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Biomedical subjects

B Asselain

Publications and source records attributed to B Asselain.

At least 145 records · Page 8Linked to original sources
PubMed1988

[Metastatic cancer of the breast treated by polychemotherapy: a new prognostic approach].

The series consisted of 759 patients with metastatic breast cancer entered into randomized clinical trials at the Curie Institute. Twenty factors were found to be significant by univariate analysis. The current report gives a detailed analysis of prognostic factors using a new method of multivariate analysis for survival data, the recursive partition. This method was based on the construction of a regression scheme consisting of eight variables and four prognostic groups. A test sample procedure was used to validate our results and a regression scheme with three variables was constructed (LDH, adjuvant chemotherapy and the Karnofsky scale). The results were compared to the stepwise Cox regression.

Actuarial Analysis↗
PubMed1988

[Lymphoceles and peritonization following lymphadenectomy for cancer of the uterus].

Pelvic lymphocysts following lymphadenectomy in the management of cervical and corporeal uterine carcinoma are recorded in one third of the cases and require surgery in 2-3% of cases. In order to prevent these lymphocysts, peritoneal suturing in front of the lymph node dissection area was progressively abandoned in order to allow peritoneal resorption of the lymph. A retrospective study analysed 226 iliac lymphadenectomies between 1982-1986 for uterine cancer treated at the Institut Curie. 220 patients received peritoneal suturing, while 46 patients were not sutured. The incidence of lymphocysts was respectively 35.9% and 17.4%. The difference is statistically significant (p = 0.01). The "no suture" technique lowered the incidence and the severity of lymphocysts. No side effect of the "no suture" technique was recorded. Multivariate analysis demonstrated that lymphocysts were significantly related to the side of the cancer in the cervix (p = 0.0001), to the preventive use of heparin (p = 0.0025) and to suturing the peritoneum with suction drainage (p = 0.004). We conclude that after pelvic lymphadenectomy the "no suture" technique for the peritoneum reduces the incidence of lymphocysts in the majority of patients.

Drainage↗
PubMed1988

[Prognostic value of estrogen and progesterone receptors in the operable breast cancer: results of a uni- and multifactorial analysis].

This study concerns 645 patients first treated with surgery for unilateral, non metastatic, invading breast cancer. Intratumoral estrogen receptor and progesterone level were determined in every case. Level greater than 5 fmoles/mg cytosolic protein was considered as positive for both receptors. Univariate analysis has pointed out a significant linkage between overall survival and the following factors: age, clinical size of the tumor, histopathological grading SBR, clinical and histological lymph node involvement, capsular tear, RO and RP status. Statistical significance of menopausal status is borderline. Number of tumor foci is not significant. Likewise, disease free survival was correlated to the same factors. Multivariate analysis (Cox), secondarily pointed out that overall survival was strongly related to age, size of the tumor, lymph node involvement, capsular tear, histopathological grading SBR, menopausal status and RP. Multivariate analysis of the disease free survival revealed that it was strongly related to age, tumor size, lymph node involvement, capsular tear, grading SBR and RP. An interaction has been pointed out between Ro and menopausal status: Ro greater than 5 fmoles/mg cytosolic protein carry its own prognostic weight (Cox) and lengthen overall survival only for post menopausal women. A prognostic score, taking into account all of these factors has been calculated for both overall survival and disease free survival, and enabled us to isolate 4 groups of patients with good, intermediate and bad prognosis. These 2 models have been validated on an independent group of patients according to the sample test procedure. This results indicate that hormonal receptors carry their own prognostic weight in operable breast cancer (only for postmenopausal women for RO), and should be taken into account when adjuvant therapies are indicated after surgical treatment for breast cancer, in association with other more usual prognostic factors.

Adult↗
PubMed1987

Inflammatory breast cancer. Determination of prognostic factors by univariate and multivariate analysis.

Between January 1977 and June 1983, 64 consecutive patients were treated for unilateral inflammatory nonmetastatic breast cancer. Our protocol included three or four courses of induction chemotherapy, then locoregional irradiation therapy with Co-60, followed by maintenance chemotherapy only if induction chemotherapy had proven effective. Eight patients with a residual tumor after radiotherapy underwent a modified radical mastectomy. Actuarial 3-year overall survival for the whole group was 38%, and the median disease-free survival time was 19 months. The effect of 17 factors on overall survival or disease-free survival was analyzed. With univariate analysis, eight factors were found to affect overall survival or disease-free survival: extent of initial erythema, size of initial edema, lymph node involvement, erythema present at the end of initial chemotherapy, erythema present at the end of radiotherapy, tumor size at the end of induction chemotherapy, residual breast tumor at the end of maintenance chemotherapy, and performance of a radical mastectomy. Age at diagnosis, menopausal status, type of chemotherapy, and date of appearance of inflammatory signs did not influence prognosis. Multivariate analysis using the Cox proportional hazard model isolated three bad prognosis factors: erythema involving the whole breast at initial diagnosis, erythema present at the end of initial chemotherapy, and lymph node involvement.

