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Biomedical subjects

M Housset

Publications and source records attributed to M Housset.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Simultaneous radiochemotherapy in locally advanced cancers of the cervix: a preliminary study].

We have designed a combined treatment strategy of bifractionated split course radiotherapy (RT) and concomitant chemotherapy (CT) to try to improve the results of RT in inoperable cervical carcinoma. After evaluation, patients were submitted to further radical surgery or additional RT-CT depending on the treatment results. Between January 1988 and January 1992, 25 patients with non metastatic inoperable disease entered in the protocol. The stage of the disease was: T3N0 4 patients, T3 with hydronephrosis seven patients, T3N1 12 patients, and T4N0 two patients. Nineteen patients received two courses of CT with fluorouracil (F), cisplatin (P) with or without etoposide. Pelvic RT was given twice daily (two fractions of 3 Gy) on days 1, 3, 15 and 17. A combination of F 400 mg/m2/d and P 15 mg/m2/d in continuous infusion with oral etoposide (100 mg/d) and hydroxyurea (500 mg/d) in 11 patients was delivered concomitantly on days 1-3 and 14-17. A clinical and radiological evaluation was performed four weeks later. Patients with objective response underwent radical hysterectomy (group A) and those with incomplete response received additional RT-CT protocol (group B). All patients had endocavitary brachytherapy at the end of treatment. After two cycles of CT there were four PR in 19 patients and 5 failures. After RT-CT there were 12 CR (48%) and eight PR. There was a relationship between disease status after RT-CT and response to initial CT in those 19 patients who received the neoadjuvant CT. Fifteen patients were in group A, six of whom had no histologically active disease in the post-operative sample. However all 15 patients were rendered free of disease. Ten patients were in group B, five of whom attained the clinical CR status. In total, 20 of 25 patients (80%) were in CR at the end of treatment. Six patients experienced pelvic recurrence and two patients distant metastases. Four of the five patients with incomplete response had evolutive disease. The overall survival is 60% and 36% at 1 and 2 years respectively after a median follow-up of 22 months (14-48 m). The protocol was tolerable. These results compare favorably with those of conventional RT and warrant further evaluation.

Adult↗
PubMed1994

[Principles of curietherapy].

Brachytherapy, the use of radioactive sources implanted into the tumor or placed in proximity to the tumor, makes it possible to obtain well defined, localized distributions of the irradiation dose. The word "brachytherapy" includes various techniques which are practiced most frequently with cesium-137 or iridium-192. Whether used alone or in conjunction with surgery and (or) external irradiation, brachytherapy has contributed to the development of organ conserving treatment for cancer, notably and more recently, for carcinoma of the breast, bladder and buccal cavity, in addition to its traditional applications in gynecological and cutaneous cancers. Refinements of brachytherapy techniques have been made possible by recent advances in 3-D imaging and by the development of highly active radioactive sources which are used to obtain very precise dose distributions and very short treatment times.

Brachytherapy↗
PubMed1994

Serum tissue polypeptide antigen (S-TPA) in bladder cancer as a tumor marker. A prospective study.

BACKGROUND: Tissue polypeptide antigen (TPA) is a differentiation and a proliferation tissue marker of non-squamous epithelia. Increased urinary and serum TPA (S-TPA) levels were found in some patients with invasive bladder cancer. The authors report the results of a prospective study evaluating the role of serum TPA (S-TPA) in bladder carcinoma. METHODS: S-TPA concentrations were measured by radioimmunoassay in 53 patients with invasive bladder tumor before treatment, at the end of treatment, and during follow-up. The upper normal limit of the test was set at 80 UI/ml. RESULTS: With a specificity of 100%, the diagnostic sensitivity of the test was 54.7%. S-TPA was increased in 88% of patients with N1 + N2 disease compared with 38.8% of the patients with N0 disease (P = 0.01) and in 100% of patients with metastatic disease and 48% of patients with nonmetastatic disease (P = 0.01). S-TPA was increased in 23% of patients with total macroscopic debulking and in 68% of patients with persistent macroscopic disease (P = 0.004). For patients staged N0 M0, no statistical correlation between S-TPA level and debulking by transurethral resection (TUR) was found (P = 0.15). In the subset of patients with normal pretherapeutic S-TPA levels, 75% achieved a complete response, compared with 44.8% of the patients with initial elevated S-TPA levels (P = 0.04). However, there was no statistically significant relationship between pretherapeutic S-TPA levels and immediate response to treatment according to the stratification for tumor volume after initial debulking by TUR. For a mean follow-up of 15 months +/- 7 months, median survival time and 1-year survival rates were studied in the subset of patients with limited disease (N0 M0) according to the pretherapeutic S-TPA levels. The median survival time was not reached, and the 1-year survival rate was 80% when the initial S-TPA level was normal; these were 10 months and 44%, respectively, when the S-TPA level was high (P < 0.01). Among the 31 patients who achieved a complete response, 9 experienced a relapse, with an increase of the S-TPA level in 8 patients. CONCLUSIONS: The S-TPA level is correlated with initial tumor volume. It appears to be a prognostic factor and a valuable parameter for follow-up.

