Nemetallah A. Ghossein

The value of aspiration cytology in the diagnosis of breast cancer: Experience at the fondation curie

Aspiration cytology was performed on 2772 breast masses, all of which subsequently had open biopsies. Of the 1745 histologically malignant tumors, 1539 (88%) had a concordant cytologic diagnosis: 54 (0.3%) were diagnosed as probably malignant; 63 (3.6%) were false negatives; and 80 (0.5%) had inadequate smears for diagnosis. Of the histologically benign lesions, 916 (89%) had a concordant cytology: only 3 (0.3%) were false positives; cancer was suggested in 42 (0.4%); and the smears were inadequate in 66 cases (6.4%). Very small or very large sized cancer and a high degree of differentation were major causes of false negative aspirates. Recurrent tumors in those breasts exclusively treated by radiotherapy were documented by cytology in 56 of 69 cases (78%). Aspiration cytology is highly reliable when the diagnosis of cancer is made, but should be ignored if no malignant cells are observed.

Experience of the curie institute in treatment of cancer of the mobile tongue. I. Treatment policies and result

Six‐hundred‐two patients were treated for cancer of the mobile tongue between 1959 and 1972. Sixteen percent had T1, 48% T2, and 36% T3 lesions. Sixty‐four percent had no palpable nodes (N0). The primary was treated in the majority of patients by radium implant alone or in association with external radiotherapy. Nodes were treated primarily by surgery. Absolute and determinate survivals at five years are 36% and 48%. Determinate survivals for T1, T2 and T3 tumors are 80%, 56%, and 25%. Fifty‐nine percent of those with clinically negative neck nodes survived five years. Recurrence at the primary site alone or associated with neck failure is 14% for TI, 22% for T2 and 29% for T3. Seventy percent of recurrences occurred within one year. Although 13% of patients who had recurrences at the primary site were alive at five years, 33% of those who had salvage surgery were rescued. Two percent of patients required surgery for radiation necrosis.

The outcome of treatment by tumorectory and radiotherapy of patients with operable breast cancer

Abstract We performed a retrospective study on 314 patients treated for a localized breast cancer by tumorectomy and radiotherapy to determine the overall survival, incidence of loco-regional failure and outcome of salvage surgery. All patients were followed for at least three years. Two hundred and fourteen patients had tumors ≤ 3 cm and 74 had tumors ≤ 6 cm. The three and five years absolute survival, free of disease (NED), is 88% ( 276 314 ) and 84% ( 190 225 ). The incidence of loco-regional failures was not dependent on tumor size and did not exceed 10% for the entire group. Recurrences were common (35%) in young patients (≤ 30). No patient older than 50 had recurrences. Eighty-one percent of failures appeared within three years. Salvage surgery was performed on 78% ( 14 18 ) of patients with recurrences; 57% ( 8 14 ) were free of disease (NED). Local failure in this group was not necessarily associated with disseminated cancer. Tumorectomy followed by radiotherapy is an acceptable alternative to mastectomy, particularly since salvage surgery can usually be successfully performed for recurrences.

Results of radical radiotherapeutic treatment of carcinoma of the pyriform sinus: Experience of the Institut Curie

Abstract Four hundred and thirty-four consecutive male patients received radical megavoltage radiotherapy for a squamous cell carcinoma of the pyriform sinus between 1958 and 1974. Those who had lateral epilaryngeal cancers were excluded since these tumors have a better prognosis. Cytological examination confirmed that 79 % of patients had T3 disease and 72 % had clinically involved metastatic nodes. The overall absolute and determinate survival at three years was 26% and 47%, and at five years 19% and 41%, respectively. The fact that the determinate survival is significantly better than the absolute survival is an indication that a sizable number of patients died of causes other than their primary tumor. Over half developed locoregional failure and could not be salvaged by surgery. Local control for patients with early stage cancer (T1−T2) who received less than 6500 rad was only 36 % ; it was 65 % for those who received higher doses. There was no significant improvement with increasing doses for advanced disease (T3). Nodal control was improved with increasing radiation doses for nodes ≤ 3 cm as well as for nodes > 3 cm. The incidence of fatal radiation complication was 2.5%. Pyriform sinus cancer is the most lethal tumor of the head and neck region. The majority of patients will present with advanced primary tumors and/or with massive neck metastasis. The results achieved in advanced stages (T3, N2, N3) are universally poor, regardless of the treatment modality used. Patients with early stages should have an improved local control if adequate radiotherapy is administered. Prevention and early diagnosis, at present, appear to be the only hope in improving the dismal survival.

