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Abstract: Since the prolongation of survival for patients treated by radiotherapy second primary cancers are not rare. Cumulative incidence of second primary malignancy after radiotherapy (SPMAR) 40 years after treatment can reach 20 % when patients were 40 years old at treatment time. Among SPMAR some of them can be promoted by irradiation. Relative risk (RR) analysis is the most common method used to estimate the proportion of such second cancers. Most of studies reported a RR around 1.1 in adult patients. In young patients RR is about 6, meaning that SPMAR attributable to irradiation is more elevated in this subgroup. Quantification of these events, biomolecular mechanisms, risk factors are complex and not yet fully understood. Information given to patients must be adapted and the cost/benefit ratio has to be justified regarding SPMAR risk. Irradiation technique optimisation is an important point especially in young patient and adults, in order to reduce at maximum the volume of organ at risk exposed while not compromising optimal dose given to the tumour volume, although no standard rules of irradiation are definitively established at the present time. [ABSTRACT FROM AUTHOR]

Objectifs Les carcinomes palpébraux peuvent être traités par irradiation ou chirurgie. L’irradiation peut être délivrée par électrons, iridium 192 ou photons de 50 kV. Les avantages de la radiothérapie de contact par photons de 50 kV sont la précision, le faible volume de traitement, la bonne protection des organes à risque, la simplicité et l’efficacité. Patients et méthodes Entre juin 2010 et juin 2014, 38 patients ont reçu une radiothérapie, par deux appareils (RT50 Philips ou PAPILLON50) délivrant un faisceau de photons de 50 kV, trois pour deux localisations synchrones. Ils étaient âgés de 48 à 94 ans, 79 ans en moyenne. La tumeur était située sur la paupière supérieure pour 12 %, le canthus externe pour 7 %, la paupière inférieure pour 22 %, le canthus interne pour 59 %. Il s’agissait d’un carcinome basocellulaire pour 76 %, un carcinome épidermoïde pour 15 %, un mélanome pour 6 %, un adénocarcinome sébacé pour 3 %, de stade T1 pour 95 % et T2 pour 5 %. La radiothérapie était exclusive et radicale pour 30 %, adjuvante pour 70 %, après une résection R0 pour 38 % et R1 pour 62 %. Un tiers (34 %) des traitements a été effectué pour des lésions en rechute de traitements antérieurs. Deux schémas principaux ont été utilisés : 42 Gy en six fractions de 7 Gy (traitements radicaux) et 35 Gy en 5 cinq fractions de 7 Gy. Résultats Le suivi médian était de 14 mois (2 à 45). Deux tumeurs (5 %) ont rechuté, à 6 et 15 mois, et ont pu bénéficier d’une chirurgie de rattrapage. Le taux de survie sans récidive était de 89 %. La toxicité aiguë était à type d’érythème de grade 1 pour 39 %, grade 2 pour 39 %, conjonctivite de grade 1 ou 2 pour 22 %, larmoiement de grade 1 pour 22 %, dépilation ciliaire transitoire pour 100 %. La toxicité tardive était à type de larmoiement de grade 1 pour 35 %, xérose oculaire de grade 1 pour 5 %, dépilation ciliaire persistante pour 15 %, dépigmentation pour 38 %. Une baisse d’acuité visuelle a été constatée chez 5 % des patients, dont deux atteints antérieurement d’un glaucome ou d’une cataracte de l’œil traité. Conclusion La radiothérapie de contact de 50 kV des carcinomes palpébraux est efficace et bien supportée dans cette population sélectionnée. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Currently, radical mastectomy represents the gold standard for ipsilateral breast cancer recurrence. However, we already showed that a second conservative treatment was feasible combining lumpectomy plus low-dose rate interstitial brachytherapy. In this study, we reported the preliminary results of a second conservative treatment using a high-dose rate brachytherapy. Patients and methods: From June 2005 to July 2009, 42 patients presenting with an ipsilateral breast cancer recurrence underwent a second conservative treatment. Plastic tubes were implanted intra-operatively at the time of the lumpectomy. After a post-implant CT scan, a total dose of 34Gy in 10 fractions over 5 consecutive days was delivered through an ambulatory procedure. The toxicity evaluation used the Common Terminology Criteria for Adverse Events v3.0. Results: The median follow-up was 21 months (6–50 months), median age at the time of the local recurrence was 65 years (30–85 years). The median delay between the primary and the recurrence was 11 years (1–35 years). The location of the recurrence was in the tumor bed for 22 patients (52.4%), in the same quadrant for 14 patients (33.3%) and unknown for six patients (14.3%). The median tumor size of the recurrence was 12mm (2–30mm). The median number of plastic tubes and plans were nine (5–12) and two (1–3) respectively. The median CTV was 68cm3 (31.2–146cm3). The rate of second local control was 97%. Twenty-two patients (60%) experienced complications. The most frequent side effect consisted in cutaneous and sub-cutaneous fibrosis (72% of all the observed complications). Conclusion: A second conservative treatment for ipsilateral breast cancer recurrence using high-dose rate brachytherapy appears feasible leading to encouraging results in terms of second local control with an acceptable toxicity. Considering that a non-inferiority randomized trial comparing mastectomy versus second conservative treatment could be difficult to perform, what proof level will be necessary to achieve in order to change the medical procedures? [Copyright &y& Elsevier]

