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M Housset

Publications and source records attributed to M Housset.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Radiotherapy and chemotherapy in infiltrating bladder tumors].

Bladder carcinoma needs multidisciplinary therapeutic approaches. Surgery classically is the main step of local treatment. Nevertheless, radiation therapy and chemotherapy are largely employed. Radiotherapy uses accelerator photon beams to treat pelvis and bladder up to a total dose of 65 Gy in 6 to 7 weeks. Local control rate after exclusive radiotherapy is 30-40% and morbidity is acceptable. Iridium-192 brachytherapy has limited indications and is generally performed after partial cystectomy. Chemotherapy is the treatment of metastatic bladder cancer. The more active drugs are cisplatin and methotrexate. They are combined polychemotherapy allowing a survival improvement in patients with metastatic disease. Concomitant radio-chemotherapy combinations appear as a promising strategy for conservative treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[Radiotherapy in locoregional treatment of inoperable non-small cell lung cancer: results from a series of 381 patients].

PURPOSE: The prognosis of inoperable non-small cell lung cancer (NSCLC) is poor and thoracic radiation therapy is usually the main step of the therapeutic approach. The results of a retrospective analysis of a series of 381 patients treated from 1977 to 1990 for an inoperable NSCLC are reported. PATIENTS AND METHODS: Three hundred and twenty two men and 59 women were included into the study. Their mean age was 66 years. A squamous cell carcinoma was observed in 276 cases (72%). A superior vena cava syndrome or a Pancoast's syndrome were present in 21 and 26 patients, respectively. Fifty-two per cent of the patients had a WHO performance status > or = 2. According to the TNM classification, the tumor distribution was as follows: 11 T1, 153 T2, 175 T3, and 42 T4. The mediastinum was involved in 174 patients. All patients were treated by external radiation therapy with a total dose of 60-65 Gy. Classical fractionation of the irradiation dose was done in 217 patients and hypofractionation was used for 164 patients. RESULTS: After treatment, improvement of the superior vena and Pancoast's syndromes was observed in 90% of the patients. Radiological complete response was obtained in 177 patients (47%). The 5-year overall survival rate was 6.2%. No significant differences in survival according to the initial tumor size, the mediastinum status or the fractionation scheme were noted. The 5-year survival rate was 13% in patients with a tumor that completely responded to irradiation. Death was mainly due to local failure (231 patients, 69%) and metastatic disease (107 patients, 32%). The radiotherapy tolerance was acceptable. CONCLUSION: Although irradiation provides good palliation and a 10%-survival rate at 3 years, the results relating to radiation therapy were disappointing.

Adult↗
PubMed1997

[Postoperative radiotherapy in non-small cell lung cancer. Apropos of a series of 374 cases].

PURPOSE: Several randomized trials have led us to address the usefulness of post-surgical external beam therapy (EBT) in non-oat cell bronchial carcinoma. Results that were obtained in a group of 374 patients submitted between 1977 and 1994 to identical therapy-the follow-up being done by the same team-and results of six randomized trials are analyzed. PATIENTS AND METHODS: The tumor stages were the following: T1, 13%; T2, 56%; T3, 29%; and T4, 2%; N0, 31%; N1, 34%; and N2, 35%. There were 85% histologically complete resections. EBT was administered according to either the classical irradiation scheme (C) or as an 'equivalent hypofractionated dose' (H) in the case of complete resection. When resection was not complete, 60 to 65 Gy were administered according to a C or an H irradiation scheme. The irradiation scheme was C in 73% of the cases and H in 27%. The EBT technique has been chosen to ensure maximum lung sparing. Following a 45 Gy-irradiation with anteroposterior beams, orthogonal or, when necessary, oblique beams were used. Non homogeneity of the lungs was taken into account in establishing the treatment planning. The treatment file was collectively checked by the medical staff in 75% of the cases. EBT was indicated for N+(N1+N2), T3 and incomplete resections. RESULTS: The overall survival was 42% at 5 years and 27% at 10 years. The 5-year survival was 52% for stage I cancer (T1N0-T2N0), 60% for stage II cancer (T1N1-T2N1), 31% for stage IIIa cancer (T3N0, T1-3N2), 45% for complete resection and 30% when resection was not complete. CONCLUSION: Regarding the benefits of post-surgical radiotherapy, the analysis of the six randomized trials does not allow any conclusion. This might be due to either the insufficient number of cases, a follow-up time not long enough, incorrect radiotherapy, or insufficient available data. Comparison of the results pertaining to the six trials with those of our series shows an advantage for the current series, indicating that survival is likely to be improved if EBT is correctly done with regard to the dose, volume and technique used.

