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The late Carboniferous–early Permian represents a key period in the Phanerozoic history, given the major global geodynamic and climate modifications. The aim of this work is to better understand the context and characteristics of the sedimentation recorded in the continental environments of eastern equatorial Pangea at this time, through the example of the Autun Basin (northeastern Massif Central, France). The Autun Basin contains the historical stratotype of the Autunian continental stage, and its stratigraphy was recently improved by accurate numerical ages. This basin formed in an extensional tectonic context during the latest stages of the Variscan orogeny, and it is essential to study its paleoenvironmental evolution to provide new insights into the sedimentary evolution of contemporaneous surrounding basins. Using field and subsurface data, we propose a refined sedimentological model for the Autun Basin, relying on updated facies interpretations, organic matter content fluctuations, and sequence stratigraphy concepts and correlations. The continental environments of the lower sedimentary succession of the Autun Basin, previously considered to be fluvial and lacustrine, are herein re-interpreted as mainly lacustrine, comprising fine-grained organic matter-rich deposits, and supplied by coarser-grained deltaic siliciclastic sediments, without preservation of strict fluvial sedimentation. The determination of the sequence stratigraphy cycles, strengthened by the quantification of the organic matter content, and reflected by the temporal succession of progradational and retrogradational trends, is used to determine new correlations between several sections, as well as to reconstruct the paleoenvironment evolution at the Carboniferous–Permian transition. This study provides evidence that the sedimentation area of the Autun Basin at the time of its filling was much larger than the preserved basin area, and suggests connections with contemporaneous neighboring French basins, pointing to a large sedimentary system in the northeastern Massif Central area rather than narrow and isolated basins. [ABSTRACT FROM AUTHOR]

Purpose: Neuroblastoma (NB) is an embryonic tumor that occurs almost exclusively in infancy and early childhood. While considerable evidence suggests that it may be initiated during embryonic development, the etiology of NB is still unknown. The aim of this study was to explore whether there is an association between maternal use of household pesticides during pregnancy and the risk of NB in the offspring.Methods: We conducted a pooled analysis of two French national-based case-control studies. The mothers of 357 NB cases and 1,783 controls younger than 6 years, frequency-matched by age and gender, responded to a telephone interview that focused on sociodemographic and perinatal characteristics, childhood environment, and life-style. Unconditional logistic regression was used to estimate pooled odds ratios and 95% confidence intervals.Results: After controlling for matching variables, study of origin, and potential confounders, the maternal use of any type of pesticide during pregnancy was associated with NB (OR 1.5 [95% CI 1.2-1.9]). The most commonly used type of pesticides were insecticides and there was a positive association with their use alone (OR 1.4 [95% CI 1.1-1.9]) or with other pesticides (OR 2.0 [95% CI 1.1-3.4]).Conclusions: Although there is the potential for recall bias due to the study design, our findings add to the evidence of an association between the household use of pesticides and NB. Until a better study design can be found, our findings add yet another reason why to advise pregnant women to limit pesticide exposure during the periconceptional period. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether parental smoking around the time of pregnancy or maternal consumption of beverages (alcohol, coffee, or tea) during pregnancy were associated with the risk of CBT.Methods: We pooled data from two French national population-based case-control studies with similar designs conducted in 2003-2004 and 2010-2011. The mothers of 510 CBT cases (directly recruited from the national childhood cancer register) and 3,102 controls aged under 15 years, frequency matched by age and gender, were interviewed through telephone, which included questions about prenatal parental smoking and maternal consumption of alcohol, coffee and tea. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional logistic regression, adjusted for age, sex and study of origin.Results: No association was seen between CBT and the mother smoking or drinking alcohol, coffee, or tea during the index pregnancy. The OR between CBT and paternal smoking in the year before birth (as reported by the mother) was 1.25 (95% CI 1.03, 1.52) with an OR of 1.09 (0.99, 1.19) for every 10 cigarettes per day (CPD) smoked. The association between paternal smoking and CBT appeared to be stronger in children diagnosed before the age of five years (OR 1.52, 95% CI 1.14, 2.02) and for astrocytoma (OR 1.86, 95% CI 1.26, 2.74).Conclusion: We found some evidence of a weak association between paternal smoking in the year before the child's birth and CBT, especially astrocytomas. These findings need to be replicated in other samples, using similar classifications of tumour subtypes. [ABSTRACT FROM AUTHOR]

