Showing papers in "Bulletin Du Cancer in 1994"

[Superoxide dismutase (Cu/Zn) in cutaneous application in the treatment of radiation-induced fibrosis].

Abstract: De 1989 a 1991, 40 patientes traitees pour un cancer du sein par radiotherapie et presentant une sclerose cutanee ou sous-cutanee sont entrees dans un protocole destine a evaluer l'effet therapeutique de la superoxyde dismutase (SOD), administree sous forme de pommade au polyethylene glycol (PEG), en application biquotidienne pendant 3 mois. Un score comprenant des elements d'evaluation qualitatifs et quantitatifs a ete defini pour apprecier l'importance de la fibrose, sous l'effet d'application locale par pommade de PEG-SOD. Des observations cliniques et examens paracliniques ont ete effectues regulierement dont la telethermographie infrarouge (IR), qui constitue une methode de surveillance originale de l'extension du processus inflammatoire provoquee par la sclerose

Chemoresistance in the clinic: overview 1994.

Abstract: One of the most exciting areas in clinical oncology today is the translation of laboratory research in drug resistance into therapeutic tools to improve responses to antineoplastic drugs. Two areas of investigation are currently under study in both the laboratory and clinic: reversal of gluthathione-mediated resistance and of P-glycoprotein mediated resistance. Studies are directed toward determining the role of the resistance mechanism in cancer, and toward its reversal. Increased expression of gluthathione and related enzymes, such as the gluthathione S-transferases, has been shown in human tumor samples. Phase I clinical studies with buthionine sulfoxime (BSO) have shown that gluthathione can be depleted without undue normal tissue toxicity. Now, clinical studies are underway evaluating the ability of BSO to enhance the efficacy of chemotherapy. Expression of P-glycoprotein has been described in human tumors, with increased levels observed after natural product chemotherapy in some malignancies. Studies with P-glycoprotein antagonists have been conducted in leukemia, lymphoma, multiple myeloma and in a variety of advanced malignancies. These studies have employed "first generation" antagonists such as verapamil and cyclosporine which were toxic at concentrations needed to block P-glycoprotein. Currently, studies are underway with "second generation" antagonists such as the dex stereoisomer of verapamil and the cyclosporine analogue, PSC 833. These agents may help determine the role of P-glycoprotein in clinical drug resistance. Together, these studies are aimed toward improving chemotherapeutic sensitivity in human cancer.

[Smoking and social class in France 1974-1991].

Abstract: We examined trends in cigarette smoking behaviour in France from 1974 to 1991 separately for men and women as well as according to social class indicators. Overall, cigarette smoking prevalence has declined among men but has increased among women over the 18-year period which was taken into consideration. Analysis by social class groupings shows, among men, that the decrease is greater among higher level executives, professionals and academics and occurred as early as 1983. Among women, there is only a slight and recent downward trend limited to those of higher socio-economic status. These findings are similar to those of other southern European countries, such as Italy or Spain, but are not as yet comparable to what has been observed over the last twenty years in northern Europe, the United Kingdom or the United States of America.

[Taxol (paclitaxel), first molecule of a new class of cytotoxic agents: taxanes].

Abstract: Taxol is the first of the taxanes, a new class of cytotoxic agents whose cellular target is the microtubules network. Taxol induces the polymerisation of the alpha and beta sub-units of the tubulin. This mechanism of action which is different from the vinca-alkaloids explains the main cytotoxic activity of paclitaxel through the formation of abnormal and stable bundles of microtubules. Severe hypersensitivity reactions which were seen in early phase I studies are prevented by an oral corticosteroids and H1 and H2 blockers premedication. Profound neutropenia is frequent but of short duration explaining that infectious manifestations are rare and neutropenia not cumulative. Thrombopenia and anemia are rare. Neurotoxicity is dose related but severe peripheral neuropathy is rare. Conduction abnormalities are mainly asymptomatic bradycardias. In second line ovarian cancer and breast metastatic cancer a noticeable level of activity has been observed, and in lung and head and neck cancer Taxol has proved to be effective.

Combined overexpression of c-erbB-2 protein and epidermal growth factor receptor (EGF-R) could be predictive of early and long-term outcome in human breast cancer: a pilot study.

