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Introduction: during radiotherapy, interfractional and intrafractional anatomic variations in pelvic organs may be observed. The purpose of this study is to evaluate these variations in patients with prostate cancer receiving intensity-modulated radiotherapy (IMRT). Methods: ten patients were enrolled in this study. Five weekly dosimetry scans were performed with delineation of prostate and pelvic organs (bladder and rectum). Volumetric variations of these three organs as well as prostate isocenter shift along the three axes of space (X, Y, Z) were recorded. Results: a significant mean decrease in prostate volume of 18.82% ± 3.87% (p= 0.008) was found at the end of treatment. Significant and random volumetric variations were detected in organs at risk with a higher amplitude at the level of the bladder compared to those of the rectum (-90.17 cc ± 151.56 cc and -23.90 cc ± 35.42 cc, respectively). Changes in rectal volume were correlated with prostate isocenter shift along the Y and Z axes, with an average migration of +1.90 mm ± 3,36 mm and -0.78 mm ± 1,21 mm, respectively. Conclusion: volumetric variation of the rectum in patients with prostate cancers receiving IMRT was accompanied by a significant displacement of the prostate along the Y and Z axes, which could cause partial deviation of the initially established prostate volume. [ABSTRACT FROM AUTHOR]

Résumé: La radiothérapie conformationelle avec modulation d’intensité a montré sa capacité à prévenir l’hyposialie dans le traitement des cancers de la tête et du cou et la rectite dans celui des cancers de la prostate. Dans la prise en charge des cancers du col de l’utérus, les nombreuses études dosimétriques publiées ont montré sa capacité à limiter l’irradiation des organes à risque. Les données cliniques restent cependant limitées à des comparaisons de cohortes, le plus souvent rétrospectives, mais prometteuses. Cette revue a pour objectif de faire le point sur l’état actuel des connaissances. [ABSTRACT FROM AUTHOR]

Résumé: La règle classique qui était d’inclure les ganglions pelviens dans le volume-cible de radiothérapie lorsque le risque d’envahissement ganglionnaire atteignait 15 % est remise en question par le résultat des séries chirurgicales ayant comporté un curage ganglionnaire extensif. Parallèlement, les progrès technologiques de la radiothérapie ont réduit le risque de cystite et rectite découlant de l’irradiation prophylactique de ces ganglions. Ces deux éléments conduisent les équipes qui réalisaient des curages ganglionnaires diagnostiques avant la radiothérapie pour préciser le statut microscopique des ganglions et éviter une irradiation ganglionnaire pelvienne inutile aux patients atteints de cancer classé N0, à remettre en question leur arbre décisionnel. Cette revue a pour objectif de faire le point sur ces données nouvelles et préciser les situations dans lesquelles le curage ganglionnaire préalable à la prise en charge d’un cancer prostatique localisé par une radiothérapie externe, associée ou non à une hormonothérapie androgéno-suppressive, garde un intérêt. [ABSTRACT FROM AUTHOR]

Résumé: La radiothérapie externe exclusive est un traitement de référence des cancers de la prostate. Selon les caractéristiques cliniques, histologiques et biologiques de la tumeur, une irradiation des aires ganglionnaires peut être proposée en association à celle de la prostate. La réalisation de cette irradiation pelvienne reste controversée et peut être source de complications par l’augmentation des volumes de tissus sains irradiés. L’exactitude de la délinéation des aires ganglionnaires devient donc un enjeu important. Cet article propose de faire le point sur les caractéristiques du drainage ganglionnaire pelvien de la prostate, les données de la littérature sur la place de l’irradiation pelvienne et la définition des volumes à irradier. [ABSTRACT FROM AUTHOR]

Résumé: La scanographie de planification permet de segmenter la prostate (volume cible anatomoclinique) avec cependant une imprécision au niveau de l’apex et surtout l’impossibilité de visualiser le cancer intraprostatique. L’IRM permet une visualisation précise du contour prostatique et dans une certaine mesure de la tumeur intraprostatique (volume tumoral macroscopique). L’intégration des données d’IRM dans la scanographie reste néanmoins complexe. L’analyse des pièces de prostatectomie a permis par ailleurs de guider la définition d’un volume cible anatomoclinique au-delà de la capsule, en fonction de facteurs préthérapeutiques. En pratique, le volume cible anatomoclinique correspond : à la prostate seule pour les tumeurs de pronostic favorable ; à la prostate (+marges de 0 à 5 mm, excluant le rectum) et aux vésicules séminales (limitées éventuellement à 2cm de leur partie proximale) pour les tumeurs de risque intermédiaire ; à la prostate (+marges de 5mm) et aux vésicules séminales pour les tumeurs de haut risque. Le volume cible prévisionnel devrait se situer entre 5mm et 10mm selon les directions de l’espace en l’absence de guidage par l’image. Il pourrait être de 5mm en cas de radiothérapie guidée par l’image. En situation adjuvante après prostatectomie, la définition du volume cible anatomoclinique doit suivre les recommandations édictées par les groupes coopérateurs. Il tient compte à la fois de l’analyse des séries de rechute locale après prostatectomie, mais également de l’analyse histologique spécifique de la pièce opératoire du patient. Le volume cible prévisionnel correspondant est de 6 à 8 mm. [ABSTRACT FROM AUTHOR]

Résumé: L’hadronthérapie, radiothérapie par les particules lourdes chargées, bénéficie depuis une dizaine d’années d’un engouement sans précédent, tant sur le plan technologique que clinique. Le premier est lié au développement commercial d’installations de protons compactes, relativement bon marché, et équipées de source rotatives isocentriques. L’arrivée du pencil beam scanning devrait simplifier et accélérer les procédures de traitement. Le second est lié aux succès rapportés dans, premièrement, le traitement de tumeurs localement agressives, non ou peu résécables, et placées au voisinage immédiat de structures saines radiosensibles : mélanomes oculaires, sarcomes de bas grade de la base du crâne et du rachis, carcinomes de la sphère ORL évolués (cylindromes) ; secondement, la protection des tissus sains : à long terme, particulièrement dans les tumeurs pédiatriques, en raison de la grande radiosensibilité des tissus en croissance (incluant le risque carcinogène) ; immédiate, sur la moelle osseuse, les muqueuses… notamment dans les associations concomitantes chimioradiothérapiques (étudiées dans les cancer du poumon et de l’œsophage). Les patients irradiés par ions carbone ne représentent qu’une minorité des 115 000 traités dans le monde mais, dans les mains des équipes japonaises, entraînent des résultats surprenants dans les formes les plus résistantes, telles que le mélanome muqueux, les sarcomes de haut grade, le cancer du pancréas. Les modifications du fractionnement utilisées, posent d’intéressantes questions biologiques et économiques. Une vive polémique s’est récemment développée autour d’une expansion des indications vers des maladies communes (cancer de la prostate). [ABSTRACT FROM AUTHOR]

