Biomedical subjects
J L Renaud-Salis
Publications and source records attributed to J L Renaud-Salis.
Epidermoid cancers of the oropharnyx.
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Outcome of squamous cell carcinoma of the gingiva: a follow-up study of 83 cases.
BACKGROUND: Squamous cell carcinomas of the gingiva are relatively rare tumours. Standard treatment is based on surgery and radiotherapy. The extent of bone involvement affects mandibulectary indications. PURPOSE: A retrospective review of squamous cell carcinomas of the gingiva was performed to evaluate the incidence of mandibular or maxillary bone involvement. Indications for marginal and segmental bone resections are specified. MATERIAL: From 1985 to 1996, 83 patients with squamous cell carcinoma of the gingiva were treated at the Department of Surgery (Institut Bergonié, Bordeaux, France) and at the Department of Maxillofacial and Plastic Surgery (Centre Hospitalier Universitaire, Bordeaux, France). Forty-three underwent surgery plus postoperative radiotherapy. Twenty-two had flap reconstructions. Clinical evaluation and panorex roentgenography were the means used to evaluate bony invasion and to decide on the extent of bone resection. METHODS: A retrospective review of 83 consecutive patients was performed. This series is unusual in its homogeneity: surgery was performed by only two individuals and the radiotherapy was the responsibility of just two physicians. Outcome was calculated using the Kaplan-Meier method. RESULTS: Primary local control was achieved in 72 patients (87%). Overall survival and rate of recurrence were comparable to those of other squamous cell carcinomas of the oral cavity and oropharynx. CONCLUSION: Surgical resection continues to be the mainstay of treatment and this study tends to confirm the validity of modified neck dissection and marginal bone resection in suitably selected patients.
[Case report forum: the example of French sarcoma group multidisciplinary discussion tools. Sarcomes de la FNCLCC].
Within the Rubis 4th framework of European project is led a pilot experiment of tools and services for health professionals in prospect for the Aquitanian healthcare network. The sarcoma group of the FNCLCC (47 people) uses on its web site a multidisciplinary dialogue with a specific discussion forum. This service allows the anonymous publication of a imaging clinical case and to start a take care discussion. 87 cases were published in 13 months involving 261 answers from February 1999 to February 2000. A case is published every 4 days on average and the deadlines for replies regularly drop (15 days in February 1999 down 1.1 day in February 2000). The cases are published either for a diagnosis or treatment request (30%) or for the physical preparation of meeting or for the continuous medical training (70%). There are many advantages in comparison with the other possibilities of discussion: availability, autonomy of publication, cost, number of experts participating. These NTIC services will be developing within the regional healthcare oncology networks and are already tested by other regional groups (Lymphoma) considering the simplicity of use, management and training of the functionality.
Supraomohyoid neck dissection in cancer of the oral cavity.
BACKGROUND: In oral cavity cancer, supraomohyoid neck dissection (SOHND) is becoming more popular for patients with N0 and N1 disease in the neck. The aim of this study was to assess the value of this surgical procedure. METHODS: The study included 237 previously untreated patients with oral cavity cancer. The neck treatment consisted of SOHND or functional neck dissection (FND). One hundred sixty patients underwent postoperative radiation therapy. Survival probabilities, neck recurrences, and distant metastases were analyzed according to the surgical procedure. RESULTS: For patients having undergone SOHND, the 5-year survival probabilities were 70.2% and 76.5% in N0 and N1 necks, respectively. The neck recurrence rate in SOHND was 2%. CONCLUSIONS: SOHND is an effective method of treatment for the clinically negative neck in patients with squamous cell carcinoma of the oral cavity. It also proves efficient, in conjunction with postoperative radiotherapy, for control of neck metastases in selected patients.
[Standards, options and recommendations (SOR) for clinical care of squamous cell carcinoma of the oropharynx. Groupe de travail SOR].
CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature systematic review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of Standards, Options and Recommendations for the management of squamous carcinoma of the oropharynx. METHODS: Data have been identified by literature search using Medline (1991-1998) and the expert groups personal reference lists. Once the guidelines were defined, the document was submitted for review to national and international independent reviewers and to the medical committees of the 20 French Cancer Centres. RESULTS: The main recommendations for squamous cell carcinoma of the oropharynx management are that: 1) diagnosis and initial assessment should be based on appropriate clinical and radiological findings; 2) the therapeutic strategy is based on surgery, radiotherapy, bradytherapy and chemotherapy; 3) in limited tumours, the recommended strategy involved the use of one of these modality; 4) a multimodality approach is recommended for the treatment of extended resectable tumours. Following results of recent meta-analyses, use of neo-adjuvant chemotherapy is not recommended. The same studies have shown that association of chemotherapy and radiotherapy either in sequence or in combination significantly improve survival of extended curable tumours. These associations are recommended within the framework of clinical trials; 5) follow-up of squamous carcinoma of the oropharynx should involve physical examination of the upper aerodigestive tract and the lymph nodes areas every three months during the first year, every six months during the second year and then every year. An annual chest x-ray is recommended. Other investigations should be performed as indicated by symptoms and clinical manifestations.
