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Biomedical subjects

B Luboinski

Publications and source records attributed to B Luboinski.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Reconstruction with free jejunal graft after total circular pharyngolaryngectomy. 73 cases].

Among the various procedures of pharyngeal reconstruction after circumferential pharyngolaryngectomy, the free jejunal autograft (FJA) has become a common one. We retrospectively reviewed 73 cases of reconstruction with FJA after resection for advanced hypopharyngeal carcinomas (70 primary reconstructions, 3 secondary reconstructions). Postoperative outcome, functional and carcinologic results were studied. There were 1 postoperative death, medical complications in 19 patients, 4 graft failures (5.5%), 11 salivary fistulas. The nasogastric tube was removed before the 15th day in more than a half of the patients. One year postoperatively all the evaluable patients were able to take an oral diet (solid or soft diet for 97% of them). The postoperative radiotherapy was well tolerated. Cancer developed further in 33 patients (13 local and/or nodal recurrences, 13 isolated metastasis, 7 second primaries). The overall survival rate was 44.8% at three years. It seems clear that FJA allows good functional results and increases the quality of life in such patients with poor prognosis.

Adult↗
PubMed1996

[Free bone flaps in esthetic and functional rehabilitation after segmental mandibulectomy. Apropos of 38 cases].

Development of microvascular free tissue transfers gives the surgeon the opportunity to realise complex reconstructions after segmental mandibular resections for tumor. We reviewed 38 cases of oromandibular reconstruction using various free bone grafts (25 fibula, 7 scapular, 3 iliac and 3 forearm free flaps). The mandibular defect was anterior in 24 cases, lateral in 9 cases and subtotal in 5 cases. In the post-operative course there were two total flap losses. Long-term esthetic results were excellent or good for 82% of the patients, 81% were able to eat a solid or a soft diet. The causes of esthetic or functional failures were studied as well as the specific interest of each donor site. The use of free bone flaps improved cosmetic and functional rehabilitation in cases of anterior mandibular defects. The secondary reconstructions or reconstructions of lateral bony defects were more disappointing. The free fibula flap allows reconstruction of wide bony defects. Scapular flap or forearm flap are indicated for smaller bony defects and in patients with severe peripheral vascular disease.

Adolescent↗
PubMed1995

Very accelerated radiation therapy: preliminary results in locally unresectable head and neck carcinomas.

PURPOSE: To report preliminary results of a very accelerated radiation therapy Phase I/II trial in locally advanced head and squamous cell carcinomas (HNSCC). METHODS AND MATERIALS: Between 01/92 and 06/93, 35 patients with an unresectable HNSCC were entered in this study. Thirty-two (91%) had Stage IV, and 3 had Stage III disease. The mean nodal diameter, in patients with clinically involved nodes (83%), was 6.3 cm. The median Karnovsky performance status was 70. The treatment consisted of a twice daily schedule (BID) giving 62 Gy in 20 days. RESULTS: In all cases, confluent mucositis was observed, which started about day 15 and resolved within 6 to 10 weeks. Eighty percent of patients had enteral nutritional support. The nasogastric tube or gastrostomy was maintained in these patients for a mean duration of 51.8 days. Eighteen patients (53%) were hospitalized during the course of treatment due to a poor medical status or because they lived far from the center (mean 25 days). Nineteen patients (56%) (some of whom were initially in-patients) were hospitalized posttreatment for toxicity (mean 13 days). Five patients (15%) were never hospitalized. During the follow-up period, 12 local and/or regional failures were observed. The actuarial 18-month loco-regional control rate was 59% (95% confidence interval, 45-73%). CONCLUSIONS: The dramatic shortening of radiation therapy compared to conventional schedules in our series of very advanced HNSCC resulted in: (a) severe acute mucosal toxicity, which was manageable but required intensive nutritional support in all cases; and (b) high loco-regional response rates, strongly suggesting that the time factor is likely to be critical for tumor control in this type of cancer.

Aged↗
PubMed1995

Tumor vascularization, mitotic index, histopathologic grade, and DNA ploidy in the assessment of 114 head and neck squamous cell carcinomas.

