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Biomedical subjects

D Peiffert

Publications and source records attributed to D Peiffert.

66 records · Page 4Linked to original sources
PubMed1994

Brachytherapy for lower lip epidermoid cancer: tumoral and treatment factors influencing recurrences and complications.

From 1972 to 1991, 237 patients with squamous cell carcinoma of the lower lip were treated by exclusive LDR brachytherapy (192Ir). There were 158 T1, 61 T2, 17 T3 and 1 T4 with 231 N0, 3 N1 and 3 N2 patients. The actuarial values at 5 years for local and regional controls, overall and specific survivals were 95%, 91%, 74% and 91%. Salvage treatment increased local control up to 99% and regional control to 94%. No heterolabial recurrence has been observed since the entire lip is treated, even for small tumors. The regional control depends closely on the thickness of the labial tumor (> or = 1 cm, p < 0.0001). The healing of treatment-induced mucositis is sometimes delayed for thick tumors (> or = 1 cm, p = 0.015). Late complications are not related to tumoral thickness but to the treated thickness (> 1.4 cm, p = 0.018) and particularly to the thickness of normal tissue included in the 85% isodose (treated thickness - tumoral thickness > 0.4 cm, p = 0.025). The use of a leaded protection and low linear radioactivity wires (< 2 mCi/cm, < 8.6 muGy/h.m2/cm) especially for large target volumes is required to lessen late complications. Based on this review, we advocate exclusive brachytherapy for small and intermediate tumors, with elective bilateral submaxillary and submental dissection for thick, high grade or commissure tumors. Simple recommendations are made to assure quality of the brachytherapy treatment.

Actuarial Analysis↗
PubMed1994

Pre-operative, post-operative and exclusive irradiation of endometrial adenocarcinoma.

PURPOSE: Surgery is the golden standard of treatment of endometrial carcinoma. The risk of central or vaginal recurrences justifies adjuvant treatment. METHODS: Brachytherapy for endometrial adenocarcinoma is given commonly as pre- or post-operative treatment. In case of medical contra-indications for surgery brachytherapy can be applied as the only treatment. Experience of the anticancer center Alexis Vautrin in Nancy of the years 1975 to 1988 is evaluated. Iridium-192 low-dose-rate (LDR) wires were used. RESULTS: Pre-operative brachytherapy was given with a vaginal mould applicator to 580 patients. The dose was 50 Gy at 0.5 cm below the surface of the vagina. The locoregional control rate was 93% after 5 years and the 5-year survival 82%. 139 patients received radiotherapy alone and no surgery. LDR-brachytherapy was given the upper third of the vagina and endometrium with an "umbrella" applicator. The locoregional control rate was 83% after 5 years and the survival rate 55%. 117 patients received a post-operative brachytherapy of the vagina. The locoregional control rate was 93% after 10 years and the survival rate 65%. CONCLUSION: A pre- and post-operative radiotherapy results in a reduction of the vaginal relapse rate. The LDR afterloading technique with primary radiotherapy of endometrial adenocarcinoma leads to a locoregional control slightly interior. The treatment results compare favourably with the best of the literature.

Adenocarcinoma↗
PubMed1991

[Mixed mullerian tumours of the endometrium. Retrospective study, with prognostic aims, comparing their evolution to that of adenocarcinomas of the endometrium].

Mixed Mullerian Tumours (MMT) of the endometrium have a bad reputation as far as prognosis is concerned. We have studied 34 cases of MMT treated between 1976 and 1988 and have compared their outcome with a matched series of 68 cases of adenocarcinoma (ADC). These were taken out of 880 cases of ADC treated during this period of time after matching them for the stage, the type of treatment, the year of treatment and the age of the patient. The curves of survival and the totals of survival were determined using Kaplan-Meier's method and also compared using Logrank's test. The 5-years overall survival was 18% for MMT as against 55% for ADC (p less than 0.001). The difference was equally significant statistically in terms of specific survival without recurrences. The 16 patients in stages I and II who were treated with the same protocol as used for ADC were matched against 32 cases of ADC taken out of the 680 cases ADC in stages I and II and treated by the same protocol (84%). After five years MMT had a higher number of survivors (35% overall, 45% with specific survival and 35% without recurrences), but the difference with survival of ADC was as significant (respectively 75, 85, 85%). Recurrences of MMT were frequent (62%), with metastases in 9 out of 10 and early (50%), in every respect opposed with recurrences of ADC (16%) which were in three out of five cases localized and late (after 10 months). These figures make one have to think of modifying the way MMT is treated. External pelvic radiotherapy should be carried out before any other treatment. The place for other methods of therapy is to be discussed.

Adenocarcinoma↗
PubMed1989

[Immediate hematological toxicity during combination chemotherapy-radiotherapy of Hodgkin's disease].

