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Résumé Les radiopharmaceutiques à tropisme osseux sont souvent utilisés dans un but diagnostique chez les patients présentant des métastases osseuses. Leurs applications thérapeutiques sont plus limitées. Le but de la radiothérapie interne vectorisée chez les patients souffrant de métastases osseuses est d’administrer une irradiation maximale des cellules osseuses tumorales, en garantissant un minimum de toxicité au niveau des cellules saines avoisinantes. Les radionucléides utilisés en thérapie sont soit des émetteurs bêta, tels que l’iode-131, l’yttrium-90, le rhénium-186, le rhénium-188, le lutécium-177, le strontium-89 et le samarium-153, soit des émetteurs alpha, tels que le radium-223, l’actinium-211, le bismuth-212, soit des émetteurs d’électrons Auger, tels que l’iode-125 et l’indium-111. À ce jour, les principales substances radioactives utilisées en pathologie métastatique osseuse de cancers de prostate sont le chlorure de strontium-89 et le samarium-153-éthylène diamine tétraméthylène bisphosphonate. Le samarium-153 peut également être utilisé dans les métastases ostéoblastiques dérivées d’autres tumeurs. Récemment, le dichlorure de radium-223 un « nouvel » radiopharmaceutique a montré son efficacité non seulement en prolongeant significativement la survie globale des patients atteints de métastases osseuses de cancer de la prostate, mais aussi en retardant la survenue de complications osseuses symptomatiques et en réduisant la douleur osseuse. Par conséquent, le dichlorure de radium-223 est recommandé dans le traitement des cancers de la prostate résistants à la castration par des directives cliniques internationales. Les avantages potentiels du dichlorure de radium-223 chez les patients présentant des métastases osseuses d’autres tumeurs sont actuellement à l’étude et les résultats seront bientôt disponibles. Bone seeking radiopharmaceutics are often used in patients with skeletal lesions during the diagnostic and, less frequently, the therapeutic setting. The aim of the radionuclide therapy in patients with bone metastases is to release the maximum of the energy on neoplastic cells, with the minimum of toxicity for the remnant bone cells and extracellular environment. The radionuclides used in nuclear medicine therapy could be β-emitters, such as 131 iodine, 90 ytrium, 188 rhenium, 186 rhenium, 177 lutetium, 89 strontium and 153 samarium, α emitters, such as 223 radium, 211 actinium, 212 bismuth or Auger electron emitters, such as 125 iodine and 111 indium. To date, 89 strontium chloride and 153 samarium ethylene diamine tetramethylene bisphosphonate are successfully used for palliative treatment in patients with bone metastases from prostate cancer; moreover, 153 samarium can be used also in osteoblastic metastases derived from other neoplasms. Recently, 223 RaCl 2 a “new” agent has been shown to be useful not only to prolong overall survival of patients with bone metastases from prostate cancer, but also to extend the delay of symptomatic skeletal events, to reduce bone pain and to reduce need for external beam radiation therapy in order to treat bone pain. Therefore, to date 223 RaCl 2 is recommended in the treatment of castrate resistant prostate cancer by international clinical guidelines. Potential benefits of 223 RaCl 2 in patients with metastases from other neoplasms are currently under investigation and results will be available very soon. [ABSTRACT FROM AUTHOR]

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Abstract: Rectal syndrome caused by locoregional evolution of low rectal cancers and anal cancers is prevented and treated by surgical resection. But, for old patients with multiple tares, carcinologic surgical resection as abdominoperineal amputation can not be considered. Management of rectal syndrome becomes a therapeutic challenge. We reported a prospective serie of 5 patients more than 80 years old with multiple tares, treated by rectal amputation by pure perineal approach with laparoscopic colostomy. This surgery avoided for all patients trying rectal symptoms and maintained acceptable quality of life with fast coming back at home. The palliative treatment of low rectal cancers or anal cancers combining rectal amputation by pure perineal approach with laparoscopic colostomy may be an interesting therapeutic option for patients who cannot undergoing aggressive carcinologic surgical treatment. [Copyright &y& Elsevier]

