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The standard treatment for endometrial cancer is surgery, although depending on the risk factors, adjuvant radiation therapy may also be given. It is proposed for high-risk carcinomas for which an improvement in progression-free survival though not overall survival has been shown. However, despite the development of radiotherapy treatments with intensity modulation and image guidance, adjuvant radiation therapy remains toxic to the digestive system. We aimed to investigate the incidence of digestive toxicity and the presence of any predictive factors.Data were retrospectively collected from patients treated with adjuvant radiotherapy for endometrial carcinoma at the Institut de cancérologie de Lorraine and centre hospitalier Émile-Durkheim between January 2010 and October 2016 and analyzed to identify factors associated with chronic digestive toxicity.One hundred and thirty-nine patients received a total dose of 50Gy fractionated into 25 sessions, five per week for five weeks. The median follow-up after irradiation completion was 38 months. The incidence of gastrointestinal and rectal toxicity in all patients treated with pelvic irradiation for endometrial carcinoma was 11.1% (95% confidence interval [95%CI]: 5.4-19%) for grade 3-4 and 25.6% (95%CI: 17.0-34.9%) for grade 2-4. No factor was found to be significantly predictive of chronic digestive toxicity. At five years, the overall survival was 74.3%, (95%CI: 65.3-81.4%), progression-free survival was 69.6% (95%CI: 60.1-77.3%) and incidence of pelvic recurrence was 7.9% (95%CI: 3.8-13.9%).Our results confirmed that pelvic radiotherapy can induce a relatively high rate of digestive toxicity but failed to identify relevant factors able to predict it.

Prostate brachytherapy techniques are described, concerning both permanent seed implant and high dose rate brachytherapy. The following guidelines are presented: brachytherapy indications, implant procedure for permanent low dose rate implants and high dose rate with source projector, as well as dose and dose-constraints objectives, immediate postoperative management, post-treatment evaluation, and long-term follow-up.

Penile cancers are uncommon and should be treated in expert center. Radiotherapy indications are mainly limited to exclusive brachytherapy for early stage penile glans cancer. Brachytherapy yields to excellent outcome for disease control and organ and function preservation. Only scarce data are available for external beam radiation therapy. It could be considered as palliative setting for irradiation of the primary tumor. For lymph node irradiation, external beam radiation therapy (with or without chemotherapy) could be discussed either as neoadjuvant approach prior to surgery for massive inguinal lymph node invasion or as adjuvant approach in case of high-risk of relapse. However, these cases should be discussed on an individual basis, as the level of evidence is poor. We present the recommendations of the French Society of Oncological Radiotherapy on the indications and techniques for external beam radiotherapy and brachytherapy for penile glans cancer.

We present the update of the recommendations of the French society of oncological radiotherapy on hepatic tumours. Recent technological progress led to develop the concept of focused liver radiation therapy. We must distinguish primary and secondary tumours, as the indications are restricted and must be discussed as an alternative to surgical or medical treatments. The tumour volume, its liver location close to the organs at risk determine the irradiation technique (repositioning method, total dose delivered, dose fractionation regimens). Tumour (and liver) breathing related motions should be taken into account. Strict dosimetric criteria must be observed with particular attention to the dose-volume histograms of non-tumoral liver as well as of the hollow organs, particularly in case of hypofractionated high dose radiotherapy "under stereotaxic conditions". Stereotactic body radiotherapy is being evaluated and is often preferred to radiofrequency for primary or secondary tumours (usually less than 5cm). An adaptation can be proposed, with a conformal fractionated irradiation protocol with or without intensity modulation, for hepatocellular carcinomas larger than 5cm.

Primary vaginal cancers are rare tumours, for which external beam radiotherapy and brachytherapy are major treatment tools. Given the complexity of brachytherapy techniques, the treatment should be performed in specialised centres. We present the recommendations of the French society for radiation oncology on the indications and techniques for external beam radiotherapy and brachytherapy for primary vaginal cancer.

We present the update of the recommendations of the French society for radiation oncology on external radiotherapy and brachytherapy of anal canal carcinoma. The following guidelines are presented: indications, treatment procedure, as well as dose and dose-constraints objectives, immediate postoperative management, post-treatment evaluation, and long-term follow-up.

Primary vulvar carcinomas are rare gynaecological cancers, for which surgery is the mainstay of treatment. There is however a major place for external beam radiotherapy in the situation of inoperable locally advanced tumours and/or as adjuvant therapy, when there are risk factors for locoregional relapse. We present the recommendations of the French society for radiation oncology on the indications and techniques for radiotherapy in the treatment of primary vulvar cancer.

The 2020 recommendations for good brachytherapy procedures ("Recorad") are updated based on the 2016 article. This new brachytherapy article took into account recent data published in the literature as well as international recommendations. The different brachytherapy steps are successively described from the treatment preparation (brachytherapy technique prescription; procedure and material, dedicated images for planification, dose distribution analysis and validation) to the end of the procedure as well as post-treatment surveillance.

