[Asplenia in the Hodgkin's patient]. / L'asplénisme du patient hodgkinien.

FEWER INDICATIONS AFTER SPLENECTOMY: Real therapeutic progress has been achieved over the last fifty years for patients with Hodgkin's disease known for their chronic immunodepression. Since the advent of effective chemotherapy protocols such as ABVD, and more recently intensive chemotherapy completed as needed with an autograft, splenectomy is no longer performed for therapeutic purposes but may be indicated for its contribution to diagnosis. STRATIFICATION OF RISK OF ASPLENISM: There remain however several questions concerning the infectious complications in these patients given chemotherapy and splenic radiotherapy. One of the objectives of this work was to propose a stratification of risk of asplenism as a function of treatments administered, the level of initial immunodepression, and the age of the patient.

[Standards, options, and recommendation for external radiotherapy of prostatic cancer: evaluation of the effect of dosage]. / Standards, Options et Recommandations pour la radiothérapie externe des patients atteints de cancer de la prostate: évaluation de l'effet dose.

CONTEXT: The "Standards, Options and Recommendations" (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical speciality societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by critical appraisal by a multidisciplinary group of experts. Draft guidelines are produced, then validated by specialists in cancer care delivery. OBJECTIVES: Produce clinical practice guidelines for the radiotherapy of prostate cancer using the methodology developed by the Standards, Options and Recommendations project. METHODS: The FNCLCC and the French Urology Association (AFU) designated the multidisciplinary group of experts. Available data were collected by a search of Medline and lists selected by experts in the group. A first draft of the guidelines was written, they validated by independent reviewers. RESULTS: The main recommendations are: 1/ a minimal dose of 70 Gy must be used, whatever the prognostic factors; 2/ it appeared that patients with favourable prognostic indicators (stage T1-2, PSA < or = 10 micrograms/L and Gleason score < or = 6) do not benefit from a dose escalation effect for doses over 70-74 Gy; 3/ patients with intermediate prognosis are the ones who benefit most from the dose escalation effect over 74 Gy, provided they receive exclusive radiation therapy; 4/ whenever possible, patients should be included in controlled trials designed to assess the effects of dose escalation and hormonotherapy.

[Standards, Options, and Recommendations for brachytherapy in patients with prostate cancer: efficacy and toxicity]. / Standards, Options et Recommandations pour la curiethérapie des patients atteints de cancer de la prostate: efficacité et toxicité.

CONTEXT: The "Standards, Options and Recommendations" (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical specialty societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by a critical appraisal by a multidisciplinary group of experts. Draft guidelines are produced, then validated by specialists in cancer care delivery. OBJECTIVES: Produce clinical practice guidelines for the brachytherapy of prostate cancer using the methodology developed by the Standards, Options and Recommendations project. METHODS: The FNCLCC and the French Urology Association (AFU) first designated the multidisciplinary group of experts. Available data were collected by a search of Medline and lists selected by experts in the group. A first draft of the guidelines was written, they validated by independent reviewers. RESULTS: The main recommendations are: 1/Brachytherapy with permanent seeds alone is a possible curative treatment for prostate cancer patients with the following prognosis factors: tumour stage T1 or T2a (TNM 1992), Gleason score < or = 6 and PSA < 10 micrograms/L. 2/Combined treatment with brachytherapy and hormonal therapy could be more efficient than brachytherapy alone for prostate cancer patients with Gleason score > 7 and/or PSA > 10.3/Combination of brachytherapy and external beam radiation therapy can be proposed to prostate cancer patients with intermediate prognosis. 4/Before and after seed implantation, risks of infection must be prevented by appropriate antibiotic therapy (recommendation). 5/Brachytherapy must not be performed within 2 months of transurethral prostate resection. 6/The height of the urethra receiving more than 200% of the prescribed dose must be reported. The portion of the rectum receiving 100 and 120% of the prescribed dose must be limited to 10 and 5 mm length, respectively.

[Isolated peritoneal metastases from an lobular infiltrating breast carcinoma. Value of laparoscopy]. / Localisations péritonéales isolées d'un carcinome lobulaire infiltrant du sein. Place de la coelioscopie.

The authors report a case of peritoneal metastasis from an infiltrating lobular carcinoma of the breast. This case report enhances the frequency of this type of secondary location in the lobular carcinoma, with special attention to the diagnostic problems.

[Granulocytic sarcoma of the testis without hematological manifestations]. / Sarcome granulocytaire du testicule sans manifestation hématologique.