Actuarial Analysis↗
PubMed1997

[Concomitant radiochemotherapy in inoperable non-small cell lung cancer].

PURPOSE: As locally advanced and inoperable non-small cell lung cancers still have a poor prognosis, the present phase II study focused on the administration of concomitant chemotherapy and radiotherapy and was aimed at increasing both local and metastatic controls. MATERIALS AND METHODS: Thirty-nine patients (36 male and three female patients, mean age, 56 years) were included into the study. Ninety five percent of them had a good performance status (OMS status 0 or 1). The histopathological analysis showed the existence of squamous cell in 64% of the cases. There was one stage I tumor, nine stage IIIA tumors and 24 stage IIIB tumors. In two cases, the tumor stage was unknown. The duration of each cycle of the protocol was 3 weeks and included the administration of cisplatin (50 mg/m2 at d1 and d2) and fluorouracil (5-FU) (1 gr/m2 in continuous infusion at d1, d2, and d3), and external beam irradiation (20 Gy subdivided into 2 Gy-fractions that were administered from d1 to d12); the 3rd week was a resting period. RESULTS: The tolerance to the treatment was good. Fifteen per cent grade 3-4 leucopenia, 3% grade 3-4 thrombopenia and 15% grade 3-4 nausea with vomiting were observed. No serious esophagitis was recorded. Chemotherapy was completed in more than 90% of the cycles. An objective response was described in 56% of the cases, with only 3% of complete responses. However, evaluation was done on average 6 weeks after radiotherapy, at a time where post-irradiation fibrosis could hamper radiological assessment. Median survival and 2- and 3-year survivals were 11.4 months, 27% and 14%, respectively. The only significant prognostic factor was the OMS performance status index, while the radiological response was particularly non-predictive of survival. Failure patterns were analyzed in 20 patients and consisted of the following: local relapse only, six cases; metastatic relapse only, 13 cases; both local and metastatic relapse, one case. CONCLUSION: The concomitant administration of 5-FU, cisplatin and external irradiation seems feasible in current clinical practice. Survival but not radiological response should be the only criteria to evaluate this type of association. Improvement in local control is not unlikely with this type of association.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[Discussion on the role of radiotherapy in non-small cell lung cancer apropos of 137 non-metastatic cases].