Actuarial Analysis↗
PubMed1987

Is it necessary to irradiate the breast after conservative surgery for localized cancer?

Two hundred one patients with operable breast cancer received postoperative irradiation after limited surgery and were followed up for five years. Fifty-three patients (26%) had positive margins. The breast cancer recurrence rate at five years was 14%, less than half the incidence reported for patients treated by limited surgery only. Those with positive margins who received irradiation had a recurrence rate of only 13%. Another 324 patients with tumors (less than or equal to 3 cm) N0 who were treated similarly were evaluated for distant dissemination in relation to local control. Patients who remained free of local disease or developed recurrences more than five years after treatment had significantly better distant disease-free and overall survival than patients who failed locally within five years. Breast irradiation after conservative surgery resulted in decrease in local recurrence and reduced the need for salvage mastectomy. Long-term follow-up of a large number of patients is necessary to determine the relation between local control and the decreased risk of distant dissemination.

Breast Neoplasms↗
PubMed1987

[Metastatic breast cancer. Modality of association of chemotherapy and hormonotherapy. Results of a controlled trial].

Two hundred forty-seven patients with metastatic breast cancer entered into the controlled trial. Its aim was to define the optimal modality of association between hormonotherapy and chemotherapy. Chemotherapy was given a monthly course of an association including: adriamycin: 45 mg/m2 on day 1; cyclophosphamide: 400 mg/m2 on days 1, 2, 3; 5 fluoro-uracil: 500 mg/m2 on days 1, 2, 3; methyl-prednisolone: 80 mg/m2 on days 1, 2, 3. Hormonotherapy was tamoxifen (TAM) at the daily dose of 30 mg. 82 patients in group I were given TAM alone for 4 months and then chemotherapy + TAM; 83 patients in group II were given simultaneously TAM + chemotherapy; 82 patients in group III were given chemotherapy alone for 8 months and then TAM + chemotherapy. The response rates in groups I, II and III were respectively of 59, 74 and 62%. The difference in favour of group II was marginally significant. The survival curves were significantly higher in group II and III than in group I (P = 0.04). This result appears as the consequence of the poor prognostic of the sub-group of 45% patients who did not respond to TAM. These results seem to emphasize that target cells of hormonotherapy are not target cells of chemotherapy and that this difference is persisting for long time under treatment, that others modalities of association between chemotherapy and hormonotherapy must be studied with the aim of reducing the kinetic's implication of chronic administration of TAM.

Adult↗
PubMed1987

[Adriamycin and chemotherapy of breast cancer. Personal experience].

The clinical results achieved for more than 10 years in patients with metastatic breast cancer have clearly demonstrated the efficacy of chemotherapy programs including Adriamycin. This therapeutic effect was confirmed when it is given in protocols of adjuvant chemotherapy. Some complementary studies have demonstrated 4 points in order to define the better modality of application of Adriamycin: the results of induction chemotherapy's protocols are not better if the treatment is given beyond 6 months, the alternative administration of 2 noncross resistant programs of chemotherapy is no more efficient than the continuous administration of a program of chemotherapy including Adriamycin, the increase of the doses of cytotoxic chemotherapy does not change the median of survival of the patients, the fractionated administration of Adriamycin is as effective as the conventional administration of the same total dose.

Adult↗
PubMed1987

[Aid to the clinical and biological diagnosis of malignancy in a nodular hepatic image discovered by echography].

When ultrasound examination of the upper abdomen detects a liver nodule, the malignancy of this lesion must be discussed. If past history of cancer is known, a benign lesion cannot be excluded. Conversely, if the examination is performed without a history of cancer, we must raise the possibility of a malignant lesion. We attempted to demonstrate that the simple clinical and biological findings allow, if well used, a diagnosis of malignancy or benign nature, rather than performing further investigations, sometimes costly or invasive. We therefore compared three different methods: the well known bayesian diagnostic process; the multivariate analysis using logistic regression model; the Decision Theory, constructing a binary discrimination tree. The three methods lead to approximately the same rate of well classified patients (93 to 95%). Advantages and disadvantages are discussed.

