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J Pigneux

Publications and source records attributed to J Pigneux.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Radiotherapy of carcinoma of the nasopharynx].

Cancer of the cavum is a rare condition in France. These tumors have, however, a poor prognosis and in general occur in young subjects. While radiotherapy would appear to be the best mean of ensuring local control, life expectancy depends solely on distant metastases. Analysis of a series of 58 cases treated at the Fondation Bergonié from 1975 to 1985 demonstrated a 30% five year survival rate. Among the 25 cases of recurrence, 1 was exclusively local and 6 were loco-regional (T and N), while 18 patients presented metastatic progression, either exclusively, or with local or lymph node failure. The prognostic factors found in this series were: age, extension beyond the cavum, the dose of radiotherapy. Results in the literature in terms of survival remain poor, especially in advanced stages and the future perspectives for better control of this disease remain early diagnosis and other forms of therapy such as combined chemotherapy and radiotherapy.

Adolescent↗
PubMed1990

[Randomized trial of initial chemotherapy in 151 locally advanced carcinoma of the cervix (T2b-N1, T3b, MO)].

From 1982 to 1987, a randomized phase III trial was performed in order to determine the long-term effect of induction chemotherapy before standard pelvic irradiation in stage IIb-N1, III squamous cell carcinomas of the cervix. Patients were randomized to either chemotherapy and radiotherapy (C + R group) vs radiotherapy alone (R group). Radiotherapy for all patients consisted of 50 Gy in the pelvis with a boost by external irradiation or by brachytherapy (cumulative dose of 68 Gy). The chemotherapy regimen was an association of methotrexate (10 mg/m2, D2-4), chlorambucil (4 mg/m2, D1-5), vincristine (0,7 mg/m2, D1), cisplatin (80 mg/m2, D5), given every 3 wks; at least 2 courses were to be given before assessing efficacy and 2 more courses were given to patients who responded. One hundred and fifty-one patients were fully evaluable, after a mean follow-up of 38 mths (range 2-7 years), 76 in the R arm and 75 in the C + R arm. The response rate (greater than 50%) to chemotherapy was 42.5%. After completion of treatment, the complete response rate was 86.8% in the R arm and 86.3% in the C + R arm. The 3 year disease-free survival was 58.7% in the C + R group and 54.5% in the R group, and the median survival was 39.5% and 47 months respectively (NS). The survival of patients with a complete response at the end of radiotherapy was significantly better in the C + R group (when chemotherapy had been active) than in the R group (p = 0.04). Although radiotherapy was not modified whether patients had initial chemotherapy or not, tolerance was not significantly different between the 2 groups. The data collected in this study indicate that: 1) efficacy of induction chemotherapy is the only available predictive test for long-term results, 2) tolerance to treatment is crucial for optimal chemotherapy delivery, 3) higher dose intensity of chemotherapy in cervical carcinoma is associated with a better tumor reduction, and probably a better survival.

Actuarial Analysis↗
PubMed1990

[Long-term clinical course after second laparotomy in ovarian cancer].

A series of thirty consecutive epithelial ovarian cancer patients were reviewed after long-term follow-up (more than 5 y) since their second-look operation (SLO). All patients had advanced tumors (stages IIb-IV). Primary chemotherapy consisted of a cisplatin-associated regimen. For all patients adjuvant treatment had been planned after completion of the SLO. Mean follow-up after SLO was 68 months (47-103 months). Tumor status at SLO divided the patients in 2 subgroups: Group A = 13 patients (43%), with no evidence of histologically proved disease at time of operation (NED); Group B = 17 patients (57%), with macroscopic persistence of tumor. Survival was significantly better in the first group than in the second (77% at 5 yr vs less than 25%). Recurrence rate in the NED group was 7.7% (1 recurrence at 32 months). Eight of 17 patients with gross tumor at SLO underwent satisfactory resection. However, recurrence rate was high (75%) and survival rate was low (25% at 5 yrs). This result was not significantly better than that of patients with no optimal resection at SLO (9 patients, survival 22%). Second effort resection at SLO does not seem to be beneficial in these patients after partial failure of initial chemotherapy with cisplatin. The usefulness of systematic second look operations is discussed. Controlled randomized trials should be made to determine the exact role of SLO in ovarian cancer treatment.

