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L'actualité en oncologie radiothérapie est marquée par les résultats d'essais stratégiques particulièrement pour les cancers de l'œsophage et du rectum. Pour l'adénocarcinome de l'œsophage, en situation préopératoire, les résultats de l'étude ESOPEC ont montré un bénéfice de survie de la chimiothérapie périopératoire par 5-fluoro-uracile, leucovorine oxaliplatine, taxotère en comparaison à la chimioradiothérapie (irradiation de 41,4 Gy avec une chimiothérapie concomitante par carboplatine/paclitaxel). En situation exclusive, l'étude CONCORDE n'a pas montré de bénéfice de l'escalade de dose et la dose standard reste 50 Gy. Pour le cancer du pancréas opérable, l'étude NRG/RTOG0848 qui comparait la chimiothérapie adjuvante avec ou sans chimioradiothérapie complémentaire a retrouvé une augmentation significative de la probabilité de survie sans maladie à 5 ans dans le sous-groupe de patients sans atteinte ganglionnaire. Pour les cancers du rectum, l'actualisation à 7 ans des résultats de l'étude PRODIGE 23 a confirmé le bénéfice non seulement en termes de survie sans récidive mais également de survie globale d'une chimiothérapie néoadjuvante par 5-fluoro-uracile, acide folinique, irinotécan et oxalipalatine avant la chimioradiothérapie, alors que l'actualisation de l'étude RAPIDO a montré un taux de rechute locale inacceptable dans le bras expérimental. L'actualisation de l'étude OPRA a montré un taux de survie avec conservation d'organe à 5 ans significativement supérieur en faveur du bras chimioradiothérapie suivie de la chimiothérapie en comparaison à la chimiothérapie d'induction première suivie de chimioradiothérapie. Une étude de phase 2 incluant 41 patients atteints d'un cancer du rectum localement avancé avec défaillance du système de réparation de l'ADN, a montré qu'un traitement exclusif par immunothérapie anti-PDL1 (dostarlimab) pendant 6 mois permettait une réponse clinique complète sans recours à un traitement complémentaire (ni radiothérapie, ni chirurgie). Pour le carcinome épidermoïde du canal anal, la survie et les profils de toxicité des patients inclus dans la cohorte anabase traités pour une tumeur de petit stade (T1 ou T2) ont été comparés selon qu'ils aient reçu exclusivement de la radiothérapie ou de la chimioradiothérapie. L'ajout d'une chimiothérapie à la radiothérapie ne montrait pas de bénéfice mais augmentait la toxicité et le risque d'allongement du traitement en raison d'interruption. Current events in radiotherapy oncology are marked by the results of strategic trials, particularly for esophageal and rectal cancers. For resectable esophageal adenocarcinoma, results of the ESOPEC study showed a benefit in overall survival from the perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin and docetaxel compared to chemoradiotherapy (41.4 Gy radiotherapy and carboplatin/paclitaxel chemotherapy). In definitive setting, the CONCORDE study did not show any benefit from dose escalation and the standard dose remains 50 Gy. For resectable pancreatic cancer, the NRG/RTOG0848 study that compared adjuvant chemotherapy with or without chemoradiotherapy found a significant increase of the 5-year disease-free survival rate in the subgroup of node-negative patients. For rectal cancers, the 7-year update of PRODIGE 23 study confirmed the benefit in disease-free- and overall survival of neoadjuvant folinic acid, fluorouracil, irinotecan and oxaliplatin chemotherapy before chemoradiotherapy of T3, T4 or N+ adenocarcinoma, while the update of the RAPIDO study revealed an unacceptable local recurrence rate in the experimental arm. The update of the OPRA study shows a significantly higher 5-year organ preservation rate in favor of the chemoradiotherapy arm followed by consolidation chemotherapy compared to induction chemotherapy followed by CRT. A phase 2 study, including 41 patients with mismatch repair deficient, locally advanced rectal cancer reported that exclusive treatment with anti-PDL1 immunotherapy (dostarlimab) for 6 months resulted in complete clinical response without the need of additional treatment (neither radiotherapy nor surgery). For anal carcinoma, the analysis of survival and toxicity profiles of patients treated for a small stage T1 or T2 tumor were compared depending on whether they received exclusive radiotherapy or chemoradiotherapy. The addition of chemotherapy to radiotherapy did not show any survival benefit but significantly increased toxicity and the risk of radiotherapy disruption. [ABSTRACT FROM AUTHOR]

Neoadjuvant chemoradiotherapy is the standard treatment for patients with locally advanced rectal cancers owing to its ability to downstage primary tumours. Some patients can achieve pathological complete response after neoadjuvant therapy, and can adopt a "watch and wait" treatment strategy to avoid overtreatment. Therefore, it is essential to develop strategies for predicting responses to neoadjuvant therapy. Radiomics has shown great potential in extracting tumour features from high-throughput medical images for the construction of mathematics models for predicting the effects of anticancerous therapies. Herein, we explored MRI-based radiomics and found that it can predict responses of locally advanced rectal cancers to chemoradiation. Efficient radiomics model allow early-stage prediction of the effect of neoadjuvant chemoradiotherapy on locally advanced rectal cancers. It helps clinicians to make informed therapeutic decisions. In this review, we discuss the workflow of radiomics, and summarize the clinical application of MRI-based radiomics in predicting pathological complete response to neoadjuvant chemoradiotherapy of locally advanced rectal cancer. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop a model for predicting chemoradiation response in non-small cell lung cancer (NSCLC) patients by integrating radiomics and deep-learning features and combined intra- and peritumoral regions with pre-treated CT images. This study enrolled 462 patients with NSCLC who received chemoradiation. On the basis of pretreated CT images, we developed three models to compare the prediction of chemoradiation: intratumoral, peritumoral and combined regions. To further illustrate each model, we established different feature integration methods: a) radiomics model with 1500 features; b) deep learning model with a multiple instance learning algorithm; c) integrated model by integrating radiomic and deep learning features. For radiomics and integrated models, support vector machine and the least absolute shrinkage and selection operator were used to extract and select features. Transfer learning and max pooling algorithms were used to identify high informative features in deep learning models. We applied ten-fold cross validation in model training and testing. The best area under the curve (AUC) of intratumoral, peritumoral and combined models were 0.89 (95% CI, 0.74–0.93), 0.86 (95% CI, 0.75–0.92) and 0.92 (95% CI, 0.81–0.95), respectively. It indicated the importance of the peritumoral region for treatment response prediction and should be used in combination with the intratumoral region. Integrated models gave better results than models with radiomics and deep learning features alone in all regions of interest and radiomics models outperformed deep learning models in any comparative models. The model that integrate radiomic and deep learning features and combined intra- and peritumoral regions provide valuable information in predicting treatment response of chemoradiation. It can help oncologists customize personalized clinical treatment plans for NSCLC patients. [ABSTRACT FROM AUTHOR]

Gastrointestinal cancers are one of the most frequent cancers and a leading cause of cancer deaths worldwide. We provide an overview of the most important practice-changing trials that were either published or presented at the international scientific meetings in 2021–2023. Highlights included reports on three phase III trials (CONCORDE/PRODIGE 26, ARTDECO, and a study by Xu et al.) that evaluated dose escalation in the definitive setting for locally advanced oesophageal cancers, as well as two phase III trials that evaluated the role of chemotherapy (neo-AEGIS) and targeted therapy (NRG/RTOG 1010) in the neoadjuvant setting for adenocarcinoma oesophageal cancers or gastroesophageal junction cancer. CheckMate 577 evaluated nivolumab in patients who had residual pathological disease after neoadjuvant chemoradiation followed by complete resection. The use of radiation therapy for borderline and locally advanced pancreatic cancer is also discussed (SMART and CONKO-007 trials). Stereotactic body radiation therapy followed by sorafenib was compared to sorafenib alone in patients with hepatocellular carcinoma in the NRG/RTOG 1112 study. New options in the management of rectal cancer are emerging such as total neoadjuvant treatment (PRODIGE 23, RAPIDO, PROSPECT), organ preservation (OPRA, OPERA), and the role of immunotherapy in patients with DNA mismatch-repair deficient/microsatellite instability. Finally, preliminary results of the ACT 4 trial that evaluated de-escalation in anal cancer are presented. [ABSTRACT FROM AUTHOR]

This single-center retrospective study aimed to observe survival and prognosis of elderly patients with esophageal cancer receiving radical radiotherapy combined with S1 chemotherapy, and to preliminarily explore whether hematologic indicators or inflammatory indicators before radiotherapy are prognostic factors. We retrospectively collected data of 80 elderly patients with esophageal cancer who had received radical concurrent chemoradiotherapy from January 2015 to July 2018. The patients were older than 70 years. Radiation therapy was delivered with intensity-modulated irradiation therapy (IMRT) or volumetric modulated arc therapy (VMAT), while the chemotherapy regimen was S1 alone. Toxicities were evaluated in accordance with the criteria of the Radiation Therapy Oncology Group. Baseline hematologic basic nutritional indicators, such as hemoglobin (HGB), albumin (ALB), and prealbumin (PAB), along with inflammatory indicators, such as the ratio of neutrophils to lymphocytes (NLR), the ratio of platelets to lymphocytes (PLR), were collected to preliminarily analyze their relationship with progression and survival. The median follow-up time was 39 months (range 30–65 months). The median overall survival and progression-free survival times were 24 and 17 months, respectively. The 1-, 2-, and 3-year overall survival rates were 76.5%, 48.1%, and 31.3%, respectively. The 1-, 2-, and 3-year progression-free survival rates were 57.5%, 37.8%, and 29.4%, respectively. T stage, clinical staging, and lesion region were independent prognostic factors for OS. No significant associations with prognosis were observed either for baseline hematologic or for inflammatory indicators (all P > 0.05). The rates of esophagitis (grade 2 and above) and hematologic toxicity were 60% and 45%, respectively. Oral S-1 combined with definitive concurrent radiotherapy for elderly patients with esophageal cancer has a significant survival benefit. The toxicities are well tolerated. It seems that prognosis does not correlate with baseline hematologic nutritional indicators and inflammatory indicators. [ABSTRACT FROM AUTHOR]

