[Conservative surgery after radiotherapy with preoperative doses in the treatment of breast cancer]. / Chirurgie conservatrice après radiothérapie à doses pré-opératoires dans le traitement des cancers du sein.

Radiotherapy as primary treatment is one of the means of increasing the rate of conservative treatment in patients with a breast tumour more than 3 cm in diameter. Between 1980 and 1986, 232 patients were treated in the Curie Institute by irradiation followed by conservative surgery for T2NO or T2N1a tumours wider than 3 cm, which accounted for 66 percent of the cases; 126 of these 232 tumours were located in the upper and outer quadrant. Axillary dissection was combined with tumoral excision in 63 percent of the cases. Conservative surgery was performed in patients who, after preoperative irradiation (50 Gy), had a persistent tumour less than 3 cm in diameter. Tumorectomy was complete in 96 percent of the cases, and the operative specimen was sterilized in 20 percent. The mean follow-up period was 46 months. The overall survival rate was 83 percent at 5 years (91 percent for T2NON1a). No local recurrence was observed in 92 percent of the patients at 3 years and 87 percent at 5 years. Nine percent of these women developed lymphoedema of the upper limb. The cosmetic result was good in 70 percent of the cases, fair in 25 percent and poor in 5 percent. The survival rate being the same with this treatment as with mastectomy, and the local recurrence rate being relatively low (13 percent at 5 years), we feel authorized to suggest that this post-radiotherapy conservative surgery should be used, at least in women with T2NON1a breast cancer.

Growth and endocrine disorders in optic glioma.

Hypothalamo-pituitary function in children with optic glioma may be impaired by the tumour itself and by the high cranial radiation doses used in treatment. This study evaluates the effect of optic glioma and its treatment on patient growth and pubertal development. Twenty-one patients (13 boys, 8 girls), treated for optic glioma by cranial irradiation (45-55 Grays) at a mean age of 5.4 years, were evaluated before (n = 10) and/or after (n = 21) irradiation. Growth hormone (GH) deficiency was present in only 1 patient tested before irradiation and in all patients after irradiation. Precocious puberty occurred in 7/21 cases, before irradiation in 5 patients and after irradiation in 2 patients. The cumulative height loss during the 2 years after irradiation was 0.2 +/- 0.2 SD (m +/- SEM) in 7 patients with precocious puberty and 1.1 +/- 0.2 SD in 14 prepubertal patients (P less than 0.01). The corresponding bone age advance over chronological age, evaluated 1-3 years after irradiation, was 1.1 +/- 0.5 and -0.7 +/- 0.3 year in the two groups (P less than 0.01). The mean height loss between time of irradiation and the final height was 2.3 +/- 0.6 SD (n = 6). Primary amenorrhoea, associated with low oestradiol levels, occurred in two of the three girls of pubertal age. These data indicate that the high dose of cranial radiation used to treat optic glioma invariably results in GH deficiency within 2 years and that hGH therapy is required when GH deficiency is documented.(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective study of the development of growth hormone deficiency in children given cranial irradiation, and its relation to statural growth.

Although GH deficiency (GHD) is the most frequent hormonal abnormality that occurs after cranial radiation, the natural course of this complication and its relationship to growth in children are not known. Therefore, we undertook a 2-yr prospective study of 16 children, aged 1.7-15 yr at the time of treatment, who received cranial [31-42 Gy (1 Gy = 100 rads)] and spinal radiation for medulloblastoma or ependymoma (group I). Their growth was compared to that of 11 children given similar doses of cranial radiation only (group II). The mean plasma GH response to arginine-insulin test (AITT) was 9.1 +/- 1.5 (+/- SE) micrograms/L in group I and 8.5 +/- 1.8 micrograms/L in group II (P = NS). After 2 yr, 16 of the 27 children had a peak plasma GH value below 8 micrograms/L after AITT, and 10 children had a peak response less than 5 micrograms/L. In addition, in group I, AITT and sleep-related GH secretion were compared; at the 2 yr follow-up only 3 of 13 children had discrepant results. At the 2 yr follow-up children treated by cranial and spinal radiation had a mean height of -1.46 +/- 0.40 SD below the normal mean. In contrast, the children given only cranial radiation had a mean height of -0.15 +/- 0.18 SD; P less than 0.02. Therefore, most of the growth retardation appeared to be due to lack of spinal growth. GHD is thus an early complication of cranial radiation in these children, and no significant growth retardation can be attributed to GHD during the first 2 yr. These data contribute to the organization of follow-up in irradiated children in order to decide when human GH treatment is necessary.

[Carcinomas of the nasopharynx in adults]. / Carcinomes du rhinopharynx de l'adulte.

