[Interventional computed tomography in thoracic oncology. Apropos of 170 cases]. / Tomodensitométrie interventionnelle en oncologie thoracique. A propos de 170 cas.

The authors report their experience with follow-up cytohistological examination of subclinical thoracic lesions in oncology by transparietal puncture with CAT-scanning localization in 170 patients. They detail a few special points concerning the material used and their techniques, in view of reducing the most common incidents and of managing the most severe complications. They analyze their results in two groups of patients, one investigated in a context of known malignancy and the other, with no history of malignancy in whom bronchoscopy, bronchial lavage and brushing were negative. They found an overall sensitivity and specificity of 86% and 100%, respectively, in the diagnosis of malignant disease. The method showed an efficacy of 83.5%. For the two populations, sensitivity was 84% and 87% respectively, and efficacy was 82 and 85% respectively. Thus, the results were better in the patients who had never received anticancer therapy. They also observed significant differences depending on whether the targets were mediastinal, pleuropulmonary or parietal. While the rapid diagnostic information appears invaluable in both groups of patients, in contrast, the small volume of the specimens, which may be hemorrhagic, necrotic, with more or less extensive fibrosis of the stroma, and the immaturity of certain tumors, sometimes make it impossible for the pathologist to give a precise diagnosis of the tumor other than the benign or malignant structural character of the lesion. This represents a significant obstacle in hematology for affections which, although non surgical, nevertheless require precise identification of the lesion for effective therapy. The elaboration of more effective sampling material, repeated punctures and immunohistoenzymatic analysis techniques would probably further improve the results of the method.

[Arterial embolization in malignant neoformations of the face and neck]. / Embolisations artérielles dans les néoformations malignes de la face et du cou.

On the basis of 25 cases of embolisation for cervico-facial tumours, it was possible to demonstrate the value of this technique in the treatment of local haemorrhage and in the relief of pain in patients with a lesion beyond hope of any treatment.

[Late progressive radiation myelopathies. A study of 27 cases]. / Les myélopathies radiques tardives progressives. Etude de 27 observations

Several conclusions seem evident from this study : firstly radiation myelopathies exist without any doubt; secondly clinical observation, even very attentive, during irradiation is perfectly blind regarding this subject; lastly, one can only, at this time, attempt to anticipate medullary accidents caused by irradiation. Radiation myelopathies exist incontestably. We report 27 new cases which are added to the more than 500 cases already analysed in the world litterature. The improvement of results of cancerology and in particular of radiotherapy make and will continue to make the number of observations published increase. However, if there is no doubt as to existence of these myelopathies, discussions persist concerning their nature : purely vascular, cytotoxic, probably mixed, perhaps maintained and prolonged by a superimposed immunologic phenomenon. Prevention is the sole method at our disposal to be effective. It must be applied as much to the patient as to the technique of irradiation. With regard to the patient treated in a medullary volume, several factors are probably favorable to the development of myelopathy and must cause one to modify eventually the technique of radiation proposed : the existence of anterior vertebral medullary pathology, whatever its nature; two ages demonstrate increased incidences : the young which have relative immaturity of tissue (we report 4 cases patients less than 25 years old), and the old, whose chances of accumulating associated pathologies are great, especially as systemic hypertension and arteriosclerosis are likely to have played a favorable role; the patients for whom restraint is difficult or who present disrupted regions anatomy are qually much more fragile. With regard to the technical plan, several factors incontestably favor the appearance of radiation myelopathy : large medullary volumes irradiated, especially when they encompass the zones of vascular medullary junction; the overlap of fields involving the spinal cord; the reduction of fields too close to the spinal cord not allowing at least 1 cm margin of relative security; the association of physical agents in the measure to which the global dosimetry is uncertain, i.e. in particular the use of high energy electrons for boost dosage, the intensity of which must be chosen with the greatest prudence; finally and most importantly, it seems desirable to us not to surpass at the level of the spinal cord, treating 5 times per week, a dose of 5 000 rads with fractions of 200 rads of 4 500 rads with fractions of 250 rads, and of 4 000 rads with fractions of 300 rads. Can one reasonable pretend always to foresee all radiation myelopathies? No, for on the one hand there exist authentic cases which have occured after doses which were below the limits of tolerance which we have indicated above, in accordance with others authors, and on the other hand, the necessity of sterilising certain inoperable tumors obliges one sometimes to deliver to region of the spinal cord aggressive doses.

[Arterial embolization in the treatment of neoplasic tumors].

Eight cancer patients treated at the centre François-Baclesse at Caen underwent arterial embolisation using Spongel. The technique was usually used in the presence of a contraindication to operation. In certain cases the problem was that of controlling haemorrhage following tumour invasion or secondary to complications of radiotherapy, under which circumstances was most successful. In addition, it was possible to reduce pain resistant to medical treatment. The method appeared to be a useful therapeutic complement post-radiotherapy for hypervascularised lesions.

[Azygography in the study of malignant tumours of the oesophagus (author's transl)]. / L'azygographie dans l'étude radiologique des tumeurs malignes de l'oesophage

Up to the present time, no simple method has existed for gauging the true size of an oesophageal tumour. The intimate relations between the azygos vein and the oesophagus in the thorax between D3 and D8 justifies this new study: azygography. On the basis of 40 examinations, 13 of which were followed by surgery in patients suffering from carcinoma of the oesophagus, as was indicated by classical anatomical data, azygography made possible the evaluation of tumour extension in the mediastinum and the involvement of adjacent structures, such as the right pulmonary artery. Azygography thus aided in the precision of surgical indications and in the delineation of the volume to be irradiated. The examination is carried out by selective opacification after catheterisation via the femoral vein. Radiological findings distinguish involvement by deviation, compression, invasion, obstruction and collateral circulation. In certain cases a part of the tumour itself is opacifield by vessels with an anarchic pattern. Comparison of the results of radiological study with surgical findings shows that the examination makes it possible to predict, between the level of the third and eighth thoracic vertebrae, difficulties in or impossibility of dissection of the tumour as well as, in the case of involvement of the arch, the necessity for total oesophagectomy with additional cervical approach. The accuracy of the information obtained is certainly less valuable as far as the lower third is concerned. Non-traumatic, simple and rapid, azygography would appear to be the examination of choice in defining the exent of a tumour of the middle third of the oesophagus, as a complement to clinical findings and barium swallow, being particularly valuable in determining the volume to be irradiated or on a pre-operative assessment.