Treatment of carcinoma of the penis by iridium 192 wire implant.

Since 1971, a group of 22 adult patients with squamous cell carcinoma of the penis have been treated by iridium 192 wires implant. There were 6 T1 tumors, 14 T2 tumors and 2 T3; only one patient (T3) presented with local failure after implant. Local necrosis occurred in 2 patients without local tumoral recurrence, but was sufficient enough to warrant amputation. Thus 19/22 (86%) patients were locally cured with penile conservation. In these patients the most frequent post-therapeutic complication is chronic urethral stenosis (9/19 patients, 47%) requiring repeated instrumental dilations. Four patients presented with initial inguinal metastatic nodes; only one was cured by radiosurgical treatment. Among patients without metastatic nodes at the time of diagnosis, none had delayed metastatic nodes. Three patients died of nodal evolution, 5 patients died of intercurrent disease without evidence of disease and 14 are now alive and NED. It appears that iridium 192 wires implant is the most effective conservative treatment of invasive squamous cell carcinoma of the penis; however, these results confirm that no particular treatment is required for inguinal nodal areas for patients who initially present with no disease.

Iridium-192 interstitial therapy for squamous cell carcinoma of the penis.

From February 1971 through February 1989, 51 patients with biopsy proven epidermoid carcinoma of the penis were treated with interstitial therapy (Iridium 192). The breakdown according to the stage was T1s = 3, T1 = 14, T2 = 28, T3 = 6, N0 = 43, N1 = 7, N2 = 1. The dose ranged from 50 to 65 Gy (mean: 60 Gy). Patients without clinical nodal involvement received no treatment to the nodes. Stage N1 and N2 patients had surgery and external irradiation to the inguinal and iliac nodes. Six of fifty-one (12%) patients developed nodal and/or metastatic disease following therapy. Five of six presented initially with clinical nodal involvement. Seven of fifty-one (14%) developed local recurrence only, requiring surgery (four partial penectomies, three total penectomies). Six of these seven patients are alive and free of disease with a mean follow-up of 5.5 years. Nine of thirty eight (23%) patients with local control developed local necrosis. The treatment consisted of local excision (one patient), partial amputation (six patients) or total amputation (two patients). Partial urethral stenosis was noted in 17/38 (45%) of the patients. Foreskin sclerosis occurred in 3/38 (8%) uncircumcised patients. Interstitial irradiation for penile carcinoma provided effective local control rates, especially for T1-T2 patients (91%). Local failures could be treated successfully with surgery. Complications could be treated conservatively in most patients. Local control with penile conservation was achieved in 67% of all patients and 75% of patients with T1-T2 disease.

Interstitial iridium-192 for bladder cancer (a multicentric survey: 205 patients).

Interstitial irradiation is a technique currently used in the treatment of bladder cancer. We report the data on 205 patients (177 men and 28 women) treated in eight French centers. The patients had received the following treatment: a short course of pre-operative pelvic irradiation, followed by surgery consisting of partial cystectomy or tumor resection, and implantation of plastic tubes filled with inactive lead wires, which were replaced by iridium 192 wires. The tumor characteristics were: transitional cell carcinoma, 88.8%; mean size of the tumor, 29 mm; pathological stages: pTis, 1; pT1, 98; pT2, 66; pT3a, 26; pT3b, 9; pT4, 1; unknown, 4 respectively; surgical lymph node status: N+, 3; N-, 118; no node dissection, 84. The mean follow-up was 51 months. Intravesical failures were seen in 35 patients (17.0%), 25 (71.4%) of them without metastases or regional recurrences. Twenty-one patients (10.2%) presented distant metastases, 2/3 of them suffered no bladder relapse. The 5-year survival, calculated according to the Kaplan-Meier method (all causes of death taken together) was 77.4% for the T1, 62.9% for the T2, and 46.8% for the T3. Fifty-three patients had immediate side-effects and three died from surgical complications. Twenty-nine patients had delayed bladder side-effects (haematuria, fistula, chronic cystitis). Six patients presented an ureteral stenosis. Of the disease-free survivors, 96.1% retained the bladder function. Three factors were significantly predictive of delayed side-effects: partial cystectomy, pre-operative radiotherapy total dose, and linear activity of the wires (p < 0.01). Comparing our results to different authors' series interstitial irradiation is likely to provide a high local and general control of the disease and good quality of life in patients with selected tumors.

