Search PubMed⌕ Search

Biomedical subjects

B Castelain

Publications and source records attributed to B Castelain.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Place of celiosurgery in the extensive diagnosis of gynecologic cancers].

Laparoscopic surgery occupies an increasingly important place in the diagnosis and staging of gynaecological cancers. It allows repeated complete investigation of the abdomen and retroperitoneum: macroscopic examination of the peritoneum, cytology, biopsies, infracolonic omentectomy, appendicectomy, pelvic and para-aortic lymphadenectomy, without interfering with therapeutic procedures (simple or radical hysterectomy) which can be associated. In cancers of the endometrium, it is part of a surgical strategy associating vaginal hysterectomy. In ovarian cancers, it is essentially applied to restaging of insufficiently explored apparent stage I tumours. In operable cervical cancer, it guides the therapeutic protocol and surgical indication by allowing interiliac lymphadenectomy. In advanced cervical cancers, it is used to detect para-aortic lymph nodes.

Endometrial Neoplasms↗
PubMed1993

Stereotactically guided radiosurgery using the linear accelerator.

Leksell initiated the concept of stereotactic radiosurgery in 1951. This last decade has seen a rapid proliferation in the development of the methodology which is certainly related in part to the simultaneous growth of high-resolution neuro-imaging techniques. By focusing the beams of 201 hemispherically arrayed cobalt 60 sources, the gamma-knife delivers a high dose of radiation to a small target. Another possibility proposed by several authors is the bragg peak cyclotron-generated irradiation with accelerated protons or helium ions. In Lille, since 1988, we have chosen to develop stereotactic radiosurgery, according to the system of Betti, by the association of Talairach's stereotactic methodology and external single-dose encephalic irradiation with high energy X-rays, delivered by means of a linear accelerator. The major indication for the use of this method is an arteriovenous malformation. Stereotactic radiosurgery may be proposed alone or in combination with surgery and embolisation. It has been shown to be a potentially effective treatment and an attractive alternative in carefully selected patients with intracranial tumours: slow-growing, well limited, deep-seated tumours, such as some gliomas, acoustic neurinomas, skull base meningiomas, pituitary adenomas. This treatment is also used to deliver a focal boost of radiation to previously administered fractionated radiotherapy in patients with small gliomas and solitary brain metastases.

Adenoma↗
PubMed1992

Prostate cancer treated by radiotherapy: a multivariate study.

According to respective proportions of evolutive status groups, results of multivariate studies are difficult to interpret. Among the 1099 cases of local form of prostate cancer, treated by radiotherapy from 1975 to 1982 in 16 French Anticancer Institutes, we can observe two homogeneous status groups of patients: disease-free survivors (285 cases) and patients who died of prostate cancer (278 cases). These correspond to 51% of the whole population. Among other things, they are comparable in size, for age at the beginning of radiotherapy and for delay between histologic diagnostic and radiotherapy. We chose to analyse them using multivariate analysis. To take survival into account, we used a Cox model and Kaplan-Meier curves; the group deceased of prostate cancer was further analyzed by a tree-structured regression method. The Cox model and the Kaplan-Meier curves confirmed two main explicative factors: Stage (p < 0.0001) and tumor grade (p < 0.001). Poorer evolution occurs in extracapsular forms and grade I has better survival than others. The tree-structured regression method indicates two other pejorative factors: hormonotherapy prior to radiotherapy and the presence of cardiovascular pathology. Though the pelvic dose does not appear to be a main explicative factor, it seems to improve survival and delay between radiotherapy and recurrence or metastasis in some categories of cases. Other factors such as tumor dose, age and delay between diagnosis and radiotherapy were not found to be significant. These results cannot be extended to the whole population for which they do not constitute a predictive study. We consider them as "baseline data".(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Localized adenocarcinoma of the lung: a retrospective study of 186 non-metastatic patients from the French Federation of Cancer Institutes--the Radiotherapy Cooperative Group.

From January 1980 to December 1984, 186 patients with non-metastatic primary adenocarcinoma of the lung were treated in 10 different French Cancer Institutes. All patients have a minimal 5-year follow-up. There were 19 Stage I, 58 Stage II, and 109 Stage III. Survival was correlated with treatment modality. Survival rates for patients treated with surgery (36 pts), surgery and radiotherapy (65 pts), or radiotherapy with or without chemotherapy (80 pts) were 44.7%, 28.5%, and 6%, respectively. In the group of patients who were operated on, local control rate was improved by adjunctive radiotherapy delivering more than 50 Gy in 5 weeks. The cumulative risk of developing distant metastasis was 37% at the end of the first year following diagnosis and 68% at 5 years. Stage of the disease, nodal involvement, and location of the primary were the main factors of prognosis.

