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I Barillot

Publications and source records attributed to I Barillot.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Assessment of the use of electronic portal imaging].

Improvement in the accuracy of the positioning of the patient during external irradiation is one of the most important issues of the last decades, due to the detrimental impact of the misplacements on treatment outcome. Since 1990, the evolution of the technologic environment has led to a full integration of the portal imaging devices into linac technology. It offers a real on-line verification tool for "high-dose, high-accuracy" treatments. This overview based upon data from the literature describes the different types of imaging devices, the strategies of use and the results obtained. It also considers the use of imaging devices as an in vivo dosimeter.

Humans↗
PubMed1999

Definition of the prostate in CT and MRI: a multi-observer study.

PURPOSE: To determine, in three-dimensions, the difference between prostate delineation in magnetic resonance (MR) and computer tomography (CT) images for radiotherapy treatment planning. PATIENTS AND METHODS: Three radiation oncologists, considered experts in the field, outlined the prostate without seminal vesicles both on CT, and axial, coronal, and sagittal MR images for 18 patients. To compare the resulting delineated prostates, the CT and MR scans were matched in three-dimensions using chamfer matching on bony structures. The volumes were measured and the interscan and interobserver variation was determined. The spatial difference between delineation in CT and MR (interscan variation) as well as the interobserver variation were quantified and mapped three-dimensionally (3D) using polar coordinates. A urethrogram was performed and the location of the tip of the dye column was compared with the apex delineated in CT and MR images. RESULTS: Interscan variation: CT volumes were larger than the axial MR volumes in 52 of 54 delineations. The average ratio between the CT and MR volumes was 1.4 (standard error of mean, SE: 0.04) which was significantly different from 1 (p < 0.005). Only small differences were observed between the volumes outlined in the various MR scans, although the coronal MR volumes were smallest. The CT derived prostate was 8 mm (standard deviation, SD: 6 mm) larger at the base of the seminal vesicles and 6 mm (SD 4 mm) larger at the apex of the prostate than the axial MRI. Similar figures were obtained for the CT and the other MRI scans. Interobserver variation: The average ratio between the volume derived by one observer for a particular scan and patient and the average volume was 0.95, 0.97, and 1.08 (SE 0.01) for the three observers, respectively. The 3D pattern of the overall observer variation (1 SD) for CT and axial MRI was similar and equal to 3.5 to 2.8 mm at the base of the seminal vesicles and 3 mm at the apex. CONCLUSION: CT-derived prostate volumes are larger than MR derived volumes, especially toward the seminal vesicles and the apex of the prostate. This interscan variation was found to be larger than the interobserver variation. Using MRI for delineation of the prostate reduces the amount of irradiated rectal wall, and could reduce rectal and urological complications.

Aged↗
PubMed1998

Preoperative radiotherapy and surgery for endometrial carcinoma: prognostic significance of the sterilization of the specimen.

INTRODUCTION: We report a retrospective study on the analysis of the operative specimen after preoperative radiotherapy for FIGO (1971) stage I or II endometrial carcinoma. METHODS AND MATERIALS: From 1976 to 1996, 221 patients were treated with external radiotherapy (XRT) and/or low-dose-rate brachytherapy (BT) followed by surgery (S). Patients with cervical involvement (89 patients) or with high-grade tumors (49 patients) received XRT and BT. Patients stage FIGO Ia (89 patients) or with low-grade tumors (57 patients) received BT alone. Surgery was performed 5 to 6 weeks after irradiation. RESULTS: The mean follow-up is 78 months (12-216). The 5-year survival was 90% for FIGO Ia, 80% for FIGO Ib, and 84% for FIGO II (p = 0.51). According to the differentiation, 5-year survival was 87% for grade 1, 84% for grade 2, 84% for grade 3 (p = 0.10). Grade 3 complications were registered in 2% (no grade 4). The tumors were sterilized in 37 patients (17%), sterilized but with dystrophic glands in 34 patients (16%), only modified and altered in 21 patients (9.5%), with viable cells in 56 patients (26%). After preoperative radiotherapy, 37/148 specimens were sterilized (25%), 14/74 after brachytherapy and surgery (19%), 23/74 after external radiotherapy-brachytherapy and surgery (31%). According to the response of the specimen, 5-year survival was 87% when the tumor was sterilized, 96% when altered glands were present, 85% when modified, and 76% if residual tumor with viable cells was identified (p = 0.043). CONCLUSION: Preoperative radiotherapy followed by surgery is a safe and effective treatment of FIGO stage I or II endometrial carcinomas. BT with two uterine tubes seems to be of interest in the contribution of the treatment of the uterus to sterilize the specimen. The analysis of this new prognostic factor remains important to select a population with worst prognosis.

