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S Schraub

Publications and source records attributed to S Schraub.

At least 37 records · Page 2Linked to original sources
PubMed1997

Carcinoma of the intact uterine cervix treated with radiotherapy alone: a French cooperative study: update and multivariate analysis of prognostics factors.

PURPOSE: To determine independent prognostic factors in a group of 1875 patients with invasive carcinoma of the intact uterine cervix treated with radiotherapy alone in a French cooperative study from 1970 to 1993. MATERIALS AND METHODS: Patients were staged according to the UICC-FIGO and MDAH substaging. The distribution per FIGO stage was Ia-Ib: 25.5%; IIa: 12%; IIb: 29%; IIIa: 5%; IIIb: 25%, and IV: 3.5%. Ninety-two percent had squamous cell carcinoma. The maximum diameter of the clinically detectable cervical disease was less than 3 cm in 24.5% of Stages I-II and in 10% of Stages III-IV, more than 5 cm in 13.5% of Stages I-II, and in 16% of Stages III-IV. Nodal involvement was shown on lymphangiogram in 16% of Stages I-II and in 32.5% of Stages III-IV. RESULTS: 1) Univariate analysis of Stages I and II: stage, cervical disease diameter, and nodal involvement are significant prognostic factors. Five-year specific survival rate (5ySS) is 83.5% in Stage Ib, 81% in IIa and 71% in IIb. Five-year disease-free survival rate (5yDFS) is 86% in tumors less of 3 cm, 76% in tumors of 3 to 5 cm, and 61.5% in tumor larger than 5 cm. Lymphangiogram strongly influences the 5-year pelvic disease-free survival rate (5yPDFS): respectively, 90% in nonpositive lymphangiogram vs. 65% when positive. A significant drop in specific and disease-free survival is observed (10 and 14%, respectively (p = 0.04) when comparing adenocarcinoma and squamous cell carcinoma. Age is a significant prognostic factor for specific survival because patients aged less than 30 years old have 91% vs. about 75% for patients over 30 years (p = 0.03). 2) Univariate analysis of Stages III-IV: Stage and positive lymphangiogram are predictive factors for relapse and death. The MDAH substaging is more reliable to predict the probability of pelvic disease-free survival in Stage III. At 5 years, the FIGO Stages IIIa and IIIb have a rather similar PDFS (65% vs. 59%). Conversely, the difference of survival rates between MDAH Stage IIIA and Stage IIIB is more demonstrative (69% vs. 47.5%). 3) Multivariate analysis (Cox P. H. R. model). Nodal involvement and stage remain significant for all three models in all stages (p < 0.0001). Age above 70 years influences specific survival for Stage I-II (p = 0.01). Tumors larger than 5 cm and adenocarcinoma also appear to be independent prognostic factors for specific and disease-free survival in Stage I-II (p = 0.05 and p = 0.005, respectively). CONCLUSIONS: The relevance of tumor size (less or greater than 4 cm) is now recognized in the 1995 revised FIGO staging in Stage Ib but unfortunately not in other stages. Tumor size per stage and nodal status should be systematically recorded to allow a better prediction of failure rates and to compare literature reports.

Adenocarcinoma↗
PubMed1997

[Radiotherapy and symptomatic treatments of advanced colorectal cancers].

Treatments of colorectal cancers can still be curative up to fairly advanced stage. Clinical situations vary greatly depending on the primary: local recurrence is a major event in rectal cancer whereas metastases are the main problem in colon cancer. Therefore, rectal cancer benefit from locoregional combined treatments, chemotherapy, radiotherapy and surgery, to control the pelvic disease. In the metastatic setting, it is important to offer potentially curative treatment as often as possible. Radiotherapy for bone or brain metastasis is well known and frequently used; irradiation of painful liver metastasis is less regularly discussed despite its efficacy. Symptomatic treatments like analgesics narcotic or not, non steroidal anti-inflammatory, anxiolytics, etc. are useful. All these treatments must be evaluated, not only in term of anti-tumoural but also from the quality of life point of view.

