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Purpose of Review: Radiation therapy plays a key role in the management of head and neck cancers (HNCs). We reviewed the recent advances in radiotherapy of HNCs and the role of imaging in treatment planning., Recent Findings: As shown in a recent update of meta-analysis of chemotherapy in head and neck cancer (MACH-NC), concurrent chemoradiotherapy was confirmed to be a standard of care in the management of locally advanced HNCs. Two recent large-scale randomized trials [Groupe d'Oncologie Radiothérapie Tête et Cou (GORTEC) and Radiation Therapy Oncology Group (RTOG)] failed to show additional benefit when combining accelerated radiotherapy with concurrent chemoradiotherapy. Updated 5-year results of a phase III pivotal trial confirmed the benefit of targeting epidermal growth factor receptor with cetuximab when combined with radiotherapy. Taxane-platinum-fluorouracil-based induction chemotherapy has been established as a reference induction regimen and has been explored as a possible part of the treatment of locally advanced HNCs, which was particularly successful in larynx preservation. The superiority of intensity-modulated radiation therapy compared with conventional radiotherapy for parotid protection has been shown in a prospective phase III trial. PET-based treatment planning is still to be validated in the HNCs., Summary: Concurrent chemoradiotherapy could still be considered as a standard of care; several new treatment combinations and new radiation technologies have been recently successfully evaluated in clinical trials.

Osteosarcoma is the most frequent second primary cancer occurring during the first 20 years following treatment for a solid cancer in childhood. Using a cohort study of children treated for a solid cancer, we investigated the incidence and etiology of osteosarcoma as a second malignant neoplasm after childhood cancer in a cohort and a case-control study. We analysed the relationship between the local dose of radiation and the risk of osteosarcoma, taking into account chemotherapy received. A cohort study of 4,400 3-year survivors of a first solid cancer during childhood diagnosed in France or the United Kingdom, between 1942 and 1986, revealed 32 subsequent osteosarcomas. In a nested case-control study, we matched 32 cases and 160 controls for sex, type of first cancer, age at first cancer and the duration of follow-up. Parameters studied were the incidence of osteosarcoma, the cumulative local dose of irradiation and the cumulative dose of chemotherapy received by cases and controls. The risk of a osteosarcoma was found to be a linear function of the local dose of radiation (excess relative risk per gray=1.8), and was found to increase with the number of moles of electrophilic agents per square meter but not with other drugs. No interaction was noted between radiotherapy and chemotherapy. Bilateral retinoblastoma, Ewing's sarcoma and soft tissue sarcoma were found to render patients susceptible to a higher risk of developing an osteosarcoma as a second malignant neoplasm. We recommend long-term surveillance of patients who were treated during childhood for bilateral retinoblastoma, Ewing's sarcoma, soft tissue sarcoma, as well as other first cancer treated with radiotherapy plus high doses of chemotherapy, without focusing exclusively on the radiation field.

At the present time, the current improvement of technical and dosimetric aspects of radiation oncology has to be evaluated in terms of potential benefit for the patient and the society. For this last point of view, specially designed economic analyses must be performed in order to justify the number of resources involved by these technical improvements. If the question is how the current technical procedures could reduce the risk of undesirable side-effects, the response cannot be immediately drawn from the literature. This paper emphasizes the possibility to evaluate the role of side-effects as endpoints of economic analyses when using special models in medical decision making such as Markov's. Only few oncologic situations are reliable to properly analyze the relationship between sophisticated radiation techniques and the incidence of post-radiation complications. These situations should be selected when prospective economic analyses are planned in the field of radiation therapy.

Purpose: Financial costs from "Z" procedures were evaluated and compared with the amount of direct costs that are needed for the annual activity of a radiation oncology department., Materials and Methods: The various components, particularly staff earnings that are estimated for each procedure according to their category and working time, were cumulated for calculation of direct loads., Results: Comparisons between direct expenses and the total amount of Z procedures led to the following results: the global cost is the same; at analysis of therapeutic procedures, however, this apparent similarity masks some very significant gaps; valorization of Z procedures is much lower than that of the corresponding real loads, especially when therapeutic procedures are quite different from techniques that are considered as "standard"; these differences do not apply to all the components of radiation therapy procedures. In particular, medical steps would be uniformly underestimated, while irradiation per se is overestimated., Conclusion: The authors suggest modifications of the general objectives and items of the nomenclature of radiotherapy and brachytherapy procedures.