Chemoradiotherapy is regarded as a standard scheme for inoperable and unresectable esophageal cancers. Our aims were to explore the prognostic factors relevant to esophageal squamous cell carcinoma (ESCC) following intensity-modulated radiation therapy (IMRT) plus chemotherapy. Totally 495 ESCC patients undergoing IMRT combined with chemotherapy in our hospital between 2011 and 2020 were retrospectively analyzed. Potential clinical prognosis-related factors were assessed by uni- and multivariate analyses. The median overall survival (OS) and progression-free survival (PFS) of the ESCC patients were 2.25 and 1.24 years, respectively. Uni- and multivariate analyses demonstrated the relevant independent prognostic factors of OS and PFS were gender, T stage, N stage, clinical stage, and tumor location (P < 0.05), but not chemotherapy or radiotherapy dose. We further compared the 5-year OS rates among different T stages, N stages, clinical stages, genders, and tumor locations. The survival rate at the higher clinical stage was significantly lower (P < 0.001). The 5-year OS in the upper thorax of the tumor was 46.0% and exceeded other tumor locations (P < 0.05). The 5-year OS was 56.1% among females and 33.3% among males (P = 0.001). For ESCC patients receiving IMRT combined with chemotherapy, their long-term curative effects are influenced by T stages, N stages, clinical stages, genders, and tumor locations. ESCC patients who are females, or have upper thoracic tumor, or are at early clinical stage own better prognosis. [ABSTRACT FROM AUTHOR]

Despite recent advances, the prognosis of pancreatic adenocarcinomas remains poor, even for patients with resectable tumors. For these latter, new approaches based on neoadjuvant treatment have been developed. Two components are used: chemotherapy and radiation therapy (RT). Indeed, pre-operative RT has many advantages in terms of efficacy and tolerance. It increases notably the chances of subsequent complete tumor resection. Several prospective trials are currently ongoing to clarify its place in the therapeutic arsenal. Another crucial question is to know which is the best RT technique: conventional normofractionated chemoradiotherapy or hypofrationated stereotactic body RT? [ABSTRACT FROM AUTHOR]

Le cancer du canal anal est une tumeur rare représentant 6 % des cancers digestifs et comptant 2000 nouveaux cas par an en France. Il est en majorité de forme localisée ou localement évoluée au moment du diagnostic. L'association de chimiothérapie et de radiothérapie est le standard thérapeutique depuis les années 1980, avec une chimiothérapie à base de 5-fluoro-uracile et mitomycine-C, sans changement thérapeutique majeur malgré la réalisation de plusieurs essais cliniques de phase III. Le pronostic est cependant plus favorable. Des progrès en imagerie, notamment grâce à l'imagerie par résonnance magnétique pelvienne et à la tomographie par émission de positons, permettent un meilleur bilan de la maladie. La radiothérapie a également connu de grands progrès techniques avec l'avènement de la Radiothérapie Conformationnelle avec Modulation d'Intensité (RCMI). L'enjeu actuel principal est une prise en charge adaptée au stade de la maladie et au pronostic qui en découle. Les stades précoces sont possiblement surtraités au prix de toxicité à long terme. Plusieurs essais thérapeutiques s'intéressent à la désescalade thérapeutique en termes d'irradiation. Au contraire, les résultats sont décevants pour les stades localement évolués. Il semble pertinent de proposer une intensification thérapeutique pour ces patients, avec une escalade de dose en radiothérapie mais aussi l'addition d'autres thérapies complémentaires à la chimioradiothérapie, notamment l'immunothérapie ou encore une chimiothérapie néoadjuvante par taxanes devant des résultats prometteurs au stade métastatique. Anal cancer is considered a rare tumor, accounting for 6 % of digestive cancers and about 2000 new cases per year in France. It is mostly diagnosed at a localized stage. For many years, the standard of care for patients with localized disease is an association with radiotherapy and chemotherapy including Mitomycin C and 5-Fluorouracil. There weren't any major changes in the therapeutic management of these tumors despite several phase III studies. However, there is an improvement in patient prognostic. This can be explained by imaging progress, using magnetic resonance imaging and positron emission tomography-computed tomography, permitting better staging and evaluation of disease. Moreover, irradiation modalities changed because of the development of Intensity Modulated Radiotherapy. Actual research focuses on a more personalized strategy according to tumoral stages. Patients with early-stage tumors are potentially over-treated with a risk of chronic digestive toxicities. Several studies are interested in irradiation de-escalation for these patients. On the other hand, treatment results for patients with advanced tumoral stages are disappointing. It seems relevant to propose a therapeutic intensification for these patients, such as dose escalation, association with new therapies like immunotherapy or induction chemotherapy using taxans given promising results at the metastatic stage. [ABSTRACT FROM AUTHOR]

Le traitement du cancer de l'œsophage non résécable et/ou chez des patients inopérables repose sur une chimioradiothérapie concomitante. Toutefois, la persistance ou la rechute locorégionale représentent le mode d'échec thérapeutique le plus fréquent. Ceci a conduit à l'émergence d'études évaluant l'intérêt d'escalader la dose au volume tumoral macroscopique au-delà de 50 Gy dans l'objectif d'améliorer le taux de contrôle locorégional. De nombreuses séries rétrospectives et méta-analyses ont conclu à des résultats discordants, certaines montrant un bénéfice à l'escalade de dose et d'autres ne montrant pas de différence. À l'heure actuelle, trois essais prospectifs randomisés (INT0123, ARTDECO [Randomized Study on Dose Escalation in Definitive Chemoradiation for Patients With Locally Advanced Esophageal Cancer] et CONCORDE) ont conclu à l'absence d'amélioration du taux de contrôle locorégional ou de celui de survie globale avec l'escalade de dose. Cet article décrit les résultats des principales études d'escalade de dose en chimioradiothérapie néoadjuvante et exclusive à partir d'une revue de la littérature. For non-operable, localized esophageal cancer, definitive concurrent chemoradiotherapy is the standard treatment. Currently, the radiation dose recommended is 50 to 50,4 Gy. However, the optimal radiation dose remains controversial. Many studies have demonstrated that locoregional failure remains a common failure pattern, most likely to occur within the original gross tumor volume. Several retrospective studies have indicated that higher radiation dose may improve local control and survival while others failed to demonstrate improved oucomes. In three randomized trials (INT0123, ARTDECO, and CONCORDE), dose escalation did not improve locoregional control nor survival, establishing 50 Gy as the standard chemoradiation dose for patients who will not undergo surgery. Here, we reviewed the results of dose escalation in the literature in the neoadjuvant and definitive settings. [ABSTRACT FROM AUTHOR]

The field of gynaecologic oncology has evolved rapidly in recent years, largely driven by advances in both radiotherapy and systemic therapies. These innovations have reshaped the management of key gynaecologic cancers, including cervical, endometrial, vaginal, and vulvar cancers, leading to more personalized and effective treatment approaches. This review explores pivotal clinical trials conducted between 2023 and 2024 that have potentially modified current practices. Through an extensive analysis of randomized controlled trials and meta-analyses, we examine the evolving role of radiotherapy, the integration and sequencing of immunotherapy, and the refinement of neoadjuvant and adjuvant treatments based on molecular classifications. The combination of immunotherapy with chemoradiotherapy has shown promising outcomes, particularly in patients with locally advanced cervical cancer. For endometrial cancer, molecular profiling has enabled a more precise classification of tumour subtypes, leading to better-targeted adjuvant therapies that reduce unnecessary interventions and increase treatment efficacy. In parallel, radiotherapy has advanced with the increasing use of modern techniques such as intensity-modulated radiotherapy and more recently the developments of adaptive treatments in order to minimize exposure to healthy tissue, thereby reducing toxicity and enhancing patient quality of life. Integration of image-guided brachytherapy and expansion of capabilities with newer generation of brachytherapy applicators have also increased possibilities to achieve efficient local treatments, including in very advanced cases. However, despite progress in common gynaecologic cancers, the management of rare cancers such as vulvar and vaginal cancers continues to face challenges due to limited clinical research and treatment data. This review highlights the transformative potential of these innovations and emphasizes the need for continued research and personalized treatment strategies to optimize patient outcomes in gynaecologic oncology., Competing Interests: Disclosure of interests CC reports personal fees and non-financial support from MSD, EISAI, GSK, Merck, support for travelling by Ipsen, and service as an investigator for clinical trials sponsored or supported by TherAgulX and Roche; ZEA, AG, GC, SC, PM have not declared their activities/relationships/interests., (Copyright © 2024 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Current events in radiotherapy oncology are marked by the results of strategic trials, particularly for esophageal and rectal cancers. For resectable esophageal adenocarcinoma, results of the ESOPEC study showed a benefit in overall survival from the perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin and docetaxel compared to chemoradiotherapy (41.4Gy radiotherapy and carboplatin/paclitaxel chemotherapy). In definitive setting, the CONCORDE study did not show any benefit from dose escalation and the standard dose remains 50Gy. For resectable pancreatic cancer, the NRG/RTOG0848 study that compared adjuvant chemotherapy with or without chemoradiotherapy found a significant increase of the 5-year disease-free survival rate in the subgroup of node-negative patients. For rectal cancers, the 7-year update of PRODIGE 23 study confirmed the benefit in disease-free- and overall survival of neoadjuvant folinic acid, fluorouracil, irinotecan and oxaliplatin chemotherapy before chemoradiotherapy of T3, T4 or N+ adenocarcinoma, while the update of the RAPIDO study revealed an unacceptable local recurrence rate in the experimental arm. The update of the OPRA study shows a significantly higher 5-year organ preservation rate in favor of the chemoradiotherapy arm followed by consolidation chemotherapy compared to induction chemotherapy followed by CRT. A phase 2 study, including 41 patients with mismatch repair deficient, locally advanced rectal cancer reported that exclusive treatment with anti-PDL1 immunotherapy (dostarlimab) for 6 months resulted in complete clinical response without the need of additional treatment (neither radiotherapy nor surgery). For anal carcinoma, the analysis of survival and toxicity profiles of patients treated for a small stage T1 or T2 tumor were compared depending on whether they received exclusive radiotherapy or chemoradiotherapy. The addition of chemotherapy to radiotherapy did not show any survival benefit but significantly increased toxicity and the risk of radiotherapy disruption., (Copyright © 2024. Published by Elsevier Masson SAS.)