Résumé: Les différentes techniques de radiothérapie guidée par l’image posent la question des modalités de réalisation du contrôle du positionnement du patient avant séance d’irradiation et du partage des tâches entre oncologues radiothérapeutes et manipulateurs en électroradiologie. Pour faire une délégation de tâches aux manipulateurs en électroradiologie avec sécurisation du processus, il a été mis en place des procédures et modes opératoires dans trois situations : contrôle par imagerie de basse énergie (kV-kV) sur repère osseux, contrôle par imagerie de basse énergie sur repères fiduciels pour les cancers de prostate et contrôle par tomographie conique pour les cancers de la prostate. Les contrôles par ces trois techniques de radiothérapie guidée par l’image demandent un temps supplémentaire médical non négligeable. Du fait de la compétence en imagerie des manipulateurs en électroradiologie, la délégation de tâches est possible au quotidien. Cependant, pour sécuriser le processus, la formation initiale et le contrôle régulier des compétences sont indispensables. L’analyse de la comparaison de l’utilisation des clichés bidimensionnels de basse énergie sur les structures osseuses a permis de réaliser une délégation partielle de ce contrôle aux manipulateurs en électroradiologie. Le contrôle du positionnement de la prostate grâce à l’utilisation des repères fiduciels intraprostatiques et au recalage automatique sur grains permet un meilleur repérage de la prostate et peut être facilement délégué aux manipulateurs en électroradiologie. L’analyse de l’utilisation de la tomographie conique quotidienne pour les patients traités par irradiation avec modulation d’intensité est en cours ainsi qu’une comparaison du recalage entre manipulateurs en électroradiologie et oncologues-radiothérapeutes. [ABSTRACT FROM AUTHOR]

Résumé: La radiothérapie occupe une place centrale dans la prise en charge des cancers de la prostate, mais l’étalement du traitement sur près de deux mois pose des problèmes de fatigue liée aux déplacements répétitifs, notamment pour les patients les plus âgés, mais aussi de coût global du traitement, incluant temps d’occupation de la machine et transport. Pour répondre à cette difficulté, différentes équipes ont développé des protocoles de radiothérapie hypofractionnée cherchant à maintenir une efficacité et une toxicité identiques tout en réduisant la durée totale du traitement. Ces protocoles hypofractionnés font appel aux techniques récentes de radiothérapie guidée par l’image et de radiothérapie conformationnelle avec modulation d’intensité (RCMI). L’analyse de séries monocentriques a validé la faisabilité d’un hypofractionnement ű léger Ƈ à des doses par fraction de moins de 6Gy. De même, différentes équipes ont montré la possibilité d’une irradiation stéréotaxique permettant de délivrer des protocoles de radiothérapie hypofractionnée ű sévère Ƈ à des doses de plus de 6Gy par fraction. Quelle que soit la dose par fraction, l’analyse des données actuelles permet de conclure qu’une radiothérapie hypofractionnée n’engendre pas de toxicité majorée à moyen terme et pourrait même améliorer le taux de contrôle biochimique. Des études ayant pour objectifs de démontrer une non infériorité sont attendues pour valider définitivement la place de l’irradiation hypofractionnée dans le traitement des cancers de la prostate. [ABSTRACT FROM AUTHOR]

Résumé: En pratique quotidienne, les fortes doses par séance restent déconseillées car source de lésions tardives des tissus sains. Les techniques avancées de la radiothérapie moderne et la constatation que certaines tumeurs pourraient avoir une sensibilité au fractionnement proche de celle des tissus sains remettent à l’ordre du jour la question des schémas hypofractionnés. L’estimation du rapport α/β nécessite des données cliniques rigoureuses et nombreuses, comportant idéalement des patients traités avec des doses par fraction et des doses totales ayant varié indépendamment. La repopulation tumorale doit être prise en compte lorsque l’étalement est modifié. Malgré les discordances entre publications, les rapports α/β du cancer de la prostate et du cancer du sein (en situation postopératoire) seraient respectivement de l’ordre de 2,5Gy et de 4Gy. S’il est encore trop tôt pour changer nos pratiques habituelles, le temps est venu pour construire des essais contrôlés comparant différents schémas de fractionnement. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs de l’étude: La radiothérapie prostatique est parfois responsable de séquelles vésicosphinctériennes qui peuvent nécessiter une prise en charge chirurgicale. L’objectif de cette étude était de rapporter les résultats obtenus après traitement chirurgical de l’incontinence urinaire post-radique. Patients et méthode: Les dossiers médicaux des patients traités par chirurgie pour des séquelles vésicosphinctériennes après radiothérapie prostatique entre septembre 2004 et février 2012 ont été revus rétrospectivement. Résultats: Au total, sept hommes âgés en moyenne de 70ans±4,1 ont été inclus. Le suivi moyen a été de 32,3mois±29 (3–86). Une cystectomie sustrigonale avec entérocystoplastie d’agrandissement a permis de traiter les troubles de complication urinaire post-radique dans tous les cas. Le taux de fistule vésicocutanée était de 33 %, avec un délai moyen de survenue de 18,5jours±2,1 (17–20). Les durées moyennes de sondage vésical et d’hospitalisation étaient respectivement de 16jours±8,4 (12–35) et de 18jours±7,8 (13–37). Dans cinq cas, il y a eu nécessité de recourir à l’implantation asynchrone d’un sphincter urinaire artificiel pour tarir les fuites urinaires persistantes. Le délai moyen entre la cystectomie sustrigonale avec entérocystoplastie d’agrandissement et l’implantation d’un sphincter urinaire artificiel a été de 27,6mois±26,4 (7–72). Conclusion: Le traitement chirurgical des séquelles vésicosphinctériennes post-radiques après irradiation de la prostate offre des résultats fonctionnels satisfaisants au prix d’une morbidité non négligeable qui doivent être proposés par des centres qui en ont l’expertise. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Évaluer la rentabilité de la tomographie par émission de positons à la (18F)-fluorocholine (TEP-fluorocholine) pour localiser la récidive après traitement local du cancer prostatique et son impact éventuel sur les indications d’un traitement local de rattrapage. Patients et méthodes: Une TEP-fluorocholine couplée à la tomodensitométrie a été réalisée chez 28 patients pris en charge pour un adénocarcinome prostatique en progression biochimique. La concentration sérique médiane d’antigène spécifique de la prostate (PSA) était de 3ng/mL (0,34–93) et 17 patients (60,7 %) recevaient une hormonothérapie au moment de l’examen. Au total, 18 patients de la cohorte étaient potentiellement candidats à une radiothérapie de rattrapage. Résultats: Une lésion pathologique d’un point de vue métabolique a été mise en évidence chez 11 patients (39,3 %). Il n’y avait chez 17 patients (61 %) aucune lésion suspecte. La concentration sérique médiane de PSA était de 2,4ng/mL (0,34–36) en l’absence de lésion hypermétabolique suspecte contre 6,75ng/mL (1,21–93) en cas de lésion suspecte visualisée (p =0,04). Sur 18 patients potentiellement candidats à une radiothérapie de rattrapage, l’examen donnait des arguments pour une irradiation chez cinq en montrant une fixation centropelvienne isolée (28 %). Chez un patient, l’examen montrait des métastases faisant récuser la radiothérapie. Après prostatectomie, l’examen n’était positif que chez un seul patient candidat à une radiothérapie (9 %) sous la forme d’une récidive maligne locorégionale de la région anastomotique. Conclusion: L’examen était positif chez près du tiers des patients éligibles à une radiothérapie. L’évaluation prospective de son impact clinique est en cours. [ABSTRACT FROM AUTHOR]

