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Biomedical subjects

S Leyvraz

Publications and source records attributed to S Leyvraz.

87 records · Page 5Linked to original sources
PubMed1989

[Iterative surgery in germ cell tumor].

Between 1979 and 1988, iterative surgery was performed on 13 patients for a germ-cell tumor. Apart from orchidectomy, surgery was not the first modality of treatment. On the other hand, 21 surgical procedures were performed for residual tumoral masses after chemotherapy or recurrences. In one third of the cases, only necrosis of fibrosis was resected. Out of 13 patients, 7 died of tumor; 6 are alive (3 with complete remission). Surgery is always indicated in stage IIA to IV nonseminomatous tumors in case of residual tumoral deposits after chemotherapy. For seminoma, surgery is carried out only for retroperitoneal residues larger than 3 cm in diameter. Surgery is also indicated for persistent pulmonary or mediastinal metastases following chemotherapy. Complete surgical excision of residual masses may be technically difficult but is of prime importance as combined chemotherapy and surgery doubles the complete remission rate in comparison to chemotherapy alone.

Combined Modality Therapy↗
PubMed1989

[Epidermoid carcinoma of the esophagus: preliminary results of combined treatment].

In 1986, a prospective study was started in CHUV on the squamous-cell carcinoma of the esophagus treated with a multimodality protocol associating preoperative chemotherapy and surgery. Nineteen patients are currently followed-up. Dysphagia is the main symptom and was found in 16 patients (84%). After chemotherapy, dysphagia disappeared completely in 7 cases (44%), regressed in 7 other cases and worsened in 1 case. Twelve patients were operated on, without operative mortality. Histologically, no tumor was found in one case (5%) after the preoperative treatment. Follow-up is currently too short to draw statistical conclusions. The rationale, advantages and perspectives of the multimodality treatment are presented and compared with different recent series.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[Totally implantable catheters. Experience at the University Hospital Center Vaudois from March 1984 to December 1987].

With cancer patients, the venous access remains a major problem. It causes phlebitis, venous sclerosis, skin necrosis and sepsis. Its maintenance implies careful nursing and a great dependence for the patient. Arterio-venous fistulas have been abandoned and replaced by Hickman-type subcutaneous indwelling catheters. These have a complication rate, mainly infectious, of about 0.4/100 days. The development of totally implanted catheters diminishes even more this rate and improves the patient's comfort. In this article we report the experience gained from 100 cancer patients equipped with 107 catheters. 31 complications occurred over a total time of 15,421 days, this averages a rate of 0.2 complications/100 days. The respectively rate of thrombosis and infections are of 0.02/100 days each. In 61% of the cases the whole system was functional after management of the complication. This results confirm the excellent tolerance of the system, its minimal rate of complication and its great possibility of reutilization.

Antineoplastic Agents↗
PubMed1988

Histological diagnosis and grading of soft-tissue sarcomas.

Grading methodology for soft-tissue tumors is not yet unequivocally established. The authors use a system that is an elaboration upon that of the National Cancer Institute: grade 1 or low-grade lesions are malignant lesions with minimal risk of metastases with a tendency for local recurrence if not totally excised, and with a capability for progression to a higher grade with recurrence; grades 2 and 3 are high-grade lesions with a significant risk of metastases; grade 2 are lesions with intermediate aggressiveness, and grade 3 are highly malignant lesions with dissemination early in the course of the disease. Whereas the great majority of grade 3 lesions recur within 24 months of the initial diagnosis, patients with grade 2 lesions may go recurrence-free beyond 36 months. Although more experience is needed in grading soft-tissue sarcomas, it is hoped that grading will continue to contribute to the management of patients with malignant tumors of the soft tissue. It represents an adjunct to histological typing, which is useful in conveying the degree of biological aggressiveness as judged by histological features. Histologically 80% of the lesions can be classified on the basis of hematoxylin and eosin-stained sections and other conventional special stains. In some instances electron microscopy and immunohistochemistry are necessary for histotyping. The most challenging area for histopathological differential diagnosis remains the distinction of tumor-like reactive conditions, and pleomorphic benign tumors from sarcomas.

Biopsy, Needle↗
PubMed1988

[Interdisciplinary detection of soft tissue sarcomas. Diagnosis, grading and staging].