En raison des propriétés physiques de la radiothérapie par faisceau de protons (PT), qui permet de déposer l'énergie à une profondeur spécifique avec une chute rapide de la dose au-delà de cette profondeur, la protonthérapie présente plusieurs avantages théoriques par rapport à la radiothérapie par photons pour le cancer de l'œsophage. Les protons ont le potentiel de réduire la dose reçue par les tissus sains et de permettre, plus sûrement, le traitement des tumeurs proches d'organes critiques, l'augmentation de la dose, le traitement trimodal et la réirradiation. Au cours des dernières années, des études rétrospectives multicentriques de plus grande envergure ont été publiées, démontrant d'excellents taux de survie, de toxicité plus faibles que prévus et même de meilleurs résultats avec la protonthérapie qu'avec la radiothérapie par photons avec la RCMI ou l'arcthérapie volumétrique modulée (VMAT). Bien que la protonthérapie soit associée à une réduction des toxicités, des complications postopératoires et des durées d'hospitalisation par rapport à la radiothérapie par photons, ces études comportaient toutes des biais inhérents à la sélection des patients pour la protonthérapie. Ces observations ont été récemment confirmées par une étude randomisée de phase II qui a montré une diminution significative de la toxicité avec les protons par rapport à la RCMI chez des patients atteints de carcinome de l'œsophage. Actuellement, deux essais randomisés de phase III (NRG-GI006 aux États-Unis et PROTECT en Europe) sont menés pour confirmer l'intérêt des protons dans les cancers de l'œsophage localement évolués et résécables. Because of the physical properties of proton beam radiation therapy (PT), which allows energy to be deposited at a specific depth with a rapid energy fall-off beyond that depth, PT has several theoretical advantages over photon radiation therapy for esophageal cancer (EC). Protons have the potential to reduce the dose to healthy tissue and to more safely allow treatment of tumors near critical organs, dose escalation, trimodal treatment, and re-irradiation. In recent years, larger multicenter retrospective studies have been published showing excellent survival rates, lower than expected toxicities and even better outcomes with PT than with photon radiotherapy even using IMRT or VMAT techniques. Although PT was associated with reduced toxicities, postoperative complications, and hospital stays compared to photon radiation therapy, these studies all had inherent biases in relation with patient selection for PT. These observations were recently confirmed by a randomized phase II study in locally advanced EC that showed significantly reduced toxicities with protons compared with IMRT. Currently, two randomized phase III trials (NRG-GI006 in the US and PROTECT in Europe) are being conducted to confirm whether protons could become the standard of care in locally advanced and resectable esophageal cancers. [ABSTRACT FROM AUTHOR]

La radiothérapie est souvent d'indication tardive pour les carcinomes différenciés de la thyroïde en rechute réfractaire à l'iode. L'objectif de cette étude était de décrire l'efficacité et la toxicité de la radiothérapie cervicale de rattrapage associée ou non à une chimiothérapie concomitante par carboplatine. Cette étude rétrospective monocentrique a collecté les données de patients atteints d'un carcinome différencié de la thyroïde, en situation de rechute après thyroïdectomie, vésiculaire ou papillaire, ayant reçu une radiothérapie cervicale à dose curative. Le critère principal évalué était le contrôle locorégional. Les critères secondaires étaient la survie sans rechute, la survie globale et la toxicité aiguë et chronique évaluée selon la Common Terminology Criteria for Adverse Events (CTCAE) v4. Trente-neuf patients consécutifs ont été traités entre 2005 et 2019. Le suivi médian était de 36,6 mois. Quinze cancers (38 %) ont rechuté locorégionalement. La probabilité de contrôle locorégional à 2 ans était de 66,7 %. La survie sans récidive locorégionale médiane était de 48 mois [32,9–non atteinte] et la survie globale médiane de 49 mois [38,8–non atteinte]. En analyse multifactorielle, la résection incomplète initiale était associée à la survie globale (hazard ratio [HR] : 24,39 [3,57–166,78], p = 0,00113) et à la survie sans récidive locorégionale (HR : 33,91 [4,46–257,61], p = 0,00066). La rupture capsulaire initiale était associée à la survie sans rechute locorégionale (HR : 13,45 [1,81–99,76], p = 0,011). Le score sur l'échelle de statut de performance de l'ECOG était associé à la survie globale (HR : 5,11 [1,57–16,66], p = 0,00688). Les survies des patients pris en charge par chimioradiothérapie concomitante et par radiothérapie exclusive n'étaient pas significativement différentes (survie globale : p = 0,34 ; survie sans récidive locorégionale : p = 0,84). Une toxicité aiguë de grade 3 a été rapportée dans 14 % des cas. La radiothérapie cervicale de rattrapage est associée à un taux de contrôle locorégional de 66,7 % à deux ans, au prix d'une toxicité acceptable. L'adjonction de carboplatine concomitant à la radiothérapie ne semble pas améliorer le taux de contrôle locorégional ni celui de survie globale par rapport à la radiothérapie exclusive. Radiation therapy is often the last resource treatment for cervical relapse in iodine refractory differentiated thyroid cancer. We present locoregional control data in patients with cervical relapse treated with curative intent radiation therapy with or without concomitant carboplatin. This monocentric retrospective study gathered data on patients with differentiated thyroid carcinoma – vesicular or papillary – in relapse after thyroidectomy who received a curative intent cervical radiation therapy. Locoregional progression free survival (LRPFS), progression free survival (PFS), overall survival (OS) were gathered as well as acute and chronic adverse events assessed with the CTCAE v4. Thirty-nine patients were consecutively included between 2005 and 2019. The median follow-up was 36.6 months. Fifteen patients (38%) had a locoregional relapse, locoregional control at 2 years was 66.7%. The median LRPFS was 48 months [32.9–not reached] and the median overall survival 49 months [38.8–not reached]. In multivariate analysis, initial incomplete resection was associated with poorer OS (HR: 24.39 [3.57–166.78], P = 0.00113) and LRPFS (HR: 33.91 [4.46–257.61], P = 0.00066), extra nodal spread was associated with poorer LRPFS (HR: 13.45 [1.81–99,76], P = 0.011). ECOG performance status was associated with OS (HR: 5.11 [1.57–16.66], P = 0.00688). Carboplatin association with radiation therapy was not associated with improved survivals (OS: P = 0.34, LRPFS: P = 0.84). The rate of acute grade 3 toxicities was 14%. Salvage cervical radiation therapy was associated with a locoregional control of 66.7% at 2 years with a reasonable toxicity rate. Carboplatin association with radiation therapy did not improve locoregional control nor overall survival in comparison with radiotherapy alone. [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]

Primary vaginal cancers are rare tumours, for which external beam radiotherapy and brachytherapy are major treatment tools. Given the complexity of brachytherapy techniques, the treatment should be performed in specialised centres. We present the recommendations of the French society for radiation oncology on the indications and techniques for external beam radiotherapy and brachytherapy for primary vaginal cancer. [ABSTRACT FROM AUTHOR]

We present the recommendations of the French society of oncological radiotherapy on the indications and techniques for external beam radiotherapy for bladder cancer. [ABSTRACT FROM AUTHOR]

External beam radiotherapy and brachytherapy are major treatments in the management of cervical cancer. For early-stage tumours with local risk factors, brachytherapy is a preoperative option. Postoperative radiotherapy is indicated according to histopathological criteria. For advanced local tumours, chemoradiation is the standard treatment, followed by brachytherapy boost, which is not optional. We present the update of the recommendations of the French Society of Oncological Radiotherapy on the indications and techniques for external beam radiotherapy and brachytherapy for cervical cancer. [ABSTRACT FROM AUTHOR]

Herein are presented the recommendations from the Société française de radiothérapie oncologique regarding indications and modalities of lung cancer radiotherapy. The recommendations for delineation of the target volumes and organs at risk are detailed. [ABSTRACT FROM AUTHOR]

Primary vulvar carcinomas are rare gynaecological cancers, for which surgery is the mainstay of treatment. There is however a major place for external beam radiotherapy in the situation of inoperable locally advanced tumours and/or as adjuvant therapy, when there are risk factors for locoregional relapse. We present the recommendations of the French society for radiation oncology on the indications and techniques for radiotherapy in the treatment of primary vulvar cancer. [ABSTRACT FROM AUTHOR]