Colorectal Neoplasms↗
PubMed1997

[Estimation of the treatment cost of cervical cancer].

BACKGROUND: The goal of this study was to estimate direct costs induced by the first year of treatment of cervix cancers according to the stage at diagnosis. METHODS: Fifteen patients of the Gynaecology Department of the Besançon hospital (Doubs, France) were involved in a prospective study to estimate the real cost of treatment of carcinomas in situ (CIS) by conization and of microinvasive carcinomas (MIC) by simple hysterectomy. Costs of invasive cancers were obtained from a retrospective analysis of 24 hospital records in the Radiotherapy Department. RESULTS: The average real cost of treatment for the CIS was 5023 FF (1995 French Francs). Real treatment cost of the MIC was 15,867 FF. The average cost of treatment for the IB and IIA cancers stage (FIGO classification) was 61,540 FF and 145,314 FF for the IIB to IV stage cancers. CONCLUSIONS: Cost-estimation of cervix cancer treatment according to the stage of diagnosis has to be done before starting a cost-effectiveness analysis of mass screening for cervix cancers. This study will allow us to take into account changes in the stages distribution following on a screening campaign.

Carcinoma in Situ↗
PubMed1996

A familial T-cell lymphoma with gamma delta phenotype and an original location. Possible role of chronic Epstein-Barr virus infection.

BACKGROUND: We describe a familial lymphoproliferative syndrome associated with Epstein-Barr Virus (EBV) infection and the gamma delta phenotype. METHODS: We reviewed clinical, pathologic, immunologic, and virologic findings in a nonconsanguineous French family, collected over a 13-year period. Specimens from the father (autopsy), son (liver, lymph nodes, and pericardial effusion), and daughter (skin, liver, and digestive tract) were studied with conventional histologic and immunohistochemical techniques. Anti-EBV latent membrane protein (LMP) antibody and T-cell receptor (TCR) gene rearrangements were also studied in the daughter. RESULTS: The father and daughter had similar clinical and histologic features with maxilofacial, nasal, laryngeal, skin, lung, gastrointestinal, and liver involvement by a high grade large cell angiocentric T-cell lymphoma. The gamma delta phenotype and clonal rearrangement were identified in the daughter's tumor. At the time of his death from pericarditis, the son had a 5-year history of a recurrent hemophagocytic syndrome and lymphadenopathy. Chronic EBV infection was found in each case. EBV infection of the son was diagnosed by means of serologic tests and detection of the EBV genome in circulating lymphocytes, and in the father and daughter by use of an anti-LMP antibody. Its pathologic role is discussed. CONCLUSION: This familial T-cell lymphoma syndrome associated with the gamma delta phenotype and an unusual location is an original clinical entity. Chronic EBV infection was present in each case, but its precise role remains to be determined.

Adult↗
PubMed1996

Childhood leukaemia in Europe after Chernobyl: 5 year follow-up.

The European Childhood Leukaemia - Lymphoma Incidence Study (ECLIS) is designed to address concerns about a possible increase in the risk of cancer in Europe following the nuclear accident in Chernobyle in 1986. This paper reports results of surveillance of childhood leukaemia in cancer registry populations from 1980 up to the end of 1991. There was a slight increase in the incidence of childhood leukaemia in Europe during this period, but the overall geographical pattern of change bears no relation to estimated exposure to radiation resulting from the accident. We conclude that at this stage of follow-up any changes in incidence consequent upon the Chernobyl accident remain undetectable against the usual background rates. Our results are consistent with current estimates of the leukaemogenic risk of radiation exposure, which, outside the immediate vicinity of the accident, was small.

Child↗
PubMed1996

The multicentre south European study 'Helios'. I: Skin characteristics and sunburns in basal cell and squamous cell carcinomas of the skin.

