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Biomedical subjects

F Flamant

Publications and source records attributed to F Flamant.

At least 109 records · Page 6Linked to original sources
PubMed1986

Optimal treatment of clinical stage I yolk sac tumor of the testis in children.

Thirty-four children with malignant germ cell tumors of the testis were seen at the Institut Gustave-Roussy from 1970 through 1980, after orchiectomy alone. The tumor was classified according the WHO classification (immature teratoma, embryonal carcinoma, choriocarcinoma, yolk sac tumor). Twenty-four of the 34 children had a stage I yolk sac tumor (YST) defined as a tumor completely removed by the inguinal approach, without clinical node involvement and/or metastases. No lymphadenectomy was performed. All the patients had an alphafetoprotein (AFP) determination before or after orchiectomy. For those (23/24) with an elevated level of AFP the clinical stage I was assigned if the AFP decreased regularly to normal values by 3 months after orchiectomy. Twelve patients received systemic chemotherapy every 3 months [methotrexate, actinomycin D, cyclophosphamide (Cytoxan)]; 12 did not receive any treatment after orchiectomy. An AFP evaluation was assayed for all of these regularly. The 3-year survival rate was 96% and the 3-year relapse-free survival rate was 84%, with no difference found between the two groups receiving or not receiving systemic chemotherapy. This series confirms the advisability of a conservative approach for clinical stage I YST, employing orchiectomy and evaluation including AFP determinations. Ten percent to 20% of patients will suffer a relapse, which can be demonstrated by an increasing level of AFP, and these children can be treated at this time. With this approach, 80% of patients having clinical stage I YST can be treated by orchiectomy alone and will not suffer any sequelae or complication of either lymphadenectomy or chemotherapy. For the few who do relapse, treatment at the time of relapse is curative for the majority. This approach requires absolute adherence to a strict follow-up program.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

High-dose busulfan and cyclophosphamide with autologous bone marrow transplantation support in advanced malignancies in children: a phase II study.

Twenty children with advanced, nonleukemic malignancies entered a phase II study of high-dose busulfan-cyclophosphamide followed by bone marrow transplantation (BMT). All had disease refractory to conventional and/or high-dose chemotherapy (HDC). There were ten neuroblastoma patients, six non-Hodgkin's lymphoma, three Ewing's sarcoma, and one rhabdomyosarcoma. Eight had primarily resistant disease, ten were in second progressive relapse, and two in third progressive relapse. One patient was not evaluable for response. Among the 19 evaluable patients the responses observed were complete response (CR), seven; partial response (PR), three; objective effect, five; and failure, four. However, survival was poor: 15 patients died, two are alive with disease, and three are alive with no evidence of disease (NED) at 8+, 11+, 14+ months post-BMT. Toxicity was high but considered as acceptable, taking into account the terminal state of these patients. Seven treatment-related deaths were observed. This combination therapy proved to be highly effective, with a response rate of 50%, and its value for eradication of residual disease in less advanced patients should be investigated.

Adolescent↗
PubMed1986

High-dose methotrexate and continuous infusion Ara-C in children's non-Hodgkin's lymphoma: phase II studies and their use in further protocols.

Twenty-three children with refractory or relapsed non-Hodgkin's lymphoma (NHL) received high-dose methotrexate (HD-MTX), and 9 received Ara-C by continuous intravenous infusion, as phase II studies. They all had previously received a protocol including vincristine, adriamycin, cyclophosphamide, IV push Ara-C, asparaginase, intrathecal MTX, and cranial irradiation, and had failed to respond or had relapsed. HD-MTX was given at the dose of 6 g/m2 or more with leucovorin rescue, Ara-C at the dose of 100 mg/m2/day by continuous infusion over 10 days. Among the 22 evaluable patients receiving HD-MTX, 10 responses (7 CR; 3 PR) were observed. Among the 9 patients receiving Ara-C, 4 responded (1 CR; 3 PR). Toxicity in those previously heavily treated patients was acceptable. These two drugs are now successfully included in childhood NHL treatment protocols.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Topography of childhood tumors: pediatric coding system.

