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C Haie-Meder

Publications and source records attributed to C Haie-Meder.

At least 37 records · Page 2Linked to original sources
PubMed2001

Results of conservative treatment in epithelial ovarian carcinoma.

BACKGROUND: The objective of this study was to assess and evaluate the clinical outcome and fertility in patients treated conservatively for epithelial ovarian carcinoma (EOC). METHODS: Thirty-one patients treated with conservative management EOC were followed up. Optimal surgical staging was performed in 2 cases during the initial surgery and in 27 patients during a reassessment surgery. Six patients underwent hysterectomy during this restaging surgery. RESULTS: Among 25 patients treated conservatively after the restaging surgery, the International Federation of Gynecology and Obstetrics (FIGO) staging distribution was 19 Stage IA (Grade 1, n = 9; Grade 2, n = 10), 1 Stage IC, 2 Stage II, and 3 patients with initial stage unknown. Seven patients had recurrence (five on the remaining ovary). The disease free survival rate at 5 years for patients with Stage IA Grade 1 and 2 tumors were 89% and 71%, respectively. All patients with Stage IA or higher disease experienced recurrence. Only four pregnancies (three spontaneous and one after in vitro fertilization procedure) were obtained. CONCLUSIONS: Conservative surgery for patients with EOC could be considered in young patients with Stage IA Grade 1 disease adequately staged and desiring to preserve fertility potential. This procedure should not performed in patients with disease staged higher than FIGO Stage IA.

Adolescent↗
PubMed2001

[Evaluation and treatment of cervical cancer].

Tumour stage, tumour size and nodal status are the most important prognostic factors in cervical cancer. Treatment of invasive cervical carcinoma consists of radio-surgical combination, exclusive radiation therapy or exclusive surgery in favourable cases. Radical hysterectomy with lymphadenectomy (pelvic +/- para-aortic) is the reference technical surgery in stage IB and II cervical carcinoma. Conservative surgery can be discussed in young patients with stage IB1 disease. Radiotherapeutic treatment is based on a combination of external irradiation and brachytherapy, with concomitant chemotherapy when bad prognostic factors are present. This treatment represents the reference treatment in advanced stages. Total dose, overall treatment time are important prognostic factors of survival and local control. Pelvic exenteration with reconstructive surgery could be discussed in young patients with centro-pelvic recurrence of a cervical carcinoma.

Adult↗
PubMed2001

Prognostic significance of epithelial disorders adjacent to invasive vulvar carcinomas.

OBJECTIVE: Epithelial disorders are found adjacent to vulvar carcinoma in 70-80% of patients. Epithelial disorder may be human papillomavirus related [undifferentiated high-grade vulvar intraepithelial neoplasia (VIN III)] or not [vulvar lichen sclerosus and squamous cell hyperplasia with or without atypia (differentiated VIN III)]. The aim of this study was to evaluate the impact of associated epithelial disorders on the outcome of patients with cancer of the vulva. METHODS: A retrospective study about 108 patients treated for a squamous cell carcinoma of the vulva was performed. Clinical, surgical, histopathologic, and follow-up data were collected and analyzed. RESULTS: Seventy-seven patients had an epithelial alteration adjacent to the invasive squamous carcinoma. Squamous cell hyperplasia and lichen sclerosus were identified in 48% (n = 52) and undifferentiated VIN III in 23% (n = 25). The 5-year disease-free and overall survival rates were 39 and 55%, respectively. In univariate analysis, age <70, a tumor size <2 cm, depth of invasion < or =1 mm, tumor thickness < or =5 mm, negative lymph node pathology, lymph node resection, and undifferentiated VIN III were predictive of survival. Using Cox's proportional hazards method, undifferentiated VIN III (P = 0.02), depth of invasion < or =1 mm (P < 0.01), and a pathological negative node status (P < 0.01) were independent predictors of survival. Patients without associated epithelial alterations had clinical and prognostic features comparable to those of patients with vulvar lichen sclerosus and squamous cell hyperplasia. CONCLUSION: The results of this study support the view that histological evidence of epithelial alterations adjacent to invasive carcinoma can serve to separate patients that differ in terms of prognosis.

Adult↗
PubMed2001

Ovarian metastasis on transposed ovary in patients treated for squamous cell carcinoma of the uterine cervix: report of two cases and surgical implications.

