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Biomedical subjects

B Chauvet

Publications and source records attributed to B Chauvet.

At least 19 recordsLinked to original sources
PubMed2002

Doxorubicin and ifosfamide in patients with metastatic sarcomatoid renal cell carcinoma: a phase II study of the Genitourinary Group of the French Federation of Cancer Centers.

PURPOSE: We assessed the efficacy and toxicity of a chemotherapy regimen combining doxorubicin and ifosfamide in patients with metastatic sarcomatoid renal cell carcinoma. MATERIALS AND METHODS: Of the 25 patients included in a prospective multicenter phase II trial 23 were evaluable for efficacy and toxicity studies after pathological review. RESULTS: A median of 3 cycles per patient (range 1 to 8) was administered. No objective response was observed. Median time to progression was 2.2 months and median overall survival was 3.9 months. A single patient died of toxicity. CONCLUSIONS: The results do not support the standard use of doxorubicin/ifosfamide chemotherapy in patients with metastatic sarcomatoid renal cell carcinoma.

Adult↗
PubMed2002

[Radiotherapy of lung cancer: the inspiration breath hold with spirometric monitoring].

A CT acquisition during a free breathing examination generates images of poor quality. It creates an uncertainty on the reconstructed gross tumour volume and dose distribution. The aim of this study is to test the feasibility of a breath hold method applied in all preparation and treatment days. Five patients received a thoracic radiotherapy with the benefit of this procedure. The breathing of the patient was measured with a spirometer. The patient was coached to reproduce a constant level of breath-hold in a deep inspiration. Video glasses helped the patients to fix the breath-hold at the reference level. The patients followed the coaching during preparation and treatment, without any difficulty. The better quality of the CT reconstructed images resulted in an easier contouring. No movements of the gross tumour volume lead to a better coverage. The deep breath hold decreased the volume of irradiated lung. This method improves the reproducibility of the thoracic irradiation. The decrease of irradiated lung volume offers prospects in dose escalation and intensity modulation radiotherapy.

Aged↗
PubMed2002

[Prostate cancer: has local radiation treatment had an impact on survival?].

Local control is an important goal in the treatment of prostate cancer. Firstly, it avoids the morbidity due to locoregional evolution (urethral obstruction, vascular compression, rectal or vesical involvement). Moreover, local control of the disease may decrease the mortality due to metastases disseminated from local relapse. Local control evaluation remains difficult: neither rectal examination nor imaging or prostate biopsies have an absolute value in diagnostic of local relapse. PSA increase does not permit to differentiate local from distant relapses. Recent developments in radiotherapy techniques allow dose escalation without major toxicity. Retrospective studies and one randomized study have shown that an increase from 70 to 80 Gy or more, improve biological relapse-free survival. In one randomized study comparing 70 to 78 Gy, the biochemical disease-free survival was improved from 69 to 79% at five years. Such an improvement can only be explained by an improvement of local control. The benefit in term of overall survival is not yet demonstrated and needs a longer follow-up and other studies. Another approach to improve local control is the association of a local radiotherapy with hormonal adjuvant therapy. Four randomized studies have been published for locally advanced prostate cancer. These studies have all demonstrated an improvement of local control, and a decrease of metastatic risk. The benefit in term of overall survival, observed in one of this trial, may be explained by the improvement of either local or distant control or both. Such therapeutic progress, associated with the development of prostate cancer screening should lead to a decrease of prostate cancer mortality for the next ten years.

Adenocarcinoma↗
PubMed2001

Activity of the forensic entomology department of the French Gendarmerie.

The criminal research Institute of the French Gendarmerie deals with several disciplines which are part of forensic science. Forensic entomology is one of the last laboratories created in Rosny-Sous-Bois. As with all other departments of the Institute, its main mission is carrying out its expertise on behalf of justice. Another important mission is to educate on one hand the "scene of crime" officers in order to increase the quality of the specimens collected and on the other hand to magistrates to make forensic entomology better known. At last, a research program is available to follow scientific development and to improve services to justice.

