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Résumé: La curiethérapie de bas débit de dose est un standard thérapeutique en complément d’une chimioradiothérapie concomitante pour les carcinomes épidermoïdes du canal anal localement évolués, sous réserve d’une sélection rigoureuse portant sur l’évaluation initiale de la maladie et la réponse à la radiothérapie externe. Le taux de contrôle local semble être meilleur lorsque le complément (boost) est délivré par curiethérapie qu’avec la radiothérapie externe. Les différentes étapes de la réalisation de la curiethérapie sont détaillées. Le schéma standard comporte une radiothérapie externe pelvienne de 45Gy en 25 fractions et cinq semaines avec potentialisation par deux cures de 5-fluoro-uracile et mitomycine-C, puis une curiethérapie de 15Gy après deux à trois semaines. Le gain apporté par des doses cumulées plus élevées de radiothérapie en termes de probabilité de survie sans colostomie pour les tumeurs plus évoluées n’a pas été formellement démontré. La curiethérapie exclusive pour les cancers in-situ ou les cancers infiltrants de moins de 10mm n’est pas recommandée du fait d’un risque élevé de récidive locale. La curiethérapie de débit de dose pulsé est une alternative à la curiethérapie de bas débit de dose continu (fils d’iridium) sous réserve de respecter le débit de dose recommandé (0,5 à 1Gy/heure). La curiethérapie de haut débit de dose est en cours d’évaluation. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The CyberKnife® system is a recent radiation therapy technique that allows treatment of liver lesions with real-time tracking. Because of its high precision, the dose administered to the tumor can be increased. We report Oscar-Lambret Cancer Centre experience in the treatment of primary and secondary liver lesions. Patients and methods: It is a retrospective study analyzing all the patients who have been treated for their liver lesions since July 2007. A hundred and twenty patients have been treated: 42 for hepatocellular carcinoma, 72 for liver metastases and six for cholangiocarcinoma. Gold seeds need to be implanted before the treatment and are used as markers to follow the movement of the lesion due to respiration. On average, the treatment is administered in three to four sessions over 12 days. A total dose of 40 to 45Gy at the 80% isodose is delivered. Local control and overall survival analysis with Log-rank is performed for each type of lesion. Results: Treatment tolerance is good. The most common toxicities are of digestive type, pain and asthenia. Six gastro-duodenal ulcers and two radiation-induced liver disease (RILD) were observed. At a median follow-up of 15 months, the local control rate is respectively of 80.4% and 72.5% at 1 and 2 years. Overall survival is 84.6 and 58.3% at 1 and 2 years. The local control is significantly better for the hepatocellular carcinoma and overall survival is significantly better for liver metastases (P <0.05). The local control rate and overall survival at 1 year for cholangiocarcinoma is 100%. Conclusion: CyberKnife® is a promising technique, well tolerated, with tumoral local control rates comparable to other techniques. Its advantage is that it is very minimally invasive delivered as an outpatient procedure in a frail population of patient (disease, age). [Copyright &y& Elsevier]

A recent phase I study showed that weekly cisplatin, irinotecan and concurrent radiotherapy can be administered with moderate toxicity in patients with oesophageal cancer. Patients with no prior treatment and oesophageal cancer stage I to III, performance status <3, caloric intake >1,500 kcal day(-1) were included. Chemotherapy, with cisplatin 30 mg m(-2) and irinotecan 60 mg m(-2), was administered at days 1, 8, 22, 29, and concurrently with radiotherapy at days 43, 50, 64 and 71. Radiotherapy was delivered with 50 or 50.4 Gy in 25 fractions/5 weeks. Forty-three patients were included, 10 stage I, 19 stage II and 14 stage III. Mean age was 59.2 years (range 44-79). A total of 30 out of 43 (69.8%) patients underwent all planned treatment. During induction chemotherapy, 14 severe toxicities of grade 3 or 4 in 10 patients (23.3%) were reported with 57.1% due to haematoxicity. During chemoradiotherapy, 31 severe toxicities of grade 3 or 4 with 64.5% due to haematotoxicity were reported in 18 patients. One toxic death occurred (diarrhoea grade 4). The complete clinical response rate was 58.1% (95% CI: 43.4-72.8%). Overall survival rate at 1 and 2 years was 62.8%, (95% CI, 58.3-77.3%) and 27.9% (95% CI, 13.4-41.3%), respectively. In conclusion, cisplatin-irinotecan-radiotherapy is an active and well-tolerated regimen feasible in out-patients. [ABSTRACT FROM AUTHOR]