Differentiation syndrome is a potentially life-threatening complication developing in 2-5-30% of patients with newly diagnosed APL receiving ATRA. Nine patients (42-9%) underwent differentiation syndrome prophylaxis (dexamethasone), and four (19%) developed true differentiation syndrome. All patients achieved cytological remission during induction therapy with a median of 34 [28;60] days and molecular remission with a median of 8 [4-26] weeks. Combined ATRA/ATO therapy for paediatric patients with SR APL was well tolerated without any severe short-term toxicity. [Extracted from the article]

Neuroblastoma (NB) is the most common extra‐cranial tumour in children. Little is known about the aetiology of NB. The early age at onset and the embryonic nature suggest a role for perinatal exposures. We conducted a pooled analysis of two French national population‐based case–control studies to explore whether there was an association between parental smoking and alcohol consumption and the risk of NB. The mothers of 357 NB cases and 1,783 controls from general population, frequency matched by age and sex, were interviewed on demographic, socioeconomic and perinatal characteristics, maternal reproductive story, and life‐style and childhood environment. Unconditional logistic regression was used to estimate pooled odds ratios and 95% confidence intervals. A meta‐analysis of our findings with those of previous studies was also conducted. Maternal smoking during pregnancy was slightly more often reported for the cases (24.1%) than for the controls (19.7%) (OR 1.3 [95% CI 0.9–1.7]; summary OR from meta‐analysis 1.1 [95% CI 1.0–1.3]. Paternal smoking in the year before child's birth were not associated with NB as independent exposure (OR 1.1 [95% CI 0.9–1.4] but the association was stronger when both parents reported having smoked during pregnancy (OR 1.5 [95% CI 1.1–2.1]. No association was observed with maternal alcohol intake during pregnancy (OR 1.0 [95% CI 0.8–1.4], summary OR from meta‐analysis 1.0 [95% CI 0.9–1.2]. Our findings provide some evidence of an association between maternal smoking during pregnancy and NB and add another reason to recommend that women refrain from smoking during pregnancy. What's new? Neuroblastoma strikes early in life, which suggests an influence from risk factors that occur before birth. Here, the authors looked at parental smoking and alcohol drinking in a large population sample in France. Cases were collected by a nationwide registry, so the sample was very complete, and included 357 cases of neuroblastoma. The analysis revealed no association between maternal alcohol drinking and the cancer, nor between neuroblastoma and paternal smoking. They did identify a slight positive association with maternal smoking, and the effect was stronger if both parents smoked. [ABSTRACT FROM AUTHOR]

Purpose: Although some specific genetic syndromes such as neurofibromatosis (NF) have been identified as risk factor of childhood brain tumors (CBT), the potential role of inherited susceptibility in CBT has yet to be elucidated.Methods: To further investigate this, we conducted a pooled analysis of two nationwide case-control studies ESCALE and ESTELLE. The mothers of 509 CBT cases and 3,102 controls aged under 15 years who resided in France at diagnosis/interview, frequency-matched by age and gender, responded to a telephone interview conducted by trained interviewers. Pooled odds ratio (OR) and 95% confidence intervals (95% CI) were estimated using unconditional logistic regression.Results: CBT was significantly associated with the family history of cancer in relatives (OR 1.2, 95% CI 1.0-1.5). The OR was slightly higher for maternal relatives than for paternal relatives, and when at least two relatives had a history of cancer. CBT was significantly associated with a family history of brain tumor (OR 2.1, 95% CI 1.3-3.7). This association seemed stronger for first-degree relatives (mother, father, and siblings), for whom, by contrast, no association was seen for cancers other than CBT. No specificity by CBT subtypes or by age of the children were found for any of these findings.Conclusion: Our findings support the hypothesis of a familial susceptibility of CBT, not due to being a known NF carrier. [ABSTRACT FROM AUTHOR]