Biomarkers, Tumor↗
PubMed1994

Successful treatment of radiation-induced fibrosis using liposomal Cu/Zn superoxide dismutase: clinical trial.

Based on experimental and clinical evidence indicating that the anti-oxidant agent liposomal Cu/Zn superoxide dismutase (Lipsod) is an effective anti-inflammatory drug and possibly might be effective in reducing late radiation-induced tissue injury, a clinical trial using Lipsod to treat long-standing radiation-induced fibrosis (RIF) was begun at the Necker Hospital, Paris in May 1984. Thirty-four patients presenting 42 distinct palpable zones of RIF involving the skin and underlying tissues were treated from May 1984 to January 1986 and followed for an average of 5 years (range, 14-89 months). Lipsod was administered over 3 weeks in twice weekly i.m. injections of 5 mg for a total of 30 mg. Patients underwent two physical examinations by independent physicians at each check-up. Parameters noted included determination of the density of the palpated fibrotic block and the dimensions of the projected cutaneous surface. The extent of change in the fibrotic zone was expressed as the ratio of the sum of the dimensions (L + W) and the ratio of the uncorrected areas (L x W) of the projected cutaneous surface before and after treatment. Changes in density were noted and scored. All patients showed some clinical regression of fibrosis. In most patients, clinically assessable regression begun during the third week of treatment and was maximum by 2 months. The mean decreases in the linear dimensions (L + W) and in the area (L x W) of the projected cutaneous surface were 41 +/- 30% and 57 +/- 26%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Salvage split course brachytherapy for tonsil and soft palate carcinoma: treatment techniques and results.

From December 1981 to October 1990, 28 patients with prior irradiation of the oropharynx underwent salvage brachytherapy for a squamous cell carcinoma of the tonsil and/or the soft palate. The patients were free of cervical nodes and without metastatic disease. There were 4 immediate failures of radiotherapy, 14 local recurrences, and 10 new malignancies. The mean size of the lesion was 2.7 +/- 1.7 cm (range, 0.5 to 7 cm). The initial irradiation had delivered 40 to 80 Gy (mean, 69 Gy) to the oropharynx with a mean interval between external therapy and salvage treatment of 22 +/- 28 months. Salvage brachytherapy consisted of two split course implants done 1 month apart, delivering 35 and 30 Gy, respectively. Fifteen patients (46.5%) were clinically disease-free before the second implant and 23 (82%) were clinically disease-free at the end of treatment. Five local failures have been observed without any influence of the tumor size, the topographic site of the tumor, or the histological differentiation. Of the 4 patients who previously had failed with external beam therapy, 3 were disease-free after salvage brachytherapy. Among the 23 patients in complete remission, 4 (17%) presented a local recurrence within a mean time of 5 months. The overall local control rate was 68% with a mean follow-up of 41 +/- 29 months. The overall actuarial survival was 25% and 19% at 2 and 5 years, respectively; it was 30% at 5 years for the patients presenting with lesions less than or equal to 3 cm. Tolerance was acceptable. Among the 23 patients who achieved complete remission, subsequent soft-tissue necrosis was observed in 4 cases. For these 4 patients, the interval between previous radiation therapy and salvage treatment was short (mean, 7 months). Interstitial split course brachytherapy offers an effective and reasonable option for salvage therapy in patients with recurrent and second cancers occurring in the tonsillar region and in the soft palate, even when the tumor arises in a zone that has previously received high-dose irradiation.

Adult↗
PubMed1993

Combined radiation and chemotherapy for invasive transitional-cell carcinoma of the bladder: a prospective study.