We present the updated recommendations of the French society for radiation oncology on radiotherapy of oesophageal cancer. Oesophageal cancer still remains a malignant tumour with a poor prognosis. Surgery remains the standard treatment for localized cancers, regardless of histology. For locally advanced stages, surgery remains a standard for adenocarcinomas after neoadjuvant treatment with chemotherapy or chemoradiotherapy. However, it is a therapeutic option after initial chemoradiotherapy for stage III squamous cell carcinomas, given the increased morbidity and mortality with a multimodal treatment, which results in an equivalent overall survival with or without surgery. Preoperative or exclusive chemoradiotherapy should be delivered according to validated regimens with an effective total dose (50 Gy), if surgery is not planned or if the tumour is deemed resectable before chemoradiotherapy. Intensity-modulated radiotherapy significantly reduces irradiation of the lungs and heart and may reduce the morbidity of this treatment, especially in combination with surgery. In case of exclusive chemoradiotherapy, dose escalation beyond 50 Gy is not currently recommended. Some technical considerations still remain questionable, such as the place of prophylactic lymph node irradiation, adaptive radiotherapy, evaluation of response during and after chemoradiotherapy and the value of proton therapy. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe the adjuvant management of high grade uterine sarcoma and highlight prognostic factors for overall survival and progression-free survival. Between 01/2000 and 01/2015, 91 patients undergoing surgery were presented at the multidisciplinary team meeting of our institution. The type of surgery, the anatomopathological features, adjuvant treatments, dates and sites of recurrence were collected. The prognostic value of the various factors was evaluated with the multivariate Cox model. A total of 50 women with uterine sarcoma were identified and lesions included 43 leiomyosarcomas (86%) and seven high grade sarcomas (14%). Eighteen patients received adjuvant pelvic radiotherapy (36%) and six adjuvant systemic therapy (12%). The median follow-up time was 63 months. Thirty-nine patients (78%) had a recurrence: 22 had only metastatic recurrence (58%), two had isolated pelvic recurrence (5%) and 15 had pelvic and metastatic recurrence (38%). Adjuvant radiotherapy was associated with survival without pelvic recurrence in univariate analysis (P = 0.005, hazard ratio [HR] = 0.15); age greater than 55 years and adjuvant radiotherapy were associated with metastatic free survival in multivariate analysis (P = 0.015, HR = 2.37, and P = 0.013, HR = 0.41 respectively) According to the results of our series, there is a benefit of radiotherapy after surgery in terms of local control of uterine sarcoma. It is necessary to identify the subgroup of patients who will benefit from an adjuvant radiotherapy in order to provide them with more optimal care. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Stereotactic radiation therapy using the CyberKnife® has been introduced in France in 2006. Two treatment modalities are currently available: the first one (Synchrony®) is a real-time fiducial-based target tracking system, while the other (Xsight Lung Tracking [XLT] System®) is completely fiducial-free. Patients and methods: Sixty-eight patients were treated for a pulmonary tumor between June 2007 and November 2009. Since august 2008, the XLT System® was used for 26 patients. We report the necessary conditions for the XLT System (position, laterality and size of the tumor), the toxicity and outcome of this treatment. Results: Twenty-two patients were analyzed. Median follow-up was 6 months (min=3; max=16). Local control rate was 100%. The main toxicity was grade grade 1 pulmonary alveolitis (27%). No grade 3 or 4 toxicities were reported. Conclusion: The high local control rate and low toxicity obtained with the CyberKnife® XLT System® suggest that such treatment is an alternative for inoperable patients. [ABSTRACT FROM AUTHOR]