A minority of children with chronic immune thrombocytopenia ( ITP) require therapeutic intervention to prevent haemorrhagic risk. This retrospective national study evaluated romiplostim in childhood non-responsive or refractory chronic ITP. Between 2009 and 2012, 10 patients whose Buchanan score was 3-4 were treated with romiplostim. The median duration of thrombocytopenia was 1·9 years (0·8-15). The median duration of romiplostim treatment was 9 months (3-36). A response was observed in 5/10 patients (one complete, four partial). No serious adverse effect was noticed. The long-term benefit/risk balance of this innovative treatment is currently recorded by Centre de Référence National des Cytopénies Auto-immunes de l'Enfant. [ABSTRACT FROM AUTHOR]

The Palaeozoic sediments from the Mauges Unit (Armorican Massif, France) are the best-preserved pre-orogenic sequences belonging to the Upper Allochthon. Two coherent sequences are identified. The southern unit (Châteaupanne Unit) represents the cover of the Proterozoic basement and consists of Ordovician sediments unconformably overlain by Emsian carbonates followed by Emsian to earliest Eifelian immature sandstones. The northern unit (Tombeau Leclerc Unit) consists of an Hirnantian to Emsian condensed sequence, in reverse position, that has been thrust over the southern unit. The Devonian unconformity is interpreted as evidence for an Early Devonian extension, recorded by normal faults affecting both the Early Devonian limestones and the underlying Ordovician series. This crustal extension, recorded here for the first time, is possibly related to the opening of a back-arc basin (Saint-Georges-sur-Loire) associated with the subduction of an ocean located further south (Galicia-Brittany-Massif Central Ocean). [ABSTRACT FROM AUTHOR]

The Châteaupanne Unit belongs to the South Armorican domain of the Armorican Massif (France), which is part of the Variscan belt. This unit includes two Lower Devonian plant levels and one of them corresponds to the Basal Member of the Chalonnes Formation. A sedimentological and palaeontological analysis of these fossiliferous deposits from the Châteaupanne quarry (Montjean/Loire, Maine et Loire, France) is presented here for the first time. The age determination based on palynology indicates that the locality records the earliest occurrence of plantmegafossils in the Armorican Massif. Their presence suggests an emergence event that has never been described before. Our study highlights the promising potential of the Basal Member of the Chalonnes Formation to aid in understanding these occurrences, and provides new insights into the history of the Variscan belt. [ABSTRACT FROM AUTHOR]

Les lymphomes lymphoblastiques pré-B (PBLL) sont une entité rare qui représentent 15 % des lymphomes lymphoblastiques ou 4,5 % des lymphomes malins non hodgkiniens de l’enfant. Objectif de l’étude: Décrire les caractéristiques cliniques et l’évolution thérapeutique des PBLL inclus dans les protocoles français LMT96 et francobelges EORTC 58881, 58951. Patients: De 1990 à 2008, 53 enfants (âge médian 7,75 ans) ont été inclus et traités selon un schéma directement dérivé de celui des leucémies aiguës lymphoblastiques (LAL). Résultats: La classification de Murphy retrouvait 10 stades I, 9 stades II, 9 stades III et 25 stades IV (23 atteintes médullaires et 3 atteintes méningées). La plupart des localisations principales étaient extra-nodales (majoritairement osseuses et cutanées). À J70, 51 patients avaient une réponse complète. Lors du dernier suivi (médiane à 77,5 mois), 45 enfants étaient toujours en rémission (2 d’entre eux ayant eu un 2nd cancer) et 8 (7 stades IV et 1 stade III) étaient décédés. Le stade de la maladie a un impact pronostic significatif, l’OS et l’EFS étant supérieures pour les stades I à III (EFS à 93 % ; OS à 96 %) par rapport aux stades IV (EFS à 71 % ; 0S à 73 %). Conclusion: Un traitement prolongé de type LAL est efficace (EFS et OS à 5 ans de 82 et 85 %). [ABSTRACT FROM AUTHOR]