The hematologic immediate toxicity during radiotherapy for Hodgkin's disease was studied from a series of 72 patients with stage IIB or III who received 3 courses or more of chemotherapy before radiotherapy. The toxicity in the group of 36 of them who received total nodal irradiation (TNI) was the most important. Sixteen of the 28 TNI had irradiation interrupted, 12 of them began with inverted Y type. The blood cells count at the beginning of the treatment was crucial; only 16% of the patients had interruption of irradiation when the blood cells count was normal; on the other side, 63% had interruption when the blood cells count was abnormal (P less than 0.05). Toxicity was due to the daily destruction of the dividing bone marrow stem cells located in the irradiated area, from the first day of treatment; there was a progressive decrease in the pool of these stem cells within a late resaturation. The absence of resaturation of this pool after initial chemotherapy and after the first part of irradiation explained the immediate and durable toxicity; in the same way, inverted Y irradiation destroyed a great part of active bone marrow (40%) and the pool of remaining stem cells with high mitotic index would be located in areas irradiated subsequently. So, waiting for the absolute normalisation of blood cells count before beginning irradiation and start irradiation by mantle field (rather than inverted Y) seem to be the 2 measures able to reduce the number of interruptions of irradiation due to hematotoxicity.

Adolescent↗
PubMedDate not supplied

[High dose endobronchial brachytherapy: a curative treatment].

PURPOSE: New endobronchial techniques of treatment allow a good unblocking. Nevertheless, only high dose rate brachytherapy delivers a curative treatment for invasive carcinomas. This study analyses the results of the first 33 consecutive patients treated with curative intent by this technique from 1994 to 1997, and followed-up more than one year. PATIENTS AND METHODS: Thirty-seven lesions were treated, with usual schedule delivering 30 Gy at 1 cm depth in six fractions and three to five weeks. All the patients were meticulously selected on the local involvement of the tumour and absolute contraindications to a surgical treatment. All of them have a pulmonary disease history or a general contraindication. RESULTS: With a 14-month follow-up, the local control at two months after the treatment was 95% (endoscopic and histologic), and 90% of the patients presented a prolonged local control. Four patients died of the treated cancer, another of a controlateral cancer. Ten patients died of another disease, five of them from a respiratory insufficiency. The overall survival rate at two years was 53% and the specific survival rate 80%. The acute tolerance was good, without incident. Asymptomatic bronchial stenoses, described by endoscopic follow-up, were described for seven patients. CONCLUSION: We conclude that, on the basis of a good selection of the patients and a respect of the indications, high dose rate endobronchial brachytherapy is an effective curative treatment. It offers a new curative option and must be proposed for the small invasive carcinomas in non-operable patients.

Brachytherapy↗
PubMedDate not supplied

[Brachytherapy in France in 1995. Final results of the national survey].

A survey questionnaire was sent to the 189 French departments of radiation Oncology and 166 responded by brachytherapy and 358 shielded rooms were available. In Low Dose Rate (LDR) 81 departments used Cesium sources (159 afterloaders, 1,060 sources). Iridium wires were used by 84 departments (673 meters used). Only six departments used other elements. Twenty-six departments were equipped with high dose rate after loaders (HDR) all of them also using LDR techniques for most of the patients. A total of 9,160 patients were treated: 7,868 with LDR and 1,292 with HDR. The common sites treated by LDR were uterovaginal (4,300), breast (1,415), head and neck (1,049), skin (610), anorectal (220) and urologic (70). HDR was used for vaginal cuff (628), bronchi (371), oesophagus (232). PDR just started (33 patients) for a feasibility trial. The rate of patients treated by brachytherapy is around 6-8% of the irradiated patients, but the indications vary is each department. The diffusion of the techniques, and new indications should increase the number of patients being treated by brachytherapy.

Brachytherapy↗
PubMedDate not supplied

[Tolerance and role of irradiation in the treatment of epithelial cancer of the ovary].

