The Nottingham prognostic index (NPI), based on tumour size in breast, node involvement and Scarff–Bloom–Richardson (SBR) grading, has been shown to constitute a definitive prognostic factor of primary operable breast cancer in the adjuvant setting. We performed a retrospective study to evaluate the prognostic value of this index in 163 patients after neoadjuvant chemotherapy. Secondly, we examined the influence on survival of a revised NPI, only based on residual tumour size in breast and SBR grading in 228 patients, and consequently called breast grading index (BGI). The prognostic value of these two indices was also evaluated by replacing the SBR grade with the MSBR grade, a French modified SBR grading; the modified NPI (MNPI) and modified BGI (MBGI) were, respectively, obtained in 153 and 222 patients. At a median follow-up of 9.3 years, survival was significantly related to these four indices (P<0.001). Multivariate analysis revealed that MBGI was the only one which retained a prognostic influence on disease-free survival (P<0.02). In conclusion, the 'amount' of residual tumour in breast and/or nodes, as defined by NPI and revised indices, confers a determinant prognosis after neoadjuvant chemotherapy, inviting an alternative postsurgical treatment for a subgroup of patients with a decreased survival.

But : la strategie therapeutique des recidives de tumeurs desmoides inoperables demeure mal definie. Nous rapportons un cas de tumeur desmoide cervicale recidivante inoperable chez une femme de 73 ans et son traitement sequentiel. Methodes : le schema therapeutique comprend une radiotherapie postoperatoire de 55 Gy (dose totale) associe au Tamoxifene (20 mg/j). Resultats : l'association radiotherapie et hormonotherapie entraine une regression de la taille tumorale avec une disparition des symptomes majeurs. Conclusion : cette etude demontre la regression de la tumeur desmoide avec le traitement combinant radiotherapie hormonotherapie.

Objective This article is to present the clinical efficacy of radiotherapy for epidemic kaposi's sarcoma (EKS) of the eyelid and conjunctiva. Methods From January 1987 to June 1997, 362 patients with EKS of the eyelid and conjunctiva were treated with radiation in the Department of Radiation Oncology of Henri Mondor University Hospital. Distribution of patient's sex were 356 males and 6 female with the median age of 38a(ranged 27～64a).All 362 patients were treated with localized field irradiation using 45kv X-ray radiation of 10～30Gy. Schedule consisted of 10Gy in one week(4 fractions of 2.5Gy), followed by 7d rest and then a second series of 10 or 20Gy. Results The complete response rate was 100%. Severe reactions were observed in 14 patients(3.9%). Moderate reactions were observed in 76 patients (21%), and mild in 272 patients ( 71.1% ). Conclusion Radiotherapy is efficient for EKS of the eyelid and conjunctiva.Radiation in a dose of 20Gy is sufficient to produce shrikage or disappearance of the tumor and good palliation of symptoms.

De juin 1986 a decembre 1996, cinq patients atteints de sarcome de kaposi classique ont ete traite par radiotherapie au departement de cancerologie de l'hopital Henri Mondor a Creteil. Les patients (2 hommes et 3 femmes) avaient un âge moyen de 78 ans (extremes 65 - 90 ans). Le siege des lesions etait : levres superieures 4 cas, inferieure 1 cas ; un patient presentait a la fois une atteinte des membres superieurs et inferieurs. Il y avait un total de 48 champs d'irradiations. Tous les patients ont ete traites par des champs localises utilisant une energie de 45 - 70 kV. Aucun patient n'a recu plus de 30 Gy. Le schema therapeutique consistait en 4 fractions de 2,5 Gy (10 Gy /semaine) suivie de 10 a 15 jours de repos puis une seconde serie de 15 a 20 Gy. La tolerance cutanee etait parfaite. Le taux de reponse complete etait de 100 %. Les resultats cosmetiques etaient satisfaisants. Deux patients ont presente de nouvelles lesions qui furent traite par radiotherapie (1 cas) et par la Vinblastine (1 cas). L'objectif de ce travail est de rapporter cinq nouveaux cas de sarcome de kaposi classique, et de souligner l'importance de la radiotherapie dans le traitement de cette rare affection.