Abstract: Sortable silt particle-size data and stable isotope analyses from the Corsica Trough, western Mediterranean Sea, provide a continuous palaeoceanographic record of the inflow, ventilation and vertical fluctuations of the Levantine Intermediate Water (LIW) in the northern Tyrrhenian Sea for the last 130,000 years. The results presented herein reveal that climate changes drive the Mediterranean intermediate circulation on Milankovitch to millennial time-scales. Intensified intermediate inflow and ventilation in the Corsica Trough occurred throughout the last glacial interval, with a cold/faster – warm/slower pattern existing between the Dansgaard-Oeschger climatic oscillations (including Heinrich events) and the LIW variability. By contrast, a weak intermediate ventilation characterised the Holocene and the Last Interglacial period, especially during insolation maxima and the sapropel deposition in the eastern Mediterranean. This variability probably reflects the changes of the eastern Mediterranean net evaporation, as well as the propagation to the western Mediterranean of the profound hydrographic adjustments of the Levantine Sea and adjacent areas to climate forcing. The implications for the formation and ventilation of the Western Mediterranean Deep Water (WMDW) in the northwestern Mediterranean basin, as well as for Mediterranean–Atlantic exchange through the Strait of Gibraltar are discussed. [Copyright &y& Elsevier]

Abstract: The Armorican Massif (western France) provides an excellent record of the Palaeozoic history of the Variscan belt. Following the Late Neoproterozoic Cadomian orogeny, the Cambro-Ordovician rifting was associated with oceanic spreading. The Central- and North-Amorican domains (which together constitute the core of the Armorica microplate) are bounded by two composite suture zones. To the north, the Léon domain (correlated with the “Normannian High” and the “Mid-German Crystalline Rise” in the Saxo-Thuringian Zone) records the development of a nappe stack along the northern suture zone, and was backthrusted over the central-Armorican domain during the Carboniferous. To the south, an intermediate block (“Upper Allochthon”) records a complex, polyorogenic history, with an early high-temperature event followed by the first generation of eclogites (Essarts). This intermediate block overthrusts to the north the Armorica microplate (Saint-Georges-sur-Loire), to the south: (i) relics of an oceanic domain; and (ii) the Gondwana palaeomargin. The collision occurred during a Late Devonian event, associated with a second generation of eclogites (Cellier). [Copyright &y& Elsevier]

Abstract: Aim of the study: The purpose of this study was to report in acute childhood idiopathic thrombocytopenic purpura (ITP) the current practices of French paediatric hematologists and to compare them to recent publications of American and British teams. Method: A questionnaire was sent online to the members of the French Society of Pediatric Hematology/Immunology (SHIP). This questionnaire, adapted from a similar american study conducted in 2001, asked 16 questions based on the clinical presentation of a 5-year-old boy referred for an acute ITP. Results: 59/123 SHIP members responded to the survey. In response to question regarding initial treatment, 86% of physicians would be given active treatments and only 9% would rarely or never administer any drug. When asked which agent would be used in case of treatment, 68% would choose to prescribe intravenous immunoglobulins and 32% corticosteroids, nobody recommended the use of anti-D immunoglobulins. Furthermore, 83% would usually hospitalize such a child. Conclusion: Finally, this study allowed us to update the current French management of treating pediatric ITP which is almost comparable among this subset of pediatric hematologists, but showed some discrepancies comparatively to the American and British studies. [Copyright &y& Elsevier]