Résumé: Avec maintenant plus de 25ans d’expérience pour les équipes pionnières américaines et européennes (et plus de 14ans en France), la curiethérapie par implantation permanente de grains d’iode 125 (les plus utilisés) s’est imposée en 2013 comme une alternative incontournable à la chirurgie pour les cancers de prostate localisés à bas risque. La tendance, ces dernières années, à élargir les indications de cette curiethérapie exclusive vers certains patients strictement sélectionnés du groupe des cancers localisés intermédiaires, s’est largement confirmée. Pour les autres cancers de risque intermédiaire et les cancers de prostate localisés à haut risque, l’adjonction d’une curiethérapie à l’irradiation externe (et souvent à l’hormonothérapie), est de plus en plus souvent proposée et va être évaluée dans un essai du groupe d’étude des tumeurs urogénitales (Gétug) ; elle permet une escalade de dose qui semble bien bénéficier à certains patients. Diverses techniques peuvent être utilisées : préplanification (totale ou partielle) en un ou deux temps, avec grains libres ou liés (ou les deux à la fois), avec implantation automatique des grains ou non. Le point capital reste ici la parfaite maîtrise de la procédure et la capacité de répondre à des contraintes dosimétriques précises qui ont été réactualisées récemment par le Groupe européen de curiethérapie de l’European Society on Therapeutic Radiology and Oncology (Gec-ESTRO) et les sociétés savantes américaines. Les résultats à moyen-long terme disponibles dans la littérature indiquent des probabilités de survie sans récidive de l’ordre de 90 % à cinq à dix ans, d’autant meilleures que les critères dosimétriques étaient satisfaisants. En termes de complications, plusieurs études comparatives ont confirmé des taux d’incontinence et d’impuissance significativement inférieurs à ceux des procédures chirurgicales. En revanche, il persiste après curiethérapie un risque de rétention urinaire, qui ne devrait pas dépasser 3 à 5 %, et surtout un syndrome irritatif urinaire qui peut être dans certains cas invalidant, durer plusieurs mois, et qui doit être signalé aux patients. Malgré ces quelques inconvénients, la curiethérapie par implants permanents, forte de ses excellents résultats à long terme, de ses taux limités d’incontinence et d’impuissance, et de nouvelles indications spécifiques (curiethérapie focale, curiethérapie de rattrapage après échec d’une radiothérapie externe, par exemple) devrait voir ses indications s’élargir encore dans les années à venir. [ABSTRACT FROM AUTHOR]

Résumé: Cet article a pour objectif de présenter l’intérêt de la curiethérapie de haut débit de dose dans le traitement par irradiation de l’adénocarcinome prostatique. Les spécificités biologique et dosimétrique de la curiethérapie pour cette pathologie, les principales études de phases II et III, les indications en pratique quotidienne dans le contexte de la médecine basée sur les preuves, ainsi que les techniques de radiothérapie externe pour les mêmes indications thérapeutiques sont donc envisagées successivement. Enfin, les potentialités de la technique pour de nouveaux développements sont discutées. [ABSTRACT FROM AUTHOR]

Résumé: Dans les dix dernières années, l’organisation de la curiethérapie en France s’est modifiée, regroupant l’activité dans 62 services sur les 173 centres recensés en 2009. Plus de 7500 patients ont été traités en 2009, presque exclusivement à visée curative et pour 80 % dans des établissements publics ou associés (établissements de santé privés d’intérêt collectif). Les cancers gynécologiques et de la prostate représentent 76 % des indications. Les techniques se sont sophistiquées avec utilisation de la dosimétrie tridimensionnelles et de l’optimisation de la distribution. La curiethérapie, bien que représentant seulement 5 % des traitements par irradiation, est le traitement de référence de nombreuses tumeurs. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of our research was to evaluate emotional distress among patients with primary and localized prostate cancer and the difficulties in emotional regulation encountered by certain patients, through the quality of their defensive functioning and the perceived social support. Method: Our sample comprises 51 patients with primary and localized prostate cancer treated using radiotherapy with or without hormone therapy (mean age=69; sd=6). Psychological evaluation comprised a semi-directive interview and three clinical scales (Defense Style Questionnaire-60, Hospital Anxiety and Depression Scale, Perceived Social Support Questionnaire). Results: Of 51, 23 patients (45 %) have a significant indicator of psychological distress (HAD≥13) which was linked with a poorer quality of the overall defensive functioning (ODF, DSQ-60), characterized by a resort more important to the less adaptive defensive levels and styles (“major distortion of the image”, “action”, “image distorting”, “affect regulating”). Moreover, patients with distress are less satisfied with informative and emotional supports provided by health-care professionals (PSSQ). Finally, we observe correlations between informative support satisfaction, on the one hand, and the emotional support satisfaction, on the other hand, with a better quality of the patients’ overall defensive functioning (ODF) and some of its dimensions (univariate analysis). Conclusion: The association between psychological distress felt by patients suffering from prostate cancer and a poorer quality of the defensive functioning reflects the vulnerability of certain patients with regard to their difficulty to cope with the emotional stress linked to the disease. Finally, their capacities to elaborate affects (mentalisation) and the role of health-care professionals in providing support and help to regulate emotions for them is questioned. [Copyright &y& Elsevier]

Abstract: Permanent seeds brachytherapy is a standard in the treatment of localized prostate cancer. Follow-up of patients treated with brachytherapy relies on monitoring the concentration of PSA. It is supposed to decrease steadily to a nadir after several years. This decrease could be disrupted by transient and benign elevation of the marker, sometimes mimicking genuine biochemical relapses, sources of anxiety for patients or even unnecessary tests. While the precise mechanisms of this phenomenon are poorly understood, their characteristics have been, however, extensively studied. This work aims to make an update on the current state of knowledge. [Copyright &y& Elsevier]