目的:分析生殖器流行性卡波西氏肉瘤(Kaposi'sSarcoma简称KS)的发病情况、临床特征及治疗方法.资料和方法:1986年6月至1996年12月,巴黎第十二大学医学院HenriMondor医院肿瘤放疗科共收治645例爱滋病KS病人,其中71例有阴茎及阴囊病变.单发于阴茎或阴囊有12例,其余59例均合并有其它部位的皮肤侵犯.中位年龄37岁,9例有排尿困难,13例有水肿或/和疼痛.均采用放射治疗,选用低能(45KV)X线,大野照射10Gy/4次·周,根据病变反应,休息15天,缩野再予5～10Gy.结果:所有病人均获客观上的缓解和器官功能的恢复.在71例共189个病变部位中,完全反应率28%,部分反应率66%,6%无反应.所有病人均获随访,平均随访期7 5个月.结论:发生于生殖器的流行性KS少见.放疗对本病可取得满意结果;尿道狭窄为放疗的主要并发症.

PURPOSE:Retrospective analysis of results of radiotherapy in epidemic Kaposi sarcoma at the Henri-Mondor hospital.MATERIAL AND METHODS:From June 1986 to December 1996, 643 patients presenting with acquired immunodeficiency syndrome (AIDS)-related epidemic Kaposi's sarcoma were treated with irradiation at the Oncology Department of Henri Mondor University Hospital. Three-hundred eighty-seven patients (60%) had previously received a treatment with interferon (259 patients, 40.2%), vinblastine (225 patients, 34.5%), doxorubicin (22 patients, 3.4%), bleomycin (19 patients, 2.9%), and/or antiviral treatment (216, 33.5%). The radiotherapy was delivered by 4 MeV or 8 MeV electron beam for extended cutaneous fields and 45-100 kV x-ray for localized fields. The delivered dose was 20 Gy in 2 weeks (2.5 Gy/fraction, 4 fractions/week) followed by 2 weeks rest and second series of 10 Gy in 1 week. For oral cavity lesions, we used a series of 15.2 Gy was delivered (1.9 Gy/fraction, 4 fractions/week), followed for three patients by a 3 week rest and by a similar second series of 15.2 Gy.RESULTS:Six-hundred and twenty-one patients were evaluable and the objective response rate was 92%, with a complete regression of clinical and functional symptoms for all patients. The skin tolerance was good, with 7.3% grade I reactions, 69.3% of grade II reactions, and 23.4% grade III reactions. There was a correlation between recurrence rate and the occurrence of opportunistic infections.CONCLUSION:This analysis shows the efficacy of dose radiotherapy for treatment of epidemic Kaposi sarcoma.

Purpose: To report to the literature the largest published series of epidemic Kaposi's sarcoma (EKS), treated with radiation therapy, to summarize and discuss our 10 years experience in the treatment of this malignancy.Methods and materials: From June 1986 to December 1996, 643 patients with acquired immunodeficiency syndrome (AIDS)-related epidemic Kaposi's sarcoma were treated with radiation therapy (RT) at the Cancerology Department of Henri Mondor University Hospital. The patients, 640 men and 3 women had an average age of 38.5 years (range 20-68 years). Three hundred eighty-seven patients (60.14) had received previous treatment for their Kaposi's sarcoma (KS). In total, 6777 fields were irradiated, as follows: face 1342 (19.8%), eyelid and conjunctiva 362 (5.3%), trunk 1903 (28.1%), upper and lower limbs 2866 (42.3%), genitals 189 (2.8%), and oral cavity 115 fields (1.7%). Radiation therapy consisted of 4 MV or 45-70 kV X-rays, depending on tumor size and location. Doses ranged from 10 to 30 Gy, according to tumor response and toxicity.Results: Objective response (CR and PR) was observed in 92% (5947/6464) of all cases, treated for cutaneous form of EKS. All patients with irradiated oral lesions had an objective response. The overall tolerance was acceptable for the cutaneous lesions. By contrast, in oral lesions, mucosal reactions were often observed after relatively low doses of radiotherapy.Conclusions: Doses of 15 Gy for oral lesions, 20 Gy for lesions involving eyelids, conjunctiva, and genitals, have been shown to be sufficient to produce shrinkage of the tumor and good palliation of the symptoms. For the cutaneous EKS, we propose 30 Gy given in a local field, using a fractionated scheme with small size applicators. Radiotherapy has its own place in the management of EKS, as an efficient treatment. (C) 1998 Elsevier Science Ireland Ltd.

