Publication date: Available online 11 December 2015
Source:Cancer/Radiothérapie
Author(s): F. Stubbe, A. Agaimy, O. Ott, S. Lettmaier, N. Vassos, R. Croner, W. Hohenberger, R. Fietkau, S. Semrau
PurposeThere is a sound theoretical basis but little clinical evidence substantiating the benefits of concurrent chemoradiotherapy with two-drug chemotherapy for locally advanced soft tissue sarcomas. Our five-year data on the feasibility and effectiveness of neoadjuvant chemoradiotherapy with systemically effective doses of adriamycin and ifosfamide combined is presented here.Patients and methodsBetween 2000 and 2011, 53 patients with UICC (2010) stage I (n=1, 1.9%), II (n=12, 22.7%) or III (n=40, 75.5%) nonmetastatic soft tissue sarcoma received neoadjuvant chemoradiotherapy with ifosfamide (1.5g/m2/day, d1–5, q28) and doxorubicin (50mg/m2/day, d3, q28) plus concurrent radiotherapy with a target dose of 50–64Gy (median 60Gy). The treatment of 34 patients (64.2%) was combined with hyperthermia.ResultsAt five years, the local control rate was 89.9% (±5.7%), distant metastasis-free survival 66.6% (±7.6%), and survival 83.3% (±6%). The R0 resection rate was 81.1%. Radiotherapy was completed as planned in all patients and chemotherapy in 42/53 (70.2%). Grades III (n=21, 29.6%) and IV (n=18, 34%) leukopenia was the main acute adverse event. All acute and chronic non-hematologic toxicities were moderate.ConclusionNeoadjuvant chemoradiotherapy for soft tissue sarcoma is associated with good feasibility, manageable acute and late toxicities, and high local efficacy.
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Cancer Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Σάββατο 19 Δεκεμβρίου 2015
Effective local control of advanced soft tissue sarcoma with neoadjuvant chemoradiotherapy and surgery: A single institutional experience
Editorial Board
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
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Issue Contents
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
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Respect de l’étalement de la radiothérapie à visée curative : étude prospective
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): C. Petit, A. Suissa, A. Finet, A. Comte, B. Soltys, C. Daveau, D. Ali, B. Dessard-Diana, P. Giraud, M. Housset, C. Durdux
Objectif de l'étudeÉvaluer le respect de l'étalement théorique dans une cohorte de 185 patients consécutifs recevant une irradiation à visée curative et les raisons de son allongement. Proposer des actions correctives.Matériel et méthodesÉtude prospective unicentrique incluant tous les patients recevant irradiation à visée curative, quelle que soit la localisation tumorale, du 1er décembre 2013 au 28 février 2014, sur les trois accélérateurs du centre. Les motifs de non-réalisation d'une séance ont été recueillis prospectivement. L'analyse a pris en compte les paramètres suivants : âge, sexe, activité professionnelle, temps et mode de transport, localisation anatomique de la tumeur traitée, dose de radiothérapie, chimiothérapie concomitante, hospitalisation, poste de traitement.RésultatsCent quatre-vingt-cinq patients ont été inclus (183 évaluables, deux n'ayant pas terminé le traitement). L'étalement théorique a été respecté pour 31 patients (17 %). Il était en moyenne allongé de 4,6jours (j) (0–29j ; médiane : 3). Le nombre moyen de séances décalées était de 3,4 séances (0–17 séances ; médiane : 2 séances). Les motifs du décalage étaient : panne 32,2 % ; maintenance 29,3 % ; jour férié 11 % ; toxicité du traitement 9,4 % ; planification inadéquate 8,6 % ; autre maladie 3,9 % ; refus de traitement 2,1 % ; convenance personnelle 1,5 % ; refus d'attente 0,8 % ; transport 0,3 % ; défaut de communication 0,3 % ; autre 0,6 %. Deux paramètres ont eu un impact significatif sur l'étalement théorique : le poste de traitement, en raison de la survenue de pannes (p<0,001) et le temps de transport (supérieur ou inférieur à 40min, p=0,022). Respectivement 138 (75 %) et 79 patients (43 %) ont été pris en charge un ou plus de deux samedis. Le traitement le samedi a réduit significativement l'étalement de 1,9j (p<0,001).ConclusionL'étalement a été bien respecté à l'exclusion des pannes et des maintenances. Leur impact sur l'étalement est minimisé par l'ouverture systématique du plateau technique le samedi.PurposeTo assess the overall treatment time of radiotherapy delivered with curative intent in a cohort of 185 consecutive patients and the causes of this possible delay. If delay, to propose corrective actions.Materials and methodsWe report a single-center prospective study including all consecutive patients receiving a radiation therapy with curative intent, from 1st December 2013 to 28th February 2014, on the three linear accelerators of the radiotherapy department. For each fraction missed, the causes of non-completion were prospectively collected. This analysis took into account the following parameters: age, sex, occupation, transport type and duration, tumour localization, radiation dose, concomitant chemotherapy, hospitalization, type of linear accelerator.ResultsOne hundred and fifty-five patients were included in the study (183 evaluable, two did not complete treatment). The overall treatment time was respected for 31 patients (17%). It was lengthened on 4.6 days (d) (0–29d; median: 3d). The mean number of delayed fractions was 3.4 (0–17; median: 2). The reasons of delay were: breakdown 32.2%; maintenance 29.3%; holiday 11%; treatment toxicity 9.4%; inadequate planning 8.6%; other disease 3.9%; treatment refusal 2.1%; unspecified personal reasons 1.5%; refusal to wait 0.8%; transportation 0.3%; error of communication 0.3%; other 0.6%. Two parameters had a significant impact on the overall treatment time: the type of linear accelerator in relation to breakdown occurrence (P<0.001) and transportation duration (more or less than 40min, P=0.022). One hundred and thirty-eight patients (75%) and 79 patients (43%) were treated on one or more than two Saturdays. Treatment on Saturday significantly reduced the overall treatment time (median, 1.9d; P<0.001).ConclusionThe overall treatment time was globally respected excluding break down and maintenance. Their impact on the overall treatment time is minimized by the systematic opening of the department on Saturdays.
