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Abstract: The 21st SFRO Congress during October 2010 focused on three main topics: prostate, radiotherapy technical innovations (including reirradiation) and quality of life. The pitfalls of IMRT (treatment time, number of monitor unit, low doses) are in competition with arctherapy dynamic techniques that offer reduction treatment time for an equivalent ballistic. These techniques with high dose gradient should be coupled with the better imagery of repositioning (IGRT) to ensure benefice. A prospective evaluation of toxicity, clinical benefit on tumor control but also on quality of life of patients is necessary. In many current and future clinical trials, quality of life related to health will be a relevant outcome measurement to secure the importance of treatment for the patient and the health system. [Copyright &y& Elsevier]

Abstract: The esophagus is a musculo-membranous tube through which food passes from the pharynx to the stomach. Due to its anatomical location, it can be exposed to ionizing radiation in many external radiotherapy indications. Radiation-induced esophageal mucositis is clinically revealed by dysphagia and odynophagia, and usually begins 3 to 4 weeks after the start of radiation treatment. With the rise of multimodality treatments (e.g., concurrent chemoradiotherapy, dose escalation and accelerated fractionation schemes), esophageal toxicity has become a significant dose-limiting issue. Understanding the predictive factors of esophageal injury may improve the optimal delivery of treatment plans. It may help to minimize the risks, hence increasing the therapeutic ratio. Based on a large literature review, our study describes both early and late radiation-induced esophageal injuries and highlights some of the predictive factors for cervical and thoracic esophagus toxicity. These clinical and dosimetric parameters are numerous but none is consensual. The large number of dosimetric parameters strengthens the need of an overall analysis of the dose/volume histograms. The data provided is insufficient to recommend their routine use to prevent radiation-induced esophagitis. Defining guidelines for the tolerance of the esophagus to ionizing radiation remains essential for a safe and efficient treatment. [ABSTRACT FROM AUTHOR]

Abstract: The liver is a large abdominal organ in the right hypondrium. Because of its anatomical situation, it is near many abdominal PTVs as well as some lower thoracic PVTs. The liver could also be at the same time the target (for irradiation of liver metastases or primary liver tumours) and organ at risk (OAR). Radiation-induced liver disease (RILD) is radiobiologically the normal tissue complication probability (NTCP), i.e., the clinical event limiting the total dose that could be delivered. This review describes radiobiological criteria justifying the NTCP data, and recommendations for conformal 3D radiotherapy and stereotactic liver irradiation. [ABSTRACT FROM AUTHOR]

Abstract: The impact of curative radiotherapy depends mainly on the total dose delivered homogenously in the targeted volume. Nevertheless, the dose delivered to the surrounding healthy tissues may reduce the therapeutic ratio of many radiation treatments. Two different side effects (acute and late) can occur during and after radiotherapy. Of particular interest are the radiation-induced sequelae due to their irreversibility and the potential impact on daily quality of life. In a same population treated in one centre with the same technique, it appears that individual radiosensitivity clearly exists. In the hypothesis that genetic is involved in this area of research, lymphocytes seem to be the tissue of choice due to easy accessibility. Recently, low percentage of CD4 and CD8 lymphocyte apoptosis were shown to be correlated with high grade of sequelae. In addition, recent data suggest that patients with severe radiation-induced late side effects possess four or more single nucleotide polymorphisms (SNP) in candidate genes (ATM, SOD2, TGFB1, XRCC1, and XRCC3) and low radiation-induced CD8 lymphocyte apoptosis in vitro. On-going studies are being analyzing the entire genome using a Genome-wide association study (GWAS) analysis. [ABSTRACT FROM AUTHOR]

Abstract: The planning of radiotherapy has known major developments during the last years. With the emergence of news techniques such as conformational radiotherapy, intensity modulated radiation therapy or stereotactic radiation therapy, the definition of target volumes was of great importance. The recommendations for the target volumes definition have been defined in the ICRU 50 and 62 reports, without any guidelines for volume delineation. Among the incertainties that may influence the outcome after irradiation, the intra- and interobservers variations in delineation are the most important. Many teams have offered guidelines or atlases to homogenize these volumes and reduce these variations related to medical intervention. The aim of this paper is to present the main recommendations. [Copyright &y& Elsevier]