Adult↗
PubMed1990

[Cancer of the lips. Results of the treatment of 299 patients].

From 1970 to 1985, 299 patients with carcinoma of the lip were entirely managed at the Bergonié Foundation. Interstitial radiotherapy was most commonly used. It resulted in a successful local control in 96% of cases (238/248), while cosmetic and functional results seemed better than those of surgery. However, surgery seemed more performant for in situ carcinomas, late aggressive T3 carcinomas, local recurrences, as for T4 lesions associated with other techniques. After reviewing the case history of patients with local recurrences, we found technical faults in one half of those managed by interstitial radiotherapy. Local control rates after surgical salvage of recurrences was 99%. Treatment of neck nodes was not discussed in this publication.

Adult↗
PubMed1990

[Pure ovarian dysgerminoma. Evaluation of experiences and definition of a therapeutic strategy].

The authors present a series of 10 pure dysgerminoma of the ovary treated between 1976 and 1984; mean age = 19.5 years, range 15-46 years. All patients had initial surgery: 8 annexectomies for 5 stages Ia and 3 stages IIIc nodal disease, 1 hysterectomy with bilateral adnexectomy for a 46 year old stade Ib patient and 1 case of salvage surgery for a progressive disease after a single adnexectomy. Two patients had no adjuvant therapy after initial adnexectomy (stage Ia tumors less than 10 cm in diameter). Four patients received a prophylactic subdiaphragmatic radiation therapy (3 stages Ia tumors larger than 10 cm, 1 stage Ib disease). Three patients received an irradiation for a subdiaphragmatic bulky disease and a prophylactic supradiaphragmatic irradiation (stage IIIc nodal disease). Two patients received chemotherapy, one for recurrence, the other for progressive disease. The authors discuss the therapeutic indications of pure dysgerminoma of the ovary, especially the conservative management of young patients wishing to preserve an hormonal and obstetric future and the value of radiologic and serologic follow-up. Recent data in the literature underline the efficacy of new combinations of cytotoxic agents and their role as an adjuvant of surgery in early as well as in advanced stages.

Actuarial Analysis↗
PubMed1990

[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.

Aged↗
PubMed1989

[Radiotherapy and cerebral stereotaxis. Examples of dosimetry with 3D reconstruction].

External stereotactic radiotherapy allows to irradiate a small and carefully delimited intracranial volume according to the spatial definition of the target. To determine the distribution of the dose in the volume irradiated, we developed a dosimetric programme adapted to our particular treatment conditions (arc therapy in the frontal and oblique planes converging onto the centre of the target volume with circular beams 8 to 20 mm in diameter using 18 MV X photons). The principle of the programme is a 3D reconstruction based on ten transverse CT slices. This reconstruction, related to the stereotactic coordinates defined during stereotactic localization, visualises the outline of each oblique frontal treatment plane and the outline of the three perpendicular reference planes passing through the centre of the target volume (i.e. transverse, sagittal, coronal). The isodose distribution is then calculated in the planes defined by these reconstructions. Under treatment conditions, we use the parameters measured for each beam with their additional collimation. We present an evaluation of this software performed on a phantom consisting of a skull containing a defined target.

Humans↗
PubMed1989

[Brachytherapy of cancer of the penis. Analysis of a series of 53 cases].