PURPOSE: Retrospective analysis of 137 patients with limited stage small cell lung carcinoma who received radiotherapy between 1978 and 1990 and literature review. MATERIALS AND METHODS: The population was divided into two groups according to the total dose of radiation delivered to the thorax: 45 Gy (1.8 Gy by fraction) or the equivalent irradiation dose administered by hypofractionation (group 1, 29 patients) and 65 Gy (1,8 Gy by fraction) or the equivalent irradiation dose administered by hypofractionation (group 2, 96 patients). RESULTS: The actuarial survival rate was 20% at 2 years and 9% at 5 years. It was 25% at 2 years and 17% at 5 years for 12 patients with surgical resection. For patients who did not undergo surgical resection, it was 20% at 2 years and 9% at 5 years for 96 patients belonging to group 2, while it was 14% at 2 years and 3.5% at 5 years for group 1. Deaths due to local relapse reached 48% in the group treated with 45 Gy and 33% in the group treated with 65 Gy (NS). For the 33 patients who were more than 70 years old at the time of treatment, the actuarial survival rate was 18% at 2 years and 6% at 5 years with death from other causes twice as high as that of patients who were less than 70 years old at the time of treatment. For the 59 patients who were less than 70 years old at the time of treatment, in whom supraclavicular node, pleural effusion or superior vena cava syndrome were not depicted and who were treated with the highest dose (4% of the total number of patients), the actuarial survival rate was 20% at 2 years and 14% at 5 years. Literature analysis shows that treatment of limited small cell lung cancer with chemotherapy and thoracic irradiation increased the overall survival rate from 16.5% to 23% at 2 years and the local control from 23% to 48%, in comparison with chemotherapy alone. CONCLUSION: Although these results are modest, they seem to be improved with more effective chemotherapy, especially with the association of radiotherapy and concomitant chemotherapy.

Actuarial Analysis↗
PubMed1997

[Endobronchial brachytherapy: the Saint-Louis Hospital experience].

PURPOSE: During the evolution of lung cancer, bronchial obstruction is often noticed and is sometimes responsible for serious symptoms. Several methods of desobstruction can be proposed, including brachytherapy. MATERIALS AND METHODS: One hundred forty-nine patients presenting with endobronchial brachytherapy were included into the study. Seventy-three were treated with curative intent, 47 with palliative intent and 29 with a combination of external irradiation and brachytherapy. We usually delivered a series of two 7-Gy fractions (1 cm from the catheter), the treatment being repeated one, two or three times. RESULTS: When all symptoms were taken into account, respiratory function improvement was present in 79% of the patients. Among the 132 tumors that could be evaluated via a new endoscopy 2 months after treatment, 64 (48.5%) were in complete histological remission. The median survival was 14.4 months for the patients treated with curative intent. Eleven massive hemoptysies and 13 radiation bronchitis were observed. CONCLUSION: These results confirm the feasibility and good results related to endobronchial brachytherapy, though controlled studies are needed to better define its place in the therapeutic strategy of bronchial carcinomas.

Aged↗
PubMed1997

Serum tissue polypeptide antigen in bladder cancer as a tumor marker: a prospective study.

PURPOSE: Tissue polypeptide antigen (TPA) is a differentiation and proliferation tissue marker of epithelia. Increased serum levels were found in some patients with invasive bladder cancer. We present the results of a prospective study that evaluated the role of serum TPA (S-TPA) in bladder carcinoma. PATIENTS AND METHODS: The series included 167 patients treated for invasive bladder cancer between 1989 and 1996. S-TPA concentrations were measured by radioimmunoassay before treatment, at the end of treatment, and during follow-up evaluation. The upper normal limit of the test was set at 80 UI/L. RESULTS: With a specificity of 100%, the diagnostic sensitivity was 46%. Pretherapeutic S-TPA levels were significantly correlated with tumor stage (T2 v T3 and T4; P = .02), with nodal stage (N0 v N1 and N2; P = .00001), and with metastatic stage (M0 v M1; P = 10[-6]), but not with histologic grading (grade 1 and 2 v 3). In the subset of patients with normal pretherapeutic S-TPA levels, 95% had no residual disease at the end of treatment, compared with 53% of patients with initial elevated S-TPA (P = 10[-8]). Among patients who achieved a complete response, 27% experienced a relapse, with an increase of S-TPA in 72% of cases. The mean follow-up time was 20 +/- 17 months. For patients with normal pretherapeutic S-TPA levels, 3-year overall survival and disease-free survival rates were 76% and 67% respectively. These were 46% (P = .001) and 25% (P = 10[-7]), respectively, for patients with high pretherapeutic S-TPA. Multivariate analysis showed that S-TPA was an independent prognostic factor for survival (P = .03). CONCLUSION: In invasive bladder cancer, S-TPA level is correlated with initial tumor stage. It is a valuable parameter for follow-up evaluation and appears to be a prognostic factor in multivariate analysis.