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What to expect from immediate salvage hysterectomy following concomitant chemoradiation and image-guided adaptive brachytherapy in locally advanced cervical cancer
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): P. Castelnau-Marchand, C. Chargari, R. Bouaita, I. Dumas, G. Farha, L. Kamsu-Kom, E. Rivin del Campo, F. Martinetti, P. Morice, C. Haie-Meder, R. Mazeron
PurposeConcomitant chemoradiation followed by brachytherapy is the standard treatment for locally advanced cervical cancers. The place of adjuvant hysterectomy remains unclear but tends to be limited to incomplete responses to radiotherapy or local relapse. The aim was to analyse the benefit from immediate salvage surgery following radiation therapy in incomplete responders.MethodsAmong the patients with locally advanced cervical cancer treated with concomitant chemoradiation followed by 3D image-guided adaptive brachytherapy and hysterectomy, cases with genuine macroscopic remnant, defined as at least 1cm in width, were identified. Their clinical data and outcomes were retrospectively reviewed and compared to the patients treated with the same modalities.ResultsFifty-eight patients were included, with a median follow-up of 4.2 years. After hysterectomy, 9 patients had macroscopic residual disease, 10 microscopic and the remaining 39 patients were considered in complete histological response. The 4-year overall survival and disease-free survival rates were significantly decreased in patients with macroscopic residual disease: 50 and 51% versus 92% and 93%, respectively. Intestinal grades 3–4 toxicities were reported in 10.4% and urinary grades 3–4 in 8.6% in the whole population without distinctive histological features. Planning aims were reached in only one patient with macroscopic residuum (11.1%). In univariate analysis, overall treatment time (>55 days) and histological subtype (adenocarcinomas or adenosquamous carcinomas) appeared to be significant predictive factors for macroscopic remnant after treatment completion (P=0.021 and P=0.017, respectively). In multivariate analysis, treatment time was the only independent factor (P=0.046, odds ratio=7.0).ConclusionsAlthough immediate salvage hysterectomy in incomplete responders provided a 4-year disease-free survival of 51%, its impact on late morbidity is significant. Efforts should focus on respect of treatment time and dose escalation. Adenocarcinoma might require higher high-risk clinical target volume planning aims.
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Médulloblastomes de l’adulte : étude rétrospective portant sur 21 patients
Publication date: Available online 17 December 2015
Source:Cancer/Radiothérapie
Author(s): C. Vigneron, D. Antoni, A. Coca, C. Niederst, D. Jarnet, P. Meyer, P. Kehrli, G. Noël
Objectif de l'étudeAnalyse rétrospective des résultats obtenus chez 21 adultes pris en charge pour un médulloblastome.Patients et méthodesEntre 1978 et 2011, 21 adultes âgés en moyenne de 31ans (18,3–50) ont été opérés puis irradiés (n=20) au centre de lutte contre le cancer de Strasbourg pour un médulloblastome. Pour 12 patients, la stratégie thérapeutique a comporté de la chimiothérapie.RésultatsAvec une surveillance en moyenne de 122 mois (19–423), six rechutes et sept décès ont été observés. Les taux de survie globale à 5ans et à 10ans étaient de 89,4±7,1 % pour les deux. Les taux de survie sans récidive à 5ans et à 10ans étaient respectivement de 79,6±9,2 % et 85,7±7,6 % et 60,6±17,7 %.ConclusionCe rapport d'expérience permet de souligner l'importance pour ce type de pathologie rare de la mise en place d'essais prospectifs multicentriques et d'une prise en charge multidisciplinaire en milieu spécialisé.PurposeRetrospective analysis of the results of 21 adults treated for medulloblastoma.Patients and methodsBetween 1978 and 2011, 21 adults with an average age of 31years (18.3–50) were treated with surgery then with radiotherapy (n=20) at the Comprehensive Cancer Center of Strasbourg. For some (n=12), treatment consisted of chemotherapy.ResultsAfter a mean follow-up of 122months (19–423), six relapses and seven deaths were observed. Overall survival at 5years and 10years was 89.4±7.1% for both. Disease-free survival at 5years and 10years was 79.6±9.2% and 85.7±7.6% and 60.6±17.7%, respectively.ConclusionThe rarity of medulloblastoma, especially in adults and these results confirm the necessity of international protocols.
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Résultats du traitement du médulloblastome à Casablanca de 2000 à 2012
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): M. Elbachiri, A. Dao, H. Jabir, S. Sahraoui, A. Taleb, Z. Bouchbika, N. Benchakroun, H. Jouhadi, N. Tawfiq, A. Benider
ObjectifDécrire les différents aspects cliniques, thérapeutiques et pronostiques des médulloblastomes chez l'adulte et l'enfant afin de contribuer à l'amélioration de la prise en charge des patients.Matériel et méthodesÉtude rétrospective de 69 cas de médulloblastomes colligés au centre hospitalier universitaire Ibn-Rochd de Casablanca entre 2000 et 2012.RésultatsCinquante-trois enfants d'âge moyen de 9ans et 16 adultes d'âge moyen de 32,4ans ont été inclus dans l'étude. Trente-sept médulloblastomes chez les enfants et huit chez les adultes ont été classés de haut risque. La dose de radiothérapie a été de 35 à 36Gy dans le névraxe et 54Gy dans la fosse cérébrale postérieure. Tous les enfants et dix adultes ont reçu une chimiothérapie concomitante, 44 enfants et quatre adultes une chimiothérapie adjuvante. Une récidive tumorale a été observée chez 17 enfants après en moyenne 38 mois et chez cinq adultes après en moyenne 42 mois. La fosse cérébrale postérieure a été le site principal de récidive. La probabilité de survie globale à 3ans était de 78 % pour les enfants et de 61 % pour les adultes (p=0,53). Elle était meilleure (70 % contre 25 %) lorsque le temps écoulé entre la chirurgie et la radiothérapie était inférieur à 40jours dans le groupe pédiatrique. Le taux de récidive était de 41 % pour les médulloblastomes de haut risque et de 13 % pour ceux de risque standard, et les probabilités de survie globale respectivement de 37,5 % et 100 %.ConclusionLes survies globales et celles sans récidive obtenues sont encourageantes. Les groupes à risque et les temps écoulés entre la chirurgie et la radiothérapie étaient des facteurs pronostiques significatifs de la survie selon le groupe d'âge. Nous recommandons la réduction de ces délais afin d'améliorer ces résultats thérapeutiques.PurposeTo describe the therapeutic results, with the aim to contribute to improving the care of patients with medulloblastoma.Patients and methodsA retrospective study of 69 cases of medulloblastoma collected in the university hospital Ibn Rochd of Casablanca between 2000 and 2012.ResultsFifty-three children with an average age of 9 years and 16 adults with an average age of 32.4 years were included in the study. Thirty-seven children and eight adults suffered from a high-risk tumour. The radiotherapy was received by all patients with a mean dose of 36Gy to the whole brain and 54Gy in the posterior fossa. All patients in the paediatric group and 10 patients in the adult group received concomitant chemotherapy, 44 children and four adults received adjuvant chemotherapy. Tumour recurrence was observed in 17 children after a mean follow-up period of 38 months. These recurrences were observed in five adults after a mean follow-up period of 42 months. The posterior fossa was the main site of relapses. Overall survival was 77.7% for the children and 61% for the adults. Overall survival was better (70% versus 25%) when the interval between radiotherapy and surgery was less than 40 days in the paediatric group. The recurrence rate was significantly higher for the high-risk group: 41% versus 13% for the standard risk. In the adult group, overall survival differences according to the risk group were significant (100% for the standard risk versus 37.5% for the high risk).ConclusionThe overall survival and recurrences rate obtained are encouraging. The risk group and time between surgery and radiotherapy were prognostic factors with significant impact on survival depending on the age group. We recommend reducing these times to improve therapeutic results.
