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B Court

Publications and source records attributed to B Court.

At least 19 recordsLinked to original sources
PubMed1997

Squamous cell carcinoma of the penis: multivariate analysis of prognostic factors and natural history in monocentric study with a conservative policy.

BACKGROUND: Penile carcinoma is uncommon in Western countries. Here we report on a large series of patients with squamous cell carcinoma (SCC) of the penis, describing prognostic factors, survival and therapeutic results. PATIENTS AND METHODS: From 1973 to 1993, 102 patients with invasive SCC of the penis were treated at the Institut Gustave-Roussy. Precancerous lesions and conditions associated with penis cancer were analyzed retrospectively. Survival curves were estimated by the Kaplan-Meier method, and groups were compared for outcome by the log rank test for univariate comparisons and by Cox's proportional hazards model for multivariate analysis. RESULTS: The median age at onset was 58 years. Sixty-nine patients presented with Jackson's stage I disease, 17 with stage II and 15 with stage III. The interval between the manifestation of symptoms and the diagnosis was more than a year in 13.7% of cases. Precancerous lesions were found in 17 (16.6%) patients, and a history of phimosis was noted in 25 (24.5%). In situ and invasive carcinoma were observed together in 17 (16.6%) cases and dysplasia was associated with invasive carcinoma in eight (7.8%) further cases. Conservative treatment was administered whenever feasible. Interstitial brachytherapy was performed alone or associated with limited surgery (local excision or circumcision) in 72 (70.6%) patients. Of the 28 patients with a local relapse, nine have died of their neoplasms (32%) compared to 21 of 28 patients with lymph node relapse (75%). The median follow-up was 111 months. Disease-free survival, disease-specific survival and overall survival were, respectively, 56%, 72% and 63% at five years and 42%, 66% and 50% at 10 years. Age (P = 0.01), the N status (P < 0.00001) or palpable nodes (P < 0.0038), corpus involvement (P = 0.006) and a verrucous histology (P = 0.038) had significant prognostic relevance for survival in the univariate analysis whereas the performance status, T status and Broders' grade did not. In the multivariate analysis only two parameters, involvement of the corpus (P < 0.0001) and palpable nodes (P = 0.009), were singled out as being independent variables influencing survival. A subgroup of nine patients with verrucous histologies were distinguished by their freedom from node involvement. These patients had an excellent prognosis: all are alive and disease-free. Penile integrity was preserved during follow-up in 54 patients (52.9%), 31 of whom are still alive. Of 72 patients treated by a conservative approach including brachytherapy, long-term penile integrity was maintained in 49 (68%). CONCLUSION: Corpus involvement and clinically palpable nodes are highly statistically significant independent factors influencing overall survival. Node relapses remain a major cause of death. Thus, better management of lymph nodes is essential for improving survival even when conservative therapy is used to treat the primary.

Adult↗
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

[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↗
PubMed1993

Treatment of stage I testis seminoma by radiotherapy: long-term results--a 30-year experience.

PURPOSE: From 1956 to 1986, we have retrospectively studied 184 patients with a Stage I testis seminoma treated by orchidectomy and radiotherapy at the Institut Gustave Roussy. METHODS AND MATERIALS: The 184 patients received adjuvant radiotherapy to the para-aortic and ipsilateral iliac nodes. Of the 184 patients, 133 received additional mediastinal and supraclavicular irradiation, 47 received supraclavicular without mediastinum irradiation, 98 patients received additional radiotherapy given to inguino-scrotal area. The mean dose of irradiation is 21 Gy which is the lowest dose published. The actuarial survival rate is, respectively, 96%, 93%, 83% and 77% at 5, 10, 15, and 20 years. RESULTS: Four patients relapsed, and four died of progressive disease. Four patients presented cardiovascular disease, all of them had mediastinal irradiation, two were heavy smokers. Seventeen second malignancies were observed, six tumors in the contralateral testis. The actuarial risk of developing a second malignancy is 10% at 10 years, 21% at 20 years. The cure rate and relapse rate in our patients is the same as that obtained by higher dosage of irradiation. CONCLUSION: We conclude that low dose of prophylactic irradiation in lumbo aortic and ipsilateral iliac lymph nodes is active and safe in the treatment of Stage I testis seminoma.

Adolescent↗
PubMed1993

Penile cancer chemotherapy: twelve years' experience at Institut Gustave-Roussy.