From 1970 through 1984, 53 patients with squamous cell carcinoma of the penis have been treated by interstitial irradiation with iridium 192 wires; in this group 33 patients have been followed for at least ten years. There were 7 T1, 31 T2, 15 T3 and 37 N0, 7N1, 6 N2, 3 N3 (WHO classification, 1979). Forty eight patients were treated by interstitial radiotherapy alone, after previous circumcision for 35 of them, and five by an association of external and interstitial radiotherapy. Eleven patients presented a local recurrence; all but one were controlled by penile amputation. Fifteen patients developed severe complications (necrosis, urethral stenoses treated by surgery) and ten of them underwent a secondary total or partial penile amputation. Complications are strongly correlated with the irradiated area and the dose (over 65 grays). Recurrences and complications may develop very late after the treatment, beyond ten years. They required 12 partial and 10 total amputations. Interstitial radiotherapy is the first line treatment for carcinoma of the penis and it is well accepted by the patients. However, to keep a reasonable rate of complications and recurrences we limit the indications of interstitial radiotherapy to the small lesions (T1-T2) and we suggest to decrease the dose under 65 grays. To avoid some local failures we treat now the whole glans.

Actuarial Analysis↗
PubMed1988

Radiotherapy alone in carcinoma of the intact uterine cervix according to G. H. Fletcher guidelines: a French cooperative study of 1383 cases.

A French Cooperative study of 1383 cases with invasive carcinoma of the intact uterine cervix treated with radiation therapy alone, using the guidelines provided by G. H. Fletcher led to the following conclusions: The techniques of treatment were easily reproducible in 9 French centers, working in a prospective cooperative study; Results similar to those of the original study were achieved in Stages I and IIA (MDAH substaging) with a locoregional failure rate of 7%; In Stage IIB, the locoregional failure rate of 16% is also comparable in both studies; Locoregional failures in Stage III are slightly lower than those reported in Houston, probably reflecting differences in patient's prognostic factors in France and Texas; The 5-year survival rate obtained in advanced Stages (UICC FIGO staging) are among the highest in the literature (76% in Stage IIb, 62% in Stage IIIa and 50% in Stage IIIb); The rate of severe complications remains acceptable and decreased throughout the study thanks to a better use of computer dosimetry.

Female↗
PubMed1988

Our experience of conservative treatment of anal canal carcinoma combining external irradiation and interstitial implant: 32 cases treated between 1973 and 1982.

Between 1973 and 1982, a selected group of 32 patients with anal canal carcinoma received conservative treatment combining external irradiation and 192Iridium implant in a split course. Survival rates at 3 and 5 years are 78 and 61%, respectively. The overall control rate at the primary site is 75%. Tumor response to external irradiation appears to be the major predicting factor of the primary growth control after subsequent interstitial therapy. Two patients (6%) showed severe radionecrosis. The probability to preserve good anal function is 69%. Interstitial irradiation preceded by an external radiotherapy offers a good alternative in the conservative treatment of anal canal carcinoma.

Adult↗
PubMed1987

A quantified approach to the analysis and prevention of urinary complications in radiotherapeutic treatment of cancer of the cervix.

This paper is the report of a dosimetric study of 79 urinary complications after radical radiation treatment (1975-1979) of 624 cervical uterine tumors. Treatment consisted of external irradiation (25 MeV linear accelerator) and intracavitary irradiation (Fletcher-Suit-Delclos applicator). Dosimetric-computerized studies were expressed as the maximum bladder dose on the trigone, as proposed by the I.C.R.U. Bladder doses were actually studied as a function of intracavitary irradiation and intracavitary + external irradiation. The results show a significant difference in patients with and without complications based on the dose reaching the bladder. The relative contribution of external therapy and intracavitary irradiation and their value can serve as one of the primary indicators for predicting complications. These values should be determined before placement of intracavitary sources. We found that the dose to the critical organs cannot be defined as a single number. These results argue in favor of adapting individual patient therapy based on rectal and bladder dosimetry and may be adjustable to all treatment modalities.

Brachytherapy↗
PubMed1987

[Long-term results of the treatment with physical agents exclusively in a series of cancers of the uterine cervix. Cooperative study of 1,383 cases].

