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Biomedical subjects

F Eschwege

Publications and source records attributed to F Eschwege.

At least 73 records · Page 4Linked to original sources
PubMed1990

Radiation therapy for head and neck cancers in the elderly.

Three hundred and thirty-one patients, aged more than 70 years, were treated for an upper aerodigestive tract carcinoma from 1978 to 1983. Larynx accounted for 28% of the primary sites, oropharynx for 27%, and the oral cavity for 16%. One-third of these patients had a contraindication to anesthesia. The treatment was consistent with our protocols in only half of the cases. Fifty-nine patients underwent a radiosurgical combination; 249 underwent an exclusive irradiation with a curative intent. Fifty-four patients underwent a palliative irradiation, which lead up to a "curative dose" in half of the cases. The immediate and long-term tolerance of the irradiation was good. The local control was 71% for patients treated with a curative intent and 19% for the palliatively irradiated patients. Five-year survival of the population was 33%. No significant relationship between age, general status, and the carcinologic outcome could be observed.

Aged↗
PubMed1990

[Combination radiotherapy and chemotherapy in the treatment of locally advanced adenocarcinoma of the pancreas. Experiences of the Gustave Roussy Institute].

Non-resectable pancreatic adenocarcinomas (PA) are of poor prognosis with median survival of 4-6 months. Radiotherapy (RT) and chemotherapy (CT) association are potential palliative treatments recently investigated. We have tested such an association in a pilot study. Twelve patients (pts) with non-resectable PA and localized tumors were treated by 2 cycles of CT (5-FU + adriamycin + cisplatinum) and then 2 or 3 split courses of RT (20 Gy/12 days and 8 fractions with a 16 day interval). CT was reintroduced, if initially active, for 3 cycles. Results were: 3 CR (11+, 13+, 16 months) for a response rate of 25%, 1 MR (4 months) and 5 stabilizations longer than 6 months. The 1 year survival was 56 +/- 15% with no patient surviving longer than 2 years. Tolerance was acceptable for RT and toxicity with CT was digestive (grade II) for all pts, leucopenia grade III for 3 pts and thrombopenia grade II for 2 pts. Two pts experienced digestive hemorrhage for anastomatic ulceration, responsible for death in one case. This pilot study confirms the transient efficacy of RT + CT association for non-resectable PA. However, the toxicity and treatment duration lead us to recommend other studies of less toxic association before initiation of randomized trials.

Actuarial Analysis↗
PubMed1990

[Predictive tests of radiocurability: towards a custom-made radiotherapy?].

Up to now, radiation oncologists had at their disposal only a number of well-known histological and clinical factors in order to define the optimal dose which should be delivered to a given tumor. Recently, radibiological studies have suggested additional parameters which may play a major role in tumor radiocurability. These parameters are: the number of clonogenic cells, intrinsic radiosensitivity, hypoxia and proliferation kinetics. "Predictive" tests are being developed and evaluated for each of these parameters. The more advanced studies deal with intrinsic radiosensitivity; preliminary data show impressive variations in radiosensitivity within groups of clinically "homogeneous" tumors. Should these tests prove to be reliably predictive of radiocurability, it will be possible, in the near future, to propose to any given patient a "custom-made radiotherapy" adapted to the precise features of his or her tumor.

Animals↗
PubMed1989

Undifferentiated carcinoma of nasopharyngeal type of tonsil.

A review of 2262 squamous cell carcinomas of the tonsillar region seen at the Institut Gustave-Roussy, Villejuif, France, from 1970 to 1986 showed 1837 well- and poorly differentiated squamous cell carcinomas and 425 undifferentiated squamous cell carcinomas. Eighteen patients with undifferentiated squamous cell carcinomas presented histologic characteristics of undifferentiated carcinomas of nasopharyngeal type. Radiosensibility and radiocurability (complete sterilization with 70 Gy administered) was found in this group with an excellent long-term control of local disease (77% at 10 years actuarial). Epstein-Barr virus-related serologic tests were performed for seven patients. Four of them presented the serologic anti-Epstein-Barr virus titer patterns, generally associated with undifferentiated carcinomas of nasopharyngeal type (1280 to 5120 for viral capsid antigen/IgG and 40 to 320 for viral capsid antigen/IgA). These observations confirm that undifferentiated carcinomas of the nasopharyngeal type may arise outside the nasopharynx.

Adult↗
PubMed1989

Radiation therapy in the treatment of early glottic carcinoma: the experience of Villejuif.

A retrospective analysis of 197 early glottic carcinoma treated with small field irradiation to a dose of 65 Gy is presented. The 5-year survival rate was 77.3%. Thirty-eight local failures have been observed, and the 5-year local control rate was 85.7%. Suspicion of extra glottic extension was the main prognostic factor. Final local control rate, taking into account the salvage treatment, was 90% at 5 years. Excellent functional results were observed.

Carcinoma, Squamous Cell↗
PubMed1989

Exclusive radiation therapy: the treatment of early tonsillar tumors.