We present the updated recommendations of the French society of oncological radiotherapy for rectal cancer radiotherapy. The standard treatment for locally advanced rectal cancer consists in chemoradiotherapy followed by radical surgery with total mesorectal resection and adjuvant chemotherapy according to nodal status. Although this strategy efficiently reduced local recurrences rates below 5% in expert centres, functional sequelae could not be avoided resulting in 20 to 30% morbidity rates. The early introduction of neoadjuvant chemotherapy has proven beneficial in recent trials, in terms of recurrence free and metastasis free survivals. Complete pathological responses were obtained in 15% of tumours treated by chemoradiation, even reaching up to 30% of tumours when neoadjuvant chemotherapy is associated to chemoradiotherapy. These good results question the relevance of systematic radical surgery in good responders. Personalized therapeutic strategies are now possible by improved imaging modalities with circumferential margin assessed by magnetic resonance imaging, by intensity modulated radiotherapy and by refining surgical techniques, and contribute to morbidity reduction. Keeping the same objectives, ongoing trials are now evaluating therapeutic de-escalation strategies, in particular rectal preservation for good responders after neoadjuvant treatment, or radiotherapy omission in selected cases (Greccar 12, Opera, Norad).

Resume Le traitement conservateur des cancers epidermoides du canal anal par irradiation est un standard en premiere intention. Malgre sa rarete, des progres significatifs ont ete accomplis au travers d’etudes cliniques historiques ou prospectives ces deux dernieres decennies, par l’utilisation de la chimiotherapie concomitante et des techniques d’irradiation conformationnelle avec modulation d’intensite du faisceau (RCMI). Cependant la personnalisation du traitement, au-dela de la repartition de la distribution de la dose, s’appuie sur peu de certitudes. Le fractionnement reste classique (1,8 a 2 Gy/Fr), le niveau de dose optimal toujours discute. Les facteurs pronostiques valides sont le volume tumoral et l’envahissement ganglionnaire. Seules les tumeurs de stade T1N0M0 peuvent beneficier d’un traitement local. Tous les autres stades necessitent une irradiation pelvienne ganglionnaire selon des regles etablies et l’usage de la chimiotherapie concomitante est recommande. La strategie concernant la determination des volumes cibles et le niveau de doses prophylactiques et curatives reste discutee. Cet article expose les donnees issues des etudes publiees, des recommandations des groupes d’etude et les orientations strategiques en cours. Au-dela de l’abandon aujourd’hui consensuel des schemas d’irradiation sequentiels, et la reduction de l’etalement ameliorant les taux de controle local et de survie, les facteurs permettant de personnaliser le traitement restent en cours d’investigation.

We present the results of the PHRC Tridicol, a prospective French phase II study whose objective was to increase the dose delivered to the target volume during brachytherapy for locally advanced cervical cancers.Eight centers included 48 patients, treated with concomitant radiochemotherapy, then uterovaginal brachytherapy.The median follow-up was 63 months. The dose of brachytherapy delivered in biological equivalent dose (EQD2) to 90% of the High Risk CTV (D90 CTV HR) was 80Gy in median dose. The 5-year local control rate (LC) was 84%, close to the hypothesis of 86.7%. The rate of severe complications (grade 3-4) was 23% at 5 years. The rectal dose was correlated with the risk of severe complications.HR CTV dose was below the target (85Gy) due to low use of parametrial interstitial needles, as the centers did not always have an adequate applicator, or were at the time at the beginning of their learning curve. The 5-year LC rate was improved compared to that of the comparable STIC PDR group (78%) but lower than the retroEMBRACE cohort of GEC ESTRO (89%). The complication rate was higher than in the comparable group of STIC PDR but close to that of retroEMBRACE. Training brachytherapy teams in interstitial implantation or referring patients to referral centers should help improve the therapeutic index of cervical cancer.

Seeking a second medical advice as a medical practitioner is a frequent situation that should be facilitated to best suit patients' expectations, while maintaining medical confidentiality. The patient and his relatives need to be involved with diagnostic and therapeutic procedures. The radiation oncologist should accept and help a patient who seeks a second advice, and patients will always appreciate when the physician helps them to seek such an advice. Examples that each practitioner should know include tertiary centers tumor boards, centers with access to innovation or clinical research, or with special teams to take care of specific populations such as adolescents and young adults. In some situations, no treatment can also be the best treatment, and it takes time to explain and discuss such watchful waiting strategies to patients. In case of recurrent disease after radiotherapy, salvage reirradiation must be discussed at a tertiary tumor board and weighed against other options, especially for rare and complex cases. Radiation oncology has gained multiple options with technological advances, such as proton therapy, brachytherapy, stereotactic body radiotherapy with respiratory tracking or contact therapy. Radiation oncologists must know the benefits associated with each option in terms of survival, local control or organ preservation in order to address patients to the best practitioner.

