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Biomedical subjects

B Luboinski

Publications and source records attributed to B Luboinski.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Total esophagoplasty using a double pedicled free graft from the jejunum: the last resort].

After repeated failures of classic oesophagoplasties (gastroplasty and coloplasty) a last chance reconstruction could rely on a free jejunal transplant. We report an exceptional and original case where digestive tract was re-established between the orostoma and the epigastric antrum. The patient has four neoplasms in the throat, thoracic oesophagus. After circular pharyngolarynectomy and total oesophagectomy, all the usable vascularized plasties had necrosed. The ultimate reconstruction was performed with a free jejunal transplant carrying two vascular bundles revascularized with the cervical vessels and the internal thoracic vessels. Several recommendations are proposed: Save as much of the digestive tube as possible; preserve the physiological gastroduodenal circuit; redissect the residual plasty in order to raise the new one as high as possible; perform a sub-cutaneous insertion of the residual plasties and the jejunal transplant; and if the loss of digestive substance is greater than 30 cm, a long free jejunal transplant with two vascular bundles should be used.

Adult↗
PubMed1993

Electrochemotherapy, a new antitumor treatment. First clinical phase I-II trial.

BACKGROUND: Electrochemotherapy is a new antitumor treatment consisting of electrical pulses administered to the tumor several minutes after intravenous injection of bleomycin. In mice, important antitumor effects were observed on subcutaneously transplanted tumors and on spontaneously occurring mammary carcinomas. Cures were obtained after one single treatment combining bleomycin and electric pulses. In humans, permeation nodules seemed an adequate oncologic situation to assay this new procedure. The authors report the first Phase I-II trial of electrochemotherapy. METHODS: Eight patients with 40 permeation nodules of head and neck squamous cell carcinomas were treated with 10 mg/m2 bleomycin intravenous bolus, followed by four or eight short (100 microseconds) and intense (1300 V/cm) pulses administered through two external electrodes located on each side of the treated nodule. RESULTS: An instantaneous painless contraction of the underlying muscles was regularly observed. Neither local nor general side effects were observed, and electrochemotherapy was well tolerated. In addition, a clear local antitumor efficacy was found: 23 (57%) nodules were in clinical complete response within a few days. CONCLUSION: The absence of toxicity, the good tolerance by the patients, and the net antitumor effects observed are encouraging for additional electrochemotherapy developments in clinical oncology.

Adult↗
PubMed1993

In vivo measurement of the potential doubling time by flowcytometry in oropharyngeal cancer treated by conventional radiotherapy.

PURPOSE: Experimental and clinical studies suggest that the pre-treatment potential doubling time could be predictive of tumor control in patients treated by conventional radiotherapy and could help to identify the rapidly growing tumors for which accelerated radiotherapy is required. METHODS AND MATERIALS: To test this hypothesis, we studied prospectively 48 patients with a squamous cell carcinoma of the oropharynx and treated by conventional radiotherapy (70 Gy/7 weeks). The duration of S phase, the labeling index and the potential doubling time were obtained by flowcytometry measurements of a tumor biopsy obtained after injection of 200 mg bromodeoxyuridine to the patient. RESULTS: Three parameters were significantly associated with an increased risk of relapse namely the tumors size (T4; p < 0.01), the nodal status (> or = N2; p < 0.05) and the site of the primary within the oropharynx (p = 0.08). The S phase, labeling index, DNA index and potential doubling time were not significantly associated with an increased risk of relapse. However when considering only the T2 subgroup of patients, high labeling indexes and short potential doubling time were associated with an increased risk of relapse: the mean pre-treatment potential doubling time of the tumors which relapsed was 3.21 versus 5.5 days when there was no evidence of local relapse (p < 0.05). The mean labeling index for the group of tumors associated with a tumor recurrence was 11.7% compared to 7.3% when there was no evidence of relapse (p = 0.02). CONCLUSION: Factors other than proliferation play a role in determining the outcome of oropharyngeal cancers treated by conventional radiotherapy. However there was a significant correlation between short potential doubling time, high labeling index and tumor recurrence in the T2 subgroup of patients. The finding of significance for potential doubling time and labeling index in the T2 subset of tumors may be a reflexion of the more homogeneous nature of these tumors with regard to prognostic variables.

