[Treatment of bone metastases].
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Bone Neoplasms↗
Biomedical subjects
G Kantor
Publications and source records attributed to G Kantor.
[Supra-tentorial low-grade astrocytomas in adults. Prognostic factors and therapeutic indications. Apropos of a series of 141 patients].
An abundant literature provides informations upon the prognosis of supratentorial low grade (grade II) astrocytomas, but the series are quite heterogeneous in terms of clinical material, neuropathological evaluation and statistical methods of analysis. So, outcome, prognostic factors and therapeutical indications are poorly defined. A retrospective study of 141 adults patients suffering ordinary low grade astrocytoma diagnosed in our unit between 1978 and 1988 was conducted. A follow up of 5 years or more, since neuropathological diagnosis, was mandatory for inclusion. Endpoint of statistical analysis was duration of survival. Results were expressed after uni and multivariates analysis. Clinical and morphological features of our series were comparable to those previously reported in the literature. Median survival time was 52 months. Considering age at diagnosis, survival curve analysis showed highly significant differences (p < 0.0001) and established three prognostic classes of age (before 50, between 50 and 60, and after 60 years of age). Comparisons of survival curves showed significant statistical differences (p < 0.0001) according to pretreatment functional status. Analysis of a clinical condition using a functional scale is more powerful, from a statistical point of view, than an individual analysis of each constituting parameters. In this series a good correlation was found between functional status and age at diagnosis. Neurological deficit was more correlated to age than to tumor location. Multivariate analysis, using the Cox model, defined some parameters acting independently on duration of survival: fronto-parietal location (p < 0.0001), pretherapeutical functional status (p < 0.001), age at diagnosis (p = 0.001), deepseated or multicentric tumor, mass effect (p < 0.01), frontal location (p < 0.02), total surgical removal (p < 0.05). Non significant parameters were: radiotherapy, time before diagnosis, age of onset, sex, contrast enhancement on CT scan. Our results are in agreement with previously reported data confirmed literature data concerning prognostic factors characteristics of the host (age), characteristics of the tumor (location) and expressing the influence of the tumor on the host (functional status). Our series documented prognostic clinical forms of these tumors (function of age, of performance status, and of tumor location). Our results confirm the relative inefficacy of therapeutic weapons, considering the population as a whole, on duration of survival. Based on our results and on recently published data, a decision tree analysis was proposed for management of grade II astrocytomas.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
[Activity of radiosurgery. The SFRO-1994 survey].
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Brain Neoplasms↗
[Preparation for transcutaneous irradiation].
To give a precise dose of radiation in an anatomically defined volume a succession of clinical and technical procedures is necessary. Clinical evaluation of tumor extension contributes to the definition of the different target volumes. Then, medical imaging techniques adapted from X ray diagnostic machines (simulators) are generally used. Number, size, shape and orientation of the different beams are defined. More complex techniques with CT scan or MRI can be useful to localise directly the different target volumes and organs at risk. Dosimetric studies are performed with radiophysicists. Calculations can be simply made from measurements of deepness or external outlining. More complex calculations including CT or MRI slices can be performed when an optimization of the treatment planning is attempted. These different steps are rewritten on a technical sheet, mandatory for the quality control assurance of the whole treatment.
Humans↗
Intraoperative interstitial iridium brachytherapy in the management of soft tissue sarcomas: preliminary results of a feasibility phase II study.
Between May 1986 and June 1992, 48 patients with soft tissue sarcomas underwent 50 intraoperative interstitial implants in conjunction with conservative tumoral resections. Brachytherapy was part of the initial treatment in 27 cases and was done in 21 other previously treated patients. For the last ones brachytherapy was, in most of the cases, the only treatment in addition to surgery. The implant dose was 40-65 Gy. When combined with external irradiation the mean prescribed dose was 20 Gy (12-25 Gy). With a median follow-up of 33 months, the 3-year actuarial survival rate was 81% and the local disease-free survival 91.7%. Five local failures were observed only in patients with recurrent sarcomas: two were inside the treated volume and three outside (local failure 5/48 = 10.4%). Acute side-effects occurred in 11 patients (11/48 = 23%), with skin breakdown (two cases) infection and hematoma (one case), infection, lymphocele, secondary skin breakdown and vascular rupture (one case), infection and limited skin breakdown (two cases) and delayed healing (five cases). As a consequence, six patients required reoperation but no amputation was necessary. The functional results were good. Only three patients had a moderate limitation of movement. Late complications occurred in five patients: bone fracture (one case), leg oedemas not interfering with normal activity (three cases), peripheral neuropathy fibrosis related requiring surgery (one case). Therefore, this preliminary report shows that adjuvant intraoperative brachytherapy is feasible and is safe in treating soft tissue sarcomas, even in previously irradiated patients. However, further evaluation is needed to determine the real place of intraoperative implant in the management of soft tissue sarcomas.