BACKGROUND: Quantification of tumor vascularization recently has been shown to a parameter of potential clinical significance. Several basic and clinical studies have demonstrated that tumor growth correlates significantly with angiogenesis. METHODS: To determine the utility of quantification of tumor vascularization and mitotic index for the pathobiologic assessment of head and neck squamous cell carcinoma, a prospective study of 114 consecutively recruited primary neoplasms was performed. Tumors were also studied for differentiation, keratinization, nuclear atypia, growth pattern, inflammation, desmoplasia, vascular tumor emboli, and DNA content. RESULTS: In this cohort, tumor vascularization was correlated with mitotic index (P < 0.001), nuclear grade (P = 0.03), presence of tumor emboli in the peripheral microvessels (P = 0.05), and lymph nodal status (P = 0.03). A strong relationship between poor differentiation and high N classification (P < 0.001), differentiation and keratinization (P < 0.001) and tumor cell emboli and clinically involved lymph nodes (P = 0.01) was also observed. Emboli were more rare in laryngeal and oropharynx/oral cavity tumors than in hypopharynx/epilarynx (P = 0.02). CONCLUSIONS: This study indicates that tumor vascularization, differentiation, and tumor emboli in peripheral microvessel network are important histologic parameters in the assessment of squamous cell carcinoma of the head and neck.

Adult↗
PubMed1995

[Pretherapeutical evaluation of cancers of upper respiratory and digestive tracts].

Pretreatment work-up in cancer of the upper aerodigestive tract should follow precise guidelines and chronology. In addition to assessment of the tumoural area, attention should be directed to the general condition of the patient and to any associated pathology. Clinical assessment of the region involved will define the localisation and extension of the tumour, its functional impact and its extension to the cervical lymph nodes. This work-up should immediately be followed by imaging study, today mainly CT scan and magnetic resonance imaging or echography. Only after these examinations are completed should panendoscopy be initiated. Its performance is essential. Routine use of this examination has led to the demonstration of the high number (up to 20% of cases) of second tumours which are underestimated in the first examination. Appropriate therapeutic indications and, in large part, the future health of the patient, depend on the proper performance of this initial work-up.

Endoscopy, Digestive System↗
PubMed1995

[Reconstruction by free jejunal transplant after circular pharyngolaryngectomy (functional results and survival)].

One hundred and ninety seven patients with cancer of the hypopharynx underwent after circular resection, reconstruction with a free jejunal graft. The quality of free jejunal grafts is controlled by many investigations: clinical examination, radiography, electromyography, fibroscopy with biopsy. These investigations show that technically jejunal grafts must be short and linear to give the best functional results. Average resumption of oral intake was 14 days. Oral feeding was possible in 92% of cases. The free jejunal grafts with microsurgery are one of the more reliable procedures for reconstruction of pharynx and cervical esophagus after resection for cancer. (2 post-operative deaths and 8 grafts necrosis on 197 cases). The cumulative survival rate of 5 years was 35% for free jejunal graft. Survival depends on selection of the patients for local and nodes invasion. The quality of survival has improved. This operation must be reserved for the hypopharyngeal cancers which need a circular resection and do not invade the esophagus. The surgery is performed for a curative aim. The distant follow up of the patients is imperative: consultation every four months and then every six months: clinical examination, endoscopic, E.N.T., bronchial, and esophageal investigation. Chemotherapy and radiotherapy have specific indications.

Adult↗
PubMed1994

Correlation between p53 gene expression and tumor-cell proliferation in oropharyngeal cancer.

The aim of our study was to analyze the correlation between tumor-cell kinetics measured in vivo and p53 gene expression in a series of 49 oropharyngeal cancers. The duration of the S phase (TS), the labelling index (LI) and the potential doubling time (Tpot) were obtained by flow-cytometry measurements of a tumor biopsy obtained after i.v. injection of 200 mg bromodeoxyuridine into patients. An adjacent section of the same samples was studied by immunohistochemistry for the detection of p53 protein. Over-expression of the p53 protein, as defined by strong p53 immunostaining of tumor nuclei, was found in 23/49 of the samples. Aneuploid tumors showed a higher LI, a shorter Tpot and a higher proportion of p53 gene over-expression. A significant correlation was seen between p53 over-expression and short Tpots. Indeed 87.5% of the tumors with a very short Tpot (< or = 3 days) had p53 over-expression, as compared with 27% of tumors with a longer Tpot (> 3 days). Our data strongly suggest that over-expression of the p53 gene is associated with rapid tumor-cell proliferation in this type of cancer.

