Search PubMed⌕ Search

Biomedical subjects

P Lasser

Publications and source records attributed to P Lasser.

At least 163 records · Page 9Linked to original sources
PubMed1987

Early adjuvant intraportal chemotherapy after curative hepatectomy for colorectal liver metastases--a pilot study.

A preliminary study was conducted with early and continuous intraportal adjuvant chemotherapy (IPAC) after a curative hepatectomy for colorectal metastases. The IPAC consisted of 14 days of 5-FU infusion at the rate of 600 mg/m2/d. The ultimate aim of this study was to reduce the frequency of recurrences in the remaining liver after curative hepatectomy. Twelve patients were included. IPAC was initiated in nine of them, while three technical failures occurred. The 14-day course with continuous 5-FU was given five times. The treatment had to be ceased prematurely because one medical and three mechanical complications occurred during the infusion. Pains and vomiting were frequent, but were usually the result of mechanical complications. No important hepatotoxicity or haematological toxicity was observed. This study shows that a full course of chemotherapy could be administered in only 40% of the patients. Further pilot studies with the aim of improving feasibility should be undertaken. If the mechanical problems are improved and IPAC duration is reduced, then feasibility should be dramatically increased. Subsequently, only a prospective randomized study would confirm the efficiency of the method in minimizing liver recurrence.

Adenocarcinoma↗
PubMed1987

A simplified surgical technical procedure for intra-arterial chemotherapy in secondary liver cancer. Experience in 50 patients.

The purpose of this study was to prove that only one intra-arterial catheter for hepatic chemotherapy can perfuse the whole liver in all anatomic cases, including cases with aberrant or accessory hepatic arteries. The ligations of various hepatic arteries induce the immediate aperture of intra hepatic arterial shunts and a total revascularization of the whole liver by the only remaining hepatic artery. Based on the experience from 50 consecutive cases of surgical implantation of intra-arterial catheters for local chemotherapy, the simplified technique is analysed principally as a function of anatomical variations of the hepatic artery. The usual procedure (catheter implanted into the gastro-duodenal artery) was performed in 58% of the cases, while in 28% of the cases this was possible only after section of a right and/or a left aberrant or accessory hepatic artery. Unusual implantations were necessary in 14% of the cases to ensure complete perfusion of liver. The evaluation was based on three criteria: intra-operative perfusion of fluorescein, post-operative scan with 99mTc macro-aggregated albumin and objective clinical responses after intra-arterial chemotherapy. The perfusion of the whole liver was good in all cases except one. Unusual procedures gave the same clinical objective responses after intra-arterial chemotherapy (61%) as usual procedures (48%) (chi-square: P = 0.40).

Adult↗
PubMed1986

[Isolated hepatic metastases. Treatment by intra-arterial chemotherapy using a subcutaneous access chamber].

Twenty eight patients with isolated liver metastases of colorectal origin have been treated with discontinuous intra-arterial chemotherapy. This treatment was performed weekly with a surgically implanted subcutaneous access chamber. In all the patients the metastases were non-resectable and involved less than 75% of the liver. The first six patients were investigated in a phase I study which demonstrated that the method was well tolerated and provided a normal life at a lower price than the totally implanted pump. A subsequent phase II study included 22 patients. After implantation, they received an 8-hour infusion of 5 Fu 1 g/m2 each day for 8 consecutive days and after discharge, a weekly 8-hour infusion of 5 Fu 1 g/m2 and mitomycin C 1.5 mg/m2 as out-patients. Twenty-one patients have now been followed up for more than 3 months and are assessable in terms of response: we observed 4/21 complete responses, 6/21 partial responses, 3/21 minor responses, 7/21 stable disease and 1/21 progression. The objective response rate was 48%. The complication rate was low (2 leukopenias and 2 duodenal ulcerations) and comfort excellent with normal life between courses. In conclusion, with discontinuous intra-arterial chemotherapy we obtained the same response rate as with the totally implanted pump, with good tolerance and quality of life and perhaps a lower rate of complication. The two methods should now be compared in a randomized trial.