Adenocarcinoma↗
PubMed1991

Laparoscopic pelvic lymphadenectomy in the staging of early carcinoma of the cervix.

Laparoscopic pelvic lymphadenectomy was performed in 39 patients. An incision of the peritoneum between the round and infundibulo-pelvic ligament on each side gave access to the retroperitoneal space. Subsequently, laparoscopic surgery allowed precise dissection of external and internal iliac vessels, umbilical artery, and obturator nerve. The peritoneum was left open, and the lymph was drained into the peritoneal cavity. No lymphocele was observed. Three to 22 (mean, 8.7) nodes were removed, and there was no significant morbidity. Sensitivity and specificity were 100% in this preliminary experience. It is thus possible to remove the first-line regional lymph nodes of the cervix for pathologic examination. Because "skip" metastases are quite rare in early cervical carcinoma, the risk of missing a positive node is low. Brachytherapy alone, vaginal surgery, or, in microinvasive carcinoma, conization alone can be applied safely without the need of a staging laparotomy in cases with negative nodes.

Biopsy↗
PubMed1990

[Stereotaxic radiosurgery:methods and indications in the treatment of cerebral arteriovenous malformations].

After Leksell and Steiner's pioneering experience with the use of the gamma units, another technically different system has been developed, using a linear accelerator. It's a very precise stereotactic radiosurgical approach which allows to deliver the necessary dose of radiation to the target volume while sparing the surrounding structures from potentially dangerous levels of radiation. This hyperselective irradiation is a new and complementary method of treatment of arteriovenous malformations located in central or functionally critical areas of the brain. The aim is to obtain a progressive and total obliteration of the lesion. The place of radiosurgery is obviously reserved for the patients who do not seem able to profit from the benefits of open surgery and/or embolization techniques.

Dose-Response Relationship, Radiation↗
PubMed1989

[Cancer of the upper aerodigestive tract. Global study of 2418 cases].

The authors present the general results of a retrospective study on 2418 patients treated between 1976 and 1980. Primaries were located on buccopharynx in 51% of cases, pharyngolarynx in 45% and nasopharynx or nasal and paranasal cavities in 4%. Two out of 3 tumours were classified T3 T4 (UICC 1979) and 1 out of 2 patients presented with palpable cervical lymph nodes. Taking into account persistent diseases and recurrences, failure at primary sites occurred in 40% of patients, in the neck in 20%, distant metastases in 10%. Synchronous and/or metachronous cancers were observed in 1 out of 3 patients. Actuarial survival rates were 2/3 at 1 year, 1/3 at 3 years, 1/4 at 5 years and 1/7 at 8 years. Endolaryngeal tumours had the best prognosis while hypopharyngeal tumours had the worst prognosis.

Adult↗
PubMed1987

[Different modalities of the radiosurgical combination in the treatment of tumors of lateral buccopharyngeal junction].

Results are presented of combined transmaxillary buccopharyngectomy-radiotherapy treatment of 290 tumors of lateral buccopharyngeal junction. Post-therapeutic course was uncomplicated but 8 postoperative deaths are reported. Secondary extension of tumor was noted in 109 patients and another cancer in 64. Actuarial survival at 3 years was 54%, at 5 years 39% and at 10 years 17%. Lingual and muscle extensions were the most difficult to control and first intention excision is therefore performed when bone invasion has occurred. In contrast, total dose radiotherapy should probably precede surgery for forms with lingual and/or muscle extension.

Adult↗
PubMed1984

[The use of the pectoralis major myocutaneous flap in cervicofacial and particularly buccopharyngeal, surgery. Apropos of 42 cases].

During the last two years, we have used a pectoralis major myocutaneous flap in 42 cases (28 after radiotherapy). The immediate post-operative periods were very simple and the flap reliability was remarkable: only three partial necrosis and no total necrosis were observed. This technique seems to be an important contribution in the field of buccopharyngeal surgery, especially in the case of extensive tumors involving the tongue. In that case, initial radiotherapy followed by extensive surgery with myocutaneous flap reconstruction seems to be the best therapeutic strategy. It is the authors' feelings that local control will probably be better but long term results will be still poor. Effectively, in case of extended tumors general prognosis has to be taken in account as well as local prognosis.