Summary. The squamous cell carcinoma of the anorectum is rare and subdivided into perianal, anal canal and combined carcinomas. Persistent infection with a high-risk human papillomavirus (HPV) is believed to be the main cause for the development of anal cancer. Therefore, the incidence in high-risk individuals (e.g. immuno-compromised patients or patients living with HIV) is much higher than in the general population. Nevertheless, a nearly three-fold overall increase was observed within the last three decades. The diagnosis is often made by chance as anal carcinoma presents with unspecific symptoms which could be attributed to many other proctological diseases, especially haemorrhoids. The diagnosis is confirmed by histology using biopsies or excisional biopsies. The subsequent staging requires a detailed documentation of the tumor's location and size as well as an overall examination focusing on palpation of the groin. Sphincter involvement in small lesions can be assessed by endoluminal ultrasound or alternatively by an angulated magnetic resonance imaging of the anal canal/pelvis. A computed tomography scan of the thorax and abdomen is usually performed to rule out a metastatic disease. Positron emission tomography-computed tomography is useful for detection of lymph node (LN) involvement and to accurately define the stage prior to treatment. The therapy of anal carcinoma requires a multidisciplinary approach. In most patients, primary treatment consists of chemoradiotherapy (CRT), which improved 5-year overall survival since its introduction in 1974. A surgical approach is reserved for small perianal lesions without sphincter infiltration, LN or distant metastasis. Furthermore, in recurrent or persistent carcinomas after CRT salvage surgical treatment is recommended. In some cases (obstruction, fistula formation) a deviation colostomy is required. Follow-up clinical and imaging evaluation should follow recommended guidelines and should involve primary physicians in addition to members of the multidisciplinary treatment team. Until now, the impact of HPV immunization on anal carcinoma is still unclear despite having been proven effective in preventing anal intraepithelial neoplasia. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the efficacy of liposome-paclitaxel and carboplatin combination chemoradiotherapy for patients with locally advanced esophageal squamous cell carcinoma (ESCC). Seventy-nine consecutive patients treated with liposome-paclitaxel based concurrent chemoradiotherapy between January 2015 and December 2019 at Cancer hospital of the University of Chinese Academy of Sciences (Zhejiang cancer hospital) were enrolled in this study. The overall response, toxicities, progression-free survival and overall survival were analyzed with SPSS software. A total of 302 cycles of weekly chemotherapy were delivered, with a median 4 courses. After concurrent chemoradiotherapy (CCRT), the efficacy was classified as CR in 4 cases (5.1%), PR in 22 cases (28.2%) and SD in 51 cases (65.4%). The median PFS and OS time were 18.2 months and 23.4 months. The 3-year PFS and OS rates were 45.1% and 43.6%, respectively. Liposome-paclitaxel and carboplatin concurrent with radiotherapy is a safe and effective modality for locally advanced ESCC. Further clinical investigation are warranted to evaluate the efficacy of this regimen. [ABSTRACT FROM AUTHOR]

A major advance has been made in the management of rectal cancer, with the emergence in 2021 of total neoadjuvant treatment. The main publications from the RAPIDO and PRODIGE-23 trials reported a significant improvement in progression-free survival and the pathological complete response rate. The aim of this review is to synthesize recent data on neoadjuvant treatment of rectal cancer, to explain the long-term results of the RAPIDO and PRODIGE-23 trials, and to put them into perspective, considering current advances in de-escalation strategies. The update of the 5-year survival data from the RAPIDO trial highlights an increased risk of loco-regional relapse, with 11.7% of relapses in the experimental group and 8.1% in the control group, while the update of the PRODIGE-23 trial confirms the benefits of this treatment regimen, with a significant improvement in overall survival. In addition, the results of the OPRA and PROPSPECT trials confirm the benefit of total neoadjuvant treatment with induction chemotherapy, as well as the possibility of surgical de-escalation in the OPRA trial and radiotherapy in the PROSPECT trial. The challenge for the future is to identify patients who require total neoadjuvant treatment with the aim of curative surgery to obtain a cure without local or distant relapse, and those for whom therapeutic de-escalation can be envisaged., (Copyright © 2024 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Longtemps, la chimioradiothérapie adjuvante est restée incontournable dans la prise en charge thérapeutique des adénocarcinomes gastriques et pancréatiques. Pour ces tumeurs, l'exérèse chirurgicale, seul espoir d'offrir au patient une survie prolongée, n'est possible que dans 20 % des cas. La survie médiane des patients opérés n'est que de 12 à 20 mois en raison de la fréquence des récidives locorégionales et/ou métastatiques. Pour les cancers de l'estomac, la chimioradiothérapie adjuvante est justifiée par les résultats de l'essai de phase III de l'Intergroup 0116, publiés par MacDonald et al. Le gain de survie l'était au prix d'une toxicité non négligeable. Ce traitement a été supplanté au début des années 2000 par la chimiothérapie périopératoire. Actuellement, des essais de chimioradiothérapie néoadjuvante sont en cours dans le but d'améliorer l'observance et la tolérance des traitements. Pour les cancers du pancréas, le rôle de la chimioradiothérapie adjuvante est discuté depuis longtemps en raison d'essais aux résultats contradictoires. La radiothérapie néoadjuvante présente de nombreux avantages en termes d'efficacité et de tolérance. Elle augmente les chances de pouvoir réséquer ensuite la tumeur de manière complète. Plusieurs essais prospectifs sont en cours pour préciser sa place dans l'arsenal thérapeutique. For many years, adjuvant chemoradiotherapy remained essential in the therapeutic management of gastric and pancreatic adenocarcinomas. For these tumours, surgical excision, the only hope of offering the patient prolonged survival, is only possible in 20% of cases. The median survival of operated patients is only 12 to 20 months due to the frequency of locoregional and/or metastatic recurrences. For stomach cancers, adjuvant chemoradiotherapy is justified by the results of the phase III trial Intergroup 0116 published by MacDonald et al. The gain in survival was at the cost of significant toxicity. This treatment was supplanted in the early 2000s by perioperative chemotherapy. Currently, neoadjuvant chemoradiotherapy clinical studies are ongoing with the aim of improving treatments observance and tolerance. For pancreatic cancers, the role of adjuvant chemoradiotherapy has long been discussed because of trials with contradictory results. Neoadjuvant radiotherapy has many advantages in terms of efficacy and tolerance. It increases the chances of subsequent complete tumour resection. Several prospective trials are currently ongoing to clarify its place in the therapeutic arsenal. [ABSTRACT FROM AUTHOR]

Imaging is involved in the management of uterine cervical cancer with several objectives: 1/to assess local and lymph node extension of the initial disease; 2/evaluate treatment response to conservative therapy; 3/detect recurrences. Pelvic MRI is the first-line examination in all these indications. It is the key element for delineation after image fusion when the indication of chemoradiation therapy is made. It is also essential for guiding the placement of applicators and optimising the dosimetry of brachytherapy. The diffusion-weighted acquisition is a sequence sensitive to the motion of water molecules. It allows distinguishing water molecules with free diffusion from water molecules with diffusion restricted by obstacles such as cell membranes or the cytoskeleton. The diffusion is thus connected to the cellularity of the explored tissue, and the cancers, being hypercellular, will present a high signal. It thus provides additional information thanks to a high contrast between the tumour and the surrounding tissues, facilitating detection, evaluation of the volume and extent of the disease. [ABSTRACT FROM AUTHOR]

Radiotherapy is one of the most common form of treatment in oncology care. Indeed, radiotherapy proved to be very effective in treating a wide range of malignancies. Nevertheless, certain tumours are intrinsically radioresistant or may evolve to become radioresistant. Resistance to radiotherapy is often associated with dysregulated DNA damage response and repair. Recently, a number of strategies have been developed to improve radiotherapy efficacy by targeting the DNA damage response and repair pathways. Ongoing clinical trials showed the potential of some of these approaches in enhancing radiotherapy, but also highlighted the possible limitations. Here, we will describe (i) the main mechanisms involved in double-strand break repair; (ii) available strategies that target these DNA repair processes to improve radiotherapy and (iii) the clinical outcomes and challenges that have emerged so far. [ABSTRACT FROM AUTHOR]

Chemoradiotherapy is now considered the standard of care for many locally advanced diseases. Cytotoxic drugs have been largely evaluated in this setting, with cisplatin and 5FU the most often used drugs. A large amount of pre-clinical studies has demonstrated the synergy between both modalities. Concomitant administration seems the more beneficial in many diseases. Emergence of new approaches, combining targeted therapies and radiotherapy (RT) is now a reality. The main example is the association of cetuximab and RT in head and neck carcinomas, even if, 14 years after the initial publication, the best way to use it is still unknown. New compounds as inhibitors of DNA-repair or immune checkpoints are under investigation and showed early promising results. [ABSTRACT FROM AUTHOR]