Abstract: Acute skin toxicity is frequent during radiation therapy and can lead to temporary arrest of the treatment. Chronic toxicity can occur and conduct to cosmetic problems. Alopecia is the most frequent toxicity concerning hair and is most of the time reversible. Several factors linked to patients influence skin toxicity, such as undernutrition, old age, obesity, smoking, skin diseases, autoimmune diseases, failure of DNA reparation. Skin, hair and nail toxicities depend also on radiation schedule. Acute toxicity is greater when dose per fraction increases. Chronic and acute toxicities are more often when total dose increases. Under 45Gy, the risk of severe skin toxicity is low, and begins above 50Gy. Skin toxicity depends also on the duration of radiotherapy and split course schedules are associated with less toxicities. Irradiation surface seems to influence skin toxicity but interaction is more complex. Reirradiation is often feasible in case of cancer recurrence but with a risk of grade 3–4 toxicity above all in head and neck cancer. The benefit/risk ratio has to be always precisely evaluated. Permanent alopecia is correlated with the follicle dose. Modern techniques of radiation therapy allow to spare skin. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Stereotactic radiotherapy using the CyberKnife® has become a key treatment in the multidisciplinary management of secondary tumours, as well as primary benign or malignant tumours located within or adjacent to vertebral bodies and the spinal cord. The aim of this treatment is to improve local control and clinical response, including previously irradiated cases. Patients and methods: In this study, we present the first patients treated with CyberKnife® between December 2006 and December 2007 for spinal or paraspinal tumours. The primary aim was to assess the feasibility and tolerance of stereotactic radiotherapy using the CyberKnife®. Secondary aims were to establish the short-term local control, to calculate the local progression-free survival and overall survival. Clinical examination and imaging procedures were performed every three months. Response was assessed according to RECIST criteria. Results: During that period, 16 patients were treated with CyberKnife®. Thirteen patients had been pre-treated, three of whom had received spinal cord doses considered to be maximal. Three patients did not receive previous irradiation. The median age was 59 (36–74). The most frequent symptoms were pain (n = 8) and motor weakness (n = 4). The median dose was 30 Gy (16–50). The median number of fractions was 3 (1–5). No patient developed acute myelitis. Three patients developed acute reaction. Overall survival at 18 months was 72.4%, with a mean survival of 18.2 months (95% CI: 15.4–20.9). Local progression-free survival at 18 months was 58.4%, with a mean value of 16.9 months (95% CI: 13.6–20.2). Conclusion: The use of stereotactic radiotherapy with CyberKnife® represents a major progress in the management of paraspinal tumours. The main advantages are better sparing of the spinal cord and the possibility of increasing the dose to the tumour target volume. [Copyright &y& Elsevier]

Abstract: Purpose: CyberKnife® (CK) allows stereotaxic irradiation for thoracic tumor thanks to a tracking system which potential is known for lung tumors. This technique has never been used to treat breast tumors but may have a real potential. Patients and method: In order to define the interest of treating breast tumors with CK, we have conducted a phase I study with a dose escalation, adding CK to neoadjuvant chemotherapy in view of allowing conservative treatment for patients that will not have surgery in first intent. Neoadjuvant chemotherapy includes six cures, including three of docetaxel and three of FEC. CK treatment is made during the second cure of chemotherapy. Two dose levels are delivered in three fractions: 19.5 and 22.5Gy. Surgery is performed six to eight weeks after the last cure. The primary objective is to define tolerance of stereotactic irradiation concomitant with neoadjuvant chemotherapy for breast tumors. Skin toxicity is the limiting criterion of the study. The secondary objectives are both histological response and quality of surgery. Here, we are presenting the preliminary results of the 2-dose level. This study participates in the French national grant called Programme hospitalier de recherche clinique (PHRC). Results: No skin toxicity of grade I or more have been find. Surgery was performed as conventional and there was no complication. Pathology exams found one complete response, one lymphangitis and one partial response. Conclusion: These preliminary results seem to be promising but need to be confirmed. We carry on the dose escalation study. [Copyright &y& Elsevier]