Prostate cancer treated by radiotherapy: a multivariate study.

According to respective proportions of evolutive status groups, results of multivariate studies are difficult to interpret. Among the 1099 cases of local form of prostate cancer, treated by radiotherapy from 1975 to 1982 in 16 French Anticancer Institutes, we can observe two homogeneous status groups of patients: disease-free survivors (285 cases) and patients who died of prostate cancer (278 cases). These correspond to 51% of the whole population. Among other things, they are comparable in size, for age at the beginning of radiotherapy and for delay between histologic diagnostic and radiotherapy. We chose to analyse them using multivariate analysis. To take survival into account, we used a Cox model and Kaplan-Meier curves; the group deceased of prostate cancer was further analyzed by a tree-structured regression method. The Cox model and the Kaplan-Meier curves confirmed two main explicative factors: Stage (p < 0.0001) and tumor grade (p < 0.001). Poorer evolution occurs in extracapsular forms and grade I has better survival than others. The tree-structured regression method indicates two other pejorative factors: hormonotherapy prior to radiotherapy and the presence of cardiovascular pathology. Though the pelvic dose does not appear to be a main explicative factor, it seems to improve survival and delay between radiotherapy and recurrence or metastasis in some categories of cases. Other factors such as tumor dose, age and delay between diagnosis and radiotherapy were not found to be significant. These results cannot be extended to the whole population for which they do not constitute a predictive study. We consider them as "baseline data".(ABSTRACT TRUNCATED AT 250 WORDS)

A randomized double-blind study evaluating Anandron associated with orchiectomy in stage D prostate cancer.

A randomized double-blind study with a 3-yr follow-up comparing the two arms "orchiectomy + Anandron (300 mg)" vs "orchiectomy + placebo" in 125 patients with stage D prostate cancer has confirmed the beneficial effects of the combined Anandron therapy on subjective parameters and on the best objective response (NPCP criteria), although these effects were not statistically significant, but failed to detect any improvement in time-to-disease progression or survival. Comparison with the results of other trials emphasizes the urgent need to establish suitable prognostic factors by further clinical research before evaluating the benefits of individual drugs.

[Prognostic value of prostatic acid phosphatase in stage B and C prostatic cancer. Apropos of 84 cases]. / Intérêt pronostique de la phosphatase acide prostatique dans les cancers de la prostate de stades B et C. A propos de 84 cas.

The authors have studied the prognostic interest of evaluating the prostatic acid phosphatase level before any treatment in 84 cases of stage B and C prostatic cancer. An abnormal PAP level did not significantly modify the 5-year life expectancy of patients, but was significantly correlated with a shorter period of disease-free survival. An abnormal PAP level increased the risk of recurrence; the higher the PAP level, the shorter the disease-free interval was. The disease stage (i.e., B or C) did not modify the 5-year survival period or the length of the remission. The prognosis is worse for a stage B prostatic cancer with a pathological PAP level than for a stage C cancer with a normal PAP level. A pathological PAP level seems to indicate the presence of occult metastases and should incite the clinician to actively investigate the matter.

[Postoperative external irradiation of epidermoid epitheliomas of the larynx and hypopharynx. Analysis of tumor control factors in and outside of the neck]. / Irradiation externe postopératoire des épithéliomas épidermoöides du larynx et de l'hypopharynx. Analyse de facteurs du contrôle tumoral dans et hors du cou.