Analysis of Variance↗
PubMed1987

[Value of drill-biopsy in breast cancer].

This study reports the results of 649 drill biopsies performed on breast tumors before any treatment. Diagnostic of malignancy was achieved with a drill biopsy in 89% cases (579/649 procedures). Pathological subtypes, i.e. common infiltrating types, special pathological types, were determined in 98% cases (566/579), while histo-prognostic grading, according to Scarff, Bloom and Richardson, was performed in 98% of the common infiltrating type carcinomas (498/507). Reliability of the technique was related to the tumor size 57%, 87.5%, 93.5% and 98.5% in T1, T2, T3 and T4 tumors (TNM classification), respectively. Comparative reliability of the three different operators was 86.5%, 88.5% and 92%, and was related to their technical experience. This study has demonstrated the diagnostic value of a "malignant" drill biopsy, which is independent of the results of the initial radiological and clinical work-up: suspicious or malignant (group A: 635 cases, or non-suspicious group B: 14 cases). However, "non malignant" drill biopsy has no value and should not be conclusive.

Biopsy, Needle↗
PubMed1986

Multifactorial study of prognostic factors in differentiated thyroid carcinoma and a re-evaluation of the importance of age.

A multivariate analysis of prognostic factors has been carried out with 375 cases of differentiated thyroid cancer (DTC) treated in the same centre by total thyroidectomy and 131I therapy. The patients have been followed for 5 to 23 years. The isolated prognostic roles of age, sex, clinical stage and histology were confirmed, but these factors were found to be strongly interrelated. Multifactorial analysis was conducted following Cox's model. It demonstrated that the prevalent role of clinical staging (nodular versus lobar or massive form) is as important as the initial presence of metastases (P = 0.0001). Histological assessment of differentiation, age and sex were of lesser importance. Thus, the most significant prognostic variable is clinical stage. These data must be taken into account when formulating management protocols for DTC.

Adolescent↗
PubMed1986

Prognosis of cloacogenic and squamous cancers of the anal canal.

From 1968 to 1982, 195 patients with invasive cancer of the anal canal were treated (average age, 67 +/- 11 years; range, 38 to 85 years; sex ratio [women/men]: 5/1). Histology revealed: cloacogenic cancer, 20 cases; squamous cancer, poorly differentiated, 30; moderately differentiated, 68; well differentiated, 77. The initial size of the cloacogenic cancers was smaller than the squamous cancers. Invasion less than half the circumference of the canal was 90 and 74 percent, respectively. No patients with cloacogenic cancer presented with positive inguinal nodes; however, there were 22 unilateral and five bilateral positive nodes in the squamous cancers. All 195 patients received radiotherapy as the first treatment. There were no differences among the patients operated on with respect to sterilized operative specimens, postradiotherapy sequelae, perineal recurrences, and/or visceral metastases in the cloacogenic and squamous cancers. Five-year survival was better in cloacogenic (62 percent) than in squamous cancers (56 percent); this difference was not significant, and was related to the initial size of the tumor. The number of patients with no evidence of disease and good anal function was significantly related to the initial size of the tumor, and was independent of the histologic findings.

Actuarial Analysis↗
PubMed1986

[Can the quality and duration of life be integrated? Proposal for a new criterion for decision].

Survival is an objective criteria, reliable, easy to measure and easy to analyse. But this criteria, the most important in almost all therapeutic trials, is a very rough one and not all fitted to many questions raised in cancer treatment decision making. We suggest a new criteria, combining quality and quantity of survival, which is equivalent in years of survival at a maximal quality level to the time of survival at a varying level of a cancer patient. This criteria could be usefull in the majority of "palliative" clinical trials (advanced cancers, recurrences, metastatic evolution...).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

[Rapidly growing breast cancer: results of a retrospective analysis with a study of prognostic factors].

