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Canada↗
Biomedical subjects
P Ronchin
Publications and source records attributed to P Ronchin.
[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↗
Treatment of recurrent malignant supratentorial gliomas with ifosfamide, carboplatin and etoposide: a phase II study.
Thirty-six patients previously treated with surgery, radiation therapy and chemotherapy with a nitrosourea for malignant supratentorial gliomas received a combination of ifosfamide, carboplatin and etoposide (ICE) at tumour progression. Carboplatin and etoposide were both given at a dose of 75-100 mg/m2/day for 3 days, whereas ifosfamide doses ranged from 750 mg/m2/day to 1500 mg/m2/ day for 3 days, according to haematological tolerance. Treatment was repeated every 4 weeks. A minimum of three courses was required to evaluate the response unless the patient had rapid tumour progression. Grade III and IV haematological toxicity occurred in 15 patients (42%) and was lethal in one patient. Grade II hepatic toxicity was observed in one patient. Five complete (CR) and five partial responses (PR) were noted. 9 patients had stable disease (SD) after a minimum of three courses. CR + PR + SD was 53% (19/36). The median time to tumour progression (MTTP) was 13 weeks. Median survival (MST) was 29 weeks (44 weeks for R + S patients and 17 weeks for patients with progressing disease). This study suggests that the ICE combination is active in recurrent supratentorial malignant gliomas after failure of surgery, radiation therapy and chemotherapy, but at the cost of substantial haematological toxicity.
Adult↗
[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↗
[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↗