BACKGROUND: To discuss risk factors for ovarian metastasis in a transposed ovary in patients treated for cervical cancer. CASES: Cases were two patients with ovarian metastasis in a transposed ovary in a series of 107 patients. These two patients were treated for a Stage IB squamous cell cervical cancer and presented with a tumor devoid of extrauterine spread (absence of nodal involvement or distant metastases) but with involvement of the uterine corpus. Furthermore, lymphovascular space involvement (LVSI) in the cervix or paracervix was present in both patients. CONCLUSIONS: Ovarian transposition should be performed in patients < or =40 years of age with a small invasive cervical carcinoma (< 3 cm) treated by primary surgery. This procedure should not be performed in patients with bulky tumor and/or in patients with LVSI.

Adult↗
PubMed2001

Retroperitoneal drainage after complete Para-aortic lymphadenectomy for gynecologic cancer: a randomized trial.

OBJECTIVE: To determine the relationship between retroperitoneal drainage after complete para-aortic lymphadenectomy for gynecologic cancer and subsequent development of lymphocysts. METHODS: Eighty women undergoing complete para-aortic lymphadenectomy up to the level of the left renal vein for ovarian (n = 43) or cervical carcinoma (n = 37) were randomly assigned to receive drainage or no drainage of the para-aortic area. Most of patients had pelvic drainage. Abdominopelvic ultrasonography was done 8 to 12 days after surgery. Postoperative complications, duration of hospital stay, and characteristics of asymptomatic lymphocysts were studied. RESULTS: Forty-two women had para-aortic drainage and 38 did not. Complications occurred in 15 patients who had drainage and in 5 patients who did not have drainage (36% versus 13%; P <.02). Three patients (8%) in the undrained group had complications potentially related to drainage (symptomatic lymphocysts or ascites) compared with 11 (26%) in the drained group (chi(2) = 4.6; P <.05). Median duration of the hospital stay was 9 days in the undrained group and 11 days in the drained group (P <.03). The number of asymptomatic para-aortic lymphocysts detected during the ultrasonography was 9 (24%) in the undrained and 2 (5%) in the drained group (chi(2) = 4.6; P <.05). CONCLUSIONS: The number of asymptomatic para-aortic lymphocysts was higher in patients who did not undergo drainage, but morbidity and the duration of hospitalization were increased in these patients. Routine drainage of the retroperitoneum after para-aortic lymphadenectomy should be abandoned.

Adolescent↗
PubMed2001

Value and cost evaluation of routine follow-up for patients with clinical stage I/II endometrial cancer.

The aim of the study was to determine the value and the costs of routine follow-up for the detection of recurrences in patients treated for endometrial cancer. Between 1986 and 1995, 390 women with clinical stage I/II endometrial carcinoma were treated with combined surgery-radiation therapy. After treatment, follow-up was based on the clinical examination, a systematic Papanicolaou (Pap) smear and radiography (chest X-ray and abdomino-pelvic ultrasonography). 27 patients relapsed: 22 patients had symptoms and 5 were asymptomatic. None of the patients had recurrence detected on the routine Pap smear nor on the systematic chest X-ray. In conclusion, the follow-up of patients treated for endometrial cancer based on routine Pap smears and systematic radiography does not permit earlier detection of recurrences. Follow-up should simply include a clinical examination whose frequency should be based on prognostic factors. Approximately two-thirds of this cost was due to systematic examinations (Pap smears and radiography). Our results indicate that such expenditure could be avoided.

Aged↗
PubMed2001

[Gross tumor volume and clinical target volume in brachytherapy of malignant tumors].

Tumours treated with radioactive implants are in most cases small and accessible to clinical examination or endoscopy. Gross tumour volume is consequently mainly determined clinically or with endoscopy. Imaging may also be useful, with classical techniques, as mammography, or with CT-scan or MRI. Clinical target volume includes gross tumour volume and a 5-10 mm margin. Distribution of dose is estimated on the basis of images performed after implantation, classically with two orthogonal films of the implant. It can then be optimised. Dose-volume histogram of gross tumour volume and critical organs can be obtained with a CT-scan or a MRI of the implant, which may be difficult to perform because of implantation material and dummy sources.

Brachytherapy↗
PubMed2001

Brainstem gliomas in adults: prognostic factors and classification.