Adult↗
PubMed1997

[Role of radiotherapy in the treatment of epitheliomas of the anterior skull base].

Prognosis of ethmoidal cancer depends on staging and local control. Use of radiotherapy is still under debate, but most authors recommend a radio-surgical procedure as first line treatment. Results and indications of exclusive irradiation or combined treatment are presented, and the interest of CT and immobilizing shell in treatment planning is discussed.

Combined Modality Therapy↗
PubMed1996

Phase II study of the oral cyclophosphamide and oral etoposide combination in hormone-refractory prostate carcinoma patients.

BACKGROUND: Hormonotherapy temporarily controls symptoms in 80% of patients with metastatic prostate carcinoma. Once progression occurs, no consensus exists on further therapy. Oral etoposide (VP-16) has shown clinical efficacy in advanced small cell lung carcinoma, breast cancer, germ cell tumors, and lymphomas, A synergistic effect between etoposide and alkylating agents such as estramustine was recently reported. We began a prospective Phase II study of an oral combination of cyclophosphamide (CPM) and VP-16 in patients with hormone-refractory [correction of refactory] prostate carcinoma (HRPC). METHODS: Patients were orally treated with CPM (100 mg/day) and VP-16 (50 mg/day) for 14 days every 28 days. Therapy continued until there was evidence of disease progression. RESULTS: From November, 1992, to February, 1995, 20 patients with HRPC were entered into the study. Patients were eligible if they had an ECOG performance status (PS) of 0 to 2. All of the patients presented with bone metastasis, and 70% presented with bone pain. Seventy-five percent had failed at least two hormonal manipulations. The mean duration of treatment was 5 months (range 2-12). Performance status improved in 26% of the patients, and bone pain was relieved in 71%. An objective response was defined as a decrease of 50% or more in the prostate-specific antigen (PSA) level. One patient demonstrated a complete response, and six patients had partial responses assessed by PSA plasma levels (objective response rate: 35%). The mean duration of response was 8 +/- 6 months (range: 2-24). Median survival was 11 months. Toxicities were minimal. CONCLUSIONS: The combination of oral CPM and VP-16 may be an active and well tolerated regimen for patients with HRPC.

Administration, Oral↗
PubMed1996

Postoperative radiation therapy in 26 patients with invasive transitional cell carcinoma of the upper urinary tract: no impact on survival?

PURPOSE: To evaluate the role of adjuvant radiation therapy in invasive transitional cell carcinoma of the upper urinary tract, we retrospectively reviewed a series of 26 patients who underwent radical surgery plus postoperative prophylactic irradiation for such a tumor. MATERIALS AND METHODS: Between February 1980 and October 1993, 18 men and 8 women (mean age 65 +/- 9 years, standard deviation) were treated for an invasive transitional cell carcinoma of the upper urinary tract. Tumor location was the renal pelvis in 15 patients (58%). The tumor was pathological stage B in 11 patients (42%) and stage C in 15 (58%). Tumor grade was 2 in 10 patients, 3 in 15 and unknown in 1. One patient had epidermoid metaplasia of urothelial cancer and 9 had node involvement. All patients underwent surgery followed by radiation therapy to a total dose of 45 Gy. to the tumor bed (23) and/or regional nodes (18). RESULTS: After a mean followup of 45 months 13 patients (50%) were alive and 11 were disease-free at analysis. Local tumor relapse, nodal recurrence and metastasis were noted in 1, 4 (15%) and 14 (54%) patients, respectively. All patients with nodal recurrence had metastasis. A secondary location was noted frequently (6 bladder, 1 contralateral renal pelvis and 1 urethral tumors). Overall 5-year survival rate and 5-year survival rate with no evidence of disease were 49% and 30%, respectively. Overall 5-year survival rates were 60% for stage B and 19% for stage C disease (p = 0.07), 49% for node-negative versus 15% for node-positive cancer (p = 0.04), and 90% for grade 2 and 0% for grade 3 tumors (p < 0.01). CONCLUSIONS: In our trial using a radio-surgical approach, local control of disease and survival rates were similar to those reported previously in surgical series. Prophylactic postoperative radiation therapy is not recommended except in prospective randomized studies.