Résumé: L'adénocarcinome du pancréas (AP) deviendra la deuxième cause de mortalité par cancer d'ici 2030. Si les taux de survie globale à cinq ans restent faibles, des progrès significatifs ont été réalisés au cours des dix dernières années. Pour les patients atteints d'AP opérables, la chimiothérapie adjuvante par FOLFIRINOX a été démontrée supérieure à la gemcitabine. Les stratégies de traitement pré-opératoire (néoadjuvant pour les tumeurs résécables d'emblée, d'induction pour les tumeurs borderline) sont en cours d'évaluation dans le cadre d'essais cliniques. Dans les stades avancés, les stratégies de traitement d'entretien ou de maintenance après une période de contrôle de la maladie sous FOLFIRINOX se développent. Alors qu'aucune thérapie ciblée n'avait jusque-là montré d'efficacité dans l'AP, les inhibiteurs de PARP ont permis d'améliorer significativement la survie sans progression en traitement de maintenance chez des patients porteurs d'une mutation germinale de BRCA (5 % des AP). Les immunothérapies ont été décevantes, à l'exception des rares tumeurs présentant un phénotype d'instabilité des microsatellites (1 %-2 %). Les soins de support occupent une place centrale pour améliorer la qualité de vie des patients. Plusieurs essais cliniques nationaux (PRODIGE) sont en cours. Le chapitre du Thésaurus National de Cancérologie Digestive (TNCD) consacré à l'AP a été récemment réactualisé (Juin 2018) pour tenir compte de ces avancées. Cette revue fait l'état de l'évolution des pratiques dans le traitement médical de l'AP. Pancreatic ductal adenocarcinoma (PDAC) is expected to become the second leading cause of cancer death by 2030. While overall survival rates at 5 years remains low, significant progress has been made over the last decade. For patients with operable PDAC, adjuvant chemotherapy with FOLFIRINOX has been demonstrated to be superior to gemcitabine. Preoperative treatment strategies (neoadjuvant for upfront resectable tumors, induction for borderline tumors) are currently evaluated in clinical trials. In advanced stages, maintenance treatment strategies after a period of disease control with FOLFIRINOX are emerging. While no targeted therapy had so far shown efficacy in PDAC, PARP inhibitors significantly improved progression-free survival as maintenance therapy in patients with a BRCA germline mutation (5%). Immunotherapies have been disappointing in PDAC, except for tumors with microsatellite instability (1%-2%). Supportive care is central to improving the quality of life of patients. Several national clinical trials (PRODIGE) are in progress. The chapter of the National Thesaurus of Digestive Oncology (TNCD) focusing on PDAC was recently updated (June 2018) to take account of these advances. This review provides an overview of recent practice changes in the medical treatment of PDAC. [ABSTRACT FROM AUTHOR]

Résumé Les cancers de l'œsophage localement évolués relèvent d'une prise en charge pluridisciplinaire où la chimioradiothérapie occupe une place essentielle. La chimioradiothérapie néoadjuvante permet d'améliorer les taux de contrôle locorégional et de survie globale des cancers de l'œsophage localement évolués opérés. La chimioradiothérapie exclusive a également une place pour les lésions non résécables et/ou pour les patients non opérables et est considérée comme une alternative à la chirurgie dans la prise en charge initiale des carcinomes épidermoïdes de l'œsophage localement évolués. La chimiothérapie associée consiste en une combinaison de sels de platine (cisplatine ou oxaliplatine) et de 5-fluoro-uracile le plus souvent, ou de carboplatine et de paclitaxel hebdomadaire selon le protocole CROSS en situation néoadjuvante. Les doses varient de 41,4 Gy (protocole CROSS) à 45 Gy en situation néoadjuvante. En traitement exclusif, une dose de 50 à 50,4 Gy est préconisée selon les recommandations françaises et américaines. Les volumes cibles tiennent compte des particularités anatomiques de l'œsophage et de son drainage lymphatique. Ainsi, une irradiation ganglionnaire prophylactique intéresse classiquement les aires ganglionnaires présentant un risque d'envahissement de plus de 15 % à 20 %. L'utilisation de la radiothérapie conformationnelle avec modulation d'intensité représente une approche prometteuse susceptible de diminuer la toxicité dans les organes à risque adjacents. Cet article décrit, à partir d'une revue critique de la littérature, la place de la chimioradiothérapie dans la stratégie thérapeutique, les volumes anatomiques d'intérêt, les doses de prescription, les contraintes de doses dans les organes à risque et les techniques de radiothérapie adaptées. Abstract Locally advanced oesophageal cancer treatment requires a multidisciplinary approach with the combination of chemotherapy and radiotherapy for preoperative and definitive strategy. Preoperative chemoradiation improves the locoregional control and overall survival after surgery for locally advanced oesophageal cancer. Definitive chemoradiation can also be proposed for non-resectable tumours or medically inoperable patients. Besides, definitive chemoradiation is considered as an alternative option to surgery for locally advanced squamous cell carcinomas. Chemotherapy regimen associated to radiotherapy consists of a combination of platinum derived drugs (cisplatinum or oxaliplatin) and 5-fluorouracil or a weekly scheme combination of carboplatin and paclitaxel according to CROSS protocol in a neoadjuvant strategy. Radiation doses vary from 41.4 Gy to 45 Gy for a preoperative strategy or 50 to 50.4 Gy for a definitive treatment. The high risk of lymphatic spread due to anatomical features could justify the use of an elective nodal irradiation when the estimated risk of microscopic involvement is higher than 15% to 20%. An appropriate delineation of the gross tumour volume requires an exhaustive and up-to-date evaluation of the disease. Intensity-modulated radiation therapy represents a promising approach to spare organs-at-risk. This critical review of the literature underlines the roles of radiotherapy for locally advanced oesophageal cancers and describes doses, volumes of treatment, technical aspects and dose constraints to organs-at-risk. [ABSTRACT FROM AUTHOR]

Résumé La radiothérapie conformationnelle avec modulation d’intensité des cancers du canal anal permet d’optimiser l’irradiation et d’épargner les tissus sains. La toxicité reste importante avec l’adjonction de la chimiothérapie concomitante. La précision du bilan par IRM et tomographie par émission de positons-scanographie permet de mieux préciser les volumes recevant une dose élevée mais nécessite le respect des règles de délinéation. L’irradiation est uniforme à ce jour pour tous les stades, mais pourrait être individualisée selon le stade clinique et la réponse tumorale initiale. De nouveaux paradigmes apparaissent concernant la biologie, le bilan d’extension, les volumes, les doses, le fractionnement et les traitements associés. Abstract Intensity-modulated radiotherapy makes possible to optimize the irradiation and spare normal tissues. The toxicity remains important with concomitant chemotherapy often associated. The improvement of MRI and PET-CT define more precisely the target volumes, which need a higher dose, but necessitates to respect the rules of contouring. The treatment is uniform whatever the stage but should be individualized based on clinical stage and tumor response. New paradigms concern biology, staging, volumes and doses, fractionation and combined treatments. [ABSTRACT FROM AUTHOR]

Résumé Lors du diagnostic de cancer du pancréas, environ 15 % des patients sont atteints d’une tumeur résécable, 50 % d’une tumeur métastatique et 25 % d’une tumeur localement évoluée (non métastatique mais non résécable du fait d’un envahissement vasculaire) ou à la limite de la résécabilité. Malgré les progrès techniques réalisés dans le domaine de la radiothérapie et l’amélioration de l’efficacité de la chimiothérapie, le pronostic reste défavorable. Ces dernières années, la place de la radiothérapie dans la prise en charge des cancers du pancréas a été très discutée. Cette revue a pour objectif d’évaluer le rôle de la radiothérapie pour ces patients. Abstract At diagnosis, about 15% of patients with pancreatic cancer present with a resectable tumour, 50% have a metastatic tumour, and 25% a locally advanced tumor (non-metastatic but unresectable due to vascular invasion) or borderline resectable. Despite the technical progress made in the field of radiation therapy and the improvement of the efficacy of chemotherapy, the prognosis of these patients remains very poor. Recently, the role of radiation therapy in the management of pancreatic cancer has been much debated. This review aims to evaluate the role of radiation therapy for these patients. [ABSTRACT FROM AUTHOR]

Résumé Le traitement standard des cancers du rectum, associant chimioradiothérapie suivie de chirurgie radicale avec exérèse totale du mésorectum permet d’assurer le contrôle local pelvien, au prix d’une morbidité importante et de séquelles fonctionnelles. Ce traitement standard identique pour tous les patients atteints d’un cancer du bas ou moyen rectum à partir du stade T3 serait excessif pour les petites tumeurs, mais probablement insuffisant pour les tumeurs localement évoluées. En effet, les récidives métastatiques restent fréquentes. La prise en charge est discutée en réunion de concertation pluridisciplinaire sur la base du bilan initial, en particulier de l’imagerie par résonance magnétique qui peut prédire la marge de résection et évaluer la réponse au traitement. La stratégie est amenée à évoluer vers un repositionnement de la chimiothérapie en début de prise en charge et vers une désescalade thérapeutique pour les petites tumeurs avec omission de la radiothérapie ou de la chirurgie dans une perspective de préservation rectale. Enfin, la stratégie thérapeutique peut être rediscutée et adaptée en fonction de la réponse tumorale, qui est associée au pronostic. Abstract Standard treatment consisting of chemoradiotherapy followed by radical surgery with total mesorectal excision, resulting in good oncologic local control but high morbidity and poor functional results. The same treatment applied to all patients presenting with low or mid T3–4 rectal tumors could result in overtreatment of small tumors. However, it remains insufficient (or unsatisfactory?) for locally advanced tumors regarding metastatic recurrence rate. Treatment is decided by a multidisciplinary board on the basis of initial staging, including MRI which allows for resection margin prediction and post-treatment response evaluation. The therapeutic strategy is changing towards upfront chemotherapy and therapeutic desescalation omitting radiotherapy or surgery in a rectal preservation strategy. Moreover, tumor response leads to new multidisciplinary board discussion and treatment adaptation. [ABSTRACT FROM AUTHOR]

Abstract While outcomes for patients with locally advanced disease have improved considerably with combined modality therapy, there is now an emphasis on developing risk-adapted treatment strategies. Moreover, the primary cause of death from locally advanced rectal cancer is related to distant progression, which now exceeds the rate of local failure. Thus, the necessity to optimally address micrometastatic disease has led to increasing interest in delivering chemotherapy in the neoadjuvant setting rather than in the postoperative setting. This review critically appraises the emerging literature on the options for sequencing of therapy, focusing on the total neoadjuvant therapy paradigm as well as emerging options for omitting components of multimodality therapy. Résumé Alors que les résultats obtenus chez les patients atteints d’une maladie localement évoluée se sont considérablement améliorés avec les associations thérapeutiques, l’accent est maintenant mis sur le développement de stratégies de traitement adaptées au risque. En outre, la cause principale de décès due à ce cancer rectal est liée à la progression à distance, dont le taux dépasse maintenant celui d’échec local. Ainsi, la nécessité d’aborder de manière optimale la maladie micrométastatique a conduit à un intérêt croissant pour la délivrance de la chimiothérapie dans le cadre néoadjuvant plutôt que dans celui postopératoire. Cette revue évalue de manière critique la littérature émergente sur les options pour le séquençage du traitement, en se concentrant sur le paradigme de la thérapie néoadjuvante totale ainsi que des options émergentes pour omettre des composants de la thérapie multimodale. [ABSTRACT FROM AUTHOR]