The aim of this study was to investigate constitutional and environmental determinants of non-melanocytic skin cancer among different populations from south Europe. Between 1989 and 1993 we interviewed incident cases and a random population sample of controls from five centres where a cancer registry was operating, whereas we selected a sample of hospital-based cases and controls from three other centres. Controls were stratified according to the age and sex distribution of cases. In all, 1549 cases of basal cell carcinoma (BCC), 228 of squamous cell carcinoma (SCC) and 1795 controls were interviewed. Both cancers affected primarily sun-exposed sites such as face, head and neck, but the prevalence of BCC on the trunk was higher than for SCC. Pigmentary traits such as hair and eye colour as well as tendency to sunburn were strong and independent indicators of risk for both BCC and SCC. In SCC, adjusted odds ratios (ORs) ranged from 1.6 for fair hair colour to 12.5 for red hair. Light-blonde hair entailed a risk of about 2 for BCC. Pale eye colour was associated with a risk of 1.8 for SCC and 1.4 for BCC. Subjects who always burn and never tan showed an adjusted OR of 2.7 for BCC and 2.0 for SCC. A history of sunburns and a young age at first sunburn were associated with an increased risk for BCC only (OR 1.7). Pigmentary traits and sun sensitivity of the skin confirmed their role as risk indicators. The effect of sunburns, as an indicator of both exposure and sun sensitivity of the skin, is less clear. Nevertheless, its association with BCC suggests, by analogy with melanoma, a relationship with intense sun exposure. Conversely, SCC would require prolonged exposure to sunlight.

Adolescent↗
PubMed1996

The multicentre south European study 'Helios'. II: Different sun exposure patterns in the aetiology of basal cell and squamous cell carcinomas of the skin.

The role of sun exposure in development of basal cell and squamous cell carcinomas among different populations from south Europe was investigated. Between 1989 and 1993 we interviewed incident cases and a random population sample of controls from five centres where a cancer registry was operating, whereas we selected a sample of hospital-based cases and controls from the other three centres. We gathered information on life-long exposure to sunlight during different activities. Results are analysed for 1549 basal cell carcinoma (BCC) cases and 228 squamous cell carcinoma (SCC) cases compared with 1795 controls. We observed a statistically significant increase of risk of SCC with increasing sun exposure beyond a threshold of 70,000 cumulated hours of exposure in a lifetime. Sun exposures during work and holidays were, however, inversely correlated. Odds ratios (ORs) of SCC were up to eight or nine times the reference for the highest exposures (200,000 cumulated hours or more). BCC exhibited a 2-fold increase of risk for lower exposure (8000-10,000 cumulated hours in a lifetime) with a plateau and a slight decrease of risk for the highest exposures (100,000 cumulated hours or more). Outdoor work showed a significantly increased risk of SCC (OR 1.6 for more than 54,000 cumulated hours of exposure in a lifetime), whereas recreational activities such as sun exposure during holidays at the beach (OR 1.6 for more than 2600 cumulated hours of exposure in a lifetime) or during water sports (OR 1.6 for more than 2600 cumulated hours of exposure in a lifetime) were associated with an increased risk of BCC. Risk patterns were different in poor or good tanners with a significant risk trend for good tanners, whereas poor tanners were on a plateau of increased risk at any level of exposure. Solar radiation is associated with a risk of BCC even for relatively short periods of exposure such as during holidays and sports, whereas SCC develops later if exposure continues. The skin's ability to tan modulates the risk of BCC; subjects who tan poorly have a steady risk increase, whereas people who tan easily develop cancer only after prolonged exposures.

Basal Cell Carcinoma↗
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

[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

The EORTC randomized trial on three fractions per day and misonidazole (trial no. 22811) in advanced head and neck cancer: long-term results and side effects.