Brachytherapy is part of the treatment of locally advanced cervical cancers, accounting for about half of the total delivered dose. The benefit of dose escalation is the most important in advanced cases or if the tumor has responded poorly. The use of interstitial implantations makes it possible to reach doses of the order of 85 to 90Gy (including external beam radiotherapy contribution) in most patients, through image-guided approaches. Brachytherapy delivery is one of the quality criteria for patient care. To date, no data allow us to consider as an alternative the use of external boost through intensity-modulated or stereotactic body radiotherapy. Indeed, the doses delivered to the tumor and the capacity to spare normal tissues remains lower, as compared to what is permitted by brachytherapy. It is therefore appropriate for centers that do not have access to the technique to establish networks with centers where brachytherapy is performed, to allow each patient to have access to the technique. It is also necessary to promote brachytherapy teaching. The issue of reimbursement will be crucial in the coming years to maintain expertise that is today insufficiently valued in its financial aspects, but has a very high added value for patients.

Stereotactic lung radiosurgery has been carried out in the team at the Georges-François-Leclerc centre (CGFL) in Dijon since 2008 on a Truebeam® accelerator (Varian®) with the RPM technique.Fifty patients with primary T1-T2 stage lung cancer (n=30) or lung metastasis (n=20) were included in the study. Since 2014, 3 successive 4D scanners on D1, D2 and D3, have been produced in order to ensure the reproducibility of ITV (Internet Target Volume). The 3 ITVs are contoured (ITV 1, 2 and 3) from the MIP (Maximum Intensity Projection) of each of the 3 scanners. A global ITV is created from the ITV volumes of the 3 scanners (MIP 2 and 3 merged with MIP 1). A CBCT (Cone Beam Computerised Tomography) is performed at the start of each irradiation session to position the patient. The study consisted in analysing the relevance of the realisation of 3 different scanners before dosimetry to define the ITV and in comparing the volumes contoured on the different CBCT to the ITV to make sure that the tumour volume is well included in the ITV during the sessions.There is a strong correlation between the different ITVs 1, 2, 3 and global, as well as between the volumes obtained on the different CBCTs. The correlation coefficient between the different ITVs and the volumes contoured on CBCT was high for upper lobar lesions. In terms of tolerance, the FEV1 (Maximum volume expired during the first second) did not seem to be a significant factor influencing the correlation between the ITV and the volumes bypassed on CBCT.Performing a single 4D planification CT is sufficient to consider stereotactic lung irradiation, regardless of the location of the lung lesions. The correlation coefficient between ITV and CBCT was high for upper lobar lesions.

Because of its principle and its high proof level clinical results, brachytherapy represents a specific irradiation technique for the treatment of primary tumors as well as some local relapses in pre-irradiated area. After a glory period between the 80's and 90's, brachytherapy has progressively lost its attractiveness. In order to provide a practical solution to this deleterious situation, it is important that guardianships, health care payers, patient associations, specialist doctors and radiation oncologists understand the reasons leading to this harmful state as well as the risks concerned. A teaching judged insufficient, non-adapted value and an aging image of brachytherapy represent the three main reasons of this degradation and constitute the three most important challenges conditioning its maintain in the anticancer treatment arsenal. An adapted communication with radiation oncologists themselves but also with the other scientific societies remains crucial as well as with guardianship and patient associations. It is central that brachytherapy could be recognized in order to make it stronger and accessible for all the patients who could need it.

The conservative treatment of squamous cell carcinoma of anal canal by irradiation is recommended as first indication. Despite its rarity, significant improvements were obtained by retrospective or prospective clinical studies these 20 past years, evaluating concomitant chemotherapy and IMRT. Nevertheless, the individualisation of the treatment, over dose distribution, has poor data available. Fractionation remains classic (1.8-2.0Gy/Fr), but the optimal dose level remains under discussion. The strategy concerning the volumes and doses for the prophylactic volumes remains under discussion. This paper will describe the data published, and the recommendations of working Groups, and the main options under evaluation. To conclude, today only the absence of gap is recommended, the benefit of a one-step schedule reducing the treatment time, then increasing local control and survival, but personalised schedules remain under investigation.

Intensity-modulated radiotherapy makes possible to optimize the irradiation and spare normal tissues. The toxicity remains important with concomitant chemotherapy often associated. The improvement of MRI and PET-CT define more precisely the target volumes, which need a higher dose, but necessitates to respect the rules of contouring. The treatment is uniform whatever the stage but should be individualized based on clinical stage and tumor response. New paradigms concern biology, staging, volumes and doses, fractionation and combined treatments.

Anal canal carcinomas remain rare, but their management has improved recently. The PET-CT is now used as a standard at the first diagnosis and after relapses. The introduction of intensity-modulated irradiation techniques makes it possible to better conform the pelviperineal and inguinal volumes, improving the homogeneity of the irradiation while sparing some pelvic structures, thus reducing acute and late effects. Nevertheless, the conversion from 3D to intensity-modulated radiotherapy needs a specific and careful approach, mainly for the management of the perineal region, where relapses and complications occur. Last but not least, new chemotherapy associations are studied for metastatic disease.

