[Definitions of target volumes in soft tissue sarcomas of the extremities]. / Définition des volumes-cibles dans les sarcomes des tissus mous des extrémités.

Soft tissue sarcomas of the extremities are currently treated with more conservative and functional approaches, combining surgery, radiotherapy and chemotherapy. The role of external beam radiotherapy and brachytherapy has been defined through randomised studies performed in the 80's and 90's. However, the ubiquity of tumour location for these tumours makes difficult a systematic definition of local treatments. Tumour volume definition is based on pre and post surgical imaging (MRI) and on described pathological report. The clinical target volume will take into account quality of the resection and anatomical barriers and will be based on an anatomy and not only on safety margins around the tumour bed. General rules for this irradiation (doses, volumes) and principal results will be presented.

[Unusual development of nonseminomatous germ cell tumors of the testis (NSGCT)]. / Evolution inhabituelle de tumeurs germinales non séminomateuses du testicule (TGNS).

The authors describe a clinical case of metastatic testicular non-seminomatous germinal tumor with several recurrences treated by the association of chemotherapy and surgery for remaining lesions. Based on this case a review of the literature is done to illustrate the evolution of treatments, to highlight the evolutive potential of mature teratoma, the delayed recurrences.

Type I insulin-like growth factor receptors in human colorectal cancer.

Type I insulin-like growth factor (IGF) receptors have been recently characterised in human colorectal cancers. The aim of this study was to determine whether type I IGF receptor concentration may be related to prognostic variables in colorectal cancers. Saturation experiments with [125I]IGF-I were performed on membrane preparations of 46 frozen specimens (20 tumours, 26 controls) and analysed according to the Scatchard method. In all the studied cases, we found a single class of high affinity binding sites in both normal and malignant colorectal tissues (median 0.17 and 0.15 nmol/l, respectively). Using paired analysis, we found no significant difference in terms of type I IGF receptor concentration between malignant and normal colorectal tissues. There was also no relationship between type I IGF receptors and any of the tumour characteristics studied. This study does not support a critical role of the type I IGF receptors in the clinical management of colorectal cancers.

Hepatic artery ligation with and without portal infusion of 5-FU. A randomized study in patients with unresectable liver metastases from colorectal carcinoma. The E.O.R.T.C. Gastrointestinal Cancer Cooperative Group (G.I. Group).

The aim of this multicentric prospective randomized clinical trial was to study the efficacy of hepatic artery ligation (HAL) with and without portal infusion (PI) of 5-FU in patients with liver metastasis of colorectal origin. Seventy-four patients were randomized. Sixty-seven were fully evaluable. Thirty-five patients were eligible in the HAL + PI of 5-FU group and 32 in the HAL alone group. The 5-FU infusion had to be discontinued for technical reasons in 13 patients. Complications of HAL were relatively high, including four hepatic failures (WHO grading greater than 2). Side effects of chemotherapy were limited. Five patients out of 30 had a partial response (WHO criteria) and one patient had a complete response in the group treated by HAL and PI of 5-FU. Only one patient had a partial response in the HAL alone group. Median survival for both groups was 12 months. Median time to progression for both groups was 6 months. This study did not show any advantage of delivery using the portal route in addition to hepatic artery ligation in terms of progression nor in survival of patients.

[Breast cancer: can axillary dissection be restricted to Berg stages 1 and 2? Study of 895 cases]. / Cancer du sein: peut-on se limiter aux étages 1 et 2 de Berg, lors du curage axillaire? Etude à propos de 895 cas.

895 axillary clearances were carried out in 3 years between 1986 and 1988 on 878 patients with primary breast cancer. Two procedures were used: either direct total axillary clearance (in stages 1, 2 and 3 of Berg) or inferior axillary clearance (stages 1 and 2 of Berg). This was carried out in association with frozen section diagnosis of the lymph node followed by clearance in Berg stage 3 if the diagnosis on frozen section was positive. The authors found a higher frequency of late complications, particularly of arm lymphoedema in patients who had complete axillary clearance than in patients who only had an inferior axillary clearance. The survival rate actuarilly calculated was not significantly different in the two groups of patients. The carrying out of total axillary clearance was "beneficial" for only 3 patients who had negative inferior axillary clearance and positive sub-clavicular clearance. Finally the frozen section diagnosis of the state of the axillary nodes shown to be correct (specificity -99% and sensitivity -76%) but it was difficult to carry out routinely.

[Surgery of pulmonary metastasis from malignant melanoma. Results and criteria of surgical excision]. / Chirurgie des métastases pulmonaires du mélanome malin. Résultats et critères d'opérabilité.