In contrast to childhood brainstem gliomas, adult brainstem gliomas are rare and poorly understood. The charts of 48 adults suffering from brainstem glioma were reviewed in order to determine prognostic factors, evaluate the effect of treatment and propose a classification of these tumours. Mean age at onset was 34 years (range 16-70 years). The main presenting symptoms were gait disturbance (61%), headache (44%), weakness of the limbs (42%) and diplopia (40%). Four patterns were identified on MRI, representing non-enhancing, diffusely infiltrative tumours (50%), contrast-enhancing localized masses (31%), isolated tectal tumours (8%) and other patterns (11%). Treatment consisted of partial resection (8%), radiotherapy (94%) and chemotherapy (56%). Overall median survival was 5.4 years. On univariate analysis, the following favourable prognostic factors were identified (P< 0.01): age of onset <40 years, duration of symptoms before diagnosis >3 months, Karnofski performance status >70, low-grade histology, absence of contrast enhancement and 'necrosis' on MRI. On multivariate analysis, the duration of symptoms, the appearance of 'necrosis' on MRI and the histological grade of the tumour remained significant and independent prognostic factors (P< 0.05). Eighty-five percent of the tumours could be classified into one of the following three groups on the basis of clinical, radiological and histological features. (i) Diffuse intrinsic low-grade gliomas (46%) usually occurred in young adults with a long clinical history before diagnosis and a diffusely enlarged brainstem on MRI that did not show contrast enhancement. These patients were improved by radiotherapy in 62% of cases and had a long survival time (median 7.3 years). Anaplastic transformation (appearance of contrast enhancement, 27%) and relentless growth without other changes (23%) were the main causes of death. (ii) Malignant gliomas (31%) occurred in elderly patients with a short clinical history. Contrast enhancement and necrosis were the rule on MRI. These tumours were highly resistant to treatment and the patients had a median survival time of 11.2 months. (iii) Focal tectal gliomas (8%) occurred in young patients and were often revealed by isolated hydrocephalus. The course was indolent and the projected median survival period exceeded 10 years. In conclusion, adult brainstem gliomas are different from the childhood forms and resemble supratentorial gliomas in adults. Low-grade tumours have a clinicoradiological pattern that is so characteristic that the need for a potentially harmful biopsy is debatable. The optimum timing of treatment for supratentorial low-grade tumours remains unclear. In high-grade gliomas, the prognosis remains extremely poor despite aggressive treatment with radiotherapy and chemotherapy.

Adult↗
PubMed2000

High-dose-rate brachytherapy as sole modality for early-stage endobronchial carcinoma.

PURPOSE: To evaluate exclusive high-dose-rate brachytherapy for localized early-stage non-small-cell bronchial carcinoma; to develop new insights in treatment-catheter positioning and tumor-volume assessment by computed tomography (CT) scan. METHODS AND MATERIALS: Between 1992 and 1996, 34 patients with non-small-cell bronchial carcinoma were treated by brachytherapy alone. All patients were medically inoperable and had contraindications for external beam irradiation. The treatment protocol was six sessions of 5 Gy over 6 weeks. The treatment catheter was placed under fiberoscopy and was positioned with the help of spacer catheters or with a surrounding plastic tube; CT scan was performed in 50% of the cases to measure the spacing between the applicator and the bronchial wall. Dose prescription was individually based on clinical and radiologic evaluation of tumor volume. RESULTS: Local disease failure occurred in 5 patients (15%). With a median follow-up of 2 years, the local control rate was 85% and the survival rate 78%. No acute toxicity was found, except one pneumothorax. CONCLUSION: Brachytherapy alone can give an optimal therapeutic ratio in small endobronchial carcinomas without radiation-induced morbidity. Such results are achieved after careful tumor volume evaluation and individualized treatment catheter positioning.

Adult↗
PubMed2000

Analysis of clinicopathologic prognostic factors for 157 uterine sarcomas and evaluation of a grading score validated for soft tissue sarcoma.

BACKGROUND: Uterine sarcomas (US) are rare and carry a poor prognosis characterized by high rates of local recurrence and metastasis. The aim of this study was to test, for what the authors believe was the first time with US, the prognostic impact of the histologic grade validated by the French Federation of Anticancer Centers (FNCLCC) for soft tissue sarcomas (STS). The grade is the sum of the scores allocated for three major histologic criteria: tumor differentiation, mitotic count, and tumor necrosis. Other histologic and clinical factors were tested as well. METHODS: The study included 157 patients in whom 78 leiomyosarcomas (LMS), 52 malignant mixed müllerian tumors (MMMT), and 27 endometrial stroma sarcomas (ESS) were documented. RESULTS: The median follow-up was 54 months (range, 6-230 months). The median OS and EFS were 33 and 13 months, respectively. The FNCLCC grade validated in soft tissue sarcomas was not a prognostic factor for survival or relapse for any of the US histologic subtypes. For LMS, stage and mitotic count were the only factors that had an influence on survival and relapse. For MMMT, stage and age were the only prognostic factors, and none of the histologic criteria impacted on the outcome. For ESS, the grade defined by Norris and Taylor was an important prognostic factor, particularly for survival. CONCLUSIONS: The FNCLCC grading score could not be used as a prognostic indicator for uterine sarcomas. The diagnosis of US is in itself an unfavorable prognostic factor, except when the diagnosis is low grade ESS.

