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L’optimisation de la prise en charge des patients atteints de cancer nécessite une organisation des sorties d’hospitalisation facile et efficiente, notamment des transferts entre établissements de soins et établissements de soins de suite, rééducation ou unités de soins palliatifs. Dans ce but, depuis juin 2012 le logiciel de la HAS Trajectoire est utilisé comme interface dans notre hôpital, le centre Oscar-Lambret (Lille).

Disposer du statut vital des patients permet de clôturer les dossiers administratifs mais également de conduire des études de survie. Depuis 2018, cette information peut être obtenue via les fichiers de l'Insee des personnes décédées. Nous avons donc chaîné les données hospitalières des patients du Centre Oscar Lambret (COL) avec les fichiers de l'Insee. Nous proposons un retour d'expérience sur la qualité du chaînage ainsi que sur l'apport de cette source d'information pour l'identification des décès. L'intégration de cette source d'information pour l'estimation de la survie globale fait l'objet d'un autre abstract.

Le chaînage direct des données hospitalières aux données de décès de l'INSEE a été réalisé pour les patients ayant une première visite au Centre Oscar Lambret (COL) entre janvier 2006 et août 2021. Après avoir exploré la qualité du chaînage (1er abstract), notre second objectif était de comparer différentes approches pour l'estimation de la survie globale de ces patients.

We present an application of the industrial Constant-Work-In-Progress (ConWIP) principle to radiotherapy treatments: from Operations Research to application in practice.

Numerous tumour types can occur in the pineal region. Because these tumours are uncommon and heterogeneous, it is often difficult to establish optimal treatment strategies based on comparative clinical trials. To date, the role of radiosurgery for the treatment of pineal region tumours remains controversial. This report of a 10-year single-department experience and review of the literature focuses on the spectrum of pathologic features found in these pineal parenchymal tumours and on the interest of radiosurgery in their management. Considering pineocytomas, although these tumours have been considered to be radioresistant to fractionated radiotherapy, our results are in agreement with similar results reported in the literature in suggesting that radiosurgery may be an alternative to surgical resection or an adjuvant therapy when the resection is not optimal. When dissemination occurs after radiosurgery, however, craniospinal radiation and chemotherapy are necessary. Radiosurgery has also proven its interest in the treatment of germinomas as an alternative to encephalic radiotherapy with limited long-term damage. Regarding the other pathologies, radiosurgery can be considered as part of a multimodal treatment including surgery, chemo-radiotherapy and its role still has to be clearly defined.

The purpose of this study is to obtain a better operational knowledge of Stereotactic Body Radiotherapy (SBRT) treatments with CyberKnife®. An analysis of both In-room Times (IRT) and technical interventions of 5 years of treatments was performed, during which more than 1600 patients were treated for various indications, including liver (21%), lung (29%), intracranial (13%), head and neck (11%) and prostate (7%). Technical interventions were recorded along with the time of the failure, time to the intervention, and the complexity and duration of the repair. Analyses of Time Between Failures (TBF) and Service Disrupting TBF(disr) were performed. Treatment time data and variability per indication and following different system upgrades were evaluated. Large variations of IRTs were found between indications, but also large variations for each indication. The combination of the time reduction Tool (using Iris®) and Improved Stop Handling was of major impact to shortening of treatment times. The first implementation of the Iris collimator alone did not lead to significantly shorter IRTs for us except during prostate treatments. This was mostly due to the addition at the same time of larger rotational compensation for prostate treatments (5° instead of 1.5°). Significant differences of duration between the first fraction and following fractions of a treatment, representing the necessity of defining imaging parameters and explanation to patients, were found for liver (12 min) and lung treatments using Xsight® Spine (5 min). Liver and lung treatments represent the longest IRT's and involve the largest variability's in IRT. The malfunction rate of the system followed a Weibull distribution with the shape and scale parameters of 0.8 and 39.7. Mean TBF(disr) was 68 work hours. 60 to 80% of the service disrupting interventions were resolved within 30–60 min, 5% required external intervention and 30% occurred in the morning. The presented results can be applied in the evaluation of the required machine time in order to implement robotic radiosurgery for different indications. The analytical distributions of IRTs and technical interruptions can be used for simulations.

Stereotactic radiotherapy (SRT) offers a treatment option for hepatocellular carcinoma (HCC) patients that are not eligible for surgery, embolization, chemotherapy, or radiofrequency ablation. We have evaluated the feasibility, tolerance and toxicity of SRT for 25 HCC patients who were not eligible for these other modalities. The patients (6 women and 19 men) were treated with CyberKnife stereotactic radiotherapy using respiratory motion tracking. All patients had liver cirrhosis with an Eastern Cooperative Oncology Group (ECOG) performance score of less than 2 and pre-treatment Child scores ranging from A5 to B9. A total dose of 45 Gy in three fractions of 15 Gy each was prescribed to the 80% isodose line (95% of the PTV received 45 Gy) and delivered to the target volume over 10 to 12 days. Overall the treatment was well tolerated with two Grade 3 acute toxicities and no acute Grade 4 toxicities. Late toxicity was minimal with all observed late toxicities occurring within the first six months of follow-up. Three hepatic recurrences at a distance from the target and one metastasis were observed. The actuarial 1- and 2-year local control rate was 95% (95% CI: 69–95%). At a median overall follow-up of 12,7 months (range, 1–24 months), six of the twenty-five (24%) patients have died. Overall actuarial survival at 1- and 2-years was 79% (95% CI: 52–92%) and 52% (95% CI: 19–78%), respectively. Our results suggest promising therapeutic efficacy and good clinical tolerance to CyberKnife SRT treatment for HCC patients not eligible for other treatment modalities.