The importance of a uniform coding system for cancer research, tumor registry, and exchange of information is recognized. However, tumors arising in children differ from those in adults, resulting in lack of precision when one coding system is used for both. Because the topographic code of the International Classification of Disease for Oncology for adult tumors does not lend itself well to pediatric tumors, the International Society of Paediatric Oncology (SIOP) developed a four-digit topographic coding system particularly adapted to childhood tumors. The four digits correspond to anatomic site, general and specific localization, and tissue of origin. An SIOP pilot study demonstrated the usefulness of this code.

Child↗
PubMed1986

[Chemotherapy and ovarian function. Retrospective analysis in 17 girls treated for malignant tumor or hematologic disease].

Ovarian function was investigated in 17 patients aged 13 5/12 to 30 years who had received various types of combined chemotherapy without any irradiation. Ovarian insufficiency was found in 6 cases with amenorrhea (n = 5) or irregular menstruations (n = 1). There is a high risk of sterility in these cases although as described in one case, a normal pregnancy occurred in spite of evidence of ovarian failure. Cyclophosphamide seemed to be less harmful when given before puberty. Great variations in individual susceptibility for relatively low doses were observed with this drug. The combination with other drugs in some protocols might play a role in these cases. At variance with results reported in adults, the MOPP chemotherapy used in children with Hodgkin's disease did not induce ovarian dysfunction.

Adolescent↗
PubMed1985

Iridium afterloading curietherapy in the treatment of pediatric malignancies. The Institut Gustave Roussy experience.

Between 1972 and 1980, 58 children with malignant tumors underwent iridium 192 (192Ir) curietherapy at the Institut Gustave Roussy. Data from only 45 of them were reviewed (bilateral retinoblastoma and salvage procedures were excluded). The pathologic diagnosis was rhabdomyosarcoma in 75% of cases, yolk sac tumor in 13% of cases, malignant mesenchymoma in two cases, clear cell carcinoma in two cases, and undifferentiated sarcoma in one case. The two major sites were pelvis-perineum (64.5%) and head and neck (31%). The treatment was essentially based on a combination of chemotherapy, which was adapted to the histologic type of the tumor, and curietherapy. Partial surgery was carried out in certain cases, either before chemotherapy for diagnostic purposes, or after chemotherapy to remove infiltrative residual tumor. External beam radiotherapy was used in a few cases in lymph node irradiation. The radioactive material was 192Ir, using afterloading techniques, either intracavitary or interstitially or both. The tumor dose, calculated by computerized dosimetry, was 60 to 65 Gy delivered over 5 to 7 days in the majority of cases. Two patients were lost to follow-up. Thirty-five patients (78%) are alive with no evidence of disease after a mean follow-up period of 5 years. Eight patients died, one of complications related to chemotherapy and seven of the evolution of their disease. The late-complication rate, studied in 33 patients with a minimum follow-up period of 3 years, is 18% (6/33). Curietherapy seems to be a preferable conservative treatment in children with localized and accessible malignant tumors.

Adolescent↗
PubMed1985

Primary chemotherapy in the treatment of rhabdomyosarcoma in children: trial of the International Society of Pediatric Oncology (SIOP) preliminary results.

This therapeutic trial deals with 81 patients with stage III rhabdomyosarcoma (RMS), from different centers of the International Society of Pediatric Oncology. These patients were included between October 1975 and March 1983. The aim of this work is to minimize the sequelae of treatment without jeopardizing the survival rate. After a pretrial course of VAC, two groups of patients are compared: the first treated with systematic extensive surgery or radiotherapy on the initial tumor volume, and the second treated with combined chemotherapy using vincristine, dactinomycin, adriamycin, cyclophosphamide until maximum tumor reduction, followed by radiotherapy or surgery on the residual mass only. Eighty one patients were included in the trail; 15 patients were not randomized due to the failure of the pretrial course of chemotherapy, 3 were excluded after randomization (2 were found not to have RMS, and in one case the protocol was not observed). The preliminary results for the 63 patients show a survival rate of 40% at 3 years. The sequential scheme for patients at 3 years follow-up does not show a superiority in either arm.