Aged↗
PubMed1996

[Value of the association of partial surgery and postoperative radiotherapy in the management of tumors of the hypopharynx. A study of 141 T1-T2 cases of hypopharyngeal cancer treated by partial surgery, radical surgery or radiotherapy alone].

A retrospective study of 142 T1-T2 hypopharyngeal cancers treated from 1977 to 1988 was carried out. Forty-seven patients were treated by local conservative surgery, curage and postoperative radiotherapy of the remaining pharyngolarynx and cervical node areas (group 1), 48 by radical surgery and postoperative radiotherapy (group 2) and 47 by radiotherapy alone (group 3). There were more T1 tumors in group 1 (64%), than in group 2 (33%), and group 3 (40%). Sixty two percent of the patients of group 1 had clinical nodes, 56% of group 2 and 49% of group 3. There were 70% N+ and 30% N+ with extracapsular invasion (N+ RC+) in group 1, 81% N+ and 35% N+ RC+ in group 2. A histologically non-satisfactory resection was observed in 21% of patients of group 1 and 6% in group 2. Patients more than seventy years old comprised 11% in group 1, 15% in group 2 and 26% in group 3. Indications for radiotherapy alone was for 75% an impossibility for surgery (surgical contraindications or refusal by the patients). Overall survival was 34% at 5 years and 18% at 10 years. Five-year survival for groups 1, 2 and 3 were 48%, 33.5% and 22%. Deaths by cancer evolution was as frequent in group 2 as in group 3 (43%) but deaths by metastatic evolutions were twice as frequent in group 2 and deaths by local regional evolution twice as frequent in group 1 (2%). Treatment of group 1 was recommended because of the good survival at 5 years, 48%, and the good voice conservation, 100% (despite non-satisfactory resections and N+ RC+). At present, some of these conservative surgeries would be replaced by radiotherapy alone in case of complete response after initial chemotherapy, which would be an advantage for cases with an indication for radical surgery, but not necessarily so for cases with an indication for partial surgery, taking into account the good results that we have achieved with an association of partial surgery and radiotherapy.

Actuarial Analysis↗
PubMed1996

[Radiotherapy of 100 cancers of the cavum].

A retrospective study of 100 nasopharyngeal cancers treated between 1977 and 1991 was carried out. There were 22% T1, 18% T2, 15% T3 and 45% T4 with 31% N0, 20% N1, 36% N2 and 13% N3. Large adenopathies N2c + N3 were twice as frequent in the T1 group than in the T2, T3 and T4 groups. There were 59% UCNT (undifferentiated carcinoma of nasopharyngeal) and 41% epidermoid carcinomas. External beam therapy has been classical with 5 fractions of 1.8 Gy per week and a total dose of 75 Gy to the tumor and palpable nodes. A chemotherapy was carried out before locoregional treatment in 53%. Overall survival was 42% at 5 years and 39% at 10 years with a plateau from 4 years (45%). The major prognostic factor was T4 which gives 21% only at 5 years. The N has nearly no prognostic influence. UCNT have better survival (50% at 5 year) than epidermoid carcinomas (36%). There were more deaths by metastatic evolution with UCNT (46.5% against 17%) and much more deaths by locoregional evolution with epidermoid carcinomas (29% against 12%). Relapses were in the first 3 years in 90%. For 22 isolated local relapses 11 were treated with curative intent (5 brachytherapies and 6 new external beam radiotherapies): 6 were without cancer evolution in the observation times.

Adolescent↗
PubMed1996

[Infiltrating cancer of the bladder: can radiochemotherapy be an alternative to cystectomy?].