Abstract: Purpose: The main objective of the economical study was to prospectively and randomly assess the additional costs of daily versus weekly patient positioning quality control in image-guided radiotherapy (IGRT), taking into account the modalities of the 3D-imaging: tomography (CBCT) or gold seeds implants. A secondary objective was to prospectively assess the additional costs of 3D versus 2D imaging with portal imaging for patient positioning controls. Patients and methods: Economics data are issued from a multicenter randomized medico-economics trial comparing the two frequencies of patient positioning control during prostate IGRT. A prospective cohort with patient positioning control with PI (control group) was constituted for the cost comparison between 3D (IGRT) versus 2D imaging. The economical evaluation was focused to the radiotherapy direct costs, adopting the hospital''s point of view and using a microcosting method applied to the parameters that may lead to cost differences between evaluated strategies. Results: The economical analysis included a total of 241 patients enrolled between 2007 and 2011 in seven centres, 183 in the randomized study (128 with CBCT and 55 with fiducial markers) and 58 in the control group. Compared to weekly controls, the average additional cost per patient of daily controls was €847 (CBCT) and €179 (markers). Compared to PI, the average additional cost per patient was €1392 (CBCT) and €997 (fiducial markers) for daily controls; €545 (CBCT) and €818 (markers) in case of weekly controls. Conclusion: A daily frequency for image control in IGRT and 3D images patient positioning control (IGRT) for prostate cancer lead to significant additional cost compared to weekly control and 2D imaging (PI). Long-term clinical assessment will permit to assess the medico-economical ratio of these innovative radiotherapy modalities. [Copyright &y& Elsevier]

Abstract: Image-guided radiotherapy is defined by the use of images acquired in the treatment room to improve the accuracy of patient positioning. Most of imaging devices use X-rays and deliver an additional dose to the patients. These non-negligible doses have to be evaluated and reported. Several studies have investigated organ-absorbed dose due to in-room imaging. Some organ doses are reported to give an idea of the magnitude, in particular for prostate cancer. Then, principles based on the as low as reasonably achievable (ALARA) concept are described and adapted to image-guided radiotherapy. Justification (what is the patient outcome?) and optimisation (image modality, acquisition frequency, treatment site…) are two main issues. They have a really big impact on patient treatment and staff organization. [Copyright &y& Elsevier]

Abstract: Intensity modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) are technological developments, which when applied in a model of prostate cancer, led to a significant reduction in the toxicity and digestive and urinary sequelae of 3D conformational radiotherapy. The major clinical benefits of these techniques with regard to reduced digestive and urinary toxicity are unequivocal since very few sequelae have been reported at 10 years (2% of grade 2 and 1% of grade 3 digestive toxicity; 11% of grade 2 and 5% of grade 3 urinary toxicity). Even when these two techniques are combined, IG–IMRT significantly diminishes late genitourinary toxicity. In the absence of adaptive radiotherapy, there are many IGRT protocols and repositioning techniques, and every step in the IGRT process must be carried out with extreme rigor: installing the patient and contention system, repositioning technique with or without fiduciary markers, type of repositioning imaging, definition of margins inherent in each technique (prostate, seminal vesicles and/or pelvic lymph nodes), frequency of repositioning during treatment, dietary constraints with or without rectal lavage. For these reasons, every centre that performs IGRT must carefully and rigorously assess the uncertainties of repositioning linked to the IGRT technique. In this review, we analyzed data from the literature based on dosimetric studies and the proven clinical impact in order to answer the different questions asked by radiation oncologists at every step of the IGRT process for cancer of the prostate. Recommendations are made for the repositioning protocols according to the most widely used repositioning techniques: fiduciary markers or soft tissues, kV-CBCT or MV-CBCT, 3D ultrasonography. [Copyright &y& Elsevier]

Abstract: Image-guided radiotherapy (IGRT) aims to take into account anatomical variations occurring during irradiation by visualization of anatomical structures. It may consist of a rigid registration of the tumour by moving the patient, in case of prostatic irradiation for example. IGRT associated with intensity-modulated radiotherapy (IMRT) is strongly recommended when high-dose is delivered in the prostate, where it seems to reduce rectal and bladder toxicity. In case of significant anatomical deformations, as in head and neck tumours (tumour shrinking and decrease in volume of the salivary glands), replanning appears to be necessary, corresponding to the adaptive radiotherapy. This should ideally be “monitored” and possibly triggered based on a calculation of cumulative dose, session after session, compared to the initial planning dose, corresponding to the concept of dose-guided adaptive radiotherapy. The creation of “planning libraries” based on predictable organ positions (as in cervical cancer) is another way of adaptive radiotherapy. All of these strategies still appear very complex and expensive and therefore require stringent validation before being routinely applied. [Copyright &y& Elsevier]

Bone metastases in prostate cancer treatment stand as a clinical challenge in order to maintain quality of life and prevent pain and skeletal-related events. Bone metastases predominantly disrupts the dynamic equilibrium existing in healthy bone between osteogenesis and osteolysis. Therefore, bone microenvironment targeting agents under development are emerging as a specific component of care in the treatment of patients with metastatic prostate cancer. [ABSTRACT FROM AUTHOR]

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Abstract: Follow-up after prostate cancer radiotherapy aims at detecting local or metastatic relapse, as well as long-term toxicity, requiring adapted treatments. Several scientific societies have published guidelines including clinical, biological and imaging recommendations. More data suggest a role for aggressive salvage therapy in case of local failure following radiotherapy. An adequate follow-up is required for the sake of patients’ safety, i.e. to a posteriori validate dose constraints and radiation technique in each radiotherapy department. [Copyright &y& Elsevier]

Abstract: During the annual congress of the SFRO, a symposium, on “Therapeutic innovations”, described some of the burning questions in the treatment of prostate cancer. What is the best technique to perform radiation dose escalation, brachytherapy or Intensity modulated radiotherapy ? Rational has been highlighted for both techniques, but without a prospective comparative trial, no definitive answer could be given today. The role of neo-adjuvant hormonal treatment, before surgery or radiotherapy is still discussed, particularly in the area of LH-RH antagonists which have a rapid and profound anti-hormonal effect. At least, the salvage treatment for biochemical relapse after external beam irradiation has been discussed: surgery, cryotherapy, and High-Intensity focalised ultrasons and the timing of hormonal treatment. [Copyright &y& Elsevier]