Adolescent↗
PubMed1984

Hypercalcemia preferentially occurs in unusual forms of childhood non-Hodgkin's lymphoma, rhabdomyosarcoma, and Wilms' tumor. A study of 11 cases.

Unusual clinical, radiologic, or histologic findings were found in 11 of 17 cases of hypercalcemia associated with childhood tumors. Four children had undifferentiated lymphoblastic lymphoma with extensive bone involvement, but no visceral or neurologic involvement. At diagnosis, four adolescents with rhabdomyosarcoma had numerous metastases, particularly in the breasts and bone marrow. Three infants had renal tumor without bone metastases. Histologically, their tumors differed from classical nephroblastoma and resembled the malignant rhabdoid tumors of the kidney. These findings allow individualization of three distinct groups of tumors with unusual features which may suggest the presence of hypercalcemia. These tumors appear to have a poor prognosis since all patients but one died of their malignancy.

Adolescent↗
PubMed1984

Nonseminomatous malignant germ cell tumors in children. Multidrug therapy in Stages III and IV.

Thirty-five children with Stage III and IV nonseminomatous malignant germ cell tumors were treated, between June 1, 1977 and December 31, 1982, at Institut Gustave-Roussy, Villejuif, France, and Hospital General de Ninos, Buenos-Aires, Argentina: 11 sacrococcygeal, 12 ovarian, 6 testicular, 5 intrathoracic, and 1 intrabdominal site. All of them had yolk sac component with high level of AFP, seven had also elevated level of HCG. Thirteen patients had primary chemotherapy, 18 received chemotherapy after incomplete surgical excision, and 4 patients with testicular Stage III tumors had chemotherapy immediately following retroperitoneal lymphadenectomy after orchiectomy, because of persistently elevated AFP levels. The chemotherapy regimen for 1 year's duration, repeated every 21 days, and consisted of 6 courses of dactinomycin-Cytoxan (cyclophosphamide) D1 to D5 and vincristine, Adriamycin (doxorubicin) D21, bleomycin D23, and cisplatin D24. Only three patients received complementary radiotherapy. The toxicity of the chemotherapy regimen was severe, but only one death was due to the therapy (pulmonary fibrosis with bleomycin). The number of surviving patients without evidence of disease was 12 of 16 for Stage III and 12 of 19 for Stage IV. The 25-month survival rate was 63% with a follow-up of 11 months to 5.5 years (median, 22 months). This constitutes a dramatic improvement when compared with the survival rate of 21% of 48 similar patients treated at Institut Gustave-Roussy between 1968 and 1977 with surgery, radiotherapy, and chemotherapy (methotrexate, dactinomycin, and Cytoxan).

Abdominal Neoplasms↗
PubMed1984

Paraaortic lymphadenectomy is not necessary in the treatment of localized paratesticular rhabdomyosarcoma.

Paraaortic lymphadenectomy is routinely recommended to treat paratesticular rhabdomyosarcoma (RMS) because of the high incidence of lymph node involvement. Taking into account the effectiveness of chemotherapy to sterilize micrometastases and aiming to reduce short-term and long-term side effects due to lymph node dissection, the RMS Group of the SIOP decided to avoid lymphadenectomy in Stage I paratesticular RMS defined by (1) complete tumor removal with negative cord section and (2) negative pedal lymphangiography. A series of 19 children (mean age 5 years, 6 months), treated between 1971 and 1981, were analyzed. Eighteen of 19 patients received adjuvant chemotherapy, using vincristine, actinomycin, cyclophosphamide, singly or alternately with vincristine, Adriamycin (doxorubicin) every 3 weeks. Duration was either 18 months (7 cases) or 8 months (11 cases). Fourteen patients are in first remission with a follow-up of more than 3 years (median 5 years); three are disease-free 35, 23, and 20 months since diagnosis; two patients are alive without evolutive disease, 32 and 56 months after an abdominal relapse. Results obtained in this series demonstrate the ineffectiveness of systematic paraaortic lymphadenectomy in Stage I paratesticular RMS and the effectiveness of chemotherapy to eradicate occult micrometastases, which obviously may exist in paraaortic lymph nodes in spite of apparently normal lymphographic findings.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