Lung metastases from malignant melanoma are frequent and they often inaugurate the metastatic stage. Exceptionally, they present as one or a few nodules, and in the absence of any other secondary lesion these cases raise the problem of surgical eradication. A retrospective multicentre study was carried out in a series of 38 patients and its results were compared to the data obtained from a review of 435 published cases in order to assess the value of surgery in terms of survival and to delimit its indications as closely as possible. Our series of 38 patients comprised 20 men and 18 women aged from 22 to 93 years (mean 51 years, median 55 years). The primary tumour was located in the trunk in 47 p. 100 of the cases; it was nodular in 33 p. 100 and superficial but extensive in 37.5 p. 100. The time elapsed before the metastases appeared varied from 0 to 108 months (median 40 months). Surgery had been radical in 70 p. 100 of the patients and usually limited, tumorectomies and segmentectomies accounting for 51 p. 100 of the operations. RESULTS. In this series the duration of survival varied between 2 and 144 months (mean 26 months, median close to 15 months), with a 20 p. 100 probability of survival at 5 years (fig. 1). Disease free survival varied from 0 to 144 months (mean 22.5 months, median 10.5 months) (fig. 2, curve 1). The parameters of response as regards patients, primary tumour, metastases and treatment were analysed. Response was uninfluenced by sex and slightly influenced by age, with a difference of borderline significance between subjects under and over 50. The primary tumour characteristics did not affect survival, and the features of metastases were of extremely varied importance. The number of operable metastases was not determinant. On the other hand, the presence of mediastinal lesions, either isolated or associated with lung lesions, worsened the prognosis of terms of survival and much more significantly so in terms of remission (fig. 3 and 4). The evaluation of evolutive characteristics, such as date of appearance and tumour doubling time, was inconclusive. Survival was of the same duration after wide and limited surgery, so that tumorectomy or segmentectomy should preferably be performed. The results of surgical treatment were determinant, with a highly significant difference in survival between radical and incomplete surgery (fig. 5 and fig. 2, curve 2). DISCUSSION. The median survival of patients operated upon for lung metastases is diversely evaluated in the literature as 8 to 29 months (table V), the mean figure of 16 months being virtually the same as that of our series. In this, as in most of the previously published series, the maximum duration of survival was beyond 8 to 10 years. The mean survival rate at 5 years is very close to the one we have recorded (20 p. 100) (table V). Compared with other treatments of lung metastases, surgery may be considered as capable of prolonging survival by 6 months; this is not much unless we add the possibility of a 5-year survival in 1 out of 5 operated patients and the possibility of a survival exceeding 8 or 10 years in 2 to 5 p. 100 of the cases. Some prognostic factors seem to constitute positive or negative criteria of operability. This is the case with mediastinal lesions which may consist of a metastasis of metastasis or of a lymph node invasion associated or not with the lung lesion, but in any case correspond to the involvement of more than one site. Mediastinal lesions must be systematically looked for and treated as contraindications of surgery, as shown by the differences in survival recorded in our series. Opinions differ as regards the value of evolutive parameters of the metastasis. For some authors, a more than 5 years interval before the metastasis appears is associated with a good chance of prolonged survival, whereas a less than 6 months or 1 year interval reflects a steadily high progressiveness and in practice precludes surgery. The value of the

[Non-Hodgkin's malignant lymphoma with primary gastro-intestinal localisation. Therapeutic aspects]. / Lymphomes malins non hodgkiniens à localisation primitive gastro-intestinale. Aspects thérapeutiques.

A retrospective analysis of 38 patients with primary gastrointestinal non Hodgkin's lymphoma (PGINHL) referred to "Center Oscar Lambret, Lille, France", from January 1964 to December 1986 has been carried out. Kiel classification and the working formulation for clinical usage were used for histologic diagnosis and Ann Arbor classification modified by Musshoff for clinical staging. The patients, 29 males and 9 females, ranged in age from 7 to 71 years with a mean of 45.5 years for men and 45.1 years for women. Seventeen patients were classified as presenting with low-grade malignancy lymphomas and 21 as high-grade malignancy lymphomas. Nineteen patients presented with early clinical forms and 19 with advanced ones. Laparotomy was performed on all patients but one. Treatment modalities included: surgical resection, chemotherapy and radiotherapy in various combinations. There were 21 patients with recurrence, 6 of them responding to retreatment. The complete population survival curve reached a plateau at 48% after a 41-month follow-up. Five-year survival was 16% for early clinical forms and 80% for advanced ones (P less than 0.001) and 24% for high-grade malignancy lymphomas versus 75% for low-grade malignancy lymphomas (P less than 0.01). Moreover, the 5-year survival rate was 82% for patients with complete surgical resection of primary lesions versus 16% for those with incomplete resections (P less than 0.001). Laparotomy seems to play a major role in diagnostic accuracy, although the role of surgery in therapeutic management remains controversial. However our findings show that surgical resection is important to achieve local control of PGINHL. According to our results the only prognostic determinant that keeps its prognostic value is the extent of surgical resection (complete or incomplete) (P less than 0.05).

