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For head and neck cancers, the radiation dose usually needed to sterilize a macroscopic tumour is at least 70 Gy in conventional fractionation. In the larynx, this dose level enables optimal tumour control while exposing the patient to a limited risk of severe complications. For oropharynx and nasopharynx tumors, it is sometimes possible to limit the dose received by the larynx according to the extent of the primary lesion. Thus, if the tumour constraints permit, the maximum dose to the larynx must be less than 63 to 66 Gy. To reduce the risk of laryngeal edema, it is recommended if possible to limit the mean non-involved larynx dose to 40 to 45 Gy. In the pharynx, literature's data suggested to minimize the volume of the pharyngeal constrictor muscles receiving a dose greater than or equal to 60 Gy. Limiting the volume receiving a dose greater than or equal to 50 Gy reduces the risk of dysphagia. These dose constraints should be tailored to each patient taking into account the extent of the initial primary lesion, the possible addition of chemotherapy or a modified fractionation radiotherapy., (Copyright (c) 2010 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

The management of the documentation is one of the key points regarding the efficacy and the performance of the quality management of health centres. It offers to all professionals the possibility to be informed on the procedures in use, leading to a pool of documents for improvement of organisations and for securing the critical steps of the patient management. In this paper, we will describe the optimal organisation of the documentation according to Haute autorité de santé (HAS) and ISO recommendations, then we will discuss in concrete terms the potential methods usable for the production of a tool well adapted to our routine practice, in order to achieve the objectives for security.

Purpose of Review: This article provides an overview of randomized studies of altered fractionated radiotherapy (RT) in Head and Neck squamous cell carcinoma., Recent Findings: Both hyperfractionated RT and accelerated RT may improve tumor control probability as compared to conventional RT, along with increased but manageable toxicity and a modest improvement in survival., Summary: Altered RT is a tool that can improve the results obtained with conventional RT in Head and squamous cell carcinoma.

Purpose: To prospectively assess 5-year late toxicity in patients treated by concomitant radiochemotherapy for locally advanced oropharynx carcinoma using three different toxicity scales., Methods and Materials: A total of 226 patients were entered in a Phase III multicenter, randomized trial comparing radiotherapy alone (70 Gy in 35 fractions: Arm A) with concomitant radiochemotherapy (70 Gy in 35 fractions with three cycles of a 4-day regimen containing carboplatin and 5-fluorouracil: Arm B). Five living patients, free of local or distant recurrences, could not be evaluated for late toxicity. Forty-four patients were eligible for late toxicity with a median follow-up of 5 years. Late toxicity was evaluated by the radiation oncologist using a large questionnaire containing 120 mixed items of three scales (NCI-CTC, LENT/SOMA, and RTOG). The data were then transposed on separate scales using corresponding grades., Results: The 5-year overall survival rate was 22% in Arm B and 16% in Arm A (p = 0.05). The 5-year locoregional control rate was 48% in Arm B and 25% in Arm A (p = 0.002). The spinal cord was not affected by the concomitant adjunct of chemotherapy, and no deaths were caused by late toxicity. Using the three late toxicity scales, 100% of the patients treated with the combined modality (Arm B) developed one or more late complications vs. 94% in the radiotherapy-alone arm (Arm A). The difference was not statistically significant. The most commonly damaged organs (all Grade 1-4) were the salivary glands (100% in Arm B vs. 82% in Arm A, p <0.05), skin (78% vs. 47%, p <0.05), teeth (67% vs. 18%, p <0.05), mucosa (59% vs. 63% p = not significant), and mandible (44% vs. 12%, p <0.05). One or more Grade 3-4 complications occurred in 82% of the patients in Arm B vs. 47% in Arm A (p = 0.02) but concerned only the teeth. The correlation between the RTOG and LENT/SOMA scale and between the NCI-CTC and LENT/SOMA scale were low for Grade 1-4 toxicity (near 30%). The transposability of a patient's symptoms was significantly greater using the LENT/SOMA or RTOG/EORTC scaling systems than using the NCI-CTC system., Conclusion: Concomitant radiochemotherapy increased overall survival and locoregional control rates. The difference between the two treatment groups for Grade 3-4 complications was only significant for the teeth. The late toxicity assessment of a treatment may depend on the toxicity scale used. The LENT/SOMA scale seems to be the most accurate scale, but most of the score results were not concordant with those obtained with other scales. The results of this study confirm the necessity of using a common late toxicity scale in clinical trials.