Adult↗
PubMed1998

Conservative management of rectal adenocarcinoma by radiotherapy.

PURPOSE: The aim of this study was to analyze the experience of Centre GF Leclerc for conservative and curative treatment by radiotherapy of low rectal cancer. PATIENTS AND METHODS: A total of 151 patients received radiotherapy alone for rectal adenocarcinoma with curative intent. They were clinically staged according to size (T1 < 3 cm, and T2 > 3 cm) and depth of infiltration (A=superficial, and B=impaired mobility and T3 fixed). Over the past 6 years, rectal ultrasound (US) has been used systematically, compared with computed tomographic scan and magnetic resonance imaging when needed. Intracavitary contact X ray was given to 129 patients (69%), and brachytherapy in 45 of 151. External radiotherapy was used in 34 cases (22.5%). RESULTS: Complete response was obtained in 93%. Local failures were observed in 50 cases (28%); two occurred in pelvic nodes after intracavitary X rays. Size (tumors > 3 cm) and alteration of mobility significantly influenced the rate of local failure (p=0.009 and 0.007). The addition of external radiotherapy in patients with poor prognostic factors improved the local control rate. A total of 39 patients with recurrence were amenable to salvage surgery. After salvage treatment, the local control rate was 82% with unlimited follow-up. The 5-year actuarial survival rate was 57%, with a specific survival of 66%. There was no difference in local control or survival according to differentiation of the tumors and distance between anal margin and the inferior level of the lesion. Severe late effect (grade 3) was 3.8%. The sphincter preservation was obtained in 104 of 124 cases (84%). The sphincter function was judged to normal in 102 of 104 patients (98%). CONCLUSION: Intracavitary contact X ray is the treatment of choice for clinical Stage T1A rectal tumors. External radiotherapy significantly improved the results of treatment of tumors > 3 cm. Clinical staging and transrectal ultrasound allows a safe selection of indications. Radiotherapy alone may be proposed for selected cases as an alternative to mutilating surgery for small rectal adenocarcinoma.

Adenocarcinoma↗
PubMed1998

[Chemoradiotherapy in cancers of the uterine cervix].

Treatment of uterine cervix carcinomas is based on radiotherapy and surgery. Prognosis of advanced carcinoma leads to the proposal of many combinations. Only concurrent radio-chemotherapy demonstrated some interests. Combination of radiotherapy and radiosensitisers failed to demonstrate any advantage and in some instances was associated with an adverse effect. Hydroxyurea and mitomycin C alone or associated were extensively tested without benefit. From modern combinations and recent studies, we could conclude that only cisplatin (and probably its derivates) can be included in future trials.

Antineoplastic Agents↗
PubMed1997

Carcinoma of the intact uterine cervix treated with radiotherapy alone: a French cooperative study: update and multivariate analysis of prognostics factors.