Animals↗
PubMed2001

[Axillary lymph node and bone marrow micrometastases of breast cancer].

Micrometastatic disease from breast cancer is a major concern both for clinicians and pathologists. Histologically, they can be defined as potentially invasive microfoci of tumoral cancer cells located in the vicinity of blood vessels and are a distinct entity from residual disease. They are mainly looked for in bone marrow and lymph nodes specimens and their diagnosis is currently easier thanks to immunohistochemistry. Provided a standard definition of micrometastatic disease and standard screening procedures can be met, the presence of micrometastases at the time of diagnosis could represent a major parameter in therapeutic decision-making. Although controversial, the presence of medullary and axillary lymph node micrometastases appears to be a major prognostic factor in terms of survival. Recognition of this entity could help in better defining the high-risk subset of patients who would potentially benefit from adjuvant chemotherapy.

Axilla↗
PubMed2001

[Are there physical, technical and morphological limits to conformational radiotherapy?].

Conformal radiotherapy results from several technical and data processing advances. The treatment planning and the daily treatments have benefited from a significant improvement of the quality control. However, all the steps of the process contain various limitations of varying effects. It appear important to identify, describe and exploit those limits to better drive the procedures and optimise the quality. Identifying the limits of the conformal radiotherapy should be an important help to implement intensity modulation radiotherapy.

Anthropometry↗
PubMed1999

Prognostic factors in urothelial renal pelvis and ureter tumours: a multicentre Rare Cancer Network study.

To assess the prognostic factors in patients with transitional-cell carcinoma of the renal pelvis and/or ureter, a series of 138 patients with transitional-cell carcinoma of the renal pelvis and/or ureter was collected in a retrospective multicentre study. 12 patients with distant metastases were excluded from the statistical evaluation. All but 3 patients underwent radical surgery: nephroureterectomy (n = 71), nephroureterectomy and lymphadenectomy (n = 20), nephroureterectomy and partial bladder resection or transurethral resection (n = 20), nephrectomy (n = 10), and ureterectomy (n = 5). Sixty-one per cent (n = 77) of the tumours were located in the renal pelvis, and 21% (n = 27) in the ureter (both in 22 [17%]). Following surgery, residual tumour was still present in 33 patients (16 microscopic and 17 macroscopic). Postoperative radiotherapy was given to 45 (36%) patients. The median follow-up period was 39 months. In a median period of 9 months, 66% of the patients relapsed (34 local, 7 locoregional, 16 regional, and 24 distant). The 5- and 10-year survival were 29% and 19%, respectively, in all patients. In univariate analyses, statistically significant factors influencing the outcome were Karnofsky index, pT-classification, pN-classification, tumour localisation, grade, and residual tumour after surgery. Multivariate analysis revealed that independent prognostic factors influencing outcome were pT-classification, the existence of residual tumour, and tumour localisation. In patients with urothelial renal pelvis and/or ureter tumours, a radical surgical attitude is mandatory; and the presence of tumour in the ureter is associated with a poorer prognosis.

Aged↗
PubMed1999

[Endobronchial brachytherapy].

Endobronchial brachytherapy was developed following the miniaturization of radio-active sources enabling the use of fiberoptic techniques to deliver treatment at high dose yet substantially reducing the duration of treatment. Endobronchial brachytherapy has been used in patients presenting with symptomatic obstruction of the proximal bronchial tree in association with laser therapy. The level of responses in these palliative indications is around 80 per cent. Currently, other investigations are undergoing evaluation to test the method in association with conventional treatment to determine whether brachytherapy can augment local control. In the treatment of small tumours when other conventional treatments are not possible brachytherapy employed alone has shown undoubted efficacy. However there remain numerous problems to resolve: what is the ideal protocol in terms of total dose, dose per fraction, the order of dosing and fractions? How can secondary complications to endoluminal irradiation be limited in particular for curative therapy. An answer should be found for all these questions before this technique is eventually integrated into the primary treatment regimes for bronchial cancer.

Brachytherapy↗
PubMed1998

High dose rate endobronchial brachytherapy: results and complications in 189 patients.