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Prise en charge et devenir des patients de plus de 80ans atteints d’un cancer du rectum, en région Provence-Alpes-Côte-d’Azur de 2006 à 2008
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): L. Moureau-Zabotto, J. Gal, M. Resbeut, L. Mineur, É. Teissier, X. Hébuterne, P. Muyldermans, É. Francois, E. Chamorey, J.-P. Gérard
Objectif de l'étudeCette étude rétrospective a évalué les modalités de prise en charge et le pronostic des cancers du rectum chez le sujet âgé en comparaison avec ceux des sujets plus jeunes.Patients et méthodesLes données de 160 patients de plus 80ans, ayant reçu un traitement pour un cancer du rectum diagnostiqué entre 2006 et 2008, en région Provence-Alpes-Côte-d'Azur, indépendamment du stade et du traitement de la maladie ont été analysées rétrospectivement. Les taux de survie globale et sans rechute ont été corrélés avec les caractéristiques de la tumeur et les traitements administrés. Le traitement administré a ensuite été comparé aux standards thérapeutiques recommandés pour les patients plus jeunes.RésultatsAvec 36 mois de suivi médian, les taux de survie globale et sans rechute à 3ans étaient respectivement de 59,2 % et 76,6 % pour les 117 patients ayant reçu un traitement à visée curative. En analyse multifactorielle, la survie globale était indépendamment influencée par le statut N et l'exérèse chirurgicale, alors que la survie sans rechute était influencée par l'âge, le statut N, et le sexe. Les tumeurs de stade T0–T2 ont été traitées conformément aux recommandations pour les patients plus jeunes, avec respectivement des taux à 3ans de 83,6 % et 95,2 % de survie globale et de survie sans rechute. Pour les patients atteints de tumeur de stade T3–T4, le taux de survie sans rechute à 3ans était de 65 %, malgré une stratégie moins agressive.ConclusionSous réserve d'une bonne évaluation oncogériatrique, la chirurgie reste le standard de traitement des tumeurs localisées (de stade T0–T2) des patients âgés. Pour les tumeurs localement évoluées (de stade T3–T4), les résultats obtenus dans cette étude suggèrent qu'une approche conservatrice pourrait être envisagée.PurposeRectal cancer is increasingly prevalent in elderly patients. Their clinical history and outcome after treatment are poorly described. This retrospective study was undertaken to provide more data and to compare therapeutic strategies to the standard of care for younger patients.Patients and methodsPatients concerned were aged 80 years or older, with a rectal cancer diagnosed between 2006 and 2008 and treated in Provence-Alpes-Côte-d'Azur (PACA), irrespective of stage and treatment of the disease. Overall survival and relapse-free-survival were correlated with patients' characteristics and treatment. The adopted therapeutic strategy was then compared to the standard-of-care for younger patients.ResultsWith a median follow-up of 36 months, among the 160 patients included, the 3-year overall survival and relapse-free survival were 59.2% and 76.6%, respectively for the 117 patients who received a treatment with curative intent. In the multivariate analysis, node status and surgery independently influenced overall survival, while relapse-free survival was influenced by age, N status, and gender. For T0–T2 tumours, patients were treated similarly to younger patients with an overall survival of 83.6% and a relapse-free survival of 95.2%. For T3–T4 tumours, the 3-year relapse-free survival was 65%, even with a less aggressive strategy.ConclusionSurgical resection after evaluation using the Comprehensive Geriatric Assessment (CGA) test should be the standard treatment for localized rectal cancer (T0–T2) in elderly patients, as it is in younger patients. For locally advanced lesions (T3–T4), results obtained after a conservative approach suggest that a non-surgical strategy can be used in elderly patients.
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Comparaison entre arcthérapie volumétrique modulée et tomothérapie pour le cancer du col utérin, avec irradiation lomboaortique
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): S. Renard-Oldrini, L. Guinement, J. Salleron, C. Brunaud, S. Huger, N. Grandgirard, N. Villani, V. Marchesi, G. Oldrini, D. Peiffert
Objectif de l'étudeLa radiothérapie conformationnelle avec modulation d'intensité (RCMI) pour les cancers du col utérin a prouvé sa supériorité dosimétrique en termes de toxicité digestive, comparativement à la radiothérapie conformationnelle non modulée. L'arcthérapie volumétrique modulée a montré son intérêt dosimétrique comparativement à la RCMI à faisceaux statiques. L'objectif de notre étude était de comparer arcthérapie volumétrique modulée et tomothérapie pour des cancers du col utérin avec irradiation lomboartique.Patientes et méthodesLes dosimétries à 45Gy de dix patientes ont été comparées entre les deux techniques (arcthérapie volumétrique modulée et tomothérapie) ainsi qu'avec la radiothérapie conformationnelle non modulée, avec recueil de la dose reçue par les volumes cibles prévisionnels, les reins, l'intestin, le rectum, la vessie, la moelle osseuse et la moelle épinière, ainsi que la dose intégrale.RésultatsUne différence significative a été observée en faveur de l'arcthérapie volumétrique modulée et de la tomothérapie sur la radiothérapie conformationnelle non modulée pour l'épargne intestinale (volumes recevant respectivement 20, 30 et 45Gy :V20 Gy, V30 Gy et V45 Gy), rectale (V30 Gy et V45 Gy), vésicale (V30 Gy et V45 Gy) et rénale (volume recevant 12Gy [V12 Gy], dose moyenne, V20 Gy). Les volumes recevant 20, 30 et 45Gy étaient significativement plus grands avec la radiothérapie conformationnelle non modulée qu'avec l'arcthérapie volumétrique modulée et la tomothérapie. La différence était en faveur de la tomothérapie comparativement à l'arcthérapie volumétrique modulée pour le V12 Gy des reins et le V45 Gy de la vessie.ConclusionCette étude confirme l'intérêt des techniques d'arcthérapie volumétrique modulée et de tomothérapie pour l'irradiation pelvienne et lomboaortique des cancers du col comparativement à la radiothérapie conformationnelle non modulée. Il y avait peu de différence entre l'arcthérapie volumétrique modulée et la tomothérapie, en dehors d'une meilleure épargne rénale avec la tomothérapie, ce qui peut être intéressant pour des patientes recevant des chimiothérapies néphrotoxiques.PurposeIntensity-modulated radiotherapy (IMRT) has proven its dosimetric superiority over conformational radiotherapy for cervix cancers in terms of digestive toxicity. Volumetric modulated arctherapy (VMAT) has shown its dosimetric interest when compared to IMRT with static beams. The purpose of our study was to compare conformational radiotherapy, VMAT and tomotherapy for cervical cancers with para-aortic lymph nodes irradiation.Patients and methodsThe dosimetric data from ten patients were compared between the three techniques, with collection of the dose received by the planning target volume, kidneys, bowel, rectum, bladder, bone marrow and spinal cord, as well as the complete dose.ResultsThere was a significant difference in favour of VMAT and tomotherapy when compared with conformational radiotherapy for the organs at risk: intestines (V20 Gy, V30 Gy and V45 Gy), rectum (V30 Gy and V45 Gy), bladder (V30 Gy and V45 Gy) and kidneys (V12 Gy, Daverage, V20 Gy). Volumes receiving 20, 30 and 45Gy were significantly higher in conformational radiotherapy than in VMAT and tomotherapy. There was a significant difference in favour of tomotherapy when compared with VMAT for V12 Gy in kidneys and V45 Gy in the bladder.ConclusionThis study confirms the interest of VMAT and tomotherapy for pelvic and para-aortic lymph nodes irradiation of cervix cancer when compared with conformational radiotherapy. There was little difference between VMAT and tomotherapy, except for kidney sparing, which was better with tomotherapy and thus may be interesting for patients receiving nephrotoxic chemotherapy.
