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Résumé Les principales indications de curiethérapie des cancers de la tête et du cou localisées sont les tumeurs des lèvres et la pyramide nasale, de la cavité buccale et de l’oropharynx. Les tumeurs du cavum sont aujourd’hui plus accessibles à la radiothérapie conformationnelle avec modulation d’intensité. La curiethérapie peut être réalisée seule ou après une radiothérapie externe ou une chirurgie. Elle fait partie des traitements de recours pour les secondes localisations en territoire irradié et les situations périopératoires à risque. La curiethérapie de débit pulsé permet de reproduire les connaissances acquises de bas débit de dose et l’optimisation de la distribution de la dose. Les résultats de séries de patients traités avec le haut débit font leur apparition dans plusieurs localisations. Cet article fait état des données issues des recommandations du Groupe européen de curiethérapie–European Society for Radiotherapy and Oncology (Gec-ESTRO) publiées en 2017, tenant compte des connaissances issues des séries en bas débit de dose, et actualisées pour les techniques de débit pulsé et de haut débit de dose. The main indications of the brachytherapy of head and neck cancers are the limited tumours of the lip, the nose, the oral cavity and the oropharynx. Nasopharynx tumours are nowadays treated by intensity-modulated radiotherapy. This technique can be exclusive, associated with external radiotherapy or postoperative. It can also be a salvage treatment for the second primaries in previously irradiated areas. If the low dose rate brachytherapy rules remain the reference, the pulse dose rate technique allows the prescription of the dose rate and the optimisation of the dose distribution. Results of high dose rate brachytherapy are now published. This paper reports the recommendations of the Gec-ESTRO, published in 2017, and takes into account the data of the historical low dose rate series, and is upgraded with the pulsed-dose rate and high dose rate series. [ABSTRACT FROM AUTHOR]

Introduction: Familial Mediterranean fever (FMF) is a hereditary auto-inflammatory disease caused by the mutation of the MEFV gene, which, for several authors, presents a particular risk for the development of malignant peritoneal mesothelioma (MPM). The aim of this paper is to focus on the relation between FMF and MPM, as well as the different mechanisms involved in this carcinogenesis. Method: A systematic review of the medical literature in the world targeting malignant mesothelioma cases reported during FMF. Results: The incidence of MPM in FMF, significantly higher than that in the general population in the concerned countries, as well as its epidemiological and clinical characteristics, suggest the 'promoting' nature of the neoplastic graft presented by this disease. This carcinogenesis seems to be multifactorial incriminating underlying chronic inflammation, a direct carcinogenic effect of the MEFV gene and its resulting mutant pyrin, oxidative stress, immune dysfunction mainly of innate immunity, and certain used immunosuppressive and biological treatments. Recurrent peritoneal irritation (classic peritonitis of FMF peritoneal access) is the primary starting point for MMP. [ABSTRACT FROM AUTHOR]

Résumé Les cancers de l’enfant sont rares, puisqu’ils représentent environ 1 % de tous les cancers. Le taux de survie globale à 5 ans est de 75 % toutes localisations confondues. La diminution des doses de radiothérapie et les améliorations balistiques ont permis de diminuer la toxicité dans certaines maladies. La toxicité tardive reste toutefois fréquente, est souvent spécifique de la pédiatrie et est liée à une survie de longue durée. Il s’agit principalement de séquelles cognitives, sensorielles, endocriniennes, de retards de croissance ou encore de complications cardiopulmonaires et de cancers radio-induits. Les doses aux organes critiques habituellement recommandées en pédiatrie sont présentées dans cette mise au point, de même que les principales séquelles spécifiques de l’irradiation en pédiatrie, en dehors des cancers secondaires qui ne sont pas inclus dans cette mise au point. Cancers in childhood are rare, representing 1% of all the cancers in developing countries. On the whole, the overall survival approaches 75% at 5 years. The radiation dose decrease in lots of indications as well as better optimized planning treatments lead to decrease the long-term toxicities in some indications. However, the radiation toxicity remains frequent, often specific of pediatric situations. Long-term toxicities are mainly neurologic, sensitive, endocrine, or linked to growth impairment (bones or muscular). Radio-induced second-cancers are also frequent after a long follow-up after cancer in childhood but will not be discussed here. Doses to critical organs as well as the most frequent radio-induced late-effects will be discussed in this paper. [ABSTRACT FROM AUTHOR]