The purpose of this study was to determine the benefit of high dose rate endobronchial brachytherapy in the treatment of obstructive lung cancer. Between September 1990 and March 1995, 189 patients with bronchogenic carcinoma were treated with high dose rate endobronchial brachytherapy. Most patients (69.3%) had received prior treatment and presented with symptomatic bronchial obstruction due to either recurrent or residual endobronchial disease. A small group (12%) was medically unfit for either surgical resection or thoracic radiotherapy and benefited from endobronchial brachytherapy alone for small endobronchial tumours. The remainder of the patients had not been treated previously and endobronchial brachytherapy was performed for life-threatening symptoms requiring emergency obstruction relief before other therapy. Treatment was performed weekly and consisted of three to four 8 to 10 Gy fractions at a radius of 10 mm from the centre of the source. Major symptomatic relief was obtained for haemoptysis (74%), dyspnoea (54%), and cough (54%). Complete endoscopic response was observed in 54% of cases. Median survival was 7 months for the entire group. For small, strictly endobronchial tumours, complete response rate was 96%, median survival 17 months, and 30 month survival 46%, with a plateau starting at 18 months. Grade 3 to 4 toxicities occurred at a rate of 17% and included massive haemoptysis (n=13), bronchial stenosis (n=12), soft tissue necrosis (n=8), and bronchial fistula (n=3). By univariate analysis, no factor was found to be predictive of late pulmonary toxicity. The present study confirms the usefulness of endobronchial brachytherapy in alleviating symptoms caused by endobronchial recurrence of bronchogenic carcinoma. In addition, this therapy can be tried with curative intent in patients who present with small endobronchial tumours and are not candidates for other forms of therapy.

Adult↗
PubMed1998

[Treatment of infiltrating cancer of the bladder with cisplatin, fluorouracil, and concurrent radiotherapy: results of a pilot study].

PURPOSE: Pilot study to assess treatment feasibility and results of a 2-drug chemotherapy (CT) regimen administered concurrently with radiotherapy (RT) for muscle-invasive bladder cancer. MATERIALS AND METHODS: Fourty-six patients were included into a prospective study from December 1992 to April 1996. The median age was 66 years. Thirty-seven percent of the patients had T3B-T4 tumors, and 46% had benefited from prior macroscopically complete transurethral resection (TUR). Pelvic irradiation consisted of 50.4 Gy in 28 fractions over 39 days. Concurrent CT consisting of cisplatin (80 mg/m2/d1) and 5-fluorouracil (800 mg/m2/d2 to 5) by continuous infusions (5-FU) was delivered during the first and fifth weeks of radiation therapy. Twenty-three patients received two additional courses of adjuvant CT with cisplatin, methotrexate and vinblastin (MCV). RESULTS: The median follow-up was 38 months. The feasibility of concurrent CT-RT was excellent: 96% of the patients completed radiotherapy and 100% of them received the two courses of P-FU. The acute toxicity was mild: no hematological toxicity or renal toxicity over grade II, 4 cases of bowel or rectal reversible grade III toxicity and 2 cases of reversible grade III cystitis. A complete response was achieved in 30 out of the 42 evaluable patients (65.2%). Nine patients received an immediate salvage treatment (3 TUR, 3 additional radiotherapy and 3 cystectomies). Ten patients had local failure. Projected 3-year locoregional control was 49% for the 46 patients. Projected overall 3-year survival was 53%. Functional results were good for disease-free patients with preserved bladder: 1 grade I, 3 grade II, and no grade III cystitis. CONCLUSION: Concurrent 2-drug chemoradiotherapy with cisplatin and 5-fluorouracil is feasible without major toxicity and offers a potentially curative and conservative treatment for patients with localized muscle-invasive bladder cancer.

Aged↗
PubMed1998

[Results of long-term treatment of inoperable cancer of the bladder with cisplatin and concurrent irradiation: prognostic factors of local control and survival].