Introduction. – Fifteen to thirty percent of colonic cancers are diagnosed at acute colic obstruction stage. In this situation surgery is associated with a high morbi-mortality. The self-expandable metallic stents (SEM) have two objectives: (a) resolution of the obstructive to allow secondary planified radical surgical procedure; (b) palliative in the event of advanced disease.Patients and methods. – From May 2001 to December 2002, 11 patients, mean age 75 ± 8 years, presenting with acute colic obstruction were initially treated by SEM placed by endoscopy. Four patients were classified score ASA 4. Ten patients had a colonic cancer, and a patient presented a peritoneal carcinomatosis from an ovarian carcinoma. Overall five patients had a carcinomatosis. Stenosis, mean length 4 ± 3 cm, were located on the left colon. In five patients the SEM was proposed as a palliative treatment.Results. – Successfully placement of SEM was obtained in 10 (91%) patient without perforation. Three complications (bleeding, reobstruction, migration) were observed. Clinical success (colonic decompression within 96 h without endoscopic or surgical reintervention) was observed in nine out of ten (90%) patients. Six patients had a SEM with curative attempt allowing (i) colonic resection (9 ± 2 days) without stomy (one postoperative death) in five patients; (ii) a colo-colic derivation for diffuse carcinomatosis discovered peroperatively. A diverting colostomy was carried out in two of the four patients (j6, j30) (reobstruction, migration) for whom the SEM had been proposed as palliative treatment.Conclusions. – This study confirms that SEM and surgery are not competitive but complementary techniques. When the SEM is placed with curative attempt, it allows resolution of the obstructive syndrome and secondary planified radical surgical procedure under better conditions. The results observed in the palliative SEM group suggested to reconsider this indication. [Copyright &y& Elsevier]

Objective. – The self-expandable metallic stents are a good alternative to surgery for the palliative treatment of malignant colonic obstructions. The aim of this paper was to emphasize the causes which could increase the risk of perforation.Patients and methods. – From november 2000 to november 2001, 6 patients with malignant colonic obstruction, to whom surgery was denied due to tumor extension and/or poor general condition, have had a palliative treatment (N = 5) or an attempt (N = 1) with self-expandable metallic stents placed by endoscopy.Results. – Only one patient did not developed any complication and died 5 months later of cancer. Five out of the 6 patients (83%) developed a colonic perforation following stenting (N = 4) or the attempt to place the stent (N = 1), two into the first 24 h after the procedure, and three 3, 5, and 10 months later. Subsequent colostomy was done in 2 patients while the 3 others have had an external drainage of the perforation and died postoperatively.Conclusion. – The self-expandable metallic stents seems to be a less aggressive alternative therapy to surgery for malignant colonic obstructions. Nevertheless, the high rate of colonic perforations, suggests reconsidering the indications in the definitive palliation of malignant colonic obstructions. [Copyright &y& Elsevier]

Abstract: The cost of radiotherapy, which concerns 150,000 new patients yearly in France has been estimated 1700 euros per patients in this country, 50% lower than the European average. Economic evaluations of radiotherapy have related the cost of either curative or palliative treatment to the medical outcome. For lung, rectal, breast cancer and bone metastases of prostate cancer, radiation therapy prolongs life by an estimated 6 to 10 months. The cost effectiveness ranges from 5,000 to 25,000 euros per life year gained. [Copyright &y& Elsevier]

Abstract: The thoracicus longus nerve originates from the C5, C6 and most often C7 roots. Its anatomical description is made difficult by the tortuous course of the nerve which passes, in part, through the scalenus muscles, span over the second rib and then finishes its course on the serratus muscle. Serratus muscle paralysis, although rare, has been regularly reported in the literature. Many causes have been postulated, the most frequent beeing a traction injury. Isolated thoracicus longus nerve entrapment has sometimes been postulated but only the anatomical and surgical works of Laulan et al. Have demonstrated a compression injury on the nerve at its crossing with the thoraco-dorsal artery, about the level of the fifth rib. We reviewed a large amount of publications and present the results of the most significant anatomical works, and our experience in the surgical release of the thoracicus longus nerve entrapment. Palliative treatments are also reported as most patients present late with definite sequelae. [Copyright &y& Elsevier]