Résumé Le traitement des carcinomes épidermoïdes des voies aérodigestives localement évolués repose sur la chimioradiothérapie concomitante. Un traitement séquentiel associant chimiothérapie d’induction par association de docétaxel, cisplatine et 5-fluoro-uracile (TPF), suivie d’une (chimio)radiothérapie, est utilisé fréquemment dans le cadre des stratégies de préservation laryngée. En dehors de cette situation particulière, le bénéfice en termes de survie d’une chimiothérapie d’induction a été beaucoup discuté ces dernières années. Dans cinq essais randomisés récents, une chimioradiothérapie a été comparée à une chimiothérapie d’induction par TPF, suivie d’une chimioradiothérapie. Parmi ces cinq essais, quatre concluent que ces traitements sont similaires. Un seul essai a montré un bénéfice de la chimiothérapie d’induction mais sa méthodologie est très discutable. Après la chimiothérapie par TPF, la chimioradiothérapie est moins bien tolérée. En cas d’envahissement ganglionnaire important (stade N2b-c-N3), la chimiothérapie d’induction permet de diminuer la survenue de métastases à distance. Le statut selon l’ Human papilloma virus (HPV) ne doit pas influencer la décision thérapeutique. The treatment of locally advanced head and neck squamous cell carcinoma is based on concomitant chemoradiotherapy. A sequential treatment combining induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF), followed by (chemo)radiotherapy is frequently used as part of laryngeal preservation strategies. Apart from this particular situation, the benefit in terms of survival of induction chemotherapy has been much discussed in recent years. In five recent randomized trials, chemoradiotherapy was compared with TPF induction chemotherapy followed by chemoradiotherapy. Of these five trials, four concluded that these treatments were similar. A single trial reports a benefit for induction chemotherapy but its methodology is highly debatable. After TPF chemotherapy, chemoradiotherapy is less well tolerated. In patients with significant lymph node invasion (N2b-c-N3), induction chemotherapy reduces the occurrence of distant metastasis. The HPV status should not influence the therapeutic decision. [ABSTRACT FROM AUTHOR]

Penile cancer is a rare entity with only 2000 new cases a year in the United States. Even though early stage penile cancer has an excellent prognosis, patients with positive pelvic lymph nodes have an overall 5-year survival rate under 10%. There is no consensus for the management of pelvic node-positive patients, although most guidelines are in favour of pelvic lymph node dissection for patients with two or more positive nodes, followed by adjuvant chemotherapy. We describe here the case of a patient with numerous metastatic lymph nodes at diagnosis, treated with chemoradiation (66 Gy with concurrent gemcitabine) after failure of first-line chemotherapy and still alive and disease-free 7 years after diagnosis. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the efficacy and safety of pelvic irradiation combined systematic chemotherapy in patients with locally advanced (cT3–T4 and/or cN+) rectal cancer and synchronous unresectable distant metastases. Patients and methods A total of 76 eligible patients who received pelvic radiotherapy and concurrent capecitabine-based chemotherapy were retrospectively reviewed. Patients survival curves were constructed using the Kaplan-Meier method, and a multivariate analysis was performed to identify independent prognostic factors. Results Most of the adverse events were mild during the period of combined chemoradiotherapy. Twenty-two patients experienced resection of primary tumour and 16 patients underwent radical surgery of all lesions. Only five patients had pelvic progression during the follow-up period. The median progression-free survival and median overall survival were 13 and 30 months, respectively. Radical surgery of all lesions following chemoradiotherapy was found to be an independent prognostic factor according to multivariate analysis. Conclusions Pelvic irradiation combined with systematic chemotherapy in patients with locally advanced rectal cancer and synchronous unresectable distant metastases is effective and tolerable, both for pelvic and distant control. A curative resection following chemoradiotherapy was associated with prolonged survival. [ABSTRACT FROM AUTHOR]

Résumé En recherche clinique, la mise en place d’une méthodologie adaptée permettra l’analyse rigoureuse des données collectées et doit intervenir dès la conception de l’essai pour définir la démarche expérimentale appropriée. Ainsi, si le but principal d’une phase I est de déterminer la dose à utiliser en phase II, la méthodologie doit être adaptée finement au(x) traitement(s) testée(s). La méthodologie des essais en chimiothérapie et thérapie ciblée est relativement bien décrite. Les essais de phase I de radiothérapie et chimioradiothérapie sont atypiques et ne peuvent suivre les schémas d’administration d’une molécule pharmacologique. La phase I de ces essais doit refléter à la fois l’efficacité et l’ensemble de la toxicité potentielle liée au traitement. La méthodologie qui en découle doit sans doute être complexe afin de limiter les échecs en phase ultérieure. Cependant, il existe très peu de données méthodologies dans les publications de ces essais. Cet article s’attarde sur ces essais particuliers, aux caractéristiques propres. Il permet ainsi de soulever les lacunes des schémas actuels afin d’inventer de nouveaux schémas méthodologiques plus adaptés. In clinical research, biostatistical methods allow the rigorous analysis of data collection and should be defined from the trial design to obtain the appropriate experimental approach. Thus, if the main purpose of phase I is to determine the dose to use during phase II, methodology should be finely adjusted to experimental treatment(s). Today, the methodology for chemotherapy and targeted therapy is well known. For radiotherapy and chemoradiotherapy phase I trials, the primary endpoint must reflect both effectiveness and potential treatment toxicities. Methodology should probably be complex to limit failures in the following phases. However, there are very few data about methodology design in the literature. The present study focuses on these particular trials and their characteristics. It should help to raise existing methodological patterns shortcomings in order to propose new and better-suited designs. [ABSTRACT FROM AUTHOR]

Résumé Après avoir publié une série rétrospective de 23 patients pris en charge pour un carcinome épidermoïde du rectum par chimioradiothérapie exclusive, nous proposons une revue de la littérature concernant le traitement à visée curative et conservatrice de cette tumeur rare. Nous avons répertorié 11 études rétrospectives, concernant 106 patients pris en charge entre 2007 et 2016. Le traitement du carcinome épidermoïde rectal devrait être calqué sur celui du canal anal et reposer sur une chimioradiothérapie exclusive à visée curative et conservatrice. Le taux de survie globale à 5 ans est supérieur à 80 % en cas de chimioradiothérapie contre 32 % pour les séries chirurgicales. Le bilan d’extension nécessaire est comparable à celui du carcinome épidermoïde anal, avec un intérêt pour la tomographie par émission de positons (TEP)-scanographie au moment du diagnostic et dans le suivi après un délai d’au moins six semaines. L’irradiation conformationnelle avec modulation d’intensité (RCMI) paraît légitime, à une dose de 36 à 45 Gy dans les aires ganglionnaires prophylactique et une dose supérieure à 54 Gy dans le volume tumoral et ganglionnaire macroscopique. Une chimiothérapie concomitante avec un anti-métabolite (5-fluoro-uracile ou capécitabine) et la mitomycine C, ou à défaut du cisplatine, est recommandée. Le taux de toxicité aiguë de grade 2 ou plus rapporté est inférieur à 30 %. Le suivi sera calqué sur celui du carcinome épidermoïde du canal anal, avec une place pour l’écho-endoscopie et la TEP-scanographie. Le carcinome épidermoïde du rectum est une tumeur rare, dont la prise en charge thérapeutique doit être calquée sur celle du carcinome épidermoïde du canal anal, à visée conservatrice et curative par chimioradiothérapie exclusive. After publishing a retrospective series of 23 patients treated for a rectal squamous cell carcinoma with exclusive curative and conservative intent chemoradiation, we aim to propose a review of the literature about this rare tumour. We identified 11 retrospective studies, on 106 patients, treated between 2007 and 2016. Treatment of rectal squamous cell carcinoma should be similar to anal carcinoma, based on exclusive chemoradiation, displaying a 5-year overall survival rate over 80%, while it was 32% in surgical series. Baseline explorations should be similar as for anal carcinoma, with an interest in PET-CT at diagnosis and monitoring, after a delay over 6 weeks after chemoradiation. Intensity-modulated radiotherapy is legitimate, to a prophylactic dose between 36 and 45 Gy, and over 54 Gy to the tumour. Concomitant chemotherapy should combine an antimetabolite (5-fluorouracil or capecitabine) and mitomycin C, or cisplatin. This treatment seems well tolerated, associated with grade 2 or above toxicity below 30%. Follow-up should be established on anal squamous cell carcinoma schedule, with endoscopic ultrasonography and PET-CT. Rectal squamous cell carcinoma is a rare tumour; it management should be based on anal curative and conservative intent chemoradiation. [ABSTRACT FROM AUTHOR]

