Pretherapeutic laparoscopic staging of locally advanced cervical carcinomas: technique and results.
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Adult↗
Biomedical subjects
B Castelain
Publications and source records attributed to B Castelain.
Prospective evaluation of surgical staging of advanced cervical cancer via a laparoscopic extraperitoneal approach.
OBJECTIVES: To report on a large series of cervical cancer patients at risk for lymph node metastasis who underwent surgical staging by a novel technique. METHODS: Between 1/97 and 3/02, we identified 111 patients who underwent an infrarenal aortic and common iliac lymph node dissection via a laparoscopic extraperitoneal approach for either bulky or locally advanced cervical cancer. We reviewed the medical records and extracted pertinent information. RESULTS: There were no intraoperative complications. Mean patient age was 46 (+/- 9) years. Mean node count was 19 (+/- 12). Thirty (27%) patients had lymph node metastasis. The mean operative time was 157 (+/- 46) min, and mean postoperative stay was 2 days. The majority of complications in the early part of the series were symptomatic lymphoceles. Since 4/01, preventive peritoneal marsupialization has been performed without lymphocele occurrence (37 patients). Two patients (2%) required reoperation. In the node-positive group, extended-field radiation and chemotherapy were well tolerated, but prognosis was dismal (median survival, 27 months). In the node-negative group, the median survival after pelvic radiation limited to the lower level of the surgical dissection was not reached after an average follow-up of 16.6 months. CONCLUSIONS: This novel technique is feasible and combines the benefits of laparoscopy with those of a retroperitoneal approach. It can be used to tailor external radiation therapy. The benefits of extended-field radiation therapy remain unclear; however, this approach does not preclude later use of radiation therapy, whereas possibly minimizing associated toxicities secondary to adhesions.
Female↗
[Pulse Dose Rate brachytherapy: optimization and place of imaging].
Pulse Dose Rate (PDR) brachytherapy presents the potential radiobiological advantages of low dose rate and the technical and radiation protection advantages of high dose rate remote afterloading technology. The different algorithms provided by the treatment planning systems allow dose rate and isodose shape optimization regarding the volumes defined by the radiologist and the radiation oncologist. The contribution of imaging together with these new optimization tools should improve brachytherapy practice and the therapeutic ratio. These new evolutions of brachytherapy will be presented here.
Algorithms↗
[Radiation protectants of the crystalline lens].
During more than a half of century, numerous compounds have been tested in different models against radiation-induced cataract. In this report, we will review the radioprotectors that have been already tested for non-human crystalline lens protection. We will focus on the most important published studies in this topic and the mechanisms of cytoprotection reported in vitro and in vivo from animals. The most frequent mechanisms incriminated in the cytoprotective effect are: free radical scavenging, limitation of lipid peroxidation, modulation of cycle progression increase of intracellular reduced glutathion pool, reduction of DNA strand breaks and limitation of apoptotic cell death. Amifostine (or Ethyol) and anethole dithiolethione (or Sulfarlem), already used clinically as chemo- and radioprotectants, could be further tested for ocular radioprotection particularly for radiation-induced cataract.
Amifostine↗
[In vivo dosimetry and radiation therapy of breast cancer].
INTRODUCTION: Verification of absorbed dose in target volume is a key factor for quality assurance in radiotherapy. In vivo measurements allow evaluation of the variations in dose with time and variations between measured doses and calculated doses by TPS. The aim of this work were to evaluate reproducibility of patient positioning and to compare calculated doses by 2 different TPS. PATIENTS AND METHODS: Twenty patients were divided in 2 groups according to the thickness of their breast (mean SSD = 92.9 cm). In vivo measurement was performed within the first two sessions. RESULTS: Reproducibility of SSD evaluation was made on 12 beams between 2 fractions. With a tolerance margin of 0.5 cm, positioning errors were present in 33% (4/12). The 2 TPS were in agreement in 75% (30/40). CONCLUSION: In vivo dosimetry can be a very interesting tool to assess patients positioning variations and TPS dose calculation.
Breast↗
[Quality control of intensity modulated treatments in radiotherapy].