PURPOSE: To determine independent prognostic factors in a group of 1875 patients with invasive carcinoma of the intact uterine cervix treated with radiotherapy alone in a French cooperative study from 1970 to 1993. MATERIALS AND METHODS: Patients were staged according to the UICC-FIGO and MDAH substaging. The distribution per FIGO stage was Ia-Ib: 25.5%; IIa: 12%; IIb: 29%; IIIa: 5%; IIIb: 25%, and IV: 3.5%. Ninety-two percent had squamous cell carcinoma. The maximum diameter of the clinically detectable cervical disease was less than 3 cm in 24.5% of Stages I-II and in 10% of Stages III-IV, more than 5 cm in 13.5% of Stages I-II, and in 16% of Stages III-IV. Nodal involvement was shown on lymphangiogram in 16% of Stages I-II and in 32.5% of Stages III-IV. RESULTS: 1) Univariate analysis of Stages I and II: stage, cervical disease diameter, and nodal involvement are significant prognostic factors. Five-year specific survival rate (5ySS) is 83.5% in Stage Ib, 81% in IIa and 71% in IIb. Five-year disease-free survival rate (5yDFS) is 86% in tumors less of 3 cm, 76% in tumors of 3 to 5 cm, and 61.5% in tumor larger than 5 cm. Lymphangiogram strongly influences the 5-year pelvic disease-free survival rate (5yPDFS): respectively, 90% in nonpositive lymphangiogram vs. 65% when positive. A significant drop in specific and disease-free survival is observed (10 and 14%, respectively (p = 0.04) when comparing adenocarcinoma and squamous cell carcinoma. Age is a significant prognostic factor for specific survival because patients aged less than 30 years old have 91% vs. about 75% for patients over 30 years (p = 0.03). 2) Univariate analysis of Stages III-IV: Stage and positive lymphangiogram are predictive factors for relapse and death. The MDAH substaging is more reliable to predict the probability of pelvic disease-free survival in Stage III. At 5 years, the FIGO Stages IIIa and IIIb have a rather similar PDFS (65% vs. 59%). Conversely, the difference of survival rates between MDAH Stage IIIA and Stage IIIB is more demonstrative (69% vs. 47.5%). 3) Multivariate analysis (Cox P. H. R. model). Nodal involvement and stage remain significant for all three models in all stages (p < 0.0001). Age above 70 years influences specific survival for Stage I-II (p = 0.01). Tumors larger than 5 cm and adenocarcinoma also appear to be independent prognostic factors for specific and disease-free survival in Stage I-II (p = 0.05 and p = 0.005, respectively). CONCLUSIONS: The relevance of tumor size (less or greater than 4 cm) is now recognized in the 1995 revised FIGO staging in Stage Ib but unfortunately not in other stages. Tumor size per stage and nodal status should be systematically recorded to allow a better prediction of failure rates and to compare literature reports.

Adenocarcinoma↗
PubMed1997

[Clinical value of the estimation of growth kinetics of primary ovarian cancer recurrences by CA125 doubling time].

The aim of this retrospective work was to study the clinical importance of growth rate determination for ovarian cancer primary recurrence in term of CA125 doubling time (dt). Fifty-one patients with epithelial ovarian carcinoma stage III or IV who developed a recurrence were included. Eighteen spontaneous dt values were calculated in non-treated patients during follow-up and 33 apparent dt values were estimated in patients undergoing treatment during CA125 increase before the clinical and/or radiological diagnosis of recurrence. No early treatment of the recurrence has permitted a drop in CA125 level. We applied exponential regression models to CA125 individual kinetics in order to calculate dt values. Individual dt values vary from 5 to 375 days. Spontaneous and apparent dt medianes (respectively 64 and 39 days) are not significantly different. Among all early clinical, histological, biological and therapeutic parameters, the initial CA125 half-life calculated during the third courses of the first-line chemotherapy is the unique predictive parameter of dt (relative risk (RR) = 78; p < 0.01). The prognostic impact was more important in spontaneous dt values than in apparent ones. Being spontaneous or apparent dt was the major predictive parameter of the delay between the initial CA125 increase and clinical and/or radiological signs of recurrence (RR = 0.3; p < 0.0001). Its prognostic impact is superior to the T1/2 one (RR = 2.9; p = 0.0010). For equivalent treatments, dt (RR = 0.4; p < 0.0001) and T1/2 (RR = 4.0; p < 0.0001) are the only predictive parameters of the survival after CA125 increase. This work shows that dt was an essential predictive parameter of ovarian epithelial tumor recurrences.

Aged↗
PubMed1996

Preoperative radiotherapy in stage I/II endometrial adenocarcinoma.

From 1972 to 1993, 170 patients received preoperative radiotherapy followed, 5-6 weeks later, by total extrafascial hysterectomy with bilateral salpingo-oophorectomy without lymphadenectomy. Eighty-three patients with good prognostic factors (low grade tumour and no cervical involvement) received low dose rate utero vaginal brachytherapy alone before surgery (Group 1). Eighty-seven patients with poor prognostic factors (high grade tumors and/or cervical involvement) received external radiotherapy to 40 Gy and low dose rate brachytherapy before surgery (Group 2). A single vaginal failure was observed (0.6%). The overall pelvic failure rate was 2.3% (four patients) including two cases with pelvic recurrence and metastases. Three of the four pelvic failures occurred in Group 1. Using the 1971 FIGO clinical staging, 5-year disease-free survival was 82% in Stage Ia, 79% in Stage Ib, and 81% in Stage II (P = 0.36). Five-year disease-free survival was 86% in Grade 1, 76% in Grade 2, and 83% in Grade 3 (P = 0.20). Five-year overall survival was 83% in Stage Ia, 79% in Stage Ib, and 83% in Stage II (P = 0.78). Five-year overall survival was 88% in Grade 1, 77% in Grade 2,83% in Grade 3 (P = 0.27). Complications were recorded with the French-Italian syllabus. Grade 2 complications occurred in 12 cases (7%), Grade 3 in five cases (3%). The lack of correlation between classical risk factors (stage, grade) and disease outcome suggests that preoperative radiotherapy strategies should be preferred when such factors can be identified before surgery.