Gastric cancer is the 6th most common cancer in the world. Gastric adenocarcinomas can be divided into two groups: gastroesophageal junction adenocarcinomas and distal gastric adenocarcinomas, with different risk factors and potentially different therapeutic strategies. Therapeutic strategy for esogastric adenocarcinoma is multimodal. Gastric adenocarcinomas are managed with surgery and peri-operative chemotherapy. Gastroesophageal junction adenocarcinomas can either be treated surgically after neoadjuvant chemoradiotherapy or in the same way than gastric adenocarcinomas. There is currently no evidence of superiority of either treatment strategy. Recently, nivolumab has been validated as an adjuvant therapy for patients with esophageal cancer who received preoperative chemoradiotherapy and had residual tumor on the surgical specimen. In the absence of preoperative treatment, adjuvant chemoradiotherapy or chemotherapy should be discussed on a patient-by-patient basis. Currently, there is not indication for targeted therapies, nor for adapting postoperative treatment according to the response to preoperative treatment. The only validated indication for immunotherapy is as adjuvant treatment of esophageal cancer, but many studies are ongoing and may change practices in the future. The objective of this review is to synthesize the literature concerning the management of localized esogastric adenocarcinoma., (Copyright © 2022 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Résumé La tête et le cou sont des sites communs des lymphomes non hodgkinien extraganglionnaires. La radiothérapie exclusive a un rôle important dans la prise en charge des lymphomes de bas grade, localisés ou diffus. Dans le cas des lymphomes de haut grade, son association à la chimiothérapie est débattue. Son rôle est cependant indéniable dans deux entités spécifiques : les lymphomes T/NK de type nasal, et les lymphomes primitifs cérébraux, qui font l’objet de cette mise au point. The head and neck are common sites for extranodal non-Hodgkin lymphomas. Radiotherapy plays an important role in the treatment of low-grade lymphomas, with curative or palliative intent. In the case of high-grade lymphomas, its combination with chemotherapy is debated. Its role is however undeniable in two specific entities: NK/T-cell lymphoma NK/T nasal type, and primary central nervous system lymphomas, which are the subject of this review. [ABSTRACT FROM AUTHOR]

Purpose To retrospectively analyse female patients treated for urethral adenocarcinoma, modalities of treatment and long-term outcomes. Patients Four cases of primary female urethral adenocarcinoma were treated in the departments of urology and radiation-oncology at Georges-Pompidou and Necker hospitals (France) over a 7-year period. Results All of them underwent surgery, with three presenting stage pT3-pT4 and one a positive cytology on inguinal node. Three patients received adjuvant cisplatin-based chemoradiotherapy up to 60 Gy, and one preoperative chemoradiotherapy at 45 Gy. Two recurrences were observed: one local relapse occurred at 9 months from the diagnosis and was treated by anterior pelvic exenteration followed by chemoradiotherapy, with no recurrence. One tumour relapsed both at the local level and on distant metastatic sites at 9 months from the diagnosis, and died 21 months after this progression. Median survival and progression-free survival are respectively 4.2 years and 13 months. Three patients are alive at 7, 4.5 and 3 years from diagnosis. Conclusion Female urethral adenocarcinoma is a very rare entity and often present in locally advanced stages. Initial extensive surgery with pelvic exenteration should be considered, followed by chemoradiotherapy according to the surgical margins and lymph nodes involvement. [ABSTRACT FROM AUTHOR]

Résumé Introduction La place du curage cervical dans la prise en charge conservatrice des carcinomes épidermoïdes localement évolués des voies aérodigestives supérieures demeure largement débattue. L’objectif de cette étude était d’analyser les caractéristiques, les facteurs pronostiques et le suivi des patients qui ont bénéficié d’un curage cervical avant une irradiation exclusive (traitement dissocié). Patients et méthodes Soixante-trois patients chez qui une atteinte ganglionnaire volumineuse (de 3 cm ou plus) ou nécrotique a été mise en évidence lors de la scanographie initiale ont fait l’objet d’un traitement dissocié entre 2000 et 2012 à l’institut Claudius-Regaud (Toulouse, France). La lésion primitive était oropharyngée, hypopharyngée ou laryngée dans respectivement 63, 21 et 13 % des cas. Résultats Les taux de contrôle locorégional et de survie globale à 3 ans étaient de 88 % et 68 % avec un suivi médian de 4 ans. Un seul patient a été atteint d’une récidive ganglionnaire isolée. En analyse unifactorielle, les variables significativement associées à un allongement de la survie sans maladie étaient : la réalisation d’un curage fonctionnel par opposition à non conservateur, ( hazard ratio [HR] : 0,39 ; intervalle de confiance à 95 % [IC 95 %] : 0,16–0,94 ; p = 0,03) et l’indice de performance de l’OMS (1–2 contre 0 ; HR = 6,27 ; IC 95 % = 2,73–14,39 ; p < 0,0001). En analyse multifactorielle, seul l’indice de performance de l’OMS reste significatif. Conclusion La réalisation d’un curage cervical avant la réalisation d’une (chimio)radiothérapie exclusive permet un bon taux de contrôle locorégional malgré une atteinte ganglionnaire initiale importante et permet de s’affranchir de la complexité d’une chirurgie cervicale de rattrapage en territoire irradié tout en gardant l’avantage d’une approche conservatrice sur la lésion primitive. Purpose Optimal timing of neck dissection remains debated in the conservative management of patients with locoregionally advanced squamous cell carcinoma of the head and neck. Patients and methods The files of 63 patients with radiographic evidence of bulky or necrotic nodal metastases treated by up-front neck dissection and definitive radiotherapy between 2000 and 2012 at two institutions were retrospectively reviewed. Results The primary site was oropharyngeal, hypopharyngeal or laryngeal in 63%, 21% and 13% cases, respectively. Overall, 83% of the tumours were staged pN2b or more. Extracapsular spread was found in 48 cases (77%). After a 48-month median follow-up, the 3-year locoregional control and overall survival were 88% and 68%, respectively. Only one isolated failure occurred in the dissected neck. Conclusion This combination therapy provides a good locoregional tumour control. It should be considered as an option in laryngeal, hypopharyngeal or oropharyngeal squamous cell carcinomas with bulky or necrotic nodal metastases at presentation. [ABSTRACT FROM AUTHOR]

Purpose There is a sound theoretical basis but little clinical evidence substantiating the benefits of concurrent chemoradiotherapy with two-drug chemotherapy for locally advanced soft tissue sarcomas. Our five-year data on the feasibility and effectiveness of neoadjuvant chemoradiotherapy with systemically effective doses of adriamycin and ifosfamide combined is presented here. Patients and methods Between 2000 and 2011, 53 patients with UICC (2010) stage I ( n = 1, 1.9%), II ( n = 12, 22.7%) or III ( n = 40, 75.5%) nonmetastatic soft tissue sarcoma received neoadjuvant chemoradiotherapy with ifosfamide (1.5 g/m 2 /day, d1–5, q28) and doxorubicin (50 mg/m 2 /day, d3, q28) plus concurrent radiotherapy with a target dose of 50–64 Gy (median 60 Gy). The treatment of 34 patients (64.2%) was combined with hyperthermia. Results At five years, the local control rate was 89.9% (± 5.7%), distant metastasis-free survival 66.6% (± 7.6%), and survival 83.3% (± 6%). The R0 resection rate was 81.1%. Radiotherapy was completed as planned in all patients and chemotherapy in 42/53 (70.2%). Grades III ( n = 21, 29.6%) and IV ( n = 18, 34%) leukopenia was the main acute adverse event. All acute and chronic non-hematologic toxicities were moderate. Conclusion Neoadjuvant chemoradiotherapy for soft tissue sarcoma is associated with good feasibility, manageable acute and late toxicities, and high local efficacy. [ABSTRACT FROM AUTHOR]

Résumé Le traitement des lymphomes de Hodgkin de stades I/II repose sur la chimiothérapie et la radiothérapie. Ces associations thérapeutiques ont changé le pronostic et la survie des patients. Actuellement, la problématique est de diminuer leur toxicité. Grâce à la tomographie par émission de positons, essentielle dans la prise en charge initiale de ces lymphomes, la définition des volumes cibles en radiothérapie est devenue plus précise, ce qui a pu permettre une radiothérapie plus ciblée de type « involved node » ou « involved site ». Abstract Treatment for stage I and II Hodgkin lymphoma is based on a combination of chemotherapy and radiotherapy, with a high successful cure rate. Now, the aim is to decrease toxicity rates. Positron-emission tomography scan is recommended as pretreatment baseline and is very useful to define precisely target volumes for planning radiation therapy. Based on these changes were developed guidelines for modern radiation therapy called involved node and « involved site ». [ABSTRACT FROM AUTHOR]

At the time of diagnosis, around 20% of patients presenting a pancreatic cancer have a resectionable tumour. 50% are metastatic and 30% or locally advanced. In spite of the advances made in chemoradiotherapy and chemotherapy, patients with a locally advanced pancreatic cancer frequently relapse in locoregional or metastatic form, with an average survival rate estimated at between 5 and 11 months. Over the past 30 years, modest improvements in the average survival rate have been gained for patients treated by chemoradiotherapy or chemotherapy. The optimal treatment for locally advanced pancreatic adenocarcinoma remains controversial. The aim of this review is to assess the role of radiotherapy and of combined treatments for these patients. [ABSTRACT FROM AUTHOR]

