[Asplenia in the Hodgkin's patient]

FEWER INDICATIONS AFTER SPLENECTOMY: Real therapeutic progress has been achieved over the last fifty years for patients with Hodgkin's disease known for their chronic immunodepression. Since the advent of effective chemotherapy protocols such as ABVD, and more recently intensive chemotherapy completed as needed with an autograft, splenectomy is no longer performed for therapeutic purposes but may be indicated for its contribution to diagnosis. STRATIFICATION OF RISK OF ASPLENISM: There remain however several questions concerning the infectious complications in these patients given chemotherapy and splenic radiotherapy. One of the objectives of this work was to propose a stratification of risk of asplenism as a function of treatments administered, the level of initial immunodepression, and the age of the patient.

[Standards, options, and recommendation for external radiotherapy of prostatic cancer: evaluation of the effect of dosage]

CONTEXT

The "Standards, Options and Recommendations" (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical speciality societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by critical appraisal by a multidisciplinary group of experts. Draft guidelines are produced, then validated by specialists in cancer care delivery.

OBJECTIVES

Produce clinical practice guidelines for the radiotherapy of prostate cancer using the methodology developed by the Standards, Options and Recommendations project.

METHODS

The FNCLCC and the French Urology Association (AFU) designated the multidisciplinary group of experts. Available data were collected by a search of Medline and lists selected by experts in the group. A first draft of the guidelines was written, they validated by independent reviewers.

RESULTS

The main recommendations are: 1/ a minimal dose of 70 Gy must be used, whatever the prognostic factors; 2/ it appeared that patients with favourable prognostic indicators (stage T1-2, PSA < or = 10 micrograms/L and Gleason score < or = 6) do not benefit from a dose escalation effect for doses over 70-74 Gy; 3/ patients with intermediate prognosis are the ones who benefit most from the dose escalation effect over 74 Gy, provided they receive exclusive radiation therapy; 4/ whenever possible, patients should be included in controlled trials designed to assess the effects of dose escalation and hormonotherapy.

[Standards, Options, and Recommendations for brachytherapy in patients with prostate cancer: efficacy and toxicity]

CONTEXT

The "Standards, Options and Recommendations" (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical specialty societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by a critical appraisal by a multidisciplinary group of experts. Draft guidelines are produced, then validated by specialists in cancer care delivery.

OBJECTIVES

Produce clinical practice guidelines for the brachytherapy of prostate cancer using the methodology developed by the Standards, Options and Recommendations project.

METHODS

The FNCLCC and the French Urology Association (AFU) first designated the multidisciplinary group of experts. Available data were collected by a search of Medline and lists selected by experts in the group. A first draft of the guidelines was written, they validated by independent reviewers.

RESULTS

The main recommendations are: 1/Brachytherapy with permanent seeds alone is a possible curative treatment for prostate cancer patients with the following prognosis factors: tumour stage T1 or T2a (TNM 1992), Gleason score < or = 6 and PSA < 10 micrograms/L. 2/Combined treatment with brachytherapy and hormonal therapy could be more efficient than brachytherapy alone for prostate cancer patients with Gleason score > 7 and/or PSA > 10.3/Combination of brachytherapy and external beam radiation therapy can be proposed to prostate cancer patients with intermediate prognosis. 4/Before and after seed implantation, risks of infection must be prevented by appropriate antibiotic therapy (recommendation). 5/Brachytherapy must not be performed within 2 months of transurethral prostate resection. 6/The height of the urethra receiving more than 200% of the prescribed dose must be reported. The portion of the rectum receiving 100 and 120% of the prescribed dose must be limited to 10 and 5 mm length, respectively.

[Isolated peritoneal metastases from an lobular infiltrating breast carcinoma. Value of laparoscopy]

The authors report a case of peritoneal metastasis from an infiltrating lobular carcinoma of the breast. This case report enhances the frequency of this type of secondary location in the lobular carcinoma, with special attention to the diagnostic problems.

[Granulocytic sarcoma of the testis without hematological manifestations]

A 30-year-old man with a testicular tumor ressembling a "round cell sarcoma" was treated for rhabdomyosarcoma. Complete remission was achieved but the patient relapsed and died of the disease. A retrospective diagnosis of granulocytic sarcoma was established using an anti-myeloperoxidase antibody, unfortunately not available at the time of the initial diagnosis. No hematological disorders were observed during the course of the disease. Four cases of granulocytic sarcoma of the testis have been reported in the literature. All these cases where accompanied or followed by leukemia. The present case seems to be the first case of granulocytic sarcoma of the testis not accompanied by hematological disorders.

Peripheral primitive neuroectodermal tumour after allogeneic bone marrow transplantation

We report a case of peripheral primitive neuroectodermal tumour (PNET) in a 36-year-old man who 10 years earlier received an allogeneic bone marrow transplantation (BMT) for a non-Hodgkin's lymphoma. Immunohistochemistry proved definitive elimination of a relapse of the original disease and confirmed the diagnosis of PNET. The role of total body irradiation pre-BMT in the genesis of this secondary tumour is discussed. The importance of registering secondary malignant solid tumours after BMT is emphasized. To our knowledge, an Ewing family tumour following BMT has not previously been reported.

[Small cell carcinoma of the prostate. Complete remission after chemoradiotherapy: apropos of a case]

The authors report a case of pure small cell carcinoma of the prostate expressing neuroendocrine markers on immunohistochemistry. Treatment consisted of chemotherapy with cisplatin and etoposide combined with regional external beam radiotherapy. The result is encouraging with complete remission 15 months after the diagnosis.

[Mature teratomas of testicular origin. Discussion of 12 cases]

Between 1979 and 1989, 135 patients with a non-seminomatous germ cell tumour of the tests were treated in the Val de Grâce Military Hospital in Paris. In twelve patients, histological examination of a residual mass after chemotherapy revealed the presence of mature teratoma. Although this tumour, considered to be benign, generally represents a favourable form of the initial tumour, it nevertheless has a potential for progression. The possibility of long-term recurrences, which are sometimes difficult to eradicate, justifies very careful long-term surveillance of these patients. The authors report three particularly demonstrative cases and present a review of the literature.

[Value of adrenaline in opaque arthrography of the knee. Comparative study of 100 cases]

A prospective study evaluated efficacy of adrenaline in image improvement of opaque arthrography of knee. Of the 100 cases assessed, adrenaline was combined with contrast medium in 50%. Quality of images was compared by double reading of couples of images taken at end of examination. Marked improvement was observed in 2 of 3 cases and it is proposed to use adrenaline routinely to prolong quality of initial arthrogram.

[Knee pain of rare etiology]

A case of chronic knee pain of rare etiology is reported. Conventional radiographs excluded any articular pathology but ultrasound images showed features typical of a transsonic type tumor. Pathologic examination was necessary to establish the diagnosis, the tumor being an Antoni type A schwannoma.

[Comparative study of computed x-ray tomography and saccoradiculography in the diagnosis of early lumbar disk herniation. Apropos of 50 surgically-proven cases]

Comparison of diagnostic accuracy using the two methods showed scanner imaging to provide superior results, with confirmation of herniated disc in 90 p. 100 cases based on purely discal semiological features. Limitations of the method result from the absence of epidural fat (narrow lumbar canals). A new hierarchy of radiological explorations in resistant lumbosciatica is proposed.