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Chimioradiothérapie concomitante des cancers du sein inflammatoire, non métastatiques, non répondeurs à une chimiothérapie première
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): A. Bellière-Calandry, C. Benoît, S. Dubois, J. Moreau, J.-L. Achard, G. Loos, M.-A. Mouret-Reynier, I. Van Praagh-Doreau, P. Gimbergues, G. Lebouedec, C. Pomel, M. Lapeyre
Objectif de l'étudeAprès l'échec d'une chimiothérapie initiale d'un cancer du sein inflammatoire et lorsque la chirurgie est impossible, une chimioradiothérapie concomitante peut être proposée.Patientes et méthodesDix patientes atteintes d'un carcinome infiltrant ont reçu une chimioradiothérapie après l'échec de la chimiothérapie initiale entre 1996 et 2010, par sept cures d'antracyclines pour toutes, des taxanes pour six et du trastuzumab pour une. Toutes ont reçu une irradiation locorégionale de 50Gy par des photons de 6 à 15 MV, avec chirurgie de clôture si possible. Deux schémas de chimiothérapie concomitante ont été utilisés : cisplatine hebdomadaire pour six patientes, cisplatine et 5-fluoro-uracile, les semaines 1 et 5 de la radiothérapie pour quatre.RésultatsLe suivi moyen était de 44 mois. Neuf patientes ont pu avoir une mastectomie après la chimiothérapie. Le taux de survie globale était de 70 % à 2ans et de 60 % à 5ans. Six cancers ont récidivé localement après en moyenne de 5 mois. Il y a eu six décès, tous dus au cancer et sept évolutions métastatiques. La toxicité était une épithéliite de grade 1 pour six patientes, de grade 2 pour deux. Trois patientes ont souffert d'une insuffisance rénale de grade 2 et une d'une neutropénie de grade 2.ConclusionLa chimioradiothérapie concomitante des cancers du sein inflammatoire résistants à une chimiothérapie peut contrôler la maladie chez certaines patientes, et mener à une chirurgie de rattrapage. Pour confirmer ces résultats, une étude multicentrique avec un effectif plus important pourrait être réalisée.PurposeTo evaluate the surgical possibility following concomitant chemoradiotherapy for inflammatory breast cancer, after unsucessful neoadjuvant chemotherapy.Patients and methodsThe data from ten patients with inflammatory breast cancer treated between 1996 and 2010 by concomitant chemoradiotherapy after unsucessful neoadjuvant chemotherapy were analysed. All patients had an invasive carcinoma. All patients received a neoadjuvant chemotherapy, including anthracyclin, six patients received taxan and one received trastuzumab. Radiotherapy was delivered to the breast and regional lymph nodes in all patients at a dose of 50Gy; a boost of 20Gy was delivered to one patient. Concomitant chemotherapy was based on weekly cisplatin for six patients, on cisplatin and 5-fluorouracil the first and last weeks of radiotherapy for four patients.ResultsThe median follow-up for all patients was 44 months. Mastectomy was performed in nine patients. Two- and 5-year overall survival rates were respectively 70 % and 60 %. Median local recurrence delay was 5 months; six patients died (all from cancer), seven developped metastasis. Grade 1 and 2 epithelite was respectively observed in six and two patients, grade 2 renal toxicity in three patients, grade 2 neutropenia in one patient.ConclusionConcomitant chemoradiotherapy for inflammatory breast cancer after unsucessful neoadjuvant chemotherapy may control the disease in some patients and lead to mastectomy. These results have to be confirmed through a multicentric study with more patients.
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Lymphome de type MALT de la prostate : place de la radiothérapie. Observation et discussion
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): R. Coquard, J.-P. Dulac, P. Chalabreysse
Nous rapportons l'observation d'un patient ayant reçu un traitement, après résection endoscopique de prostate, par irradiation de 30,6Gy en 17fractions pour un lymphome de type MALT (mucosa-associated lymphoid tissue) de la prostate. Après 6ans de suivi, il était en vie sans récidive. Au vu de la littérature et de cette observation, une irradiation locale à visée curative devrait être proposée dans cette maladie rare.We report the case of a patient presenting with MALT (mucosa-associated lymphoid tissue) lymphoma of the prostate, who received an irradiation delivering 30.6Gy in 17fractions after transurethral resection. With a follow-up of 6years, he remained alive and free of disease. In view of the literature and this case report, definitive local irradiation should be administered in this rare disease.
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Neuroblastome néonatal, compliqué d’une hépatomégalie tumorale menaçante, traité par irradiation : absence de séquelle 20ans après
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): M. Doré, M.-A. Mahé, N. Corradini, C. Demoor-Goldschmidt
Nous rapportons ici le cas d'un nouveau-né ayant présenté un neuroblastome métastatique, de stade MS, compliqué d'une hépatomégalie menaçante, avec détresse respiratoire grave à 12jours de vie. Une radiothérapie hépatique de faible dose à visée décompressive a été réalisée en urgence. Une chimiothérapie a également été délivrée du fait d'une réévolution tumorale 1mois après la radiothérapie. Avec 20ans de recul, cette jeune femme est en situation de rémission complète persistante sans séquelles.In this article, we report the case of a newborn who presented a life-threatening hepatomegaly with respiratory distress at 12days of life, complicating a metastatic neuroblastoma. Low-dose liver radiotherapy was performed in emergency in order to decompress. Chemotherapy has also been delivered due to a tumoral relapse 1month after radiotherapy. After a follow-up of 20years, this young woman is still in complete remission, with no long-term sequelae.
