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Abstract: Head and neck squamous cell carcinomas are frequently diagnosed at an advanced stage. Their treatment remains controversial, and has to be multidisciplinary. External beam radiotherapy is a recognized treatment option after radical curative surgery in order to improve local control. Different adjuvant treatment options have been studied in order to improve the outcome of these patients. We review in this paper the different prognostic factors indicating an adjuvant treatment and the interest of treatment intensification in bad prognostic patients. [Copyright &y& Elsevier]

PURPOSE: To assess the feasibility and activity of radio-chemotherapy with mitomycin C (MMC) and cisplatin (CDDP) in locally advanced squamous cell anal carcinoma with reference to radiotherapy (RT) combined with MMC and fluorouracil (5-FU). PATIENTS AND METHODS: Patients with measurable disease >4 cmN0 or N+ received RT (36Gy+2 week gap+23.4Gy) with either MMC/CDDP or MMC/5-FU (MMC 10mg/m(2) d1 of each sequence; 5-FU 200mg/m(2)/day c.i.v. daily; CDDP 25mg/m(2) weekly). Forty patients/arm were needed to exclude a RECIST objective response rate (ORR), 8 weeks after treatment, of <75% (Fleming 1, alpha=10%, beta=10%). RESULTS: The ORR was 79.5% (31/39) (lower bound confidence interval [CI]: 68.8%) with MMC/5-FU versus 91.9% (34/ 37) (lower bound CI: 82.8%) with MMC/CDDP. In the MMC/5-FU group, two patients (5.1%) discontinued treatment due to toxicity versus 11 (29.7%) in the MMC/CDDP group. Nine grade 3 haematological events occurred with MMC/CDDP versus none with 5-FU/MMC. The rate of other toxicities did not differ. There was no toxic death. Thirty-one patients in the MMC/5-FU arm (79.5%) and 18 in the MMC/CDDP arm (48.6%) were fully compliant with the protocol treatment (p=0.005). CONCLUSIONS: Radio-chemotherapy with MMC/CDDP seems promising as only MMC/CDDP demonstrated enough activity (RECIST ORR >75%) to be tested further in phase III trials; MMC/5-FU did not. MMC/CDDP also had an overall acceptable toxicity profile. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: This trial randomly assessed short-term adjuvant hormonal therapy added to radiotherapy (RT) for intermediate- and high-risk (UICC 1997 cT2a or cT1b-c with high PSA or Gleason score) localised prostate cancer. We report acute toxicity (CTCAE v2) assessed weekly during RT in relation to radiation parameters. Patients and methods: Centres selected the RT dose (70, 74 or 78Gy) and RT technique. Statistical significance is at 0.05. Results: Of 791 patients, 652 received 3D-CRT (70Gy: 195, 74Gy: 376, 78Gy: 81) and 139 received IMRT (74Gy: 28, 78Gy: 111). During RT, grade 3 gastrointestinal (GI) and genitourinary (GU) toxicities were reported by7 (0.8%) and 50 (6.3%) patients, respectively. No grade 4 was reported. The risk of grade ⩾2 GI toxicity increased significantly with increasing D50%-rectum (p =0.004) and that of grade ⩾2 GU toxicity correlated only to Dmax-bladder (p =0.051). 3D-RT technique, increasing total dose and V95% >400cc increased D50% and Dmax. One month after RT, only 14 patients (1.8%) reported grade 3 toxicity. AST did not seem to influence the risk of GU or GI acute toxicity. Conclusion: RT up to 78Gy was well tolerated. Dmax-bladder and D50%-rectum influenced the risk of grade ⩾2 GU toxicity and GI toxicity, respectively. Both were lower with IMRT but remained high for an irradiated RT volume>400cc for 3D-RT and for a dose of 78Gy. Hormonal treatment did not influence acute toxicity. [Copyright &y& Elsevier]

Abstract: Squamous cell carcinoma of the head and neck (SCCHN) is a common disease that develops in the upper aerodigestive epithelium. The most important risk factors are tobacco and alcohol consumption. There is also increasing evidence that human papillomavirus plays an important role in the cause of SCCHN. The complex anatomy, the vital functions of the upper aerodigestive tract and the close proximity to vital structures, explain that the goal of treatment is not only to improve survival outcomes, but also to preserve organ function. Radiotherapy and surgery are the standard modalities of treatment, reflecting the locoregional predominance of SCCHN. Chemotherapy plays an important role in the treatment of patients with locoregionally advanced disease, in conjunction with radiotherapy and surgery. Indeed, standard therapy for resectable locoregionally advanced (stage III or IV) SCCHN cancers consists either of surgery and adjuvant chemoradiotherapy or definitive concomitant chemoradiotherapy, depending upon disease site, stage and resectability of the tumour, or institutional experience. Concomitant chemoradiotherapy has been shown in several randomised trials to improve disease-free and overall survival in the postoperative setting for resected disease with poor prognostic factors. Furthermore, multiple randomised studies and meta-analyses have shown that definitive chemoradiotherapy, as well anti-epidermal growth factor receptor treatment in one randomised study, improved disease-free and overall survival when compared with radiotherapy alone. This overview reviews the most relevant published studies on the multidisciplinary management of SCCHN and discusses future strategies to reduce locoregional failures. [Copyright &y& Elsevier]

