Psychological impact of referral to an oncology hospital on patients with an ovarian mass.

OBJECTIVES: In patients with an ovarian mass, a risk of malignancy assessment is used to decide whether referral to an oncology hospital is indicated. Risk assessment strategies do not perform optimally, resulting in either referral of patients with a benign mass or patients with a malignant mass not being referred. This process may affect the psychological well-being of patients. We evaluated cancer-specific distress during work-up for an ovarian mass, and patients' perceptions during work-up, referral, and treatment. METHODS: Patients with an ovarian mass scheduled for surgery were enrolled. Using questionnaires we measured (1) cancer-specific distress using the cancer worry scale, (2) patients' preferences regarding referral (evaluated pre-operatively), and (3) patients' experiences with work-up and treatment (evaluated post-operatively). A cancer worry scale score of ≥14 was considered as clinically significant cancer-specific distress. RESULTS: A total of 417 patients were included, of whom 220 (53%) were treated at a general hospital and 197 (47%) at an oncology hospital. Overall, 57% had a cancer worry scale score of ≥14 and this was higher in referred patients (69%) than in patients treated at a general hospital (43%). 53% of the patients stated that the cancer risk should not be higher than 25% to undergo surgery at a general hospital. 96% of all patients were satisfied with the overall work-up and treatment. No difference in satisfaction was observed between patients correctly (not) referred and patients incorrectly (not) referred. CONCLUSIONS: Relatively many patients with an ovarian mass experienced high cancer-specific distress during work-up. Nevertheless, patients were satisfied with the treatment, regardless of the final diagnosis and the location of treatment. Moreover, patients preferred to be referred even if there was only a relatively low probability of having ovarian cancer. Patients' preferences should be taken into account when deciding on optimal cut-offs for risk assessment strategies.

External radiotherapy for carcinoma of the eyelid: report of 850 cases treated.

PURPOSE: We report a retrospective series of 850 patients treated by external irradiation for carcinoma of the eyelid at Institut Curie and we compare our results with other techniques: brachytherapy and surgery. METHODS AND MATERIALS: Eight hundred fifty patients were treated by external radiotherapy for carcinoma of the eyelid. None of these patients have been previously treated. All the patients were classified according to the TNM classification of (UICC). We distinguished five histological types and five clinical groups according to the site of the skin tumor. Three modalities of external radiotherapy were used: contact therapy, conventional radiotherapy, and electrontherapy. We reviewed the clinical files of the 850 patients who went regularly at follow-up visits. RESULTS: We report the 5-year survival results--alive with no evidence of disease: 72%; alive with progression: 2%; died from tumor progression: 0.5%; died from intercurrent disease: 19.5%; and lost to follow-up: 5%. The 5-year local control rate was 97.5%. We observed 45 failures--lymph node, metastatic, and local--and emphasize this last group by presenting the results of treatment of these local failures. We studied the complications of treatment: 2.3% of corneal complications, 2% of cataracts, and 1.4% of serious ocular complications. CONCLUSIONS: Our results concerning local failures and loss of the eye are comparable to those reported for other techniques involving brachytherapy or surgery. Overall, external radiotherapy is a safe and effective treatment, as it ensures a high local control rate and provides perfectly satisfactory functional and esthetic results. It seemed particularly useful to report this series in that few publications are available on this subject that, nevertheless, constitutes a topical issue.

An experience of the use of radioactive plaques after failure of external beam radiation in the treatment of retinoblastoma.

The authors have reviewed the results of radioactive plaques in recurrent retinoblastoma after external beam radiation in 34 eyes. They give their results on ocular conservation and on the visual outcome and compare these results with other series previously published. They think radioactive plaques are an alternative to enucleation in recurrent retinoblastoma after external beam.

Second non-ocular tumours in survivors of bilateral retinoblastoma. A 30-year follow-up.

The authors have reviewed a series of 80 patients treated at the Curie Institute before 1965 for bilateral retinoblastoma. They present their cases of second non-ocular tumours in these patients and discuss their results and the possible factors influencing the percentage of second tumours in these patients.

The effect of peritoneal dialysis with and without aprotinin on acute experimental pancreatitis in rats.

Acute pancreatitis was induced in 139 Wistar rats by injection of trypsin in the common bilio-pancreatic duct. Peritoneal dialysis was performed in 93 rats. In some of these rats, aprotinin (250,000 UI/L) was added to the lavage fluid. Macroscopically, we noted the amount of steatonecrosis, pulmonary congestion and pleural effusion produced. The pancreatic and pulmonary lesions were studied microscopically. The effect of peritoneal dialysis with and without aprotinin on the survival rate was evaluated. Survival curves were established for the different groups of rats i.e. the non-treated group and the two groups of dialysed rats (with and without aprotinin). Peritoneal dialysis reduces the amount of steatonecrosis and the incidence of pulmonary complications of trypsin-induced pancreatitis in rats, but does not influence the pancreatic lesions. Peritoneal dialysis significantly improves the early survival rate. Addition of aprotinin to the dialysis fluid reduces the total mortality rate.

[Maculopathy caused by irradiation in patients treated for choroid melanoma]. / Maculopathies par radiations chez les patients traités pour mélanomes choroïdiens.