Abstract: In order to determine the prognostic value of c-erbB-2 protein and Epidermal Growth Factor Receptor (EGF-R), we used an immunohistochemical procedure with specific antibodies on paraffin-embedded material from a series of 73 operable breast cancer carcinomas. c-erbB-2 protein (c-erbB-2 score > 1) was overexpressed in 10/73 cases (14%) and EGF-R (EGF-R ratio > 1) in 42/73 cases (58%). c-erbB-2 overexpression was correlated with tumour size (P 1) c-erbB-2 score and 1 vs 3 for patients with an EGF-R ratio 1 (P = 0.03). Moreover, c-erbB-2 protein overexpression is more specifically an early factor of poor prognosis whereas EGF-R overexpression is a long-term factor of poor prognosis. Patients with an early good prognosis (c-erbB-2 score = 0-1) are found to relapse with time when EGF-R is overexpressed. In a multivariate analysis including axillary lymph-node status, histological grade, tumour size, ER status, c-erbB-2 score, EGF-ratio and hormonal treatment, c-erbB-2 overexpression was the most powerful parameter (P = 0.001) followed by EGF-R overexpression (P = 0.02). We concluded that, in our series, the combined determination of c-erbB-2 protein and EGF-R appeared to be a prognostic indicator whereby both early and long term prognosis could be determined in breast cancer patients.

Study of mdm2 gene amplification in primary breast tumors

Abstract: La proteine mdm2 (mouse double minute) semblerait conduire, par son hyperexpression, a une inactivation de la proteine p53 avec comme consequence un role potentiel dans la carcinogenese. Nous avons etudie au niveau de l'ADN extrait de 239 tumeurs primitives du sein, l'amplification du gene mdm2. Celle-ci est retrouvee dans 10% des cas (25 sur 239). L'amplification du gene mdm2 est etroitement correlee a l'amplification de c-erbB2 (P<10 -3 ). Nous ne trouvons pas d'autre correlation avec les diverses categories cliniques et biologiques etudiais. Cependant il existe une correlation inverse liant l'amplification de c-erbB2 et les recepteurs hormonaux (P<10 -4 ) exclusivement chez les patientes sans amplification du gene mdm2

[Intraperitoneal hyperthermic chemotherapy (IPHC), a promising treatment of peritoneal carcinomatosis].

Abstract: La CHIP est un traitement prometteur de la carcinose peritoneale et est en cours d'evaluation par quelques equipes chirurgicales. Les auteurs rappellent les bases physiopathologiques de la CHIP avant de decrire les differentes series publiees dans la litterature. Ils soulignent l'heterogeneite de ces series et discutent les points les plus divergents tels les indications, le choix des agents antimitotiques, leurs dosages, la temperature de la CHIP, l'ampleur de la cytoreduction chirurgicale, la morbidite et les resultats. Enfin, ils tendent d'apporter quelques suggestions sur ces points pratiques encore mal standardises

[Undifferentiated carcinoma of the nasopharynx: epidemiological, clinical and therapeutic aspects].

Abstract: Undifferentiated carcinoma of the nasopharynx (UCNT) is a particular head and neck epidermoid lineage tumor related to the Epstein-Barr Virus (EBV). It has geographically selective endemic epidemiologic features, without relation to external carcinogens. Its systemic agressiveness is the source of most disease related demises, since radiotherapy achieves excellent local control and a significant percentage of cure in patients with exclusive locoregional disease. Differences in the staging systems currently in use, the recent changes in imaging and radiotherapy technology, and the lack of distinction between UCNT and SCC of the nasopharynx in Western literature reports make for some difficulty in therapeutic results evaluation when analyzing available literature. Its chemosensitivity is a relatively recent acknowledged fact, and its use in metastatic patients results in a high percentage of objective responses, many of long duration. Neoadjuvant cisplatin based chemotherapy seems to be of benefit, but outstanding controversies in this regard will be soon answered through ongoing phase III trials. After a review of the current literature of all the above mentioned aspects of this fascinating nosologic entity, our own experience in over 250 patients seen during the past 8 years, both in metastatic and locoregional disease patients is analyzed.

[Epstein-Barr virus replication in Hodgkin disease].

