Showing papers by "Hal G. Bingham published in 1984"

Radical mastectomy versus radical mastectomy plus internal mammary dissection (ten-year results of an international cooperative trial in breast cancer)

Abstract: A multicentric randomized trial evaluated the interest of internal mammary dissection on operable breast cancer patients. One thousand four hundred and fifty-three patients were included in the study and were followed for ten years. There is no difference in survival or in relapse-free survival between the two groups. There were significantly more local recurrences in the group without internal mammary dissection, but these recurrences occurred mainly on patients who developed metastases. A great difference between centers was observed in the number of nodes examined and there is therefore a difference in the prognostic value of the number of nodes invaded.

Recurrent squamous cell carcinoma of the skin

Abstract: A retrospective analysis of all patients having the diagnosis of squamous cell carcinoma of the skin at a single hospital over a ten-year period was performed. These lesions are less common than both basal cell carcinomas and malignant melanomas. Noninvasive squamous cell carcinomas were not observed to recur. There was a 20% incidence of recurrence in 86 patients with invasive squamous cell carcinoma. The presence of solar changes in the skin did not obviate recurrence. The larger, less differentiated lesions had a greater probability of recurrence. When the depth of invasion of the lesions were determined, it was found that only the lesions that penetrated to Clark's Level IV or V recurred. Squamous cell carcinomas that penetrate to this depth have the potential to recur and metastasize to regional lymph nodes and should be considered malignant lesions, even if they are associated with actinic skin changes.

The value of combining radiotherapy with surgery in the treatment of hypopharyngeal and laryngeal cancers

Abstract: Two-hundred and six cases of hypopharyngeal and laryngeal squamous cell carcinoma treated at the Institut Gustave-Roussy were retrospectively analyzed. All of them were treated by surgery and they were divided into three therapeutic groups following the adjuvant radiotherapy: (A) Postoperative radiotherapy at doses equal to or greater than 4500 rad; (B) Postoperative radiotherapy at doses less than 4500 rad; and (C) Preoperative irradiation at doses less than 4500 rad. Group A included a greater proportion of patients with hypopharyngeal cancer and patients with advanced tumors (T3, T4; N1b, N2, N3). However, the local and regional control rate in this group is significantly higher than those of the other groups in spite of the poor prognostic factors. The survival rate is comparable in all the three groups, with distant metastases more frequently found in group A. The results showing a significant improvement in lymph node control with postoperative radiotherapy, this adjuvant therapy is used systematically in this center in patients being operated on for hypopharyngeal and laryngeal cancer with incomplete histologically defined resection and/or with lymph nodes histologically involved.

Alteration of the genomes of tumor cells

Abstract: The transfer of DNA from tumor cells into normal cells has made possible the definition of oncogenes in the DNA of the donor tumor cells. Some of these oncogenes have been isolated by molecular cloning and found to derive from closely related normal cellular sequences. These normal antecedents are termed proto-oncogenes. Analysis of molecular clones of the proto-oncogene and its transforming allele indicate that the two genes are very similar. In one case the alteration of a single nucleotide in the normal gene resulted in the creation of an active oncogene. This point mutation affected a sequence encoding the 21,000 dalton protein, resulting in a glycine at its residue 12 being replaced by a valine. This altered protein mediates the resulting transformation of the cell. Such altered proteins are found in a number of lung and colon carcinomas. Although these oncogenes represent important determinants of the carcinogenic process, other genetic alterations appear to be necessary in order to achieve full conversion of a normal cell into a tumor cell.

Preoperative or postoperative irradiation as adjunctive treatment with radical mastectomy in breast cancer

Abstract: Results from the standpoint of survival rates and locoregional failures are compared in three series of patients having had a radical mastectomy for breast cancer: (1) radical mastectomy alone for the patients who had essentially outer quadrant lesions and a negative axilla; (2) postoperative irradiation when the axillary nodes were positive and/or the tumor was centrally located or in the inner quadrants; and (3) preoperative irradiation for patients with an outside biopsy presenting with a very disturbed breast with edema and ecchymosis, and in a small group of patients with a lesion of clinically borderline operability. The ten-year survival rates are identical in the three groups. In the radical mastectomy alone group, 14% of the patients had positive axillary nodes, in the preoperative irradiation group 30% (probably one half of the true incidence without preoperative irradiation), and in the postoperative group, 71%. This data is indicative that irradiation, either pre- or postoperatively, has survival benefits since there is direct relationship between the percentage of patients with positive axillary nodes and the survival rates. However, there is no evidence that preoperative irradiation is superior to postoperative irradiation.