La radiothérapie a été l'une des premières spécialités médicales à implémenter l'assurance qualité (AQ) dans sa pratique quotidienne. Ces programmes d'AQ sont longtemps restés focalisés sur la performance des équipements négligeant l'importance du facteur humain. Le management du risque est une problématique relativement nouvelle dans cette discipline médicale. Des méthodes d'évaluation et de management des risques doivent donc être identifiées et mises en œuvre en les adaptant aux spécificités de ce domaine. En s'appuyant sur l'expérience de l'industrie, la gestion des risques doit nous permettre de faire des progrès substantiels en matière de sécurité et de développer nos propres modèles de gestion. Des expériences récentes utilisent ces approches pour mettre en œuvre des démarches de management des risques dans les services de radiothérapie.

Solid human tumours contain areas with low oxygen tension (pO2). For bioreductive drugs it is important to define the cytotoxic effect according to drug concentration and to clinically relevant pO2. In this study, the pO2 dependence of the survival of three human cell lines (HRT 18, Na11+, and MEWO), exposed to tirapazamine (SR-4233) alone or combined with ionizing radiation, was studied in vitro. Gas changes were made to obtain five different oxygen concentrations: air (20·9% O2), 10, 2, 0·2 and 0·02% O2 (hypoxia). Tirapazamine below a concentration of 100 μM was not cytotoxic in air or at 10% O2. At 100 μM tirapazamine was toxic in 2% O2, and at 50 μM in 0·2% O2. For pO2 < 0·2% O2, there was a marked increase in cell killing when 10 μM tirapazamine was combined with 2 Gy, compared with either 10 μM or 2 Gy given alone (p < 0·03). The cytotoxic effect of tirapazamine on human tumour cells in vitro is highly dependent on clinically relevant pO2's. The activation of tirapazamine at a low concentration and at a pO2 found mainly in tumours could yield a very beneficial therapeutic ratio.

There is evidence that some human tumours could be treated with a combination of buthionine sulfoximine and hypoxic cell sensitizers. However, clinical application of this technique requires a prior knowledge of the level of non-protein bound sulfhydryl (NPSH) compounds in these tumours. The present study provides data on the levels of glutathione (GSH) and cysteine (CYS) in human tumour biopsies from the cervix and from the head and neck. The NPSH compounds were measured by high performance liquid chromatography. The median GSH values were 20.5 nmol/mg protein (cervix) and 23 nmol/mg protein (head and neck) while the median CYS values were 4.4 (cervix) and 4.2 nmol/mg protein (head and neck). The values varied widely from one patient to another.

Recent data have shown that the in vitro and in vivo cytotoxicity of bioreductive drugs could be significantly increased when combined with chemotherapy drugs such as cisplatinum, depending on the timing of administration. The aim of this study was to define the toxicity (animal lethality) and the activity (growth delay assay, excision assay) of a bioreductive drug, tirapazamine, alone and combined with chemotherapy agents (5-FU, VP16, bleo, DTIC and c-DDP) on nude mice bearing xenografted human tumours: a rectal carcinoma (HRT18) and a melanoma (Na11+). Animal lethality was markedly increased when tirapazamine at the lethal dose 10% was combined with the other drugs. For the HRT18 tumour the combination of tirapazamine and bleomycin significantly increased the delay of regrowth compared with bleomycin alone (P = 0.04) and was more cytotoxic than tirapazamine alone (P = 0.04). For the Na11+ tumours the combination of tirapazamine with VP16 significantly increased tumour doubling time compared with the controls (P = 0.001) or VP16 alone. The combination of tirapazamine and VP16 was more cytotoxic than VP16 alone (P = 0.0001). When compared with c-DDP or tirapazamine alone, there was a significant decrease in plating efficiency when tirapazamine and c-DDP were given at the same time (P = 0.04), but not when tirapazamine was given 3 h before c-DDP. In conclusion, tirapazamine was shown to be cytotoxic against clonogenic human tumour cells. Its efficacy in vivo may depend on its combination with already active chemotherapy drugs on the tumour model used. The timing of administration may be less important than previously thought.

The authors followed up 41 consecutive patients (21 symptomatic) with internal carotid artery stenosis ≥70% and previous neck irradiation. After 28 months, 15 patients (36.6%) had died, five (12.2%) had had an ischemic stroke, and 15 (36.6%) had a new malignancy. Having a new malignancy was the only independent predictor of death. The major risk for patients with ICA stenosis ≥70% and previous neck irradiation is malignancy, not stroke.