Since January 2001, radiotherapy treatments with modulated intensity beams (IMRT) have started at the Centre Oscar-Lambret. This paper presents the tests and measurements made before the clinical implementation as well the quality control performed before each routine treatment. We use the treatment planning system Helax-TMS (MDS-Nordion) and the Primus accelerator (Siemens) linked to the Lantis network with Primeview and Simtec modules (Siemens) allowing to deliver intensity modulated beams with Step-and-Shoot technique. A prostate case and a head and neck case have been studied and have permitted to evaluate the benefit of IMRT compared to a "classical" conformal radiotherapy. In a second time, we have tested the accelerator's capabilities to deliver these intensity modulated beams, id-est, the accuracy of the leaf positions and the linearity of the monitor chamber. The third step has been the verification of the dose distributions calculated by Helax-TMS, id-est, the dose for different segment sizes, the dose profiles for an intensity modulated beam and the dose distribution for all the traitment beams. The used phantom has been especially developed at the Centre Oscar-Lambret for IMRT. The results have allowed to start clinical treatments and to establish a quality control set for this technique. The next step is the real time dosimetry with a portal imager.
Humans↗
Pulsed dose rate brachytherapy in head and neck cancers. Feasibility study of a French cooperative group.
PURPOSE: To prospectively evaluate the feasibility of pulsed dose rate (PDR) brachytherapy to mimic the continuous low dose rate (cLDR) iridium wire technique in head and neck carcinomas. MATERIALS AND METHODS: A series of 30 patients were included from June 1995 to May 1998. The primaries were located in the oral cavity (four T1, seven T2 and two T3), the velotonsillar arch (eight T1 and eight T2) and the posterior wall (one T3). Thirteen were irradiated by exclusive brachytherapy (dose, > or =45 Gy). The PDR delivered 0.5 Gy/pulse, one pulse/h, day and night, to mimic cLDR irradiation. RESULTS: The implantation was feasible for all the patients, usually easy and of good quality. The mean duration/pulse was 13 min, with a mean source activity of 171 mCi. Patient tolerance was poor in nine cases. Sixteen patients could receive the whole PDR treatment with a total ranging from 30 to 120 pulses without any problem. Seven had short breakdowns (< or =6 h). Seven had definitive breakdowns, but could end the irradiation by manual afterloading of iridium 192 wires. The radioprotection was better (or complete), except for one patient. Most of the breakdowns were related to kinking or flattering of the tube. CONCLUSIONS: PDR is feasible in head and neck carcinomas, but necessitates improvement of the quality and control of the plastic tubes.
Brachytherapy↗
[Comparison of conventional and conformational dosimetry in radiotherapy of cerebral neoplasms].
PURPOSE: We prospectively compared a conventional treatment planning (PT2D) and 3-dimensional conformal treatment planning (PT3D) for radiotherapy of cerebral tumours. PATIENTS AND METHODS: Patients treated between 1/10/98 and 1/4/99 by irradiation for cerebral tumours were analysed. For each case, we planned PT2D using conventional orthogonal x-ray films, and afterward, PT3D using CT scan. Gross tumor volume, planning target volume and normal tissue volumes were defined. Dose was prescribed according to report 50 of the International Commission on Radiation Units and Measurements (ICRU). We compared surfaces of sagittal view targets defined on PT2D and PT3D and called them S2D and S3D, respectively. Irradiated volumes by 90% isodoses (VE-90%) and normal tissue volumes irradiated by 20, 50, 90% isodoses were calculated and compared using Student's paired t-test. RESULTS: There was a concordance of 84% of target surfaces defined on PT2D and PT3D. Percentages of target surface under- or-over defined by PT2D were 16 and 13% respectively. VE-90% was decreased by 15% (p = 0.07) with PT3D. Normal brain volume irradiated by 90% isodose was decreased by 27% with PT3D (p = 0.04). CONCLUSION: For radiotherapy of cerebral tumors using only coplanar beams, PT3D leads to a reduction of normal brain tissue irradiated. We recommend PT3D for radiotherapy of cerebral tumors, particularly for low-grade or benign tumors (meningiomas, neuromas, etc.).
Brain Neoplasms↗
[Dosimetry with radiosensitive gels in radiotherapy. Methods].
The goal of conformal radiotherapy is to concentrate the dose in a well-defined volume by avoiding the neighbouring healthy structures. This technique requires powerful treatment planning software and a rigorous control of estimated dosimetry. The usual dosimetric tools are not adapted to visualize and validate complex 3D treatment. Dosimetry by radiosensitive gel permits visualization and measurement of the three-dimensional dose distribution. The objective of this work is to report on current work in this field and, based on our results and our experience, to draw prospects for an optimal use of this technique. Further developments will relate to the realization of new radiosensitive gels satisfying, as well as possible, cost requirements, easy realization and use, magnetic resonance imagery (MRI) sensitivity, tissue equivalence, and stability. Other developments focus on scanning methods, especially in MRI to measure T1 and T2.
