Purpose. - To report retrospective long-term results of historical experience of breast radiotherapy (RI) including external beam radiotherapy (EBRT) followed by low dose rate (LDR) brachytherapy.Patients and methods. - Between 1971 and 1983, at our service 474 breast cancer patients underwent exclusive conserving radiotherapy treatment. The RT included an initial external irradiation followed by interstitial LDR brachytherapy (37 Gy) to the residual tumour. The local regional nodes received 47.5 Gy followed by a 15 Gy boost delivered to the mammary nodes internal (IMN) and 25 Gy axilla.Results. - Median follow-up was 139 months (8-342). There were 40 T1, 356 T2, and 78 T3. Local recurrences (LR) were observed in 20% of cases. The rate of recurrences free at 5, 10, 15 and 20 years were 86%. 77%, 73% and 67% respectively. At 5, 10, 15 and 20-year, the disease-free survival rates were 63%, 42%, 32% and 24%. Overall survival rates at 5, 10, 15 and 20-years were 75%, 53%, 34% and 25% respectively.Conclusion. - Although the historical retrospective character of these series, it is interesting to have this experience and to analyse it according to our new knowledge and advances. The described technique was a standard for many years and could be still used in some cases. (c) 2012 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

To report retrospective long-term results of historical experience of breast radiotherapy (RT) including external beam radiotherapy (EBRT) followed by low dose rate (LDR) brachytherapy.Between 1971 and 1983, at our service 474 breast cancer patients underwent exclusive conserving radiotherapy treatment. The RT included an initial external irradiation followed by interstitial LDR brachytherapy (37Gy) to the residual tumour. The local regional nodes received 47.5Gy followed by a 15Gy boost delivered to the mammary nodes internal (IMN) and 25Gy axilla.Median follow-up was 139months (8-342). There were 40 T1, 356 T2, and 78 T3. Local recurrences (LR) were observed in 20% of cases. The rate of recurrences free at 5, 10, 15 and 20years were 86%, 77%, 73% and 67% respectively. At 5, 10, 15 and 20-year, the disease-free survival rates were 63%, 42%, 32% and 24%. Overall survival rates at 5, 10, 15 and 20-years were 75%, 53%, 34% and 25% respectively.Although the historical retrospective character of these series, it is interesting to have this experience and to analyse it according to our new knowledge and advances. The described technique was a standard for many years and could be still used in some cases.

The results of an intercomparison which took place in 1976 when 2 sets of 192Ir wire, one English, the other French, were exchanged and their activities measured by the producers, one standardizing laboratory and two radiation therapy centres. The average differences ranged from 0.7 to 3.2 per cent. The differences in the derivation of basal dose rate as defined in the Paris system, by the two radiation therapy centres, were also investigated.

We analyzed local recurrence and survival rate in breast cancer treated by radiotherapy alone with Pierquin technical after reclassified the stage according to the U.I.C.C. Tumor Classification System in 1997. From 1971 to 1983, 474 (39 T1, 325 T2, 65 T3) (UICC 1997) breast cancer were treated conservatively at Henri Mondor Hospital by an initial course of external irradiation (45 Gy, 25 fractions, 5 weeks) followed by interstitial iridium-192 implant for a further 37 Gy to the tumor. The mean age was 56 years old. Clinical positive nodes were 187 (36.2%) cases. 62 (9.7%) patients were received chemotherapy. The mean interval between external irradiation and Brachytherapy was 2.56 weeks (S.E. 0.11, range 0.5–23). Eighty-nine local failures were observed at 9–361 months (mean 65 months). The actuarial probabilities (S.E.) of local control at 5, 10, 15 and 20 years were 0.87, 0.80, 0.76 and 0.72, respectively. The local control rate was 79%, 80% and 83 %( p = 0.87) for T1, T2 and T3, respectively. The mean and median distant metastasis was 73 months (ST error 4.33) ( 3–298 months) and 195 (ST error 6.64). At 5, 10, 15 and 20-year metastases-free survival rates, respectively, 75%, 60%, 52% and 48%. The metastases-free survival rate was 48%, 57% and 50 %( p = 0.16) for T1, T2 and T3 in this group, respectively. The mean and median disease-free survival was 106 months (ST error 4.16) (3–361 months) and 126 months (ST error 19), respectively. At 5, 10, 15 and 20-year disease-free survival rates, respectively, were 68%, 51%, 43% and 38 %. The disease-free survival rate was 41%, 48% and 43 %( p = 0.24) for T1, T2 and T3 in this group, respectively. The mean and median overall survivor was 136 months (ST error 4.22) (8–384 months) and 188 months (ST error 23.25). Overall survival rates at 5, 10, 15 and 20-year, respectively, were 80%, 65%, 51% and 47%. Overall survival rates of clinic positive nodes and negative, respectively, were 53% and 52%, (p = 0.03). Disease-free survival rates of clinic positive nodes and negative, respectively, were 43% and 38%, (p = 0.06). Distant metastasis-free survival rates of clinic positive nodes and negative, respectively, were 58% and 49%, (p = 0.01). According to the results of local recurrence, there were no significal difference in the size of tumor. There was a relationship between size of tumor (T3) and metastasis and disease-free survival rate. Clinical positive nodes were closed relationship with distant metastases and survival rate. Radiotherapy association chemotherapy was probably advantageous