PURPOSE: 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 fluorouracil (5-FU) plus cisplatin and concomitant radiation therapy, followed by either cystectomy or additional chemoradiotherapy. PATIENTS AND METHODS: Fifty-four patients with stage T2 to T4 operable untreated invasive bladder cancer were entered onto the study. Treatment was begun in all patients by transurethral resection (TUR) and followed by the 5-FU-cisplatin combination with concomitant bifractionated split-course radiation therapy. A control cystoscopy was performed 6 weeks after completion of the neoadjuvant program. Patients with persistent tumor underwent cystectomy. Complete responders were treated by either additional chemoradiotherapy (group A) or cystectomy (group B). RESULTS: At control cystoscopy, 40 of 54 patients (74%) had a histologically documented complete response. Four responders developed recurrent pelvic disease after a mean follow-up time of 27 +/- 12 months (three in group A and one in group B). Metastatic disease, which developed in 16 patients, occurred more frequently in the nonresponders (71%) than in responders (15%). The disease-free survival rate at 3 years was 62%; it was significantly better in responders (77%) than in nonresponders (23%). There was no difference in survival between groups A and B. CONCLUSION: This neoadjuvant chemoradiotherapy combination, easy to implement and well tolerated even in elderly patients, provides a high complete response 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↗
PubMed1993

[Iatrogenic fibrosis in cancerology (2): main etiologies and therapeutic possibilities].

Fibrosis in oncology concerns iatrogenic pathology, after radiotherapy or bleomycin, and also after surgery or neoadjuvant chemotherapy. Specificity of certain etiologic conditions are described in detail. Some therapeutic attitudes are discussed. Corticoids are useful in the management of inflammatory fibrosis attacks. Other drugs under study are used in an attempt to reduce the late fibrotic process, namely liposomal superoxide dismutase.

Anti-Inflammatory Agents↗
PubMed1993

[Iatrogenic fibrosis in cancerology (1): descriptive and physiopathological aspects].

Tissue fibrosis is a non specific proliferation of connective tissue, overriding the limits of normal wound healing and essentially encountered in oncological practice as an iatrogenic pathology. This study reviews the data pertaining to the cellular and extracellular components of fibrosis and their regulation. Regulation of the fibrotic process is studied in several steps: chemotaxis and proliferation of fibroblasts, collagen metabolism, and interactions between inflammatory cells and the extracellular matrix.

Collagen↗
PubMed1992

Split course interstitial brachytherapy with a source shift: the results of a new technique for salvage irradiation in recurrent inoperable cervical lymphadenopathy greater than or equal to 4 cm diameter in 23 patients.

Between June 1981 and December 1986, 23 patients with prior irradiation of the neck for epithelial ENT tumors underwent salvage irradiation for isolated recurrent inoperable cervical lymphadenopathy greater than or equal to 4 cm. The initial irradiation had delivered 45-80 Gy to the cervical lymph nodes. Split course interstitial brachytherapy was used with a source shift in an attempt to decrease treatment complications. The first and second course of the split course implants delivered 35 Gy and 30 Gy at a 1 month interval. The active lines of the second implant were placed parallel to and in between the position of the lines of the first implant. Three patients did not receive the second implant (one death, one disease evolution, one necrosis). For the patient who died between the first and second implants the local control rate could not be determined. The immediate overall local control rate was 73% (16/22) with a later recurrence rate of 62% (10/16), but only in three cases was recurrence within the treated volume (19%-3/16). The local control rate was better (3/9) if the initial lymphadenopathy was greater than or equal to 4 cm less than or equal to 6 cm but worse (3/13) in those with initial lymphadenopathy greater than 6 cm. Survival of these patients overall was poor with 26% survival at 1 year and 13% at 2 years. Tolerance overall was acceptable with tissue necrosis occurring in 36.5% of cases including those with initial skin involvement. If these cases were excluded the necrosis rate was only 15.5%. In this patient population with inoperable recurrent cervical lymphadenopathy in whom a further dose of external irradiation is not possible interstitial brachytherapy should be considered. Our technique of implantation, split over two sessions with a source shift, is practicable with an acceptable toxicity. It may be used even after high dose external beam irradiation and in large volumes of disease, and it gives better results than classical brachytherapy.

Aged↗
PubMed1992

Iridium 192 plesiocurietherapy using silicone elastomer plates for extensive locally recurrent breast cancer following chest wall irradiation.

From July 1985 to October 1988, 11 patients with prior treatment for breast cancer, and presenting an isolated superficial widespread inoperable chest wall recurrence, underwent plesiocurietherapy for salvage. Most patients (91%) had had a mastectomy. The recurrences developed in tissue that had previously been irradiated to 45-55 Gy in three patients and 65 Gy in eight patients. Salvage was attempted using two or three courses of plesiocurietherapy at monthly intervals to decrease treatment complications. The position of the active sources was maintained parallel but slightly shifted at each application. A total dose of 60 Gy was delivered to a Reference Isodose (R.I.) located 2 to 4 mm under the skin surface. The guide system consisted of plastic tubes inserted at 1.5 cm intervals into flexible silicone plates that were applied to the skin surface to maintain the actives lines 0.5 cm above the skin surface. The high dose sleeves surrounding the actives lines (dose greater than 2 x R.I.) were contained within the thickness of the silicone plate. The mean surface treated was 480 cm2 (range 30-1030 cm2). Two patients had continued progression of the lesions within the treated volume during and after curietherapy and died rapidly of metastatic disease. Nine (89%) patients showed complete regression of treated lesions. But two patients developed a new recurrence outside the treated volume. Complications were acceptable: five patients experienced regressive moderate to severe radiation dermatitis and one had skin necrosis that healed in 2 months. These preliminary results have shown that even when tumor extension and previous treatment theorically counter-indicate further local therapy for locally recurrent breast cancer, it is possible to obtain immediate and, at times, lasting control of local disease using two or three courses of plesiocurietherapy with a source shift.