PURPOSE: Therapeutic strategies for muscle invasive bladder cancer are currently evolving. A recent European randomized study has shown that neoadjuvant chemotherapy does not improve the chance of cure or and radiotherapy would provide better results but there is a need to identify by prognostic factors patients who may benefit from such a conservative strategy. MATERIAL AND METHODS: One hundred and nine patients with localized muscle-invasive bladder cancer, who were not candidates for radical cystectomy, were treated with concomitant cisplatin and radiation therapy. Their mean age was 71. Thirty-six percent of the patients had T3B-4 tumors, and 37% had benefited from prior macroscopically complete transurethral resection (TUR). Pelvic irradiation consisted of 40 to 45 Gy and was followed by a boost to the bladder to a total dose of 55 to 60 Gy. Continuous infusion cisplatin (20 to 25 mg/m2/d for 5 days) was delivered during the second and fifth weeks of radiation therapy. RESULTS: Median follow-up was 73 months. The projected 5-year locoregional control rate was 43% for the 109 patients and 55% for the 86 patients with complete response. The projected overall 5-year survival rate was 36% for all patients and 44% for complete responders. Univariate analysis of prognostic factors was carried out for local control, and survival. The local control was statistically better in patients with good performance status, T2-3A, complete initial TUR, and in patients without hydronephrosis. In terms of overall survival, four factors were significant: the performance status, T-stage, absence of hydronephrosis, and complete response. By multivariate analysis, performance status, hydronephrosis and T-stage were significant factors for local control, while T-stage and complete response were the strongest determinants for survival. CONCLUSION: Concurrent cisplatin and radiation therapy is a potentially locally curative treatment for 43% of patients with muscle-invasive bladder cancer not candidates for radical surgery. Clinical T-stage and hydronephrosis have a significant and independent prognostic value on local control but appears not discriminant enough to select patients for conservative treatment.

Adult↗
PubMed1997

[Concomitant radiochemotherapy with cisplatin-etoposide with or without surgery in stage III non-small cell lung cancers: results of a pilot study in 67 patients].

PURPOSE: This pilot phase II study was aimed at determining the feasibility, toxicity, response rate, local control, and survival of concomitant chemotherapy with cisplatin-etoposide and radiotherapy in stage IIIA or IIIB non small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Between February 1992 and February 1994, 67 patients with either medically or technically inoperable stage III NSCLC were treated with concomitant chemoradiotherapy. Thoracic radiotherapy was administered to a median dose of 60 Gy over 6 weeks. Concomitant chemotherapy consisted of cisplatin 20 mg/m2/day plus etoposide 50 mg/m2/day from day 1 to day 5, every 4 weeks over four cycles. Medically operable patients were evaluated for surgical resection after a 45-Gy irradiation and two cycles of concomitant chemotherapy. Only 14 patients could undergo subsequent surgery. RESULTS: With a median 49-month and a minimum 34-month follow-up, the overall survival rate was 42% at 2 years, and 34% at 4 years. The median survival was 19 months and the actuarial local control rate was 57% at 3 years. Toxicity was mainly associated with myelosuppression and esophagitis, but could be treated and was of short duration. CONCLUSION: Concomitant chemoradiotherapy with cisplatin and etoposide at this dose level provides a well tolerated outpatient regimen that results in high local control rate and encouraging survival at 2.4 years. A similar regimen is being compared in a phase III trial including induction chemotherapy followed by radiotherapy.

Adult↗
PubMed1997

[Conformational radiotherapy in cancers of the prostate: contribution of pelvic immobilization and new fiducial markers].

PURPOSE: To reduce errors in the positioning of patients treated with external conformal radiotherapy for prostate cancer, we evaluated both the use of an immobilization device and new fiducial markers. MATERIALS AND METHODS: The immobilization device consisted of an individual mold made of polyurethan foam. Two sets of skin markers located on the anterior tibial surfaces were used to identify the pelvic isocenter. The patient's position was evaluated by orthogonal port films which were then compared with the original simulation film. RESULTS: Results are presented with respect to orthogonal axes. Comparison with classic procedures without immobilization showed that use of the mold and new fiducial markers led to a decrease in set-up errors which were less than 5 mm. CONCLUSION: With the use of an immobilization device and optimized techniques for patients' positioning, conformal radiotherapy of prostate cancer is more accurate.