Résumé Certaines tumeurs rares et de l’enfant sont de bonnes indications de protonthérapie, qui permet une forte probabilité de contrôle tumoral sans toxicité sévère ; la multiplication des centres de traitement s’est accompagnée d’une accumulation de données dosimétriques et cliniques pour d’autres cancers. L’objectif de cette étude est de faire une mise au point sur les indications potentielles de protonthérapie. Une recherche a été faite sur Medline avec les mots clés suivants : proton beam radiotherapy , cancer , heavy particle , charged particle . Aucun essai de phase III comparant la protonthérapie avec la meilleure photonthérapie n’a pour l’instant été publié, mais de nombreuses études rétrospectives ont montré des avantages dosimétriques et cliniques potentiels importants, laissant présager d’un avantage en termes de toxicité pour la protonthérapie, en particulier lorsque la contrainte de dose implique des organes en parallèle (tumeurs thoraciques et abdominales) ; de nombreux essais de phase 0, I, II, III et IV sont en cours pour déterminer la place de la protonthérapie dans les cancers les plus fréquents. L’utilisation de cette technique dans les cancers les plus fréquents est en expansion dans le cadre d’essais, mais certaines indications pourraient être envisagées devant des avantages dosimétriques majeurs in silico avec la protonthérapie. Proton beam therapy is indicated as a treatment for some rare tumours and paediatric tumours because the technique allows a good local control with minimal toxicity; the growing number of centres that use proton beam therapy is associated with an increase of dosimetric and clinical data for other malignant tumours as well. This paper reviews potential indications of proton beam therapy. A systematic review on Medline was performed with the following keywords proton beam therapy, cancer, heavy particle, charged particle. No phase III trial has been published using proton beam therapy in comparison with the best photon therapy, but numerous retrospective and dosimetric studies have revealed an advantage of proton beam therapy compared to photons, above all in tumours next to parallel organs at risk (thoracic and abdominal tumours). This could be accompanied with a better safety profile and/or a better tumoural control; numerous phase 0, I, II, III and IV studies are ongoing to examine these hypotheses in more common cancers. Use of proton beam therapy is growing for common cancers within clinical trials but some indications could be applied sooner since in silico analysis showed major advantages with this technique. [ABSTRACT FROM AUTHOR]

Bisphosphonates (BP) have been used since 1960s for their capability to alter the mechanism of bone resorption and remodeling. Intravenous (IV) BP are effective in the treatment and management of cancer-related conditions including hypercalcemia of malignancy, skeletal-related events associated with bone metastases in the context of solid tumors such as breast cancer, prostate cancer and lung cancer, and management of lytic lesions in the setting of multiple myeloma. Oral BP are used to treat osteoporosis and osteopenia. In 2003, oral and maxillofacial surgeons first recognized and reported cases of non-healing exposed bone in the maxillofacial region in patients treated with IV bisphosphonates. This adverse effect was called BONJ for bisphosphonate-related osteonecrosis of the jaws. Clinically, BONJ is defined by an exposed bone in the maxillofacial region that has persisted for more than 8 weeks. So far, the etiopathogenesis of BONJ remains uncertain. It is worth noting that BP act at the following levels: physicalchemical, tissue, cellular, and molecular. In 2007, then in 2009, strategies for management of patients with or at risk for BONJ were set forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper on BONJ. BONJ's treatment comprises the following: pain control, antibiotic therapy, mouth rinse, BP discontinuation, and surgical debridement. Such measures, however, do not always achieve the resolution of the clinical findings. That led numerous authors to suggest, in complement to treatments advised by AAOMS, many experimental treatments as hyperbaric oxygen therapy (HBOT). HBOT is a way of treatment which increases the oxygen content of the blood and, consequently, the amount of oxygen delivered to tissues. The proposed rationale behind the beneficial effects of HBOT in ONM is increased wound healing, reduction of oedema and inflammation, stem cell mobilization and moderation of the suppression of bone turnover by BP. At the moment there is a controversy concerning the effectiveness of HBOT in the treatment of BONJ. But there are two ongoing randomized controlled trials in USA which are testing specifically the effectiveness of adjunctive HBOT in the management of BONJ. Although early results are encouraging, evidence-based conclusions could be made after the final results of these studies are published. [ABSTRACT FROM AUTHOR]

