[Efficacy of the combination of mitomycin, ifosfamide and cisplatin with irradiation for the treatment of cerebral metastasis in non small cell lung carcinoma]. / Efficacité de l'association mitomycine, ifosfamide, cisplatine avec irradiation pour le traitement des métastases cérébrales des cancers bronchiques non à petites cellules.

We initiated prospective study testing efficacy of multidrug chemotherapy (cisplatin, ifosfamide, mitomycin) with irradiation in brain metastases of non small cell lung cancer at first diagnosis. Among 22 patients we obtained ten objective local responses (45%). Median survival was 7 months. Toxicity was mild (> 2 - OMS): hematologic = five patients; gastrointestinal = one patient. Among 11 patients who received chemotherapy before radiotherapy we had seven objective responses (patients evaluated after three courses of chemotherapy and before radiotherapy). This result indicates the interest of this protocol of chemotherapy in brain metastases. The association of this protocol of chemotherapy and radiotherapy appears effective, well tolerated and few toxic.

[Primary granulocytic sarcoma of the pancreas: efficacy of early treatment with intensive chemotherapy]. / Sarcome granulocytique primitif du pancréas: efficacité d'un traitement précoce par chimiothérapie intensive.

In the absence of systemic chemotherapy after the diagnosis of primary granulocytic sarcoma (PGS), all patients will subsequently develop acute myelogenous leukemia (AML). The authors describe a case of PGS of the head of the pancreas found at laparotomy in a 32-year-old man. The patient received early after surgery, two courses of high-dose chemotherapy and, with a follow-up of 2 years, never developed AML. This rare observation illustrates the necessity of further early systemic chemotherapy after surgical excision of PGS.

Docetaxel plus 5-fluorouracil in locally recurrent and/or metastatic squamous cell carcinoma of the head and neck: a phase II multicenter study.

This phase II study evaluated docetaxel-5-fluorouracil (5-FU) in locally recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN). Patients were divided into 2 cohorts--those previously treated with chemotherapy and those nonpretreated--that received docetaxel 75 mg/m2 (day 1) plus 5-FU 1,000 mg/m2/day (days 1-5 every 3 weeks). Of 63 patients entered, 20 (31.7%) were pretreated and 43 (68.3%) were nonpretreated. Fifty-nine patients (93.7%) had received prior radiotherapy. After inclusion of 20 patients, the 5-FU dose was reduced to 750 mg/m2/day due to unacceptable toxicity. The overall response rate (ORR) was 20.6% on radiologic review (22.2%, investigator assessment). Pretreated patients achieved an ORR of 25.0% versus 18.6% for nonpretreated patients. This unexpected finding was partly attributed to differences in patient characteristics between the groups. Overall major grade 3 to 4 toxicities comprised neutropenia (66.6%), febrile neutropenia (31.7%), and mucositis (31.7%). Grade 3 to 4 toxicities were lower at the reduced 5-FU dose (750 mg/m2/day): Febrile neutropenia declined from 40.0% to 27.9%; mucositis declined from 55.0% to 20.9%. Three treatment-related deaths occurred (2 with 5-FU 750 mg/m2/day, 1 with 5-FU 1,000 mg/m2/day). Docetaxel-5-FU appears active in locally recurrent and/or metastatic SCCHN with acceptable toxicity at the dose of 5-FU 750 mg/m2.

Correlative imaging study in the diagnosis of ovarian cancer recurrences. The INSERM Research Network (Nantes, Rennes, Reims, Villejuif, Saclay), France.

A correlative imaging study was carried out in 61 female patients previously treated for ovarian carcinoma. Upon suspicion of recurrence, abdominopelvic immunoscintigraphy (IS) using F(ab')2 fragments of indium-111-labelled OC 125 monoclonal antibody was performed in all patients, Ultrasonography (US) and computed tomography (CT) were performed 53 and 37 times, respectively. The diagnostic accuracy of the different imaging techniques was studied per site (abdomen and pelvis) and per patient. The diagnostic accuracy of planar scintigraphy (PS) was slightly lower than that of emission computed tomography (ECT): 66% vs 73% for abdomen, 65% vs 72% for pelvis, and 78% vs 84% in analysis per patient. The accuracy of IS (PS and ECT combined) was markedly better than that of US and CT for abdomen (IS = 73%; US = 30%; CT = 47%), pelvis (IS = 73%; US = 37%; CT = 52%) and analysis per patient (IS = 85%; US = 43%; CT = 59%). The results of IS and morphological imaging techniques (MIT: US and/or CT) were correlatively analysed with the frequency of recurrence. When IS and MIT were both negative, the frequency of non-recurrence was 14/23 for abdomen, 7/12 for pelvis and 8/13 in analysis per patient. On the other hand, when both IS and MIT were positive, the frequency of recurrence was high (9/9 for abdomen, 17/21 for pelvis and 24/26 for analysis per patient). It was also found that a positive IS associated with a negative MIT was still highly suggestive of recurrence (17/21 for abdomen, 16/22 for pelvis and 17/19 for analysis per patient).(ABSTRACT TRUNCATED AT 250 WORDS)

Usefulness of imaging ovarian cancer recurrence with In-111-labeled monoclonal antibody (OC 125) specific for CA 125 antigen. The INSERM Research Network (Nantes, Rennes, Reims, Vuillejuif, Saclay.

BACKGROUND: A progressive rise in serum CA 125 concentration during follow-up monitoring of ovarian cancer after treatment of primary tumor is suggestive of a recurrence. PATIENTS AND METHODS: A study was carried out in 19 patients with suspected recurrence of a previously treated ovarian carcinoma. All patients underwent ultrasonography (US), computed tomography (CT) and immunoscintigraphy (IS) using F(ab')2 fragments of indium-111-labeled OC 125 monoclonal antibody (specific for CA 125 antigen). The definitive diagnosis of recurrence was made on the basis of histological data obtained at surgery. RESULTS: In all 15 of the patients with recurrence, all three of the imaging methods had false negative results once. In 7 patients, only the IS method had positive results; six of these 7 benefited from a macroscopically total resection of the recurrence. IS was positive and concordant with US and/or CT in 7 further patients. Two of them benefited from a total resection of their recurrence. The usefulness of IS was more evident when serum CA 125 concentration was below 500 U/ml. The absence of recurrence was correctly indicated by IS and CT in 1 case and by IS associated with negative US and CT in 2 other cases. IS and CT were falsely positive in 1 case. CONCLUSION: Thus, immunoscintigraphy would appear to be an efficient method for detecting a recurrence early when limited involvement can make it possible for the surgeon to achieve total resection.