Calibration↗
De novo adhesions with extraperitoneal endosurgical para-aortic lymphadenectomy versus transperitoneal laparoscopic para-aortic lymphadenectomy: a randomized experimental study.
OBJECTIVE: The objective of this study was to compare the risk of adhesion formation and the site of postoperative adhesions after transperitoneal versus extraperitoneal laparoscopic para-aortic lymphadenectomy. STUDY DESIGN: A prospective study was conducted on 66 pigs, randomly allocated to 2 groups of 33 animals that underwent transperitoneal versus extraperitoneal laparoscopic para-aortic lymphadenectomy. RESULTS: No statistically significant difference was observed between the 2 techniques in terms of operating time, number of lymph nodes removed, and intraoperative and postoperative morbidity. More lymphoceles were observed in the extraperitoneal laparoscopy group (P =.0002). The overall adhesion rates were 76% in the transperitoneal group and 43.33% in the extraperitoneal group (P =.04). The adhesion score specific to the operative site was lower in the extraperitoneal group (P =.0005). A stereolocalization study showed that almost all adhesions after transperitoneal laparoscopy were situated in the para-aortic external irradiation field, whereas adhesions after extraperitoneal laparoscopy were predominantly situated outside this field. CONCLUSION: Extraperitoneal laparoscopy generates significantly fewer adhesions in the para-aortic irradiation field.
Animals↗
[Laparoscopic surgery in gynecologic oncology in 2000].
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Endometrial Neoplasms↗
[New therapeutic plans for cancer of the cervix].
New methods of staging (MRI, laparoscopic surgery) and therapy (concomitant radio-chemotherapy, debulking of diseased nodes), with a trend towards the reduction of the aggressivity of surgical procedures (minimal access surgery, ovarian preservation, reduction of the extent of radical hysterectomy, uterine conservation) may and should by integrated in new therapeutic protocols. As a consequence, the management of invasive cervical cancer becomes even more multidisciplinary and specialized.
Antineoplastic Agents↗
[Comparison of transperitoneal versus extraperitoneal laparoscopic para-aortic lymphadenectomy: randomized experimental study].
OBJECTIVES: The objective of this study was to compare the risk of adhesion formation and the site of postoperative adhesions after transperitoneal versus extraperitoneal laparoscopic paraaortic lymphadenectomy. MATERIAL AND METHOD: A prospective randomized trial was conducted on 66 pigs, submitted to transperitoneal (n = 33) or extraperitoneal (n = 33) laparoscopic paraaortic lymphadenectomy. The efficacy and the intra and postoperative morbidity (adhesion score taking into account the number of adhesions and the surface area involved) of each approach were compared. The site of postoperative adhesions in relation to a simulated external irradiation field was determined by a stereo-localization system (Syslav) on 20 pigs. RESULTS: No statistically significant difference was observed between the two techniques in terms of operating time, number of lymph nodes removed, and intra and postoperative morbidity except for lymphoceles and adhesions. No case of lymphocele was observed in the transperitoneal group versus 13 cases (43.33%) in the extraperitoneal group (P = 0.0002). Final total adhesion score was 76% (n = 22) in the transperitoneal group versus 63.33% (n = 19) in the extraperitoneal group. Adhesion score specific to the operative site was 76% (n = 21) in the transperitoneal group versus 43.33% (n = 13) in the extraperitoneal group (P = 0.04). A statistically significant difference was observed between the two approaches in terms of final total adhesion score (P = 0.008) or adhesion score specific to the operative site (P = 0.0005). The stereolocalization study showed that almost all adhesions were situated in the paraaortic external irradiation field after transperitoneal laparoscopy, while adhesions were predominantly situated outside this field after extraperitoneal laparoscopy. CONCLUSIONS: Extraperitoneal laparoscopy generates significantly fewer adhesions in the paraaortic irradiation field and should have a risk of radiation enteritis less important than transperitoneal laparoscopy.
Animals↗
Treatment of squamous cell anal canal carcinoma with pulsed dose rate brachytherapy. Feasibility study of a French cooperative group.