Aged↗
PubMed1993

Oxygenation of head and neck tumors.

BACKGROUND: Tumor hypoxia could play a role in the response to radiation therapy. Few data are available on oxygen tension (pO2) measurements in head and neck tumors. METHODS: The KIMOC-6650 Histograph (Eppendorf, Hamburg, Germany) was used to measure the oxygenation status of normal tissues and head and neck tumors in 20 patients. RESULTS: The median pO2 for normal tissues was 43 mmHg with very low pO2 values (2.0 mmHg or less) recorded in two patients. Low median pO2 levels (10 mmHg or less) were recorded in 2 of 5 primary tumors and in 11 of 15 metastatic lymphadenopathies, with very low values in 11 nodes. The median pO2 in tumors was lower than that of normal tissues in 12 of 15 patients with comparative measurements. Oxygen tension was recorded in three nodes after an evaluation of tissue density (by computed tomographic scanner); in two nodes, the mean and median pO2 values were lower in the hypodense areas than in isodense areas. The data for N2 and N3 nodes showed significantly more values below 2.0 mmHg as nodal size increased (P < 10(-4), by chi-square test). No systematic decrease in pO2 was recorded from the periphery to the center of the tumors. CONCLUSIONS: Very low pO2 values, corresponding to radiobiologic hypoxia, were found in most of these tumors. The prognostic value of these pO2 measurements in regard to treatment response remains to be demonstrated.

Adult↗
PubMed1993

Principles and techniques of irradiation for the N0 neck.

The absence of palpable lymph nodes is one of the important elements in the choice of treatment of head and neck cancers. Irradiation of the neck represents one possible treatment chosen on the basis of historical, clinical and biological arguments. Currently available techniques for irradiation at the Gustave Roussy Institute are reviewed.

Head and Neck Neoplasms↗
PubMed1993

Changes in the oxygenation of head and neck tumors during carbogen breathing.

The oxygenation of head and neck tumors and changes during carbogen breathing were assessed in 20 patients. The median oxygen tension (pO2) for each patient was lower in tumors before breathing carbogen than in normal tissues. The median pooled pO2 of all the tumors was 20 mmHg; for normal tissue it was 60 mmHg. Low values (below 10 mmHg) were found in 4 patients for the normal tissue and in 18 patients for tumors. During carbogen breathing, the median (61 mmHg) pO2 readings for all tumors was higher than that recorded before carbogen breathing. The frequency of low (< 10 mmHg) pO2 values decreased with carbogen breathing in 11 patients; only 4 patients still exhibited very low values (< 2 mmHg). Maximal effect was obtained within 1-6 min of gas exposure. The pO2 stayed high under carbogen breathing in 15 out of 16 patients. Return to pre-carbogen levels of oxygenation occurred in 1 min after the end of gas exposure. These data suggest that carbogen breathing increases tumor oxygenation as assessed by polarography. The breathing time appears to be important for therapeutical use and should to be taken into consideration.

Adult↗
PubMed1993

Principal xenobiotic-metabolizing enzyme systems in human head and neck squamous cell carcinoma.