From 1981 to 1984, a randomized study was done by the EORTC Radiotherapy Group comparing a fractionation schedule with three fractions per day (multiple fractions per day, MFD), with or without misonidazole, to conventional fractionation. The aim of the study was to obtain improved local and regional control and survival by shortening of the treatment time in the first 2 weeks of irradiation. Three fractions of 1.6 Gy/day (4-h interval) were given during 10 irradiation days to a total of 48 Gy. After 3-4-weeks interval, a boost was given to 67.2 or 72 Gy also in three fractions per day. This schedule was compared to an identical arm with misonidazole 1 g/m2/day and a third arm with conventional fractionation (70 Gy in 35 fractions, 7 weeks or 75 Gy in 44 fractions, 9 weeks). A total number of 523 patients was included in the study. Acute mucositis was much heavier in patients treated with three fractions per day (Van den Bogaert et al. Int. J. Radiat. Oncol. Biol. Phys. 8: 1649-1655, 1982). Early results, communicated in 1986 (Van den Bogaert et al. Int. J. Radiat. Oncol. Biol. Phys. 12: 587-591, 1986) showed no differences in treatment outcome between the three treatment arms. Long-term results and data on late effects are now available. Survival at 5 years was 18% (SE 1.9%) and locoregional control was 27% (SE 2.9%). No statistically significant differences could be observed between the three treatment arms.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1995

The EORTC randomized trial on three fractions per day and misonidazole in advanced head and neck cancer: prognostic factors.

In trial no. 22811 on a randomized comparison of multiple fractions per day (MFD), with or without misonidazole, to conventional fractionation in advanced head and neck cancer, a large number (523) of patients was entered in a short period of time. No differences in treatment results were obtained, but the study created an important database, allowing for detailed evaluation of the most important factors influencing prognosis. In univariate analysis, factors significantly influencing survival and locoregional control were: performance status, histological differentiation, tumor site, tumor and nodal staging, and tumoral and nodal volume. In multivariate analysis, significant factors for survival were nodal involvement, tumor stage, performance status, and tumor site. Significant factors for locoregional control were nodal involvement and total tumor burden. This analysis suggests that total tumor burden (volume) should be included in the interpretation of treatment results in head and neck cancer.

Combined Modality Therapy↗
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

Sensitization to mite allergens is a risk factor for early and late onset of asthma and for persistence of asthmatic signs in children.

BACKGROUND: To describe the natural history of asthma between the ages of 7 and 10 years and to analyze risk factors for prevalences, as well as new onset of asthma-like symptoms, a longitudinal study of 1812 children was conducted. METHODS: In four surveys, each 1 year apart, four asthma-like symptoms and several hypothetical risk factors were ascertained through standardized questionnaires. Sensitization to seven common inhalant allergens was measured by skin prick testing. Exposure to mite allergens (Der p I, Der f I) was assessed by measuring the antigen concentrations in the dust of each child's mattress. Occurrence of more than one asthma-like symptom closely related to the practioner's diagnoses of bronchial asthma and recurrent wheezy bronchitis was used as the outcome variable. RESULTS: After an initial prevalence of 14.5%, new onset of symptoms in children unaffected at the beginning was reported in 7.2% during the 3 years. Of the factors explaining prevalence and persistence of asthma-like symptoms (sensitization to mite allergens and animal danders, history of hay fever and eczema, low gestational age, male gender, parental atopy), only sensitization to mite allergens (odds ratio = 2.3, 95% confidence interval = 1.1-4.7) and parental atopy (odds ratio = 2.1, 95% confidence interval = 1.2-3.7) were also significantly associated with new onset. In a relatively small number of sensitized subjects with new onset of symptoms (n = 31), mite antigen concentration did not appear to be associated with incidence of symptoms. CONCLUSION: Sensitization to mite allergens antedated the onset of asthma-like symptoms, and no strong effect of allergen exposure on clinical development could be found. Thus the primary focus should be on preventing sensitization to mite allergens by implementing avoidance measures in infancy or at early school age in order to reduce the onset of asthma at a later stage.

Allergens↗
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↗