Radiation therapy is one of the most effective treatment for cancer patients. Many developments in radiotherapy have resulted from new technologies or have been made empirically by clinicians. Radiobiology, which provides a conceptual basis for radiotherapy, identifying mechanisms and processes that underlie the response of tumors and normal tissues to irradiation, is the best research way to enhance the therapeutic index of radiation therapy. Raising the standards of radiation dose using multiple fractions per day, treating patients with accelerated radiotherapy to reduce the effect of tumor-cell repopulation during treatment, overcoming hypoxic cell radioresistance, using biological response modifiers, combining radiation and chemotherapy are principal ways to enhance radiation results. Some of them are now in the clinical practice, other are still under evaluation.

To determine the prognostic significance of local relapse after conservative treatment of an invasive carcinoma of the breast, we analysed the results obtained in a series of 512 patients. All patients had a lumpectomy with axillary dissection followed by irradiation. Adjuvant medical treatment was administered to 168 patients. The actuarial 5 years and 10 years overall survival rates were respectively 92.5% and 79.7%. Local relapses occurred in 35 patients (6.8%). The actuarial 5 and 10 years local control rates were respectively 91.2% and 83.6%. In these patients, risk of metastasis was significantly increased as compared with patients without a local relapse. Recurrence in the breast within 2 years of initial treatment several affected the risk of metastasis occurring as compared to later relapses. We conclude that the occurrence of a breast relapse after successful local conservative treatment is a bad prognostic factor, predictive of a high risk for the development of distant metastases.

We are reporting a localised skin angiosarcoma of the breast. As far as we can tell this is only the fourth time this condition has been published. The tumour appeared 6 years after a conservative lumpectomy with removal of lymphatics and follow-up radiotherapy had been carried out for an adenocarcinoma of the breast. This tumour was characterised by the presence of several round blue-coloured nodules in the skin with some inflammation surrounding them. The glandular tissue underneath was normal, as was the opposite breast, and there was no spread. The patient was pyrexial and a syndrome of inflammation persisted until the tumour had been removed by a simple mastectomy. We have discussed the clinical and histological aspects of this case and compared them with those found in the literature. Differential diagnosis with in particular Stewart-Treves syndrome has been emphasized. The treatment consists in wide excision and sometimes followed by radiotherapy or chemotherapy. The prognosis is very poor, survival never having been more than 22 months. Finally the role of irradiation in the causation of this tumour has been discussed. (Our patient is alive after 2 years without any sign of a recurrence).

Background and purposeThe Meta-Analysis of Chemotherapy in squamous cell Head and Neck Cancer (MACH-NC) demonstrated that concomitant chemotherapy (CT) improved overall survival (OS) in patients without distant metastasis. We report the updated results.Materials and methodsPublished or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT + CT or adding another timing of CT to LRT + CT (main question), or comparing induction CT + radiotherapy to radiotherapy + concomitant (or alternating) CT (secondary question) were eligible. Individual patient data were collected and combined using a fixed-effect model. OS was the main endpoint.ResultsFor the main question, 101 trials (18951 patients, median follow-up of 6.5 years) were analyzed. For both questions, there were 16 new (2767 patients) and 11 updated trials. Around 90% of the patients had stage III or IV disease. Interaction between treatment effect on OS and the timing of CT was significant (p