Abstract: Epstein-Barr virus (EBV) is present in up to 40% of Hodgkin's disease (HD). The viral genomes remain latent within Reed-Sternberg cells (RS cells), but the recent detection of Zebra protein in rare neoplastic cells of a few EBV+ HD cases, suggests an activation of EBV replication. We have studied fifty HD cases containing EBV genomes and expressing LMP1 protein (including five AIDS-related cases), by immunohistochemistry with anti-Zebra antibodies. Four of these cases (all HIV-) showed Zebra+ tumor cells. One of these four cases showed numerous Zebra+ neoplastic cells (approximately 1% of tumor cells) and positive staining for EA-R protein, thus indicating early gene expression. In situ hybridization with biotinylated BamHI W probe revealed in this case, a signal of unusual strength within some Reed-Sternberg cells, probably related to increased number of EBV genomes, thus suggesting EBV replication. Viral replication was finally confirmed in this case, by the detection of BLLF1 transcripts (encoding for the membrane antigen gp 350/220) using reverse transcriptase and polymerase chain reaction. Thus, a very few Zebra+ neoplastic cells are concerned by viral replication, most of them harboring EBV involved in an abortive, instead of a full lytic cycle. EBV replication in RS cells remains an exceptional event, but may provide clues to immunologic mechanisms of control of viral latency. Clinical implications need further investigations.

PS2 as a prognostic factor in 1065 cases of human breast cancer. A multicenter study

Abstract: pS2 protein assay was performed with Elsa-pS2 kit (CIS-Biointernational) on a group of 1,065 patients with operable breast cancer who underwent breast surgery in the years 1982 through 1990. The median follow-up was 57 months. This group included exclusively infiltrating ductal carcinoma with primary surgery. Age mean was 58 yr; T0-T1, 33.6%; T2-T4, 66.4%; Differentiation grade I, 29%; node negative, 53%; estrogen receptor (ER) positive, 62.4%; progesterone receptor (PR) positive, 55.2%; mean tumor size, 2.4 cm; local recurrence, 5.2%; metastasis, 17.5%. pS2 values varied from 0.1 to 707 ng/mg of cytosol protein (median, 5.6; mean 24.5; 95th percentile 112 ng/mg p). There was no significant relationship between the mean level of pS2 and age, tumor size, nodal status, whereas pS2 was related to histological grade (P < 10(-3)), ER (P < 10(-5)), and PR (P < 10(-5)). By using 2 ng/mg p as pS2 cutoff, 77/391 (19.7%) of ER+PR+ tumors were pS2-, and 122/345 (35.4%) of ER-PR-tumors were pS2+; with this cutoff, a strong relationship existed between pS2 and overall survival, but not between pS2 and relapse-free survival. With Cox multivariate analysis, pS2 protein was classified after lymph node status, histological size, ER, differentiation grade, age, clinical stage, PR. In patients with axillary lymph node involvement (N+), pS2 status could discriminate between good and bad prognosis, specially for patients with small tumors (< 2 cm) and with less than seven invaded nodes. This study showed that pS2 protein was a poor prognostic factor in comparison with classical factors.

[Radio-chemotherapy combinations: from biology to clinics].

Abstract: Combination of radiotherapy and chemotherapy (CRC) is actually one important way of research in oncology. Theoretical advantages are: 1) Spatial cooperation; 2) Additivity, which is only obtained if the toxicity of each modality are different; 3) Supra-additivity, which needs a rigorous in vitro definition; the only way to prove it is to make an isobologram analysis. This model has however, some limitations: qualitative variable could not be used, results could be different, depending on the cell line and isoeffect chosen... In fact, a supra-additivity was only demonstrated for cisplatinum and etoposide. Interactions mechanisms were: 1) at the molecular level, creation of new lesions or inhibition of radiation lesions repair; 2) At the cellular level, either cytokinetic cooperation with S-phase dependent drugs, or synchronisation for the drugs which blocked the cells in M-phase; 3) At the tissular level, reoxygenation, cycle redistribution... In clinical practice, three mains schedules have been described: sequential, alternating and concomitant. Only the latter try to use the supra-additivity phenomena. Aims of CRC could be: improvement or in survival or in local control, preservation of an functional organ... Depending on the tumor site and aim of the CRC, some schedules had to be preferred. For head and neck cancers, alternating or concomitant schedules offer a better local control. In bronchial carcinomas, sequential administration of the two modalities reduce the metastatic rate, but not the local control. Concomitant schedule improve the local control rate only. In some conservative protocol of bladder cancers, sequential and concomitant administration were used. In conclusion, CRC begins to be the usual clinical practice. The present schedules could be improved with the help of laboratory findings, which are now more and more precise.