Abstract: Purpose: To compare two Intensity Modulated Radiation Therapy (IMRT) techniques for prostate cancer: the Volumetric Modulated Arc Therapy (VMAT) and the “Step and Shoot” technique (S&S). Materials and methods: VMAT and S&S plans (RX 18MV) were created and compared (Wilcoxon test) for 10 patients. The dosimetric goal of both treatments was to deliver 46Gy to the seminal vesicles and 80Gy to the prostate, while respecting the dose constrains in the organs at risk of toxicity. For one patient, the two techniques were compared for dose painting and escalation in target volumes defined on MRI and registered thanks to intraprostatic fiducials. Results: VMAT, compared to S&S, offered: an increase of the PTV2s (prostate) volume receiving 77 to 80Gy and a decrease of V82 and V83; a decrease of V4 to V6, V16 to V23, and V69 to V73 for the rectal wall; a decrease of V25 for the bladder wall; a decrease of V21 to V43 for the femoral heads; a decrease of V26 to V44 and V72 to V80 but an increase of V1 to V21 and V49 to V60 for the healthy tissues. The Conformal Index “COIN” was better with VMAT than S&S (0.60 to 0.66). The delivered MU were significantly reduced with VMAT (8% mean) as well as the delivery time (4min to 1.5min). VMAT allowed delivering theorically 90Gy in the peripheral zone and 100Gy in the tumor. Conclusion: In case of prostate irradiation, VMAT shows improvement compared with S&S. In particular, organs at risk are better spared, the delivery time is shortened and the number of delivered UM is decreased. [ABSTRACT FROM AUTHOR]

Abstract: The goal of localized prostate cancer radiotherapy is to cure patients. The decision-making must integrate the survival but also the quality of life of patients. Some French validated self-reported questionnaires are available to evaluate quality of life. Whatever the treatments (radical prostatectomy, brachytherapy, external beam radiation, with or without hormonotherapy), even if patients report more sequelae, their long-term quality of life is similar to that of the general population, except for patients treated with hormonotherapy who complain more decline of physical quality of life. In comparison with prostatectomy, patients treated with external beam radiation report less long-lasting urinary symptoms, but more bowel side effects, with no difference in global quality of life. Sexual disorders are initially less important with external beam radiation but increase over time. Brachytherapy shows no sexual function preservation benefit relative to radiation and may be less favourable with more urinary sequelae. The association of hormonotherapy and external beam radiation decreases the quality of life of the patients, with a negative impact on vitality, sexuality and increase urinary disorders. Intensity-modulated radiotherapy (IMRT) seems to better preserve the long-term digestive quality of life in comparison with conformal radiation therapy. Post-prostatectomy could induce more digestive toxicity, such as rectal irritation. The adjunction of hormonotherapy to radiation, the previous medical history of abdominal surgery, the field of radiation and the acute reactions to radiation are the main predictive factors to late toxicity and should be considered in the choice of initial treatment and for the follow-up. [ABSTRACT FROM AUTHOR]

Abstract: The combination of radiotherapy and androgen suppression with luteinizing hormone releasing hormone agonist is mainly devoted to locally advanced prostate cancer and intermediate or poor risk localized prostate cancer. They are based on phase III randomized trials which have shown that for locally advanced prostate cancer, a four-month complete androgen blockade initiated two months prior radiotherapy and stopped at the completion of radiotherapy increased overall survival in patients with Gleason scores 2–6, meanwhile, an adjuvant long-term androgen suppression (2.5 to three years) improved significantly the overall survival. Complete androgen blockade with a four to six months duration, combined with external irradiation, enhanced the overall survival in patients with intermediate or poor risk localized prostate cancer. [ABSTRACT FROM AUTHOR]

Abstract: After radical prostatectomy, the risk of biological recurrence at 5 years varies from 10 to 40 % and this natural evolution of the disease has led radiation therapy being proposed as a supplement to surgery. When the recurrence risk is essentially local, supplementary radiotherapy is justified in the aim of improving biological recurrence-free survival, local control, metastasis-free survival and specific and global survival, while respecting patient quality of life. Three recent studies, EORTC 22911, ARO 9602 and SWOG 8794 found a similar advantage for biological recurrence-free survival without higher major additional toxicity. However, only the SWOG 8794 study found a significant improvement for metastasis-free survival and global survival. In an adjuvant setting, the optimal moment to propose this postoperative radiotherapy remains uncertain: should it be proposed systematically to all pT3 R1 patients, running the risk of pointlessly treating patients who will never recur, or should it only be proposed at recurrence? The GETUG AFU 17 trial will provide answers to the question of the optimal moment for postoperative radiotherapy for pT3-4 R1 pN0 Nx patients with the objective of comparing an immediate treatment to a differed early treatment initiated at biological recurrence. [ABSTRACT FROM AUTHOR]

Abstract: Sexual dysfunctions are a quality of life main concern following prostate cancer treatment. After both radiotherapy and brachytherapy, sexual function declines progressively, the onset of occurrence of erectile dysfunction being 12–18 months after both treatments. The pathophysiological pathways by which radiotherapy and brachytherapy cause erectile dysfunction are multifactorial, as patient comorbidities, arterial damage, exposure of neurovascular bundle to high levels of radiation, and radiation dose received by the corpora cavernosa at the crurae of the penis may be important in the aetiology of erectile dysfunction. Diagnosis and treatment of postradiation sexual dysfunctions must integrate pretherapeutic evaluation and information to provide to the patient and his partner a multidisciplinary sexual medicine management. [ABSTRACT FROM AUTHOR]

Abstract: Brachytherapy techniques by permanent implant of radioactive sources or by temporary high-dose-rate (HDR) fractions are nowadays extensively used for the treatment of prostatic carcinoma. Long-term results (at 20years) concerning large amount of patients have been published by major centers confirming both in terms of efficacy and toxicities that permanent implant of radioactive iodine-125 seeds yields at least the same good results of surgery and of external beam irradiation when proposed to patients affected by low-risk disease. For intermediate to high-risk tumors, HDR temporary implants are proposed as a boost for dose escalation. For both techniques, several topics still need to be clarified dealing with a recent enlargement of indications (HDR alone for low-risk, iodine-125 seeds boost for intermediate-high-risk cancers), or with technical aspects (loose seeds versus linked ones, number of fractions and dose for HDR protocols), while dosimetric issues have only recently been addressed by cooperatives groups. Last but not least, there is a real need to address and clearly characterize the correct definition of biochemical disease control both for iodine permanent implant and for HDR implant. New challenges are facing the prostate-brachytherapy community in the near future: local relapse after external beam radiotherapy are currently managed by several salvage treatments (prostatectomy, cryo, high intensity focused ultrasounds [HIFU]) but the role of reirradiation by brachytherapy is also actively investigated. Focal therapy has gained considerable interest in the last 5 years aiming at treating only the area of cancer foci inside the prostate and preserving nearby healthy tissues. Encouraging results have been obtained with the so-called “minimally invasive” approaches and both permanent seed implantation and HDR brachytherapy techniques may be worthwhile testing in this setting because of their capability of exactly sculpting the dose inside the prostatic gland. [Copyright &y& Elsevier]