Adenocarcinoma↗
PubMed1996

[Prognostic value of CA 125 initial half-life measured during first-line chemotherapy in 62 patients with epithelial ovarian cancer stage III or IV].

The prognostic value of CA 125 initial half-life in serum (Tb) during the first cycles of first-line chemotherapy was studied in 62 patients with stage III or IV ovarian cancer. The half-life was strongly correlated; 1) with the rate of biological remission (P < 0.001). This one was respectively equal to 94.7% when Tb was lower than 20 days, 66.6% when Tb was between 20 and 40 days and 7.7% when Tb was higher than 40 days; 2) with the rate of histological remission (P < 0.001) which was equal to 66.6% when Tb was lower than 13 days; 3) with the speed of recurrence growth measured by the doubling time (dT) of CA 125. The median of dT was equal to 182 days when Tb was lower than 13 days, 63 days when Tb was between 13 and 20 days (P < 0.02) and 38 days when Tb was higher than 20 days (P < 0.001); 4) with the duration of disease-free survival (DFS) (P < 0.001): the medians were equal to 23.9 months, 18.0 months, 12.0 months, and 5.5 months, respectively, when Tb was lower than 13 days, between 13 and 20 days; 20 and 40 days, and higher than 40 days; and 5) with the duration of overall survival (OS). The probability of survival at five years was equal to 48% when Tb was lower than 13 days. This probability falled to 13%, 12%, and 8%, when Tb was respectively between 13 and 20 days, 20 and 40 days and higher than 40 days. Multiple regression analysis showed that CA 125 half-life was the most important prognostic factor for DFS and OS. Analysis of correlation allowed to identify a relation between: 1) dT and Tb [dT = Tb/[-0.305 + (0.0388)(Tb)]; P < 10(-4)]; 2) the slope of CA 125 initial regression (P) and DFS [DFS = 201.9e (-16.64*P); P < 10(-8)]; 3) P and OS [OS = 285.0e(-17.00*P); P < 10(-7)]. The initial CA 125 half-life measured during the first cycles of first time chemotherapy seemed to be a critical predictor of response to therapy.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1994

Maximum and mean bladder dose defined from ultrasonography. Comparison with the ICRU reference in gynaecological brachytherapy.

The reference bladder dose for gynaecological intracavitary brachytherapy (BT), as defined by the ICRU 38 Report, is often criticised as it is seldom representative of the highest bladder dose nor it gives an idea of the area exposed to a significant dose. Since November 1990, ultrasound measurements are routinely made in order to determine the actual dose delivered to the bladder of each patient. The technique was as follows. (1) the bladder is filled up with 150-200 cm3 of sterile isotonic saline. (2) The intrauterine position of the tube is checked. (3) The bladder anatomy is controlled. (4) Points of measurements are identified: ICRU bladder reference, minimum distance between bladder mucosa, uterine tube and other similar measurements taken every 15 mm along the radio-active line. Maximum and mean doses are calculated at the sagittal plane. Measurements are performed by moving the transducer along the skin of the patient and included in the calculation of dose distribution. Doses delivered to each relevant point are compared. This enables determination to be made of the differences between the ICRU and the doses actually observed at the bladder wall with aid of ultrasonography. BT applications were checked in 58 patients (69 measurements). The method was feasible in all cases. The comparison between ICRU dose from orthogonal films and the ICRU dose from ultrasonography resulted in a 90% accuracy. The maximum and mean doses for utero-vaginal BT are higher than the ICRU dose in 75% of cases (range, 2-8). Measurements are now abandoned for vaginal applications as the ICRU dose only could be measured.(ABSTRACT TRUNCATED AT 250 WORDS)

Brachytherapy↗
PubMed1994

Radiotherapy for head and neck cancers including chemoradiotherapy.

