[Immune competence before and after curative radiotherapy in breast cancer (author's transl)]. / Bilan immunitaire avant et après radiothérapie curative de malades porteuses de cancer du sein.

The level of non-specific immune response was evaluated in 409 operable breast cancer patients by a battery of classical tests performed at least before and after treatment. We propose a synthetic classification of the various tests into 5 categories (from I 1 to I 5) of growing pejorative weight for a rapid and better understanding between the laboratory and the clinicians and also for overall comparison in time. With this type of evaluation the percentage of patients exhibiting depressed immune response was 14 per cent initially and rose to 39 per cent at the end of irradiation. Six months later, however, only 3 per cent of the patients had an immune assessment lower than the initial level. The pronounced immune depression observed by other authors concerned mainly patients having undergone post-operative irradiation after removal of the breast. The curative treatments used here in the hope of avoiding radical breast surgery was performed under much different ballistic, biological and psychological conditions which should be taken into account before condemning the dangers of this method.

[Yield of the thoracoscopic biopsy in experimental pulmonary infections in the immunosuppressed rabbit]. / Rendement de la biopsie thoracoscopique dans les infections pulmonaires expérimentales chez le lapin immunodéprimé.

Using thoracoscopy lung biopsy we investigated the bacteriological diagnostic yield in immunodepressed and/or infected NZ rabbits. 84 rabbits were used: 18 controls, 30 immunodepressed rabbits and 36 rabbits immunodepressed and then infected with Aspergillus fumigatus. Candida albicans or B.C.G. The thoracoscopy technique was the one we designed for humans, the instruments were adapted to the size of animals. Thoracoscopy biopsy results were compared to those of surgical biopsies made in the same animals. The results of both techniques were similar: indeed, the sensitivity of thoracoscopy biopsy was 88.9% in immunodepressed rabbits (versus 100% with surgical biopsies), 86% in the group of rabbits infected with B.C.G. (versus 86%), 90.1% in rabbits infected with Aspergillus fumigatus (versus 100%) and 88.9% in rabbits infected with Candida albicans (versus 100%). The indications for thoracoscopic lung biopsy in immunodepressed patients with infectious lung diseases are drawn from these experimental data, from our experience and the known mortality and morbidity of surgical lung biopsy.

[Prolonged survival in multiple myeloma. Characteristics of presentation and response to treatment of 73 patients who survived 5 years or longer]. / Survie prolongée au cours du myélome multiple. Caractéristiques de présentation et de réponse au traitement de 73 malades ayant vécu 5 ans ou plus.

Data concerning the presentation and response to treatment of 73 patients with multiple myeloma who survived for 5 years or more were reviewed. At the time of diagnosis, the proportion of patients with hypercalcaemia (4%), severe anaemia (9%), renal failure (10%) or high beta 2-microglobulin levels (25%) was low. Less than one-third of our patients belonged to a "high risk" group, as defined by the three classification systems adopted: the lowest percentage of such patients (18%) was observed with the Medical Research Council classification. In all patients, but even more in those with an initially aggressive disease (P less than 0.05), obtaining a plateau (70% of the cases) or even an optimal tumoral regression with complete disappearance of monoclonal immunoglobulin (26% of the cases) seems to be a highly favourable factor. The same applies, though to a lesser degree, to slow response to chemotherapy (18 months on average). In all responders whether the remission was maintained or not by chemotherapy seemed to have no influence on the frequency (70%) and delay of relapses (4 1/2 years on average from the time of diagnosis). The risk of secondary blood disease (2 AML 1, 1 AML4, 1 RAEB, 1 ASIA, four of which were directly responsible for death) after 4 years on average of chemotherapy must be taken into consideration.

[Assessment of activity in bone tumours by telethermography (author's transl)]. / Surveillance téléthermographique des tumeurs osseuses irradiées.

The assessment of activity in bone tumours after irradiation is somewhat uncertain. In most cases, the process of healing cannot be assessed. The authors propose the use of tele-thermography, which was used 14 patients. In 8 cases, amputation was performed when tele-thermography showed persistent activity. In all cases, secondary microscopic examination of the amputated limb showed remaining active tumour in spite of negative radiological appearances. In 6 cases, in which tele-thermography was negative, the limb was not amputated with no recurrence up to the present time. The follow up study has varied from 15 months to 5 years. The authors consider that this technique is of great value in the assessment of the activity of irradiated sarcomata.

[Concomitant radiotherapy-chemotherapy for unresectable cancers of the head and neck: a retrospective analysis of 130 patients]. / Radiothérapie-chimiothérapie concomitante des cancers non opérables de la tête et du cou. Etude rétrospective sur 130 patients.

OBJECTIVES: We analyzed retrospectively the files of 130 patients with unresectable cancer of the head and neck who were given concomitant radiotherapy-chemotherapy between January 1993 and February 2000. PATIENTS AND METHODS: The series included 41 patients with grade III cancer, 64 grade IVA, and 25 grade IVB. Treatment combined radiotherapy (70.2 Gy centered on the tumor with 50.4 Gy on the lymph nodes) and chemotherapy using three cycles of cisplatinium combined with 5-fluorouracil in continuous infusion for 120 hr. RESULTS: Local control was achieved in 51% of the patients at two years and 48% at five years. Overall survival was 45% at two years and 33% at five years, all grades included. CONCLUSION: Univariate analysis of prognostic factors points out the importance of the nutritional status before and during treatment.

Population pharmacokinetics of cisplatin after 120-h infusion: application to routine adaptive control with feedback.

OBJECTIVE: A Bayesian population pharmacokinetics study of data from routine therapeutic drug monitoring cisplatin during a 5-day infusion of cisplatin. METHODS: A total of 95 kinetics data sets (58 patients) were available to perform this study. Individual pharmacokinetic parameters, estimated from 20 courses of treatment in 18 patients, were used to calculate the population parameters (cl: 0.175 +/- 0.034 L/h; t(1/2): 327 +/- 91 h). The accuracy of Bayesian forecasting was tested by comparing in 40 other patients the clearance values calculated either from a complete kinetics profile (eight sampling times) or from three early samples and the new population parameters. Finally, drug monitoring efficacy was assessed by comparing the target Cmax values with the Cmax obtained after dose adjustment based upon early Bayesian estimation of the individual pharmacokinetic parameters. RESULTS: : No significant difference was found between Bayesian and experimental clearances. Besides, dose-individualization proved to successfully adjust Cmax values around their respective target. CONCLUSION: The new reference pharmacokinetic population parameters lead to accurate estimation of individual pharmacokinetic parameters from a limited number of samples, thus allowing efficient therapeutic drug monitoring during 5-day infusion regimens of cisplatin.