Computer Simulation↗
PubMed1997

[Adjuvant combined radiochemotherapy: a feasibility study of a new strategy in stages I and II].

Adjuvant radiotherapy is the rule after conservative surgery for breast cancer. Furthermore, an anthracycline-based chemotherapy is recommended in node-positive patients and in poor prognosis tumors. The optimal schedule of treatment has yet to be determined, but ideally, none of these therapeutic modalities should be delayed. We have therefore conducted a feasibility trial using post-operative concurrent chemoradiation therapy with an anthracenedione. Between May 1990 and October 1994, 154 patients with stage I or II breast cancer who had benefited of either limited or radical surgery were treated with adjuvant concurrent chemoradiotherapy. Radiotherapy consisted of 50 Gy in 25 fractions over 5 weeks to the chest wall or the breast, and to the supraclavicular and internal mammary lymph nodes. When indicated, a boost of 15 Gy was then delivered to the primary tumor bed (n = 75). Starting on the first week of radiotherapy, combined chemotherapy with 5-fluorouracil, mitoxantrone, and cyclophosphamide was administered at 21-day intervals, for 4 to 6 cycles. Compliance to therapy was excellent. Median radiotherapy dose was 49.5 Gy to the chest wall or breast, and to the lymph nodes, and 14.2 Gy to the tumor bed. Chemotherapy was given at full dose in over 80% of the cases and the 21-day interval between cycles was respected in 31%. In 45% of the cases, a 28-day interval was required due to toxicity, and at least one interval longer than 28 days was necessary in the remainder of the patients. Main toxicities were nausea and vomiting (20.8%) and grade 3-4 neutropenia (12.3%). Grade 1 cutaneous toxicity occurred in 62.3% of the cases, and severe grade 3 radiation dermatitis requiring temporary interruptions of therapy in 4.5%. With the exception of one case of grade 3 acute cardiac toxicity, there was no other severe side-effects. In conclusion, this pilot study demonstrates the feasibility of concurrent chemoradiation therapy with an anthracenedione for stage I and II breast cancer in the adjuvant setting. Whether this approach compares favorably with standard sequential therapy in terms of long-term results remains to be determined and should be assessed in a phase III trial.

Adult↗
PubMed1996

Concurrent cisplatin, etoposide, and radiotherapy for unresectable stage III nonsmall cell lung cancer: a phase II study.

PURPOSE: Prognosis of unresectable Stage III nonsmall cell lung cancer (NSCLC) treated with thoracic radiotherapy alone has been disappointing. In recent years, several Phase III trials have demonstrated encouraging results with induction chemotherapy, but with poor long-term local control. Concurrent cisplatin alone during the radiation therapy course has resulted in improved local control, but without efficacy on occult metastatic disease. Intensification of chemotherapy during radiation has the potential of improving both local control and metastasis-free survival. This Phase II study was undertaken to determine the feasibility, toxicity, response rate, local control, and survival of concurrent chemotherapy with cisplatin-etoposide and radiotherapy in unresectable Stage IIIA and IIIB nonsmall cell lung cancer. METHODS AND MATERIALS: Between February 1992 and April 1993, 50 patients with either medically or technically inoperable Stage III NSCLC were treated with concurrent chemoradiotherapy. Thoracic radiotherapy was administered to a total dose of 60 Gy. Concurrent chemotherapy consisted of cisplatin 20 mg/m2/day plus etoposide 50 mg/m2/day, from day 1 through day 5, every 4 weeks for four cycles. Medically operable patients were evaluated for surgical resection after 45 Gy and two cycles of concurrent chemotherapy. All patients received an esophagitis preventive regimen. RESULTS: Response rate was 84%, including 68% complete response. With a minimum follow-up of 23 months, overall survival was 70% at 1 year, 39.7% at 2 years, and 34.7% at 3 years. Median survival was 18 months. Age, performance status, histologic type and grade, and stage and tumor size, did not influence survival, with the exception of contralateral nodal involvement (p = 0.0055). Patients achieving a complete response (n = 34) had a 2-year survival of 58.4% compared to 0% for nonresponders (p < 0.0001). Patients who could benefit from surgery (n = 9) had a 2-year survival of 77.8% compared to 31.2% for nonoperated patients (p < 0.013). Seventeen patients (34%) are currently alive and free of disease. Actuarial local control was 63.4% at 1 year, and 58.5% at 2 and 3 years, respectively. Major hematologic toxicity occurred in 24% of the patients. CONCLUSIONS: Concomitant chemoradiotherapy with cisplatin and etoposide at this dose level is a well tolerated outpatient regimen, which resulted in a high local control rate, and an encouraging survival at 1, 2, and 3 years. A direct comparison of this treatment schedule to induction chemotherapy followed by radiotherapy, or concurrent chemoradiation therapy using cisplatin alone, appears warranted.