We are using Cobalt 60 plaques at Curie Institute since 1968 for the treatment of malignant choroidal melanoma. We reviewed a series of 79 patients treated between 1982 and 1984 with a minimal follow up of 5 years. Tumors thickness varies between 2 and 11 mm with a mean thickness of 5.7 mm. All the tumors received at least 70 grays at the apex. 7 patients died from other cause, 7 patients presented metastasis 65 patients are alive and well, 49 of them have kept their eye and 16 have been enucleated. 18 patients have a visual acuity below 20/200 because of severe maculopathy, 29 patients have a visual acuity between 20/200 and 20/25. The most severe functional visual loss was due to maculopathy. It consisted of obliteration of the capillaries, exsudation and cystoid macular oedema. If we compare these results to other authors we see that maculopathy is a frequent problem with cobalt 60. For these reasons, we intend in the future to use iodine 125 plaques and prothontherapie that should give us better functional results.

[Melanoma of the uvea in young patients. Apropos of 3 cases]. / Les mélanomes de l'uvée du sujet jeune. A propos de 3 cas.

The authors report 3 cases of uveal melanoma, appeared on young women: 20, 23 and 28 years old. The melanomas were localized on the iris, the ciliary body and on the choroid. The authors studied the different notions of the literature about happened age of these lesions.

Fine-needle cytology of 292 palpable orbital and eyelid tumors.

Fine-needle cytology (FNC) of 292 palpable orbital and eyelid tumors was performed with a 25-gauge (0.5-mm), 3-cm needle and compared with the histopathologic findings in 286 cases. Among these 286 cases, a concordant diagnosis of malignancy and type was achieved in 249 cases (87%). False positive diagnoses were made in four cases (1.6%) and false negative diagnoses in five cases (1.8%). No complications were encountered. These results led to the conclusion that FNC is an accurate tool in the diagnosis of orbital and eyelid tumors, especially when sampling and interpretation are performed by an experienced pathologist.

[Preliminary dosimetry study of the Orsay synchrocyclotron proton beam with a view to applying it therapeutically]. / Etude dosimétrique préliminaire du faisceau de protons du synchrocyclotron d'Orsay en vue de son application thérapeutique.

Using proton beams for treatment of malignant tumors of the eye allows high dose irradiation of the tumor volume with negligible irradiation of the surrounding critical structures. Actually, the clinical results reported from the Boston or Villigen groups which have experience of such a technique, are impressive. In France, it is planned to use soon 200 MeV proton beams from the Orsay synchrocyclotron 20 km from Paris. Therefore, a feasibility study has been conducted during year 1988, consisting of a dosimetric analysis of the characteristics of the Orsay proton beams. It was concluded that only simple modifications were necessary to make the beam clinically available for protontherapy and more specifically for treatment of uveal melanomas.

Prognosis and treatment of retinoblastoma. 105 cases treated at Institut Curie.

In a retrospective study of 105 retinoblastoma cases, the authors studied the clinical symptoms, survival and ocular conservations. The results are much better in case of early diagnosis. They discuss the therapeutic modalities in their institute and elsewhere.

[Prognosis and treatment of retinoblastoma. 105 cases treated at the Curie Institute]. / Pronostic et traitement du rétinoblastome. 105 cas traités à l'Institut Curie.

We reviewed 105 cases of retinoblastoma treated in our institution between 1977 et 1981. We statistically analyse the prognosis according to various factors and we compare our results with the results of the other authors. We discuss the therapeutic modalities and the results.

[Value of angiography in the surveillance of choroid melanoma treated by cobalt disk]. / Intérêt de l'angiographie dans la surveillance des mélanomes choroïdiens traités par disque de cobalt.

Conservative management of choroidal melanoma by radioactive plaques or protonbeam is widely used since 1968. The treatment of these tumors at Curie Institute has been done with cobalt plaques since 1968. Indications were first monophthalmic patients but are now much wide. We have been treating since 1981 all patients with tumor diameter less than 17 mm and tumor height less than 12 mm. The technic includes general anesthesia to place the disc with localisation of the tumor by transillumination or by indirect ophthalmoscopy. A dose of 70 to 90 grays is delivered to the apex of the tumor. We report two cases of patients treated by cobalt 60 plaque for choroïdal melanoma. The first patient has a 5 mm high choroïdal melanoma temporal to the macula. After treatment by cobalt plaque, he showed no echographic changes but angiograms revealed an hypofluorescent zone in the central part of the tumor. The second patient has an 8 mm tumor that after plaque showed only angiographic changes. Evolution after treatment of choroïdal melanoma by radioactive plaque is variable. Echographic changes are very low and it is frequent to observe no modification in the height of the tumor for a long time for this reason, repeated angiograms can be very useful in the follow up of these patients. They frequently show hypofluorescent spot in the central part of a tumor that was hyperfluorescent before treatment. Sometimes there is diffuse lowering of the fluorescence. We think that these modifications of fluorescence can be due to diminution of the vascularisation of the tumor or may be to central necrosis of the tumor.(ABSTRACT TRUNCATED AT 250 WORDS)