Familial adenomatous polyposis

Abstract: La polypose adenomateuse familiale est une maladie hereditaire a transmission autosomique dominante, impliquee dans environ 1% des cancers colorectaux, dont le traitement est actuellement chirurgical. Le gene responsable, appele APC, a ete localise sur le bras long du chromosome 5 puis isole. Ses alterations structurales constitutionnelles ont ete determinees parmi des grandes series de patients atteints de polypose adenomateuse, et certaines ont pu etre mises en relation avec une expression phenotypique attenuee. Parallelement le diagnostic genetique par analyse familiale a ete developpe, et les consequences du suivi systematique et precoce des sujets a risque ont pu etre evaluees, en particulier sur le taux et le pronostic des cancers decouverts au moment du diagnostic clinique

[Pharmacological control of P-glycoprotein expression].

Abstract: Calcium channel inhibitors, such as verapamil, have been identified as having the ability to modulate the multidrug-resistant (MDR) phenotype due to overexpression of P-glycoprotein (Pgp). We have studied the effect of verapamil on Pgp expression levels in a cell line originating from acute myeloblastic leukemia and resistant to adriamycin, K562/ADR. In this line, the addition of 15 microM verapamil in the culture medium gives a 3-fold decrease of Pgp expression after 72 hours of treatment. Similar results have been obtained for two other MDR cell lines, which suggest that this phenomenon is not specific of a single model. The level of mdr1 mRNAs is decreased in the presence of verapamil (with a maximum effect obtained at the 24th hour), which suggests that the mechanism of action of verapamil is transcriptional and/or post-transcriptional. We have also studied the effect of verapamil on the level of expression of mdr1 mRNAs in non-drug selected cells such as the HEL line (human acute myeloblastic leukemia) and the parental K562 line, which present a very low level of expression of Pgp, detectable only by PCR. In these lines, verapamil treatment has no effect on the level of expression of mdr1 mRNAs. The effect of verapamil is therefore restricted to drug-selected lines presenting high levels of Pgp expression. The impact of the negative regulation of Pgp expression on the MDR phenotype has been studied in the K562/ADR line. When the cells are treated for 72 h by verapamil, there is a decrease of resistance and an increase of intracellular accumulation of anticancer agents such as daunorubicin or vinblastine. Negative regulation of Pgp expression appears therefore as a possible strategy for MDR phenotype reversal. The effect of verapamil, whose molecular mechanism of action is being studied, could constitute a basis for this strategy.

Cardiotoxicity of 5-fluorouracil: a question of formulation

Abstract: The cardiotoxicity of 5-fluorouracil (FU) was attributed to degradation compounds present in the injected vials, fluoroacetaldehyde (Facet) and fluoromalonaldehydic acid (FMald). These compounds are formed with time in the basic medium necessary to solubilize FU. FU-NaOH vials were much less cardiotoxic than FU-Tris vials on the isolated perfused rabbit heart model since, in FU-Tris vials, Facet and FMald are stored in stable "depot" forms, which are adducts with Tris, whereas, in FU-NaOH vials, they are extensively chemically transformed. Cardiotoxic fluoroacetate (FAC), arising from Facet metabolization, was found in urine of patients, with a ratio FAC/FU catabolites 10-30 fold lower in patients treated with FU-NaOH than in those treated with FU-Tris.

[Antitumor electro-chemotherapy].

Abstract: We summarize the way which, starting at the electropermeabilization of cultured cells, a technique currently used in molecular and cellular biology, had led up to the electrochemotherapy, the new antitumor treatment that we have designed at the Institut Gustave-Roussy. Electrochemotherapy consists in intravenous administration of a low dose of bleomycin followed by local delivery of electric pulses on tumor nodules by means of two electrodes located at each side of the nodule. We describe the basis of the electrochemotherapy and we report the results obtained in mice and in clinical trials. Lastly we discuss the reasons for which electrochemotherapy, a treatment relevant to some precise clinical situations, might be widely instrumental in the treatment of cancer.

[Non small-cell bronchial cancers: toxicity of the association radiotherapy-chemotherapy. Review of the literature].