Abstract: External beam radiotherapy (RT) is used to treat all stages of localized prostate cancer. Using a 3D conformal RT (3DCRT) without any androgen deprivation, a clear dose–effect relationship has been shown in terms of both biochemical control and also unfortunately of rectal and urinary toxicity. Compared to a “standard” 3DCRT, intensity modulated RT (IMRT) improves the dose distribution by mainly providing concave dose distribution and tight dose gradients. Based on large clinical experiences for at least one decade, IMRT is widely used to increase the dose in the prostate and therefore local control, without increasing toxicity. Indeed, toxicity rates observed after high dose delivered in the prostate (80Gy) with IMRT appear no different than those observed after a standard dose (70Gy) delivered by a standard 3DCRT. Arc IMRT appears a new promising IMRT modality, decreasing dramatically treatment duration. However, this IMRT-based dosimetric benefit may not be translated into a full clinical benefit, if intra-pelvic prostate motion is not taken in account. Image-guided radiotherapy (IGRT) should be therefore associated with IMRT for a maximal clinical benefit. This article is a literature review showing the interest of both combined approaches. [ABSTRACT FROM AUTHOR]

Abstract: Radiotherapy is nowadays a major therapeutic option in prostate cancer. Technological improvements allowed dose escalation without increasing late toxicity. Some randomized trials have shown that dose escalation decreases the biochemical failure rate, without any benefit in survival with the present follow-up. However, some studies indicate that the distant metastases rate is also decreased. Most of these studies have been done without hormonal treatment, and the role of dose escalation in case of long-term androgen deprivation is unknown. The target volume encompassed the whole gland: however, complete or partial focal treatment of the prostate can be done with sophisticated IMRT technique and must be evaluated. Proximal part of the seminal vesicles must be included in the target volumes. The role of nodal irradiation is another debate, but it could be logically proposed for the unfavourable group. [ABSTRACT FROM AUTHOR]

Abstract: Dose escalation in prostate cancer is made possible due to technological advances and to precise dose–volume constraints to limit normal tissue damage. This article is a literature review focusing on the correlations between exposure (doses and volumes) of organs at risk (OAR) and rectal, urinary, sexual and bone toxicity, as well as on mathematical models aiming at toxicity prediction. Dose–volume constraint recommendations are presented that have been shown to be associated with reduced rectal damage. Indeed, the clinical data is relatively strong for late rectal toxicity (bleeding), with constraints put on both the volume of the rectum receiving high doses (≥70 Gy) and the volume receiving intermediate doses (40 to 60 Gy). Predictive models of rectal toxicity (Normal Tissue Complication Probability) appear to accurately estimate toxicity risks. The correlations are much weaker for the bulb and the femoral heads, and nearly do not exist for the bladder. Further prospective studies are required, ideally taking into account patient-related risk factors (co-morbidities and their specific treatments), assays of normal tissue hypersensitivity to ionizing radiation and mathematical models applied on 3D images acquired under the treatment machine (e.g. Cone Beam CT). [ABSTRACT FROM AUTHOR]

Abstract: Local recurrence after external radiotherapy or brachytherapy occurs in 30% of patients treated for prostate cancer. These recurrences can be localised to the prostate and controlled by salvage treatment. Salvage prostatectomy is the gold standard treatment, however, it is associated with a high morbidity rate. Minimally invasive treatments such as cryotherapy and high intensity focused ultrasound (HIFU) can be proposed to treat local recurrences. Indications, complications and oncological results of these salvage treatments are discussed in this article. [ABSTRACT FROM AUTHOR]

Le bilan d’extension du cancer de la prostate est dominé par la possibilité de proposer un traitement à visée curative. Le bilan d’extension locorégionale repose sur l’IRM endorectale et le bilan à distance sur la scintigraphie osseuse. Le TEP/CT à la choline marquée sera sans doute l’examen de choix pour la recherche d’une récidive devant une remontée du PSA. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Discuss the place of radiotherapy given in a curative intent in elderly patients with localised prostate cancer according to complications, local control, survival observed in a specific and a review of the literature. Patients and methods: The cohort consisted of 65 males aged 80 or more with localised prostate cancer who choose radiotherapy as a curative modality. Twelve radiotherapy centres affiliated to the Rare Cancer Network participated to the study. The retrospective analysis was carried out on immediate and late side-effects, biological free of relapse survival and global survival. Multivariate analysis took into account the comorbidities, the initial prostatic specific antigen (PSA) value, the Gleason score and the therapeutic modalities. Results: From January 1990 to December 2000, 65 patients were included into the cohort. Mean age was 81 years. The specific series consisted of 10 T1, 40 T2 and 15 T3 N0M0. Median follow up was 65 months. Immediate and late complications were comparable to those described in younger patients who received a similar irradiation. There were no negative impact of the treatment on disease free survival and global survival. Recent literature did suggest analogous results. Conclusions: Radiation therapy with a curative intent should not be systematically withheld in elderly patients with localised prostate cancer. [Copyright &y& Elsevier]

Abstract: Introduction: The aim of this work was to report the experience of image-guided radiotherapy at the CLCC Nantes-Atlantique using three repositioning imaging devices, the ExacTrac® (BrainLAB™), the OBI®-CBCT (Varian™) and the MVCT (Tomotherapy Inc™), in the case of prostate external radiotherapy. Material and methods: For each linac and its imaging device, a treatment plan was described. Moreover, studies concerning calculated shifts after imaging sessions were achieved. Using ExacTrac®, for eight patients, a study compared daily shifts based on bony anatomy or on implanted markers. Considering mean values of displacements over a course of radiotherapy, dosimetric impact was evaluated. With the OBI®-CBCT, two imaging modalities were used, kV–kV (0° and 270°) and CBCT. Up to now, whatever the images, displacements were calculated using the bony anatomy. For both modalities and for 26 patients, shifts were compared. Since the beginning of the Tomotherapy HiArt® use, MVCT was performed for each session of each patient. For 12 patients, mean displacements were calculated after five fractions. Then the deviations to those values were calculated. This was done to show the relevance of daily MVCT. Results and conclusion: This work allows us to report the use of three repositioning imaging devices in the radiotherapy department. At least they provide an efficient positioning tool. And they let us see the future radiotherapy which would probably be the dose-guided radiotherapy. [Copyright &y& Elsevier]