Retrospective analysis of eight new cases of radiation-induced sarcomas following radiotherapy for breast carcinoma and literature review.Eleven patients presenting with radiation-induced sarcoma after radiotherapy for breast cancer have been treated between 1983 and 1997 at Henri Mondor University Hospital (France). Eight of these patients respected the criteria established by Cahan et al. The others had Stewart-Treves Syndrome and were thus excluded from the analysis. Only one of the eight patients had received chemotherapy. All of the patients at the time of diagnosis of radiation-induced sarcoma were free of breast cancer recurrence. Radiation-induced sarcoma appeared with a latency period of 5 to 18 years (mean: 10.3 years). Patients' ages ranged from 39 to 88 years (mean: 57.6 years) at the time of diagnosis of sarcoma. Three sarcomas occurred in the treated breast, two in the chest wall, one in the preclavicular area and two in the axillary region. There were two angiosarcomas, three fibrosarcomas, one osteosarcoma, one malignant fibrous histiocytoma (MFH), and one undifferentiated sarcoma. All patients have received treatment for their sarcoma: all of them underwent surgery, one patient combined radiotherapy and chemotherapy, and three patients chemotherapy.Two patients were alive and free from disease. Six patients died (5-34 months); all six had local and/or metastatic recurrence.Radiotherapy can induce malignancies after a latent period of several years. Radiation-induced sarcomas are associated with poor overall prognosis. The treatment in most of the cases is late and ineffective, therefore careful follow-up is needed. There are still many uncertainties and questions about radiation-induced sarcomas.

Objectif de l'étude. — Analyse rétrospective des résultats de la radiothérapie du sarcome épidémique à l'hôpital Henri-Mondor.

La radiothérapie joue un rôle important dans le traitement des tumeurs cutanées. Pour les carcinomes, l'irradiation externe (rayons X de basse énergie ou électrons selon la présentation clinique) est préférable à la curiethérapie réservée aux cancers de la lèvre ou du vestibule nasal. Dans le mycosis fongoïde, l'électronthérapie corporelle totale est efficace dans les formes superficielles et limitées. La radiothérapie permet le contrôle local des formes classiques de sarcome de Kaposi et représente un traitement palliatif valable des formes épidémiques.Radiotherapy plays an important role in the treatment of skin tumours. For skin carcinomas, external irradiation (kilovoltage X-rays or electrons according to clinical characteristics) is more valuable than interstitial brachytherapy, which is recommended for tumours of the lip and of the nasal vestibule. In mycosis fungoides, total cutaneous electron beam radiation therapy is efficient for patients with limited superficial plaques. In the classical form of Kaposi's sarcoma, radiotherapy can achieve local control whereas it obtains good palliative results in the epidemic form.