Abstract: Radiation therapy is the elective treatment of inoperable non small cell lung cancer, but is potentially curative only for a few of them: failures result from distant metastases and/or from progressive local disease. During the last years, following the progress in chemotherapy, combining radiation and drugs is becoming a more common approach. Nevertheless, one of the main concerns remains the potential interference between both modalities leading to an increased toxicity, which may outweigh all potential benefit. Several organs can be a target for acute or late toxicity: lung (pneumonitis and fibrosis), esophagus (acute esophagitis, stenosis), heart (pericarditis, impaired ventricular functions, heart failure, coronary stenosis), spinal cord (transient myelopathy, radiation myelitis), skin (moist desquamation, fibrosis, telangiectasia). The current published trials combining drug and radiation appear to be a rather safe approach especially when avoiding concomitant treatment. However, several points remain unsolved: the optimal combination scheme, the real risk of late damage observation including the second cancer occurrence risk. This risk is uneasy to evaluate due to the long latency period. The way of describing the late damage is crucial, seeking for a more precise system of evaluating, recording and reporting late effects, taking into account objective damage as well as the patient's symptoms. Therefore, combining drug and radiation should preferentially be performed within prospective studies, with precise evaluation procedures.

[Prognostic value of urokinase-type plasminogen activator and 2 inhibitors PAI-1 and PAI-2 in breast cancer].

Abstract: It is now clearly established that proteolytic enzymes, and in particular plasminogen activator (uPA), play an important role in breaking down the extracellular matrix, which is considered to be a step in metastasis formation. Plasminogen activators are controlled at various levels. Two inhibitors, PAI-1 and PAI-2, have been identified, the latter being more specific for uPA. In attempts to determine their prognostic value, it is essential to investigate the relative importance of these parameters and their interactions. We used an immunoenzymatic method to assay uPA, PAI-1 and PAI-2 antigens in cytosols prepared from 314 primary breast tumors. The patients were followed up for a minimum of six years and all relevant clinical and laboratory findings had been recorded. Univariate analysis confirmed the poor outcome of patients whose tumors contained large amounts of uPA and PAI-1. In addition, low levels of PAI-2 correlated with shorter disease-free survival in the overall population (P = 0.02), post-menopausal women (P = 0.02) and women without lymph node involvement (P = 0.02). Multivariate analysis using the "Main Effects" Cox model identified node involvement, macroscopic tumor size and PAI-2 as significant variables. The "interactive" Cox model, taking into account interactions between uPA and its two inhibitors, identified a first subgroup with a very poor prognosis associating either high levels of PAI-1 with low levels of PAI-2 in the overall population as well as following stratification for axillary node negative disease, or high levels of uPA with low levels of PAI-2 in the group of menopausal women. We conclude that PAI-1 provides the same prognostic informations as uPA, and does not appear to play its role as an inhibitor. In contrast, PAI-2 increased the prognostic value of both uPA, particularly in post-menopausal women, as well as PAI-1 in a subgroup of axillary node negative patients.

What can be now expected of the determination of estrogen and progesterone receptors in the treatment of breast cancers

Abstract: Since the first published correlations around the years 1975 between estrogen and progesterone receptors and response to hormone therapy, numerous data have modified our insight on hormone dependency. For instance, it is now well established that tumors are not "receptor positive" or "receptor negative" but contain variable receptor quantities synthesized by a more or less important fraction of tumor cells. This allows to better understand events leading to partial response or to relapse. Receptor detection by classical assays gives no indications on receptor functionality, and data from molecular biology have shown that mutated receptors exist that have lost their property to induce genes, or that present new acquired properties. Nevertheless, these functional modifications are rare, and must not mask a reality: 75 to 80% of tumors with high receptor levels respond to hormone therapy, and the clinician must take this fact into account in three situations: for adjuvant therapy, for metastasis therapy, and for some special cases of difficult diagnosis.

Obstacles and reticences in the screening of cancer of the cervix by the general practitioner

Abstract: Pour comprendre la faible participation des medecins generalistes au depistage systematique du cancer du col de l'uterus, les auteurs ont mene une enquete qualitative, basee sur des entretiens ouverts, aupres d'un echantillon d'omnipraticiens du departement du Bas-Rhin (France). L'analyse du discours des medecins interroges revele la place qu'occupe, dans leur pratique, le frottis cervicovaginal de Papanicolaou, le sens qu'ils entendent donner a ce geste de depistage et les principaux obstacles qui s'opposent a sa realisation systematique

Attitude of the French female population to cancer screening

Abstract: Les attitudes de la population feminine francaise face au depistage de certains cancers ont ete etudiees dans le cadre d'une enquete telephonique aupres d'un echantillon aleatoire de la population francaise de 18 a 75 ans (n=2099). Principaux resultats: le cancer demeure la maladie la plus crainte de la population. Cette crainte est plus affichee chez les femmes que chez les hommes (61,5% de crainte moyenne ou forte versus 52,6%). Ces dernieres ont de plus une tendance plus frequente a declarer l'existence de cas de cancers dans la famille. Au cours des 3 dernieres annees, respectivement 28,4 et 70,5% des 1075 femmes de l'echantillon avaient beneficie d'une mammographie et d'un frottis cervicovaginal

[Occupational cancers: notification, compensation and prevention].