PURPOSE: In a retrospective analysis, our aim was to evaluate the immediate tolerance and the early and late complications of abdomino-pelvic radiotherapy in the Centre Alexis-Vautrin (France). PATIENTS AND METHODS: From 1st January 1983 to 31st December 1993, 117 patients were treated at Centre Alexis Vautrin in Nancy for epithelial ovarian cancer by abdominal and/or pelvic irradiation after surgery. They were aged from 24 to 85 with a median of 56 years. There were ten patients with stage I (9%), 28 patients with stage II (24%), 60 patients with stage III (61%) and 19 patients with stage IV (16%) disease. Results of surgery were determined as follows: satisfactory with absence of tumoral residuum in 26% cases (30 patients) and with residuum inferior to 20 mm in 46% cases (52 patients; incomplete in 26% cases (31 patients) either because of residuum superior in 20 mm and/or incomplete surgery; and not evaluable in 3% cases (four patients). Seventy-seven patients were sent to the Centre for postoperative treatment (66% patients of the series), 48 of them (62.4%) after non-satisfactory surgery, 29 after satisfactory surgery (37.6%). Chemotherapy was administered to only 104 patients (89% cases), and contained platinum salts and cyclophosphamid for 87% of these patients. Fourteen patients (12%) received a single irradiation dose after surgery: three in stage I, three with poor evaluation of the disease in the initial stage, three with medical contraindications to chemotherapy treatment, six with contraindications due to advanced age (?? Makes 15 ). Histologically, 46% of patients had a serous adenocarcinoma, 9% a mucinous adenocarcinoma, 11% an endometrioid adenocarcinoma, 2% a clear cell adenocarcinoma, 1% an undifferentiated adenocarcinoma, and 31% an epithelial carcinoma without any other indication. The histological grade which was recently introduced was rarely indicated. Complementary radiotherapeutic treatment consisted of pelvic irradiation for 14 patients (12%), abdomino-pelvic irradiation for 63 patients (54%), and total abdominal irradiation with a pelvic boost for 40 patients (34%). RESULTS: The immediate tolerance to irradiation can be considered as globally satisfactory since 9% of the patients (ten cases) had no problems and 64% of the patients developed a minor intolerance easily controlled by symptomatic treatments. There were also digestive complications: nausea, vomiting and diarrhea for 66% of the patients (50 cases); to a lesser extent, 20% of the cases experienced associated digestive and hematological complications (15 patients); 9% isolated hematological troubles such as anemia (seven patients); 4% digestive complications (three patients) and 1% hematological and urinary digestive troubles (one patients). Late irradiation sequelae were evaluated for 89 patients with a follow-up lasting from 4 months to 11 years. Sixty-six patients had no sequelae, eleven patients had minor tolerability problems--mainly digestive for more than half of them. Five patients presented severe complications, including hematological problems such as chronic thrombopenia in two cases, urinary-problems in two other cases, and one patient presented with a case of histologically proven malabsorption. Two patients presented major problems; one case of radic cystitis and one of radic bowel. Two patients died of iatrogenic causes: one of induced leukemia, the other of treatment-induced digestive and renal complications. The overall survival rate was 30% at 5 years and 22% at 10 years. It was 90% at 5 and 10 years for stage I patients, 60% at 5 years and 30% at 10 years for stage II patients, 22% at 5 years and 8% at 10 years for stage III patients, and finally 10% at 5 years for stage IV patients. CONCLUSION: In this retrospective analysis of 117 epithelial ovarian cancers, treated over 10 years and which all received pelvic and/or abdominal irradiation, we can conclude that this treatment is globally well tolerated and that it yields a

Adenocarcinoma↗
PubMedDate not supplied

[Low-dose postoperative vaginal brachytherapy of adenocarcinoma of the endometrium].

PURPOSE: Surgery is the primary treatment for endometrial carcinoma. Methods of complementary treatment are still debated, with the potential association of external radiotherapy and/or brachytherapy before or after surgery. This study was aimed at evaluating local control and complications rates in a series of patients treated by hysterectomy followed by postoperative vaginal low-dose rate brachytherapy (BT) combined with pelvic irradiation in case of poor prognosis factors. PATIENTS AND METHODS: From 1978 to 1993, 101 patients were treated at the Centre Alexis-Vautrin, France according to this scheme. Forty five had deep myometrial invasion, and thirteen cervical involvement. Fifty patients received pelvic irradiation (median dose 46 Gy) combined with BT (dose 14 Gy, median volume 127 cm3); 51 patients had BT alone (dose 60 Gy, median volume 71 cm3). RESULTS: The 5-year overall survival rate was 83% and the local control rate 97% with a median follow-up of 7 years. Multivariate analysis showed two factors of bad prognosis, i.e., deep myometrial invasion and cervical involvement. Three severe complications occurred in two patients for whom the treated volume was larger than the theoretical target volume. Eleven patients developed metastases. CONCLUSION: Results obtained from this series are comparable with those of previous studies, particularly in regard to pre-operative BT. The complication rate is also satisfactory and depends on the irradiation precision and the definition of the target volume.

Adenocarcinoma↗
PubMedDate not supplied

[Radiotherapy in leukemia excluding total body irradiation].

Radiation techniques and indications in leukemias have been described in detail, yet prophylactic cranial irradiation in acute leukemia still has few indications. Cerebrospinal and testicular irradiation are reserved for relapsing disease. Radiation usually results in rapid functional improvement when used in neurologic emergencies and symptomatic neurologic or gross tumors relapses. Nevertheless, the improvements recently obtained by systemic chemotherapy have resulted in the reduction in the use of irradiation, especially in children, where it was considered deleterious with neuropsychological sequellae. Splenic irradiation remains useful for symptomatic myeloproliferative syndrome.

Adult↗