The authors present a retrospective analysis of 138 patients with squamous cell carcinoma of the hypopharynx and larynx treated with post-operative irradiation. Overall tumoral control rate within the treated areas was 73.9%, uncorrected actuarial survival rates at 3 years and at 5 years were respectively 49.4 and 37.6%. The clinical status (TNM-UICC, 4th edition, 1987) seems to be the main determinant for the prognosis in terms of cervical tumoral control. Patients with N0-N1 nodal stage presented 14/88 (15.9%) cervical failures, while patients staged as N2-N3 presented 22/50 (44%) tumoral recurrences within the treated areas (P less than 0.001). Pyriform sinus tumors were found to present cervical relapses in 13/32 cases (40.6%). This recurrence rate was significantly higher than cervical failure risk in other tumoral sites (P less than 0.05). Cervical relapse (P less than 0.0001), N2-N3 nodal stage and pyriform sinus localization (P less than 0.05) were all found to increase metastasis rate. On the other hand, our results show that the use of post-operative irradiation reduces the prognostic influence of the primary tumor volume; in the same manner, the use of modulated post-operative external irradiation permits the control of microscopically positive surgical margins. In conclusion, the initial staging alone is sufficient to safely evaluate the risk of cervical relapse or metastatic spread; the use of these clinical parameters for selecting patients who could benefit from adjunctive chemotherapy is discussed.

[Cancer of the prostate: results of radiotherapy. Multicenter study]. / Cancer de la prostate: résultats de la radiothérapie. Etude intercentres.

From 1975 to 1982, 597 patients with localized prostatic adenocarcinoma were treated using external beam irradiation in one of 6 cooperating centers. The mean patient age was 67 years. The 5 and 10 years actuarial survivals (including all causes of death) were 70% and 40% respectively. The adjusted survival rates become 86% at 5 years and 61% at 10 years when only death due to cancer is taken into consideration. Despite the fact that patients with stage A1 and A2 disease show different patterns of lymphatic spread, the actuarial and adjusted 8 years survivals were identical for both staging groups, in this study, 57% and 90%, respectively. It is significant that the majority of patients in both group A1 and in group A2 received irradiation to the pelvic lymph nodes as well as the prostate. Patients with stage B1 disease showed a 7 years actuarial survival of 53% and an 82% survival adjusted for death due to cancer only. Patients in both group B2 and group C, showed an identical 10 year actuarial survival rate of 49%. However, without CT scanning, it is difficult to differentiate between these 2 staging groups. Patients with stage C2 disease showed 10 years actuarial and adjusted survival rates of 20% and 40% respectively. The local recurrence rate after primary radiation therapy did not exceed 11% in any patient group. These data demonstrate, once again, that the dogma pertaining to the radioresistance of prostatic cancer is outdated.

[Cancer of the prostate: intolerability and morbidity of external radiotherapy]. / Cancer de la prostate: intolérance et morbidité de la radiothérapie externe.

The pertherapeutic intolerance and morbidity are analyzed in a group of 597 patients with localized prostatic carcinoma treated by definitive radiotherapy between 1975 and 1982. Minimum follow-up is 2 years, median is 46 months. The results are compared to following parameters: associated diseases, associated surgical treatments, doses and irradiated target volumes. Pertherapeutic intolerance manifestations were found in 73% of patients and lead to complications. Urinary incontinence and chronic cystitis were more frequent after transurethral resection or prostatic surgery. Proctitis was the most disabling and can be reduced by a better estimation of prostatic target volume and by split course irradiation. Chronic diarrhea was more frequent when using large target volume. Leg edema was closely associated with pelvic lymphadenectomy. The control of pertherapeutic manifestations and the prevention of complications should improve survival in patients treated by external radiotherapy.

[Cervical lymph nodes metastasis from an unknown primary: diagnosis, treatment and prognosis. A retrospective study of 127 cases observed from 1959 to 1973 (author's transl)]. / Adénopathies cervicales sans primitif connu. Diagnostic, traitement et pronostic. A propos d'une série de 127 malades suivis au Centre Claudius-Regaud de 1959 à 1973.