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Léon Bouchacourt (1865–1949) : comment un obstétricien mit en évidence la radiosensibilité individuelle
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): N. Foray
Léon Bouchacourt (1865–1949) fut un pionnier de la radiologie et de la radiothérapie d'origine lyonnaise bien trop méconnu. Interne en obstétrique des hôpitaux de Paris en 1894, période pendant laquelle il rencontra Charcot, le futur explorateur polaire, il réalisa la première thèse de médecine concernant les rayons X. Il inventa une technique de radiographie des organes cavitaires comme le vagin, le rectum et la bouche, l'endodiascopie, qui lui permit de réaliser les toutes premières pelvimétries et radiographies dentaires en France. Alors qu'il effectuait déjà les premiers essais de contact-radiothérapie, il dut faire face aux réactions tissulaires radio-induites. En 1911, il publia le tout premier article sur la notion de radiosensibilité individuelle. Pendant la Première guerre mondiale, commandant de l'une des voitures radiologiques, il côtoya Irène Curie et développa la « bonnette » qui portera son nom et deviendra indispensable à la radiologie interventionnelle. Après-guerre, aux côtés de Béclère et de dix autres pionniers, Léon Bouchacourt fonda la Société française de radiologie. Il termina sa carrière en se passionnant pour la santé publique, les divers aspects de son métier et les devoirs du radiologue.Léon Bouchacourt (1865–1949) was a misknown pioneer of radiology and radiotherapy from Lyon, France. While he was resident in obstetrics in Hôpitaux de Paris from 1892 to 1898, he met Charcot, the future polar explorer, and wrote the first thesis dissertation about X-rays. He invented a new radiology technique for cavitary organs such as vagina, rectum and mouth, the endodiascopy, which permitted him to perform the first pelvimetry and dental radiographies in France. While he undertook the first trials of contact-radiotherapy, he was confronted with radiation-induced reactions. In 1911, he wrote the first paper about individual radiosensitivity. During the First World War, he commanded one of the radiology vehicles, he met Irène Curie and developed his « radiological helmet », which will hold his name and became essential for interventional radiology. After the war, with Béclère and ten others, Léon Bouchacourt funded the French Radiology Society. He ended his career by thinking about public health and the different aspects of the duties of radiologists.
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Tumeurs malignes ophtalmologiques : indications de la radiothérapie et techniques
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): P. Jardel, J.-P. Caujolle, L. Gastaud, C. Maschi, W. Sauerwein, J. Thariat
Les tumeurs malignes de l'œil sont des maladies rares, représentant environ 1 % de tous les cancers. Cet article pratique permet d'avoir un résumé épidémiologique, diagnostique et thérapeutique pour chacune des principales tumeurs malignes de l'œil, en insistant particulièrement sur les techniques de radiothérapie. Les différentes maladies étudiées sont les métastases orbitaires, les lymphomes intra-oculaires et annexiels de l'œil, les mélanomes uvéaux, les tumeurs malignes conjonctivales, les tumeurs malignes des paupières et les rétinoblastomes. Le dernier chapitre est consacré aux complications de la radiothérapie oculaire et à leur prise en charge.Malignant tumours of the eye are not common, barely representing 1 % of all cancers. This article aims to summarise, for each of the main eye malignant diseases, aspects of epidemiology, diagnostic methods and treatments, with a focus on radiation therapy techniques. The studied tumours are: eye metastasis, intraocular and ocular adnexal lymphomas, uveal melanomas, malignant tumours of the conjunctive, of the lids, and retinoblastomas. The last chapter outlines ocular complications of radiation therapy and their management.
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Paediatric brain tumours: A review of radiotherapy, state of the art and challenges for the future regarding protontherapy and carbontherapy
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): A. Laprie, Y. Hu, C. Alapetite, C. Carrie, J.-L. Habrand, S. Bolle, P.-Y. Bondiau, A. Ducassou, A. Huchet, A.-I. Bertozzi, Y. Perel, É. Moyal, J. Balosso
Background and purposeBrain tumours are the most frequent solid tumours in children and the most frequent radiotherapy indications in paediatrics, with frequent late effects: cognitive, osseous, visual, auditory and hormonal. A better protection of healthy tissues by improved beam ballistics, with particle therapy, is expected to decrease significantly late effects without decreasing local control and survival. This article reviews the scientific literature to advocate indications of protontherapy and carbon ion therapy for childhood central nervous system cancer, and estimate the expected therapeutic benefits.Materials and methodsA systematic review was performed on paediatric brain tumour treatments using Medline (from 1966 to March of 2014). To be included, clinical trials had to meet the following criteria: age of patients 18 years or younger, treated with radiation, and report of survival. Studies were also selected according to the evidence level. A secondary search of cited references found other studies about cognitive functions, quality of life, the comparison of photon and proton dosimetry showing potential dose escalation and/or sparing of organs at risk with protontherapy; and studies on dosimetric and technical issues related to protontherapy.ResultsA total of 7051 primary references published were retrieved, among which 40 clinical studies and 60 papers about quality of life, dose distribution and dosimetry were analysed, as well as the ongoing clinical trials. These papers have been summarized and reported in a specific document made available to the participants of a final 1-day workshop. Tumours of the meningeal envelop and bony cranial structures were excluded from the analysis. Protontherapy allows outstanding ballistics to target the tumour area, while substantially decreasing radiation dose to the normal tissues. There are many indications of protontherapy for paediatric brain tumours in curative intent, either for localized treatment of ependymomas, germ-cell tumours, craniopharyngiomas, low-grade gliomas; or panventricular irradiation of pure non-secreting germinoma; or craniospinal irradiation of medulloblastomas and metastatic pure germinomas. Carbon ion therapy is just emerging and may be studied for highly aggressive and radioresistant tumours, as an initial treatment for diffuse brainstem gliomas, and for relapse of high-grade gliomas.ConclusionBoth protontherapy and carbon ion therapy are promising for paediatric brain tumours. The benefit of decreasing late effects without altering survival has been described for most paediatric brain tumours with protontherapy and is currently assessed in ongoing clinical trials with up-to-date proton devices. Unfortunately, in 2015, only a minority of paediatric patients in France can receive protontherapy due to the lack of equipment.
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TEP et radiothérapie stéréotaxique pulmonaire : rôles dans la préparation du traitement et le suivi de la maladie
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): J.-E. Bibault, A. Oudoux, J. Durand-Labrunie, X. Mirabel, É. Lartigau, H. Kolesnikov-Gauthier
La radiothérapie stéréotaxique est le traitement de référence des patients inopérables atteints de carcinomes pulmonaires de diamètre inférieur à 5cm sans atteinte ganglionnaire. Les taux de contrôle local rapportés varient entre 80 et 90 % deux ans après traitement. La place de la tomographie par émission de positons dans la sélection des patients est déjà bien établie mais son utilisation dans la définition optimale de la cible ou dans l'évaluation de la réponse thérapeutique reste à préciser. Cette revue de la littérature propose de décrire l'état de l'art dans ce domaine.Stereotactic body radiation therapy is the standard treatment for inoperable patients with early-stage lung cancer. Local control rates range from 80 to 90 % 2 years after treatment. The role of positron emission tomography in patient selection is well known, but its use for target definition or therapeutic response evaluation is less clear. We reviewed the literature in order to assess the current state of knowledge in this area.