The pathogenesis of the prothrombotic state of cancer patients ismostly due to the ability of cancer cells to activate the coagulation system. There are several complex and not fully understood interactions between the malignant cell and the clotting system. Tumour cells possess the capacity to interact with the haemostatic system in multiple ways. The principal mechanisms include the expression of haemostatic proteins by tumour cells, the production of inflammatory cytokines and the direct adhesion of tumour cells to platelets, endothelial cells and monocytes. This paper summarizes the prothrombotic mechanisms of tumour cells and their role in both coagulation and tumour growth and metastasis. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this paper was to make a brief review of the main problematics raised by depression in oncology in terms of prevalence, semiology, screening, risk, prognosis factors and treatment. This reflection was based on recent literature data obtained through a PubMed search. Depressive disorders have frequently been encountered in cancer patients. During routine oncology daily care, depression screening, assessment and treatment are of paramount importance regarding psychosocial management. Depressive elements have a tremendous impact on the quality of life, tolerance and compliance with anticancer treatment. Moreover, depression morbidity and its possible influence on prognosis represent an important challenge in terms of prevention. A specific semiology for depressive disorders in the oncologic field might be more relevant with practical clinical implications. Optimal care of these mood disorders have to be implemented as soon as possible and be supported by the association of pharmacological treatment and psychotherapy. [ABSTRACT FROM AUTHOR]

The French National Cancer Institute encourages the organization and implementation of meetings and national structured networks dedicated to the management of rare cancers such as adult osteosarcoma. The goal is to improve the quality of care, to help obtaining specialized expertise and advice, and to promote clinical research. Professors Gouin (Orthopaedics, Nantes) and Anract (Orthopaedics, Paris) are driving this national project. This paper presents a literature review focused on the management of adult osteosarcoma and its specificities. [ABSTRACT FROM AUTHOR]

This paper reviews the indications, evaluation criteria and treatment modalities for curative external beam radiotherapy in managing non-metastatic prostate cancer. The current guidelines for determining progression after radiotherapy are the PSA nadir + 2 μg/l for nonoperative patients and a PSA value > 0.2 μg for postoperative, prostatectomy patients. We discuss the present data on dose escalation, combined hormone therapy and clinical target volume, with respect to prognostic factors. [ABSTRACT FROM AUTHOR]

Abstract: The specificity of cancer is at the origin of emotional, cognitive and behavioural reactions in old age as well as in other stages of life. It is important to understand the particularities due to ageing to be able to listen to, to help express emotions, to inform and to better support patients. That is why in this paper the authors envisage the psychological vulnerability of elderly persons, the psychological processes at work from the first symptom of cancer to the treatment phase via investigations and announcing the diagnosis. Finally they evoke the psychopathological disorders that arise with elderly patients with cancer and the specificities of the diagnosis approach. [Copyright &y& Elsevier]

The most common causes of cancer pain are not due to tumours, but rather to the consequences of cancer treatment, including systemic chemotherapy (vinca alkaloids, taxanes, platinum-based compounds, epothilones, etc.). These drugs can induce painful neuropathy, a dose-limiting side effect that can severely affect the quality of life of cancer patients. In this paper, we review the clinical and laboratory findings on the characteristics of chemotherapy-induced neuropathic pain and present a schema explaining the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Networks of palliative care for patients who wish to die at home have recently spread all over the country. Some clinical psychologists working in the private sector joined in with homecare teams, thus dealing with an aspect of care, which was new to them. These clinical psychologists support patients and their families throughout the palliative period. This paper, describes the traditionnal practice of clinical psychologists working in the private sector, and then how these networks of palliative care were developed in France. Finally, it explains what is specific to this new type of practice for the clinical psychologists working in the private sector. [ABSTRACT FROM AUTHOR]

Abstract: Every year in France, we observe 60,000 vertebral fractures, 50,000 hip fractures and 35,000 wrist fractures. However, only 20% of these patients receive adequate pharmacologic therapy to prevent new fractures and their complications. At the present time, clinicians have not a perfect knowledge of the therapeutic class of SERMs (Selective Estrogen Receptor Modulators). In this paper, the authors show the strong capacity of these drugs to product, in osteoporotic postmenopausal women, major therapeutic effects on bone (reduction of fracture risk), on breast (reduction of cancer risk), and without any side effects on arterial diseases except an increased risk of venous thromboembolism. [Copyright &y& Elsevier]