One hundred and ninety-three T1 or T2 tumors of the tonsillar region have been treated by exclusive external irradiation between 1970 and 1982. Seventy-five percent of these tumors were classified as T2. There was no relationship between T and N stages. The nodal involvement was essentially linked to the macroscopic appearance of the tumor (superficial or nodular) and to the histology. The 5-year survival rate of the whole population was 58%. N stage and macroscopic appearance only influenced the survival. The local control was 88% for T1, 79% for T2. The main prognostic factors for local control were the histological type, with a 93% local control rate for poorly differentiated tumors versus 73% for well differentiated ones, and the macroscopic appearance, with a 83% local control rate for nodular tumors versus 75% for superficial ones. Superficial tumors spreading forward the anterior pilar have a higher local failure rate. All the patients' charts have been reviewed, and we observed a high percentage of marginal recurrences. The technique of irradiation, above all in case of a superficial tumor, must take into account the possibility of "geographic miss" and keep large safety margins.

Adult↗
PubMed1989

External irradiation plus curietherapy boost in 108 base of tongue carcinomas.

From 1960 to 1983, 108 patients underwent an association cobaltherapy plus curietherapy boost for a base of tongue carcinoma. This group included 18 T1 tumors, 39 T2, and 51 T3. Cobaltherapy was delivered to a dose of 45 Gy/4.5 weeks to the primary site and the neck. It was completed by an electron boost or a nodal surgery in case of initial nodal disease. Two techniques of Curietherapy were used: plastic tubes and guide-gutters. As most of these implants have been done before 1975, all the doses have been recalculated on the 85% isodose according to the Paris system. They varied from 22 to 88 Gy. The tolerance of the implantation was excellent. Five-year survival of the whole group is 26%. The local control rate is 85% for T1 tumors, 50% for T2, and 69% for T3. Despite the importance of cumulated doses, a few necrosis were observed. Considering the poor outlook of this cancer, its treatment by exclusive radiotherapy requires very high doses which can only be delivered without major sequellae or complication by a combination of cobaltherapy and curietherapy boost.

Adult↗
PubMed1989

[Invasive tumors of the bladder. A study of 56 cases treated at the Gustave-Roussy Institute by total cystectomy and radiotherapy].

Between July 1973 and December 1984, 56 patients with invasive bladder cancer were treated at the Gustave-Roussy Institute by total cystectomy and, generally, radiotherapy (45 patients). Four modalities of irradiation were used: preoperative flash (21 patients), preoperative flash and postoperative irradiation (9 patients), preoperative irradiation according to conventional fractionation (12 patients), postoperative irradiation (3 patients). The actuarial 5 year survival for all of the patients treated was 28%. The essential prognostic factors were depth of emboli. Analysis of the deaths revealed loco-regional recurrence in 8 patients (14%), metastases in 11 patients (20%) another cause in 14 patients (24%); treatment appeared to be directly involved in 13 cases. However, toxicity has been considerably reduced since 1980, due to more rigorous patient selection for total cystectomy, improvement in pre- and postoperative intensive care and by the use of a radiotherapy protocol no longer involving large concentrated fractions.

Adenocarcinoma↗
PubMed1989

[Focus on research and results of unusual radiotherapy technics (heavy particles, hyperthermia, radiosensitizers)].

Heavy particles have been used in transcutaneous radiotherapy for almost 50 years. If these particles and pi mesons remain the domain of highly specialized centers, neutron therapy and, to a lesser degree, proton therapy can be considered common clinical protocols; their limits, complications, efficacities and costs are sufficiently well known to encourage several centers to acquire the necessary equipment. Their practical advantages involve a limited number of patients however, for the patients implicated, the prognoses are appreciably improved by the application of these therapies. Hyperthermia-associated radiotherapy is limited by the poor technical capabilities of the currently available hyperthermia machines. If biological experimentation was highly promising, clinical results to date have been unfulfilling. Nonetheless, hyperthermia-associated interstitial radiotherapy represents an interesting clinical possibility. Radiosensitizers are being extensively developed. The results of randomized therapeutic trials are still contradictory and the toxicity of these products renders their use difficult. New products are being tested; their lower toxicity and potent radiosensitization capacity are encouraging for the future use of this class of compounds.

Helium↗
PubMed1989

[Radiotherapy of cancer limited to the vocal cords].

197 patients, with an early glottic cancer, were heated with radiotherapy at the Institute Gustave Roussy, between 1970 and 1983. Radiation was delivered up to a dose of 65 Gy over 6 1/2 weeks on a small area centered on the glottic region. All patients had previously undergone direct laryngoscopy and showed T1 stage tumours (175 T1a and 22 T1b) although in 32 cases there was a suspicion of very limited involvement of the ventricle or sub-glottis. 5 year survival for the overall population was 77.5%. 38 local recurrences were observed, 1/4 of these occurring after 3 years. For the overall population, local control at 5 years was 85.7%. Suspicion of supra or sub-glottic involvement and the presence of impaired mobility of the larynx were shown to be important prognostic factors. Local control at 5 years was 90% for "true T1" cases. Few complications were observed and the functional results of irradiation were judged to be excellent.