Abstract: Purpose: Although a recent increase in number of young radiation oncologists in training has been observed during the past decade, the general demographic evolution of radiation oncologists covers partially future needs. Material and method: During the seven past national annual courses, which were organised and supported by the Société française des jeunes radiothérapeutes oncologues (SFJRO), the Société française de radiothérapie oncologique (SFRO), the Collège national des enseignants de cancérologie (CNEC) and the Institut national du cancer (Inca), different types of surveys were realized in order to analyse demography, quality of training and motivations of French residents in radiation oncology. The latest results were collected during the last national course, which took place in March 2008. Seventy-five young French radiation oncologists (“internes des hopitaux” or residents) out of 110 participants who attended the national course and 75 questionnaires were analysed. Results: Since 2002, the total number of residents increased regularly (50, 75, 103 and 109 residents respectively in 2000, 2005, 2007 and 2008). Men and women are presently 48.5% and 51.5% respectively. Qualitative analysis of practical and theoretical training was performed using a visual analogical scale from zero to 10. Scores of 56 and 61 were respectively observed. Other descriptions of local training in the different universities (clinical skills, clinical cases analysis, bibliography session…) are described. Finally, analysis of the motivations for choosing the radiation oncology speciality demonstrates common interests in both medical practice and technical aspects in oncology. Innovation, technology, imaging and research are also widely mentioned. Sixteen residents will finish their training by the end of 2008, 42 are expected in 2009 and 27 in 2010. Almost all residents believe that a postgraduate position is necessary to complete their training as assistant professor (“chefs de clinique–assistants des hôpitaux”) in a university hospital or a cancer centre. Unfortunately, only 36 assistant professor positions are available in France, representing half of the need. Only 21 residents out of 104 already have a position as assistant professor. The availability of such a position remains undetermined for the rest of them. Conclusions: Despite the recent increase in the number of residents in radiation oncology in France, the need to create new assistant professor positions is crucial to assure quality of training for this both medical and technical speciality. Since 2002, the establishment of SFJRO has facilitated national links among residents, between residents and professors (CNEC), and between the French society (SFRO) and the European society (ESTRO). [Copyright &y& Elsevier]

We present the recommendations of the French society of oncological radiotherapy on the indications and techniques for external beam radiotherapy for bladder cancer. [ABSTRACT FROM AUTHOR]

Il est proposé une délinéation des volumes cibles anatomocliniques de la tumeur primitive dans les cancers du sinus maxillaire et des cavités nasales traités par irradiation postopératoire. Ce concept s'appuie sur la connaissance de la radioanatomie et celle de l'histoire naturelle des cancers. Il repose sur le recalage de la scanographie de planification avec les imageries préopératoires pour la remise en place du volume tumoral macroscopique préopératoire et l'utilisation du concept géométrique complété du concept anatomique pour la délinéation des volumes cibles anatomocliniques de la tumeur primitive. Cet article ne traite pas des indications de radiothérapie externe (ni des traitements systémiques concomitants) mais précise les volumes à traiter si une radiothérapie est retenue. In this article, we propose a consensus delineation of postoperative clinical target volumes for the primary tumour in maxillary sinus and nasal cavity cancers. These guidelines are developed based on radioanatomy and the natural history of those cancers. They require the fusion of the planning CT with preoperative imaging for accurate positioning of the initial GTV and the combined use of the geometric and anatomical concepts for the delineation of clinical target volume for the primary tumour. This article does not discuss the indications of external radiotherapy (nor concurrent systemic treatment) but focuses on target volumes when there is an indication for radiotherapy. [ABSTRACT FROM AUTHOR]

Head and neck carcinomas are initially metastatic in about 15% of cases. Radiotherapy is a cornerstone in the multimodal strategy at the locoregional phase. In patients with head and neck cancer, often heavily pretreated and with comorbidities, who relapse locoregionally or at distant sites, radiotherapy has also become increasingly important at the metastatic phase. Data on the optimal sequence of systemic treatments and metastasis-directed treatments including stereotactic irradiation are still lacking. Several randomized head and neck trials have been initiated that should provide important answers, including one recent GORTEC trial. [ABSTRACT FROM AUTHOR]

Abstract: 3-D conformal radiotherapy is based on accurate target volumes delineation. Radio-anatomy knowledge''s are useful but sometimes difficult to obtain. Moreover, the sources of recommandations for volume definition are disparate. We thus developed a free radio-anatomy website dedicated to volumes delineation for radiation-oncologists (www.siriade.org). This website is a search engine allowing to access to delineation characteristics of main tumours illustrated with clinical cases. It dœs not aim to provide guidelines. Its main purpose is to provide an iconographic training support with frequent updatings. We present the features of this website and one year connexion statistics. [Copyright &y& Elsevier]

