Current treatments for metastatic breast cancer are not associated with significant survival benefits despite response rates of over 50%. High-dose therapy with autologous bone marrow transplantation (ABMT) has been investigated, particularly in North America, and prolonged survival in up to 25% of women has been reported, but with a significant treatment-related mortality. However, in patients with haematological malignancies undergoing autologous transplantation, haematopoietic reconstruction is significantly quicker and mortality lower than with ABMT, when peripheral blood progenitor cells (PBPCs) are used. In 32 women with metastatic breast cancer, we investigated the feasibility of PBPC mobilisation with high-dose cyclophosphamide and granulocyte colony-stimulating factor (G-CSF) after 12 weeks' infusional induction chemotherapy and the subsequent efficacy of the haematopoietic reconstitution after conditioning with melphalan and either etoposide or thiotepa. PBPC mobilisation was successful in 28/32 (88%) patients, and there was a rapid post-transplantation haematopoietic recovery: median time to neutrophils > 0.5 x 10(9) l-1 was 14 days and to platelets > 20 x 10(9) l-1 was 10 days. There was no procedure-related mortality, and the major morbidity was mucositis (WHO grade 3-4) in 18/32 patients (56%). In a patient group of which the majority had very poor prognostic features, the median survival from start of induction chemotherapy was 15 months. Thus, PBPC mobilisation and support of high-dose chemotherapy is feasible after infusional induction chemotherapy for patients with metastatic breast cancer, although the optimum drug combination has not yet been determined.

Adult↗

PubMed1996

The use of single fraction Leksell stereotactic radiosurgery in the treatment of uveal melanoma.

Fourteen patients with posterior uveal melanomas were treated using single fraction stereotactic radiosurgery. In each case a dose of 70 Gy was administered to the periphery of the tumour. Regression of the tumour has been observed in 13 patients, whilst the lesion has remained unchanged in one patient. The visual acuity has deteriorated in all 14 patients. Significant radiation induced adverse reactions were noted in 13 patients and include; retinopathy, optic neuropathy, rubeosis iridis, and secondary glaucoma. Two patients have required enucleation because of intractable rubeotic glaucoma. One patient has died from proven metastases. Although stereotactic radiosurgery appears to be a practical and effective method of treating uveal melanomas, its usefulness is limited by a high incidence of radiation induced adverse reactions. Further work is required to refine the current treatment protocol and establish an optimal prescription dose.

Adult↗

PubMed1994

Cancer of the upper gastrointestinal tract. Palliative chemotherapy unproved in advanced gastric cancer.

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Antineoplastic Agents↗

PubMed1993

A glossary for reporting complications of treatment in gynecological cancers.

Reporting and scoring treatment complications in gynecological cancers is difficult because of the variety of normal tissues, anatomical structures and treatment disciplines involved, making it impossible to compare series of patients treated in different institutions even with the same strategy. An international group of experts (gynecologists, radiotherapists and surgeons) developed a multidisciplinary database to identify, score and report early and late normal tissue damage regardless of treatment strategy. The principles involve: (1) The identification of relevant organs and tissues; (2) An accurate definition of the type and score of each complication; (3) Reporting combinations of complications of various degrees; (4) A computerized format for data acquisition, update and retrieval. In the present version, the "Glossary" describes five degrees of increasing severity (0 to 4) in 14 organs and/or normal tissues. The rationale of the glossary leaves it open for as yet undescribed types of complications. This paper contains the definition and scoring for each type of complication, general guidelines for their use.

Databases, Factual↗

PubMed1992

Combined radio-surgical treatment in early invasive cervix carcinoma according to prognostic factors. Experience of the Gustave-Roussy Institute.

In the Gustave-Roussy Institute the standard protocol of limited stages (IB, proximal II) of cervix carcinoma, combines endocavitary brachytherapy (low dose rate) and surgery (BSOH + lymphadenectomy) are eventually followed by external beam irradiation. According to age of patients and to prognostic factors adaptations of this combined treatment are discussed: young patient (40 years) with small tumor, large volume of primary tumor (4 cm), lymphatic node involvement. Analysis of the results in 2 series of patients entirely treated at the Gustave-Roussy Institute: survival, local control, metastases, complications.

Age Factors↗

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↗

PubMed1988

Correlation between size and external temperature in four rat tumours after treatment with cytostatic agents.

The reduction in size of four experimental tumours (ISIS 130 and ISIS 208 immunocytomas, S 437 mammary adenocarcinoma, S 447 colon adenocarcinoma) was investigated in LOU rats under the influence of cytostatic agents belonging to different classes (5-fluorouracil, methotrexate, vinblastine, cisplatin, doxorubicin, cyclophosphamide). External tumour and rectal temperatures were measured at the same time, twice daily, during the whole experiment. With the rectal temperature of the rats kept constant, the reduction in tumour dimensions following chemotherapy correlated via a linear relationship with the duration and degree of tumour hypothermia for the three tumours S 437, ISIS 208, ISIS 130. However, for the same reduction in tumour volume following chemotherapy, the duration and degree of transient tumour hypothermia varied according to the type of tumour and cytostatic agent studied. There was not correlation between the decrease in size of S 447 and external tumour hypothermia. Even when the reduction in tumour size was statistically significant, the hypothermic tumour phase after drug administration was not sufficient to be significant, except for vinblastine. However, the temperature of this slowly growing tumour before chemotherapy was particularly low. The measurement of the degree and duration of external tumour hypothermia of tumours following chemotherapy would represent a new physiological technique for measuring the efficacy and duration of action of cytostatic agents.

Animals↗

PubMed1988

Radical radiotherapy alone in non-operable breast cancer: the major impact of tumor size and histological grade on prognosis.

This retrospective study involved 319 non-operable breast cancer patients treated by radiotherapy alone with doses of 65 Gy at the Institut Gustave-Roussy (IGR). These patients either had operable tumors but were unfit for general anesthesia or had inoperable tumors due to local contraindications. Most of them had advanced tumors: 21% less than 7 cm; 30% N2 or N3; 30% with inflammatory carcinomas. The 5- and 10-year survival was 40 and 19%, respectively. The local and distant relapse-free rate was 56 and 33% at 5 years and 44 and 28% at 10 years respectively. Results were analyzed according to tumor size, clinical node involvement, histologic grade, age, skin invasion and tumor dose. A multivariate analysis demonstrated that tumor size (p = 10(-3)) and histological grade (HG) (p = 10(-2)) were both significant factors predicting local relapse. Histological grade (p = 10(-3)), tumor size (p = 10(-2)) and clinical node involvement (p = 10(-2)) were the most significant factors predicting distant relapses. An individual risk (IR) of local recurrence and of distant recurrence was defined according to the above factors and was demonstrated to be good prognostic index. Tumor doses above 80 Gy did not increase local control. We recommend the general use of histological grading as it seems important for prediction of local and distant control in patients treated by radiotherapy alone.

Actuarial Analysis↗

PubMedDate not supplied

NICE.

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England↗