (1 to 3% of primary tumors of the vertebral column); they are most frequently secondary to Paget's disease, giant cell tumor or to radiation therapy and their prognosis is poor.

Humans↗
PubMed1989

[Primary tumors of the spine. Radiotherapy and chemotherapy].

Complete surgical excision of a primary spinal tumor without contamination of the surgical wound is not always possible, and adjuvant therapy by chemotherapy and/or radiation therapy is important to improve local and survival disease free. The efficacy of radiation therapy is limited above L2 because of the risk of radionecrosis of the spinal cord if one exceeds 45 Gy over 4.5 weeks. According to drugs and radiation sensitiveness, three groups can be distinguished: i) malignant tumors with low sensitiveness: chordoma, osteo-, chondro-, and fibro-sarcoma; ii) malignant tumors with high sensitiveness: Ewing's sarcoma, plasmocytoma, and non Hodgkin lymphoma; iii) benign tumos, occasionally aggressive like giant-cells tumor. For each type of tumor, a literature review and our personal experience is presented.

Combined Modality Therapy↗
PubMed1988

[Radiotherapy of thymomas].

For ten years radiotherapy has had a role in the diminution of local and regional recurrence post-operatively in thymomas. The therapy was for a long time empirical, but today radiotherapy is more standardised: there is a consensus on the methodology of the trajectory and on the optimal doses (50 to 60 gy in 6/7 weeks) according to the volume of tumour remaining. In numerous recent retrospective trials it is apparent that the overall level of survival at 5 years is 46 to 66%. Since 1982 the study group of thymic tumours (GETT) has carried out a prospective trial. It has adopted the same surgical and anatomical classification (table 5) and the same radiotherapy and chemotherapy protocol.

Combined Modality Therapy↗
PubMed1987

[Half-body irradiation and drug-resistant non-Hodgkin's lymphomas. Apropos of 9 cases].

Nine patients, aged 19 to 57 years (mean: 37 years) with non hodgkin lymphoma (NHL) secondarily resistant to chemotherapy (8 stages CS IV involving the bone marrow and 1 stage III) were studied. Histologic forms according to the Lennert classification were as follow: 1 nodular centrocytic which developed into a diffuse centroblastic, 3 diffuse immunoblastic, 4 diffuse centrocytic-centroblastic, and 1 T cell lymphoblastic. The nine patients were managed by external irradiation of the lower half of the body (LHBI), followed six weeks later by irradiation of the upper half of the body (UHBI). A single dose of 8.00 Gy in 7 cases and 6.00 Gy in 2 cases was delivered. Three patients developed severe medullary aplasia. Each of these patients had received 8.00 Gy and been given a course of chemotherapy between the two radiation sessions. The aplasia was fatal in two patients. Overall apparent clinical remission rate was 5/9, with one iatrogenic death at 3.5 months; one lost to follow-up after 8 months; for three other cases, the duration of apparent complete remission was 15, 22 and 36 months. One patient was alive in partial remission 30 months after irradiation. Three patients who failed to respond to treatment, were died between 4 and 11 months.

Adult↗
PubMed1984

[Radiotherapy of primary malignant tumors of the trachea. Apropos of 31 cases].

We report 31 cases of primary malignant tumours of the trachea, treated with radiotherapy at the Tumour Centre, Pitié-Salpêtrière, from June 1968 to January 1982. Three patients received complementary post-operative irradiation: one had an epidermoid carcinoma, operated by incomplete resection and anastomosis, and survived 12 months after irradiation with 60,00 grays in 6 weeks (local recurrence of tumour and mediastinal extension); the other two had cylindromas of the trachea with complete resection and anastomosis: the first remains alive 6 years after an irradiation of 65,00 grays over 6 weeks, the second is alive 5 years after post-operative irradiation of 60,00 grays in 6 weeks. These two latter tumours evolved slowly and local recurrence may occur after five years and sometimes longer, after local treatment. 28 other cases presenting with an epidermoid carcinoma of the trachea received radiotherapy exclusively, when a surgical cure was impossible. Irradiation was interrupted in two patients: one after a dose of 12,00 grays for sudden massive haemoptysis, the other after a dose of 22,00 grays for an oesophago-tracheal fistula. An apparent complete remission was obtained in 80% of cases, judged by a tracheo-bronchial endoscopic examination carried out in the six weeks following the treatment. Two deaths were seen from intercurrent disease: one at two months from a granulocytosis caused iatrogenically from medication and the other at five months from bilateral bronchopneumonia. One patient was alive at 9 months in apparent complete local remission, but lost to follow up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗
PubMed1983

[Epiduritis disclosing non-Hodgkin's lymphoma. Apropos of 11 cases].

