[Estimation of the probability of mediastinal involvement: a statistical definition of the clinical target volume for 3-dimensional conformal radiotherapy in non-small-cell lung cancer?]. / Estimation de la probabilité d'envahissement tumoral médiastinal: une définition statistique du volume-cible anatomoclinique pour la radiothérapie conformationnelle des cancers bronchiques non à petites cellules?

PURPOSE: Conformal irradiation of non-small cell lung carcinoma (NSCLC) is largely based on a precise definition of the nodal clinical target volume (CTVn). The reduction of the number of nodal stations to be irradiated would render tumor dose escalation more achievable. The aim of this work was to design an mathematical tool based on documented data, that would predict the risk of metastatic involvement for each nodal station. METHODS AND MATERIAL: From the large surgical series published in the literature we looked at the main pre-treatment parameters that modify the risk of nodal invasion. The probability of involvement for the 17 nodal stations described by the American Thoracic Society (ATS) was computed from all these publications and then weighted according to the French epidemiological data. Starting from the primitive location of the tumour as the main characteristic, we built a probabilistic tree for each nodal station representing the risk distribution as a function of each tumor feature. From the statistical point of view, we used the inversion of probability trees method described by Weinstein and Feinberg. RESULTS: Taking into account all the different parameters of the pre-treatment staging relative to each level of the ATS map brings up to 20,000 different combinations. The first chosen parameters in the tree were, depending on the tumour location, the histological classification, the metastatic stage, the nodal stage weighted in function of the sensitivity and specificity of the diagnostic examination used (PET scan, CAT scan) and the tumoral stage. A software is proposed to compute a predicted probability of involvement of each nodal station for any given clinical presentation. CONCLUSION: To better define the CTVn in NSCLC 3DRT, we propose a software that evaluates the mediastinal nodal involvement risk from easily accessible individual pre-treatment parameters.

[Benzodiazepines and pregnancy]. / Benzodiazépines et grossesse.

The use of benzodiazepines is not negligible in pregnant woman and self-medication is considerable. To investigate the effects on the fetus of benzodiazepines used during pregnancy, we reviewed animal and clinical studies completed with observations of CRPV (Centres Régionaux de Pharmacovigilance). Pooled results indicate that the risk of malformations associated with first-trimester exposure to benzodiazepines remains small. However, in a fetus exposed essentially to long-acting benzodiazepines on a long-term basis, neonatal hypotonicity, failure to feed and/or withdrawal syndrom could be observed.

[Detection of multivessel lesions after myocardial infarction. Improvement of the predictive value of early exercise stress test by discriminant analysis]. / Détection des lésions multitronculaires après infarctus du myocarde. Amélioration de la valeur prédictive de l'épreuve d'effort précoce à l'aide d'une analyse discriminante.

The aim of this study was to assess, by a discriminant analysis, the different parameters of exercise stress testing associated with multivessel disease after uncomplicated myocardial infarction and to determine whether their combination improved the diagnostic value of ST depression alone, the usual diagnostic criterion. One hundred and seventeen out of 240 consecutive pts admitted for acute myocardial infarction between october 1992 and may 1994 underwent early exercise stress testing and coronary angiography 8.5 +/- 3 days and 13 +/- 8 days respectively after infarction. The population was divided into two groups: a "study" group (pts recruited between october 1992 and october 1993) for whom a diagnostic equation had been established based on a discriminant analysis, and "a control" group (pts recruited between november 1993 and may 1994) allowing validation of the diagnostic equation. Of the 9 clinical and 14 exercise stress test variables, only 3 remained statistically significant after discriminant analysis in this study group: the number of METS achieved (p < 0.0005), maximal ST depression in V5 (p < 0.005) and maximal heart rate (p < 0.01). Using these three parameters, a discriminating equation was established in the study group and then validated in the control group. Using this equation, the percentage of pts correctly identified as having multivessel disease was 75% in the study group and 79% in the control group, whereas ST depression, the most commonly used criterion, only classified 68% of the study group and 60% of the control group correctly. This study confirmed the good tolerance of early maximal exercise stress testing after uncomplicated myo-cardial infarction. The combination of three easily discernable parameters improved the diagnostic performance of the stress test in identifying multivessel disease after myocardial infarction.

[Doppler echocardiography after anatomical repair of transposition of great vessels]. / Echocardiographie Doppler après réparation anatomique des transpositions des gros vaisseaux.