Résumé La chimioradiothérapie suivie de chirurgie radicale avec exérèse du mésorectum a permis d’améliorer les résultats oncologiques du traitement des cancers du rectum, au prix cependant d’une morbidité et de séquelles fonctionnelles anorectales, urinaires et sexuelles. Comme la chimioradiothérapie permet une stérilisation tumorale dans 15 à 25 % des cas, l’utilité de la chirurgie radicale chez les patients en situation de bonne réponse est remise en cause et deux stratégies de préservation d’organe ont été proposées, la surveillance ( watch and wait ) et l’exérèse locale. Cette revue de la littérature a pour objectif de faire un état des lieux des résultats des séries de préservation d’organe après chimioradiothérapie dans le traitement des cancers du rectum et de souligner les questions relatives à la sélection initiale des patients, la définition de la réponse complète, le risque ganglionnaire mésorectal, les modalités de la surveillance ainsi que les résultats oncologiques et fonctionnels. For rectal cancers, the current standard of care consists of chemoradiation followed by radical surgery with total mesorectal excision. Oncologic results are good, especially regarding local recurrence rates, but at the cost of high morbidity rates and poor anorectal, urinary and sexual function results. Since chemoradiation yields 15 to 25% pathological complete response, the role of radical surgery is questioned for patients presenting with good response after chemoradiation and two organ preservation strategies have been offered: watch and wait strategy and local excision strategy. The aim of this review is to give the results of organ preservation after chemoradiotherapy series and to highlight different questions regarding initial patient's selection, complete clinical response definition, risk of mesorectal nodal involvement, follow-up modalities as well as oncologic and functional results. [ABSTRACT FROM AUTHOR]

Résumé Le traitement de référence des carcinomes épidermoïdes du canal anal localement évolués (stades II et III) est la chimioradiothérapie exclusive. Celle-ci délivre une dose de 45 Gy à raison de cinq fractions de 1,8 Gy par semaine dans un volume pelvien, puis un complément de dose de 14 à 20 Gy dans la tumeur. La chimiothérapie concomitante la plus souvent utilisée comprend une association de 5-fluoro-uracile et de mitomycine-C délivrée lors de la première et cinquième semaine d’irradiation. Une couverture optimale des volumes cibles est parfois difficile à obtenir avec une irradiation conformationnelle (jonctions des faisceaux, combinaison d’électrons et photons parfois complexes dans les aires ganglionnaires). La toxicité cutanéomuqueuse et digestive induite par le traitement peut nécessiter un intervalle libre avant la réalisation du complément d’irradiation. Celui-ci peut avoir un effet délétère sur les résultats s’il est prolongé (plus de 38 jours). Les différentes techniques de radiothérapie conformationnelle avec modulation d’intensité (statique segmentée, dynamique, arcthérapie volumique modulée et tomothérapie hélicoïdale) ont leur intérêt dans cette localisation. Elles permettent d’obtenir une stérilisation tumorale et ganglionnaire avec une baisse des doses intermédiaires et élevées aux organes à risque (intestin grêle, périnée/organes génitaux, vessie, moelle osseuse) entraînant une réduction de la toxicité aiguë de grade 3 ou plus ainsi qu’une meilleure conservation fonctionnelle du sphincter anorectal. Une description de la réalisation de l’arcthérapie volumique modulée est présentée dans cet article. Les avantages et inconvénients de cette technique par rapport aux autres y sont discutés. The standard treatment of locally advanced (stage II and III) squamous cell carcinoma of the anal canal consists of concurrent chemoradiotherapy (two cycles of 5-fluoro-uracil, mitomycin C, on a 28-day cycle), with a dose of 45 Gy in 1.8 Gy per fraction in the prophylactic planning target volume and additional 14 to 20 Gy in the boost planning target volume (5 days per week) with a possibility of 15 days gap period between the two sequences. While conformal irradiation may only yield suboptimal tumor coverage using complex photon/electron field junctions (especially on nodal areas), intensity modulated radiation therapy techniques (segmented static, dynamic, volumetric modulated arc therapy and helical tomotherapy) allow better tumour coverage while sparing organs at risk from intermediate/high doses (small intestine, perineum/genitalia, bladder, pelvic bone, etc.). Such dosimetric advantages result in fewer severe acute toxicities and better potential to avoid a prolonged treatment break that increases risk of local failure. These techniques also allow a reduction in late gastrointestinal and skin toxicities of grade 3 or above, as well as better functional conservation of anorectal sphincter. The technical achievements (simulation, contouring, prescription dose, treatment planning, control quality) of volumetric modulated arctherapy are discussed. [ABSTRACT FROM AUTHOR]

Résumé Objectif de l’étude Au cours des dernières décennies, la prise en charge des cancers du rectum a été nettement améliorée par l’optimisation du traitement chirurgical avec l’implémentation de l’excision totale du mésorectum et le développement des stratégies néoadjuvantes de radiothérapie avec ou sans chimiothérapie. Dans cette étude, nous avons évalué l’impact de l’évolution des pratiques sur l’efficacité du traitement au cours d’une période de 15 ans dans un centre expert. Patients et méthodes Cette étude rétrospective a été conduite chez des patients qui ont reçu une chimioradiothérapie pour un adénocarcinome rectal localement évolué (de stade T3–4 ayant ou non colonisé les ganglions) entre 1993 et 2008 au centre hospitalier universitaire (CHU) Jean-Minjoz de Besançon. Nous avons étudié les taux de conservation sphinctérienne, de réponse complète histologique (ypT0), de contrôle et de survie, ainsi que la toxicité selon la chimiothérapie concomitante utilisée et la période de prise en charge. Résultats Au total, 179 patients ont été ainsi pris en charge. Une dose moyenne de 45 Gy a été délivrée en 25 fractions de 1,8 Gy avec une chimiothérapie concomitante par 5-fluoro-uracile et leucovorine, capécitabine, et capécitabine et oxaliplatine pour respectivement 56,4, 28,5 et 15,1 % des patients. La probabilité de survie sans récidive à 5 ans était de 74,3 % et celle de survie globale de 68,8 %. Les taux de récidive locale et à distance étaient de 6,1 et 23,6 %. En analyse bifactorielle, la chimiothérapie concomitante par capécitabine et oxaliplatine a montré un taux de réponse complète histologique supérieur (22,2 % contre 6 % avec la capécitabine et 10, 3 % avec le 5-fluoro-uracile et la leucovorine) mais non significativement ( p = 0,12), avec des taux de toxicité et d’interruption de traitement plus importants. Le taux de conservation sphinctérienne ne s’est pas amélioré significativement durant la période de prise en charge (1993–2004 contre 2005–2008), mais la probabilité de survie sans récidive a augmenté de 72,2 à 87,5 % ( p = 0,03). Conclusion Nos résultats sont concordants avec ceux de la littérature. La chimiothérapie concomitante par 5-fluoro-uacile ou capécitabine reste le schéma standard. L’évaluation de la chimiothérapie néoadjuvante, avant la chimioradiothérapie, doit être poursuivie au regard de la prédominance des récidives à distance. Purpose In recent decades, the management of rectal cancer has been significantly improved by optimizing the surgical treatment with the total mesorectal excision and the development of neoadjuvant radiotherapy with or without chemotherapy. In this study, we investigated the impact of changes in practice over a period of 15 years in an expert centre. Patients and methods A monocentric study was conducted retrospectively on cT3-resectable T4 patients who received chemoradiotherapy for a locally advanced rectal adenocarcinoma between 1993 and 2008. We studied sphincter preservation, pathological complete response (ypT0), survival, and toxicities by different concomitant chemotherapy and treatment period. Results Among the 179 patients who had a chemoradiotherapy, 56.4% were received concomitant 5-fluoro-uracil-leucovorin, 28.5% with concomitant capecitabine, and 15.1% with concomitant oxaliplatin and capecitabine. The average dose of radiotherapy was 45 Gy (25 × 1.8 Gy). Five-year disease-free survival was 74.3% and overall survival 68.8%. The rate of local recurrence and distant metastases were 6.1 and 23.6%. In multivariate analysis, concomitant chemotherapy oxaliplatin and capecitabine improved the pathological complete response rate (ypT0; capecitabine: 6%, 5-fluoro-uracil-leucovorin: 10.3%, capecitabine-oxaliplatin: 22.2%), but not significantly ( P = 0.12) and with more toxicities, and treatment interruptions. Sphincter preservation rate was not improved significantly during the study period (1993–2004 vs. 2005–2008), but disease-free survival improved from 72.2% up to 87.5% ( P = 0.03). Conclusion Our results are consistent with those published in the literature. Concomitant chemotherapy with 5-fluoro-uracil or capecitabine remains the standard scheme. Upfront chemotherapy, before chemoradiotherapy, should be investigated with regard to the predominance of metastasis. [ABSTRACT FROM AUTHOR]

Résumé Le traitement des cancers du rectum repose sur une prise en charge pluridisciplinaire et le plus souvent sur une approche multimodale comprenant la gastro-entérologie, l’oncologie médicale, l’oncologie–radiothérapie et la chirurgie. Les différents objectifs qui doivent être discriminés dépendent des caractéristiques de la tumeur. Le défi de la prise en charge des petites tumeurs repose sur la conservation d’un sphincter fonctionnel sans risque de récidive locale. Le traitement standard des maladies localement évoluées vise, par ordre de priorité, à guérir le malade en minimisant les séquelles tardives de la prise en charge. Chacune de ces situations cliniques se trouve désormais démembrée grâce aux progrès de la chirurgie et d’une approche personnalisée au patient à la caractéristique clinique de la maladie. Elles sont désormais l’objet d’études thérapeutiques spécifiques. The treatment of rectal carcinoma is based on multidisciplinary strategy and multimodal approaches including gastrointestinal tract specialists, medical oncologists, radiation oncologists and surgery. The different objectives should be declined according to the characteristics of the tumours. The aim of the therapist would be to select the best strategy offering to the patient to be cured with as less as possible late adverse toxicity. The challenge of the treatment of small tumours is to maintain a functional anal sphincter while minimizing the risk of local recurrence. The standard treatment of locally advanced disease is aiming firstly to cure the patient and secondly to prevent late complications. Each of these clinical presentations of the disease has to be considered as a whole taking into account the new surgical techniques and a personalized approach adapted to the tumour. Nowadays they should be studied with dedicated clinical trials. [ABSTRACT FROM AUTHOR]