Authors present clinical records of 127 patients bearing metastatic cervical lymph nodes of unknown origin and referred to the Cl. Regaud Cancer Center between 1959 and 1973. According the prognosis, it is possible to distinguish patients into three groups. In group I, patients (10%) have a lower neck involvement by an adenocarcinoma. The survival is dramatically bad. Group II includes also 10% of patients who have a fairly better prognosis, they are younger people bearing poorly differenciated squamous metastatic lymphonode(s) in the upper neck. Group III. The remaining eighty per cent of patients are heavy drinkers and smokers. Their upper neck is hurt by lymphatic metastases from a well or moderately differenciated squamous cell carcinoma. They have much about the same prognosis than people bearing a known primary carcinoma of the upper aerodigestive tract. After having excluded the first group of patients who is at high risk of having a widely disseminated illness, we can remark that about one half of relapses occurred in the cervical area. A well planned combination of neck dissection and whole cervical lymphatic areas irradiation may further reduce such recurrences and so may enhance the present results: 23% survival 3 years after completion of treatment.

[Epidermoid carcinoma of paranasal sinuses. 61 cases treated at the Claudius-Reguad Center from 1961 to 1976 (author's transl)]. / Epithéliomas épidermoïdes du sinus maxillaire. A propos de 61 malades traités au Centre Claudius-Regaud, de 1961 à 1976.

Authors present a critical review of 61 cases of squamous carcinoma of paranasal sinuses. Most of these cases were diagnosed at an advanced stage, allowing only external radiotherapy to be proposed. The mean delivred dose was 6,000 to 6,500 rads, mainly to telecobaltherapy. Survival rates are poor (SVI = 50%, SV3 = 14%, SV5 = 8%) in the same range than values previously published by others. However, it seems possible to point out some practical trends in order to improve the management of the disease:--in all cases, irradiated volumes must be large;--prophylactic irradiation of cervical nodes in also a key point, especially when tumor reaches the oral cavity, the skin or the pterygomaxillary fossa.

[Cancer of the prostate: curative radiotherapy preceded by lymphadenectomy in 20 patients. Follow-up over 10 years]. / Cancer de la prostate: radiothérapie à visée curatrice précédée d'une lymphadénectomie chez vingt patients. Recul supérieur à dix ans.

Twenty patients with prostatic cancer were treated by external beam radiotherapy after ilioobturator lymphadenectomy. The patients could be divided into two groups: Group I: no lymph node invasion and Group II: presence of lymph node metastases. In Group I, only one death was due to cancer and the 6-year survival was 90%. In Group II, 7 deaths were due to cancer and the 6-year survival was 20%. Secondary endocrine treated administered at the time of recurrence appeared to significantly prolong survival in comparison with the stage D1 cancers treated immediately by endocrine therapy.

[Carcinoma of the nasopharynx. Clinical signs and therapeutic problems]. / Carcinome du nasopharynx. Présentation clinique et problèmes thérapeutiques.

Most of the carcinoma of the nasopharynx diagnosed in our country, are loco-regionally advanced disease. Thus 31/54 (57%) of our patients referred to the Centre Claudius Regaud between 1970 and 1980 were T2 N3, T3 N3, T4 N0 or N1 N2 N3. In spite of this poor initial presentation external radiotherapy can achieve a quite good rate of tumoral control inside the treated volume. In our series there were 17/47 (36%) tumoral and/or nodal recurrences and 7/47 (15%) metastases without local or regional failure. Improvement of initial évaluation of the tumoral volume is now obtained by the systematic use of C.A.T. and this procedure should reduce local failure rate. In the other hand, the association of chemotherapy and radiotherapy should be useful in treating advanced disease or poorly differentiated carcinomas with high metastatic risk.

[The use of disposable vascular catheters in interstitial brachytherapy of skin cancers (author's transl)]. / Technique d'endocuriethérapie par fil d'iridium dans les épithéliomas cutanés à l'aide de cathéters à ponction vasculaire.

Authors present technical improvements dealing with interstitial brachytherapy (Ir192) of skin cancers. They use fine disposable plastic tubes fitted with mandril, which allow loading of light radioactive material in any case. Short term results are discussed according to 101 applications.