We report eleven cases of non-Hodgkin lymphoma (NHL) revealed by epidural involvement treated at the Pitié Salpêtrière Tumor Center over ten years. This condition is uncommon. The tumor can be excised after laminectomy, thus establishing diagnosis. Rather than on histological type, prognosis is dependent on the presence or absence of associated vertebral involvement. Four patients presented with apparently primary, localized, epidural involvement without vertebral lesions; they are still alive 2, 3, 6 and 11 years after onset. Prognosis is guarded in the seven other patients as they have vertebral involvement; other localizations are frequently found and survival does not exceed 8 to 36 months. Only 3 patients are still alive, 8 months, 10 months and 3 years after onset. We advocate preoperative irradiation of the tumor delivering 45.00 Grays, followed by systematic combination chemotherapy. Chemotherapy can be given both before and after radiotherapy in patients with vertebral bone involvement.

Adolescent↗
PubMed1983

[Superoxide dismutase treatment of 2 cases of radiation-induced sclerosis].

Two patients with severe radio-induced necrosis were treated with bovine copper superoxide dismutase encapsulated in lysosomes (SOD). Two milligrams were injected subcutaneously every other day. This therapy was apparently effective on radio-induced inflammation and fibrosis. These are preliminary results that need confirmation. They suggest that SOD is useful, not only before radiation exposure, as a preventive, but also after exposure, as curative treatment for radiation injury.

Aged↗
PubMed1979

[The use of potentiating agents in megavoltage therapy of non-resected localized carcinoma of the lung (author's transl)].

A 5 years survival of 20% without local recurrence and/or metastasis was obtained after radiation therapy alone. This figure is slightly inferior to the survival rate of surgically treated tumours. Failure is mostly due to the appearance of metastases after radical treatment in spite of additional chemotherapy and/or immunotherapy. But experience has also shown that certain cancers "locally controlled" by radiation therapy can recur 3, 5, 8 or even more years later. Two thirds of squamous cell carcinomas are sterilized with doses of 60 Gy. A dose of 80-90 Gy has a greater curative effect on tumours usually unresponsive to doses of 60 Gy. But this level of radiation results in significant damage to normal tissue with inacceptable complications. Even with such doses, quiescent cells and hypoxic cells remain unresponsive. These cell populations are both clonogenic later. Megavoltage therapy must therefore be associated with chemical and physical radiosensitizing agents (e. g. hyperthermia and drugs of the nitro-imidazole group). Treatment protocols also fully exploit the biological effect of chemotherapy recruitment, cell synchronisation and synergistic lethal effect. The biological effects to neutrons on hypoxic cells were also explored, as most of the latter respond to neither X nor kappa therapy. In all, the new treatment strategy must seek the complementarity of the specific biological effects or radiotherapy chemotherapy and radiosensitizing agents (chemical and/or physical). The goal is a 10% growth rate in the cure of squamous cell carcinomas.

Carcinoma, Squamous Cell↗
PubMed1979

[Modalities and interest of preoperative staging in primary lung cancer (author's transl)].

The study of the extension of primitive lung cancer involves, on one hand, the determination of the locoregional extension concerning the tumator and adenopathies, and on the other hand, the determination of the metastatic extension. A careful clinical examination determines the need for complementary examinations providing decisive information for or against interventions. Systematic lung endoscopy should consist of staged biopsies. Mediastinoscopy estimates the locoregional extension in a more satisfactory manner than angiography or lung scintigraphies. The search for bone or cerebral metastasis is often negative in the absence of clinical symptomology in spite of the recent contribution of tomodensitometry. The detection of abdominal metastasis by biological examination, scintigraphies or contrast X-rays is liable to interpretational errors in one-third of the cases. It is for this reason that we preconize laparotomy before lung exeresis. In our series, among 175 laparotomies, 35 revealed abdominal metastasis whose discovery enables us to avoid useless, if not harmful, thoracic surgery.

Abdominal Neoplasms↗