La Société française des jeunes radiothérapeutes oncologues (SFjRO), le Syndicat national des radiothérapeutes oncologues (SNRO) et la Société française de radiothérapie oncologique (SFRO), s'investissent pour concilier opportunités de carrière et besoins démographiques oncologiques. En 2021, le Conseil national de l'ordre des médecins (CNOM) recensait 932 oncologues radiothérapeutes en activité régulière en France, soit une augmentation de plus de 20 % en dix ans. La répartition de ces effectifs évolue entre hôpitaux publics, centres libéraux et établissement de santé privé d'intérêt collectif (ESPIC) dont les centres de lutte contre le cancer (CLCC). Actuellement un tiers des oncologues radiothérapeutes exerce dans chacun de ces secteurs. À noter que 15 % des oncologues radiothérapeutes ont une activité mixte (publique et libérale). En 2021, la SFjRO a soumis un questionnaire ciblant 180 oncologues radiothérapeutes en formation en France. Il portait notamment sur l'accès aux stages de radiothérapie, la perception de l'encadrement lors de la formation, mais aussi sur les orientations professionnelles envisagées. La SFjRO, conjointement avec le SNRO et la SFRO a organisé au cours du congrès national de 2021, une session « Choix de carrière » afin de restituer les résultats de ce questionnaire. Plus de 70 % des oncologues radiothérapeutes en formation interrogés ont répondu au sondage. L'installation professionnelle était jugée difficile pour 55 % d'entre eux. Afin de répondre aux questions des oncologues radiothérapeutes en formation et permettre une discussion sur les carrières en radiothérapie, lors de cette session, trois oncologues radiothérapeutes seniors ont présenté leurs activités : en centre hospitalier public, en centre libéral ou avec une activité mixte. L'objectif de cet article est de rapporter les échanges lors du 32e Congrès de la SFRO, en reprenant les résultats du questionnaire soumis aux oncologues radiothérapeutes en formation et en synthétisant les principaux avantages et inconvénients de chaque mode d'exercice. The French Society of Young Radiation Oncologists (SFjRO), the National Union of Radiation Oncologists (SNRO) and the French Society of Oncological Radiotherapy (SFRO) aim to reconcile career opportunities and demographic needs in oncology. In 2021, 932 radiation oncologists (RO) are in regular activity in France, this represents an increase of more than 20% in ten years. Physician distribution is changing in public hospitals, cancer centers and private clinics. Currently one third of ROs works in each sector. In addition, fifteen percent of ROs have a mixed activity. In 2021, 180 young RO (trainees and residents) were questioned by SFjRO board about their training, internship, coaching and career guidance. An interactive communication was organized during the 32nd SFRO Meeting in 2021. It was an opportunity to bring the results of this study. More than 70% RO interviewed answered to the survey, for 55% among them, career choice was difficult. In order to help young ROs in their professional approach, three RO made an oral presentation during this session, about radiotherapy in public hospitals, private centers or with a mixed practice. The aim of this article is to summarize the highlights of the last SFjRO/SFRO session: expectations of young RO, career prospects and trends. [ABSTRACT FROM AUTHOR]

Résumé Les effets de la dose sur les principales structures orbito-oculopalpébrales (nerf optique, rétine, glande lacrymale principale, cristallin) sont encore décrits très globalement sans analyse des relations dose–volume du fait du volume réduit de la plupart des structures impliquées et des limitations balistiques des techniques d’irradiation. La capacité de techniques de radiothérapie conformationnelle avec modulation d’intensité et de protonthérapie à générer des gradients de dose très abrupts permet d’envisager dans l’avenir des modèles plus précis. La toxicité peut être sévère et irréversible, induisant une perte de vision, comme dans le cas de la neuropathie optique radio-induite, pour laquelle les traitements à visée curative sont peu ou pas efficaces. La toxicité peut aussi induire une perte de vision mais être réversible sans complication, comme dans le cas d’une cataracte radique. Nous résumons dans cet article les effets dose décrits pour les principales structures-oculaires, orbitaires, palpébrales et lacrymales. Radiation-induced damage of ocular, orbital and eyelid structures are mainly reported for the optic nerve, retina, lens and lacrimal gland. Dose–volume relationships are, however, inaccurate due to the small volume of most of the organs at risk involved and limited ability of irradiation techniques to spare these structures in the pre-IMRT (intensity-modulated radiation therapy) era. The ability of newest radiation techniques including IMRT and proton therapy to generate steep dose gradients may yield more accurate models in the future. Some toxicities are severe and irreversible, leading to vision loss, as in the case of radiation-induced optic neuropathy for which curative treatments are suboptimal. Other toxicities can lead to reversible vision loss but can be surgically corrected, as is the case for radiation-induced cataract. In this paper, we will review the dose effects for the ocular; orbital and eyelid structures. [ABSTRACT FROM AUTHOR]