Moriz Kaposi was the first who, in 1872, described five patients presenting with "sarcoma idiopathicum multiple hemorrhagicum". In 1912 Sternberg termed this disease Kaposi's sarcoma. Since then various forms of this rare disease have been observed. In 1914 Hallenberg described the first cases of African or endemic Kaposi's sarcoma. In the 1960s the first reports discussing Kaposi's sarcoma following organ transplantation and immunosuppressive therapy were published. After 1981, the epidemic form associated with the acquired immunodeficiency syndrome (AIDS) was described. All these forms, their history, treatment methods and the role of radiation therapy in the management of this rare malignancy are discussed, and the literature is reviewed.

Resume En 1872, Moriz Kaposi a, le premier, decrit cinq patients ayant un ≪ sarcome idiopathique multiple hemorragique ≫. En 1912, Sternberg a propose le nom de sarcome de Kaposi. Des lors ont ete observees differentes formes de cette maladie rare. Hallenberg a decrit en 1914 les premiers cas de la forme africaine ou endemique. Dans les annees 60, la forme survenant apres transplantation d'organes et therapie immunodepressive a ete identifiee. C'est enfin, apres 1981, que la forme epidemique associee au syndrome d'immunodeficit acquis (sida) a ete mise en evidence. Toutes ces formes du sarcome de Kaposi sont decrites a partir d'une revue de la litterature, ainsi que les methodes therapeutiques, en particulier la radiotherapie. Les indications therapeutiques sont discutees.

Between 1975 and 1986, 326 patients with stage II breast cancer were treated with an adjuvant combination of doxorubicin, vincristine, cyclophosphamide, and 5-fluorouracil (AVCF) following regional therapy (232 modified radical mastectomy, 94 lumpectomies, 304 irradiations). The AVCF regimen consisted of 4-week cycles of doxorubicin (30 mg/m2 day 1, modified radical mastectomy), vincristine (1 mg/m2 day 2), 5-fluorouracil 400 (mg/m2), and cyclophosphamide (300 mg/m2) days 3-6. Two hundred twenty-four patients (pts) had six cycles and 102 pts 12 cycles; 90 pts also received 30 mg daily tamoxifen for 1 year after chemotherapy. As of March 1994, the median follow-up was 130 months (range 86-221). One hundred eighteen pts developed recurrences (7 local, 19 controlateral, 92 metastatic) and 104 died. Estimated disease-free survival (DFS) was 5 years, 76 +/- 5%; 10 years, 64 +/- 5%; 15 years, 54 +/- 9%. Overall survival (OS) was 5 years, 85 +/- 4%; 10 years, 70 +/- 5%; 15 years, 58 +/- 10%. Survival was affected by the number of involved lymph nodes (258 pts were N+), menopausal status (OS at 15 years: 53% for MP+ and 65% for MP-) and Scarff-Bloom-Richardson grading, but not by hormonal receptors, number of courses, or associated hormonotherapy. Minimal cardiac toxicity was induced by doxorubicin either during or subsequent to treatment completion.