After two decades of clinical investigations on hyperfractionation, a 10% local control gain at 5 years was finally demonstrated by a large, randomized trial in oropharyngeal carcinoma, which confirms promising data from numerous uncontrolled studies. Moreover, this progress was achieved without additional late morbidity, in agreement with radiobiology predictions of the linear quadratic model. Data from in vivo measures of the survival fraction after 2 Gy and potential doubling time show a trend for a poorer prognosis in rapidly proliferating tumors, however, unequivocal evidence does not yet exist. Retrospective studies document the detrimental effect of prolonged overall treatment time and support investigations on accelerated radiotherapy as a priority. Reports on the combination of chemotherapy and radiotherapy (mostly concomitantly) still leave the reader with a feeling of frustration. All reports, except one, have a poor methodology without a control arm to use the best-known regimens of radiotherapy and surgery. Nasopharyngeal tumors should not be mixed up with other head and neck sites because impressive responses can follow adequate combination strategies of chemoradiotherapy. Xerostomia is no longer an unavoidable and hopeless side-effect of radiotherapy; individualized treatment planning and stimulation of remaining salivary glands by pilocarpine can improve the comfort in about 50% of irradiated patients.

Combined Modality Therapy↗
PubMed1994

[Factors determining the choice between mastectomy and conservative treatment in the Côte-d'Or department (France). The Côte-d'Op6 register of gynecological cancers].

The aim of this study is to check, for a defined period and within a geographic area, whether the increased use of breast conserving treatment was related to changes in tumor characteristics, or whether changes in therapeutical practice persisted after adjustment on patients and tumor characteristics. From 1982 to 1990, 1,952 women with invasive carcinomas were registered in the French "departement" of Côte-d'Or. Seventeen hundred and seven non metastatic patients were treated by loco-regional surgery. A breast conserving surgery was performed in 60% of cases. The incidence of this treatment raised from 32% in 1982 to 73% in 1987. In univariate analysis, factors determining the type of tumor excision were: age, hormonal status, tumor size, tumor location, "clinical seriousness", nodal status, multiple tumors, inflammatory tumors, neoadjuvant treatments and year of diagnosis. Age and tumoral factors remained significant in a logistic regression analysis. Other factors being constant, the odds ratios of mastectomy was 12.9 times lower in 1987-1990 than in 1982, and 2.1 times lower than in 1985-1986, showing a "period effect". Ninety four percent of patients treated by breast conserving surgery were irradiated post operatively, showing that the clinical research recommendations were well transferred to the clinical practice in this department.

Adult↗
PubMed1993

Carcinoma of the cervical stump: a review of 213 cases.

From 1970 to 1987, 213 cases of carcinoma of the cervical stump were accrued in a multi-institutional prospective cooperative study. This group accounted for 5.5% of cervical carcinoma diagnosed during the same period. 13 had in situ carcinoma and 200 had invasive carcinoma (96% squamous cell carcinoma, 4% adenocarcinoma). Radiotherapy alone (external and brachytherapy) was given to 77%, brachytherapy and surgery to 15% and surgery alone to 8%). FIGO stage distribution was: I (31%), IIa (15%), IIb (27%), IIIa (5%), IIIb (17%) and IV (5%). Five-year locoregional control per stage was 100% in Ia, 85% in Ib, 82% in IIa, 71% in IIb, 45% in IIIa, 54% in IIIb and 30% in IV. Corrected 5-year survival per stage was 82% in Ib, 78% in IIa, 73% in IIb, 69% in IIIa, 38% in IIIb and 0% in IV. The diameter of disease in stage II strongly influenced the 5-year locoregional control (81% for tumours of less than 3 cm vs. 68% for tumours more than 3 cm). Lymphangiogram was associated with a 44.5% 5-year locoregional control when positive vs. 74% when non-positive. Brachytherapy was advantageous in obtaining locoregional control in patients receiving external irradiation and brachytherapy: 81.5% vs. 38.5% in patients treated with external radiotherapy alone. Surgery was performed only for in situ carcinoma and for part of stages Ia, Ib and IIa. There is no significant difference in locoregional control at equal stage between radiotherapy alone and treatment schemes including surgery. However, lethal complications were observed in 6% of the patients of the surgical group as compared to 0.6% of the patients treated with radiotherapy alone. Radical radiotherapy seems to provide similar results of locoregional control and survival at equal stages in carcinoma of the cervical stump compared to carcinoma developed on an intact uterus. The rate of severe complications reported with the French-Italian glossary is 13% for G3 and 3% for G4, which is close to the observed rate during the same period in our series of radical radiotherapy to the intact uterus.

Adult↗