Ambulatory Care↗
PubMed1986

Conservative management of breast cancer.

Between 1970 and 1982, 592 patients with T1 and small T2 breast cancers were treated at the Institut Gustave-Roussy by a combination of conservative surgery and radiotherapy. Mean follow-up was 78 months. The actuarial survival rate at 5 and 10 years was 92 per cent and 80 per cent respectively. There were 36 locoregional relapses of which 26 were within the treated breast. The actuarial relapse rate within the breast was 5 per cent at 5 years. If operable, a relapse within the breast did not significantly affect overall survival. The efficacy of conservative management of small breast tumours is confirmed.

Adult↗
PubMed1986

[Early adjuvant intraportal chemotherapy after hepatectomy for metastases of colorectal origin].

EAIPC was tested in a preliminary study, with continuous 600 mg/m2/day 5 FU with twelve consecutive patients after curative hepatectomies for colo-rectal metastases. The aim of this study is to reduce the frequency of recurrences inside the remaining liver. The numerous reasons explaining this kind of treatment are detailed. Results about technic problems and tolerance are analysed. This work should be initiate a prospective randomized study to evaluate the efficiency of the EAIPC.

Colonic Neoplasms↗
PubMed1986

[Pelvic cancers: radioprotection of the small intestine by using a mammary prosthesis for postoperative irradiation. Apropos of 12 cases].

A preventive technique of radiation injuries to small intestines with intrapelvic mammary prosthesis is described. It has been used for twelve cases in which 9 concerned rectal adenocarcinomas (local recurrences 7 and fixated tumors 2). After this short experience, we can recommend this reliable technique without important local complication and describe the irradiation technique. The indications of this method are precised because it is finally an unfrequent therapeutic.

Adenocarcinoma↗
PubMed1986

Epidermoid cancers of the anus. Changes in therapeutic ideas.

Under this term, the authors discuss cancers of the anal canal. Cancers of the edge of the anus are skin cancers whose treatment will not be discussed here. Cancers of the anal canal are rare and are much more frequently found in women than in men. They are more or less differentiated epidermoid cancers. The therapeutic problems raised: cure a cancer with a loco-regional evolution beginning in the mucous lining of the anal canal and able to spread throughout the pelvic cavity; treatment should be total (on the tumor and ganglia) and conservative; treatment should avoid major complications such as necroses, fistulas, incontinence; it will often be carried out in elderly patients in poor general condition, poorly supporting lengthy treatments, hospitalization and anaesthesia. The therapeutic possibilities; two major therapeutic techniques possible, radiotherapy and surgery.

Anal Canal↗
PubMed1985

[Prevention of radiolesions of the small intestine by intrapelvic silicone breast prosthesis].

In a patient with non resectable pelvi-perineal recurrence of epidermoid carcinoma of the anus, a silicone breast prosthesis inserted into the lower pelvis made it possible to irradiate the malignant lesion without risk of radiation-induced damage to the small intestine displaced upward by the prosthesis. This unusual technique, indicated when epiplooplasty cannot be performed, has several advantages over other techniques of radioprotection of the small intestine.

Anus Neoplasms↗
PubMed1985

Squamous cell carcinoma of the anal canal: treatment by external beam irradiation.

External beam radiation therapy alone or in combination with curietherapy is the recommended treatment for anal canal carcinoma in some countries. In others, surgery is the sole accepted treatment. The results for 64 patients treated by external radiotherapy alone show excellent survival for stage T1T2 tumors but results are poor for large tumors (stage T4). The overall 5 year crude survival rate is 46%. The 5-year results are better for stage T1T2 (72%) than for stage T3T4 (35%). The presence of inguinal node involvement at first examination is a very poor prognostic sign. Local recurrences and metastases are infrequent for stage T1T2, but are more common for stage T3 and T4. Complications follow radiotherapy more frequently in those with stage T3 and T4 tumors. The analysis of local recurrences, complications and survival shows that radiation therapy may be sufficient treatment for stage T1 and T2 and for some stage T3 tumors. The importance of anal sphincter involvement and the poor quality of life for patients who are cured but develop complications, shows the need for combined treatment with surgery and perhaps with chemotherapy. For small tumors the results obtained by external radiotherapy alone are comparable with those obtained by external radiotherapy and curietherapy in terms of survival and complications.