Adult↗
PubMed1996

[High-dose rate endobronchial brachytherapy: results and complications in 189 patients].

Between September 1990 and March 1995, 189 patients were treated with high-dose-rate endobronchial brachytherapy. Most patients (70%) presented with either recurrent or persistent symptomatic endobronchial tumor after standard therapy. A minority of the patients (12%) had small endobronchial tumor and were unfit for surgical resection or radiotherapy. Treatment was delivered weekly and consisted of three to four 8- to 10-Gy radiotherapy fractions applied at 10 mm from the source. Major symptomatic improvement was obtained on hemoptysis (74%), dyspnea (54%), and cough (54%). Complete endoscopic response occurred in 54.5% of the cases. Median survival was 7 months for the entire group. For small strictly endobronchial tumors, complete response rate was 95.5%, median survival was 17 months, and 30-month survival was 46%, with a plateau starting at 18 months. The rate of late grade 3 to 4 toxicity was 17%, including hemoptysis (n = 13), stenosis (n = 12), local necrosis (n = 8), and bronchial fistula (n = 3). By univariate analysis, no factor was found to be predictive of late toxicity. Our study confirms the benefit of endobronchial brachytherapy in the palliative treatment of endobronchial recurrences and in the curative intent treatment of small endobronchial tumors in patients not suitable for other forms of therapy.

Adult↗
PubMed1996

Concurrent cisplatin and radiotherapy for patients with muscle invasive bladder cancer who are not candidates for radical cystectomy.

PURPOSE: We assessed the results and prognostic factors in patients with bladder cancer treated conservatively with concurrent cisplatin and radiotherapy. MATERIALS AND METHODS: A total of 109 patients with localized muscle invasive bladder cancer who were not candidates for radical cystectomy underwent concomitant chemotherapy and radiation. Median patient age was 70 years. Of the patients 36% had stages T3B and 4 tumors, and 37% had benefited from prior macroscopically complete transurethral resection. Pelvic irradiation consisted of 40 to 45 Gy., and was followed by a boost to the bladder to a total dose of 55 to 60 Gy. Continuous infusion cisplatin (20 to 25 mg./m.2 daily for 5 days) was delivered during weeks 2 and 5 of radiation therapy. RESULTS: Median followup was 54.8 months. The projected 4-year locoregional control rate was 47.6% for the 109 patients and 61.2% for 76 with a complete response. Projected overall 4-year survival was 41.9% for all patients and 51.4% for complete responders. Univariate analysis of prognostic factors was done for local control and survival. Local control was statistically better in patients with a good performance status, stages T2 and 3A disease, complete initial transurethral resection and without hydronephrosis. In terms of overall survival 4 factors were significant: 1) performance status, 2) T stage, 3) absence of hydronephrosis and 4) complete response. By multivariate analysis performance status, hydronephrosis and T stage were significant factors for local control, while T stage and complete response were the strongest determinants for survival. CONCLUSIONS: Concurrent cisplatin and radiation therapy is a potentially curative and conservative treatment for patients with localized muscle invasive bladder cancer who are not candidates for radical surgery, particularly those with intravesical stages T2 and T3A tumors.

Adult↗