Showing papers by "Sylvette Hoffstetter published in 1994"

The study of tumoral, radiobiological, and general health factors that influence results and complications in a series of 448 oral tongue carcinomas treated exclusively by irradiation.

Abstract: Purpose : Our aim was to study the different factors that influence the results and complications in a series of 448 carcinomas of the oral tongue treated from January 31, 1972 to December 31, 1986, by brachytherapy (Br) ± neck dissection (181 cases) or combination of external beam irradiation and brachytherapy (EBI + Br) (267 cases). Methods and Materials : The patients distribution (TNM classification 1979) was: 125 T1, 186 T2, 128 T3, 9 T4Tx, 78% N0, and 22% N+. We used guide gutter or plastic tubes technique (Paris system dosimetry). Results at 5 and 10 years are: local control 68% and 64%, locoregional control 58% and 53%, specific survival 45% and 39%, and overall survival 44% and 27%. Results : In the univariate analysis for local control (LC) and overall survival (OS), we considered the tumoral factors. At 5 years, the LC for T1, T2, T3 are 93%, 65%, and 49%, and the OS 69%, 41%, and 25%, respectively (p 12 cm2), and the dose rate > 0.7 Gy/h were significant. Conclusion : The multivariate study showed that the small size of the lesion is the most important factor for local control, with brachytherapy alone for T1T2N0 and the number of days between EBI and brachytherapy ≤ 20 days. For the complications, the most important factors are the total dose > 80 Gy and a treated surface > 12 cm2.

Salvage irradiation by brachytherapy of velotonsillar squamous cell carcinoma in a previously irradiated field: results in 73 cases.

Abstract: Purpose: The salvage brachytherapy performed in patients presenting velotonsillar carcinoma in a previously irradiated field is evaluated in terms of local control, complications and survival. Methods and Materials: Between 1976 and 1990, 73 patients presenting with velotonsillar squamous cell carcinoma in a previously irradiated area were treated at Center Alexis Vautrin with brachytherapy alone using an 192 Ir implant (afterloading technique) with curative intent. According to the UICC 1987 TNM classification, there were 45 T 1 N 0 , 20 T 2 N 0 , one T 3 N o , one T 3 N 2 and six T x N x . Results: The 5-year actuarial local control for T 1 N 0 and T 2 N 0 are 80% and 67% respectively. The regional relapse rate was 10% in both groups. Grade 2 complications occured in 13% of patients and these were neither related to the volume treated nor the dose rate. There were no Grade 3 or 4 complications. The 5-year specific survival is 64%, with a plateau after the 5th year, but the 5-year overall survival is only 30%. Fourty-two percent of the patients in this series died from another carcinoma. All but two of these were related to continued alcohol and tobacco intoxication. Conclusion: We conclude that brachytherapy alone (60 Gy) is optimal treatment for patients presenting with velontonsillar carcinoma in a previously irradiated field. The greatest challenge is the screening of these patients and the prevention of subsequent head and neck cancers. Recognizing the fact that these patients are at high risk for subsequent malignancies of upper aerodigestive tract, lung and esophagus, close surveillance is necessary for: (a) early diagnosis and prompt treatment; and (b) development of prevention strategies of field cancerization.

Influence of tumoral, radiobiological, and general factors on local control and survival of a series of 361 tumors of the velotonsillar area treated by exclusive irradiation (external beam irradiation+brachytherapy or brachytherapy alone)

Abstract: Purpose: To evaluate statistically the factors influencing the therapeutic results. Methods and Materials: A statistical study was carried out concerning 361 patients treated from 1977 to 1991 for velotonsillar carcinoma. They received either brachytherapy alone (18) or a combination of external beam irradiation and brachytherapy (343 patients) using an afterloading iridium technique in plastic tubes. The distribution of patients according to the localization was: 128 tonsils, 134 soft palates, 9 posterior pillars, 63 anterior pillars, and 27 glossotonsillar sulcus. The patients were staged as follows: 90 T1, 141 T2, 119 T3, 2 T4, 9 Tx with 230 N0, 93 N1, 9 N2, 20 N3, and 9 Nx. Results: The results at 5 and 10 years show: local control 80% and 74%, locoregional control 75% and 70%, overall survival 53% and 27%, specific survival 63% and 52%, respectively. The univariate study shows at 5 years a better local control for TI T2 (87%) compared with T3 (67%) with p = 0.00004. The locoregional control is better for N0 (80%) than for N+ (55%) with p = 0.002. This is the same for the overall survival (59% vs. 42%, p = 0.002). Tumors with an extension to the mobile tongue or the base have a poor prognosis ( p Conclusions: For the combination external irradiation and brachytherapy, the multivariate study for local control shows that ony T, localization, and the total duration of treatment are significant. For complications , classified into four grades, only the dose rate is signifcant.

Pre-operative, post-operative and exclusive irradiation of endometrial adenocarcinoma.

Abstract: PURPOSE Surgery is the golden standard of treatment of endometrial carcinoma. The risk of central or vaginal recurrences justifies adjuvant treatment. METHODS Brachytherapy for endometrial adenocarcinoma is given commonly as pre- or post-operative treatment. In case of medical contra-indications for surgery brachytherapy can be applied as the only treatment. Experience of the anticancer center Alexis Vautrin in Nancy of the years 1975 to 1988 is evaluated. Iridium-192 low-dose-rate (LDR) wires were used. RESULTS Pre-operative brachytherapy was given with a vaginal mould applicator to 580 patients. The dose was 50 Gy at 0.5 cm below the surface of the vagina. The locoregional control rate was 93% after 5 years and the 5-year survival 82%. 139 patients received radiotherapy alone and no surgery. LDR-brachytherapy was given the upper third of the vagina and endometrium with an "umbrella" applicator. The locoregional control rate was 83% after 5 years and the survival rate 55%. 117 patients received a post-operative brachytherapy of the vagina. The locoregional control rate was 93% after 10 years and the survival rate 65%. CONCLUSION A pre- and post-operative radiotherapy results in a reduction of the vaginal relapse rate. The LDR afterloading technique with primary radiotherapy of endometrial adenocarcinoma leads to a locoregional control slightly interior. The treatment results compare favourably with the best of the literature.