Aims Recent data suggest that patients with pulmonary metastases from sarcomas might benefit from ablation of their metastases. Some data are available regarding osteosarcomas/angiosarcomas and lung metastases. The purpose of this study was to assess the efficacy of local ablative treatment on the survival of patients with oligometastases (one to five lesions, any metastatic site, any grade/histology) from sarcomas. Materials and Methods A multicentric retrospective study of the French Sarcoma Group was conducted in sarcoma patients with oligometastases who were treated between 2000 and 2012. Survival was analysed using multivariate sensitivity analyses with propensity scores to limit bias. Results Of the 281 patients evaluated, 164 patients received local treatment for oligometastases between 2000 and 2012. The groups' characteristics were similar in terms of tumour size and remission of the primary tumours. The median follow-up was 25.7 months; 129 (45.9%) patients had died at this point. The median overall survivals were 45.3 (95% confidence interval = 34–73) months for the local treatment group and 12.6 for the other group (95% confidence interval = 9.33–22.9). Survival was better among patients who received local treatment (hazard ratio = 0.47; 95% confidence interval = 0.29–0.78; P < 0.001). Subgroup analyses revealed similar findings in the patients with single oligometastases (hazard ratio = 0.48; 95% confidence interval = 0.28–0.82; P = 0.007); a significant benefit was observed for grade 3, and a trend was observed for grade 2. Conclusion Local ablative treatment seemed to improve the overall survival of the patients who presented with oligometastatic sarcomas, including soft tissue and bone sarcomas. The survival benefit remained after repeated local treatments for several oligometastatic events. Surgery yielded the most relevant results, but alternative approaches (i.e. radiofrequency ablation and radiotherapy) seemed to be promising. The relevance of these results is strengthened by our analysis, which avoided biases by restricting the population to patients with oligometastatic disease and used propensity scores. [ABSTRACT FROM AUTHOR]

Abstract: The Lauzanier area represents the northernmost extension of the Annot Sandstone series and contains deposits between 650 and 900m-thick. This basin was active from upper Bartonian or lower Priabonian to early Rupelian. It is composed of two superposed units separated by a major unconformity. The sediment supply is due to channelled flows coming from the south. Flow processes include mass flow to turbidity currents. The size of the particles and the absence of fine-grained sediment suggest a transport over a short distance. The Lower Unit is made of coarse-grained tabular beds interpreted as non-channelled lobe deposits. The Upper Unit is made of massive conglomerates interpreted as the channelled part of lobes. These lobe deposits settle in a tectonically confined basin according to topographic compensation that occurs from bed scale to unit scale. The abrupt progradation between the lower and the upper unit seems related to a major tectonic uplift in the area. This uplift is also suggested by a change in the petrographic nature of the source and an abrupt coarsening of the transported clasts. This field example allows providing high resolution analysis for depositional sedimentary sequences of terminal lobe deposits in a coarse-grained turbidite system. The outcrop analysis shows the lateral evolution of deposits and the system progradation allows a longitudinal analysis of facies evolution by superposing on the same outcrops the channelled lobe system and the non-channelled lobe system. These results of high-resolution outcrop analysis can be extrapolated to results obtained on sedimentary lobes in recent deep-sea turbidite system that are either restricted to cores, or with a lesser resolution (seismic). [ABSTRACT FROM AUTHOR]