From 1959 through 1980, 139 MO adult patients (greater than 15 Y.) presenting with nasopharyngeal cancer were treated by definitive radiotherapy: 103 (74%) undifferentiated carcinomas and 36 (26%) squamous cell carcinomas. Chemotherapy was prescribed only in case of failure of treatment. Case distribution is the following according to UICC classification: stages I and II: 12%, stage III: 16%, stage IV: 72%. Survival rate is respectively 70%, 45%, 20%. The overall 3 and 5 year survival rate is 46% and 30%. Almost 80% of the failures occur by the end of the second year. Local control is 95% for T1-T2, 73% for T3 and around 50% for T4 cases. Isolated node failure occurs in 2% and distant metastases in 30%.

[Conservative surgery after preoperative radiotherapy in the treatment of breast cancer. Indications and results]. / La chirurgie conservatrice après radiothérapie à doses préopératoires dans le traitement des cancers du sein. Indications et résultats.

From 1969 to 1983, 122 patients with unifocal breast cancer, equal or more than 3 centimeters in diameter, NON1a or N1b, were treated at the Institut Curie with conservative surgery after pre-operative external irradiation. Among them were 68% T2NON1a, and 26% N1b (with 21% T2N1b); 80% of the tumors were located in the upper part of the breast. Initial radiotherapy with a moderate dose (50 to 55 Gy for the breast and the lower axillary area) was followed 6 weeks later by a lumpectomy either alone (42 cases) or associated to an axillary node resection (80 cases). Five year survival rate with non evident disease T2NON1a cases is 79%, similar to the radical surgery rate in this group. We noted 8% local recurrences with no axillary recurrences. Post operative courses were a little more troubled than with initial lumpectomy. We noted 8% of upper limb oedema, only in patients who received both radiotherapy and surgery in the axilla. Cosmetic results are good in 65% of the cases, while they are good in 80% for initial lumpectomy. So this therapeutic method gives satisfactory results, but we need more cases with a longer follow-up to draw definitive conclusions.

[Treatment of epitheliomas of the parotid. Apropos of 93 cases treated at the Curie Institute]. / Traitement des épithéliomas de la parotide. A propos de 93 cas traités à l'Institut Curie.

From 1955 through 1982, a series of 93 cases of parotid gland carcinoma were treated at the Institut Curie: 55 primarily and 28 for recurrent tumors. Treatment modalities included surgery alone (n : 14), surgery followed by radiotherapy (n : 43), and radiotherapy alone (n : 36). The most advanced cases were mostly in the latter group. With a mean follow-up of 13 years, the actuarial loco-regional control is 67% (62/93) and the median survival 10 years. Ultimate loco-regional control was achieved in 86% of cases managed by surgery alone, 88% of cases managed by surgery and radiotherapy and 33% of cases managed by radiotherapy. In the latter group, control rate was 42% (8/19) in those primarily treated by radiotherapy. Prognosis was related to histology. Twenty patients (22%) presented distant metastasis. The potential advantages of neutron irradiation for parotid neoplasms is discussed.

[Cancer of the anal canal. Results of the treatment of a series of 195 cases]. / Cancer du canal anal. Résultats du traitement d'une série de 195 cas.

Between 1968 and 1982, 195 patients with invasive anal canal carcinoma were treated at Institut Curie (Paris, France). There were 168 females and 27 males --sex-ratio: 5.7/1, mean age: 67 +/- 11 yrs. (range: 38-85 yrs.). The initial size of the tumors was analyzed according to the circumferential invasion of the anal canal. The tumor involved 1/4 of the circumference in 49 cases, 1/2 of the circumference in 108 cases, 3/4 of the circumference in 22 cases and the whole circumference in 16 cases. Pathological examination revealed 20 cloacogenic carcinomas and 175 squamous carcinomas. All patients received radiotherapy as initial treatment and none received chemotherapy as a curative procedure. Eight patients received only palliative treatment. Twenty-seven patients were operated on because the response of the tumor to irradiation was partial or incomplete. One hundred and sixty patients received the full course of irradiation with a complete response. Among the latter, 100 patients were alive NED with a normal anal function with at least a 2-year follow-up. Local recurrences (n = 42) underwent salvage surgery in 50 p. 100 of the cases with a 3-year survival over 50 p. 100. Actuarial survival of the 195 patients was 68.5 p. 100 at 3 years and 58 p. 100 at 5 years. Survival was highly related to the initial size of the tumor and to the presence of positive inguinal nodes (p less than 0.0002). The histologic type was not related to the response to radiotherapy, nor to local recurrence or to survival.(ABSTRACT TRUNCATED AT 250 WORDS)

[Reconstruction surgery and repair using a musculocutaneous flap. Apropos of 124 cases]. / Chirurgie de rattrapage et réparation par lambeau myo-cutané. A propos de 124 cas.