Adolescent↗
Tufted angioma of the thigh.
Tufted angioma or angioblastoma of Nakagawa is a rare vascular tumor that usually appears in early childhood. It frequently is seen as an erythematous to red-brown, frequently indurated plaque that usually occurs on the trunk or neck. Typically tufted angiomas enlarge for a few years and then cease growing and remain stable. Histopathologic findings are pathognomonic. We describe a patient with a tufted angioma of the thigh who sought treatment for paroxysmal episodes of pain. Treatment with topical clobetasol propionate resulted in a decreased frequency of painful episodes.
Adolescent↗
The effects of selected stimulus waveforms on pulse and phase characteristics at sensory and motor thresholds.
BACKGROUND AND PURPOSE: The purposes of this investigation were to determine the effect of five commonly used voltage waveforms (four pulsed and one sinusoidal) on excitation of sensory and motor nerves and to characterize variables associated with reaching threshold. SUBJECTS: Eighteen healthy subjects were stimulated during one session via surface electrodes placed over the forearm and leg. METHODS: Stimulation amplitude was increased at a constant rate, and the threshold of sensory and motor excitation was determined. Measured variables included peak voltage, peak current, phase charge, and total pulse charge. RESULTS: Three-factorial, repeated-measures analysis of variance and Newman-Keuls tests revealed that phase charge varied the least during excitation induced by the five waveforms. Total pulse charge markedly increased when bursts of 10 symmetrical pulses, 25 symmetrical pulses, or amplitude-modulated waveforms were used. Monophasic and symmetrical biphasic waveforms required the least amount of total pulse charge. All measurements were higher during motor threshold than during sensory threshold, and the measurements were higher in the leg than in the forearm. CONCLUSION AND DISCUSSION: The authors concluded that all five studied waveforms were effective at threshold excitation of peripheral sensory and motor nerves. Of the five waveforms, the symmetrical biphasic waveform, having a low total pulse charge, may be the preferred waveform, and the 25 symmetrical pulses and amplitude-modulated waveforms may be considered the least preferred due to high total pulse charge.
Adult↗
Effects of electrode size on basic excitatory responses and on selected stimulus parameters.
Recent data have implicated the size of surface electrodes as an important factor affecting peripheral nerve excitation. Therefore, we studied the effects of electrode size on the basic excitatory responses and on stimulus characteristics. Four different sizes of self-adhesive surface electrodes were applied over the medial and lateral gastrocnemius muscle of 20 healthy subjects. The excitatory levels were sensory threshold, motor threshold, pain threshold, and maximally tolerated painful stimulation. Stimulus parameters included a symmetric biphasic waveform, 200 microseconds phase duration, and a pulse repetition rate of 50 pps. Amplitude was increased until the appropriate excitatory response was achieved. At this amplitude level, the computerized recording system collected data of stimulus peak current, peak voltage, and phase charge as well as isometric plantar flexion force. Repeated measure analysis of variance and Newman-Keuls post hoc tests revealed that increasing electrode size significantly decreased voltage but increased current and phase charge magnitudes. With increasing electrode area, the ratios of voltage/current decreased nonlinearly, while the ratios of charge/voltage increased nonlinearly. The comfort of stimulation for the same amount of plantar flexion force improved significantly as electrode size became larger. We concluded that electrode size affects the stimulus parameters, comfort, and force generation associated with electrically induced excitatory responses. Electrode size should be considered an integral part of the attempt to improve subject response to transcutaneous electrical stimulation.
Adult↗
[Activity of radiosurgery and stereotaxic radiotherapy. The SFRO survey, 1993].
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France↗
[MRI and radiotherapy. External references, selection of plans and measurement of distortion].
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Humans↗
[An intensive course for general practitioners in a university hospital for oncology. Evaluation of a 5-year experience].
For 5 years, 121 general practitioners (GP) had a one-week course of continuing medical education, organized by the League against cancer, by groups of five, in oncology university services. A few years later they were asked, through a postal questionnaire, about their appreciation of this course and its consequences on their practice. Seventy six (55%) answers indicate that, except for two GP, such a course was considered as very valuable. They think it was useful to improve their clinical expertise and to reduce radiological and biological investigations. Their relations with patients, families and oncologists had been improved. They hope such an experiment will continue. Limits and difficulties of this experiment are briefly underlined.
Education, Medical, Continuing↗
Blunt cardiac injury and intraoperative hypoxaemia.
A 28-yr-old man sustained blunt chest trauma in a motor vehicle accident. Severe intraoperative hypoxaemia occurred, unresponsive to oxygen and positive expiratory pressure therapy. Trans-oesophageal echocardiography revealed myocardial contusion and tricuspid valve rupture. Dobutamine improved left ventricular function and ejection fraction resulting in an immediate improvement in arterial oxygenation and saturation. Tricuspid injury and the diagnosis of myocardial contusion are discussed. The case highlights the importance of a non-pulmonary mechanism of hypoxaemia.