Aged↗
PubMed1994

Accelerated radiation therapy in the treatment of very advanced and inoperable head and neck cancers.

PURPOSE: A Phase II trial testing a continuous and accelerated regimen of radiotherapy in very advanced head and neck cancers. METHODS AND MATERIALS: From 1988 to 1990, 47 patients with very advanced and inoperable tumors (38/47 T4) of the oral cavity and the oropharynx were submitted to a continuous and accelerated regimen of hyperfractionated radiation therapy: three daily fractions of 0.9 Gy were delivered 5 days-a-week, up to the 70 Gy total dose, reducing the overall treatment time to 5.5 weeks. RESULTS: Immediate tolerance was good: only 56% of the patients experienced a Grade 3 mucositis, and the mean weight loss was 2 kg. The 2-year survival rate was 24.6%. The 2-year local control rate was 42.6%, which compares favorably with the 20% local control rate obtained in a historical control group of patients treated with another hyperfractionated regimen between 1978 and 1986. Mid- and long-term tolerance were excellent, no late complication or sequellae were observed which was also quite different from our previous experience. CONCLUSION: These results suggest an improvement of the local control and the therapeutic ratio with acceleration of radiotherapy in head and neck cancers.

Adult↗
PubMed1994

Surgical salvage treatment of T1/T2 glottic carcinoma after failure of radiotherapy.

PURPOSE: To evaluate the use of conservative surgical salvage techniques (eg, vertical partial laryngectomy and subtotal laryngectomy with cricohyoidopexy) versus total laryngectomy for radiotherapeutic failure of early glottic cancer by retrospective review of medical records. PATIENTS AND METHODS: Of 950 previously untreated endolaryngeal carcinomas managed at the Gustave-Roussy Institute in France between 1975 and 1984, 259 of 344 early glottic cancers (T1, N0 and T2, N0) received radiation therapy. Local failure rates were 14% in T1a cancers, 16% in T1b cancers, and 36% in T2 cancers with normal vocal-cord mobility. RESULTS: Nine of 54 patients with treatment failure were ineligible for salvage surgery. Among the remaining 45 patients, 35 underwent a total laryngectomy; these patients had a 77% 5-year survival rate. Ten patients treated with partial surgery (6 vertical partial laryngectomies and 4 subtotal laryngectomies with cricohyoidopexy) had a 100% survival rate at 5 years. Seven of the 10 patients treated with partial surgery had healing problems that delayed canula and nasogastric tube removal for 30 to 60 days. CONCLUSIONS: Salvage surgery is effective for radiotherapeutic failures of early glottic cancers. In some cases, partial surgery can be performed with good tumor control and satisfactory laryngeal functions. Subtotal laryngectomy is an alternative to total laryngectomy if vertical partial surgery is not suitable.

Disease-Free Survival↗
PubMed1994

Lymph node prognostic factors in head and neck squamous cell carcinomas.

BACKGROUND: This retrospective study included 914 patients who underwent a lymph node dissection at our institute between 1980 and 1985. The primary tumor sites were oral cavity, 287; hypopharynx, 249; larynx, 247; and oropharynx, 131. PATIENTS AND METHODS: On the basis of anatomic considerations, the sentinel nodes for well-lateralized oral cavity tumors were defined as homolateral levels I, II, and III; for oropharyngeal, hypopharyngeal, and laryngeal tumors, the sentinel nodes were defined as levels II and III. We took into account the ipsilateral side of the neck for well-lateralized tumors, and both sides for medium or large tumors. For clinically positive nodes of more than 3 cm, a radical neck dissection was performed. Other patients underwent a selective neck dissection on sentinel nodes, with immediate pathologic evaluation. Modified radical neck dissections with contralateral selective dissection were performed when frozen sections were positive. Patients with positive nodes were given postoperative radiotherapy. RESULTS: The prognostic factors studied, using the Cox survival model adjusted on the primary tumor site, surprisingly showed a nonsignificant value for extracapsular spread (P = 0.09), and a significant value for the number of positive nodes (P < 0.001) and for the positive node in or out of the sentinel node sites (P < 0.001). Although the node location factor can be used instead of positive node in or out of the sentinel node site, it has a less significant prognostic value. CONCLUSIONS: The most significant prognostic factors are the site of the positive node in or out of the sentinel node and the number of positive nodes; and a more accurate approach can be obtained by combining both factors. Node location in the upper or lower neck remains a substitute prognostic factor for the site of the positive node in or out of the sentinel node.