Resume Objectifs La radiotherapie stereotaxique robotisee (RTS) pour le traitement des carcinomes hepatocellulaires necessite la pose de grains d’or en perilesionnel pour le reperage par scopie. Le but de cette etude est de savoir si la pose de grains d’or est toujours possible, sous quelle technique d’imagerie et avec quels resultats. Patients et methodes Il s’agit d’une etude prospective basee sur la pose de fiduciaires hepatiques dans notre service en vue d’un traitement par RTS pour un carcinome hepatocellulaire chez 38 patients (49 lesions a traiter) sur une periode d’un an. En premiere intention, il s’agissait d’un guidage echographique et en cas d’impossibilite, le guidage scanographique etait utilise. Resultats Le nombre moyens de grains poses par procedure etait de 2,68 (± 0,61) avec un guidage echographique quasi exclusif (36 sur 38 patients soit 95 % des patients). La distance moyenne entre les grains et la lesion etaient de 32 mm (± 11 mm) et celle entre les grains etaient de 17 mm (± 7 mm). Conclusion La RTS est en cours d’evaluation pour le traitement des lesions hepatiques. Le radiologue a un role important a jouer car la pose de fiduciaires hepatiques est indispensable. Elle est presque toujours possible avec un guidage echographique y compris pour des lesions non accessibles a des microbiopsies, a un traitement par radiofrequence ou pour des lesions mal individualisables en echographie ou en scanner.

The main indications of the brachytherapy of head and neck cancers are the limited tumours of the lip, the nose, the oral cavity and the oropharynx. Nasopharynx tumours are nowadays treated by intensity-modulated radiotherapy. This technique can be exclusive, associated with external radiotherapy or postoperative. It can also be a salvage treatment for the second primaries in previously irradiated areas. If the low dose rate brachytherapy rules remain the reference, the pulse dose rate technique allows the prescription of the dose rate and the optimisation of the dose distribution. Results of high dose rate brachytherapy are now published. This paper reports the recommendations of the Gec-ESTRO, published in 2017, and takes into account the data of the historical low dose rate series, and is upgraded with the pulsed-dose rate and high dose rate series.

Resume Introduction La curietherapie des cancers de la prostate s’est progressivement implantee dans l’arsenal therapeutique comme une alternative a la prostatectomie radicale et a la radiotherapie externe. Dans le groupe des patients presentant un cancer de pronostic favorable, les survies specifiques depassent 95 % a 10 ans. L’objectif de cette etude est de decrire la place actuelle et les pratiques de la curietherapie en France. Materiel et methodes Un questionnaire realise en association avec l’Association francaise d’urologie (AFU) et la Societe francaise de radiotherapie oncologique (SFRO) et evaluant les differentes pratiques de la curietherapie en France a ete adresse a tous les urologues et radiotherapeutes qu’ils pratiquent ou non la curietherapie. Resultats Au total, 1417 questionnaires ont ete envoyes et 285 reponses ont ete recueillies provenant de 211 urologues (74 %) et 74 radiotherapeutes (26 %). Soixante (21 %) pratiquaient la curietherapie (31 urologues, 29 radiotherapeutes). La technique a faible debit de dose par implants permanents etait la plus frequemment utilisee (83,3 %). Quatre-vingt-dix pour cent des sondes recommandent la curietherapie pour les cancers de prostate a faible risque tandis que 73 % pratiquent dans les risques intermediaires favorables et seulement 13 % chez les hauts risques. Conclusion La curietherapie reste rarement realisee pour les cancers de prostate a faible risque. Une revision des recommandations est sans doute indispensable au vu des bons resultats dans ce groupe moyennant une selection rigoureuse des patients. Le binome urologue-radiotherapeute reste indispensable dans une prise en charge globale du patient. Niveau de preuve 4.

For more than a century, brachytherapy has been a treatment of choice for delivering a high dose in a small volume. However, over the past 15 years, this irradiation technique has stalled. Even so, brachytherapy allows the delivery of the right dose at the right place by dispensing with target volume motion and repositioning. The evolution of brachytherapy can be based on a road-map including at least the following three points: the acquisition of clinical evidence, teaching and valuation of the procedures. The evolution of brachytherapy will be also impacted by technological considerations (end of the production of low dose rate 192 iridium wires). Regarding the evolution toward a personalized treatment, brachytherapy of the future should take its place as a partner of other modern external beam radiation techniques, be performed by experimented actors (physicians, physicists, technicians, etc.) who received adequate training, and be valued in proportion to the delivered medical service.

During the last decade, the organization of brachytherapy in France moved to 62 units in 173 radiotherapy centres in 2009. More than 7500 patients were treated in 2009, quite exclusively with curative intent, for 80% in public or associated hospitals. The techniques improved to high tech 3D dosimetry and optimization of the dose distribution. Brachytherapy, despite representing only 5% of the treatments by irradiation, is a reference treatment for several tumors.