Adult↗
PubMedDate not supplied

Interstitial brachytherapy and early tongue squamous cell carcinoma management.

The results of treatment of 341 previously untreated patients with early squamous cell carcinoma (SCC) of the anterior two thirds of the tongue using iridium 192 implants (January 1974-December 1983) are presented. Furthermore, 265 patients underwent neck dissection, followed, in 102 cases, by radiotherapy. Incidence of local treatment complications was 19% (66 patients; however, only 3% (11 patients) needed more than a single medical treatment. Two months after completion of overall treatment, 326 patients (96%) were free of disease. Local failures occurred in 18% of cases; however, after successful salvage surgery this rate was reduced to 11%. Neck failures occurred in 18% of cases, but after successful salvage were reduced to 12%. Distant metastases were rare (1.5%), whereas metachronous cancers were frequent (102 patients). Survival rates were 61% (56% to 66%) at 3 years, 46% (41% to 51%) at 5 years, and 26% (23% to 34%) at 10 years. Deaths due to tongue cancer evolution (20%) equalled those due to metachronous cancers (18.5%) and intercurrent diseases (21%).

Adult↗
PubMedDate not supplied

Lymph node invasion in hypopharynx and lateral epilarynx carcinoma: a prognostic factor.

Hypopharynx (HC: pyriform fossa, postcricoïd area, and posterior wall) and lateral epilarynx carcinomas (LEC: aryepiglottic fold, pharyngoepiglottic fold, and arytenoïd) have a high tendency to cervical lymph node invasion. Such nodal extension is a well-known prognostic factor. This study is based on a retrospective review of 884 clinical records of previously untreated HC or LEC. Seventy percent of patients revealed palpable nodes at their first examination, with a higher percentage for HC (73%) than LEC (62%). The 5-year survival rate was divided by three in the presence of contralateral, bilateral, or fixed nodes, or in cases of nodes exceeding 3 cm. Multiple positive nodes, extracapsular spread, or lower-neck positive nodes significantly decreased survival, doubled the number of neck recurrences, and tripled the number of distant metastases while control at the primary site remained unvaried.

Adult↗
PubMedDate not supplied

[Role of laparoscopy in the management of uterine cervix cancer].

At the turn of this century, the evidence of the benefits of a concurrent chemo-radiotherapy in locally advanced tumors and the development of mini-invasive surgery (laparoscopic and radical vaginal surgery) are the two main advances in the management of cervical carcinomas. From a personal experience of 304 cervical carcinomas, the different techniques of laparoscopy used in cervical carcinomas are addressed and discussed. Their long-term results when involved in the management protocols of cervical carcinomas at different stages are reported. From this series, some conclusions are drawn: 1) laparoscopy can spare a laparotomy in early-stage node-negative patients with low tumoral volume; 2) it can spare a systematic extended-field radiation therapy in high-risk patients with node-negative para-aortic exploration; 3) it can spare surgery in patients with a centro-pelvic advanced stage or recurrence, possibly candidates for an exenterative procedure, if occult spread is found in the intra- or retroperitoneal areas. The more and more frequent combination of the mini-invasive surgery for staging and treatment and radiotherapy or chemotherapy explains the need for new protocols of a more and more complex and specialized management.

Adenocarcinoma↗
PubMedDate not supplied

[Dosimetric quality control in stereotactic radiotherapy with the aid of radiosensitivity].

Typical dosimeters used in stereotactic radiation therapy, such as ionization chambers, films, and thermoluminescent diodes, allow basic physical measurements. They are, however, neither well suited to discern small target volumes with high dose gradient, nor suitable for three-dimensional (3D) dose measurements. Gel dosimetry is becoming more and more interesting, owing to magnetic resonance imaging (MRI). It permits isocenter position planning verification of accuracy and the precision of the 3D dose mapping in the brain (when irradiated in realistic conditions), especially when several different targets are concerned. Many authors have assessed stereotactic radiation therapy quality control using different gels, and different irradiation procedures. This paper consists of the review of these different methods to assess quality control. Gel dosimetry cannot provide absolute dose measurements. However, gels can be used to check the 3D dose mapping with a high degree of detail. In our experiment, the difference between the stereotactic frame center and the isocenter is about 1 mm. The difference between the theoretical isodoses obtained by the treatment planning system and the experimental isodoses obtained by the MRI gray level calibration is also about 1 mm, the order of magnitude of the MRI pixel size.

Gels↗