[Internet: importance in cancerology and practical connection sites].
There has been a considerable increase in World Wide Websites on the Internet on medicine and oncology. The clinician has access to an abundance of useful documentary and graphic information. The challenge is firstly to find a relevant site and then to evaluate the quality of the material available on that site. In future, there may well be a service on the network which reviews sites. The aim of this paper is to give practical guidance to connecting on the Internet as well as a list of the best sites for clinicians, researchers, students and oncologists.
[Prognosis of epidermoid carcinoma of oropharyngeolaryngeal region].
Knowledge of pronostic factors is essential for assessment of therapeutic procedures and for individual treatment selection and adjustment for patient with squamous cell carcinomas of the head and neck. This paper reviews known clinical, histological and biological prognostic factors and their prognostic significance in predicting survival, response to treatment and locoregional and distant recurrences. Most significant criteria include tumor site and extension, absence or presence of cervical lymph nodes and their location, size and mobility. Histological, disease-related factors include number and location of involved nodes, and extra-capsular spread, which is the most significant independent factor. Response to treatment is an essential factor which should be used to alter or complement the treatment plan. Other treatment-related factors include technical parameters that can impact the outcomes and should be taken into account when assessing treatment procedures. Preliminary studies suggest that biological factors may be used as efficient predictors within the next few years but they are still under evaluation and therefore are not to be used in routine practice. They are expected to improve prediction of response to radiotherapy and chemotherapy as well as prediction of the risk of distant metastases and of metachronous head and neck cancers.
[Methodology of the development of diagnostic and therapeutic standards, options and recommendations in oncology].
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[Quality control of care in a surgical department. Experience of the Fondation Berganié].
Activity in a surgical department can be evaluated quantitatively, but is should also be assessed qualitatively. One way to control the quality of care is to determine as accurately as possible the incidence of pre- peri- and post-operative complications and to analyse these date in a critical comparative study. This was accomplished in the surgical department of the Fondation Bergonié, Bordeaux during three test periods over the last five years--March 1987 (127 patients), June-July 1989 (276 patients), and June 1991 (147 patients). Results of this analysis cannot validly be compared with those of other departments with different patient recruitment and activity functions. However, this study within a department with regular, homogeneous activity did demonstrate, over a period of several years, a clear reduction in operative mortality, essentially by improved control of infectious complications by the extensive use of prophylactic antibiotic therapy for all surgery with a septic risk or for debilitated patients. Results also demonstrated the low cost effectiveness of routine pre-operative exploratory examinations.
[Treatment of cervical lymph nodes in lip cancers].
From 1970 to 1985, 299 patients with lip cancer were examined, treated and followed-up at the Bergonié Foundation. In most cases, interstitial radiotherapy was used and the local control rate reached 94%. Local recurrences could usually be treated again, so that the final local control rate was 99%. However, the management of neck nodes remains controversial in some cases: 5.6% only of T1-2 N0 stages developed neck nodes, which were successfully controlled in 78.9% of cases and it was therefore considered that the preferred option should be to maintain the patients under close follow-up. For T3 N0 cases, of which 17.6% would evolve, it was considered that a sub-mental and sub-maxillary neck node dissection was advisable when performance status was satisfactory and when a close follow-up was difficult. The recurrence rate was 40% for patients with palpable neck nodes who were often submitted to a combined radio-surgical treatment. In such cases, recurrences were controlled in 22% of patients who died 7 times out of nine.
[Contribution of the combination of radiation and surgery in the treatment of invasive pharyngo-laryngeal carcinoma].
On the basis of the retrospective analysis of 269 cases of pharyngo-laryngeal carcinoma, the authors recall that the degree of tumour invasion is one of the essential prognostic factors for this disease. The macroscopic appearance of the tumour should therefore play a determinant role in the choice of treatment, as invasive lesions are generally responsive to radiotherapy.
[Conservative axillary curettage in the treatment of operable breast cancers].
Functional motor and sensory sequelae of conservative or non-conservative treatment of breast cancer are due essentially to axillary curettage, during which the nerve branches crossing the axillary pyramid are often sectioned. Analysis of axillary glands is now fundamental for determination of prognosis and adjuvant treatment required. The present report demonstrates that knowledge of the glandular state can be obtained, while limiting functional sequelae, by careful dissection of axilla avoiding all nervous elements (motor nerves of latissimus dorsi, serratus anterior and pectorals, perforating intercostal sensory nerves) and the must important vascular structures (inferior scapula pedicle and pedicle of pectoral muscles.
[Approach to therapeutic risk by study of operative mortality. From 102 postoperative deaths between 1975 and 1984 at the Fondation Bergonié].
