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Introduction Les cathéters à chambre implantable (CCI) sont utilisés en oncologie pour l’administration de chimiothérapies, de traitement intraveineux ou d’une nutrition parentérale (NP). Les infections liées au cathéter (ILC) et les thromboses sont les complications les plus fréquentes. Étude du taux d’incidence des infections sur CCI et de la corrélation avec l’utilisation d’une NP à la suite d’une politique de réduction de la NP. Matériels et méthodes Étude observationnelle rétrospective en oncologie générale au CHP Saint-Grégoire et comparative avec l’étude réalisée en 2013. Recueil des ILC sur CCI de janvier 2015 à avril à 2016 chez les patients ayant bénéficié de la pose d’une CCI de janvier 2015 à décembre 2015. Résultats L’étude a duré de janvier 2015 à avril 2016 permettant d’inclure 403 patients. Pas de différence significative entre les caractéristiques des cohortes de 2013 et 2015. Diminution de la proportion des ILC sur CCI en 2015 à 8,9 % vs 14 % en 2013 et de la NP 8,68 % vs 15,8 %. Différence significative de la densité d’incidence (DI) globale entre 2013 et 2015 avec une diminution de celle-ci en 2015 : 0,39 vs 0,7 (ILC pour 1000 jours-cathéter) en 2013 et de la DI avec NP : 2,65 en 2015 vs 3,59 en 2013. Parmi tous les facteurs de risque étudiés, la NP reste le seul facteur de risque indépendant important en analyse univariée et multivariée. Les staphylocoques sont responsables de 50 % des infections, 1/3 proviennent du groupe coagulase negative, 14 % par E.coli . Conclusion La NP est un facteur de risque important d’ILC sur CCI. Les nouvelles recommandations ont permis une diminution de la survenue des ILC mais le risque persiste. Une prise en charge nutritionnelle optimisée avec l’appui d’un médecin nutritionniste, la formation du personnel de soins et l’utilisation de verrous de solutions non-antibiotiques en prophylaxie secondaire sont proposés pour réduire ce risque. [ABSTRACT FROM AUTHOR]