Des cohortes monocentriques ont suggéré que le taux d’apoptose lymphocytaire radio-induit CD8 (RILA) peut prédire les toxicités pelviennes (pt+) tardives après radiothérapie (RT) prostatique en intention curative. Nous avons évalué le rôle du RILA comme prédicteur de pt+ après radiothérapie prostatique dans un essai prospectif multicentrique français.

L’efficacité et la tolérance du pemetrexed+cisplatine (PC) et radiothérapie thoracique concomitante (RTTc), suivie d’une consolidation par P vs autres chimiothérapies ont été évaluées ; les résultats intermédiaires de tolérance ont été présentés (Vokes et al., 2013).

La prise en charge de la récidive locale du cancer de la prostate (cap) après prostatectomie et radiothérapie externe de rattrapage (ebrt) n’est pas standardisée. Environ 20 patients traités par radiothérapie stéréotaxique (sbrt) pour récidive locale après prostatectomie et ebrt de rattrapage ont été décrits dans la littérature. Nous rapportons nos résultats préliminaires d’une irradiation sbrt (Cyberknife®) dans le lit prostatique pour les récidives locales de cap.

Solid human tumours contain areas with low oxygen tension (pO2). For bioreductive drugs it is important to define the cytotoxic effect according to drug concentration and to clinically relevant pO2. In vitro, the pO2dependence of the survival of three human cell lines (HRT 18, Na11 +, and MEWO), exposed to tirapazamine alone or combined with ionizing radiation, was studied at five different oxygen concentrations: air (20.9% O2), 10, 2, 0.2 and 0.02% O2(hypoxia). Tirapazamine below a concentration of 100/μM was not cytotoxic in air or at 10% O2. At 100/μM tirapazamine was toxic in 2% O2, and at 50/μM in 0.2% O2. For pO2<0.2% O2, there was a marked increase in cell killing when 10/μM tirapazamine was combined with 2 Gy, compared with either 10/μM or 2 Gy given alone (P<0.03). In vivo, tirapazamine was combined with various drugs (5 FU, VP 16, DTIC, CDDp, BLEOMYCINE). Mice lethality, regrowth delay and excision assay were studied. In the latter, the most effective combination was tirapazamine-bleo for HRT 18 and tirapazamine-VP 16 for NA 11+. The activation of tirapazamine at a low concentration and at pO2found mainly in tumours could yield a very beneficial therapeutic ratio. Such a bioreductive drug will be preferably used in combination with ionizing radiations andior cytotoxic drugs.

Brachytherapy (BT) plays an essential role in the local control of cervix carcinoma. Numerous applicators have been designed for intracavitary BT. Among them, custom-made vaginal moulds fit the anatomy of the vagina and the topography of the tumor. Dose prescription has been frequently reported at a single point, the Manchester point A. More recently, ICRU Report 38 has defined a reference volume of the 60 Gy isodose, specific envelope reference points associated with normal tissues (bladder, rectum, pelvic side walls). The ICRU recommendations also include the description of the technique. The aim of this Report 38 is to uniform the dosimetry report and to find correlations between dosimetrie characteristics and complications.Interstitial BT techniques were developed for bulky parametrial or vaginal involvement or vaginal or limited central recurrences. A higher incidence of severe complications was observed with this approach.Traditional dose-rate in gynecological BT is low-dose rate BT More recently, high-dose rate BT was used in cervical carcinoma. Two randomized trials showed results in favour of high-dose rate BT, but other authors have described a higher incidence of complications when the dose rate increases.More clinical studies are required to better define the exact role of high dose rate in the therapeutic approach of cervical carcinoma.

High dose rate brachytherapy (HDRB) is an effective palliative treatment for bronchial carcinoma with an obstructive component.We have studied the toxicity and efficacy of palliative HDRB for endobronchial tumors in areas previously irradiated or not.HDRB (I192source) delivered a same total dose of 24 Gy, giving 6×4 Gy in 36 days for patients with previous irradiation (Group A), or 3×8 Gy in 15 days for patients without previous irradiation (Group B). The given dose was prescribed according to the target volume, and the physical dose was specified at 1cm. The treatment catheter was positioned by the pneumologist (P. B.) and the treatment volume defined according to the endoscopy and to pre-treatment CT scanner, with a 2cm safety margin on each extremity of the macroscopic tumor. The catheter was checked by radiographic films before any HDR treatment.Five patients were included in group A, and 15 in group B. With a mean follow up time of 12 months, three patients out of 5 in group A developed a lethal hemoptysis. No toxicity was found in group B (one limited necrosis).HDBR is a safe and effective palliative treatment in patients without previous irradiation. For patients with previous irradiation, we noticed severe complications even if a protracted treatment with low dose per fraction is used.

Endobronchial high dose rate brachytherapy (BT) is an alternative treatment for very small and limited bronchial carcinomas in patients with chronic respiratory deficiency after past history of lung cancer treated by surgery and/or external radiotherapy.Study of toxicity and results of high dose rate B.T. in 18 patients with 21 limited and endoscopically visible lesions.