The authors present a study of 1,383 cases of invasive carcinoma of the cervix treated exclusively by radiotherapy between 1970 and 1981. Combination external radiotherapy followed by intra-cavitary applications was carried out. The study was carried out in 9 different radiotherapy centres in France using the same protocol and the same recording systems. The therapeutic results which have been recorded at every stage are among the best obtained until now, with 90% success for stage I after 5 years, 80% success for stage II, 52% for stage III growths. Only 2.1% failures occurred in the cervico-vaginal region. Pelvic recurrences were 7% in stage I and IIA, 14% in stage IIB and 24% in stage III. These recurrence rates are lower than have generally been recorded. Complication rates are also low and became less as the study continued, thanks to better use of dose distribution in individual cases which took note of doses received by neighbouring organs. The prognostic value of lymphography was analysed.

Cesium Radioisotopes↗
PubMed1986

[Palliative chemotherapy of endometrial cancer. Value of combinations with doxorubicin and cisplatin].

The study of a series of 21 consecutive cases of adenocarcinomas of the endometrium requiring chemotherapy, has permitted to demonstrate the superior efficacy of an association of doxorubicin and cisplastin as compared to other plans containing only anthracyclin (45% of partial and complete remissions versus 20%); this difference, however, is not statistically significant. Intolerance reactions were similar in both groups. Confirming recent data from the literature, the results conclude in favor of: the determinant contribution of cisplastin to chemotherapy, the need of a strict selection of the patients intended for chemotherapy, the usefulness of induction chemotherapy trials, prior to pelvic radiotherapy in locally advanced forms, to improve their distant prognosis.

Adult↗
PubMed1985

Results of radiotherapy alone in 581 patients with Stage II carcinoma of the uterine cervix.

From January 1976 to December 1978, 581 previously untreated patients with Stage II carcinoma of the uterine cervix were treated by radiotherapy alone in nine departments of radiotherapy in France. This retrospective analysis was undertaken in an attempt to evaluate the therapeutic results and prognostically significant factors. The initial clinical staging and the therapeutic guidelines were as outlined at the U.T. M. D. Anderson Hospital in Houston; all our patients were treated by standardized protocols combining external beam irradiation and intracavitary irradiation with cesium sources. The overall locoregional control rate was 83.2%, with total disease control of 74.5%. Uncorrected actuarial survival rates are 76% at 3 years and 68% at 5 years. The incidence of severe posttherapeutic complications is 7.2%. Clinical substaging, patient's age at the time of the diagnosis, lymphangiogram findings, and tolerance to external irradiation were all found to have prognostic significance. According to those findings, the possibilities of improving the results are discussed.

Actuarial Analysis↗
PubMed1985

[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.

Adult↗
PubMed1984

[Role of interstitial radiation in the treatment of glioma].

Therapy of glioma is a function of numerous factors: their histology, localization and size, but also the age and functional state of the patient. Interstitial radiation by temporary implantation of Iridium 192 needles is recommended only under certain precise conditions: for tumors surgically inaccessible because of their deep localization or their site in a highly functional region, and for those with diameters of less than 35 mm. This restricts the number of cases that can be treated (45 in the present series). Numerous adverse reactions developed, either in the short (initial deficit and edematous reactions), medium (epilepsy) or long term (radionecrosis). However, many were regressive and the treatment is satisfactorily tolerated in view of the localization of these tumors in highly functional regions.

Adult↗
PubMed1984

[Prognostic factors in cancer of the endometrium and therapeutic indications].

Between 1970 and 1979, 270 patients were treated at Fondation Bergonie for carcinoma of the endometrium (169, for the whole treatment). The cases were classified according to the FIGO staging system. The mean age of the patients was 62.2, with a range from 31 to 95. 62% of patients had stage I carcinoma, 16% stage II, 18% stage III and 4% stage IV. The operability rate, according to the patients ages was considered a main factor in the prognosis. The 5 years survival was 64% for stage I, 60% for stage II, 47% for stage III and 0% for stage IV. Histologic grade of the tumor and depth of myometrial invasion are also important prognosis factors; both influencing survival. This study compared with others, provides the main prognosis factors: age and operability, stage of the tumor, histologic grade, depth of myometrial invasion and pelvic and/or para-aortic lymph nodes involvement. The authors conclude by specifying the indications for treatment.

Adult↗