Yoann Pointreau,1 Rene-Jean Bensadoun,2 Guillaume Bera,3 Christian Sire,3 Amandine Ruffier,4 Guillaume Janoray,4,5 Gilles Calais,4 Marc Bollet,6 Baptiste Pinel,7 Viorica Braniste,8 Xavier Amores8 1Radiotherapy Department, Interregional Cancer Institute (ILC) - Jean Bernard Center, Le Mans, France; 2Radiotherapy Department, High Energy Center, Nice, France; 3Oncology and Radiotherapy Department, Southern Brittany Hospital Group, Lorient, France; 4Oncology and Radiotherapy Department, University Hospital of Tours, Tours, France; 5Oncology and Radiotherapy Department, François Rabelais University, EA 7505, Education Ethique Santé (EES), Tours, France; 6Radiotherapy Department, Hartmann Clinic, Neuilly-sur-Seine, France; 7Oncology and Radiotherapy Department, University Hospital of Poitiers, Poitiers, France; 8Kyowa Kirin Pharma, Neuilly-sur-Seine, FranceCorrespondence: Yoann Pointreau Email y.pointreau@cjb72.orgObjective: The severity of breakthrough cancer pain (BTcP) impacts patients’ quality of life, increases the risk of anxiety and depression, lowers functional capacities, and may lead to poor compliance with cancer treatments. The aim of the current study was to assess, in a real-life setting, patient satisfaction with a fentanyl-pectin-nasal-spray (FPNS) for BTcP management in head and neck (H&N) cancer patients treated by radiotherapy.Materials and Methods: This non-interventional, prospective study was conducted in 92 adult H&N-cancer patients undergoing radiotherapy and who started FPNS treatment for BTcP. Throughout the radiotherapy period, the patients completed self-diaries to assess their BTcP episodes, FPNS use, satisfaction on FPNS efficiency (primary outcome), tolerability and ease of use.Results: Prior to FPNS treatment, 86% of the patients were experiencing ≤ 4 BTcP episodes/day. During the radiotherapy period, the BTcP episodes were treated with a median dose of 100μg of FPNS. Patients were “satisfied/very-satisfied” with the efficiency (73% of assessments), ease of use (87% of assessments) and tolerability (87% of assessments) of FPNS. In total, 27% of patients reported at least one adverse event related to FPNS and 4% of patients discontinued treatment due to adverse events. None of the adverse events were serious. Patient quality of life was maintained throughout the radiotherapy period.Conclusion: This study showed, in a real-life setting, that a clear majority of H&N cancer patients treated with FPNS for BTcP throughout radiotherapy expressed satisfaction with this analgesic treatment.Keywords: patient satisfaction, fentanyl nasal spray, breakthrough pain, radiotherapy, head and neck cancer

Abstract: Larynx preservation in advanced pharyngolaryngeal cancers has been a major challenge in clinical research over the past two decades. Subtotal surgery (endoscopic laser surgery, supracricoid partial laryngectomies and hemilaryngopharyngectomies) has allowed reducing the indications of the so-called “mutilating” surgery. On the other hand, the modification of fractionation has notably improved the results of definitive irradiation (but most probably for supraglottic tumors). The main clinical research has been carried out with either sequential or concurrent chemo-irradiation. Induction chemotherapy followed by irradiation in good responders or by surgery in poor responders allowed to preserve the larynx in around half the cases without deleterious impact on overall survival. Concurrent chemo-irradiation trials suggested that the larynx preservation rates could be increased but overall survival remained unchanged and mucositis was a notable side effect. The next step could be the combination of induction chemotherapy followed by concurrent chemo-irradiation in good responders. Finally, the place of new drugs (taxanes, targeted therapies) is to be explored in this context. [Copyright &y& Elsevier]

In breast cancer, radiation therapy improves local control rate and survival. When chemotherapy and radiation are indicated the sequencing of the two treatments is still controversial. Several studies have suggested that adjuvant radiotherapy could be safely delayed until adjuvant chemotherapy was completed. Other studies, most of them retrospective, pointed out that a delay in the initiation of radiotherapy to give chemotherapy first, will result in a increased rate of local recurrence. Concomitant administration of the two treatments is an alternative. Pilot studies have suggested the feasibility of simultaneous administration using selected regimen as CMF or FNC. A randomized phase III trial has been conducted to compare sequential treatment with chemotherapy first and radiation versus concomitant treatments. Preliminary results of this study are presented. [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]