Adult↗
PubMed1992

Postoperative radiation therapy for cervical lymph node metastases from an occult squamous cell carcinoma.

One hundred thirteen patients with cervical metastases from a squamous cell carcinoma and no evidence of the primary tumor were treated for cure by surgery and routine large-field postoperative irradiation. Patients were staged according to the 1987 American Joint Committee on Cancer (AJCC) classification. There were 24 N1, 54 N2, 29 N3, and 6 Nx lesions. One hundred four patients underwent cervical lymph node dissection and 9 had adenectomy. All patients received postoperative external beam therapy to the entire naso-oro-pharyngo-larynx and all cervical lymphatics. The overall nodal failure rate was 13.7%. Nodal failure was significantly correlated with N staging (P = .01) and with the number of histologically involved nodes (P = .05). NOdal failure was 21% when nodes were initially fixed versus 7.5% when they were not (P = .07) and 18% when there was extracapsular spread versus 4.3% when the capsule was intact (P = .11). Eleven patients (9.7%) developed a subsequent primary lesion. In 3 patients (2.6%), this primary was located in the previously irradiated area and, in 2 cases, under the anterior block of lateral fields. Metastases occurred in 18 patients (16%). The five-year overall survival rate was 38%. Survival was correlated with N staging (P less than .02), nodal fixation (P = .05), extracapsular spread (P = .01) and loosely with the number of histologically involved nodes (P = .08). On the contrary, histological differentiation did not influence the local control rate, nor the development of metastases or subsequent primary lesions. Large-field prophylactic radiation therapy appears to be effective in preventing the emergence of initially occult primary lesions. However, control of disease in the neck and survival remain disappointing in patients with advanced nodal disease, even after combined surgery and radiation therapy.

Adult↗
PubMed1992

T1 squamous cell carcinoma of the arytenoid.

Twenty-two cases of early squamous cell carcinoma of the arytenoid cartilage staged as T1 according to the 1983 American Joint Committee for Cancer Staging Classification system were reviewed. Eighteen percent of the patients showed no symptoms. In the remaining 82%, the main presenting symptom was pain in the form of sore throat, odynophagia, or otalgia. Radiotherapy and partial laryngeal surgery were the options retained for the treatment of the larynx. A "watch and wait" policy or preventive treatment of the ipsilateral jugulocarotid lymph nodes were the treatment options retained for the neck. Significant differences were noted in terms of local and nodal recurrence between the two programs. Results indicate that partial laryngeal surgery with total arytenoidectomy and preventive treatment of the neck appear to be advisable for this particular type of primary lesion.

Adult↗
PubMed1992

[Primary cervical lymph nodes of epidermoid type. Results of a series of 123 patients treated by the association surgery-radiotherapy or irradiation alone].

Between 1972 and 1986, 123 patients were treated with curative intent for a metastatic squamous cell carcinoma in cervical lymph nodes of an unknown primary. The lesions, staged according to the 1987 AJC classification were 24 N1, 59 N2, 34 N3 and 6 Nx. A hundred four patients underwent a cervical lymph node dissection and 9 an adenectomy. All these patients received post-operatively external beam therapy on the Waldeyer ring, the pharyngo-larynx, the cervical nodal areas (45 Gy); a boost (20 Gy) was delivered to nodes presenting with extracapsular spread. The 10 remaining patients were inoperable and were treated by radiation therapy alone to a total tumor dose of 70-75 Gy. In the group treated by surgery-radiation therapy, the 5-year overall nodal failure rate was 13.7% and it was 60% for the patients treated by radiation therapy alone. For the first group, this failure rate was correlated to the AJC stage (p = 0.01) and to the number of histologically involved nodes (p = 0.05). The failure rate was 7.7% if the node was clinically fixed versus 21% if it was not (p = 0.07). It was 18% when there was an extracapsular spread and 4.3% when it was absent (p = 0.11). Thirteen patients developed a subsequent primary lesion, in pre-irradiation volume in 5 cases (4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