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Tumeurs malignes ophtalmologiques : indications de la radiothérapie et techniques
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): P. Jardel, J.-P. Caujolle, L. Gastaud, C. Maschi, W. Sauerwein, J. Thariat
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Paediatric brain tumours: A review of radiotherapy, state of the art and challenges for the future regarding protontherapy and carbontherapy
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): A. Laprie, Y. Hu, C. Alapetite, C. Carrie, J.L. Habrand, S. Bolle, P.Y. Bondiau, A. Ducassou, A. Huchet, A.I. Bertozzi, Y. Perel, É. Moyal, J. Balosso
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TEP et radiothérapie stéréotaxique pulmonaire : rôles dans la préparation du traitement et le suivi de la maladie
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
Author(s): J.-E. Bibault, A. Oudoux, J. Durand-Labrunie, X. Mirabel, É. Lartigau, H. Kolesnikov-Gauthier
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Relecteurs 2015 pour Cancer Radiothérapie
Publication date: December 2015
Source:Cancer/Radiothérapie, Volume 19, Issue 8
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Bladder Dose-Volume Parameters Are Associated with Urinary Incontinence After Post-operative Intensity-Modulated Radiation Therapy for Prostate Cancer
Publication date: Available online 19 December 2015
Source:Practical Radiation Oncology
Author(s): Christina H. Son, James Melotek, Chuanhong Liao, Greg Hubert, Charles A. Pelizzari, Scott E. Eggener, Stanley L. Liauw
PurposeUrinary incontinence is a potential side-effect of prostatectomy and intensity modulated radiation therapy (IMRT) for prostate cancer. There are limited data on dosimetric parameters that may predict for poor continence recovery in men who receive post-operative IMRT.Materials and MethodsEighty-seven men with non-metastatic prostate cancer who underwent prostatectomy followed by adjuvant (13%) or salvage (87%) IMRT were identified. The Expanded Prostate Cancer Index composite (EPIC) questionnaire was prospectively collected at baseline, 6 weeks, and 6, 12, 18, 24, 36, and 48 months post-IMRT. Relevant critical structures were contoured and dose-volume metrics collected. The primary endpoint was urinary continence global score. Longitudinal analysis using a generalized estimating equation model was performed.ResultsThere was no statistically significant change in EPIC urinary continence global scores over time as compared to baseline (all p>0.05). In univariate analysis, bladder V70Gy and penile bulb V70Gy were associated with urinary continence (OR 0.82, p<0.05). In a multivariable model that included body mass index, distance between vesicourethral junction and genitourinary diaphragm, time from surgery, use of anti-hypertensive medications, age, diabetes, and bladder V70Gy, only bladder V70Gy (OR 0.82, p=0.03) was associated with outcome. After 2 years, there was a significant difference in global score for those with V70Gy < 42.27 vs. ≥ 42.27 cc (all p<0.05 at 2 and 3 years post-IMRT).ConclusionThere was no significant change in patient-reported urinary continence scores after post-prostatectomy IMRT. Bladder V70Gy was independently associated with a decrease in urinary continence scores. Further evaluation is necessary to optimize quality of life in these men.
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Acute Gastrointestinal Toxicity and Bowel Bag Dose-Volume Parameters for Pre-Operative Radiotherapy for Retroperitoneal Sarcoma
Publication date: Available online 19 December 2015
Source:Practical Radiation Oncology
Author(s): Kimberley S. Mak, John G. Phillips, Constance M. Barysauskas, Leslie K. Lee, Edward G. Mannarino, Liam Van Benthuysen, Chandrajit P. Raut, John T. Mullen, Mark Fairweather, Thomas F. DeLaney, Elizabeth H. Baldini
PurposeAcute gastrointestinal (GI) toxicity has been studied in GI and gynecological (GYN) cancers, with V15<830 cc, V25<650 cc, and V45<195 cc identified as dose constraints for the peritoneal space [bowel bag (BB)]. There are no reported constraints derived from retroperitoneal sarcoma (RPS), and prospective trials for RPS have adopted some of the GI and GYN constraints. This study quantified GI toxicity during pre-operative RT for RPS, assessed toxicity using published constraints, and evaluated predictors for toxicity.Methods and MaterialsFrom 2003-2013, 56 patients with RPS underwent pre-operative RT at two institutions. Toxicity was scored using Radiation Therapy Oncology Group (RTOG) criteria for upper and lower acute GI toxicity. BB was contoured on planning CT scans per RTOG atlas guidelines with review by a radiologist. Relationships between toxicity, clinical factors and BB dose were analyzed.ResultsThree patients (5%) developed Grade ≥3 acute GI toxicity: two Grade 3 toxicities (anorexia and nausea) and one Grade 5 toxicity (tumor-bowel fistula). Thirty-six patients (64%) had Grade 2 toxicity (nausea, 55%; diarrhea, 23%; pain, 20%).Tumor size was the only significant clinical predictor of Grade ≥2 acute GI toxicity. Larger mean BB volumes predicted for Grade ≥2 toxicity (p=0.001). On ROC analysis, V30 was the best discriminator for toxicity (p=0.0001). Median BB V15 was 1,375 cc; 75% of patients had V15 ≥830 cc. Median V25 was 1,083 cc; 68% had V25 ≥650 cc. Median V45 was 575 cc; 82% had V45 ≥195 cc. V25 ≥650 cc was significantly associated with Grade ≥2 toxicity (p=0.01).ConclusionsAmong patients treated with pre-operative RT for RPS, significant acute GI toxicity was very low despite BB dose exceeding established constraints for most cases. Acceptable dose constraints for RPS may be higher than those for GI or GYN cancers. Further assessment of dose-volume constraints for RPS is needed.
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Angiotensin system inhibitors and survival in patients with metastatic renal cell carcinoma treated with VEGF targeted therapy: A pooled secondary analysis of clinical trials
Abstract
Use of angiotensin system inhibitors (ASIs; angiotensin receptor blockers or angiotensin converting enzyme inhibitors) have been reported to be associated with improved survival in metastatic renal cell carcinoma (mRCC), particularly when used with vascular endothelial growth factor targeted therapies. This study was a secondary pooled analysis of two Phase-III randomized controlled trials (RCTs) of patients with mRCC: NCT00334282 comparing pazopanib to placebo, and NCT00720941 comparing pazopanib to sunitinib. ASI users were defined as patients using an ASI at baseline. Association with overall survival (OS; primary outcome) and progression-free survival (PFS) was evaluated using Cox proportional hazards regression. The association was adjusted in multivariable analysis for baseline systolic blood pressure (SBP), use of other antihypertensive drugs, and prognostic factors comprising the Heng risk criteria for mRCC. Of 1,545 patients pooled from the two RCTs, 649 (42%) were using one or more antihypertensive drugs at baseline, 385 (59%) of which were using an ASI. In the multivariable analysis of patients using pazopanib or sunitinib, no significant association was observed between baseline ASI use and OS (hazard ratio [HR] 0.97 [95% confidence interval (CI); 0.80 – 1.18], P=0.80), or PFS (HR 0.88 [95% CI 0.73 – 1.06], P=0.17). Exploratory subgroup analysis of NCT00720941 highlighted that the effect of baseline ASI use on OS may differ between patients treated with sunitinib and pazopanib. In conclusion, use of ASIs at baseline was not a significant independent prognostic factor for improved survival in a pooled analysis of mRCC patients treated with pazopanib or sunitinib. This article is protected by copyright. All rights reserved.