Adult↗
PubMed1988

Radiotherapy alone for oropharyngeal carcinomas: the role of fraction size (2 Gy vs 2.5 Gy) on local control and early and late complications.

This retrospective study involved 150 patients treated for oropharyngeal carcinoma by external radiotherapy alone at the Institut Gustave-Roussy. The midplane tumor dose was 70 Gy delivered in 7 weeks. During 1981, 63 patients were treated with 5 fractions (5 F) of 2 Gy per week. The following year, 87 patients, were treated with 4 fractions (4 F) of 2.5 Gy per week. Prognostic factors were equally distributed in both groups. The locoregional tumor control was 83% for the 4 F patients and 83% for the 5 F patients. Degree and incidence of acute reactions with both fractionation regimens were similar. Necrosis of the oropharyngeal mucosa and trismus were significantly more severe and more frequent in the 4 F group (23% and 20% respectively) than in the 5 F group (10% and 5% respectively) (p = 0.03 and p = 0.01). Other late effects such as skin necrosis (6% in the 4 F group versus 0% in the 5 F group) and severe cervical sclerosis (12 vs 5%) were also more frequent in the 4 F group than in the 5 F group but the difference was not significant. The results suggest a greater sensitivity of late compared to early normal tissue effects and of tumor response to an increase in dose per fraction (from 2 Gy to 2.5 Gy) in oropharyngeal carcinoma.

Female↗
PubMed1988

Interstitial and external radiotherapy in carcinoma of the soft palate and uvula.

Forty-three patients, all male, with limited epidermoid carcinoma of the soft palate and uvula were treated by interstitial implant usually associated with external radiotherapy. Most patients received 50 Gy external irradiation to the oropharynx and neck followed by 20-35 Gy by interstitial iridium-192 wires using either guide gutters or a plastic tube technique. Twelve primary tumors and two recurrences after external irradiation alone had implant only for 65-75 Gy. Total actuarial local control is 92% with no local failures in 34 T1 primary tumors. Only one serious complication was seen. Overall actuarial survival was 60% at 3 years and 37% at 5 years but cause-specific survivals were 81% and 64%. The leading cause of death was other aerodigestive cancer, with an actuarial rate of occurrence of 10% per year after treatment of a soft palate cancer. Interstitital brachytherapy alone or combined with external irradiation is safe, effective management for early carcinoma of the soft palate and uvula but second malignancy is a serious problem.

Actuarial Analysis↗
PubMed1988

Ten-year results of randomized trial comparing radiotherapy and concomitant bleomycin to radiotherapy alone in epidermoid carcinomas of the oropharynx: experience of the European Organization for Research and Treatment of Cancer.

This trial of treatment for head and neck carcinoma was initiated in 1973 by the European Organization for Research and Treatment of Cancer. Its purpose was to investigate the value of single-agent chemotherapy with bleomycin (BLM) given during the course of a conventional treatment by external radiotherapy (RT) compared to treatment by external RT alone. In this randomized study, we compared treatment results in 2 groups of patients with squamous cell carcinoma of the oropharynx (T2, T3, and T4; International Union Against Cancer classification). One group of 92 patients was treated by RT at the prescribed dose of 70 Gy. The other group of 107 patients received radiation according to the same protocol and simultaneously received im injection of BLM at a dose of 15 mg twice a week, 2 hours prior to the session of RT, for a total dose of 150 mg in 5 weeks. The occurrence of local toxic effects (i.e., mucositis and epidermatitis) was significantly greater in the RT-BLM group (RT-BLM, 72%, vs. RT, 21%). Primary tumor response 6 weeks after completion of RT was the same in both arms of the study (RT, 68%, vs. RT-BLM, 67%). The 6-year survival rate was 24% (RT-BLM) versus 22% (RT). Long-term analysis (10 yr) is given.

Bleomycin↗
PubMed1988

[Epidermoid cancers of the esophagus: combined chemotherapy, surgery and radiotherapy. Preliminary results in 50 cases].

Fifty operable epidermoid esophageal carcinomas were treated by combined chemotherapy, surgery and radiotherapy. The post-operative mortality was 5.4% and the severe post-operative morbidity was 29%. The vindesine-5FU-platinum association and the vindesine-endoxan-platinum association gave respectively 55% and 35% objective responses (OR) after two preoperative courses without increasing the operative mortality. The patients who showed an OR had a less important tumoral extension. Thus, an objective response to the pre-operative chemotherapy is in fact a new prognostic factor. Survival without recurrence seems to be increased when chemotherapy is efficient in the curative resection group. These findings incite to promote prospective randomized studies with this kind of combined therapy.

Antineoplastic Combined Chemotherapy Protocols↗