Prostate cancer brachytherapy can be used as an alternative to the radical prostatectomy and radiotherapy. In the low-risk group, specific survivals are up to 95% after 10years. The aim of the study is to describe the practices in brachytherapy in France.A survey made by AFU (French Urologic Association) and SFRO (French Society Of Oncological Radiotherapy) assessing the practices in brachytherapy in France was sent to all the urologists and radiotherapists even if they did not practice it.In total, 1417 surveys were sent, 285 were received coming from 211 urologists (74%) and 74 radiotherapists (26%). Sixty (21%) practiced brachytherapy (31 urologists, 29 radiotherapists). Low dose rate with permanent implants was used in 83,3%. Brachytherapy was advised for low-risk group by 90% who responded the survey, 73% used it in intermediate risk and only 13% in high risk.Brachytherapy is hardly used in low risk prostate cancer. It probably needs a reconsideration of recommendations due to the good results in association with a good picking. The urologist-radiotherapist couple is essential in the overall care of the patient.4.

Novel paradigms emerge in oncology today. Systemic treatments are more effective and diversified along with an increased life expectancy in oligometastatic patients. Stereotactic radiotherapy using hypofractionation opens new perspectives for local tumour control. The area of radiobiology has expanded with integration of tumour microenvironment in which radiation-induced inflammation mediators and immune system play a major role. Immunity checkpoints inhibitors experience a major development. This rapidly evolving field seems involved in the abscopal effects, especially when radiation is combined with checkpoints inhibitors, as demonstrated in numerous preclinical studies and several clinical trials. Paradoxically, irradiation also produces immunosuppressive effects. This manuscript aims to report the dual effects of ionizing radiation on the immune system and reviews some results of the combination of radiation and immunity chekpoints inhibitors and also research perspectives.

Indications, doses and techniques of conformal radiotherapy for anal canal cancers are presented. The recommendations for delineation of the target volumes and organs at risk are detailed.

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.

Indications, doses and techniques of conformal radiotherapy for rectal carcinoma are presented. The recommendations for delineation of the target volumes and organs at risk are detailed.

Recent technological developments led to develop the concept of focused liver radiation therapy. We must distinguish primary and secondary tumors as the indications are restricted and must be discussed as an alternative to surgical or medical treatments. For hepatocellular carcinoma 5 to 10cm (or more), a conformational radiation with or without intensity modulation is performed. Stereotactic body radiotherapy (SBRT) is being evaluated and is increasingly proposed as an alternative to radiofrequency ablative treatment for primary or secondary tumors (typically less than 5cm). Tumor (and liver) movements induced by respiratory motions must be taken into account. Strict dosimetric criteria must be met with particular attention to the dose-volume histograms to liver and the hollow organs, including cases of SBRT.

Intensity modulated radiation therapy (IMRT) and brachytherapy are standard techniques for the irradiation of oral cavity cancers. These techniques are detailed in terms of indication, preparation, delineation and selection of the volumes, dosimetry and patient positioning control.

To study overall survival, risk of neurological death, local recurrence and development of new brain metastasis in patients treated for brain oligometastases with hypofractionated stereotactic radiotherapy with CyberKnifeInstitutional retrospective study of 102 patients treated for one to three brain metastasis: 76 with exclusive hypofractionated stereotactic radiotherapy and 26 with hypofractionated stereotactic radiotherapy and whole brain irradiation. Objectives were assessed and compared between these two groups according to the Kaplan-Meier method and Cox model.Median follow-up was 18.8 months. There were no difference between exclusive hypofractionated stereotactic radiotherapy and hypofractionated stereotactic radiotherapy with whole brain irradiation for overall survival (respective median 21.5 and 20.1 months), risk of neurological death (respectively 9.2% and 15.4% at one year). At one year: the risk of cerebral progressive disease was greater in the group receiving exclusive hypofractionated stereotactic radiotherapy (respectively 43.4% vs. 26.2%, P=0.043), the risk of local recurrence was 25% versus 17.6% (P=0.28) and the development of new brain metastasis was 23.7% versus 11.5% (P=0.27). After salvage treatments, crude local control was similar in the two groups, respectively 78.6% and 73.5%. Whole brain irradiation has been avoided for 72.4% of patients in the group receving exclusive hypofractionated stereotactic radiotherapy.Whole brain irradiation improves local control of brain metastatic disease in addition to hypofractionated stereotactic radiotherapy. Sparing whole brain irradiation for salvage treatments only does not affect overall survival or risk of neurological death in selected patients with favourable prognosis.

The anal canal is regarded as an organ at risk more often in pelvis radiation, but also in brachytherapy. Acute or chronic complications depend on its different components and are different from the anal margin or the rectum. The toxicity scale can be the NCI CT C version 3, completed by the tardive toxicity SOMALENT scale. The mean dose and maximal dose are recognized as predictors of complications. The maximum recommended dose despite the paucity of literature is 55 Gy.