In order to improve the results obtained by cystectomy alone and to determine the possibilities of conservative treatment in invasive bladder cancer, we designed a prospective study using a combination of 5-FU--Cisplatin and concomitant radiation therapy, followed either by cystectomy or additional chemoradiotherapy. Sixty six patients (pts) with T2-T4 operable untreated invasive bladder cancer were entered into the study. Treatment was begun in all patients by trans-urethral resection (complete in 30 pts) and followed by 5-FU-Cisplatin combination with concomitant bifractionated split course radiation therapy. The neo-adjuvant irradiation dose was 24 Gy delivered in 8 fractions over 17 days, according to a modified bifractionated split course schedule. Each fraction delivered 3 Gy, twice on day (D1, D3, D15 and D17. The patients received concomitant Cisplatin (15mg/m2/d) and 5-FU (400mg/m2/d) on day D1, D2, D3 and D15, D16, D17. A control cystoscopy was performed six weeks after completion of the neoadjuvant program. Patients with persistent tumor underwent cystectomy. Complete responders were treated either by additional chemoradiotherapy (group A) or cystectomy (group B). At control cystoscopy, 51 of the 66 patients (77%) had histologically documented complete response. Among the 51 patients with complete tumor regression 31 were treated by conservative chemoradiotherapy and 20 underwent cystectomy. With a mean follow-up of 35 months, five responders developed recurrent pelvic disease (4/31 in group A and 1/20 in group B). Metastatic disease, which developed in 22 patients, occurred more frequently in the non responders (93%) than in responders (16%). Disease free survival at 5 years was 51%; it was significantly better in responders than in non responders. There was no difference in survival between groups A and B. This neoadjuvant chemoradiotherapy combination, easy to implement and well-tolerated even in elderly patients, provides a high CR rate. It may prove to be effective in inoperable patients and may be proposed as conservative treatment in patients with a complete response to the initial course of chemoradiation.

Adult↗
PubMed1996

[Infiltrating cancer of the bladder. Is concomitant radiochemotherapy an alternative to cystectomy?].

Infiltrating bladder cancer is an extremely severe condition causing death within 5 years due to metastatic extension in one-half of the patients whatever the treatment. It is well known that radiotherapy is successful in treating some patients while partial exeresis (open surgery or laparoscopic surgery) is effective in others. Current chemotherapy protocols (usually well-tolerated) increase the efficacy of radiotherapy but it is surprising that over the last 10 years, total cystectomy has become the first line treatment proposed for patients with infiltrating bladder cancer. The operation is a major procedure leading to an important morbidity and mortality. Since 1988, we have decided not to rely on total cystectomy for such patients, but rather to use a treatment protocol associating endoscopic exercise of the tumour and radiochemotherapy. Our results allow confirmation that this protocol can provide curative treatment in certain cases without removing the entire bladder. We thus suggest that systematic amputation of the bladder for cancer is an obsolete procedure and raise the question as to the usefulness of total cystectomy in this disease?

Adult↗
PubMed1996

[Value of postoperative radiotherapy in malignant tumors of the upper urinary tract. Apropos of a series of 26 patients].