The authors present a retrospective analysis dealing with the cost of therapeutic procedures achieved in the department of radiotherapy of the Centre Claudius-Regaud. This analysis was performed according to the actual cost of the different components of each treatment including the human costs. For this last purpose, serial countings of time spent by each category of employees were performed and then translated into financial terms. Results show a large discrepancy between the costs of therapeutic procedures. These differences are mainly related to the purpose of therapeutic plan, dealing with the most expensive procedures dealing with the developmental treatments. This study provides a tool that can be used by medical and/or administrative managers of radiation oncology departments when changes or innovations in therapeutic procedures. This cost accounting analysis is compared to the French administrative procedures used to pay the health care services and to determine the level of hospital resources.

To increase geometric treatment accuracy in radiation therapy, we used a novel digitized method and original image processing. The radiographic films that are conventionally used for verifying each beam during the treatment were digitized by a Kodak digital system and then an original image enhancement was applied. For the evaluation of our technique, a clinical trial with two tests was used. The trial involved four readers doing 80 reading. The enhanced films were judged to be of higher quality than the non enhanced films (p = 0.001) and were read more accurately (p < or = 0.001). This automatic enhancement of digitized captured portal images can be easily integrated into the busy routine of a radiotherapy department.

Résumé: Objectif: Évaluer les résultats de la radiothérapie chez les patients atteints de carcinomes épidermoïdes du larynx avec atteinte sous-glottique. Patients et méthodes: Entre 1998 et 2012, 56 patients ont reçu une radiothérapie ou une radiochimiothérapie (63 %) sans ou avec chimiothérapie d’induction (37 %) dans notre établissement. Résultats: Le suivi médian était de 74mois. À cinq ans, les probabilités de survie globale, de survie sans progression et de survie spécifique étaient respectivement de 64 % (intervalle de confiance à 95 % [IC 95 %] : 48–90 %), 45 % (IC 95 % : 28 %–61 %) et 88 % (IC 95 % : 78 %–98 %), respectivement. Les probabilités de contrôle locorégional et de contrôle à distance à cinq ans étaient de 69 % (IC 95 % : 56–83) et 95 % (IC 95 % : 89–100). Il n’y avait pas de différence de survie globale ni de contrôle locorégionale en fonction des traitements reçus (radiothérapie/chimioradiothérapie contre chimiothérapie puis radiothérapie/chimioradiothérapie) ou en cas d’atteinte sous-glottique primitive. Un indice de performance de 1 ou plus et la présence d’adénopathie cervicale au moment du diagnostic étaient des facteurs pronostiques défavorables de survie globale en analyse multifactorielle (hazard ratio [HR] [IC 95 %], respectivement de 6,5 [1,3–34 ; p =0,03] et 11 [1,6–75 ; p =0,02]). La probabilité de contrôle locorégional des cancers de stades T3-T4 était plus basse (HR : 3,1 ; IC 95 % : 1,1–9,2, p =0,04) en analyse unifactorielle mais aucun facteur pronostique n’a été retrouvé dans l’analyse multifactorielle. Aucune différence de probabilité de contrôle locorégional n’a été observée en fonction du premier traitement reçu (p =0,3). La probabilité de préservation laryngée à cinq ans était de 88 % (IC 95 % : 78–98) pour l’ensemble des patients et 58 % en cas de cancer de stade T3. Les probabilités de préservation laryngée à cinq ans étaient de 91 % (IC 95 % : 79–100) et 83 % (IC 95 % : 66–100), respectivement chez les patients qui n’ont pas et ont reçu une chimiothérapie néoadjuvante. Conclusion: Cette analyse suggère que les résultats obtenus pour les cancers du larynx avec atteinte sous-glottique par la radiothérapie avec ou sans chimiothérapie seraient comparables à ceux obtenus pour les autres tumeurs laryngées. Des protocoles de préservation laryngée pourraient donc être proposés en cas d’atteinte sous-glottique, dans certains cas sélectionnés. D’autres études sont nécessaires pour préciser ces données préliminaires. [ABSTRACT FROM AUTHOR]