Carcinoma, Squamous Cell↗
PubMed1994

Rapid tumor cell proliferation after induction chemotherapy in oropharyngeal cancer.

Tumor cell kinetics were studied in vivo in a series of 97 patients with oropharyngeal cancer. The duration of S phase (tS), the labeling index (LI), and the potential doubling time (Tpot) were obtained by flow cytometry measurements of a tumor biopsy obtained after intravenous injection of 200 mg 5-bromodeoxyuridine to the patient. The mean LI was 9.7% (standard deviation [SD], 5.4), the mean tS was 10.1 hours (SD, 3.6), and the mean Tpot was 4.6 days (SD, 3.5). No significant relationship was found between the Tpot or LI and the size of the tumor, nodal status, histological grade, or the site of the primary within the oropharynx. Conversely, aneuploid tumors had longer tS (P < .001), higher LI (P < .001), and shorter Tpot (P < .05) than the diploid tumors. The mean LI and Tpot of the tumors obtained after induction chemotherapy were significantly higher and shorter, respectively, than those measured before any treatment. The data strongly suggest that rapid tumor cell proliferation frequently occurs in oropharyngeal cancer which had responded poorly to chemotherapy.

Aged↗
PubMed1994

Tumor oxygenation after 1) carbogen and/or perflubron emulsion administration in tumor xenografts 2) carbogen administration in patients.

This study examines the changes in tumor pO2 distribution assessed by polarography (KIMOC 6650, Eppendorf) in 1) two human tumor xenografts after carbogen inhalation with or without a perflubron (perfluorooctylbromide) emulsion (Oxygent, Alliance Pharmaceutical corp.) and in 2) human head and neck carcinomas after carbogen inhalation. Mice bearing HRT18 or NA11+ tumors were restrained and their body temperature was kept constant. Perflubron emulsion (4 ml/kg) was injected i.v. in the mice. In patients, oxygenation of the head and neck metastatic lymph nodes was assessed before and/or during carbogen exposure. The distribution of pO2 values shifted upwards during carbogen exposure in both animals and patients while the proportion of low pO2 values decreased. The maximal effect was obtained with patients after 1 to 6 minutes of carbogen exposure, but 4 patients still maintained very low pO2s. Carbogen plus 4 ml/kg perflubron emulsion was more efficient than carbogen alone for increasing hypoxic tumor pO2 in animals. If the animals data could be extrapolated to humans, then the effect of carbogen on tumor oxygenation should be increased by perflubron emulsion administration.

Administration, Inhalation↗
PubMed1994

[The subscapular combined free flap. Original technique].

Combinations of subscapular pediculated flaps have been used in recent years. These single pedicle flaps include the latissimus dorsi, the serratus, the scapular crest and the ortho and para-scapular skin flaps. Together these flaps comprise a combined subscapular transplant. This combined flap is particularly important since the different components provide great spatial flexibility. Complex and massive pluri-tissular substance losses can thus be reconstructed. We report our work in anatomy and techniques. We found variations in the origin of the subscapular pedicle in 25% of the cases in our anatomy study (50 cases). We recommend dissection of the vascular pedicle via the axillary route first. Thus necessary adaptations can be made as a function of the variations observed. This combined flap can be removed with the patient in supine position. The fact that the position of the patient does not have to change is essential for cervicofacial surgery performed by two teams. The pedicle of the cutaneous scapular flaps is dissected starting ventrally. Since 1990, we have performed 15 combined subscapular transplantations for cervicocephalic reconstructions.

Humans↗