A 30-year-old man with a testicular tumor ressembling a "round cell sarcoma" was treated for rhabdomyosarcoma. Complete remission was achieved but the patient relapsed and died of the disease. A retrospective diagnosis of granulocytic sarcoma was established using an anti-myeloperoxidase antibody, unfortunately not available at the time of the initial diagnosis. No hematological disorders were observed during the course of the disease. Four cases of granulocytic sarcoma of the testis have been reported in the literature. All these cases where accompanied or followed by leukemia. The present case seems to be the first case of granulocytic sarcoma of the testis not accompanied by hematological disorders.

Peripheral primitive neuroectodermal tumour after allogeneic bone marrow transplantation.

We report a case of peripheral primitive neuroectodermal tumour (PNET) in a 36-year-old man who 10 years earlier received an allogeneic bone marrow transplantation (BMT) for a non-Hodgkin's lymphoma. Immunohistochemistry proved definitive elimination of a relapse of the original disease and confirmed the diagnosis of PNET. The role of total body irradiation pre-BMT in the genesis of this secondary tumour is discussed. The importance of registering secondary malignant solid tumours after BMT is emphasized. To our knowledge, an Ewing family tumour following BMT has not previously been reported.

[Small cell carcinoma of the prostate. Complete remission after chemoradiotherapy: apropos of a case]. / Carcinome de prostate à petites cellules. Rémission complète après chimio-radiothérapie: a propos d'un cas.

The authors report a case of pure small cell carcinoma of the prostate expressing neuroendocrine markers on immunohistochemistry. Treatment consisted of chemotherapy with cisplatin and etoposide combined with regional external beam radiotherapy. The result is encouraging with complete remission 15 months after the diagnosis.

[Inflammatory pseudo-tumor of the lung. Clinico-pathologic report of a case]. / Pseudo-tumeur inflammatoire du poumon. Etude anatomo-clinique d'une observation.

One case of a solitary pulmonary nodule occurring in a 54-year-old woman with history of breast carcinoma is presented. Histological examination of the surgical specimen excluded breast carcinoma metastasis and revealed an inflammatory pseudotumor. Principal clinico-pathological findings in previously reported cases are described. Inflammatory pseudotumors may exhibit, as in our case, some nuclear atypia making the diagnosis sometimes difficult with malignancy.

[Therapeutic modalities for germinal testicular tumors, excluding surgery. Radiotherapy--chemotherapy]. / Modalités thérapeutiques des tumeurs germinales testiculaires, chirurgie exclue. Radiothérapie--chimiothérapie.

There are two other treatments for germ cell tumours of the testis apart from surgery: radiotherapy and chemotherapy. Radiotherapy is ideally administered with a linear accelerator delivering photons and electrons. The dose is well established and smaller volumes are now irradiated. The precision is increased by CT and by the use of personalized shields. Radiotherapy is indicated in pure seminomas, with two exceptions: rare seminomas with a large tumour mass (2%), rare palliative indications for non-seminomatous germ cell tumours. Chemotherapy, following the progress due to the combination of vinblastine and bleomycin, has been based, for the last 10 years, on cisplatin, which must be administered at the correct dose. VP 16, ifosfamide and other drugs have also been introduced. In forms with a poor prognosis and depending on the clinical course, this chemotherapy should be administered at high doses with the protection of autologous bone marrow transplantation. This requires an appropriate infrastructure and a well trained team. The short-term and long-term effects of radiotherapy are more clearly defined than effects of chemotherapy.

[Therapeutic indications for germinal testicular tumors]. / Les indications thérapeutiques des tumeurs germinales testiculaires.

The therapeutic indications for germ cell tumours of the testis depend on the histology (pure seminoma: 45%, non-seminomatous germ cell tumour: 55%), the extension and the severity of the prognosis. The well standardised approach to pure seminomas is less clear for non-seminomatous germ cell tumours. Stage I, IIAB pure seminomas (95 to 98% of cases) should be irradiated. The dose and target volume are adapted to prophylactic (I) and curative (II) objectives. Rare seminomas with a large tumour bulk should be treated with chemotherapy. Survival is close to 100%. Stage I non-seminomatous germ cell tumour offers several theoretical possibilities. Radiotherapy is not very popular and chemotherapy appears to be to aggressive, lumboaortic lymph node dissection is being replaced by new imaging modalities and simple follow-up requires a rigorous and disciplined approach. At the Val-de-Grâce hospital (France) since 1987, we perform simple orchidectomy in favourable stage I disease: 80% are cured with no other treatment, 20% relapse and are cured by chemotherapy, in the unfavourable stage I cancers (histology, markers) or with uncertain follow-up, limited chemotherapy is performed (3 cycles of EP). Stage II and more advanced non-seminomatous germ cell tumours are divided into moderate forms (IIA, B, III, IVL1) and major forms (IIC, IVL2, L3, H+, CNS+). In the exclusive infradiaphragmatic involvement of moderate forms, some authors propose bilateral lumboaortic lymph node dissection which is invasive surgery with an efficacy declining from 90% (IIA) to 50% (IIB). The majority of teams, particularly Val-de-Grâce, administer 3 or 4 courses of BEP followed by assessment (CT scan - markers) and salvage surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Staging evaluation and surveillance in tumors of the testicle]. / Bilan d'extension et de surveillance des tumeurs du testicule.