Nous avons revu les résultats de 165 carcinomes épidermoïdes classés T1–T2 de l'arche véloamygdalienne traités par irradiation exclusive incluant ou non une curiethérapie par iridium 192. De mars 1971 à novembre 1990, 58 T1 et 107 T2 (NO : 107/165; N1 : 30/165; N2 : 9/165; N3 : 19/165) carcinomes épidermoïdes prouvés par biopsie de la région amygdalienne (104 sur 165) et du voile du palais (61 sur 165) ont été traités à l'hôpital Henri-Mondor par irradiation exclusive. De 1971 à 1981 (période 1), la technique des gouttières vectrices était seulement disponible, si bien que la curiethérapie a été réservée aux plus petites tumeurs: les patients ont été traités soit par une irradiation externe exclusive de la tumeur primitive et des aires ganglionnaires cervicales (groupe 1, n = 48; dose moyenne: 70 Gy; intervalle de confiance: ± 5,5; cinq fractions de 1,8 Gy par semaine), soit par curie exclusive (groupe 2, n = 11; tous T1NO, 64 Gy ± 4,8), soit par une combinaison d'une irradiation externe de la tumeur primitive et des aires ganglionnaires cervicales et d'une curiethérapie (groupe 3, n = 40). En 1981 (période 2), une nouvelle technique d'implantation par tubes plastiques qui autorise le traitement d'un plus large volume, a été introduite dans le département (groupe 4, n = 66) et les patients ont alors été tous traités par une irradiation externe (groupe 3 + 4: 47 Gy ± 4,3), complétée par une curiethérapie par iridium 192 (31 Gy ± 10,5). Les ganglions cervicaux cliniquement métastatiques ont fait l'objet soit d'un complément d'irradiation externe, soit d'une exérèse chirurgicale. La survie globale à 5 ans (Kaplan-Meier) a été respectivement de 23 %, 50,5 % et 60 % dans les groupes 1, 2, et 3 + 4 (p < 0,001, log rank). Le contrôle local à 5 ans a été respectivement de 58 %, 100 %, et 91 % (p < 0,001). La probabilité de nécrose à 5 ans a été respectivement de 10 %, 25 % et 30 % (NS). La comparaison des résultats entre les deux périodes de l'étude (groupe 1 + 2 + 3 versus groupe 4) montre que ces deux groupes sont statistiquement comparables selon le site et le diamètre de la tumeur et le statut ganglionnaire, et que à la fois le contrôle local (77 % versus 94 % à 5 ans; p < 0,01) et la survie sans signe évolutif (56 % versus 71 %; p = 0,03) ont été améliorés après 1980, tandis qu' on notait une tendance à une amélioration de la survie globale (42 % versus 53 % à 5 ans; p = 0,08); le contrôle ganglionnaire (86 % versus 95 % à 5 ans) et la probabilité de nécrose (11% versus 20 % à 5 ans) n'ont pas été modifiés. L'analyse multivariée a montré que, à la fois le contrôle local (p < 0,0001) et la survie globale (p < 0,0001) ont été améliorés quand la tumeur a été implantée. Nous recommandons de traiter les carcinomes épidermoïdes classés T1 ou T2 de l'arche véloamygdalienne par une irradiation externe de la tumeur primitive et des aires ganglionnaires (45 Gy / 25 fractions / 5 semaines), suivie par une curiethérapie par iridium 192 de 30 Gy et, pour les patients ayant des métastases ganglionnaires cervicales, soit par un complément d'irradiation par électrons de 25–30 Gy, soit par un curage ganglionnaire cervical.