[Ulcerated cancers of the breast: results of modified mastectomy. Apropos of 64 cases]. / Les cancers ulcérés du sein: résultats des mastectomies de propreté. A propos de 64 observations.

Although, happily, at the present time the actual tendency in mammary neoplastic disease is being increasingly orientated towards conservative treatment, a fairly large number of total mastectomies are still being performed in patients diagnosed at a late stage. The frequency, technical aspects and precise local and general prognosis of this affection are discussed in relation to 63 breast cancers treated surgically between 1975 and 1984. These so-called "trimming" mastectomies represent 4.22% of overall total mastectomies performed during the same period. The surgical technic employed was the Patey type total mastectomy with either primary suturing after-wide separation of borders or closure with a thoraco-epigastric fasciocutaneous flap with internal pedicle. Actuarial survival was satisfactory: 58% at 2 years, 34% at 5 years, survival being significantly better in patients with lack of glandular invasion. This surgical technic should be considered, in combination with other therapy, for these patients, who should not be classed as "unrecoverable".

[Cervical adenopathies of unknown primary site. Apropos of 190 cases]. / Les adénopathies cervicales sans porte d'entrée. A propos de 190 cas.

From 1974 to 1983 a total of 190 patients with metastatic cervical adenopathy from an undetected epidermoid cancer were treated, this group representing 3% of total cervicofacial tumors seen. In half the cases the lymph node had evolved over more than 3 months and measured 6 cm or more. Prognosis was poor (27% survival at 3 years and 19% at 5 years). The presumed primary tumor was detected in 16% of cases and 27% of patients developed distant metastases, whereas the 86 patients treated by neck dissection and irradiation showed cervical evolution in only 23% of cases. The therapy proposed includes total radical neck dissection followed by pharyngeal and bilateral cervical irradiation, the value of chemotherapy remaining to be determined during controlled trials.

In vivo sustained release of cisplatin from bioresorbable implants in mice.

Two kinds of cisplatin-containing implants were prepared from polylactic acid (type I) and from lactic acid-glycolic acid copolymer (type II). Type I implants were almost unaffected when inserted in the renal parenchyma of mice. In contrast, type II implants evolved clearly after in vivo implantation. X-ray pictures and platinum concentration measurements showed a continuous release of platinum over at least three weeks. The release resulted in high platinum concentrations in the kidney tissues and low plasma concentrations, compared to systemic injection. Type II implants seem adequate for further clinical trials of local treatment by cisplatin.

Uptake enhancement of platinum in the dog kidney by microencapsulation of cisplatin and local injection.

Microcapsules containing cisplatin were administered into the renal artery of mongrel dogs. Significant increase of the platinum tissue concentration in the kidney was observed 17 days after administration compared to injection of cisplatin only. The highest drug tissue levels were obtained when the renal artery was ligated after microcapsule injection. In addition the decrease in plasma levels indicated that microencapsulation causes, at least, a 100-fold enhancement of the ratio: exposure of infused tissue to the drug over total body exposure. On the contrary, no major change in drug urine excretion could be related to microencapsulation.

Vascular access for intravenous chemotherapy: totally implanted systems.

This is a prospective study conducted in order to evaluate totally implanted venous access systems. The report concerning 42 patients is presented. The follow-up is 5 to 17 months (median 9 months). A variety of antineoplastic agents were administered through the device. Complications rarely occur and after utilization all patients are still treated in this way. Physician-, nurse- and patient-acceptance were excellent and this system appears to improve the quality of life style of cancer patients.

Preparation and release kinetics of microencapsulated cisplatin with ethylcellulose.

Several kinds of microcapsules containing cisplatin were prepared by the ethylcellulose coacervation process in an attempt to administer cisplatin with chemoembolization. Microcapsules made either with mechanical stirring or with sonication showed similar properties; the chemical structure of cisplatin was not affected by the micro-encapsulation process. The release kinetics of cisplatin from ethylcellulose-walled microcapsules followed different patterns, according to the wall thickness. In each case, the release kinetics did not depend on the stirring rate of the surrounding medium. Only microcapsules with a cisplatin release ratio from 80 to 100% within 24 h were selected for later clinical use.