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Biomedical subjects

C Chastang

Publications and source records attributed to C Chastang.

At least 199 records · Page 11Linked to original sources
PubMed1984

Adjuvant immunotherapy with nonviable Mycobacterium smegmatis in resected primary lung carcinoma. A randomized clinical trial of 219 patients.

Two hundred and nineteen patients with resected lung carcinoma were randomized 3 weeks after surgery between two treatment arms: a control group (110 cases) and an immunotherapy group (109 cases). The immunostimulant was a nonviable saprophytic mycobacterium, M. smegmatis, given monthly by subcutaneous injection in four sites. The two groups were equivalent in terms of prognostic factors, including a nonsignificant difference favoring the control group based on the N (node) classification. This interim analysis was carried out on June 1, 1981. Treatment comparison by the log-rank test did not show any significant differences between these two groups in regards to disease-free interval and overall survival. There was no significant difference between the two groups after stratification of the comparison according to the N classification or adjustment with a subset of eight prognostic parameters through the Cox model. The initially expected difference (20% 1-year survival) will probably not be achieved, given these interim results, but patients will continue to be treated and followed-up according to the protocol as to allow further evaluation of this nonspecific immunotherapy.

Adult↗
PubMed1984

[Negative results of a randomized therapeutic trial of nonspecific immunotherapy in primary, surgically-treated non-small cell bronchial cancer].

Between March 1978 and May 1981, 219 patients suffering from non-small cell primary bronchial carcinoma underwent surgical excision which was intended to be curative. Three weeks later the patients were randomised into two groups: 1. A control group, with no other treatment following excision (110 patients). 2. A non-specific immunotherapy group (109 patients). The immunostimulant used was an aqueous suspension of heat killed mycobacterium smegmatis administered subcutaneously once a month. The trial was analysed on December 1, 1982. There were 117 recurrences and 112 deceased. There was no significant difference as regard survival without relapse or overall survival; all causes of death were included.

Adenocarcinoma↗
PubMed1984

[Establishment of a 2-stage prognostic classification of primary malignant melanoma derived from a multidimensional analysis and from an agreement study].

Slides of 198 patients with primary malignant melanoma have been reevaluated independently by three pathologists; considered parameters were histologic type, Clark's level and tumor thickness. The agreement between pathologists is excellent, especially for histologic type and thickness. The use of the Cox's regression model, dealing with disease free interval as response criterion, shows that the main prognostic factor is tumor thickness, whatever the pathologist. A prognostic staging is thus proposed, based only on the tumor thickness, less than 2 mm, greater than 2 mm. The prognostic value of this staging is confirmed on a new sample of 145 patients. This classification is used as decision tool in a new randomized clinical trial.

Clinical Trials as Topic↗
PubMed1984

Chronic myelomonocytic leukemia according to FAB classification: analysis of 35 cases.

Thirty-five patients who fulfilled the FAB diagnosis criteria of chronic myelomonocytic leukemia (CMML), i.e., myelodysplastic features, monocytosis over 10(9)/liter, bone marrow monocyte infiltration, blast cells less than 5% in the peripheral blood and less than 30% in the bone marrow, are analyzed. CMML appears as an entity distinct from myelodysplastic and myeloproliferative disorders. Splenomegaly, anemia, thrombocytopenia, leukocytosis with monocytes and granulocytic cells in all stages of development, increased blood and urine lysozyme levels without renal failure, and polyclonal hyperimmunoglobulinemia are its main clinical and biologic features. With conventional cytotoxic drugs (6-mercaptopurine, hydroxyurea), the prognosis of CMML appears poor (median survival 475 days). None of the clinical hematologic or biologic parameters tested had a significant effect on prognosis. As other chemotherapy trials seemed necessary, we recently administered small doses of cytosine-arabinoside (ARA-C) to six patients over several consecutive days and obtained a complete remission in four. These preliminary results must be confirmed by larger series using the diagnostic criteria proposed by the FAB cooperative group.

Aged↗
PubMed1983

[Inoperable primary bronchial cancers: treatment by chemotherapy combinations including cis-platinum].

Sixty-seven assessable patients with advanced primary bronchial carcinoma of the epidermoid or large cell undifferentiated type (37 with non-resectable stage III Mo and 30 with stage III M1) were included in two prospective non-randomized phase 2 chemotherapeutic trials. Thirty-five received a COPAC-type regimen and 32 were treated with a COPAB-RT protocol combining a COPAC-type chemotherapy with local radiotherapy. Both combination therapies contained cis-platinum. With either of these treatments the major response rate averaged 45% and the median survival rate was about 9 months. However, a significant (p = 0.03) difference in survival rate was elicited between the population of treated patients and a control group of 30 untreated patients of similar age, stage and histology (mean survival in controls: 5 months). Both chemotherapeutic regimens were regarded as reasonably well tolerated. These results suggest that platinum-based combination chemotherapy is effective in these carcinomas.