La radiothérapie externe avec chimiothérapie concomitante (5-fluoro-uracile–mitomycine C) est le traitement de référence du cancer de canal anal. Une analyse des données de sept essais a été faite pour quantifier l'effet des paramètres relié avec la radiothérapie externe sur les résultats thérapeutiques. Après fusion des jeux de données l'impact des paramètres de radiothérapie (étalement, durée de l'intervalle de temps, dose totale) sur les résultats thérapeutiques (récidive locorégionale, taux de survie sans progression à 5 ans et toxicité) ont été évalués. Les données ont été reçues de dix essais publiés sur 13, réalisés entre 1987 et 2008 (n = 3031). Une régression de Cox a été utilisée. Seuls les dossiers de 1343 patients des sept essais plus récents et homogènes ont été analysés (durée médiane de suivi :4,1 ans). Un taux supérieur de récidive locorégionale à 5 ans avait une corrélation significative avec un étalement plus long (22,8 %, intervalle de confiance à 95 % [IC 95 %] : 22,3–27,3 %, p = 0,030), une taille tumorale supérieure (p < 0,001) et avec les sexe masculin (p = 0,045). Les analyses par sous-groupe de la récidive locorégionale(intervalle de dose : 50,4–59 Gy) semblaient en faveur des doses plus basses (p = 0,412). La comparaison avec un intervalle de temps de deux semaines (dose : 59,4 Gy) suggérait que trois semaines pouvaient être désavantageux (p = 0,245), et ne montrait pas de différence (p = 0,89) avec aucun intervalle de temps (intervalle de dose : 55–59,4 Gy). La probabilité de survie sans progression à 5 ans était 65,7 % (IC 95 % : 62,8–68,5 %). Des taux de survie sans progression plus élevés ont été observés chez les femmes (p < 0,001), les tailles tumorales plus petites (p < 0,001) et les étalements plus courts (p = 0,025). La survie globale à 5 ans était en relation avec les femmes (76,7 % ; IC 95 % : 73,9 % > 79,3 % ; p < 0,001), tailles tumorales plus petites (p = 0,027) et étalements plus courts (p = 0,026). Les données descriptives de la toxicité seront présentées. Pour des patients pris en charge par chimioradiothérapie concomitante par deux agents et une radiothérapie externe, un étalement plus long semble désavantageux. De futurs essais avec des techniques modernes pourraient mieux définir l'étalement optimal et le rôle de l'escalade de dose. [ABSTRACT FROM AUTHOR]

Abstract: The implementation of new techniques of imaging in the daily practice of the radiation oncologist is a major advance in these last 10 years. This allows optimizing the therapeutic intervals and locoregional control of the disease while limiting side effects. Among them, positron emission tomography (PET) offers an opportunity to the clinician to obtain data relative to the tumoral biological mechanisms, while benefiting from the morphological images of the computed tomography (CT) scan. Recently hybrid PET/CT has been developed and numerous studies aimed at optimizing its use in the planning, the evaluation of the treatment response and the prognostic value. The choice of the radiotracer (according to the type of cancer and to the studied biological mechanism) and the various methods of tumoral delineation, require a regular update to optimize the practices. We propose throughout this article, an exhaustive review of the published researches (and in process of publication) until December 2011, as user guide of PET/CT in all the aspects of the modern radiotherapy (from the diagnosis to the follow-up): biopsy guiding, optimization of treatment planning and dosimetry, evaluation of tumor response and prognostic value, follow-up and early detection of recurrence versus tumoral necrosis. In a didactic purpose, each of these aspects is approached by primary tumoral location, and illustrated with representative iconographic examples. The current contribution of PET/CT and its perspectives of development are described to offer to the radiation oncologist a clear and up to date reading in this expanding domain. [Copyright &y& Elsevier]

In this retrospective study we evaluated the long-term results of 35 early-stage favourable T1-2 N0 M0 anal cancer patients treated with intensity-modulated radiotherapy techniques combining low dose prophylactic inguinal-pelvic irradiation with dose-escalated boost. Optimal locoregional control and good tolerance makes this treatment a valuable alternative to brachytherapy boost and involved-field radiotherapy plans. [ABSTRACT FROM AUTHOR]