Grâce aux succès des inhibiteurs de checkpoint , l'immunothérapie occupe désormais une place majeure dans la prise en charge d'un grand nombre de tumeurs solides, tandis que le nombre des indications continue de croître et que de nouvelles combinaisons pourraient, dans un avenir proche, modifier encore les standards de traitement. Cependant, les taux de réponse des immunothérapies en monothérapie sont modestes et leur utilisation s'envisage de plus en plus au sein de combinaisons avec d'autres traitements anticancéreux (chimiothérapies, chirurgie, radiothérapie ou certaines thérapies ciblées). Les combinaisons avec la radiothérapie semblent particulièrement attractives car il existe un fort rationnel expérimental qui lie une partie de l'efficacité des rayonnements ionisants à une stimulation induite sur le système immunitaire (réponse innée et adaptative). De nombreux essais de phase précoce et un certain nombre de grands essais randomisés de combinaison ont donné des résultats d'efficacité et de tolérance, tandis que des essais importants sont encore en cours et apporteront des réponses dans un avenir proche. Cette revue rapide rappelle le rationnel biologique expérimental de l'immuno-radiothérapie et présente certains axes fondamentaux en cours d'exploration, puis présente les résultats cliniques d'efficacité et de tolérance disponibles à ce jour, ceux qui sont attendus prochainement, et enfin esquisse un tableau des perspectives dans ce domaine en évolution rapide. Thanks to the success of checkpoint inhibitors, immunotherapy now plays a major role in the management of a large number of solid tumors, while the number of indications continues to grow and new combinations could, in the near future, further modify treatment standards. However, the response rates of immunotherapies as monotherapy are modest and their use is increasingly considered in combination with other cancer treatments (chemotherapy, surgery, radiotherapy or certain targeted therapies). Combinations with radiotherapy seem particularly attractive because there is a strong experimental rationale linking part of the efficacy of ionizing radiation to an induced stimulation of both of the innate and adaptive response. Many early phases and a number of large randomized combination trials have published efficacy and safety results, while important trials are still ongoing and will provide answers in the near future. This short review recalls the experimental biological rationale for immuno-radiotherapy and highlights some of the fundamental directions being explored, then presents the clinical efficacy and safety results available to date, those expected in the near future, and finally outlines the outlook in this rapidly evolving field. [ABSTRACT FROM AUTHOR]

L'incidence des cancers oropharyngés liés au papillomavirus augmente dans les pays occidentaux depuis plusieurs décennies. S'ils sont individualisés au sein de la dernière classification TNM, les standards actuels de prise en charge n'autorisent pas à singulariser la prise en charge de ces patients. Cependant, leur oncogenèse distincte et leur pronostic très favorable a permis le développement de plusieurs essais cliniques centrés sur la question de la désescalade thérapeutique. Cette revue de la littérature a pour objectif de faire le point sur les éléments apportés par la recherche clinique ces dernières années. The incidence of HPV-related oropharyngeal cancers has been increasing in Western countries for several decades. If they are individualized within the latest TNM classification, the current standards of management do not authorize the management of these patients to be singled out. However, their distinct oncogenesis and their excellent prognosis compared to other patients has allowed the development of several clinical trials based on the question of therapeutic de-escalation. This review of the literature aims to take stock of the elements provided by clinical research in recent years. [ABSTRACT FROM AUTHOR]