Purpose: As part of the multidisciplinary team, radiation therapists are in charge of elements of treatment preparation and delivery of radiotherapy to cancer patients. Helping scientific and technological improvements, more and more patients with cancer were treated with radiotherapy including hypofractionnated radiotherapy, that explain the increase of demands on services. The professional impacted by this increase of demands are radiation oncologists and medical physicists. The opportunity to push forward the radiation therapist's competencies appears with the possibility to shift them some tasks. In this context, a first work was performed with objectives to have an overview of the tasks shifted to radiation therapists in France, the tasks that they could perform but also to evaluate some criteria of job satisfaction., Material and Methods: The committee of "new status and value of status" including six radiation oncologists (the French society of radiation oncology [SFRO] et national union of radiation oncologists [SNRO]) and six radiation therapists committee members of the French association of radiation therapists (AFPPE), built a questionnaire including three parts: demographic characteristics, tasks shifted and job satisfaction criteria. In total, the questionnaire included 19 questions and 24 items assessed with a four point-Likert scale (ranging from "completely disagree" to "completely agree"). This survey, formatting with google form, was tested by the committee members and the final version was sent to the SFRO, AFPPE and SNRO members, before being disseminated on the social networks., Results: From November 18th 2022 to December 31st 2022, 492 responses were received (response rate=18.3%): 55 % of the respondents had at least 11 years of experience in radiotherapy. The respondents worked in different type of health facilities (36 % in specialized cancer centres, 19.5 % in private centers, 17.5% in university and general hospital, 10.2% in general hospital). More than ¼ of the respondents had a teaching lecturer activity, 20% had a management team activity and a research activity for 18%. Less than 10% of the respondents had another degree than that of radiation therapist: university degree (n=27), degree in dosimetry (n=11) and master (n=3). More than 76% would like to be trained and to have access to the advanced practice, more than 50% would like expend competencies with a university degree, 30% with a master and 67% would like to participate in research. Forty-two percent of the respondents were involved in a task shifting (excluding decree relating to acts and activities carried out by radiation therapists) and among the radiation therapists non-involved, 63% would be interested in being. Regarding job satisfaction, 53% of the respondents were satisfied with their job and their salary and 68% believed that their job occupation is in line with their professional aspirations. More than 2/3 of the respondents described a significant workload and mental load, 53% thought to have time for their patient care and 70% felt some organisational difficulties., Conclusion: This survey shows: (i) A significant involvement of radiation therapists in the task shifting; (ii) A very strong demand for career development, in particular with existing degrees or to be created degree such as advanced practice; and (iii) The need to reinforce a job satisfaction for almost the half of the respondents, linked to a workload, a mental load and some organisational difficulties., (Copyright © 2023 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Purpose: Radiation therapists shortage has been evaluated at national level in France, specifically in oncology radiotherapy, in terms of: (i) organizational adaptations, (ii) impact on patients care, and (iii) difficulties in deploying new missions and/or tasks delegation., Materials and Methods: French professional organisations representing radiation therapists - SFRO, SNRO and AFPPE - sent their members a national survey (ten questions on 32 items)., Results: From 18 November 2022 to 31 December 2022, 55 responses were received (response rate: 31%) from radiotherapy managers or department heads; 51% had a structure comprising three to five treatment rooms (receiving 500 to 1000 patients per year [36%], or 1500 to 2000 patients per year [33%]). Activities performed were intensity-modulated radiotherapy (100%), stereotaxic radiotherapy (85%), brachytherapy (40%), adaptive radiotherapy (34%). These structures described consequences in closing machine time for 25% of them (reduction of the hourly volume greater than 10% in 57%) with the following consequences in the last 6 months: (i) an extension of the period of medical care (78%), a closing of one or more accelerators (50%) and the development of moderate hypofractionation scheme or extreme hypofractionation (50%). In current functioning, linear accelerators can deliver treatments with a team of two radiation therapists per room for a short day (43%) or two to four radiation therapists per room teams for a long day (40%). During the last 6 months, there has been a 10% increase in linear accelerators operating with a single team. (ii) regarding treatment planning: 16.4% reported a decrease in the opening amplitude (less than 20% in 44% of cases, from 20 to 50% in 33 % of cases). The initial scheduling of appointments for radiotherapy sessions was carried out by radiation therapists in 84% of the departments in current functioning (0.1 to 1 FTE dedicated to this activity in 62% of the departments). Over the last 6 months, there has been a clear reduction in the number of dedicated FTEs: [FTE=0.1 to 1]=-8%; [FTE=0]=+7%. (ii) Regarding tasks delegation (excluding the decree on acts and activities carried out by the radiation therapist): organ at risk delineation is partially performed by radiation therapist in 26% of the centres; caregiver support time in 78% (56% totally or 22% partially). This activity has been reduced by 42%. Seventy-five percent of departments want to develop new techniques, patient-centered approaches (44%), implement task delegation (organ at risk delineation: 58%; weekly consultations: 67%; positioning imaging validation: 71%), and 78% of departments are interested in developing advanced radiotherapy practice. However, the number of radiation therapists is considered insufficient in their implementation in 76% of cases (one to two FTE missing for 72% of structures)., Conclusion: This survey shows a significant impact of radiation therapist shortage in radiotherapy oncology care (treatment delays, access to caregiver support time, workload on treatment teams), and represents a major obstacle to the development of radiotherapy structures., (Copyright © 2023 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Hippocampi plays a fundamental role in immediate or long-term memory and the spatial learning. This structure is rarely involved by metastasis and their irradiation is at the origin of some impairment of the neurocognitive function. Sparing hippocampi during whole brain radiation therapy becomes possible with volumetric modulated arc therapy (VMAT) or with helical tomotherapy. The delineation of the structures should be performed after coregistration of gadolinium-enhanced T1-weighted MR-images with the planning. The D40 to both hippocampi should not be greater than 7.3 Gy. Patients who are more likely to benefit from a hippocampal-sparing strategy must have a 6 months or longer life expectancy and a Karnosky index above 70. Hence, patients who are more likely to be deemed fit for this strategy are frequently patients with NSCLC, breast cancer, gastointestinal cancers or patients. Patients with small cell lung carcinoma who are selected for prophylactic cerebral irradiation should be also considered, as they are unfit for ablative treatments such as stereotactic radiotherapy or brain surgery. Moreover, brain metastasis located in the area surrounding the hippocampi are unlikely. To date, no randomized study is available to confirm these assumptions. Two on-going prospective trials (RTOG 0933 and a French phase II trial) are currently investigating whether breast cancer patients with a single resected metastasis could benefit from the hippocampal-sparing strategy during whole brain radiotherapy., (Copyright © 2013. Published by Elsevier SAS.)

Combined radical radiation therapy for head and neck carcinoma should be planned with intensity modulated beams to provide a rapid answer to patients' requirements in terms of quality of treatment. The most frequent late toxicity of radiation therapy is xerostomia, which may be prevented by using this technique able to significantly spare salivary glands irradiation. Selection of indications is a very important step. The objective of sparing salivary functions, strongly associated with optimization criteria of quality of life should be considered as a main objective in irradiation of head and neck tumours. The various possibilities offered by this technique allowing to boost a target volume included in prophylactically irradiated regions could offer the possibility to escalate the dose in selected patients. The feasibility of this process is currently validated in prospective studies. Finally, routine implementation of intensity modulated radiation therapy should be performed with strong and robust quality assurance procedures, ensuring that the expected benefit could be increased with the current developments by using rotational techniques., (Copyright © 2011 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

Due to its increasing incidence and a grim prognosis, primary liver cancer remains a diagnostic and therapeutic challenge. For small localized tumors, surgical resection and liver transplantation are standard treatments with a curative-intent. Therapeutic options for locally advanced or metastatic diseases are limited. Globally, surgery fits less than 20% of patients. Early detection in high-risk patients and prevention of risk factors remain the key points in the standard care. External radiotherapy is a non invasive treatment with encouraging results for non operable patients. Emerging stereotactic radiotherapy yields high rates of local control without compromising toxicity. Tumors with bad prognostic factors could be cured with this approach., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)