To better understand drug and carcinogen metabolism pathways in head and neck squamous cell carcinoma we assayed the principal drug- and carcinogen-metabolizing enzyme systems in both tumors and their corresponding adjacent non-tumoral tissues. Cytochromes P450 (1A1/A2, 2B1/B2, 2C8-10, 2E1, 3A4), epoxide hydrolase and glutathione S-transferases (GST-alpha, GST-mu, GST-pi) were assayed by immunoblotting. GST activity, total glutathione, UDP-glucuronosyltransferase, beta-glucuronidase, sulfotransferase and sulfatase, were determined by spectral assays. Results showed the absence of all probed cytochromes P450 in tumors and non-tumoral tissues, including P450 1A1/1A2 known to be involved in tobacco-related carcinogenesis. No statistical difference was noted between tumors and adjacent non-tumoral tissues for most enzymes studied (GST-alpha, GST-mu, GST-pi, GST activity, UDP-glucuronosyltransferase, beta-glucuronidase, sulfotransferase and sulfatase). However, total glutathione concentrations were significantly higher (P < 0.05) in tumors (47 +/- 20 nmol/mg protein) than in non-tumoral tissues (19 +/- 9). On the contrary, epoxide hydrolase was significantly less expressed in tumors (18 +/- 9 micrograms/mg protein) compared to corresponding non-tumoral tissues (37 +/- 9). These data provide new information concerning human head and neck cancer biology that could possibly have clinical implications.

Carcinoma, Squamous Cell↗
PubMed1993

Rhabdomyosarcoma of the head and neck in adults: a study of 26 patients.

The clinical records of 26, predominantly male, adults with rhabdomyosarcomas in the head and neck were analyzed. Patients' ages ranged from 18 to 74 years (mean: 24.5 years). According to the retrospective clinical group classification, 18 (69%) of 26 were advanced tumors at initial presentation belonging to group III or IV. The ethmoids were the most common primary site of origin in 12 (46%) of 26 patients. Nodal and systemic metastases were noted in 12 (46%) and 6 (23%) patients, respectively. Bone metastases were noted in 4 patients. Heterogeneous treatment protocols were used with a variety of chemotherapy combinations in most cases, with surgery and radiotherapy. Overall results were poor, with a survival rate of 7.6% at 5 years. Neither histopathology nor response to chemotherapy was found to influence survival. All long-term survivors belonged to the early-stage groups (clinical groups I and II) for which complete surgical excision was possible. In spite of a poor prognosis after relapse, the use of aggressive chemotherapy appeared to prolong life in some patients.

Adolescent↗
PubMed1993

Keratins 6, 13 and 19. Differential expression in squamous cell carcinoma of the head and neck.

One hundred forty-one head and neck squamous cell carcinomas were analyzed for keratin (K) 6, 13 and 19. Staining was evaluated by light microscopy (with or without grading) and image analyzer and expressed as a percentage of positive versus all tumor surface (PSA). Both techniques rendered strongly correlated results. Strong expression was noted in 108 carcinomas (76.1%) for K6, in 18 (12.7%) for K19 and in 21 (14.8%) for K13 (P = .001). One hundred thirty-six (96%) tumors were positive for K6, and their PSA ranged from 0.6% to 48.8%; K19, 48 cases (0.2-44%); K13, 59 (0.2-38.1%). Expression of K6 was related to differentiation. K19 was expressed mainly in moderately and poorly differentiated tumors, and K13 was manifest more in well-differentiated carcinomas or in keratinized areas of less-differentiated ones. Nineteen (13.38%) tumors were positive for both K13 and K19. K19 thus was related to tumor progression and K13 to differentiation. There was no correlation with tumor site or TNM category.

Adult↗
PubMed1993

[Induction chemotherapy in T1 and T2 tumors of the tonsillar area].

Tumors of the tonsillar Fossa classed T1T2 are generally treated by irradiation with high rates of local control. Patient survival is related to the risk of developing distant metastatic disease and second head and neck cancers. The use of induction chemotherapy for squamous cell carcinoma of the head and neck gives a high rate of clinical tumor response and for this reason, it is increasingly used in standard treatment regimens. However, the long term results in terms of improved local control and improved survival (from a decreased rate of metastases) has not been clearly demonstrated. In addition, the toxicity of primary chemotherapy is not negligible. After review of the literature, the role of induction chemotherapy should be evaluated only in reference to randomized trials.