Between 1980 and 1992, 14 patients (median age 50 years) with penile carcinoma were treated with multidrug combination chemotherapy in our institution. Twelve patients had Stage IV (Jackson classification) tumor, 1 patient each had Stage III and Stage II. All patients received cisplatin-based chemotherapy. Cisplatin was associated with either 5-fluorouracil (4 patients), methotrexate and bleomycin (4 patients), methotrexate (3 patients), Adriamycin (1 patient), bleomycin and vinblastine (1 patient), or bleomycin and epirubicin (1 patient). Thirteen patients were evaluable for response. Objective response was encountered in 2 patients (15%) with 1 complete response and 1 partial response. Response duration was difficult to determine because of additive radio-therapy or patient was lost to follow-up. There were 2 patients with long-term evidence of no disease among 12 patients with Stage IV disease. These 2 patients received complementary irradiation in association with the chemotherapy. The response rate was dismal in our series. Methotrexate-based regimens seem to be the most active. The bimodality treatment with multidrug chemotherapy and radiotherapy for advanced penile cancer could offer a survival advantage in the management of these patients.

Adult↗
PubMed1989

[Invasive tumors of the bladder. A study of 56 cases treated at the Gustave-Roussy Institute by total cystectomy and radiotherapy].

Between July 1973 and December 1984, 56 patients with invasive bladder cancer were treated at the Gustave-Roussy Institute by total cystectomy and, generally, radiotherapy (45 patients). Four modalities of irradiation were used: preoperative flash (21 patients), preoperative flash and postoperative irradiation (9 patients), preoperative irradiation according to conventional fractionation (12 patients), postoperative irradiation (3 patients). The actuarial 5 year survival for all of the patients treated was 28%. The essential prognostic factors were depth of emboli. Analysis of the deaths revealed loco-regional recurrence in 8 patients (14%), metastases in 11 patients (20%) another cause in 14 patients (24%); treatment appeared to be directly involved in 13 cases. However, toxicity has been considerably reduced since 1980, due to more rigorous patient selection for total cystectomy, improvement in pre- and postoperative intensive care and by the use of a radiotherapy protocol no longer involving large concentrated fractions.

Adenocarcinoma↗
PubMed1986

Phase II trial with D-Trp-6-LH-RH in prostatic carcinoma: comparison with other hormonal agents.

Various approaches to hormonal treatment of prostate carcinoma are discussed. Eighty-one patients with prostatic carcinoma, eight with stage B, nine with stage C, and 64 with stage D disease, were treated subcutaneously daily for 3 months with the LH-RH agonist D-Trp-6-LH-RH (Decapeptyl) in order to evaluate the incidence of remissions according to WHO recommendations for oncologic trials. The findings were compared to those obtained with other hormonal therapies of prostatic carcinoma according to the statistical method of "expected response rate" as adapted by Lee and Wesley for phase II trials. Treatment with D-Trp-6-LH-RH greatly reduced serum LH and testosterone levels without raising serum prolactin. After 1-2 weeks of therapy, there was relief of subjective symptoms and a reversal of the signs of prostatism as well as a marked decrease in bone pain. At 90 days 52 patients had complete relief of prostatism and 21 had only mild signs and symptoms. Seventy patients were experiencing no bone pain and an additional six had only mild pain. Prostatic size, evaluated by rectal examination and transabdominal ultrasonography, reverted to normal in 26.4% of patients (complete remission) and was reduced by more than 50% in an additional 17.6% (partial remission), the overall rate of complete plus partial regression of prostatic enlargement being 44%. Scans showed a major improvement of bone lesions in 14.8% of cases. This response increased to 37% after more than 6 months of follow-up. Prostatic acid phosphatase levels were decreased by more than 50% in 61% of the patients, but this test appears to be a less valid marker than the lipid-associated sialic acid (LASA). The increase in LASA before treatment and a reduction after treatment can frequently be correlated with the objective volume of the neoplasms. No flare-up of the disease was encountered, and there were no side effects except for impotence. Statistical analyses of results by the method of Lee and Wesley indicated that the incidence of complete and partial regression (CR and PR) observed with D-Trp-6-LH-RH was not significantly different from that recorded in previous studies for another LH-RH analog, Buserelin. However, CR and PR obtained with D-Trp-6-LH-RH (44%) were significantly higher than with subcapsular orchiectomy (22%). Hormonal effects and some other actions of D-Trp-6-LH-RH were compared and contrasted with those produced by castration, estrogens, antiandrogens, and progestogens.(ABSTRACT TRUNCATED AT 400 WORDS)

Acid Phosphatase↗