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Objectif de l’étude L’objectif était l’évaluation de la réponse tumorale et de la tolérance clinique dans une cohorte prise en charge par un complément de curiethérapie de haut débit de dose anale après l’abandon de la curiethérapie de bas débit avec fils d’iridium en 2010. Matériel et méthode Il s’agissait d’une analyse rétrospective des dossiers d’une cohorte de patients prise en charge par un complément de curiethérapie de haut débit de dose anale après une radiothérapie conformationnelle pelvienne avec chimiothérapie concomitante. La tumeur ne dépassait pas l’hémiconférence, en excluant celles de stade T4. Il a été implanté des aiguilles selon le système de Paris, sous anesthésie générale, avec un applicateur papillon modifié, avec guidage par une échographie endorectale. Nous avons réalisé une dosimétrie tridimensionnelle unique sur la scanographie et/ou non l’IRM, qui a été transférée cinq fois au projecteur de source. La prescription était de 3 Gy par fraction sur l’isodose 85 % de la dose de base ; puis il a été réalisé une optimisation manuelle graphique devant couvrir le volume cible anatomoclinique et minimiser le volume recevant 150 % de la dose de base. Résultats De mai 2010 à mars 2017, 65 patients atteints de carcinome épidermoïde ont bénéficié d’un complément de curiethérapie de haut débit de dose anale délivrant 15 Gy en cinq fractions sur 2,5 jours après 45 Gy en 25 fractions par radiothérapie conformationnelle tridimensionnelle. L’évolution de l’implantation vers cinq aiguilles au minimum (trois internes, deux périphériques) par rapport à la curiethérapie de bas débit pour les réponses complètes après une radiothérapie conformationnelle tridimensionnelle permettait de minimiser les manchons de surdosage (150 % de la dose de base) au contact de la muqueuse anale grâce au débit de dose. Avec un suivi moyen de 3 ans, probabilité de contrôle local était de 91 %, celle de survie globale de 93 % celle de toxicité digestive chronique de grade 3 ou plus de 7,5 %. Conclusion Le complément de curiethérapie de haut débit de dose anale permet un taux contrôle tumoral comparable à celui de la curiethérapie de bas débit de dose. La toxicité digestive était comparable, à condition de faire une implantation en deux plans au minimum pour réduire les manchons de surdosage au contact de la muqueuse. La réalisation d’un seul plan de traitement pour une fraction de 3 Gy transféré cinq fois sur le projecteur permet une simplification du traitement et d’épargner des ressources humaines. [ABSTRACT FROM AUTHOR]

Glycosylation is a complex multienzyme-related process that is frequently deregulated in cancer. Aberrant glycosylation can lead to the generation of novel tumor surface-specific glycotopes that can be targeted by antibodies. Murine DS6 mAb (muDS6) was generated from serous ovary adenocarcinoma immunization. It recognizes CA6, a Mucin-1 (MUC1)-associated sialoglycotope that is highly detected in breast, ovarian, lung, and bladder carcinomas. SAR566658 antibody-drug conjugate (ADC) is a humanized DS6 (huDS6) antibody conjugated through a cleavable linker to the cytotoxic maytansinoid derivative drug, DM4. SAR566658 binds to tumor cells with subnanomolar affinity, allowing good ADC internalization and intracellular delivery of DM4, resulting in tumor cell death (IC 50 from 1 to 7.3 nmol/L). SAR566658 showed in vivo antitumor efficacy against CA6-positive human pancreas, cervix, bladder, and ovary tumor xenografts and against three breast patient-derived xenografts. Tumor regression was observed in all tumor models with minimal effective dose correlating with CA6 expression. SAR566658 displayed better efficacy than standard-of-care nontargeted tubulin binders. These data support the development of SAR566658 in patients with CA6-expressing tumors., (©2020 American Association for Cancer Research.)

In the era of intensity-modulated radiation therapy, image-guided radiotherapy (IGRT) appears crucial to control dose delivery and to promote dose escalation while allowing healthy tissue sparing. The place of IGRT following radical prostatectomy is poorly described in the literature. This review aims to highlight some key points on the different IGRT techniques applicable to prostatic bed radiotherapy. Furthermore, methods used to evaluate target motion and to reduce planning target volume margins will also be explored.

Prostate brachytherapy techniques are described, concerning both Iodine 125 high dose rate brachytherapy. The following parts are presented: brachytherapy indications, technical description, immediate postoperative management and post-treatment evaluation, and 4 to 6 weeks as well as long-term follow-up., (Copyright © 2016. Published by Elsevier SAS.)

Between 10 and 40% of patients who have undergone a radical prostatectomy may have a biologic recurrence. Local or distant failure represents the possible patterns of relapse. Patients at high-risk for local relapse have extraprostatic disease, positive surgical margins or seminal vesicles infiltration or high Gleason score at pathology. Three phase-III randomized clinical trials have shown that, for these patients, adjuvant irradiation reduces the risk of tumoral progression without higher toxicity. Salvage radiotherapy for late relapse allows a disease control in 60-70% of the cases. Several research in order to improve the therapeutic ratio of the radiotherapy after prostatectomy are evaluate in the French Groupe d'Étude des Tumeurs Urogénitales (Gétug) and of the French association of urology (Afu). The Gétug-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. The Gétug-Afu 22 questions the place of a short hormonetherapy combined with image-guided, intensity-modulated radiotherapy (IMRT) in adjuvant situation for a detectable prostate specific antigen (PSA). The implementation of a multicenter quality control within the Gétug-Afu in order to harmonize a modern postoperative radiotherapy will allow the development of a dose escalation IMRT after surgery., (Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

The identification of the optimal radiation technique in prostate cancer is based on the results of dosimetric and clinical studies, although there are almost no randomized studies comparing different radiation techniques. The feasibility of the techniques depends also on the technical and human resources of the radiation department, on the cost of the treatment from the points of view of the society, the patient and the radiation oncologist, and finally on the choice of the patient. The slow evolution of prostate cancer leads to consider the biochemical failure as the main judgment criteria in the majority of the studies. A proper urinary radio-induced toxicity evaluation implies a long follow-up. Intensity-modulated radiotherapy (IMRT) combined with image-guided radiotherapy (IGRT) is recommended in case of high dose (≥76Gy) to the prostate, pelvic lymph nodes irradiation and hypofractionation schedules. For low-risk tumors, the aim of the treatment is to preserve quality of life, while limiting costs. Stereotactic body radiotherapy shows promising results, although the follow-up is still limited and phase III trials are ongoing. Focal radiation techniques are in the step of feasibility. For intermediate and high-risk tumors, the objective of the treatment is to increase the locoregional control, while limiting the toxicity. IMRT combined with IGRT leads to either a well-validated dose escalation strategy for intermediate risk tumors, or to a strategy of moderate hypofractionated schedules, which cannot be yet considered as a standard treatment. These combined radiation techniques allow finally large lymph node target volume irradiation and dose escalation potentially in the dominant intraprostatic lesion. The feasibility of simultaneous integrated boost approaches is demonstrated., (Copyright © 2014. Published by Elsevier SAS.)