BACKGROUND AND PURPOSE: To evaluate the feasibility of pulsed dose rate (PDR) brochytherapy in squamous cell anal canal carcinoma (SCACC). MATERIALS AND METHODS: In this study a series of 19 patients with SCACC were included between 1995 and 1997. All patients were treated with curative intent with external beam radiotherapy (EBRT) (44-50 Gy) and one or two cycles of concomitant fluorouracilcisplatinum. After a gap of 2-3 weeks PDR interstitial brachytherapy was performed with a rigid needles technique. The dose was between 10-25 Gy (PARIS system). RESULTS: All patients are alive. No severe grade 3-4 toxicity was encountered. One local relapse one metastatis were seen in two distinct patients. There was no dysfunction of the after loading machine. CONCLUSION: The feasibility of PDR brachytherapy appears good in SCACC. It is an attractive alternative to low dose rate brachytherapy.
Adult↗
[Spermatocytic seminoma. Apropos of 4 cases].
The records of 4 patients treated for a spermatocytic seminoma between 1974 and 1993 were reviewed. We described pathological and clinical features of this entity of seminoma which differs from those of classic seminoma. Spermatocytic seminoma is an essentially non metastasizing neoplasm unless complicated by the rare development of a sarcomatous component or metastatic spread.
Adult↗
[Pituitary radiotherapy. Current data and future prospects].
Some technical improvements have allowed to minimize the frequency of severe complications following fractionated pituitary conventional radiotherapy, without altering its efficiency. "Conformational" radiotherapy is currently under development, aiming at the best fitting of the tumor borders to the irradiation zone, by the means of stereotactic imaging. More recently, radiosurgery has been proposed for pituitary adenomas. It consists in a single high radiation dose to the tumor, by the means of either cobalt minibeams (Gamma Unit) or photon beams from a linear particle accelerator. These techniques require the use of a stereotactic frame and precise 3D imaging in order to tightly superimpose the target volume to the reference isodose. They must not be viewed as an alternative to conventional radiotherapy. They can be applied only to small lesions (less than 20 mm in their maximal axis) which are distant (> 5 mm) from the optic chiasma and nerves. Their efficiency is similar to the one of fractionated conventional radiotherapy, with a shorter response time. In conclusion, radiotherapy can be used safely for pituitary adenomas. It remains however a second line treatment, when surgery has been incomplete and when a simple, effective and inexpensive medical treatment is not possible.
Adenoma↗
[Endometrial cancer: total simple hysterectomy or radical hysterectomy? Abdominal or vaginal route?].
Total abdominal hysterectomy and bilateral salpingo-oophorectomy has long been the standard surgical treatment for endometrial cancer. Radical hysterectomy is not useful in stage I. in women with extreme obesity and medical risk factors, vaginal hysterectomy is recommended. Laparoscopy-assisted vaginal hysterectomy complete the oncologic treatment if lymphadenectomy is necessary.
Endometrial Neoplasms↗
Treatment planning optimization by conjugate gradients and simulated annealing methods in stereotactic radiosurgery.
PURPOSE: This paper presents a new optimization method of treatment planning in linac stereotactic radiosurgery. METHODS AND MATERIALS: On a workstation integrating x-rays, computed tomography (CT), magnetic resonance imaging (MRI), and digital subtracted angiography (DSA) images, we first determine the outlines of the target volume and surrounding healthy tissues to spare. To achieve complete optimization of the treatment plans, this method decomposes the optimization process in two steps. The position of the isocenters and the diameter of the collimators are first deduced by a conjugate gradients method, from the position and size of ellipsoids or spheres modeling the target volume. The other irradiation parameters, such as the isocenter dose, the aperture, and the weight of each irradiation plane and of their irradiation sectors are finally deduced by a simulated annealing optimization algorithm. RESULTS: The system can perform multitarget/multisector treatment plans that are automatically obtained in a satisfactory time (as a rule, 20 min for a two-target irradiation), much faster than the time needed for a manual treatment planning. We present the results in two cases: the simulation of a single-target treatment and a two-target real treatment with constraints. In these two cases, we can control the dose received by target and sensitive volumes. CONCLUSION: This method achieves an excellent conformation of the estimated isodose curves with the outlines of the target volume, which allows us to avoid the surrounding healthy tissues, thanks to the different weighting factors given on each volume concerned according to the importance we grant to each of them.
Angiography, Digital Subtraction↗