Radiotherapy for locally advanced head and neck cancer classically include large prophylactic node volume. However, the use of these large volumes can be responsible for significant toxicity. Furthermore, the disappointing results of radioimmunotherapy combinations in head and neck tumors raise concerns about radiotherapy's potential negative impact on the immune response when large lymph node volumes are treated. Besides, in other tumor locations, such as lung cancers, the volumes of elective irradiation have been considerably reduced, with the same local control as before. This opinion piece reviews the current state of radiation volumes in head and neck cancers, the rationale for these volumes, the potential impact of radiotherapy on immune response, and the volume changes that would improve the efficacy of radioimmunotherapy combinations. [ABSTRACT FROM AUTHOR]

Résumé Objectif de l’étude L’implémentation de la radiothérapie conformationnelle avec modulation d’intensité (RCMI) dans un centre nécessite régulièrement une revue critique des pratiques médicales et un retour d’expérience afin d’optimiser la prise en charge ultérieure des patients. Patients et méthodes Nous avons déterminé à partir d’une étude monocentrique rétrospective les sites de récidives chez 167 patients consécutifs pris en charge pour un carcinome épidermoïde des voies aérodigestives supérieures en excluant les tumeurs primitives cutanées ou des sinus. La majorité des patients était atteinte d’un cancer localement évolué de stade III ou IV ( n = 123). Résultats Les taux de contrôle locorégional à 1 et 2 ans étaient respectivement de 87,9 % (intervalle de confiance à 95 % [IC95 %] : 81,6 %–92,1 %) et 77,6 % (IC95 % : 70,1 %–83,5 %). Parmi les 55 cancers en rechute, 20 étaient en poursuite évolutive. Les cancers traités à la dose de 70 Gy ont majoritairement rechuté dans le volume à haut risque (78 %), ceux traités avec une dose de 66 Gy soit régionalement en dehors du volume irradié ( n = 4), soit dans le volume irradié à haut risque ( n = 3), soit sous la forme d’une évolution métastatique isolée ( n = 3), ceux irradiés à la dose de 50 Gy régionalement en dehors du volume irradié ( n = 2) ou sous la forme d’une évolution métastatique isolée ( n = 2). Des rechutes isolées ont été observées localement chez 10,2 % des patients et dans les ganglions cervicaux chez 4,2 %. Une évolution métastatique isolée a été notée chez 5,4 % des patients. Conclusion Nos résultats sont en accord avec les données de la littérature. Certaines actions correctrices ont été engagées pour améliorer nos pratiques. Purpose The implementation of intensity-modulated radiotherapy (IMRT) in a centre requires regular critical review of medical practices and feedback to optimize the subsequent management of patients. Patients and methods We reviewed and determined through a retrospective single-centre study recurrence sites of 167 consecutive patients treated for head and neck squamous cell carcinoma excluding skin or sinuses. Patients had mostly stage III or IV locally advanced cancer ( n = 123). Results Locoregional control rates at 1 and 2 years were respectively 87.9% (95% confidence interval [95%CI]: 81.6%–92.1%) and 77.6% (95%CI: 70.1%–83.5). Among 55 relapses, 20 patients (36.4%) had treatment failures. Patients treated with 70 Gy relapsed mainly in high risk volume (78%). Those treated with 66 Gy recurred regionally outside the irradiated volume ( n = 4) or in the irradiated high risk volume ( n = 3) or had isolated metastatic failure ( n = 3). Those irradiated with 50 Gy had regional relapse outside the irradiated volume ( n = 2) or isolated metastatic relapse ( n = 2). We noticed respectively 5.4%, 10.2% and 4.2% isolated metastatic, local, cervical lymph node relapse. Conclusion Our results are consistent with data from the literature. Corrective actions were performed to enhance our practices. [ABSTRACT FROM AUTHOR]

We present the update of the recommendations of the French society of radiotherapy and oncology on the indications and the technical methods of carrying out radiotherapy of sinonasal cancers. Sinonasal cancers (nasal fossae and sinus) account for 3 to 5% of all cancers of the head and neck. They include carcinomas, mucosal melanomas, sarcomas and lymphomas. The management of sinonasal cancers is multidisciplinary but less standardized than that of squamous cell carcinomas of the upper aerodigestive tract. As such, patients with sinonasal tumors can benefit from the expertise of the French expertise network for rare ENT cancers (Refcor). Knowledge of sinonasal tumour characteristics (histology, grade, risk of lymph node involvement, molecular characterization, type of surgery) is critical to the determination of target volumes. An update of multidisciplinary indications and recommendations for radiotherapy in terms of techniques, target volumes and radiotherapy fractionation of the French society of radiotherapy and oncology (SFRO) was reported in this manuscript. [ABSTRACT FROM AUTHOR]