To evaluate the role of adjuvant radiation therapy in invasive transitional cell carcinoma of the upper urinary tract, we retrospectively reviewed a series of 26 patients who underwent radical surgery plus post-operative prophylactic irradiation for such a tumor. Between 1980 and October 1993, 18 men and eight women (mean age: 65 +/- 9 years) were treated for an invasive transitional cell carcinoma of the upper urinary tract. Tumor location was the renal pelvis in 15 patients (58%). The tumor was pathological stage B in 11 patients (42%) and stage C in 15 patients (58%). Tumor grade was 2 in ten patients, 3 in 15 and unknown in one. Nine patients had node involvement. All patients underwent surgery followed by radiation therapy to a total dose of 45 Gy to the tumor bed (23 patients) and/or regional nodes (18 patients). After a mean follow-up of 45 months, 13 patients (50%) were alive and 11 were disease-free. Local tumor relapse, nodal recurrence, metastasis and second urothelial location were noted in one, four (15%), 14 (54%) and eight patients (30%) respectively. Overall 5-year survival and 5-year disease-free survival were 49% and 30% respectively. Overall 5-year survival rates were 60% for stage B and 19% for stage C disease (P = 0.07), 43% for node-negative versus 15% for node-positive cancer (P = 0.04) and 90% for grade 2 and 0% for grade 3 tumors (P < 0.01). In this study using a radio-surgical approach, local control of disease and survival were similar to those reported previously in surgical series. Prophylactic post-operative radiation therapy is not recommended.

Adult↗
PubMed1995

Phase I-II study of the somatostatin analogue lanreotide in hormone-refractory prostate cancer.

Lanreotide (BIM 32014), a somatulin analogue, was found to be as effective as castration in a rat prostate tumor model. Therapeutic benefit was also demonstrated in the hormone-resistant phase of this tumor model. The activity of lanreotide may be due to a reduction in the levels of growth factors such as insulin growth factor 1 (IGF1). A total of 30 patients with hormone-refractory prostate cancer were treated with a slow-release formulation of lanreotide. The mean age was 71 years. Patients were treated with one intramuscular injection of 30 mg BIM 23014 once a week and were followed for prostate-specific antigen (PSA) level evolution until disease progression or WHO grade 3 or 4 toxicity and for survival. The patients were treated for a mean duration of 12 weeks (range, 2-60 weeks). The performance status and bone pain were improved in 40% and 35% of patients respectively. In all, 20% of the patients had a decrease of > or = 50% in PSA levels and 16% showed a stabilization. The biological response was correlated with clinical improvement. The 1-year global survival rate was 72%, with the rate being 89% in the group of patients who were responders on PSA plasma level and 64% in patients with progressive disease. The response duration ranged from 16 to 60 weeks. Toxicity was minor, with transient grade I digestive side effects being noted in a few patients. Lanreotide given at 30 mg once a week to patients with metastatic hormone-refractory prostate cancer was well tolerated. The response rate was higher than that reported in recent published series. Higher doses of lanreotide should be evaluated.

Aged↗
PubMed1995

Use of perioperative or split-course interstitial brachytherapy techniques for salvage irradiation of isolated local recurrences after conservative management of breast cancer.

Treatment of local recurrence after conservative management for breast cancer is mastectomy. When mastectomy is contraindicated or refused, could brachytherapy be a therapeutic alternative for such isolated local relapses (ILR)? From February 1977 to June 1990, 38 patients, previously treated by radiation therapy or by a combination of radiotherapy and surgery for breast cancer, underwent salvage brachytherapy for an ILR. Fifteen patients were treated by limited tumorectomy plus 30 Gy perioperative brachytherapy for a 2.4-cm mean diameter IRL (Group A). Twenty-three patients were treated by exclusive split-course brachytherapy, delivering 60-70 Gy by two implants at 1-month interval, for a 3.9-cm mean diameter IRL (Group B). All patients achieved a clinical complete response after treatment. With a mean follow-up of 40 +/- 24 months, eight patients (21%) experienced local relapse between 9 and 48 months (four patients in Groups A and B). This second local recurrence was isolated in one case and was associated with metastatic disease in seven cases. At 5 years, overall survival was 55% (61% for Group A and and 50% for Group B). Three patients developed local complications requiring mastectomy (skin necrosis, two patients; severe breast pain, one patient). Cosmetic results in locally controlled patients were good in four patients, acceptable in twelve patients, mediocre in nine patients, and nonvaluable in two patients. Both perioperative brachytherapy and exclusive split-course brachytherapy appear to be feasible techniques and may be used occasionally as an alternative therapy to radical mastectomy for ILR.

Adult↗