[Postoperative radiotherapy of carcinoma of the breast. Microscopic lymph node invasion, a primordial prognostic factor].
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Biomedical subjects
Publications and source records attributed to V Dragon.
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Presentation of 60 patients with cerebral metastases irradiated with a telecobaltotherapy machine (concentrated high dose treatment) from 1976 to 1979; 47 patients fully completed the treatment: 11 patients had only one part of the concentrated treatment and 36 patients had both parts of the concentrated treatment. Of the 11 patients who received only one part of the concentrated high dose treatment (3 x 650 rads mid-line dose to the whole brain during 3 consecutive days and then, after a rest period of 3 weeks, 12 x 170 rads mid-line dose given in two weeks using classical fractionation, total dose 3990 rads), 9 (81.8%) responded favourably with average survival of 5 months. Of the 36 patients who received both parts of the concentrated high dose treatment, i.e. 3 x 650 rads mid-line dose in 3 consecutive days and then the same treatment repeated 3 weeks later. giving a total dose of 3900 rads, 31 (86.1%) responded favourably with an average survival of 5 months. This type of regimen, using the two-part concentrated high dose treatment ("split course therapy"), not only spectacularly alleviated neurological signs and symptoms but had the added advantage of appreciably reducing the patients' stay in hospital.
With one or serveral charges of 137 Cs placed in an ordinary indwelling catheter, one can deliver to the prostate a radiation dose in 24 hours equivalent to the same dose which could be produced by 226 Ra in five days, or 60 Co in 6 to 7 weeks using the usual methods. 10 patients in whom a carcinoma of the prostate was discovered during adenomectomy (hidden Ca, stage A) have been treated in this way with hardly any immediate disadvantages.
In 29 patients treated in the Department of radiotherapy of the University Hospital, Lausanne, between 1963 to 1978, 18 of these lesions were localized in the stomach (1 was confined to the oesophago-gastric region), 10 in the small intestine and 1 in the rectum. The patients comprised 18 men and 11 women; the majority (21 out of 29) were over 50 years of age. Using the former histological classification, 13 patients had lymphomas of the lymphocytic type (in which 1 was a Brill-Symmers), 13 had reticulum cell sarcomas and 3 had mixed type. 28 patients had previously undergone surgery: 7 had had extensive surgery, 15 resections were classified as macroscopically tumour free by the surgeons though histologically the end of the surgical specimens was sectioned through tumour and/or regional lymphatics were positive, and 6 patients had undergone exploratory laparotomies. Radiotherapy was carried out using high energy machines in 28 of the 29 patients (i.e. telecobalt therapy and a betatron) and in the remaining patient a 200 kV conventional therapy machine was used. 21 patients received radical radiotherapy (in 15 patients the irradiation was confined to the tumour bed and the regional lymphatic ganglia, 1 patient was treated over the whole abdominal cavity using various parallel opposing portals, and 5 patients were treated by the moving-strip technic). In 8 patients the treatment was considered incomplete. The patients who were treated radically received doses of 4000-4500 rads in 5 weeks to the tumour bed and the regional lymphatic ganglia, and 2000-2500 rads in 5 weeks when the moving-strip technic was used and when the whole abdominal cavity was treated. Seven patients also received chemotherapy involving either one drug or in some cases multiple drug therapy. The best survival figures were in patients treated radically by both surgery and radiotherapy regardless of histology. The only prognostic factor was the initial extent of the disease.
Circulating immune complexes (CIC) have been studied in one or several serum samples obtained from 249 patients with cancer. 42.4% of patients with evolutive tumors and 26.9% of patients in complete remission have elevated levels of CIC. It appears that, in approximately one case out of 3, the presence of CIC is not necessarily in relationship with the tumor, but could be the consequence of other clinical factors. In some instances, repeated plasmapheresis results in decreased CIC levels. The specificity of the antibodies present in CIC is not yet known.
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From 1964 to 1977, 315 carcinomas of the bronchus either inoperable or recurring following surgery were treated by radiotherapy using high energy machines (telecobalt therapy and/or Betatron: X-rays or electrons). 116 patients (36.8%) had well-differentiated squamous cell carcinomas, 70 (22.2%) had undifferentiated or poorly differentiated carcinomas, 97 (30.8%) had small-cell anaplasic carcinomas, and 32 patients (10.2%) had adenocarcinomas or other types of bronchial carcinoma. 199 patients (63.2%) were treated exclusively by radiotherapy and 116 (36.8%) by surgery followed by radiotherapy: 28 had exploratory thoracotomies, 73 curative resections and 15 palliative resections. At the end of irradiation treatment 140 patients (44.5%) showed a subjective and objective (clinical and radiological) improvement, whereas 111 patients, (35.2%) although chest X-rays showed no radiological improvement, had a subjective response; 64 patients (20.3%) showed deterioration. 33.5% of the patients (88/263) lived at least 1 year after completion of radiotherapy: in 25.9% (42/162) the treatment was exclusively radiotherapy and 45.5% (46/101) underwent irradiation after surgery. 12.4% (31/249) of the patients were alive 2 years after completion of irradiation and 5.4% (11/203) after 5 years.
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Aspiration biopsy is a very useful method of obtaining morphologic evidence of metastasis and recurrences in surgical and/or irradiated cancer patients. The merits of the technic are ease of performance and rapidity of diagnosis. Moreover, it does not leave a scar which may delay the commencement of radiation therapy if required. Histologic typing of metastasis is not always possible in cytologic material, but comparison with the usually known structure of the primary tumor and evaluation of the clinical state affords sufficient evidence, for practical purposes, of the origin of the metastasis. Some aspects of 709 positive aspiration biopsies carried out in a radiotherapy department are discussed.
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