Radiotherapy alone or in association with systemic treatment plays a major role in the treatment of head and neck tumours, either as a primary treatment or as a postoperative modality. The management of these tumours is multidisciplinary, requiring particular care at every treatment step. We present the update of the recommendations of the French Society of Radiation Oncology on the radiotherapy of head and neck tumours from the imaging work-up needed for optimal selection of treatment volume, to optimization of the dose distribution and delivery. [ABSTRACT FROM AUTHOR]

Il est proposé une délinéation des volumes cibles anatomo-liniques de la tumeur primitive (CTV-P) dans les cancers de l'ethmoïde traités par irradiation postpératoire. Ce concept s'appuie sur la connaissance de la radioanatomie et celle de l'histoire naturelle des cancers. Il repose sur le recalage de la scanographie de planification avec les imageries préopératoires pour la remise en place du volume tumoral macroscopique (GTV) initial et la création de marge autour de celui-ci étendue aux zones risques microscopiques selon le concept anatomique. Cet article ne traite pas des indications de radiothérapie externe mais précise les volumes à traiter si une radiothérapie est retenue. It is proposed to delineate the anatomo-clinical target volumes of primary tumor (CTV-P) in ethmoid cancers treated with post-operative radiotherapy. This concept is based on the use of radioanatomy and the natural history of cancer. It is supported by the repositioning of the planning scanner with preoperative imaging for the replacement of the initial GTV and the creation of margins around it extended to the microscopic risk zones according to the anatomical concept. This article does not discuss the indications of external radiotherapy but specifies the volumes to be delineated if radiotherapy is considered. [ABSTRACT FROM AUTHOR]

Résumé Objectif de l'étude Pour faciliter la formation à la délinéation, la Société française de radiothérapie oncologique (SFRO) et l'association de formation continue en oncologie radiothérapie (Afcor) ont créé en 2008 un site Internet de radioanatomie et d'aide à la délinéation. Matériel et méthodes Entre 2015 et 2017, une mise à jour du site a été entreprise, nécessitant la mise en place de deux parties : des cours théoriques d'une part, et des ateliers de délinéation en ligne d'autre part. Résultats Un nouveau site exploitant l'ensemble des nouvelles technologies numériques a été mis en ligne. Les cours ont été réalisés sous forme de vidéos commentées et consultables à tout moment. La partie pratique offre une interface de délinéation en ligne qui génère à la fin de l'exercice un rapport permettant de quantifier la qualité de sa délinéation. Conclusion Siriade 2.0 est un outil numérique innovant qui s'inscrit en complément des formations initiales et continues déjà disponibles. Abstract Purpose In 2008, the French national society of radiation oncology (SFRO) and the association for radiation oncology continued education (AFCOR) created Siriade, an e-learning website dedicated to contouring. Material and methods Between 2015 and 2017, this platform was updated using the latest digital online tools available. Two main sections were needed: a theoretical part and another section of online workshops. Results Teaching courses are available as online commented videos, available on demand. The practical section of the website is an online contouring workshop that automatically generates a report quantifying the quality of the user's delineation compared with the experts'. Conclusion Siriade 2.0 is an innovating digital tool for radiation oncology initial and continuous education. [ABSTRACT FROM AUTHOR]

Purpose To search for factors correlated with relapse-free survival following stereotactic reirradiation in patients with recurrent glioma following radiochemotherapy and evaluate tolerance to this treatment. Patients and methods Initial radiotherapy was given according to the protocol of Stupp and al. Reirradiation was performed using the CyberKnife ® system. Patients could have had surgical resection initially and at the time of recurrence. We analysed 13 patients treated between July 2010 and September 2014. The median age was 55 years. The doses delivered ranged from 20 to 36 Gy, in one to ten fractions. Results Median survival after stereotactic radiotherapy was 14 months. Survival without relapse was 3.7 months. Factors significantly influencing duration of relapse-free survival were: age ( P = 0.04), total dose ( P = 0.02), dose per fraction ( P = 0.04) and number of fractions ( P = 0.01). We found no correlation between gross tumour volume, clinical target volume, grade of tumour or prescription isodose and relapse-free survival following radiochemotherapy. Three patients developed radionecrosis. Conclusion Reirradiation under stereotactic conditions is well tolerated. A dose of more than 30 Gy delivered in 5 or more fractions seems to prolong relapse-free survival. [ABSTRACT FROM AUTHOR]