Adult↗
PubMed2000

Ovarian transposition for patients with cervical carcinoma treated by radiosurgical combination.

OBJECTIVE: To assess the indications, effectiveness, and complications of ovarian transposition before pelvic irradiation for cervical cancer. DESIGN: Prospective study. SETTING: Gynecologic oncology department at a French cancer center. PATIENT(S): One hundred seven patients treated for cervical cancer. INTERVENTION(S): Ovarian transposition to the paracolic gutters with radical hysterectomy and lymphadenectomy. MAIN OUTCOME MEASURE(S): Clinical and laboratory follow-up tests for ovarian function. RESULT(S): Bilateral ovarian transposition was achieved in 104 patients (98%). Twelve patients were lost to follow-up or excluded because of evolution of the disease. Preservation of ovarian function was achieved in 83% of the patients having follow-up. The rates of ovarian preservation were 100% for patients treated exclusively by surgery, 90% for patients treated by postoperative vaginal brachytherapy, and 60% for patients treated by postoperative external radiation therapy and vaginal brachytherapy. The main risk for ovarian failure was found in patients treated by external radiation therapy. CONCLUSION(S): Ovarian transposition is a safe and effective procedure for preserving ovarian function in patients treated by a radiosurgical combination. This procedure should be performed in patients <40 years of age with a small invasive cervical carcinoma (<3 cm) treated by initial surgery. In such selected cases, the risk of ovarian metastasis is low.

Abdominal Pain↗
PubMed2000

Neuroendocrine small cell carcinoma of the uterine cervix: what disease? What treatment? Report of ten cases and a review of the literature.

Neuroendocrine small cell carcinoma of the uterine cervix (NESCCC) is an entity with very aggressive behaviour. The optimal initial therapeutic approach to this rare disease has not yet been clearly defined. We reviewed our experience of this disease over the past 10 years with regard to chemosensitivity. Since 1988, ten patients (mean age 33 years; range 24-47) have been diagnosed with NESCCC and treated in our institutions. Disease stage at presentation was IA (one), IB (five, two with lymph node involvement), IIB (one), IIIB (one), and IV (two). One patient had metastatic disease at presentation; three developed metastases during initial treatment. Eight patients underwent surgery and eight received radiation therapy. Six patients received pre- or postoperative cisplatinumvepeside (PE) combination chemotherapy, either alone or concurrently with radiation therapy. PE alone as primary chemotherapy led to disease stabilization in the two patients so treated; concurrent PE and radiation therapy resulted in a pathological complete response in one patient. Eight patients relapsed within 16 months and died of their disease within 29 months from the initial diagnosis. Two patients are alive with no evidence of disease at 13 and 53 months. Our series confirms the previously described very poor prognosis of NESCCC, despite initial aggressive multidisciplinary treatment. It may be that the introduction of chemotherapy, especially combined primary chemoradiotherapy, might allow patients to do a little better, although at the moment there is no good evidence one way or the other.

Adult↗
PubMed2000

[Concomitant radiochemotherapy in cancer of the cervix uteri: modifications of the standards].

For a long time, combined external irradiation and brachytherapy has been considered as the standard treatment in patients with advanced cervical cancers. Recently, five clinical randomized trials assessing the role of cis-platin-based chemotherapy delivered concomitantly to radiotherapy have been conducted in the United States. Another clinical randomized trial assessing the role of epirubicin was conducted by the Queen Mary Hospital in Hong Kong. With more than 2,000 enrolled patients, these studies showed converging results with an overall and disease-free survival improvement in the arms combining cis-platin and epirubicin-based chemotherapy and irradiation. These combinations led to a significant decrease in loco-regional evolution or recurrence rates, or even in pulmonary metastases rates. The relative risk of recurrences was decreased by 50%. The relative risk of death was decreased by 40%. The differences, however, were less significant in patients with advanced stages III or IVA. Hematological and digestive acute toxicity was significantly higher in the radiochemotherapy groups, but long-term complications were comparable. The results of these randomized trials have led to a modification in the standard of treatment in these poor prognosis cervix cancers. Five of the randomized trials evidenced the superiority of cis-platin-based chemotherapy, but the optimal chemotherapeutic regimens remain to be defined.