Analyse rétrospective de huit nouveaux cas de sarcome radio-induit après une radiothérapie pour un cancer du sein et revue de la littérature. Onze patientes atteintes de sarcome radio-induit après une radiothérapie pour cancer du sein ont été traitées entre 1983 et 1997 à l'hôpital HenriMondor de Créteil. Huit tumeurs avaient les critères requis par Cahan Les trois autres étaient atteintes d'un syndrome de Stewart-Treves et ont été exclues de l'analyse. Une seule des huit patientes avait reçu une chimiothérapie. Elles étaient en situation de rémission complète au moment du diagnostic de sarcome survenu après une période de latence de 5 à 18 ans (moyenne: 10,3 ans). L'âge variait de 39 à 88 ans (moyenne: 57,6 ans) au moment du diagnostic de sarcome qui était localisé au sein traité (trois cas), à la paroi thoracique (deux cas), à la région claviculaire (un cas) et à la région axillaire (deux cas). Sur le plan histologique, il s'agissait de deux angiosarcomes, de trois fibrosarcomes, d'un ostéosarcome, d'un mésenchymome malin et d'un sarcome indifférencié. Toutes les patientes ont eu, pour leur sarcome, une exérèse chirurgicale, trois une chimiothérapie et une, une association de radiothérapie et de chimiothérapie. Deux patientes étaient en vie en situation de rémission complète à 6 et 115 mois. Six patientes sont décédées dans un délai de 5 à 34 mois et avaient toutes une récidive locale et/ou métastatique. La radiothérapie peut induire des tumeurs malignes après une période de latence de quelques années. Le sarcome radio-induit est de pronostic défavorable. Son traitement est en général tardif et inefficace, d'où la nécessité d'une surveillance prolongée après traitement d'un cancer du sein. Des incertitudes demeurent et beaucoup de questions restent posées en ce qui concerne les sarcomes radio-induits. Retrospective analysis of eight new cases of radiation-induced sarcomas following radiotherapy for breast carcinoma and literature review. Eleven patients presenting with radiation-induced sarcoma after radiotherapy for breast cancer have been treated between 1983 and 1997 at Henri Mondor University Hospital (France). Eight of these patients respected the criteria established by Cahan The others had Stewart-Treves Syndrome and were thus excluded from the analysis. Only one of the eight patients had received chemotherapy. All of the patients at the time of diagnosis of radiation-induced sarcoma were free of breast cancer recurrence. Radiation-induced sarcoma appeared with a latency period of 5 to 18 years (mean: 10.3 years). Patients' ages ranged from 39 to 88 years (mean: 57.6 years) at the time of diagnosis of sarcoma. Three sarcomas occurred in the treated breast, two in the chest wall, one in the preclavicular area and two in the axillary region. There were two angiosarcomas, three fibrosarcomas, one osteosarcoma, one malignant fibrous histiocytoma (MFH), and one undifferentiated sarcoma. All patients have received treatment for their sarcoma: all of them underwent surgery, one patient combined radiotherapy and chemotherapy, and three patients chemotherapy. Two patients were alive and free from disease. Six patients died (5–34 months); all six had local and/or metastatic recurrence. Radiotherapy can induce malignancies after a latent period of several years. Radiation-induced sarcomas are associated with poor overall prognosis. The treatment in most of the cases is late and ineffective, therefore careful follow-up is needed. There are still many uncertainties and questions about radiation-induced sarcomas.

A recent phase II study [1] has shown a high response rate of 50 % with Vinorelbine in metastatic breast cancer. It seemed logical to combine this new compound with the well tolerated and effective drugs Epirubicine and Methotrexate (respective response rate of 45% and 20%). A weekly (day 1 & 8) administration of Vinorelbine was performed as proposed in the phase II study; Epirubicine and Methotrexate were also infused at day 1 and 8 to decrease toxicity. In metastatic relapse, our aim was to increase complete response rate (CR); and in Neo-Adjuvant situation, aims were to obtain maximal tumor’s reduction to avoid modified radical mastectomy (MRM) and increase of clinical and pathological response rates.

Most patients with Hodgkin's disease (HD) are cured with chemotherapy and/or radiotherapy. However, half of those with advanced stage disease (IIIB, IV) do not respond adequately to treatment or relapse. Salvage therapy used in such cases gives from 10% to 50% complete remission but only 10% long term survival. The results of bone marrow transplantation reported in acute leukemia and non-Hodgkin's lymphoma encouraged some authors to develop this new therapeutic strategy in Hodgkin's disease. In the early 1980's promising results were achieved when refractory and relapsed patients were selected to receive myeloablative therapy followed by bone marrow transplantation. Today, high dose chemotherapy with hematopoietic stem cell transplantation (HSCT) is used more and more often in poor prognosis Hodgkin's disease. After a review of the literature concerning the results of transplantation in Hodgkin's disease, we develop the numerous problems associated with this procedure which remain to be solved such as: the optimal indication, the timing of HSCT, the type of graft, the conditioning regimen, the place of radiotherapy and the optimal use of hematopoietic growth factors. We conclude with future prospects.