Search PubMed⌕ Search

Biomedical subjects

A Gerbaulet

Publications and source records attributed to A Gerbaulet.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Method for evaluating long term complications. A study from a phase III trial comparing two low dose rates in gynecologic brachytherapy].

When treatment complications are the main criteria of a study, the simplest way for estimating the complication rate over time is to use the Kaplan-Meier method. The failure is the onset of the first complication. A new way is proposed here which takes into account the time to an eventual second, and third complication, and their duration as well. Results from a phase III randomized trial comparing two preoperative brachytherapy low dose rates in localized stage cervix carcinoma patients are used to illustrate both methods. The new method showed a greater long term complication rate in the higher dose rate group.

Brachytherapy↗
PubMed1994

[Brachytherapy of the bladder].

Brachytherapy has a key role to play in the treatment of bladder carcinoma. It is generally combined with partial bladder resection for limited tumours (T1-2, N0, M0). Results obtained in Holland and France have shown 80% local control with limited morbidity.

Brachytherapy↗
PubMed1994

[Brachytherapy in prostatic adenocarcinoma].

Brachytherapy can represent the exclusive treatment of localized prostatic adenocarcinoma. Several techniques have been described: permanent implantations with 125-iodine or 198-gold seeds or temporary implantations with 192-iridium. These implantations are performed either via a retropubic approach, often combined with pelvic lymphadenectomy, or via a transperineal approach, with or without ultrasound guidance. The largest clinical experience is from Memorial Sloan-Kettering Cancer Center, with 1119 patients treated from 1970 to 1985 for stage B or C prostatic adenocarcinoma with pelvic lymph node dissection and interstitial iodine-125 brachytherapy. The 15-year overall local control is 51%. One of the strongest prognostic factors is lymph node involvement. The comparison between brachytherapy and other treatment modalities such as radical prostatectomy or external irradiation or even expectant management in localized tumors has never been performed prospectively. This type of randomized trial appears to be necessary in the assessment of the results published with brachytherapy.

Adenocarcinoma↗
PubMed1994

[The role of brachytherapy in the therapeutic strategy of vesico-prostatic rhabdomyosarcoma in children].

Because of its ballistic and physical characteristics, brachytherapy (BT) represents the optimal irradiation treatment in pediatric tumors, especially in prostate or bladder rhabdomyosarcoma. In a limited series of 15 children treated with BT (including three patients treated with salvage BT), 8 out of 9 patients surviving with NED benefited from conservative treatment among 12 patients treated with BT as first-line treatment. Sequelae were minimal consisting of one grade I cystitis and one asymptomatic vesical and ureteral reflux. BT allows administration of high doses to limited volumes sparing normal tissues. BT--whenever possible--represents the treatment of choice compared with external radiotherapy. Indications of BT depend on tumor accessibility and size (usually < or = 4 cm).

Adolescent↗
PubMed1994

[Brachytherapy in cancer of the penis].

Brachytherapy can play an essential role in the conservative treatment of penile cancer limited to the glans. This treatment is usually performed using hypodermic needles with templates which are subsequently loaded with iridium wires. Various studies, particularly French reports, show a local control rate of 80%, penis preservation in 75% of cases and a specific survival rate of 60%.

Brachytherapy↗
PubMed1994

[Brachytherapy in cancer of the urethra].

Carcinomas of the male and female urethra are serious cancers because they frequently present late with lymph node involvement. Brachytherapy plays a significant role, often associated with external beam irradiation and surgery, in the conservative management of these tumors. This radiation treatment uses a catheter or a vaginal mould applicator for intraluminal/intracavity brachytherapy, and hypodermic needles or guide gutters for the interstitial portion. The radioactive source usually employed is iridium 192. The total dose administered is usually between 60 and 70 Gy. Disease free survival is 50%, local control 70%, and the complication rate is 20%.

Brachytherapy↗
PubMed1994

[Cervical cancer in the young woman].

Uterine cervix carcinoma is considered by some authors to carry a poor prognosis in young patients (< 35 years of age). From 10 years, many series have been published with divergent conclusions. However, a group of patients with poor prognosis could be individualized; age < 30 years, locally aggressive tumour, poorly differentiated, nodal involvement, amplification of c-Myc proto-oncogene. New imaging technics and coelioscopy could help to the diagnosis. The role of combined treatment remains to be demonstrated and biological factors (kinetics, oxygenation) will help in the future to more adapted treatments.

Adult↗
PubMed1993

Overall treatment time in advanced cervical carcinomas: a critical parameter in treatment outcome.

PURPOSE: To search for possible influence of overall treatment time on the clinical outcome of advanced cervical carcinomas treated with radiation alone. METHODS AND MATERIALS: Three hundred and eighty-six patients with Stage IIB and III cervical carcinomas treated with external radiation and intracavitary curietherapy between 1973 and 1983 were entered in the study. A multivariate analysis was carried out on data concerning these patients to determine whether overall treatment time was a prognostic factor. RESULTS: Overall treatment time and blood transfusions during treatment were the two most highly significant factors in the multivariate analysis. Loss of local control and overall survival, when treatment exceeded 52 days, was approximately 1% per day in both cases. CONCLUSION: These results suggest that overall treatment time might be a highly significant prognostic factor in the treatment outcome of advanced cervical carcinomas. Prospective randomized studies are strongly warranted to confirm this hypothesis.

Adult↗
PubMed1993

Phase III trial comparing two low dose rates in brachytherapy of cervix carcinoma: report at two years.