In 1992, the staging and follow-up of testicular germ cell tumours is based on a combination of computed tomography and tumour markers. Due to the development of medical imaging over the last decade, abdominal and thoracic CT has now replaced the combination of lymphography and pulmonary tomographies. Testicular ultrasonography is valuable for the diagnosis and contributes to staging and follow-up. The chest x-ray is still performed and MRI has very exceptional indications. Tumour markers, essentially alpha-foetoprotein and the free beta fraction of human chorionic gonadotrophin, are useful in more than 80% of NSGCTs and about 15% of seminomas (beta-HCG alone). A very high initial level often indicates a poor prognosis. Monitoring of markers is essential after exclusive orchidectomy and to assess the efficacy of chemotherapy.

[Mature teratomas of testicular origin. Discussion of 12 cases]. / Les tératomes matures d'origine testiculaire. Réflexions à propos de douze cas.

Between 1979 and 1989, 135 patients with a non-seminomatous germ cell tumour of the tests were treated in the Val de Grâce Military Hospital in Paris. In twelve patients, histological examination of a residual mass after chemotherapy revealed the presence of mature teratoma. Although this tumour, considered to be benign, generally represents a favourable form of the initial tumour, it nevertheless has a potential for progression. The possibility of long-term recurrences, which are sometimes difficult to eradicate, justifies very careful long-term surveillance of these patients. The authors report three particularly demonstrative cases and present a review of the literature.

[Advanced testicular seminoma: treatment of residual masses after chemotherapy. A review of 3 cases]. / Séminomes testiculaires évolués: traitement des masses résiduelles après chimiothérapie. Réflexions à partir de 3 observations.

Based on 3 cases of advanced testicular seminoma classified as stage IIC, the treatment of residual masses after chemotherapy is discussed. The excellent therapeutic response confirmed by histological study of the residual masses, which show a fibrotic or necrotic appearance, allows the adoption of a strategy using imaging techniques: either there is persistence of a gland mass syndrome and resection needs to be carried our or retroperitoneal fibrosis is visualised and careful follow up would appear to be sufficient.

[Biological markers and germinal tumors of the testis. Value and limitations of the assay of chorionic gonadotrophin hormone and alpha-fetoprotein]. / Marqueurs biologiques et tumeurs germinales du testicule. Intérêts et limites du dosage de l'hormone chorionique gonadotrope (HCG) et de l'alpha-foeto-protéine (AFP).

Between 1978 and 1985, 128 patients with germinal tumors of the testes were treated at the Val-de-Grâce Hospital; biological market levels--beta HCG and AFP--were determined before and after orchidectomy in the peripheral blood and during orchidectomy in testicular blood in 76 patients. HCG levels were elevated in 13% of seminomas and HCG and/or AFP levels were elevated in 76% of non seminomas; the sensitivity of the determination was greater in testicular blood. However, in our study, there was no parallelism between marker levels before orchidectomy and tumor stage or prognosis. The change in HCG and/or AFP levels appears to an index of the response to therapy: 4 patients with high HCG and/or AFP levels during chemotherapy died. The diagnosis of recurrence is not always documented by elevated marker levels and monitoring must always documented by elevated marker levels and monitoring must always include both determination of marker levels and imaging.

[Value of adrenaline in opaque arthrography of the knee. Comparative study of 100 cases]. / Intérêt de l'adrénaline dans l'arthrographie opaque du genou. Etude comparative portant sur 100 cas.

A prospective study evaluated efficacy of adrenaline in image improvement of opaque arthrography of knee. Of the 100 cases assessed, adrenaline was combined with contrast medium in 50%. Quality of images was compared by double reading of couples of images taken at end of examination. Marked improvement was observed in 2 of 3 cases and it is proposed to use adrenaline routinely to prolong quality of initial arthrogram.