Adult↗
PubMed1983

Critical assessment of routine preoperative investigations.

The use of routine investigations is widespread in medical practice, particularly for preoperative assessment. Recent studies showed that some routine preoperative investigations are uninformative when ordered without a clinical indication. The rationale for preoperative investigations includes emphasis on history taking and clinical examination, as well as specific targets correlated to the surgical situation. Investigations could fall into three broad categories: discretionary tests which complete clinical history, baseline tests for interpretation of anticipated perioperative disturbances and screening tests for conditions affecting perioperative morbidity and mortality. Each investigation should answer a specific question and the result should influence decision-making. Application of these principles should lead to elimination of unnecessary tests and better utilization of medical information but further studies are needed for evaluation of such strategies.

Clinical Laboratory Techniques↗
PubMed1982

Poor-prognosis acute lymphoblastic leukemias.

Burkitt's-type leukemias have specific cytologic, immunologic, and cytogenetic characteristics. Initial symptomatology frequently includes abdominal tumors and initial CNS involvement. Despite intensive treatment including high-dose cyclophosphamide, prognosis remains poor in most patients because of failures to achieve complete remission (CR) or because of early relapses, especially CNS relapses. Class III acute lymphoblastic leukemia in children is defined by the presence of two or more unfavorable parameters and recent progress has been achieved by intensive therapy. Cox's multifactorial analysis allows improved discrimination. A phase I protocol for increased-risk leukemias, including testis preventive irradiation and monthly reinductions without continuous maintenance for the first 6 months of CR, seems promising.

Adolescent↗
PubMed1981

[Autoimmune thrombocytopenic purpura. Clinical and therapeutic retrospective study of 544 cases (author's transl)].

A retrospective study of 544 patients with autoimmune thrombocytopenic purpura showed that 81 had immunological abnormalities (antinuclear factors and/or positive direct Coombs; test and/or anti-smooth muscle antibodies). After one year, 58-8% of all patients were still in complete remission, irrespective of treatment. The outcome of the disease was studied in relation to therapeutic regimens. Prognosis was worst in patients with immunological abnormalities, since 11% died as compared with 4% of the whole patient population. Most relapses occurred during the first two years following remission.

Adolescent↗
PubMed1981

A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis.

Survivals of two series of CLL patients (99 from a retrospective series and 196 from a prospective series) were studied separately. The three main staging systems (Rai, Binet, Rundles) agreed well, but as far as survival is concerned, too many stages are defined. The authors performed a Cox multivariate analysis of survival in order to isolate important prognostic factors at diagnosis and to use them to build a simple three-stage classification. Thrombopenia and anemia appeared as the most important risk factors. Among the nonanemic and nonthrombopenic patients, the number of involved areas was clearly related to prognosis in the authors' two series. This study allowed the authors to propose a new classification in three prognostic groups. Group C: anemia (Hb less than 10 g) and/or thrombopenia (platelets less than 100,000/mm3); about 15% of the patients; median of 2 years. Group B: no anemia, no thrombopenia, three or more involved areas (counting as one each of the following: axillary, cervical, inguinal, lymph nodes, whether unilateral or bilateral, spleen and liver); about 30% of patients; median of 7 years. Group A: no anemia, no thrombopenia, less than three involved areas; about 55% of patients; the survival of this group does not seem different from that of the French population of the same age and sex distribution. This three-stage classification only requires clinical examination and routine hemogram, has a good prognostic value which was confirmed on the series of Montserrat and Rozman (146 patients), and should therefore be helpful in planning new clinical trials.

Aged↗
PubMed1981

[Parenthood diagnosis within a family. II. Determination of an optimal sequence of genetic markers (author's transl)].

The rapid discovery of new markers systems makes it impossible for financial reasons to study the polymorphism determination of all known genetic markers when dealing with parenthood problems. We propose to use the percentage of rejected subjects with respect to the (mother, children) set as a decision tool to define a sequence which provides the maximum information for the minimum cost. This decision rule is evaluated with a sample of 150 families whose polymorphism is determined on the same sequence of 20 genetic markers.

Family↗
PubMed1980

[Acute monoblastic leukaemia. Clinical data and therapeutic results in 74 patients (author's transl)].

Seventy-four patients with acute pure monoblastic leukaemia treated between 1970 and 1978 were studied retrospectively. The disease was usually hyperleucocytic and tumoral in character. It occurred with equal frequency in subjects of both sexes and at all ages, with peaks at the two extremes of life. Rubidazone gave a high percentage (75%) of complete remissions, but the prognosis remained sombre, with a mean survival time of 200 days. The incidence of meningeal relapses was reduced by prophylactic measures at central nervous system level, but gingival and cutaneous relapses were frequent. The possibility of bettering the present modest therapeutic results by more intensive chemotherapy is discussed.