Forty seven patients who underwent anatomical repair of transposition of the great arteries were assessed by Doppler Echocardiography on average 16 months after surgery. Thirty three had transposition alone and 14 had an associated ventricular septal defect. Abnormal left ventricular function was observed in 4 patients (8%) and was associated with a preoperative left to right ventricular systolic pressure ratio less than that of patients with normal left ventricular function (0.76 +/- 0.22 vs 0.90 +/- 0.14 respectively, p = 0.10). Aortic regurgitation was detected in 19 children (40%). It was minimal in 18 cases and mild in the other case, in which a ventricular septal defect has been approached via the original pulmonary valves. Previous pulmonary banding before detransposition was a predisposing factor for postoperative aortic regurgitation. Thirteen patients had pulmonary pressure gradients of over 20 mmHg. The site of obstruction was usually the main pulmonary artery. The 3 cases in which the coronary orifices were closed with two patches instead of one had significant stenosis of the main pulmonary artery. Pulmonary regurgitation was detected in 38 patients (81%); it was minimal in 29 cases, mild in 5 cases and severe in 4 cases. Five patients (11%) had minimal mitral regurgitation and 16 (34%) tricuspid regurgitation. In the 22 cases who had serial echocardiographic evaluation with an average follow-up of 18 months, the postoperative abnormalities were characterised by their stability, with no significant progression of the regurgitant lesions. A reduction in pulmonary pressure gradient was observed in 5 patients and an increase in 1 patient (from 28 to 40 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

Non small cell lung carcinoma (NSCLC) at stage 3. A fourteen years retrospective study of 449 patients. Indications of surgery in a multidisciplinary management.

Through a fourteen years retrospective study of all the patients treated at the State University of Liège, we have focused on the survival of 449 patients with, at least, a clinical stage 3 NSCLC disease (NORMS UICC). The whole study was divided in two periods (1972-1978, period 1, and 1979-1985, period 2) because, everything remaining nearly equal as far as the clinical material was concerned, period 2 was characterized by a different therapeutic attitude. Since 1979, the NSCLC stage 3's surgical indications have been widely extended. We have performed surgical resections in patients with NSCLC N2 disease because of positive homolateral mediastinal lymph nodes or with T3 disease. This led the NSCLC stage 3 resection rate to move from 26% in period 1 to 47% in period 2. We report here the effects of such a management on the short and long term survival and the stage 3 NSCLC global prognosis. We noted a modest significant increase in the NSCLC stage 3 global prognosis with a five year survival of 4% and 6% (period 1 and 2 respectively; P = 0.03). The 172 resected patients' outcome did not change (five year survival 11% (P1) and 12% (P2]. Although patients were not randomized, our results suggest that adjuvant therapy should not be added whenever the patient underwent a complete resection. On the other hand, it seems very useful indeed whenever the resection was partial. NSCLC patient at stage 3 who underwent a complete resection achieved a 37% five years survival.

[Results of a policy of conservative treatment of breast cancer (146 cases)]. / Résultats d'une politique de traitement conservateur du cancer du sein (146 cas).

Tumorectomy and irradiation for small cancer of the breast. Tumorectomy followed by breast irradiation and a single course of chemotherapy is the most accurate treatment for small cancer of the breast. The 5 and 10 years survival are 92.5% and 85% respectively: this demonstrates the efficacy of the conservative treatment in the control of most of the small breast cancer provided a strict selection of the cases was done. Patients who develop local recurrence have the same life expectancy than the other cases when they are soon treated by mastectomy.

Quality of life of inoperable non-small cell lung carcinoma. A randomized phase II clinical study comparing radiotherapy alone and combined radio-chemotherapy.

Eighty one patients with inoperable non-small cell lung carcinoma (NSCLC) were entered in a randomized phase II trial comparing split-dose irradiation alone to combined treatment radiotherapy and polychemotherapy (C.A.P. + V.D.S.). The quality of life and the survival of the patients were studied. We have defined three classes of quality of life responses based on the time elapsed before the performance status index drops. A higher quality of life failure rate was observed in the combined treatment group (p non-significant) but the time elapsed before the Karnofsky index drops is longer in the combined treatment group for the quality of life "no change" subgroup (p = 0.15). Survival and quality adjusted survival are similar in both treatment groups. The same conclusion holds for retrospective stratified treatment groups. The results of the study are presented according to the decision tree theory. We conclude that as far as the quality of life is concerned, polychemotherapy combined with the particular split-dose irradiation schedule used is an effective treatment of inoperable NSCLC. Its efficiency is comparable to, but not better than, the same radiotherapy schedule alone taken as a reference baseline.

[Data bank experience on cancer patients in a radiotherapy department]. / Expérience d'informatisation du dossier du patient cancreux dans un service de radiothérapie

6 000 cancer patients records are presently computerized in the department of Radiotherapy of the University of Liége. This registry is closely similar to a hospital based cancer registry. The aims of the registry are: clinical use, descriptive epidemiology and end results. The set up and the use of the registry have underlined the necessity to clarify a certain number of concepts to permit coding; the running cost of such a record estimated in December 1973 is of about 400 Belgian francs.