Abstract: Less than 140 occupational cancers (OC) are compensated every year in France although the incidence is estimated for at least 6,000 new cases, as estimated by the epidemiologists (4% of the mortality by cancers). This situation can be explained by different factors: few compensation claims by the patients or families, frequent lack of interest from medical doctors for relation between cancer and work, occurrence of the OC after retirement, difficulty to distinguish the role of occupational factors from individual comportmental factors in many OC (for ex. a lung cancer hitting a smoker). The consequences of such a situation are multiple: no compensation for more than 95% of patients or relatives, taking for granted that OC is a minor problem, insufficient prevention of the carcinogenic factors on the work place, prevention of cancers restricted to individual comportmental changes. Physicians working in cancerology units have to incite their patients in notifying the OC and help them in compensation claims. They have also to ask for epidemiologic and toxicologic research when clusters of OC are identified in a plant, in order to get better prevention, compensation and regulations.

Comment mesurer le risque de cancer du sein dans une population

Abstract: On dit souvent qu'une femme sur 11 en France, et une femme sur neuf aux Etats-Unis, aura un cancer du sein. Ce chiffre eleve de l'hypothese irrealiste que toutes les femmes restent exposees jusqu'a l'âge de 90 ans, et neglige le risque de mourir avant 90 ans. Il est possible, en fait, de pendre en compte la probabilite de mourir avant 90 ans. La methode a utiliser est decrite, et le risque de cancer est evalue sur la vie entiere (entre 0 et 90 ans): il est de un sur 14 en France. L'estimation du risque sur des periodes plus limitees de la vie peut aussi etre utile

[Small cell lung carcinoma: role of thoracic irradiation and its timing in relation to chemotherapy].

Abstract: Combined modality therapy is of great importance in the management of small cell lung cancer. Randomized studies of the design chemotherapy with or without thoracic irradiation are required to demonstrate the impact of radiotherapy on rates of survival, local control and adverse effects. The method of meta-analysis allows one to analyse in a single study a set of different clinical trials of the same design. The first purpose of this paper is to briefly present the method, and the results of a meta-analysis on the role of thoracic irradiation combined with chemotherapy in the treatment of this disease. Thoracic irradiation added to chemotherapy results in a major decrease in local relapse (from 65% to 40% at 2 years), a modest increase in overall survival (from 16 to 22% at 2 years), and a small increase in lethal toxicity (from 1 to 2%). The second purpose is to discuss timing of thoracic irradiation with respect to the administration of chemotherapy using the results of a recently published trial. This Canadian study is based on the hypothesis that chemo resistant cells may develop as a result of spontaneous mutations during therapy. Limited disease patients all received the same chemotherapy (alternating 3-week cycles of CAV [cyclophosphamide, doxorubicin, vincristine] over EP [etoposide, cisplatinum] for a total of six cycles), after having been randomized to receive thoracic irradiation given either early (at 3 weeks following the beginning of treatment) or late (at 15 weeks). Of the 308 patients for analysis 155 were randomized to the "early radiotherapy" arm, and 157 to the "late radiotherapy". Prognostic factors were equally distributed between the two arms. The radiotherapy regiment consisted of a dose of 40 Gy in 15 fractions to a target volume including the primary tumor and mediastinum, and prophylactic brain irradiation (25 Gy in ten fractions in 2 weeks) to patients without progression of disease. The overall survival rate was better in the "early radiotherapy" arm, with a median survival of 21 months and on overall survival rate of 20% at 5 years, compared to a median of 16 months and a 5 years survival of 11% in the "late radiotherapy" arm. The survival curves are significantly different by the log rank (P = 0.008) and Wilcoxon (P = 0.005) tests, in favour of "early radiotherapy". After allowing for prognostic factors (sex, ECOG performance status) by the Cox model, the "early" arm retains a statistically significant advantage (P = 0.006).(ABSTRACT TRUNCATED AT 400 WORDS)

[Soft tissue sarcomas: general review].