Adenocarcinoma↗
PubMed2000

[Brachytherapy in the treatment of vesicoprostatic rhabdomyosarcomas in children].

Brachytherapy has been widely used at the Institut Gustave-Roussy since 1972 in pediatric oncology. In genitourinary rhabdomyosarcoma, because of its ballistic and physical characteristics, it represents the optimal treatment whenever irradiation is required and brachytherapy feasible. Between 1976 and 1998, 23 children with bladder or prostate rhabdomyosarcoma were treated with a protocol including brachytherapy, with five of them treated with a salvage brachytherapy. All but one brachytherapy was performed during the surgery. Among the 18 brachytherapies performed as a first-line treatment, eight presented a tumoral evolution: five presented a local evolution, one a local and nodal evolution and two a nodal evolution. Brachytherapy allowed a conservative treatment among ten out of 11 children alive with no evidence of disease. Among the five patients with salvage brachytherapy, two presented a second recurrence. Sequelae were minimal, consisting of one grade I rectitis and one asymptomatic vesical and ureteral reflux. These results are consistent with the published data using more radical treatment. Brachytherapy can represent an alternative to radical surgery, when indications are clearly defined in bladder or prostate rhabdomyosarcoma. This type of treatment can be performed only integrated with other treatments, more particularly with surgery. This approach requires a close cooperation between the different specialists: pediatricians, surgeons and brachytherapists.

Adolescent↗
PubMed1999

Interest of pelvic and paraaortic lymphadenectomy in patients with stage IB and II cervical carcinoma.

OBJECTIVES: The objectives of this study were to evaluate the interest and the potential therapeutic value of systematic pelvic and paraaortic lymphadenectomy in patients with stage Ib and II cervical carcinoma. METHODS: This was a prospective study including 421 patients with cervical cancer treated, from 1985 to 1994, by combined radiation therapy and surgery with systematic pelvic and paraaortic lymphadenectomy. RESULTS: The overall rate of pelvic lymph-node involvement was 26% (106 patients), and the rate of paraaortic metastases was 8% (32 patients). Pelvic nodal involvement was unilateral in 14% (59 patients) and bilateral in 11% (47 patients). Macroscopic positive nodes were found in 12% (52 patients). In a univariate analysis, a young age (<30 years), a tumor size >/=4 cm, stage II disease, and nodal involvement were associated with significantly decreased survival. The nodal status and the characteristics of positive nodes (number and location) were the most significant prognostic factors. In the multivariate analysis, age, the tumor size, and the site of nodal involvement (pelvic or paraaortic) were prognostic factors. Three-year survival was 94% for patients with negative nodes compared to 64% for patients with positive pelvic nodes and 35% for patients with positive paraaortic nodes (P < 0.0001). CONCLUSION: These results confirm the diagnostic and prognostic value of systematic complete lymphadenectomy when planning adjuvant treatment and the therapeutic value of complete removal of bulky positive nodes.

Adult↗
PubMed1999

How can laparoscopic management assist radiation treatment in cervix carcinoma?

PURPOSE: To determine the role of laparoscopic lymphadenectomy (pelvis +/- para-aortic nodes) and laparoscopic hysterectomy in cervical cancer compared to 'classic radical surgery' in patients undergoing surgery in comparison with modern imaging in patients treated with radiotherapy alone. MATERIALS AND METHODS: The limitations of modern imaging are presented as well as how complication rates can be increased when classic laparotomy is followed by radiation therapy. Laparoscopic procedures are described with particular emphasis on how to provide information on lymph node metastases with the risk of overlooking microscopic involvement. A number of clinical experiences are cited to illustrate this problem and show how treatment approaches can be adapted. RESULTS: The role of laparoscopy is evaluated according to different clinical situations and treatment protocols emphasizing the possibilities offered by this method to the radiotherapist. CONCLUSION: When developing laparoscopic techniques for the management of cervical carcinoma, caution must be exercised to ensure that these techniques are not detrimental to the prognosis.

Female↗