Between January 1977 and December 1982, 66 consecutive patients have been treated for unilateral, rapidly progressing, non metastatic breast cancer. They were divided into three groups: Group A (n = 10): tumor whom volume had increased during the 2 months before diagnosis; Group B (n = 30): inflammatory signs (erythema, skin oedema, elevated local temperature) involving less than one half of the breast; Group C (n = 26): inflammatory signs involving more than one half of the breast. All patients where managed similarly: 3 to 4 courses of chemotherapy (CMF: n = 24; AVCF: n = 42), then loco regional irradiation therapy with cobalt 60, followed by maintenance chemotherapy, only if the first chemotherapy had proved effective (CMF: n = 13; AVCF: n = 27). Nine patients with residual tumor after radiotherapy underwent mastectomy with axillary dissection. The actuarial 5 years survival for the whole group is 29%, and respectively 49%, 38% and 9% for the groups A, B and C. The median disease free intervals are 43, 29 and 12 months respectively. Fifteen prognostic factors likely to influence overall survival or disease free survival were evaluated. With univariate analysis, 8 factors were found to be of individual prognostic value: extent of initial erythema, erythema present after initial chemotherapy, erythema present after radiotherapy, non menopaused status, tumor diameter greater than 10 cms, residual breast tumor (clinical or radiographic) after maintenance chemotherapy, supra clavicular adenopathy (N3). Age at the diagnosis, type of chemotherapy, or performance of a radical mastectomy did not influence the prognosis. Multivariate analysis using the Cox-model isolated 3 factors of bad prognosis: erythema involving the whole breast at initial diagnosis, erythema present at the end of initial chemotherapy, N3.

Adult↗
PubMed1985

[Colonoscopy detection of polyps in patients operated on for colorectal cancer. Prospective study].

Subjects operated upon for colorectal carcinoma seem to constitute a population at high risk of a second colorectal malignancy and/or colonic adenoma (polyp). Ninety-four such patients were examined by colonoscopy. Their distribution by age and sex and the location of cancers in the colon were comparable to those reported in the literature. Colonoscopy was performed 12 +/- 6 months after surgery in 52 patients and was complete in 90% of them. Twenty-seven patients (52%) were found to have one or several polyps distributed throughout the colonic frame and varying in size from 2 to 75 mm (75% were less than 10 mm long). The larger the polyp, the more severe the dysplasia. Three malignant polyps were discovered; they were more than 10 mm in diameter. The colonoscopic examination was repeated annually over more than 3 years in 30 patients: at first repeat examination 54% had polyps which were still present in more than 30% at subsequent examinations. It is concluded that patients operated upon for colorectal carcinoma are at high risk of polyps and/or a second colorectal carcinoma and must therefore be followed-up by repeated colonoscopy.

Colonic Neoplasms↗
PubMed1985

Comparison between the nuclear diameters of primary and metastatic breast cancer cells obtained by cytologic aspiration.

In order to determine if there are morphologically identifiable characteristics between malignant cells obtained from a primary cancer and its metastasis the nuclear diameter was used as an indicator of the degree of malignancy, since there is good correlation between nuclear size, DNA content, and chromosome numbers. The nuclear diameter of primary and metastatic mammary carcinoma cells, obtained by cytologic aspirates, was measured by ocular micrometry. The purpose was to investigate whether a cell population at the primary site developed, at the metastatic sites, a population with the same nuclear size or one having larger and more anaplastic nuclei. One hundred eighty-five patients with infiltrating ductal carcinoma of the common variety were examined. The primary cancer and axillary nodal metastasis were examined in 97 patients before treatment. Thirty had cytologic examination of the breast cancer, as well as of the metastasis, which developed 1 to 14 years after treatment. Eleven were examined before radical breast irradiation and again at the time of relapse in the breast. Forty-seven had bilateral synchronous mammary carcinoma and both primary cancers were studied. The data presented indicate that there is extreme similarity between the nuclear diameters of the primary tumor and its metastasis. This similarity persists for several years regardless of both the location of the recurrence or radical irradiation. These results support the view that the majority of tumors are monoclonal in origin. The clone that invades the metastatic site appears to be the same as the one that initiated the primary cancer. In contrast, the nuclear diameters of cell populations obtained from synchronous bilateral breast cancer were dissimilar, indicating that they arose from separate clones of malignant cells.

Adult↗
PubMed1985

[Prevention of postoperative lymphocele after breast amputation].

Closed suction drainage is widely used after modified radical mastectomy to prevent accumulation of serum or lymph and to promote adherence of the skin flaps to the chest wall. However, between 5 and 35% of the patients develop seroma, which may prolong their stay in hospital and require more frequent post-operative outpatient visits. The prospective study reported demonstrate a significant correlation between the incidence of post-operative seromas, the duration of suction drainage and the amounts of fluid drained. The incidence of seroma also correlated significantly with the patient's age, the size of the breast removed, the presence of arterial hypertension and the post-operative use of heparin. Pre-operative radiotherapy and the TNM type of the tumour had no effect on the duration and volume of drainage nor on the occurrence of seromas. A drainage of short duration and a short stay in hospital are advocated for most mastectomy patients. Delayed mobilization of the shoulder should decrease the volume of accumulated fluid and the incidence of seromas.

Adult↗