Résumé Cet article passe en revue les grands principes thérapeutiques en matière d’irradiation des cancers de la tête et du cou. La radiothérapie avec modulation d’intensité (RCMI), associée à une chimiothérapie par cisplatine est désormais le standard en situation exclusive hors préservation laryngée. Le cétuximab doit être privilégié en cas de contre-indications aux sels de platine tandis que l’hyperfractionnement peut être évoqué en cas de contre-indication à un traitement concomitant. En situation postopératoire, une chimiothérapie par cisplatine est proposée en cas d’effractions capsulaires et d’atteinte des tranches de section, et peut également être discutée en cas de facteurs d’agressivité histologique. Plusieurs études de désescalade thérapeutique en cas d’infection par les papillomavirus sont en cours. La radiothérapie adaptative, l’immunothérapie, ainsi que l’imagerie pour guider la thérapeutique représentent également des domaines de recherche qui aboutiront certainement à des modifications de prise en charge dans les années à venir. Therapeutic principles of radiation therapy in head and neck carcinomas will be discussed in this review. Intensity-modulated radiotherapy with concomitant cisplatin should be standard. In case of contraindication to chemotherapy, cetuximab is an option, while hyperfractionation should be considered in patients unfit for concomitant treatment. Concomitant chemotherapy should be administered in the presence of extracapsular extensions and positive margins in the postoperative setting. Current research areas such as desescalation in human papillomavirus-positive tumours, adaptive radiotherapy, radiomics and immunotherapy will also be addressed. [ABSTRACT FROM AUTHOR]

Résumé Les tumeurs nasosinusiennes sont rares (10 % des tumeurs de la tête et du cou) et sont principalement représentées par les carcinomes épidermoïdes des fosses nasales ou du sinus maxillaire et les adénocarcinomes de l’ethmoïde (maladie professionnelle, poussière de bois). Le signe clinique le plus fréquent est l’obstruction nasale, mais on peut aussi retrouver une rhinorrhée et/ou une épistaxis (signes à présentation le plus souvent unilatérale). Une imagerie par résonance magnétique du massif facial est systématique dans le bilan initial avant traitement. La prise en charge consiste en une chirurgie première si le patient est opérable et la tumeur résécable. Si ce n’est pas le cas, le traitement consiste en une radiothérapie associée à une chimiothérapie, en fonction des données initiales (stade T3/T4 ou atteinte ganglionnaire). Après chirurgie première, une radiothérapie est indiquée (sauf si stade T1N0 avec résection complète), associée à une chimiothérapie en fonction des données postopératoires (rupture capsulaire ou résection incomplète). Une irradiation ganglionnaire est à discuter au cas par cas, mais est indiquée devant tout envahissement ganglionnaire. La radiothérapie doit être délivrée avec modulation d’intensité (RCMI), statique ou dynamique, et guidée par l’imagerie (IGRT). Selon le rapport 83 de l’International Commission on Radiation Units and Measurements (ICRU), les doses reçues par les organes à risque et les volumes cibles doivent être rapportées. Enfin, après une imagerie de référence post-thérapeutique entre 2 et 4 mois, le suivi est alterné avec le chirurgien ORL tous les 2 à 3 mois pendant 2 ans, puis tous les 4 à 6 mois pour 5 ans au minimum. The nasal cavity and parasinusal cancer are rare (10% of tumors of the head and neck) and are mainly represented by squamous cell carcinoma of the nasal cavity or the maxillary sinus and adenocarcinoma of the ethmoid sinus (occupational disease, wood dust). The most common clinical sign is nasal obstruction, but tumors can also manifest as rhinorrhea and/or epistaxis (usually unilateral signs). A magnetic resonance imaging of the facial structure is systematic for staging before treatment. The treatment consists of a first surgery if the patient is operable with a resectable tumor. If it is not the case, the treatment consists of radiotherapy (RT) associated with chemotherapy (CT) according to the initial data (T3/T4 or N+). After first surgery, RT is indicated (except T1N0 with complete resection) associated with a CT based on postoperative data (capsular effraction or incomplete resection). Lymph node irradiation is considered case by case, but is indicated in any nodal involvement. RT must be an intensity modulated RT (IMRT), static or dynamic, and must be imagery guided (IGRT). According to ICRU 83, doses to organs at risk and target volumes must be carried. Finally, after a post-treatment baseline imaging between 2 and 4 months, monitoring will be alternated with the ENT surgeon every 2 or 3 months for 2 years, then every 4 to 6 months for 5 years. [ABSTRACT FROM AUTHOR]