Abstract: Purpose: To describe our practice day to day with a VARIAN™ linac “Clinac 2100®” fully equipped with an On Board Imager® (OBI) for patients with prostate cancer. Materials and methods: A volumetric and dosimetric study was performed in 2006 using ARTIVIEW® software (AQUILAB®) for nine patients and 76 Cone Beam CT kV (CBCT kV). We have contoured targets and organs at risk from CBCT kV slides acquisitions. Second, we achieved a dose–volume histogram (DVH) study for a patient treated in 2007 with IMRT technique in comparison with the 2006 study. Results: 2006 analysis: The study showed a very important variability of organ measurements. Seminal vesicles were strongly influenced by adjacent organs; observed differences for prostate could be explained by contouring uncertainty on the apex. Inter-sessions motions could be observed for bladder, rectum and seminal vesicles (SV). Part of prostate volume not encompassed by PTV is about 2.5%; VS volume outside PTV is about 35%. Tumoral conformation index (TCI) is inferior to 97.5% in 22% of all cases. Anteroposterior displacements of the prostate barycentre is superior to 5mm. From this analysis, we recommended the strict respect of hygienodietetic rules, and we have adapted the system settings for better immobilization, which were applied for the 2007 study. For the 2007 analysis, since April 2007, most of patients are treated with IMRT for prostate cancer, at the second part of the radiation therapy to encompass only the prostate volume. Dose–volume histograms showed a great spreading out for 2006 patients, and not for the 2007 patient. Conclusions: IMRT and IGRT should permit a margin reduction for PTV. Strict respect of hygienodietetics rules is necessary to avoid rectal distension and local recurrence. [Copyright &y& Elsevier]

Abstract: Prostate cancer is associated with a risk of lymph node involvement, which increases with clinical stage, Gleason score, and PSA level at diagnosis. When this risk is higher than 15%, it has been suggested to irradiate the pelvis in addition to the prostate despite an increased risk of gastrointestinal toxicities. However, several randomized trials seem to call into question this therapeutic approach. This review presents the potent role of pelvic irradiation in the treatment of locally advanced prostate cancer treated with exclusive radiotherapy. [Copyright &y& Elsevier]

Abstract: Radiation therapy is now widely accepted as an efficacious treatment of localized prostate cancer. Recent advances, namely with the development of conformal radiotherapy, allowed to increase the total dose in the target volumes with greater local control. A forward step achieved with intensity modulated radiotherapy (IMRT) in terms of therapeutic ratio between target volumes and critical organs. IMRT offers an inverse planning dosimetry and a modulation of the fields during irradiation. This article presents recent technical and clinical advances in IMRT focused on prostate cancer. [Copyright &y& Elsevier]

Abstract: Image guide radiotherapy with the Cone Beam CT kV (CBCT-kV) developed by Elekta™ has been implemented at the centre Léon Bérard in November 2006. The treatment procedure is presented and detailed for prostate cancer IGRT and non small cell lung cancer (NSCLC) stereotactic radiotherapy (SRT). CBCT-kV is routinely used for SRT, selected paediatric cancers, all prostate carcinomas, primitive brain tumours and head and neck cancers that do not require nodes irradiation. Thirty-five to 40 patients are treated within a daily 11-hours period. The general procedure for 3D images acquisition and their analysis is described. The CBCT-kV permitted to identify about 10% of prostate cancer patients for whom a positioning with bone-based 2D images only would have led to an unacceptable dose distribution for at least one session. SRT is now used routinely for inoperable NSCLC. The easiness of implementing CBCT-kV imaging and its expected medical benefit should lead to a rapid diffusion of this technology that is also submitted to prospective and multicentric medico-economical evaluations. [Copyright &y& Elsevier]

Abstract: Purpose: To quantify the prostate and seminal vesicles (SV) anatomic variations in order to choose appropriate margins including intrapelvic anatomic variations. To quantify volumetric benefit of image-guided radiotherapy (IGRT). Patients and methods: Twenty patients, receiving a total dose of 70 Gy in the prostate, had a planning CT scan and eight weekly CT scans during treatment. Prostate and SV were manually contoured. Each weekly CT scan was registered to the planning CT scan according to three modalities: radiopaque skin marks, pelvis bone or prostate. For each patient, prostate and SV displacements were quantified. 3D maps of prostate and SV presence probability were established. Volumes including minimal presence probabilities were compared between the three modalities of registration. Results: For the prostate intrapelvic displacements, systematic and random variations and maximal displacements for the entire population were: 5mm, 2.7mm and 16.5mm in anteroposterior axis; 2.7mm, 2.4mm and 11.4mm in superoinferior axis and 0.5mm, 0.8mm and 3.3mm laterally. Margins according to van Herk recipe (to cover the prostate for 90% of the patients with the 95% isodose) were: 8mm, 8.3mm and 1.9mm, respectively. The 100% prostate presence probability volumes correspond to 37%, 50% and 61% according to the registration modality. For the SV, these volumes correspond to 8%, 14% and 18% of the SV volume. Conclusions: Without IGRT, 5mm prostate posterior margins are insufficient and should be at least 8mm, to account for intrapelvic anatomic variations. Prostate registration almost doubles the 100% presence probability volume compared to skin registration. Deformation of SV will require either to increase dramatically margins (simple) or new planning (not realistic). [Copyright &y& Elsevier]

Abstract: Purpose: To study the dose delivered by a megavoltage cone beam computed tomography imaging system (MVCBCT) installed on a Oncor Impression® linac (Siemens™). Materials and methods: The acquisition of MVCBCT images was modelled in a treatment planning system by 67 photon beams (6 MV). A study was conducted to: compare the calculated and measured dose at the centre of a cylindrical phantom; compare the calculated and measured dose distributions in the Alderson-Rando phantom (pelvis); study the influence of MVCBCT image acquisition for the repositioning of a prostate cancer patient treated by 3D conformal radiotherapy (prescribed dose of 74 Gy), on the dose–volume histograms (DVH) for the treatment plus seven MVCBCT (protocol D1–3 and weekly), treatment plus 37 MVCBCT (one for each day of treatment). Results: The difference between calculated and measured doses at the centre of the cylindrical phantom was less than 3%. A deviation of 7% maximum was found between the dose distribution calculated in the Rando phantom and the measured doses normalized at the beam isocentre. The dose delivered at the isocentre was equal to 3,7 cGy for a “5 MU” protocol, with a maximum dose of 6 cGy. In the case of the patient considered, the acquisition of 37 MVCBCT corresponded to an additional mean dose to the PTV of 1.2 Gy for a protocol “5MU” with a significant influence on the DVH. Conclusion: In view of this study, it appears that the doses delivered in frequent use of MVCBCT must be taken into account by the radiation oncologist in assessing the therapeutic dose delivered to the target volume and organs at risk. [Copyright &y& Elsevier]