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]

Abstract: Background: Two phase III trials of neoadjuvant treatment in T3-4 rectal cancer established that adding chemotherapy (CRT) to radiotherapy (RT) improves pathological complete response (pCR) and local control (LC). We combined trials to assess the clinical benefit of CRT on overall (OS) and progression free survival (PFS) and to explore the surrogacy of pCR and LC. Patients and methods: Individual patient data from European Organisation for Research and Treatment of Cancer (EORTC) 22921 (1011 patients) and FFCD 9203 (756 patients) were pooled. Meta-analysis methodology was used to compare neoadjuvant CRT to RT for OS, PFS LC and distant progression (DP). Weighted linear regression was used to estimate trial-level association (surrogacy R 2) between treatment effects on candidate surrogate (pCR, LC, DP) and OS. Results: The median follow-up was 5.6years. Compared to RT (881pts), CRT (886pts) did not prolong OS, DP or PFS. The 5-y OS-rate was 66.3% with CRT versus 65.9% in RT (hazard ratios (HR)=1.04 {0.88–1.21}). CRT significantly improved LC (HR=0.54, 95%confidence interval (CI): 0.41–0.72). PFS was validated as surrogate for OS with R 2 =0.88. Neoadjuvant treatment effects on LC (R 2 =0.17) or DP (R 2 =0.31) did not predict effects on OS. Conclusion: Preoperative CRT does not prolong OS or PFS. pCR or LC do not qualify as surrogate for PFS or OS while PFS is surrogate. Phase III trials should use OS or PFS as primary endpoint. [Copyright &y& Elsevier]

Abstract: Purpose: In 1996, a multicenter randomized study comparing after breast-conservative surgery, sequential vs concurrent adjuvant chemotherapy (CT) with radiation therapy (RT) was initiated (ARCOSEIN study). Seven hundred sixteen patients were included in this trial. After a median follow-up of 6.7 (4.3–9) years, we decided to prospectively evaluate the late effects of these two strategies. Patients and methods: A total of 297 patients were asked to follow-up from the five larger including institutions. Seventy-two percent (214 patients) were eligible for late toxicity. After breast-conserving surgery with axillary dissection, patients were treated either with sequential treatment with CT first followed by RT (arm A) or CT administered concurrently with RT (arm B). In all patients, CT regimen combined mitoxantrone (12 mg/m2), 5-FU (500 mg/m2), and cyclophosphamide (500 mg/m2), 6 cycles (day 1-day 21). In arm B, patients received concurrently the first 3 cycles of CT with RT. In arm A, RT started 3 to 5 weeks after the 6th cycle of CT. Conventional RT was delivered to the whole breast using a 2 Gy-fraction protocol to a total dose of 50 Gy (±boost to the primary tumour bed). The assessment of toxicity was blinded to treatment and was graded by the radiation oncologist according to the LENT–SOMA scale. Skin pigmentation was also evaluated using a personal 5-points scoring system (excellent, good, moderate, poor, very poor). Results: Among the 214 evaluated patients, 107 were treated in each arm. The two populations were homogeneous for patients'', tumors'' and treatment characteristics. Subcutaneous fibrosis (SF), telengectasia (T), skin pigmentation (SP), and breast atrophy (BA) were significantly increased in arm B. Twenty patients experienced grade superior or equal to 2 (SF) in arm B vs five in arm A (P =0.003). Twenty-five and seven patients showed grade superior or equal to 2 (T) in arm B and A, respectively (P =0.001). Forty-four and twenty patients showed grade superior or equal to 2 (BA) in arm B and A, respectively (P =0.0006). Thirty patients experienced grade superior or equal to 3 (SP) in arm B vs fifteen in arm A (P =0.02). No statistical difference was observed between the two arms concerning grade superior or equal to 2 pain, breast oedema, and lymphoedema. No deaths were caused by late toxicity. Conclusion: Following breast conserving surgery, the concurrent use of CT with RT is significantly associated with an increase incidence of grade 2 or greater late side effects. [Copyright &y& Elsevier]