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Vandetanib as a potential new treatment for estrogen receptor-negative breast cancers
Abstract
The receptor tyrosine kinase RET is implicated in the progression of luminal breast cancers (BC) but its role in estrogen receptor (ER) negative tumors is unknown. Here we investigated the expression of RET in breast cancer patients tumors and patient-derived xenografts (PDX) and evaluated the therapeutic potential of Vandetanib, a tyrosin kinase inhibitor with strong activity against RET, EGFR and VEGFR2, in ER negative breast cancer PDX.
The RT-PCR analysis of RET expression in breast tumors of 446 patients and 57 PDX, showed elevated levels of RET in ER+ and HER2+ subtypes and in a small subgroup of triple-negative breast cancers (TNBC). The activity of Vandetanib was tested in vivo in three PDX models of TNBC and one model of HER2+ BC with different expression levels of RET and EGFR. Vandetanib induced tumor regression in PDX models with high expression of RET or EGFR. The effect was associated with inhibition of RET/EGFR phosphorylation and MAP kinase pathway and increased necrosis. In a PDX model with no expression of RET nor EGFR, Vandetanib slowed tumor growth without inducing tumor regression. In addition, treatment by Vandetanib decreased expression of murine Vegf receptors and the endothelial marker Cd31 in the four PDX models tested, suggesting inhibition of tumor vascularisation.
In summary, these preclinical results suggest that Vandetanib treatment could be useful for patients with ER negative breast cancers overexpressing Vandetanib's main targets. This article is protected by copyright. All rights reserved. © 2014 Wiley Periodicals, Inc.
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Plasma Hyaluronic Acid level as a Prognostic and Monitoring Marker of Metastatic Breast Cancer
Abstract
Conventional tumor markers have limited value for prognostication and treatment monitoring in metastatic breast cancer (MBC) patients and novel circulating tumor markers therefore need to be explored. Hyaluronic acid (HA) is a major macropolysaccharide in the extracellular matrix and is reported to be associated with tumor progression. In our study, we investigated plasma HA level with respect to progression free survival (PFS) and overall survival (OS), as well as the treatment monitoring value in MBC patients. The prognostic value of plasma HA level was investigated in a discovery cohort of 212 MBC patients with 2.5-year follow-up and validated in an independent validation cohort of 334 patients with 5-year follow-up. The treatment monitoring value of plasma HA level was investigated in 61 MBC patients from discovery cohort who had been radiographically examined after 1st complete cycle of chemo therapy. We found a robust association between high plasma HA level and poor prognosis of MBC patients in both discovery (pPFS = 7.92 × 10−6 and pOS = 5.27 × 10−5) and validation studies (pPFS = 3.66 × 10−4 andpOS = 1.43 × 10−4). In the discovery cohort, the plasma HA level displayed independent prognostic value after adjusted for age and clinicopathological factors, with respect to PFS and OS. Further, the decrease of plasma HA level displayed good concordance with treatment response evaluated by radiographic examination (AUC=0.79). Plasma HA level displays prognostic value, as well as treatment monitoring value for MBC patients. This article is protected by copyright. All rights reserved.
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Progression of HPV infection to detectable cervical lesions or clearance in adult women: Analysis of the control arm of the VIVIANE study
Abstract
The control arm of the phase III VIVIANE (Human PapillomaVIrus: Vaccine Immunogenicity ANd Efficacy; NCT00294047) study in women >25 years was studied to assess risk of progression from cervical HPV infection to detectable cervical intraepithelial neoplasia (CIN) . The risk of detecting CIN associated with the same HPV type as the reference infection was analysed using Kaplan-Meier and multivariable Cox models. Infections were categorised depending upon persistence as 6-month persistent infection (6MPI) or infection of any duration. The 4-year interim analysis included 2838 women, of whom 1073 (37.8%) experienced 2615 infections of any duration and 708 (24.9%) experienced 1130 6MPIs. Infection with oncogenic HPV types significantly increased the risk of detecting CIN grade 2 or greater (CIN2+) versus non-oncogenic types. For 6MPI, the highest risk was associated with HPV-33 (hazard ratio [HR]: 31.9 [8.3-122.2, p<0.0001]). The next highest risk was with HPV-16 (21.1 [6.3-70.0], p<0.0001). Similar findings were seen for infections of any duration. Significant risk was also observed for HPV-18, HPV-31 and HPV-45. Concomitant HPV infection or CIN grade 1 or greater associated with a different oncogenic HPV type increased risk. Most women (79.3%) with an HPV infection at baseline cleared detectable infections of any duration, and 69.9% cleared a 6MPI. The risk of progression of HPV infection to CIN2+ in women >25 years in this study was similar to that in women 15-25 years in PATRICIA. This article is protected by copyright. All rights reserved.
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Associations between unprocessed red and processed meat, poultry, seafood and egg intake and the risk of prostate cancer: A pooled analysis of 15 prospective cohort studies
Abstract
Reports relating meat intake to prostate cancer risk are inconsistent. Associations between these dietary factors and prostate cancer were examined in a consortium of 15 cohort studies. During follow-up, 52,683 incident prostate cancer cases, including 4,924 advanced cases, were identified among 842, 149 men. Cox proportional hazard models were used to calculate study-specific relative risks (RR) and then pooled using random effects models. Results do not support a substantial effect of total red, unprocessed red and processed meat for all prostate cancer outcomes, except for a modest positive association for tumors identified as advanced stage at diagnosis (advanced(r)). For seafood, no substantial effect was observed for prostate cancer regardless of stage or grade. Poultry intake was inversely associated with risk of advanced and fatal cancers (pooled multivariable RR [MVRR], 95% confidence interval, comparing ≥45 vs. <5 g/d: advanced 0.83, 0.70-0.99; trend test p-value 0.29), fatal, 0.69, 0.59-0.82, trend test p-value 0.16). Participants who ate ≥25 vs <5 g/d of eggs (1 egg ∼ 50 g) had a significant 14% increased risk of advanced and fatal cancers (MVRR: advanced 1.14, 1.01-1.28, trend test p-value 0.01; fatal 1.14, 1.00-1.30, trend test p-value 0.01). When associations were analyzed separately by geographical region (North America vs. other continents), positive associations between unprocessed red meat and egg intake, and inverse associations between poultry intake and advanced, advanced(r) and fatal cancers were limited to North American studies. However, differences were only statistically significant for eggs. Observed differences in associations by geographical region warrant further investigation. This article is protected by copyright. All rights reserved.