Abstract: Purpose: To investigate if the regular use of kV-CBCT notably increases the dose delivered to tumor and surrounding healthy tissues. Material and methods: Images were obtained using a Varian™ equipment (OBI version 1.3, 645 to 650 projections in 370° to acquire image), and patients were irradiated at source–tumor distance: 100cm. In vivo measurements were performed using radio-thermoluminescent dosimeters Harshaw-TLD700H (TLD) at skin (anterior–posterior and lateral axis crossing the rotation axis), with a fourth TLD group under the table thanks to a retrolaser. TLD''s were calibrated at the kV-CBCT effective energy (64 keV), and the method validated using an anthropomorphic phantom, in which Gafchromic EBT films were also inserted. Results: The phantom study showed that the dose distribution depends on the phantom position relative to the axis and that the doses measured at the phantom surface using TLD and films (good agreement) were maximum at the entrance of the anterior–posterior axis. Their arithmetic mean was equal, or a slightly greater than doses measured at mid-thickness of the phantom and at the level of the rectum (OAR). In vivo measurements performed on the five first patients (125 kV-CBCT) yield a mean skin dose per kV-CBCT varying from 5.8±0.1 to 7.3±0.2 cGy on the anterior–posterior axis. Lateral skin doses vary from 3.4±0.2 to 4.5±0.2 cGy. Conclusion: Doses delivered by repeated kV-CBCT are not negligible. They should be taken into account, but questions about the RBE to be applied to kilovoltage X-rays are raised. [Copyright &y& Elsevier]

Docetaxel is the standard first line treatment in metastatic castration-resistant prostate cancer. The time to begin docetaxel remains questionable. Regarding conventional therapy, the old cytotoxic agent estramustine is still controversial, but data suggest a survival advantage when combined with docetaxel. This therapeutic improvement has resulted in the clinical development of several new agents, some as monotherapy, others in combination with docetaxel, as first or second line treatment. Numerous clinical trials have improved the comprehension of the disease continuum, generating new recommendations, especially concerning outcome measures. Two new drugs are being tested: the satraplatin and the ixabepilone. The principle of targeting bone metastasis has induced new options of treatment, such as targeting RANK-ligand, systemic radioisotopes, or the inhibition of the endothelin 1 receptor A. Antiangiogenic agents are also tested in clinical trials, especially bevacizumab, VEGF-trap and vandetanib. Furthermore, hormone manipulations appear promising, especially abiraterone acetate and the antagonists of the androgen receptor. [ABSTRACT FROM AUTHOR]

An update on the side effects of hormone therapy in the treatment of prostate cancer is presented. Standard treatment is to reduce testosterone to castration levels. The major complications of androgen deprivation include hot flushes, sexual dysfunction, osteoporosis, decreased muscle mass, weight gain, altered lipid levels and anaemia. Intermittent androgen blockade and anti-androgen monotherapy in selected patients may decrease the rate of side effects encountered with androgen suppression. Recommendations to the patients at initiation of androgen deprivation therapy as well as management of side effects are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Comparative study between a classical conformational prostate radiotherapy (3DRTC) and two arctherapy techniques, a coplanar (AT-C) and the other non-coplanar (AT-NC). Patients and Methods: The comparison has been made retrospectively on 30 patients with localized prostate cancer (T2-T3a, PSA<20ng/ml, Gleason<7). The objective criteria for comparison were the NTCP, EUD, and dose volume (on DVH), for the volumes of bladder wall, rectal wall, femoral heads, small bowel, prostate (P) and seminal vesicles (VS). The treatment was 46Gy on PTV1 (VS+P+margins), and then an overdose of 30Gy on PTV1 (P+margins). Results: For prostate volumes exceeding 75cm3, arctherapy leads to a decrease in uniformity in the target volume and an increase in the dose received by the femoral heads, this method does not seem appropriate. For prostate volumes less than 75cm3, in addition to the coverage almost tumor, and radiation toxicity equivalent to the bladder and the small intestine, there is a significant increase in the dose to the femoral heads, while the remaining is still within limits, such as clinically tolerable. The contribution of arctherapy is mainly observed at the level of rectal doses. The dose received by 30% of the rectum is reduced by –12% for AT-C and –11.7% for AT-NC, and EUD rectum –5.2% and –4.8%. Conclusion: In this virtual study, the arctherapy seems to generate a true dose reduction in the rectum wall. These results encourage us to continue the investigation for a possible integration in a dynamic clinical routine. [Copyright &y& Elsevier]

Abstract: Purpose: An automatic segmentation tool of pelvic structures from MRI images for prostate cancer radiotherapy was developed and dosimetric evaluation of differences of delineation (automatic versus human) is presented here. Materials and methods: CTV, rectum and bladder were defined automatically and by a physician in 20 patients. Treatment plans based on “automatic” volumes were transferred on “manual” volumes and reciprocally. Dosimetric characteristics of PTV (V 95, minimal, maximal and mean doses), rectum (V 50, V 70, maximal and mean doses) and bladder (V 70, maximal and mean doses) were compared. Results: Automatic delineation of CTV did not significantly influence dosimetric characteristics of “manual” PTV. Rectal V 50 and V 70 were not significantly different; mean rectal dose is slightly superior (43.2 versus 44.4Gy, p =0.02, Student test). Bladder V 70 was significantly superior too (19.3 versus 21.6, p =0.004). Organ-at-risk (OAR) automatic delineation had little influence on their dosimetric characteristics; rectal V 70 was slightly underestimated (20 versus 18.5Gy, p =0.001). Conclusion: CTV and OAR automatic delineation had little influence on dosimetric characteristics. Software developments are ongoing to enable routine use and interobserver evaluation is needed. [Copyright &y& Elsevier]

Abstract: Brachytherapy using I 125 permanent implants as monotherapy is a validated technique of treatment for localised prostate cancer with favorable prognostic factors, as external beam irradiation or surgery are. It necessitates a strict selection of the patients and a precise technique in a specialised unit. The narrow collaboration between radiation–oncologist, urologist en medical physicist is necessary along the successive steps of the selection, treatment, and follow-up of the treatment. The good carcinologic and functional 10 years results confirm the preliminary results. New indications of brachytherapy using other techniques and different combinations with external beam irradiation are investigated. [Copyright &y& Elsevier]

The precise assessment of sexual dysfunction after treatment of prostatic cancer cannot be avoided in 2002. These iatrogenic complications may significantly alter the quality of life of the patients. In addition, sexual toxicity is progressively becoming a cardinal parameter for the treatment choice, both for the patient and the physician. Significant efforts allowed to reduce sexual toxicity after therapy in the recent years. As an example, nerve-sparing surgical techniques have been proposed, whenever reasonable. However, in spite of these surgical advances, data suggest that overall, the new irradiation techniques (conformal radiotherapy and brachytherapy) are responsible for less alteration of sexual life than surgery. Another potential advantage is that sildenafil (Viagra®) is able to restore potency in a majority of cases after radiotherapy, while it is usually poorly effective after surgery. [Copyright &y& Elsevier]