We have reviewed the results of 165 T1 and T2 squamous cell carcinomas of the faucial arch treated by definitive irradiation including or not iridium 192 brachytherapy to ascertain whether a significant relationship exists between iridium implantation, local control, complications and survival. From March 1971 to November 1990, 58 T1 and 107 T2 (NO: 107/165; N1: 30/165; N2: 9/165; N3: 19/165) biopsy proven squamous cell carcinomas of the tonsillar region (104/165) and the soft palate and uvula (61/165) were treated in the Henri Mondor Hospital by definitive irradiation with curative intent. From 1971 to 1981 (period 1), only guide gutter technique was available, so that implants were reserved for small tumors: patients were either managed by definitive telecobaltherapy to tumor site and neck node areas (group I; n = 48; mean dose: 70 Gy; confidence interval: +/- 5.5, 5 fractions of 1.8 Gy per week) or by exclusive iridium implant (group 2; n = 11; all T1NO; 64 Gy +/- 4.8) or by a combination of external beam radiation therapy to tumor site and neck nodes areas and iridium implant (group 3; n = 40). In 1981 (period 2), a new plastic tube technique, which enables implantation of larger areas, was introduced and all patients (group 4; n = 66) were then managed by external radiation therapy (group 3 + 4: 47 Gy +/- 4.3) followed by an iridium implant (31 Gy +/- 10.5). Clinically positive neck nodes either received additional external dose with electrons or were excised. Overall 5-year survival (Kaplan Meier) was 23%, 50.5%, and 60% in groups 1, 2 and 3 + 4, respectively (p < 0.001, log rank). Five-year local control was 58%, 100%, and 91%, respectively (p < 0.001). Five-year necrosis rate was 10%, 25% and 30%, respectively (NS). Comparison of results between the two periods of the study (group 1 + 2 + 3 vs group 4) shows that these two groups are statistically comparable according to site and size of tumor and N status and that both local control (77% vs 94% at 5 years; p < 0.01) and disease free survival (56% vs 71%; p = 0.03) were improved after 1980, while there was a trend to an increase in overall survival (42% vs 53% at 5 years; p = 0.08); nodal control (86% vs 95% at 5 years) and necrosis rate (11% vs 20% at 5 years) were not modified. Multivariate analysis showed that both local control (p < 0.0001) and overall survival (p < 0.0001) were improved when tumor was implanted. We recommend then to treat T1 and T2 squamous cell carcinomas of the faucial arch by external radiation therapy to tumor site and neck areas (45 Gy/25 fractions/5 weeks) followed by a 30 Gy iridium implant and, for patients with clinically positive nodes, either a further 25-30 Gy electron beam irradiation to the nodes or neck node dissection.

The effects of fluorogestone acetate (FGA) and/or pregnant mare serum gonadotrophin (PMSG) on follicular growth and LH secretion in cyclic ewes were determined. Suffolk ewes (n = 40), previously synchronized with cloprostenol were divided into 4 experimental groups (n = 10 ewes per group). Group I served as the control, while groups II, III and IV received FGA, PMSG, FGA and PMSG respectively. Four ewes of each group underwent daily laparascopy for 17 d. All the ovarian follicles ≥ 2 mm were measured, and their relative locations were recorded on an ovarian map in order to follow the sequential development of each individual follicle. Comparisons were made of the mean day of emergence and the mean number of small, medium and large follicles, the atresia rate and the ovulation rate. For each group, 3 waves of follicular growth and atresia were observed during the cycle. During luteal phase, FGA treatment accelerated the mechanisms of follicular growth but reduced the number of large follicles and increased the atresia rate. In the follicular phase, FGA treatment was detrimental to both the number of large follicles and the ovulation rate. By contrast, PMSG enhanced recruitment of small follicles and the ovulation rate. Serial blood samples were collected during the luteal and follicular phases to study LH secretion. None of the treatments had any effect on LH secretion patterns.