Resume Introduction L’objectif de cette etude a ete de determiner l’incidence de la preservation de la fonction sexuelle au long cours chez les patients traites par curietherapie en utilisant un auto-questionnaire valide et determiner le role des differents parametres cliniques et therapeutiques. Materiel et methode De decembre 1999 a juin 2002, 157 patients traites consecutivement par curietherapie prostatique ont ete retenus pour l’etude. Un questionnaire de l’EORTC le « QLQ C30 » adjoint du module « PR25 » leur a ete soumis avant traitement et au second trimestre 2007. Cent vingt-huit patients ont renvoye leur questionnaire (81,5 %). L’analyse statistique s’est faite sur 64 patients. La mediane de suivi a ete de six ans (± 0,57 an). Les parametres pouvant interferer avec la fonction sexuelle ont ete evalues : âge, volume prostatique, co-morbidite, hormonotherapie adjuvante, D 90, V 150 et V 240. L’analyse statistique s’est faite en mode univarie selon la procedure d’Anova et Chi2 et en mode multivarie (regression logistique), la variable etudiee etant « conservation d’une activite sexuelle Oui/Non ». Resultats Le taux de conservation de la fonction sexuelle a ete de 64 %. Aucune variable pouvant expliquer la perte de la fonction sexuelle n’est ressortie statistiquement significative (p Conclusion La curietherapie de prostate a preserve la fonction sexuelle au long cours dans 64 % (chez les 64 patients analyses) et s’inscrit donc comme une option interessante pour les patients souhaitant la conserver.

Les accidents de radiotherapie d’Epinal et de Toulouse, identifies respectivement en 2006 et 2007, ont concernes un tres grand nombre de patients. La sur-irradiation des organes cibles lors de la radiotherapie a entraine des effets deterministes graves. Un retour d’experience a ete effectue et a indique que les erreurs qui conduisent aux evenements graves resultent de defaillances humains et organisationnelles. C’est dans ce domaine du facteur organisationnel et humain que doivent porter les efforts pour prevenir la survenue de nouveaux accidents.

Stereotactic radiotherapy delivers allows for a highly precise irradiation, and was originally developed in the 70s by neurosurgeons. Gradually, it has been developed in extracranial indications. Moreover new innovative treatment devices such as the robotic radiosurgery with CyberKnife have emerged. Indications are currently being validated by the HAS in intracranial locations that are treated by conventional radiosurgery for several decades. Three robotic radiosurgery facilities were opened in France in 2006 thanks to a grant from the INCa. Those are posed in Lille, Nice, Nancy. Since 2007, 140 patients were treated as off today in Alexis Vautrin Cancer Center (40 intracranial locations, 100 extracranial). Thirty five primitive lung cancer or pulmonary metastasis, twenty primary liver tumor or metastasis, 21 spinal locations (schwanomas or bone metastasis), and nineteen other (pelvic lymph nodes, chordomas, H&N, etc.). The lung diseases were treated on the 80% isodose as follow: 60 Gy in three fractions for peripheral tumors and 54 Gy for central ones. The one-year local control rate reaches 90%. The hepatic tumors received 45 Gy in three fractions prescribed on the 80% isodose with a six months local control rate of 83%. Any of the 140 patients has suffered from acute or late toxicity > grade 3. These encouraging outcomes are confirmed by both other French centers and phase II trial are pending to assess the most effective and safe radiations protocols.

Resume But Le traitement du cancer de la prostate par ultrasons focalises de haute intensite (HIFU) est un traitement dit mini-invasif qui a en principe une faible morbidite. L’objectif de cette etude etait d’evaluer la qualite de vie des patients traites par HIFU. Patients et methode Cinquante patients consecutifs traites de premiere intention par HIFU pour cancer localise de la prostate entre 2003 et 2005 ont recu le questionnaire de qualite de vie « UCLA/RAND PCI » en preoperatoire et un an apres traitement. Les scores de qualite de vie postoperatoires ont ete compares aux scores preoperatoires et a une population test sans cancer de prostate. Resultats Quatre-vingt pour cent des patients ont repondu aux deux questionnaires. 72,5 % des patients etaient « satisfaits » ou « tres satisfaits », 2,5 % etaient « tres mecontents » et 25 % etaient sans opinion. Les scores de qualite de vie generale (SF-36) n’ont pas mis en evidence de differences significatives avant et apres traitement. Une alteration de la fonction et de la gene ressentie etait statistiquement significative sur le plan sexuel et urinaire. Pour la fonction digestive, il n’y avait pas de difference avant et apres traitement ; en revanche, il y avait une degradation statistiquement significative de la gene ressentie. Conclusion Le traitement HIFU du cancer de prostate est bien accepte par le patient, la qualite de vie est preservee a un an. Il y a une degradation significative de la fonction sexuelle et plus moderee de la fonction urinaire.