This Phase III randomized trial examined the effect of two low dose rates (0.73 or 0.38 Gy.h-1) on the local control, survival, relapse-free survival, complications, and secondary effects in the treatment of cervical cancers. A total of 204 Stage Ib or II cervical carcinoma patients were included between January 1985 and September 1988. Treatment consisted of uterovaginal 137Cs irradiation followed by surgery. The two groups were similar for age, tumor stage and medical or surgical history. Their brachytherapy parameters were also similar (60 Gy pear dimensions, dose to critical organs, total kerma, etc....) There were no differences in the short-term effects or therapeutic outcome. However, overall complications and side effects observed after 6 months were significantly more frequent (p < 0.01) in the higher dose rate group.

Adenocarcinoma↗
PubMed1993

Radiotherapy after ovarian transposition: ovarian function and fertility preservation.

The outcome of ovarian function preservation and fertility after ovarian transposition was examined in women treated for cancer. Of 134 patients, 126 were treated with radiotherapy and 72 with chemotherapy. In a multivariate analysis, three factors appeared to be prognostic of ovarian castration: the age over 25, MOPP chemotherapy and a total dose to the ovaries higher than 5 Gy. The incidence of birth was lower in the general population but no abnormality was observed.

Adolescent↗
PubMed1993

HDR versus LDR gynecological brachytherapy revisited.

Despite the obvious breakthrough of high dose-rate (HDR) afterloading systems on the gynecological brachytherapy market, questions still remain regarding the transfer of available expertise gained throughout the last 80 years with low dose-rate (LDR) radium and cesium, especially regarding the conversion of LDR total dose into equivalent HDR dose per fraction and total dose. Calculation of biologically equivalent schedules requires a knowledge of repair capacity and repair kinetics of tumors and normal tissues, both of which influence the biological effect of any radiation dose. The clinical experience with HDR is, however, accumulating and it is acknowledged that the new technique entails an acceptable therapeutic index as compared to the classical LDR. There is thus a state of apparent 'equivalence' between the two treatment modalities. This state is influenced by many factors in which, in contrast to what is frequently claimed, radiobiological factors do not play the most important role. It is probably its high-tech environment which makes HDR an acceptable alternative. Treatment at LDR, indeed, has proven to be quite tolerant to a lack of absolute precision, something that would be disastrous with HDR techniques. Because HDR intracavitary brachytherapy has not been compared in controlled trials with the best existing LDR brachytherapy, but only retrospectively with heterogeneous LDR clinical data, it cannot be claimed to be equivalent, but simply feasible.

Brachytherapy↗
PubMed1993

A glossary for reporting complications of treatment in gynecological cancers.

Reporting and scoring treatment complications in gynecological cancers is difficult because of the variety of normal tissues, anatomical structures and treatment disciplines involved, making it impossible to compare series of patients treated in different institutions even with the same strategy. An international group of experts (gynecologists, radiotherapists and surgeons) developed a multidisciplinary database to identify, score and report early and late normal tissue damage regardless of treatment strategy. The principles involve: (1) The identification of relevant organs and tissues; (2) An accurate definition of the type and score of each complication; (3) Reporting combinations of complications of various degrees; (4) A computerized format for data acquisition, update and retrieval. In the present version, the "Glossary" describes five degrees of increasing severity (0 to 4) in 14 organs and/or normal tissues. The rationale of the glossary leaves it open for as yet undescribed types of complications. This paper contains the definition and scoring for each type of complication, general guidelines for their use.

Databases, Factual↗
PubMed1992

Interstitial iridium-192 for bladder cancer (a multicentric survey: 205 patients).

Interstitial irradiation is a technique currently used in the treatment of bladder cancer. We report the data on 205 patients (177 men and 28 women) treated in eight French centers. The patients had received the following treatment: a short course of pre-operative pelvic irradiation, followed by surgery consisting of partial cystectomy or tumor resection, and implantation of plastic tubes filled with inactive lead wires, which were replaced by iridium 192 wires. The tumor characteristics were: transitional cell carcinoma, 88.8%; mean size of the tumor, 29 mm; pathological stages: pTis, 1; pT1, 98; pT2, 66; pT3a, 26; pT3b, 9; pT4, 1; unknown, 4 respectively; surgical lymph node status: N+, 3; N-, 118; no node dissection, 84. The mean follow-up was 51 months. Intravesical failures were seen in 35 patients (17.0%), 25 (71.4%) of them without metastases or regional recurrences. Twenty-one patients (10.2%) presented distant metastases, 2/3 of them suffered no bladder relapse. The 5-year survival, calculated according to the Kaplan-Meier method (all causes of death taken together) was 77.4% for the T1, 62.9% for the T2, and 46.8% for the T3. Fifty-three patients had immediate side-effects and three died from surgical complications. Twenty-nine patients had delayed bladder side-effects (haematuria, fistula, chronic cystitis). Six patients presented an ureteral stenosis. Of the disease-free survivors, 96.1% retained the bladder function. Three factors were significantly predictive of delayed side-effects: partial cystectomy, pre-operative radiotherapy total dose, and linear activity of the wires (p < 0.01). Comparing our results to different authors' series interstitial irradiation is likely to provide a high local and general control of the disease and good quality of life in patients with selected tumors.

Adenocarcinoma↗
PubMed1992

Feasibility of measuring oxygen tension in uterine cervix carcinoma.

Cellular hypoxia is a cause of radioresistance. The oxygen tension (pO2) in normal tissues and in tumours can be measured by polarography. In this feasibility study we have measured the tissue pO2 of 10 patients suffering from uterine cervix carcinoma, using the Eppendorf histograph. The measurements were performed at the time of the brachytherapy after external radiotherapy. The machine was found to be reliable and no adverse effect was noted. The mean pO2 values in tumours were lower than those of normal tissues.

Adult↗