Accidents, Traffic↗
Acute intermittent porphyria and caesarean delivery.
A 29-yr-old patient was diagnosed with acute intermittent porphyria (AIP) during pregnancy. She had a Caesarean section under lidocaine/fentanyl epidural blockade. Because of inadequate analgesia, general anaesthesia was induced with propofol. Postoperatively urinary porphobilinogen excretion (625 mumol.day-1) exceeded the upper limit of normal but no symptoms of porphyria developed. In anecdotal clinical reports and in a previously described rat model of porphyria, propofol was found to be safe. This is the first reported use of propofol in a pregnant porphyric patient. Anaesthetic drug safety in porphyria is reviewed and the choice of induction agent discussed. Data on which to base these decisions is limited but we conclude that propofol may be suitable for use in patients with porphyria.
Acute Disease↗
Prognostic variables for the selection of patients with operable soft tissue sarcomas to be considered in adjuvant chemotherapy trials.
From 1975 to 1988, 144 patients naive of treatment, with non-metastatic soft tissue sarcoma were treated at Fondation Bergonié by surgery, followed by radiotherapy and without chemotherapy. An analysis of prognostic variables was done on this population to determine patients for whom an adjuvant chemotherapy would be relevant. Prognostic variables in overall survival (OS), metastasis-free survival (MFS), disease-free and local free recurrence survivals were analysed by univariate and multivariate analysis. In multivariate analysis using Cox's model, only tumour depth and tumour grade were significant with the MFS end point, while tumour depth, tumour grade and tumour site were significant when considering OS. A predictive stratification for patients is proposed: a favourable prognostic group with grade 1 tumour or superficial, grade 2 tumour (5-year OS: 97.8%; 5-year MFS: 100%); an intermediate prognostic group with deep, grade 2 tumour or superficial, grade 3 tumour (5-year OS: 58.8%; 5-year MFS: 48.1%); and finally a poor prognostic group with deep, grade 3 tumour (5-year OS: 31.7%; 5-year MFS: 34.1%). Patients in the intermediate and poor prognostic groups who present a high metastatic risk are to be considered for adjuvant chemotherapy trials.
Adolescent↗
[Neoadjuvant chemotherapy and combined conservative treatment of soft tissue sarcoma in the adult].
Between 1980 and 1990, 64 adults with a locally advanced soft tissue sarcoma, but without metastasis, were treated with neoadjuvant chemotherapy before conservative local treatment. Tumour localizations were limbs in 26 patients (40.6%) and other parts of the body in 38 patients (59.4%). Moreover, 27 patients had bone and/or vasculo-nervous axis involvement. Response to chemotherapy was > or = 50% for 23 patients (37.7%) with 3 complete remissions, < 50% for 36 patients and only 2 tumours progressed during chemotherapy. Conservative surgery was thus carried out for 51 patients (79.7%), 11 received external radiotherapy only. At the end of treatment, 49 patients (76.5%) were in complete remission. With a median follow-up of 76 months (range: 25 to 147), 25 patients are alive with no evolutive disease. For the whole population, the actuarial 5-year overall survival is 33.8%. Among the patients who were in complete remission at the end of therapy, 15 developed local recurrences (with metastasis for 7 patients) and 10 became metastatic. Actuarial 5-year overall survival for this subset of patients is 44.8%.
Actuarial Analysis↗
[Postoperative radiotherapy in soft tissue sarcomas of the limbs. Analysis of irradiation volumes and doses in a series of 31 cases].
From October 1985 to October 1988, 31 patients with a soft tissue sarcoma of extremities were treated in our institute by conservative resection and post-operative radiation therapy. The initial target volume encompasses the entire musculoskeletal area occupied by the tumor. The compartmental definition of this initial target volume is based on clinical, radiographic, histopathologic and operative findings. We analyzed the irradiated volume in terms of the anatomical definition and feasibility. We then evaluated the distribution of the dose in the irradiated volume. The variation of the dose is always less than 10%. Accordingly, the range of dose in the irradiated volume varies from 45 to 50 Gy in the compartmental volume after a complete resection, and from 55 to 60 Gy in the tumor bed after a marginal or incomplete resection. For this series, the median follow-up is 27 months. We observed 3 distant metastases and 1 progressive disease in the irradiated volume. No locoregional recurrence appeared in the margins or outside the irradiated volume. These preliminary results validate the compartmental definition of the initial target volume. Furthermore, they point out the lack of opportunity to encompass tendinous insertions in the irradiated volume and to boost the scar. Finally, the definition of optimal dose for the control of microscopic residual tumor is discussed.
Adult↗