Background Post-excisional brachytherapy with Iridium 192 is a treatment of keloids scars (KS). Its indications and its parameters are not subject to any consensus. Objective We wanted to assess the effectiveness and satisfaction of patients treated in our centre. Patients and Methods This was a retrospective study conducted from November 2006 to November 2007. Patients with clinically and histologically proven KS treated between 1990 and 2005, were convened in consultation between September and October 2007. Clinical data and parameters of the brachytherapy have been collected. Results Eighty-seven patients (138 KS) were treated. Eighty-two KS (46 patients) met the criteria for inclusion. Thirty-two patients (55 KS) have been seen in consultation. The average time between the onset of KS and treatment was 63.5 months. The brachytherapy has begun after a maximum of 7 hours posterior to surgery for all KS. The average dose was 17.9 Gy calculated at 5 mm. We observed 23.6% of recurrence after treatment. Seventy-nine per cent of itching and 87.5% of pain have totally disappeared. The phototypes 5 and 6 had an increased risk of reccurence. Discussion This is the most important series of KS treated with Post-excisional brachytherapy presented so far. The technique is efficient in preventing keloid reccurence and in treating the functional signs, but at the expense of an unaesthetic result, of wich patient must be warned about. A follow-up of at least two years after treatment is recommended. Conflicts of interest None declared

Resume Objectif de l’etude En 2005, une etude prospective multicentrique non randomisee (programme de soutien aux techniques innovantes couteuses curietherapie pulsee, STIC PDR) a ete debutee pour comparer deux groupes de patientes traitees pour un cancer du col de l’uterus selon des methodes de curietherapie differentes. Dans le groupe « curietherapie classique bidimensionnelle », la dosimetrie a ete realisee sur des radiographies orthogonales ; pour le groupe « curietherapie innovante tridimensionnelle », elle etait realisee sur imagerie tridimensionnelle et les patientes traitees avec un debit pulse. Nous decrirons les 637 premieres patientes sur 801 incluses. Patientes et methodes Deux cent quatre-vingt-huit patientes etaient dans le groupe curietherapie bidimensionnelle, 349 dans le groupe curietherapie tridimensionnelle. Trois sous-groupes ont ete definis : curietherapie, puis chirurgie (159 patientes) ; chimioradiotherapie, curietherapie, puis chirurgie (264 patientes) ; chimioradiotherapie, puis curietherapie (214 patientes). Les donnees cliniques etaient comparables entre les groupes curietherapie bidimensionnelle et curietherapie tridimensionnelle. La dose mediane de radiotherapie externe de 45 Gy a ete delivree en 25 tractions et associee a la chimiotherapie dans 80 % des cas. Pour la curietherapie bidimensionnelle, les points ICRU de vessie et rectum ont ete reperes et le volume l’isodose 60 Gy mesure. Pour la curietherapie tridimensionnelle, les volumes cibles anatomocliniques (CTV) a haut risque et a risque intermediaire ont ete delinees selon les recommandations du groupe gynecologie du groupe europeen de curietherapie – European Society of Therapeutic radiology and Oncology (GYN-GEC-ESTRO), ainsi que les parois externes des organes a risque. Les donnees relevees etaient le V60, volume cible anatomoclinique recevant 60 Gy , les D100 et D90, doses entourant 100 % et 90 % du volume cible anatomoclinique et les doses maximales recues aux organes a risque (doses minimales recues dans 2 et 0,1 cm 3 ). Resultats Les resultats dosimetriques etaient comparables entre les groupes curietherapie bidimensionnelle et curietherapie tridimensionnelle. Dans le groupe curietherapie tridimensionnelle, les doses recues par les volumes cibles anatomocliniques etaient inferieures aux recommandations du GYN-GEC-ESTRO. L’examen anatomopathologique des pieces operatoires a montre un taux similaire de remission complete histologique entre les groupes curietherapie bidimensionnelle et curietherapie tridimensionnelle (54 et 55 %) ; il n’y avait pas non plus de difference de couverture des volumes cibles anatomocliniques selon que la tumeur etait en remission complete ou partielle. Conclusion L’analyse des resultats preliminaires du STIC PDR montre une evolution progressive vers la curietherapie pulsee tridimensionnelle. Le suivi de cette cohorte de patientes apportera des donnees cruciales sur la relation entre la couverture du volume cible anatomoclinique et le taux de controle local et entre les doses recues par les organes a risque et les complications tardives.

Resume La curietherapie par implants permanents d'iode 125 est une methode validee de traitement des cancers de la prostate localises de pronostic favorable, au meme titre que la radiotherapie externe et la chirurgie. Elle necessite une selection rigoureuse des patients et la realisation d'une technique precise au sein d'un plateau specialise. La collaboration etroite entre oncologue–radiotherapeute, urologue et physicien medical est indispensable a toutes les etapes de la selection, du traitement et du suivi des patients. Les bons resultats carcinologiques et fonctionnels avec actuellement plus de dix ans de suivi se confirment. De nouvelles indications de curietherapie avec des techniques differentes et des associations avec la radiotherapie externe sont en cours d'evaluation.