Change in volume of irradiated human metastases. Investigation of repair of sublethal damage and tumour repopulation.

Twenty-one patients, each having at least one metastasis per lung were investigated. A single dose of 1000 rad was delivered to the metastasis located in one lung. while the metastasis located in the other lung received 2 doses of 500 rad separated by a 3-hour interval. The changes in volume of the irradiated metastases were followed at least until the metastases reattained their initial volume. By comparing in each patient the effects of the 2 types of exposure it was possible to estimate the extrapolation number, n, of the survival curve of the tumour cells. In spite of many sources of inaccuracies, it seems possible to conclude that n is not very high, probably smaller than in many normal tissues.Furthermore this work demonstrated, in practically all the tumours studied, an acceleration of the growth rate of the metastases after irradiation.

[Diagnostic and therapeutic problems posed by 2 cases of exudative enteropathy]. / Problèmes diagnostiques et thérapeutiques posés par deux observations d'entéropathie exsudative

The authors report two cases of exsudative enteropathy characterised by the existence of oedema of the lower limbs associated with hypoproteinemia and marked lymphopenia with disturbances of the P.V.P. test. In both cases lymphography demonstrated major abnormalities with obvious obstruction in one case, and signs of slowing of lymph flow with appearances of dysplasia in the other. Surgery permitted us in one case, to discover a calcified lymph node probably due to tuberculosis. The etiology of these cases is discussed and seems to be mainly related to abnormalities of the lymphatic system. A low fat diet and administration of medium-chain triglycerides, gave an undoubted improvement when the treatment was followed by the patient. These two cases illustrate well the difficult diagnostic and therapeutic problems sometimes raised by syndromes of exsudative enteropathy, in particular owing to the many possible causes.

[Primary tumors of the renal pelvis and ureter: value of postoperative external radiotherapy (author's transl)]. / Tumeurs primitives urétéro-pyelo-calicielles. Etude comparative de l'importance thérapeutique de la radiothérapie loco-régionale.

Twenty-four observations of primary malignant tumors of the renal pelvis and ureter derived from epithelial cells were included in this study. Thirteen patients were treated by radiotherapy and surgery. In eleven patients, surgical excision was the only treatment. Although patients were not randomized there was no significant difference between the two groups concerning the following parameters: age distribution, sex ratio, stage of disease, histological grade, surgical procedure. The morbidity related to external radiotherapy (megavoltage technique, delivering 45 grays in 5 weeks) was low: only one patient developed retroperitoneal fibrosis. No patient was lost to follow-up. Local recurrence occurred in 54.5% of the patients treated by surgery alone, against 15.5% after combined radio-surgical therapy. The overall three-year survival rate was 35% without any significant difference between the two groups. The authors advocate postoperative high-voltage radiotherapy for non-disseminated carcinoma of the renal pelvis and ureter.

[External radiotherapy after radical prostatectomy for cancer of the prostate, stage C or DI. Preliminary study]. / Radiothérapie externe après prostatectomie radicale pour cancer de la prostate, stade C ou D1. Etude préliminaire.

Between february 1985 and february 1988, 45 patients upstaged to stages C or D 1 cancer after radical prostatectomy, were treated by adjuvant radiotherapy with a view to control the risk of local recurrence and distant metastases. Radical prostatectomy has a low morbidity (less than 10%) whereas the radiotherapy morbidity rate is important (40% with 10% severe complications). With an average 33.4 months follow-up, we observe cancer dissemination in 37.7% of the cases and local recurrence in 13.3% of the cases. The prognosis seems to be worse, on one hand when the urethral margins are invaded and/or when the seminal vesicles are macroscopically invaded (C3) and on the other hand when the pelvic nodes are macroscopically invaded. Radiotherapy avoids locals recurrence in some cases but does not permit a general control of the disease. This observation leads us to recommend an early postoperative hormonotherapy in patients upstaged to stage C3 or with positive nodes.