Carcinoma, Squamous Cell↗
PubMed1993

Prevertebral fascia flap in hypopharyngeal reconstruction: a preliminary report.

Ablative surgery for pyriform sinus cancer often leaves a defect which cannot be closed primarily. Many techniques for hypopharyngeal reconstruction have been described but no single technique can be recommended for use in all situations. The prevertebral fascia flap described in this article provides an alternative to hypopharyngeal repair when a more complex technique is contra-indicated. It is a one stage procedure, fashioned with locally available tissue, and technically simple. Its use in two anecdotal cases is described herewith.

Cervical Vertebrae↗
PubMed1992

[Epidermoid cancers of the operated esophagus. High incidence of associated neoplasia].

In a retrospective study we counted the number of neoplasias associated with oesophageal epidermoid cancer, as we thought that their frequency and influence on treatment had been underestimated. Between 1982 and 1990, 181 patients underwent surgery of oesophageal epidermoid cancer. The global actuarial 5-year survival rate was 20.7 percent (28.8 percent after complete excision of the tumour). The mean follow-up period was 4.2 +/- 2.6 years. These 181 patients had a total of 324 cancers, 97 percent of which were cancers of the upper respiratory and digestive tracts. The frequency of associated cancers was 56 percent (102 out of 181), and 50 percent of the patients presented with at least one associated head and neck cancer. Twenty-two percent of the patients had been treated for another cancer before the oesophageal epidermoid cancer, and in 19 percent of the cases this was a head and neck cancer. Thirty-five percent had a malignancy that was contemporary with the oesophageal cancer (this malignancy affected the head and neck in 18 percent of the cases and consisted of multiple lesions in 25 percent). During the short period under study, in only 10 percent of the patients did a cancer develop after the oesophageal one, and 6 percent of these affected the head and neck. This high incidence of associated neoplasia was due to tobacco and alcohol abuse. The presence of multiple cancers should alter as least as possible the treatment required by each associated cancer in order to optimize the chances of complete cure. Close surveillance of the high-risk population may result in the early discovery of a 2nd cancer at a curable stage. For the time being, the prevention of such associated cancers relies more on daily administration of retinoids than on alcohol and tobacco abstinence which is difficult to obtain.

Adenocarcinoma↗
PubMed1992

Salvage surgery by composite resection for epidermoid carcinoma of the tonsillar region.

Radiation therapy has usually been used as the primary treatment of squamous cell carcinoma of the posterior aspect of the oral cavity and the lateral aspect of the oropharyngeal walls. However, local failure occurs in a certain number of cases, depending on the initial tumor stage. One hundred thirty-four composite resections (transmaxillary buccopharyngectomies) have been performed as a salvage treatment at the Institut Gustave-Roussy, Villejuif, France, from January 1, 1976, through December 31, 1985, for local failure of epidermoid carcinomas treated initially by radiotherapy. Average time between primary irradiation and salvage surgery was 18 months. Most of the patients underwent some kind of supraomohyoid neck dissection. A myocutaneous flap was used in 18% of cases, which significantly reduced the rate of local complications. The nasogastric tube and the tracheostomy cannula were removed after a median delay of 23 days and 24 days, respectively. Early postoperative local complications occurred in 45% of cases; most of them were minor. A new locoregional recurrence occurred in approximately half of the patients and was usually fatal. Overall survival after salvage surgery was 34% at 3 years and 23% at 5 years. The only statistically significant prognostic factor was the adequacy of surgical margins.

Adult↗
PubMed1992

True carcinosarcoma of the larynx.

A case of carcinosarcoma of the larynx and pyriform sinus with sarcomatous and epithelial malignant components is described in a 68-year-old male. The primary site was composed of spindle-shaped malignant mesenchymal cells with osteosarcomatous and chondrosarcomatous differentiation intermingled with areas of well differentiated squamous cell carcinoma, tubular and papillary adenocarcinoma, and trabecular neuroendocrine carcinoma. The metastatic lymph node showed squamous cell carcinoma and chondrosarcoma. Immunohistochemical studies showed that keratin was present in epithelia cells and negative in sarcoma, whereas vimentin and S-100 protein were present in sarcoma, but negative in carcinoma. Neuron-specific enolase was present in the neuroendocrine part of the tumour.