The collaboration between the clinician and the pathologist is necessary for an optimal diagnosis and management of patients with soft tissue sarcoma. The clinician provides information about the patient and about the clinical aspect of the tumor. The pathologist gives a histological diagnosis, a grading of the tumor and information on the surgical margins. A staging of the tumor is then possible that will provide a prognosis for each tumor and will allow a stratification of patients with a similar prognosis and a comparison between treatments. A modification of the AJC (American Joint Committee on Cancer) staging system is proposed according to a better understanding of the different prognostic factors achieved during the last decade.

Humans↗
PubMed1987

[Immunoscintigraphy using radio-labeled monoclonal antibodies. Development of a method of cancer diagnosis and hopes for a new form of therapy].

Personal results are presented to illustrate the development of immunoscintigraphy for the detection of cancer over the last 12 years, from the early experimental results in nude mice grafted with human colon carcinoma to the most modern form of immunoscintigraphy applied to patients, using I123 labeled Fab fragments from monoclonal anti-CEA antibodies detected by single photon emission computerized tomography (SPECT). The first generation of immunoscintigraphy used I131 labeled, immunoadsorbent purified, polyclonal anti-CEA antibodies and planar scintigraphy, as the detection system. The second generation used I131 labeled monoclonal anti-CEA antibodies and SPECT, while the third generation employed I123 labeled fragments of monoclonal antibodies and SPECT. The improvement in the precision of tumor images with the most recent forms of immunoscintigraphy is obvious. However, we think the usefulness of immunoscintigraphy for routine cancer management has not yet been entirely demonstrated. Further prospective trials are still necessary to determine the precise clinical role of immunoscintigraphy. A case report is presented on a patient with two liver metastases from a sigmoid carcinoma, who received through the hepatic artery a therapeutic dose (100 mCi) of I131 coupled to 40 mg of a mixture of two high affinity anti-CEA monoclonal antibodies. Excellent localisation in the metastases of the I131 labeled antibodies was demonstrated by SPECT and the treatment was well tolerated. The irradiation dose to the tumor, however, was too low at 4300 rads (with 1075 rads to the normal liver and 88 rads to the bone marrow), and no evidence of tumor regression was obtained. Different approaches for increasing the irradiation dose delivered to the tumor by the antibodies are considered.

Animals↗
PubMed1987

Combination of mitomycin, vindesine, and cisplatin in the treatment of head and neck squamous cell carcinoma.

Thirty patients with squamous cell carcinoma of the head and neck were treated with a combination of mitomycin (10 mg/m2, Day 1), vindesine (3 mg/m2, Days 1 and 8), and cisplatin (60 mg/m2, Day 1), repeated every 28 days. Seven patients were previously treated by surgery, radiotherapy, or chemotherapy, and 23 had untreated advanced tumors. Objective responses were seen in 17 of 27 evaluable patients (63%), with three (11%) complete remissions. Moderate myelosuppression was the main toxic effect. Considering the advanced tumor staging (54% N3 tumors), this chemotherapeutic regimen appears as effective as other cisplatin-based chemotherapies.

Adult↗
PubMed1985

Phase 1 study of carboplatin in patients with advanced cancer, intermittent intravenous bolus, and 24-hour infusion.

We undertook a phase 1 study of Carboplatin (CBDCA) on an intermittent single intravenous (IV) bolus (schedule A) and a 24-hour continuous infusion schedule (schedule B). Hydration and forced diuresis were not performed. Patients were not premedicated for anticipated vomiting. Thirty-eight adult patients with solid tumors received a total of 71 courses. In schedule A, doses were escalated from 20 to 600 mg/m2. The dose-limiting toxicity was myelosuppression. At doses of 270 mg/m2 and higher, leukopenia and thrombocytopenia were reproducibly seen. The dose of 600 mg/m2 was the maximally tolerated dose, producing severe thrombocytopenia (platelet counts less than 30,000/microL). Other toxicities included a fall in hemoglobin levels and tolerable nausea and vomiting. Schedule B produced comparable hematologic and emetogenic toxicities to those in schedule A. In three patients audiograms became abnormal with high-frequency hearing loss without overt deafness. Two patients developed hypomagnesemia without irreversible renal dysfunction. Patients with poor performance status, preexisting renal dysfunction, a third fluid space, or bone metastases seemed to develop increased hematologic toxicity. The recommended phase 2 dose for good risk patients is 400 mg/m2 IV bolus and for poor risk patients 270 mg/m2 IV bolus. Responses were seen in one patient each with head and neck carcinoma (partial response), small cell lung cancer (minor response), and breast cancer (minor response).

Adult↗