Abstract: Oxidative stress has deleterious effects on health of the population and of selected groups of chronically and critically ill patient, that some micronutrients and dietary patterns can modulate. These beneficial effects have been attributed to the reduction of oxidative damage caused by the excessive free radical production. The paper reviews evidence of antioxidant (AOX) supplementation trials in the general population and critically ill patients. AOX vitamin and trace element intakes are low in a large part of the European population: selenium is particularly affected. AOX micronutrients have been shown to be particularly important in the prevention of cancer, cardiovascular diseases, age related ocular diseases and in aging. In animal models, targeted interventions have been associated with reduction of tissue destruction is brain and myocardium ischemia-reperfusion models. In the critically ill AOX supplements have resulted in reduction of organ failure (kidney, lung) and of infectious complications, especially when selenium is included: diagnostic categories with benefits include major burns and trauma, sepsis and SIRS. Vitamins alone have no significant effect at nutritional doses. AOX micronutrients have beneficial effects in defined models and pathologies, in the general population and in critical illness – the inclusion of selenium appears of particular importance. Further research is required to determined the optimal micronutrient combinations and the doses required according to intervention timing. [Copyright &y& Elsevier]

A large number of new anticancer agents are currently under development in order to obtain marketing authorisation. By the end of 2005, centralised European submission will become mandatory for any new drug in the field of oncology. New regulations will apply to the registration of anticancer products. Some of these compounds exert their effects through mechanisms of action that do not involve direct cytotoxicity. A new version of the Guideline for Evaluation of Anticancer Medicinal Products in Man will take this fact into account and will integrate as far as possible the experience linked to the most recent procedures. This paper briefly summarizes the main regulatory changes and their corresponding scientific adaptations. [ABSTRACT FROM AUTHOR]

Cancer patients often suffer from associated renal disease, which may manifest itself either as renal failure or electrolyte disturbances. This renal impairment may result from the neoplastic disease itself and/or from the treatments administered. When renal insufficiency is diagnosed, physicians should investigate it as they do for non-cancer patients. Here, we detail the most frequent renal pathologies encountered in patients with cancer. Electrolyte disturbances are also frequently observed in these patients and are detailed in this paper. [ABSTRACT FROM AUTHOR]

Prognosis of pancreatic carcinoma remains poor, with one-year and five-year overall survival rates of 20 and 5% respectively. Only 5 to 15% of patients present with tumors amenable to resection. Long-term (5 years) survival after curative resection is less than 20%, and the median survival is about 12 months. This paper updates recent trends about concomitant chemoradiation. At first, a review of the studies on adjuvant chemoradiation after surgery is proposed. Then, indications of preoperative chemoradiation for patients with localized resectable adenocarcinoma are discussed. The last part concerns the most important and recent studies about chemoradiation in locally advanced pancreatic cancer, either with 5-fluoro-uracile or based on new drugs like gemcitabine. [Copyright &y& Elsevier]

Skeletal metastases are common in patients with breast and prostate cancer and cause considerable morbidity and aversely affects the quality of life (bone pain, pathological fractures, hypercalcaemia and nerve compression syndromes). In this paper emerging new concepts of breast cancer-bone interactions, in particular the involvement of angiogenesis and the role of cancer-induced bone resorption in skeletal metastasis are discussed.Because of the progress made in early detection and surgical treatment of the primary tumor, mortality in cancer patients is increasingly linked to metastatic disease. Bone is the second most common site of metastasis. and the frequency of bone metastases at autopsy of cancer patients varies between 60 % and 85 %, depending on the cancer type. Clinical and experimental observations indicate that the hematopoietic marrow, rather than the bone tissue, is the initial site of cancer cell seeding. Micrometastases in bone marow represent the pathophysiological basis of minimal residual disease that will eventually lead to cancer relapse as overt metastases. Understanding of the molecular events in bone metastasis is, therefore, a prerequisite for the evaluation of novel therapies aiming at repressing initial stages of metastatic growth. [ABSTRACT FROM AUTHOR]

Introduction. – Treatment of malignant tumors can delay some opportunistic infections. In this paper, we report three cases of alveolo-interstitial pneumonia among HIV negative patients who received chemotherapy.Exegesis. – All three patients received corticotherapy for a long time. In two cases, it was pneumocystis-tuberculosis coinfection. Evolution was favourable for two patients with sulfame´thoxazole-trime´thoprime (one with corticotherapy).Conclusion. – The possible role of chemotherapy, corticotherapy and malignant tumor in the pathogenesis of opportunistic infections will be discussed. [ABSTRACT FROM AUTHOR]