Adolescent↗
PubMed1980

Chemotherapy--radiotherapy association in Hodgkin's disease, clinical stages IA, II2A: results of a prospective clinical trial with 166 patients.

One hundred sixty-six patients with clinical stages IA, II2A Hodgkin's disease were treated between April 1972 and December 1976 with three courses of multiagent chemotherapy (methylchlorethamine, vincristine, procarbazine, prednisone) followed by mantle irradiation--excluding mediastinum for those with initial upper cervical presentation and absence of mediastinal involvement--or inverted Y radiotherapy. None had staging laparotomy. With a follow-up of 12--84 months, median 40 months, the overall survival is 93.5% and the overall relapse-free survival 89.9%. Eight patients died, three of them with evident disease. Ten patients relapsed; four are now free of disease after retreatment. With chemotherapy-radiotherapy sequence, staging laparotomy is not indicated. Results and side effects of this treatment strategy are compared with those of other treatment policies.

Adolescent↗
PubMed1980

High risk acute lymphocytic leukemia: a study of 141 cases with initial white blood cell counts over 100,000/cu mm.

The cases of one hundred and forty-one patients (85 males, 56 females) treated for hyperleucocytic acute lymphocytic leukemia (H-ALL) were reviewed. In all cases the initial white blood cell count was over 100,000/cu mm. One hundred patients (71%) attained complete remission (CR). The median duration of CR was six months and the median survival was nine months for all patients and 11 months for those who attained CR. Age, initial hemoglobin, and the height of initial white blood cell count over 100,000 had no significant prognostic value. Relapses occurred earlier in patients with a mediastinal mass. The results depended on the treatment used. With modern treatment, including more intensive chemotherapy and central nervous system prophylaxis, CR rate increased from 65% to 81% and median duration of CR improved from four months to ten months. The most important prognostic difference was related to the sex: CR rate was higher (78.5% vs. 66%) and median duration of CR and hematological remission was longer for females (nine months vs. six months and ten months vs. 6.5 months, respectively). This difference only appeared with modern treatments, however: before 1972 the median duration of CR was four months for both sexes, and after 1972, it was eight months for males and 17 months for females. This difference could be explained by the site of the first relapse, which was testicular in only 2% of cases before 1972 and 27% (47% of the males who relapsed) after 1972.

Adolescent↗
PubMed1980

Acute monoblastic leukemia: a clinical and biologic study of 74 cases.

Seventy-four cases of pure acute monoblastic leukemia (AMol) have been retrospectively studied. All patients were treated at Hospital Saint-Louis between 1970 and 1978. Diagnosis was based on morphological and cytochemical features according to the FAB classification. This type of leukemia occurred at any age and in both sexes, with a high frequency of extramedullary involvements. Hyperleukocytosis was very frequent and was significantly correlated with increased blood and urine levels of lysozyme, with renal failure and hypokalemia, and with coagulation abnormalities. AMol still has a poor prognosis, despite a best remission rate (75%) obtained with rubidazone, since the duration of complete remission was short. Central nervous irradiation prolonged remission and prevented meningeal relapses, while 6 meningeal relapses occurred in the patients not irradiated. The high frequency of the extramedullary relapses, including gum and skin, emphasized the question of persistant blast cell sanctuaries after achievement of bone marrow remissions. A more intensive induction with several drugs active against monoblasts could be more efficient and prolong the duration of complete remissions.

Adolescent↗
PubMed1980

[Maxillary cancer. A retrospective study of 239 cases (author's transl)].

A study of the distribution of these cancers demonstrated that they were mainly epidermoid carcinomas (144 cases), cylindromas (38 cases), and sarcomas. The series included 58% of male patients, but the percentage of women is high because of the predominance of muco-epidermoid epitheliomas and hematosarcomas in female patients. Age distribution was identical for both sexes. The period between the first sign and the diagnosis varied according to the histological type (5 months for epidermoid carcinoma, 10 months for the cylindromas, and 28 months for muco-epidermoid epitheliomas). The initial examination revealed the presence of palpable glands in 40% of the cases with epidermoid cancer of the gums, as against 25% of those with facial epidermoid carcinomas. Survival rate after 5 years was 33% for epidermoid cancer, 72% for cylindromas, and 15% for muco-epidermoid epitheliomas. For epidermoid carcinomas, survival was related to their size (56% for T1, 52% for T2, 30% for T3, and 16% for T4). No significant differences in relation to the site of the lesion were found. The incidence of glandular invasion is of the greatest importance. All N3 cases died within 30 months. In fact, two categories of patients can be conveniently distinguished; those with T1, T2, T3, NO who have an overall mean survival rate of 68% after two years, and all the other cases with a mean survival rate of 28%.

Adult↗