Desmoid tumors in adults: The role of radiotherapy in their management

Twenty-six adult patients with the pathologic diagnosis of desmoid tumor were treated between 1964 and 1983 at the Institut Curie in Paris with megavoltage irradiation. Twenty of these patients (76 percent) had extraabdominal tumors. Definitive surgical resection was performed on nine patients (one received preoperative radiotherapy). At last follow-up 1 1/2 to 10 years after treatment, all of the patients had no evidence of disease. Seven of the nine had follow-up examinations from 5 to 10 years after treatment. Seven patients had postoperative radiotherapy with doses from 4,700 to 6,500 rads (47 to 65 Gy) for either microscopic (three patients) or gross (four patients) residual disease. All but one patient had no evidence of disease from 2 to 8 years after treatment. Nine patients had radiotherapy for recurrent inoperable tumors and six had no evidence of disease from 3 to 20 years after treatment. Recurrences developed in three patients; outside the treatment portal in one, and the other two had received less than 5,000 rads (50 Gy). Clinical regression of tumors after treatment was slow, with complete regression taking up to 2 years. Postoperative radiotherapy with doses of at least 5,000 to 6,000 rads (50 to 60 Gy) was effective in achieving local control of inoperable or incompletely resected tumors, thus the need for repeated resections was avoided. Computerized tomography has greatly improved the assessment of tumor extension and should be used routinely before either operation or radiotherapy to obtain adequate margins and minimize the chance of missing disease.

Experience of the curie institute in treatment of cancer of the mobile tongue. II. Management of the neck nodes

Treatment of neck nodes of 602 patients with cancer of the mobile tongue was mainly surgical. Three‐hundred‐eighty‐three (64%) were clinically N0, and 244 had elective neck dissection. Thirty‐four percent (84/244) had occult metastasis. Thirteen percent (33/244) had major nodal involvement (>3N+ and/or extracapsular spread) and received postoperative radiotherapy. Twenty‐one percent (7/33) recurred in the neck. Thirty‐six percent (12/33) were alive, NED, at five years.

Treatment of supraglottic cancer by radical high dose radiotherapy

Megavoltage radiotherapy was used as a treatment in 218 patients with supraglottic cancer. Forty‐five percent had positive nodes and 43% had extralaryngeal disease. Absolute 3‐ and 5‐year survival for T1‐T2 was 70 and 60%; for T3‐T4 lesions it was 42 and 35%. Differences in survival between patients with negative nodes and those with mobile nodes was unremarkable. One percent recurred in the neck when there was no palpable node initially. Ninety‐five percent of mobile nodes were controlled when the primary was cured. The most common failure site was the larynx. Neither subglottic extension nor specific sites of extralaryngeal involvement worsened the prognosis. Eight had major radiation complications, 1 fatal, 7 requiring tracheotomy. Twenty‐five had surgery for recurrence, and 7 were salvaged. Our present policy is radiotherapy for early tumors, and for T4, if more than total laryngectomy is required. Surgery is reserved for radiation failure and often for advanced disease limited to larynx.

Elective postoperative radiotherapy after incomplete resection of colorectal cancer

It is known that patients with incompletely resected epithelial cancers are at high risk of local recurrence. A prospective study to determine whether elective postoperative radiotherapy can decrease the incidence of local recurrence and thus improve survival of those patients with an incompletely resected tumor was made of 125 irradiated patients with locally advanced colorectal cancer (B2 C1, C2) 78 patients had rectosigmoid tumors and 47 had colonic cancers. Complete resection (R0) was performed in 94 patients (75 per cent). Thirteen (10 per cent) had microscopic (R1) and 18 (14 per cent) had gross residual disease (R2).Local control and survival (average follow-up, 38 months) of patients with microscopic residual cancer (R1) were 84 per cent (11/13) and 77 per cent (10/13) respectively. These results were identical to those obtained in patients without residual disease (R0). Patients with gross residual disease (R2) had a local control of 50 per cent (9/18) and a survival of 39 per cent (7/18). Radiation complication occurred in seven of 125 patients (6 per cent). One patient died, of radiation enteritis. One patient required a nephrostomy. The remaining five patients were treated conservatively. Elective postoperative radiotherapy given to patients who had incomplete resection of a colorectal cancer prevented local recurrence in the majority and may have increased survival.

Local control and site of failure in radically irradiated supraglottic laryngeal cancer

The local control and complications after radical irradiation were analyzed in 203 patients with supraglottic cancer, using time-dose scattergrams and nominal standard dose (NSD). A dose-response curve was obtained for early (T-1, T-2) tumors but was not demonstrated in advanced neoplasms (T-3, T-4). All nodes less than 2.5 cm in diameter were controlled with 7,000 rads. Of the early lesions 89% were controlled with 7,700 rads in six weeks. Over 85% of the involved nodes were controlled when the primary was cured. The incidence of major complications did not exceed 7%.

Primary management of operable breast cancer by minimal surgery and radiotherapy

109 cases of breast cancer were treated by tumorectomy and radiotherapy or radiotherapy alone. Almost 30% with small tumors (T1, T2) were considered inoperable for medical reasons and 70% refused mastectomy. Over the past five years the number of patients refusing mastectomy has definitely increased. 49 cases of surgically resectable cancers (T1, T2, T3, NO, N1) had a minimum followup of two years (average 4 years ± 3 months). Absolute and determinate survivals NED were 65% and 86%. There were four local recurrences (8%). Secondary mastectomy could be performed on three. Microscopic involvement of the surgical margin by cancer did not alter the local control rate. The cosmetic results were good in 98%. Gross removal of the tumor followed by radiotherapy may be offered as an alternative to mastectomy in patients with operable breast cancer. Cancer 42:2054–2058, 1978.