Adult↗
PubMed1985

[Surgical treatment of severe radiation injuries of the small intestine and colon-rectum. Apropos of 85 patients surgically-treated at the Gustave-Roussy Institute].

Radiation lesions of the small intestine, colon and rectum were treated surgically in 85 patients between 1970 and 1983. These were serious complications in all cases involving the short-term vital prognosis in patients lacking signs of recurrence of cancer for which they had received radiotherapy. Immediate operative mortality was 26%. Anastomotic digestive fistulae complicated 31% of resection-anastomosis and 29% of internal bypass operations. During the next 2 years the progression of the chronic radiation lesions themselves required repeat operations due to further complications in 19% of patients, with an operative mortality of 33%. Rather than comparing efficacy of resection-anastomosis with that of internal bypass procedures they should be considered as complementary, since they have different indications. Based on the analysis of results and acquired experience, a surgical strategy is proposed for treating complicated radiation lesions of the intestines.

Adolescent↗
PubMed1985

[Surgical technics for implantation of hepatic intra-arterial catheters for local chemotherapy. Experience with 42 cases].

Based on the experience of 42 cases of surgical implantation of hepatic intra-arterial catheters (HIAC) for local chemotherapy, the techniques used are analyzed principally as a function of anatomical variations of the hepatic artery. A conventional procedure (HIAC implanted into gastroduodenal artery) was performed in 60% of cases, while in 26% of patients this was possible only after section of a right and/or left hepatic artery. Atypical implantation was necessary in 14% of cases to ensure complete perfusion of liver. The different methods employed and the reasons for their choice are discussed.

Adult↗
PubMed1985

[Combination vindesine, cyclophosphamide, cis-platinum and CCNU in esophageal epidermoid cancer. Preliminary analysis of 64 cases].

We have treated 64 patients with esophageal squamous cell carcinoma using a combination of Vindesine 1.4 mg/m2 on day 1-2, Cyclophosphamide 200 mg/m2 on day 2-3-4, Cis-Platin 100 mg/m2 on day 3 and CCNU. 28 of the 37 patients considered to be inoperable were evaluable. We observed three complete responses and three partial responses in this group (overall response rate 21,5%). Twenty seven patients considered to be operable received the same chemotherapy without CCNU, owing to the risk of thrombopenia. 23 of these patients were evaluable in whom we observed 35% partial responses and no complete responses. No severe toxicity related to the chemotherapy protocol was observed. The mediocre results among the group of inoperable patients suggest that other chemotherapy protocols need to be tested. On the other hand, in the group of operable patients, the preliminary results encourage us to continue this study.

Adult↗
PubMed1985

[Cancers of the rectum: predictive factors in locoregional recurrence. Multifactorial study].

Local recurrences (LR) after curative surgery have been analyzed in series of 173 rectal adenocarcinomas treated between 1973 and 1983. LR predictive factors were analyzed by univariate and multivariate (Cox model) studies. Five factors had no predictive value on LR: age, sex, tumor differentiation, tumor size, and number of metastatic nodes. Five factors had a predictive value on LR: severe clinical symptoms (fixation, obstruction and perforation) (p = 0.03), tumors localized within five cm of the anal verge (p less than 0.001), intramural infiltration (p = 0.09), localization of positive nodes (p = 0.02), and tumor emboli inside the vessels (p less than 0.01). The multivariate study underlined the two main predictive factors: the tumor site within 5 cm of the anal verge (p less than 0.001) and involvement of the serosa (p = 0.05). An equation of LR risk is presented and four subgroups of different LR risk patients are defined. This study might provide guidelines for indications and evaluation of major adjuvant treatments in the highest LR risk patients.

Adenocarcinoma↗