Between 1981 and 1983, 116 patients (109 men and 7 women) underwent reconstructive surgery with musculocutaneous flaps following major surgical excision of a cervicofacial tumor recurring after curative radiotherapy. Mean age of patients was 54 years. The most frequently used flap (110/124) was from the pectoralis major. Advantages of the use of a musculocutaneous flap for repair appear to be: first intention healing in most cases; notable reduction in hospital stay; possibility of wider tumoral excision and also of combining lymph node excision, and improved functional results. Follow-up surveillance has been for a mean of only one year, too short a period for assessing carcinologic results.

[Value of the study of the kinetics of 85 strontium for the classification of osteogenic sarcomas ]. / Intérêt de l'étude cinétique au 85 Sr pour la classification des sarcomes ostéogènes.

Because of the polymorphism of osteogenic sarcomas, examination of a biopsy specimen, which is necessarily small, cannot give an accurate evaluation of the differentiation of the whole tumor. Therefore, a test which provides an overall assessment of the functional capacity of the tumor is needed. For the last ten years, we have been using 85 strontium, which has a metabolism similar to that of calcium and radioactive characteristics that allow external measurements. With this isotope, classification of osteogenic sarcomas is more accurate, ensuring better therapeutic trials.

[Preliminary results for a 434 MHz microwave hyperthermia applicator (author's transl)]. / Résultats préliminaires d'un applicateur d'ondes électromagnétiques à 434 MHz pour hyperthermie.

Laboratory tests on inert gel and gel of different compositions were conducted to determine the distribution of isothermal temperature zones. The repartition in depth and along a perpendicular plane to the applicator axis was studied as a function of different parameters: the skin cooling water temperature of the applicator, the incident microwave power, the application time, the gel composition and the antenna position. Experimental results were compared to theoretical values corresponding to a plane microwave penetrating into a tissue-equivalent medium. To take into account in vivo temperature regulation phenomena, the same measurements were made in vivo in pigs and humans and compared to in vitro results.

[Value of the cytologic diagnosis of adenopathies by aspiration biopsy. Cytohistologic comparison of 1756 cases]. / Valeur du diagnostic cytologique des adénopathies par ponction aspiration. Confrontation cyto-histologique de 1756 cas

The value of the cytologic diagnosis by aspiration needle biopsy is analysed in a series of 1756 adenopathies, verified by histological examination (1311 malignant nodes and 445 inflammatory or normal lymph nodes). The result is that a large number of lymph node tumours, either primary or secondary, are identified by the cytologic examination (from 77% to 91% of the cases according to the explored zone). Furthermore the virtually non existent percentage of false positive results (3% of the cases) proves the great accuracy of this method in the diagnosis of malignancy. In contrast, the diagnosis of benign nature must never be stated without biopsy (2% to 4% of the cases are erroneous by negative according to the explored zone). Indeed, even if benign cells are obtained, nothing allows to eliminate a malignant tumour or a limited inflammatory zone, not reached by the needle.

Laryngeal carcinomas.

This study is based upon 214 cases of laryngeal carcinoma treated at the Foundation Curie, Paris, France, from January, 1958, to 1968. The results in terms of five-year survival have been: (see article). A statistical study of these results was made by Professor Daudel and demonstrated the absence of significant difference for the groups of tumors classed T1 and in Stage I and II treated either by radiocobalt or by surgery, whether followed or not by radiotherapy. By contrast there was a clearly significant difference in favor of surgery for the group of tumors classified as T2, T3, T4, or in Stage III. This significant difference in favor of primary surgery disappeared if we excluded the patients who died of intercurrent illnesses or of a second cancer not involving the larynx, and when we took into account those cures obtained by surgery in the event of failure of radiation and inversely, of those cures having been obtained by radiation therapy in the event of failure of surgery.

[Cytological examination. Solid breast tumors examined by means of fine-needle puncture]. / Examen cytologique. Tumeurs solides du sein par ponction à l'aiguille fine

The value of cytological diagnosis of solid tumours of the breast where the cells were obtained by suction aspiration through a needle has been analysed in a consecutive series of 2,401 cases, all of which were checked by histological examination. They consisted of 1,745 malignant tumours and 656 benign tumours. The cytological diagnosis of malignancy was confirmed, almost always, error being practically non-existent (4 out of 1,000). This confirms that this simple and rapid test is very valuable in the diagnosis of mammary cancer. On the other hand, when the diagnosis of a benign tumour was made a certain number of cancers were missed (3.6 per cent). This is not therefore as valuable a test when the result is negative as when the result is positive. All the same, in certain cases it can suggest the diagnosis without giving the precise type of lesion, which can only be finally diagnosed histologically.