From 1971 to 1988, 133 T1 and 141 T2 biopsy-proven squamous cell carcinomas of mobile tongue and floor of mouth were definitively managed by Iridium-192. Implantations were performed using either guide gutters or afterloading plastic catheters. The prescribed dose at the reference isodose (85% of the basal dose rate, Paris system) was 60-70 Gy. Total dose was not adjusted to dose rate or tumor volume. Results of the 274 implants have been analysed to look for a possible influence of intersource spacing on local control and necrosis. Follow up for patients free of local recurrence is 1-180 months with median of 35 months. The 274 tumors were divided into two groups according to intersource spacing: 9-14 mm (n = 204), and 15-20 mm (n = 70). At 5 years, the estimated local control (Kaplan Meier) was 86% and 76%; respectively (p = 0.13); the necrosis rate was 33% and 46%, respectively (p = 0.04). Multivariate analysis shows that dose and activity of wires were significantly related to local control, while only tumor site was predictive of necrosis; there was a non-statistically significant relationship between intersource spacing of wires and local control (p = 0.055). When considering only patients with oral tongue cancers, necrosis was significantly related to activity of wires (p = 0.013), and there was a non-significant trend to a relationship between necrosis and intersource spacing (p = 0.066) and tumor diameter (p = 0.065). For patients with floor of mouth cancer, none of these factors was significantly related to necrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Purpose: This paper reviews the results of intranasal brachytherapy for epistaxis in 43 patients with Rendu-Osler disease treated between 1971-1991 at Henri Mondor Hospital.Methods and Materials: 2-3 intranasal catheters were afterloaded with Ir-192 sources. Computer dosimetry was performed and then the dose was prescribed to an isodose thought to cover the nasal mucosa. The dose rate ranged from 0.16 Gy/h-0.63 Gy/h with a median of 0.34 Gy/h. Dose at one application ranged from 15-35 Gy with a median of 30 Gy. The severity of epistaxis was graded 1 to 5.Results: The time to recurrence of significant epistaxis ranged from 6-178 months with a median of 24 months. The dose prescribed did not correlate with control rate. The only brachytherapy complication was septal perforation in 4 patients; in one this was a result of repeated nasal coagulation.Conclusion: We suggest that intranasal brachytherapy is a useful modality in the management of epistaxis in Rendu--Osler disease.

Between 1980 and 1987, 25 patients with rectal cancer were treated with a combination of preoperative external irradiation of 35 Gy in 15 fractions over 3 weeks which was followed, 6 to 8 weeks later, by a tumorectomy and peroperative placement of a plastic tube loop for post-operative interstitial therapy by iridium-192. This boost dose was 20 Gy (Paris System) for submucosal lesions (seven patients) and 25 Gy for intramural (eight patients) and extramural (ten patients) lesions. With a mean follow-up of 40.5 months, there have been five local recurrences, the latest occuring 16 months post-tumorectomy. Two of these five patients are alive and disease-free 1 year post salvage abdominoperineal resection. The 20 patients with local control have preserved a full functional sphincter and 19 of them are disease-free; there were few complications. This sphincter preserving combined approach seems promising for patients with tumors of the middle and lower rectum who cannot undergo major surgery and for selected patients who refuse abdominoperineal resection.