The improvement in survival associated with combined chemotherapy in childhood rhabdomyosarcoma. A historical comparison of 345 patients in the same center.

Since no randomized trial with a control group without chemotherapy is ethically possible in rhabdomyosarcoma patients in view of the first results of chemotherapy in this disease, the authors report the results of an historical comparison of 345 patients treated with or without combined chemotherapy. The results confirm the overall improvement of survival rates with combined chemotherapy. The greatest benefit from combined chemotherapy was observed in clinical Stage III and IV tumors of the head and neck (with the exception of orbital tumors) and of the genitourinary tract. The efficacy of combined chemotherapy is uncertain for other clinical stages and for limb tumors.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Diversity of the ribosomal structures in the Euglena gracilis chloroplast genome: description of a mutant with two ribosomal operons and possible mechanism for its production.

We studied the bleached mutant of Euglena gracilis Y3BUD producing carotenoids and rich in chloroplast DNA. This mutant which was produced more than twenty years ago segregates permanently, forming 30 to 50% daughter cells without carotenoids and poor in chloroplast DNA. Electron microscopy and mapping with restriction enzymes show the deletion of a complete ribosomal operon out of the three present in the original strain.

Chloroplasts↗
PubMed1984

[2nd malignant tumors in children. Study of 38 cases].

Thirty-eight children, followed in the pediatric Department of Institut Gustave-Roussy, developed second malignant neoplasms. Intervals between the two neoplasms ranged from 1 to 26 years. The second neoplasms were defined as having a different histologic diagnosis than the first ones: osteosarcoma, fibrosarcoma, thyroid carcinoma, leukemia were the most frequent second neoplasms. The potential carcinogenic part of chemotherapy and radiotherapy is emphasized. In addition, some genetic susceptibility may enhance the carcinogenic effects of therapy. Nevertheless the incidence of second malignant neoplasms is low. Its estimation is discussed here.

Adolescent↗
PubMed1983

[Tumors of the vitelline sac located in the vagina in children. Apropos of 11 cases].

Eleven infants were treated at the Institut Gustave-Roussy between 1967 and 1980 for a yolk sac tumor localized to vagina. All the children had high serum alpha-foetoprotein levels. The average age was 10 months and the first symptoms were vaginal hemorrhages. The volume of the tumor and tumoral extension, as well as the biopsy, were appreciated by vaginal examination under general anesthesia. Treatment fluctuated during these years; 7/11 children were cured and since 1977, 6/8 (average follow-up 3 1/2 years) with the following therapeutic schedule: primary chemotherapy reducing the tumoral volume, and either partial colpectomy or curietherapy or both. So, these 6 girls were cured with a conservative treatment, preserving uterus and vagina. Two of them had moderate sequelae due to curietherapy.

Adolescent↗
PubMed1981

[Conservative treatment of malignant vulvo-vaginal tumors (in childhood, by multi-disciplinary approach (clear cell carcinomas excluded) (author's transl)].

Malignant vulvovaginal tumors in 24 children were treated at the Institut Gustave-Roussy between 1970 and 1979 (16 embryonal rhabdomyosarcomas and 8 yolk sac tumors), with conservative treatment: chemotherapy, curietherapy and partial surgery according to each case. After a mean follow-up period of three years, 20 patients had been cured, while only 4 patients had moderate sequelae.

Antineoplastic Agents↗