Résumé Les troubles fonctionnels chroniques affectant le pharyngolarynx ont émergé parmi les effets secondaires radio-induits impactant la qualité de vie des patients atteints de cancer de la sphère ORL survivant à long terme. Plusieurs structures anatomiques impliquées dans le fonctionnement complexe de cette région ont été identifiées. Une limitation de la dose délivrée sur ces structures pourrait contribuer à réduire les risques d’œdème laryngé, de dysphonie et surtout de dysphagie. Quelques recommandations dosimétriques peuvent être émises, comme maintenir la dose moyenne aux constricteurs du pharynx en dessous de 50 à 55 Gy, la dose moyenne délivrée au larynx sus-glottique en dessous de 40 à 45 Gy et si possible la dose moyenne délivrée au larynx glottique en dessous de 20 Gy. Une épargne des muscles du plancher de la bouche et de l’œsophage cervical serait également bénéfique. Néanmoins, la qualité des données bibliographiques ne permet pas de considérer de telles recommandations comme suffisantes. Il est préconisé de retenir une philosophie d’épargne maximale des structures suscitées, la qualité de couverture des volumes cibles tumoraux restant prioritaire. Radio-induced pharyngolaryngeal chronic disorders may challenge the quality of life of head and neck cancer long survivors. Many anatomic structures have been identified as potentially impaired by irradiation and responsible for laryngeal edema, dysphonia and dysphagia. Some dose constraints might be plausible such as keeping the mean dose to the pharyngeal constrictor muscles under 50 to 55 Gy, the mean dose to the supra-glottic larynx under 40 to 45 Gy and, if feasible, the mean dose to the glottic larynx under 20 Gy. A reduction of the dose delivered to the muscles of the floor of the mouth and the cervical esophagus would be beneficial as well. Nevertheless, the publications available do not provide an extensive enough level of proof. One should consider limiting as low as possible the dose delivered to these structures without compromising the quality of irradiation of the target tumor volumes. [ABSTRACT FROM AUTHOR]

Abstract: Acute radiation dermatitis remains one of the most commonly observed side effect during radiation therapy leading to complication such as superinfection or treatment disruption. Its management is characterized by a great heterogeneity. Few strategies have demonstrated a benefit in preventing radiation dermatitis, which relies mostly on decreasing dose delivered to the skin and skin care practices. Simple emollients and use of topical steroids can be useful in early stages. The singularity of the skin toxicity seen with cetuximab and radiotherapy warrants a specific grading system and distinctive clinical treatment with use of antibiotics. [Copyright &y& Elsevier]

Abstract: For the second year, the French Radiotherapy Database presents information from French radiation oncology centers. Among 179 centers, 159 have participated (90 %). The number of accelerators increased from 371 to 384 between 2006 and 2007, 11 % of these machines are more than 15 years old. On average, centers are open 50hours per week for treatment and 9.5 % more for maintenance. The lack of dedicated CT remains a difficulty: 158 from 159 centers have an access to a CT, but only 50 % have a dedicated scanner. There is no progress compared to 2006. The proportion of centers having a MU double calculation system has increased from 51 to 58 %. Two thirds of centers do not implement in vivo dosimetry. The activity is stable around 190 000 treatments per year. Three-dimension conformal radiotherapy is used for more than half of treatments in 77.2 % of private centers and 50 % of public hospitals. Intensity modulated radiotherapy remains rarely used. The number of radiation oncologists and technologists remains stable. The number of radiophysicists has increased from 7.6 %. Despite some progress, the difficulties of this speciality persist in France and are equally distributed across all regions, and between private and public centers. In 2009, the French Society for Radiation Oncology and the associated partners will continue this survey, which interest is recognized by both professionals and health administrations. [Copyright &y& Elsevier]

Résumé Les indications, doses, techniques de radiothérapie, association à une chimiothérapie concomitante des cancers de l’oropharynx sont présentées. Les recommandations de délinéation des volumes cibles et organes à risques sont détaillés. Indication, doses, technique of radiotherapy and concomitant chemotherapy for oropharynx carcinoma are presented. The recommendations for delineation of the target volumes and organs at risk are detailed. [ABSTRACT FROM AUTHOR]