Aged↗
PubMed1992

Adenoid cystic carcinoma of the head and neck: evaluation with MR imaging and clinical-pathologic correlation in 27 patients.

Twenty-seven adenoid cystic carcinomas (ACCs) of the head and neck in 27 patients were evaluated in a retrospective study based on findings at magnetic resonance (MR) imaging and pathologic and clinical examination. Clinical follow-up was obtained over a mean period of 6.3 years (range of follow-up, 3 months to 17 years); all patients underwent one to seven MR examinations. On T2-weighted images, lesions with low signal intensity corresponded to highly cellular tumors (solid subtype) with a poor prognosis; lesions with high signal intensity corresponded to less cellular tumors (cribriform or tubular subtype) with a better prognosis. MR images were not specific in differentiation of ACCs from other types of tumors; this result underscores the need for biopsy to ensure correct diagnosis. Local, intracranial, osseous, and perineural invasion was depicted, but because of its lack of specificity, MR imaging caused overdiagnosis of tumor extension, particularly perineural spread and bone abnormalities.

Adolescent↗
PubMed1992

Neoadjuvant chemotherapy in multiple synchronous head and neck and esophagus squamous cell carcinomas.

A consecutive series of 22 patients with multiple synchronous squamous cell carcinomas of the upper aerodigestive tract was retrospectively reviewed. These patients were treated initially with cis-platinum combination chemotherapy before definitive locoregional therapy (surgery and/or radiation therapy). Sixteen of 21 patients had simultaneous head and neck and esophageal primaries, 3 patients had multiple synchronous head and neck primaries, 2 patients had head and neck (HN) and a bronchial epidermoid cancer, and 1 patient had simultaneous esophageal and bronchial carcinomas of epidermoid lineage. Sixteen (77%) of the 21 patients responded to chemotherapy in all the tumor sites evaluated, and a clinically complete response was obtained in 6 (29%). After definitive locoregional treatment, the complete local control rate was 68%, with 34 complete responses for 50 primary tumor sites in 21 patients. Twelve patients were free of disease after locoregional treatment. Six patients are still alive 27 to 57 months after complementary definitive locoregional treatment and a minimum follow-up of 27 months. Median survival for the overall group is 17 months. The response to chemotherapy is remarkable, which may be due to the small tumoral volume present in many of the cases (T1 to T2). Nevertheless, the present report stresses the importance of an aggressive combined therapeutic approach in this difficult clinical situation.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

[Free myocutaneous flap of the latissimus dorsi in cervicofacial surgery].

Free myocutaneous latissimus dorsi transplants are exceptionally used in cervicofacial surgery. The authors have performed an anatomical study of 23 non-embalmed subjects, using injections of neoprene latex and barium sulfate into the axillary artery and dye injections. Dissections, arteriographs and corrosion show that the lower scapular pedicle is constant, with an average length of 9.5 cm and a caliber that is sufficient for vasuclar microsurgery. Eight patients with large T4 cervicocephalic neoplasms were operated, including two with tongue tumors, one with a tumor of the oropharynx, two oromandibular lesions, two lesions of the maxillary sinus and a neuroblastoma involving the middle level of the facial structures. A free myocutaneous latissimus dorsi transplant was used. The transplant was revascularised by neck vessels using microsurgical techniques. Complete success was obtained in all eight patients. Good functional, cosmetic and morphological results were obtained as a rule. In cervicofacial surgery, the authors have thus chosen and used a free myocutaneous latissimus dorsi transplant in three topographic indications: for the oropharynx, to fill large cavities, especially the maxillary sinus, and to fill the middle level of the facial structures and of the base of the skull.

Adult↗