Abstract: Soft tissues sarcomas are an heterogeneous group of neoplasms. Their epidemiology is still poorly known. Great strides have been made in the genetic study over the last few years. Histologic grade, tumor size and deep location are the main independent prognostic factors in multivariate analysis using the Cox model. Overall 5-year survival is approximately 50% in most of the studies. Surgical conservative treatment associated with radiotherapy is actually preferred to radical surgery, because no survival difference is found between the two treatments. Radiation therapy modalities are discussed: preoperative, postoperative irradiation, interstitial brachytherapy. Doxorubicin, ifosfamide and DTIC are the most efficient drugs. However, response rates obtained with polychemotherapy are still less than 50%. High-dose chemotherapy is an encouraging concept. Edatrexate and Taxotere show interesting response rates in phase II clinical trials. Adjuvant chemotherapy efficiency is probably low: a meta-analysis shows a 5-year survival increase of 9%. Neoadjuvant chemotherapy allows a high rate of conservative treatment.

[Primary, highly malignant B-cell lymphoma of the prostate. Apropos of a case and review of the literature].

Abstract: We report a case of prostatic non Hodgkin lymphoma arising in a 61-year-old man. The treatment consisted of a chemotherapy with cyclophosphamide, adriamycine, vincristine and prednisone (CHOP regimen). A complete remission histologically proved was obtained. The literature and the treatment approach of prostatic lymphomas are reviewed.

Grossesse et hémopathies malignes : approche thérapeutique

Abstract: Pregnancy coexisting with evolutive malignant blood disease (Hodgkin's disease, acute leukemia, non-Hodgkin's lymphoma, chronic myeloproliferative disorder) is a therapeutic dilemma because of possible adverse reactions associated with the use of cytostatic agents. Therapeutic abortion, when needed, must be proposed only after a careful evaluation of the following parameters: the emergency of treatment, the prognosis of the disease, the term of pregnancy, the risks of therapy for the foetus and the mother, and the psychosocial context. From the clinical data published so far, the teratogenicity of cytostatic drugs seems to be minimal after the second trimester, and the outcome of pregnancy is often favorable, whatever the hemopathy. Radiation therapy must be used very cautiously and only in supradiaphragmatic areas. An overview of specific problems is done for each category of malignant blood disease.

Fertility after antimitotic treatments

Abstract: Antimitotic chemotherapy and radiation therapy can induce temporary or permanent infertility in men, transitory amenorrhea or premature ovarian failure in women, and genetic mutations responsible of foetal deaths or congenital malformations in the progeny. Alkylating agents and radiotherapy can provoke definitive male infertility and ovarian failure, but individual susceptibility seems quite variable. In man, return of spermatogenesis can still be observed more than 10 years after treatment and pregnancies are obtained with very low sperm counts. In women, the progressive depletion of the follicular pool explains the increasing frequency of ovarian failure, with lower doses of treatment. Antimitotic and immunosuppressive therapy can also induce irreversible lesions in children's gonads.

Cancers bronchiques non à petites cellules : toxicité de l'association radiothérapie-chimiothérapie. Revue de la littérature

Abstract: L'irradiation est le traitement de choix pour les patients porteurs d'un cancer bronchique non a petites cellules non operable mais elle n'a de potentiel curatif que pour peu d'entre eux: les echecs sont le fait des metastases et/ou d'une progression locale. Recemment, a la suite des progres de la chimiotherapie, l'association chimiotherapie-irradiation est devenue une approche plus frequente et justitiee. Cependant, l'interference potentielle entre les deux modalites therapeutiques, avec risque d'augmentation de la toxicite, masquant le benefice therapeutique potentiel, est une des preoccupations principales

Problem of perception and denial of illness in women who had breast cancer

Abstract: It has been noted that some patients demonstrate denial when they have a severe illness such as cancer. We observed this type of denial with respect to perception of illness by patients. We interviewed twenty women who had been treated for breast cancer for more than one year. During these interviews, every patient narrated the story of her illness as she remembered it. One year or more after treatment, four women denied the diagnostic which was given to them when the treatments started. These four women were the only ones who never perceived the first signs of the illness. They never saw or felt any change around their breasts, and they are among the five women for whom breast cancer was detected from a systematic mammography. In contrast the other women, who did not manifest such denial, detected themselves an anomaly or were alerted by their physician. Based upon these observations, we discuss the notion of denial when patients have no perception of the illness or its first signs of onset. We pose a question concerning the interest and usefulness of such research concerning the representational process of illness by patients.