A retrospective analysis of operative mortality in the cancer surgery department of the Fondation Bergonié between 1975 and 1984 allowed priority objectives to be defined requiring maximum efforts of the treating team. During this decade, 18,582 patients underwent surgery; 15,794 "first hand" operations were for cases not previously treated. Amongst the latter, 102 died within 90 days of surgery, 45 due to multifocal or apparently isolated pulmonary infection and 57 without any known infectious context. Separating patients into two groups: periods 1975-1979 and 1980-1984, demonstrated a notable decrease in postoperative mortality from 68 to 34. This improvement was due mainly to a reduction in deaths from infection (from 37 to 8 patients in the period 1980-1984). This marked improvement was probably the result of various combined causes: Mastery of parenteral nutrition enabling patients to be operated upon in better condition, or to tolerate possible complications better; Use of routine antibiotic therapy before surgery to digestive tube or ORL regions. These encouraging result suggest the need for enlargement of indications for routine prophylactic antibiotic therapy.
[Development of a knowledge-based system for aiding therapeutic decision in breast cancer].
The SENEX project has been initiated at the fondation Bergonié in 1985 and is intended for providing physicians in general hospitals with knowledge based systems for the management of cancer treatment protocols. The design and building of a knowledge-based system for the management of breast cancer protocols (SENEX) was the first goal of this project. SENEX has been developed using a commercially available development tool (Personal Consultant Plus, Texas-instruments) derived from EMYCIN. It runs on IBM and compatible microcomputers. The knowledge base embeds the formal knowledge contained in the breast cancer protocols currently in use at the fondation Bergonié, and some judgmental knowledge acquired form breast cancer experts. Production rules and frames allowed us to adequately represent and structure this knowledge and the problem solving processes related to the management of breast cancer. A preliminary informal evaluation of the system has shown that it performs at the expert-level in giving advice for patients included in formal protocols. Its use and acceptability are good. However, we have to add judgmental knowledge into the knowledge base and to interface the system with a temporal data base management system to improve the overall performances of SENEX. Moreover the effectiveness of the system remains to be demonstrated before one can anticipate is routine use in clinical practice.
[Prognostic significance of isolated local recurrences in breast cancer following mastectomy and axillary node excision. Apropos of 77 recurrences in 2362 patients].
During the years 1958-1984, 2 362 patients presenting with breast carcinoma were treated at the Fondation Bergonié by modified radical mastectomy and followed or not by radiotherapy or adjuvant chemotherapy. A retrospective analysis of this series showed that 77 patients (3.3%) presented an isolated locoregional recurrence as the first sign of treatment failure. A chest wall recurrence alone was noted in 47 patients, while 30 presented an involvement of the lymph nodes, sometimes associated with chest wall disease. The prognosis' factors of isolated locoregional recurrence, studied by multidimensional analysis by Cox's model are by decreasing order the disease free interval and the Scarf and Bloom's histologic grade. The median survival is 29 months after isolated locoregional recurrence and the survival curve is very similar to that of patients with isolated bone metastatic recurrences (median survival of 26 months) and slightly better than the median survival of patients with non osseous metastasis (median survival of 16 months).
[Immediate repair of urethroperineal fistulas after abdominoperineal amputation by means of a cutaneo-muscular flap of the gluteus maximus. Apropos of 2 successfully treated cases].
Although a rare complication, the development of a urethro-perineal urinary fistula immediately after abdomino-perineal amputation is a difficult problem to solve. The fragility of the membranous urethra immediately in contact with the exenterated pelvic cavity which takes several weeks to fill in makes any attempt at isolated direct suture very hazardous. Secondary repair is also frequently difficult and the "functional prognosis is far from being always favourable". The major handicap resulting from the perpetuation of this type of fistula has led us to propose an attempt at immediate repair as soon as it is diagnosed with filling of the pelvi-perineal cavity by a cutaneo-muscular flap taken from gluteus maximus. In the two cases in which this treatment was performed, the fistula was cured and a good quality functional result was obtained.
[Cancer of the oral cavity without palpable adenopathy: value of external irradiation exclusively].
Between 1970 and 1978, 99 patients with a squamous carcinoma of the buccal cavity without palpable lymphadenopathy were treated at the Bergonié Foundation by radiotherapy only and regularly followed up. All received a minimal dose of 40-50 Grays either to the primary node groups or the entire cervico-supraclavicular areas. Eight patients developed an isolated lymph node recurrence, in two cases only in the irradiated zone. The other 6 lymph node recurrences occurred either below the radiotherapy fields when the latter had been limited to the neck (4 cases) or at the posterior border of the field (2 cases). Secondary control was possible in two patients of the 8 by combined radiotherapy and surgery. Exclusive radiotherapy for lymph node areas up to a dose of 45-50 Grays thus protected 92% of patients from a lymph node recurrence. The methods of such irradiation and in particular the extent of radiotherapy fields are then discussed on the basis of the clinical aspects of the tumour.