Background and Purpose: Ependymoma is the third most frequent childhood braintumor. Standard treatment is surgery followed by radiation therapy including proton therapy (PBT). Retrospective studies have reported higher rates of brainstem injury after PBT than after photon therapy (XRT). We report a national multicenter study of the incidence of brainstem injury after XRT versus PBT, and their correlations with dosimetric data., Material and Methods: We included all patients aged < 25 years who were treated with PBT or XRT for intracranial ependymoma at five French pediatric oncology reference centers between 2007 and 2020. We reviewed pre-irradiation MRI, follow-up MRIs over the 12 months post-treatment and clinical data., Results: Of the 83 patients, 42 were treated with PBT, 37 with XRT, and 4 with both (median dose: 59.4 Gy, range: 53‑60). No new or progressive symptomatic brainstem injury was found. Four patients presented asymptomatic radiographic changes (punctiform brainstem enhancement and FLAIR hypersignal), with median onset at 3.5 months (range: 3.0‑9.4) after radiation therapy, and median offset at 7.6 months (range: 3.7‑7.9). Two had been treated with PBT, one with XRT, and one with mixed XRT-PBT. Prescribed doses were 59.4, 55.8, 59.4 and 54 Gy., Conclusion: Asymptomatic radiographic changes occurred in 4.8% of patients with ependymoma in a large national series. There was no correlation with dose or technique. No symptomatic brainstem injury was identified., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: We investigated the impact of the implementation of a network of reference centers for sarcomas (NETSARC) on the care and survival of sarcoma patients in France since 2010., Patients and Methods: NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTBs), funded by the French National Cancer Institute (INCa) since 2010. Its aims are to improve the quality of diagnosis and care of sarcoma patients. Patients' characteristics, treatments, and outcomes are collected in a nationwide database. The objective of this analysis was to compare the survival of patients in three periods: 2010-2012 (non-exhaustive), 2013-2015, and 2016-2020., Results: A total of 43 975 patients with sarcomas, gastrointestinal stromal tumors (GISTs), or connective tissue tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n = 9266 before 2013, n = 12 274 between 2013 and 2015, n = 22 435 in 2016-2020). Median age was 56 years, 50.5% were women, and 13.2% had metastasis at diagnosis. Overall survival was significantly superior in the period 2016-2020 versus 2013-2015 versus 2010-2012 for the entire population, for patients >18 years of age, and for both metastatic and non-metastatic patients in univariate and multivariate analyses (P < 0.0001). Over the three periods, we observed a significantly improved compliance to clinical practice guidelines (CPGs) nationwide: the proportion of patients biopsied before surgery increased from 62.9% to 72.6%; the percentage of patients presented to NETSARC MDTBs before first surgery increased from 31.7% to 44.4% (P < 0.0001). The proportion of patients with R0 resection on first surgery increased (from 36.1% to 46.6%), while R2 resection rate decreased (from 10.9% to 7.9%), with a better compliance and improvement in NETSARC centers., Conclusions: The implementation of the national reference network for sarcoma was associated with an improvement of overall survival and compliance to guidelines nationwide in sarcoma patients. Referral to expert networks for sarcoma patients should be encouraged, though a better compliance to CPGs can still be achieved., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

We present the update of the recommendations of the French society of radiation oncology on soft tissue sarcomas. Currently, the initial management of sarcomas is very important as it may impact on patients' quality of life, especially in limb soft tissue sarcomas, and on overall survival in trunk sarcomas. Radiotherapy has to be discussed within a multidisciplinary board meeting with results of biopsy, eventually reexamined by a dedicated sarcoma pathologist. The role of radiotherapy varies according to localization of soft tissue sarcoma. It is part of the standard treatment in grade 2 and 3 sarcomas of the extremities and superficial trunk>5cm. In case of R1 or R2 resection, reexcision should be discussed. In such cases, it may be delivered preoperatively (50Gy/25 fractions of 2Gy) or postoperatively. In retroperitoneal sarcomas, preoperative conformal radiotherapy with or without modulated intensity cannot be proposed systematically in daily practice. Concomitant chemoradiotherapy cannot be considered a standard treatment. Intensity-modulated radiotherapy has become widely available. Other soft tissue sarcoma sites such as trunk, head and neck and gynaecological soft tissue sarcomas will be addressed, as well as other techniques that may be used such as brachytherapy and proton therapy., (Copyright © 2021 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Objectives: While hypofractionated stereotactic body radiotherapy (SBRT) has been largely adopted in the adult setting, its use remains limited in pediatric patients. This is due, among other factors, to fear of potential toxicities of hypofractionated regimens at a young age. In this context, we report the preliminary acute (<3 months from SBRT) and middle-term (3-24 months) toxicity results of a national prospective study investigating SBRT in pediatric patients., Methods: Between 2013 and 2019, 61 patients were included. The first 40 patients (median age: 12 y, range: 3-20) who completed a 2-year-follow-up were included in the present analysis. SBRT was used for treating lung, brain or (para)spinal lesions, either as first irradiation (35%) or in the reirradiation setting (65%)., Results: Acute and middle-term grade ≥2 toxicities occurred in 12.5 and 7.5% of the patients, respectively. No grade ≥4 toxicities occurred. Almost all toxicities occurred in the reirradiation setting., Conclusion: SBRT showed a favorable safety profile in young patients treated for lung, brain, and (para)spinal lesions., Advances in Knowledge: SBRT appeared to be safe in pediatric patients treated for multiple oncology indications. These results support further evaluation of SBRT, which may have a role to play in this patient population in the future.