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Acute toxicity grade 3 and 4 after irradiation in children and adolescents: results from the IPPARCA collaboration
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Caroline Pixberg, Raphael Koch, Hans-Theodor Eich, Ulla Martinsson, Ingrid Kristensen, Christiane Matuschek, Rolf-Dieter Kortmann, Fabian Pohl, Khaled Elsayad, Hans Christiansen, Normann Willich, Jack Lindh, Diana Steinmann
Background and PurposeIn the context of oncologic therapy for children, radiotherapy is frequently indicated. The aim of this study was to identify the frequency of and reasons for the development of high-grade acute toxicity and possible sequelae.Patients and MethodsIrradiated children have been prospectively documented since 2001 in the RiSK-registry in Germany and since 2008 in the RADTOX-registry in Sweden. Data were collected using standardized, previously published forms. Toxicity classification was based on the criteria of RTOG/EORTC.ResultsAs of June 2013, 1500 children had been recruited into the RiSK-database and 485 into the RADTOX-registry leading to an analysis population of 1359 patients (age range 0-18). A total of 18.9% (n=257) of all investigated patients developed high-grade acute toxicity (grade 3/4). High-grade toxicity of the bone marrow was documented for 63.8% (n=201) of those patients, oral mucositis for 7.6% (n=24) and dermatitis for 7.6% (n=24). Patients with high-grade acute toxicity received concomitant chemotherapy more frequently (56%) compared to patients with no or lower acute toxicity (31.5%). In multivariate analyses, concomitant chemotherapy, a diagnosis of Ewing sarcoma and total radiation dose showed a statistically noticeable effect (p≤0.05) on acute toxicity, whereas age, concomitant chemotherapy, Hodgkin lymphoma, Ewing sarcoma, total radiation dose, acute toxicity influenced the time until maximal late toxicity.ConclusionIn general high-grade acute toxicity after irradiation in children and adolescence occurs in a moderate proportion of patients (18.9%). As anticipated, the probability of acute toxicity appeared to depend on the prescribed dose as well as concomitant chemotherapy. The occurrence of chronic toxicity correlates with the prior acute toxicity grade. Age seems to influence the time until maximal late toxicity but not the development of acute toxicity.
Teaser
In the context of radiotherapy at children the aim of this study is to identify the frequency and reasons of the development of a high grade acute toxicity as well as possible sequelae. For this purpose prospectively documented data of irradiated children is evaluated whereby for the first time data of two international projects is combined ("Risk" and "IPPARCA"). From this we gain better inside into the side effects of radiotherapy.from Cancer via ola Kala on Inoreader http://ift.tt/1RZrJwh
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Proton Therapy as Salvage Treatment for Local Relapse of Prostate Cancer Following Cryosurgery or HIFU
Publication date: Available online 19 December 2015
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Adam L. Holtzman, Bradford S. Hoppe, Haley P. Letter, Romaine C. Nichols, Randal H. Henderson, William M. Mendenhall, Christopher G. Morris, Christopher R. Williams, Zuofeng Li, Nancy P. Mendenhall
PurposeLocal recurrence of prostate cancer after cryosurgery (CS) and high-intensity focused ultrasound (HIFU) is an emerging problem for which optimal management is unknown. Proton therapy (PT) may offer advantages over other local therapeutic options. The purpose of this paper is to review a single institution's experience in using PT for salvage of local recurrent disease after HIFU or CS.Methods and MaterialsWe reviewed the medical records of 21 consecutive patients treated with salvage PT following a local recurrence of prostate cancer after CS (n=12) or HIFU (n=9) between January 2007 and July 2014. Patients were treated to a median dose of 74 Gy(RBE) (range, 74-82 Gy[RBE]) and 8 patients received androgen deprivation therapy (ADT) with RT. Patients were evaluated for quality of life (QOL) using the EPIC questionnaire and toxicity using Common Terminology Criteria for Adverse Events, version 3.0, weekly during treatment, every 6 months for 2 years after treatment, and then annually.ResultsMedian follow-up was 37 months (range, 6-95 months). The 3-year biochemical progression-free survival (bPFS) rate was 77%. The 3-year PT-related grade 3 toxicity rates was 17%. At 1 year, bowel summary, urinary incontinence and urinary obstructive quality of life (QOL) scores declined, but only the bowel QOL score at 12 months met the minimally important difference MID threshold.ConclusionPT achieved a high rate of bPFS with acceptable toxicity and minimal changes in QOL scores compared with baseline pre-PT function. Although most patients have done fairly well, the study size is small, follow-up is short, and early results suggest that outcomes with PT for salvage after HIFU or CS failure are inferior to outcomes with PT given in the de novo setting with respect to disease control, toxicity, and QOL.
Teaser
Local recurrence of prostate cancer after cryosurgery (CS) or high-intensity focused ultrasound (HIFU) is an emerging problem as these treatments are increasingly offered in lieu of standard radiation therapy and surgery. In this small study, salvage proton therapy (PT) achieved a high rate of bPFS with acceptable toxicity and minimal changes in the IPSS and EPIC summary scores compared with baseline pre-PT function.from Cancer via ola Kala on Inoreader http://ift.tt/1T8kqRp
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A prospective study of measured body size and height and risk of keratinocyte cancers and melanoma
Publication date: February 2016
Source:Cancer Epidemiology, Volume 40
Author(s): Petra H. Lahmann, Maria Celia B. Hughes, Gail M. Williams, Adèle C. Green
BackgroundThe potential influence of measured body weight and height on keratinocyte skin cancer risk has scarcely been studied. Some evidence indicates melanoma risk increases as self-reported height increases, but an association with body mass index (BMI) is less certain.MethodsWe measured body weight and height of 1171 Australian men and women in a community-based skin cancer study in Queensland and prospectively examined the association of BMI, body surface area (BSA) and height and incidence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma while accounting for skin phenotype, sun exposure, clinical/cutaneous signs of chronic photodamage and other risk factors.ResultsDuring 16 years of follow-up, 334 and 188 participants newly developed BCC and SCC, respectively; 28 participants were diagnosed with primary melanoma. BMI and BSA were unrelated to skin cancer incidence. After full adjustment, height was significantly associated with SCC development in men (relative risk (RR)=1.66; 95% confidence interval (CI)=1.11–2.48, for ≥175cm vs ≤171cm, Ptrend=0.017), and BCC in women (Ptrend=0.043). Melanoma in men, was similarly positively associated with height (RR per 5cm increment=1.55; 95%CI 0.97–2.47, P=0.067) though not significantly.ConclusionThis study shows that after adjusting for sun exposure tall stature may be a risk factor for the most common types of skin cancer BCC, SCC, and melanoma, while body mass and surface area appear unrelated to risk.
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Is the irradiated small bowel volume still a predictor for acute lower gastrointestinal toxicity during preoperative concurrent chemo-radiotherapy for rectal cancer when using intensity-modulated radiation therapy?
The small bowel (SB) represents the most important dose-limiting structure in pelvic radiotherapy (RT). However, we observed that the majority of rectal cancer patients who received preoperative pelvic intensi...
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