From 1971 to 1983, 398 (33 T1, 309 T2, 56 T3) biopsy-proven breast adenocarcinomas were treated conservatively at Hôpital Henri Mondor by an initial course of external irradiation (45 Gy, 25 fractions, 5 weeks) followed by interstitial iridium-192 implant for a further 37 Gy to the tumor. The mean interval between external irradiation and brachytherapy was 5.9 weeks (S.D. 1.7, range 1-18). Seventy-seven local failures were observed at 10-148 months (median 34.5). The actuarial probabilities (S.E.) of local control at 5 and 10 years were 0.86 (0.02) and 0.74 (0.03), respectively. The follow-up for patients free of local recurrence was 4-205 months (median 95). Multivariate analysis showed an increasing probability of local failure with longer interval between external irradiation and brachytherapy (Relative Risk [R.R.] 1.23 [95% confidence limits: 1.07, 1.41] per week, p = 0.005), and a lower risk of failure in case of complete tumor regression after external irradiation (R.R. 0.47 [0.25, 0.90], p = 0.022), and higher brachytherapy dose rate (R.R. 0.13 [0.02, 1.02] per Gy/h, p = 0.053). No influence of tumor size and total dose (possibly because only limited variations in total dose were observed), or histological grading (not performed in 140 [35%] patients) was found. Because of the lack of dose-control relationship, quantification of the effects of delay between external irradiation and brachytherapy (in terms of compensatory dose) and of dose rate (Incomplete Repair Model) was not possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Between December 1982 and October 1986, 131 patients with stage II-III-IV squamous cell carcinoma of the oropharynx or oral cavity were randomized to induction chemotherapy, consisting of bleomycin (10 mg/m2/day in continuous infusion from day 1 to day 5), methotrexate (120 mg/m2 on day 2) followed by folinic acid, 5-fluorouracil (5 FU) (600 mg/m2 on day 2), and cisplatin (120 mg/m2 on day 4) every 4 weeks for a total of three cycles followed by definitive locoregional treatment versus locoregional treatment alone. The modalities of definitive treatment (radiotherapy +/- surgery) were chosen prior to randomization. A total of 116 patients were evaluable. Of 55 patients in the chemotherapy arm, four (7%) had a complete response (CR) and 23 (42%) a partial response (PR) following the induction regimen. At the completion of locoregional treatment, 76% (42 of 55) of patients in the experimental group were in CR compared to 89% (54 of 61) in the control group. There was no difference in survival, cause-specific survival, and pattern of relapse between both groups. The median survival was 22 months in the chemotherapy group and 29 months in the control group. Responders to chemotherapy did not fare better than nonresponders. Chemotherapy-related toxicities were few and most of them related to cisplatin which was reduced to 100 mg/m2 for 35 patients. There were no treatment-related deaths and, in the experimental arm of the trial, no increased morbidity from locoregional treatment. This induction regimen does not offer any advantages over standard treatment.

Dose specification in intraluminal brachytherapy varies considerably in the literature. A terminology is proposed, inspired from the Paris System of interstitial brachytherapy, to define some dosimetric guidelines. The dose is specified in the central plane which is a plane perpendicular to the source and passing through its centre. The reference dose rate is calculated in this plane. The treated volume is the volume encompassed by the reference isodose. The hyperdose sleeve is the volume receiving a dose equal to or greater than twice the reference dose. A study of the dose distribution along a linear source of iridium-192 was undertaken. Results obtained, also valid for caesium-137 and cobalt-60, show that the radius of the hyperdose sleeve is relatively independent of the length of the source. It is approximately 0.6 times the distance between the source axis and the point of dose specification when the active length varies from 3 to 20 cm. Reporting not only the dose, but also the thickness of tissue covered by the reference isodose and the thickness of tissue included in the hyperdose sleeve, is recommended to assist in evaluation of the results of treatment and to facilitate the exchange of clinical information in intraluminal brachytherapy. Practical examples are given.

From 1981 to 1987, 138 patients with breast cancer unsuitable for primary tumorectomy received initial external radiotherapy (45 Gy/25f/35d) in order to reduce the tumor volume so that secondary limited surgery could be performed. There were 81 T2 and 57 T3. Fifty-seven percent of the patients had a tumor larger than 4.5 cm. After completion of the radiotherapy, 22 patients (16%) showed no more evidence of a tumor either clinically or radiologically and received a boost of 25 Gy. In 52 cases (38%) the tumor regression allowed for secondary tumorectomy followed by a boost of 20 Gy. Sixty-four patients (46%) showed either little or no tumor regression: radical surgery was performed in 14 cases (10%) and high dose boost curietherapy (37 Gy) in the 50 (36%) remaining patients who refused mastectomy. Breast conservation in good condition was thus obtained in 74 patients (54%). Sufficient tumor regression to allow secondary tumorectomy was more often observed in T2 than in T3, in poorly differentiated tumors or mucinous type, and in tumor with well defined mammographic aspects. Actuarial 5-year local control and disease-free survival rates after limited surgery were, respectively, 90% and 73%. No particular complications were observed after secondary tumorectomy. This therapeutic approach is encouraging in patients with large T2 and T3 breast tumors, but a longer follow-up is required to assess definitive conclusions.