Purpose: The aim of this study was to retrospectively study survival and long-term morbidities of children with nasopharyngeal carcinoma (NPC) treated by induction chemotherapy and concurrent chemoradiation (CRT). The total dose of radiation was adapted to the response following neoadjuvant chemotherapy., Methods: Children with non-metastatic NPC treated in France between 1999 and 2015 were retrospectively included in the study. The strategy combined neoadjuvant platinum-based chemotherapy, followed by adapted CRT to tumor response., Results: In total, 95 patients (median age 15 years [range, 7-23 years], male-to-female ratio 1.8) with undifferentiated NPC were included; 59% of patients had TNM stage IV. Intensity-modulated radiotherapy (IMRT) was delivered to 57 patients (60%), while the other patients were treated with conformal RT (3D-RT). After a median follow-up of 4.5 years [range, 3.6-5.5 years], 13 relapses and seven deaths had occurred. The 3‑year overall and relapse-free survival (RFS) were 94% [95% CI, 85-97%] and 86% [77-92%], respectively. The locoregional failure rate was 6% [95% CI, 2-14]. Long-term treatment-related sequelae of grade 2+ were reported by 37 (50%) patients; odynophagia was significantly reduced treated by IMRT vs. conventional 3D-RT (7% vs. 55%, p = 0.015). Using a reduction dose of 59.4 Gy, 54 Gy, and 45 Gy, respectively, to the primary, involved, and uninvolved neck nodes, after a favorable tumor response, was not associated with an increased locoregional failure rate., Conclusions: The survival rates for NPC have been considerably improved by means of multimodal therapy, but long-term locoregional morbidity remains common. Use of IMRT may induce less residual odynophagia. Radiation dose reduction adapted to chemotherapy response does not have a negative impact on outcome. These findings support the use of an RT protocol adapted to the tumor response to neoadjuvant chemotherapy for a long-lasting improvement in the patient's quality of life.

Purpose: Skin cancer is the most common malignancy in white populations. We evaluated the local cure rate and cosmetic outcome of patients with basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) of the face treated with low-dose rate brachytherapy., Methods and Materials: Between February 1990 and May 2000, 147 facial carcinomas in 132 patients were treated by (192)Ir wire implantation. Side effects of brachytherapy were noted. Follow-up was 2 years or more. Locoregional recurrence-free survival (LRFS) and overall survival were recorded. Group A included patients treated by primary brachytherapy, and Group B included those treated after recurrence., Results: A total of 121 carcinomas were BCCs (82.3%) and 26 were SCCs (17.7%); the median tumor size was 10 mm. Of the tumors, 86 (58.5%) were in men and 61 (41.5%) were in women; the median age was 71 years. Group A comprised 116 lesions (78.9%), and Group B, 31 (21.1%). There were 17 relapses (11.6%) after a median follow-up of 72 months: 12 local, 4 nodal, and 1 local and nodal. Locoregional-free survival was 96.6% at 2 years and 87.3% at 5 years. Five-year LRFS was 82.6% in men and 93.3% in women (p = 0.027). After adjustment for gender, LRFS was better after primary treatment than after recurrence (hasard ratio HR, 2.91; 95% confidence interval, 1.06-8.03; p = 0.039). Five-year LRFS was 90.4% for BCC and 70.8% for SCC (p = 0.03). There were no Grade 3 complications., Conclusions: Low-dose rate brachytherapy offers good local control and cosmetic outcome in patients with periorificial skin carcinomas, with no Grade 3 complications. Brchytherapy is more efficient when used as primary treatment., (Copyright © 2011 Elsevier Inc. All rights reserved.)