International audience; Anal canal carcinoma is a rare and curable disease for which the standard of care is radiation therapy with concurrent 5-fluoro-uracil and mitomycine-based chemotherapy. Post-treatment follow-up however is rather poorly defined. This article offers a review of the various post-treatment surveillance options both for early diagnosis of relapse and care for late treatment effects. While follow-up remains mostly clinical, we will discuss morphologic (endorectal echoendoscopy, pelvic magnetic resonance imaging, tomodensitometry and positron emission tomography) and biologic (squamous cell carcinoma antigen and pathology) follow-up so as to determine their diagnostic and prognostic value.; Le carcinome épidermoïde du canal anal est une maladie rare et souvent curable dont le traitement standard repose sur la radiothérapie en association avec une chimiothérapie à base de 5-fluoro-uracile et de mitomycine-C. La surveillance après ce traitement reste cependant mal codifiée. L’objectif de cet article est de proposer une mise au point sur les différentes modalités de surveillance après traitement à la recherche de rechute ou d’effets secondaires. Si cette surveillance est essentiellement clinique, nous évoquerons les différentes perspectives de surveillance morphologique (échoendoscopie endorectale, imagerie par résonance magnétique pelvienne, tomodensitométrie et tomographie par émission de positons) ainsi que biologique (squamous cell carcinoma antigen et histologie) et leur apport diagnostique et pronostique.

To evaluate prospectively chronic gastrointestinal toxicity in patients with cervical cancer treated with conventional irradiation or with intensity-modulated irradiation (IMRT).Between June 2005 and September 2013, 109 patients underwent external radiotherapy followed by brachytherapy for cervical cancer at the "Institut de Cancérologie de Lorraine". Each patient receiving IMRT was paired with a patient receiving conventional radiotherapy on the following criteria: concomitant chemotherapy, additional nodal dose, treatment of para-aortic lymph node area, age. The toxicity collection was prospective using the RTOG scale. The main objective was to compare the incidence of gastrointestinal toxicity chronic between the two groups. In a second time, the influence of dosimetric parameters on chronic GI toxicity was investigated. Comparisons of acute toxicity, chronic genitourinary toxicities, overall survival, disease-free survival were secondary objectives.Sixty-six patients were able to be matched. Overall survival at 36 months was 71% in the conventional radiotherapy group against 73% in the IMRT group (P=0.54). There was no significant difference between the two groups in terms of digestive chronic toxicity (P=0.17), nor in terms acute gastrointestinal toxicities (P=0.6445) and genitourinary (P=0.5724). IMRT spared significantly small bowel (P=0.0006) and rectum (P=0.0046) from 30Gy dose, and bladder from 45Gy (P0.001). The incidence of genitourinary toxicity was significantly different between the two groups (P=0.03) in favor of conventional radiotherapy.Our study does not seem to show significant difference in the occurrence of chronic gastrointestinal toxicities between the two groups. Clinical efficacy seems comparable. Larger studies with longer follow-up period should be conducted.

Resume La curietherapie joue un role fondamental dans le traitement des patientes atteintes d'un cancer du col uterin de stades I a IV selon la classification de la Figo (Federation internationale des gynecologues–obstetriciens). Les modalites techniques ont evolue ces dernieres decennies : technologie des sources se deplacant pas a pas, developpement des modalites d'imagerie, en particulier l'IRM, systemes de planification dosimetriques integrant l'imagerie en trois dimensions. L'imagerie scanographique ou remnographique a contribue a une meilleure connaissance de l'extension tumorale et des organes a risque. Les applicateurs compatibles avec une scanographie ou une IRM ont permis la realisation d'images avec une amelioration de la definition du volume tumoral par rapport a l'approche traditionnelle. L'introduction de l'approche tridimensionnelle fondee sur l'imagerie implique de nouvelles definitions et un langage commun. En 2000, un groupe de travail a ete cree au sein du GEC–ESTRO (Groupe europeen de curietherapie–European Society for Therapeutic Radiology and Oncology) afin de travailler sur la dosimetrie tridimensionnelle fondee sur l'imagerie dans les cancers du col uterin. L'objectif de ce groupe etait de decrire une terminologie commune permettant a differentes equipes d'utiliser un langage commun. Des recommandations ont ete decrites et proposees sur la base d'experiences cliniques et de concepts dosimetriques provenant de differentes institutions. Deux volumes cibles anatomocliniques (CTVs) ont ete decrits en relation avec le risque de recidive locale : un CTV dit a haut risque et un CTV dit a risque intermediaire. Afin de mieux determiner le role de ces definitions et leur impact potentiel sur l'incidence des complications, un programme de soutien aux techniques innovantes couteuses (STIC) a ete developpe en France. L'objectif de ce programme est l'etude de l'incidence a deux ans des complications severes dans deux populations comparables. Un premier groupe est traite par une technique de curietherapie pulsee avec applicateur en place permettant une dosimetrie tridimensionnelle sur images scanographiques ou remnographiques avec possibilite d'optimisation, le second groupe est traite a partir de radiographies standard sans delineation ni possibilite d'optimisation. Il est prevu que chaque groupe inclut 425 patientes. Une evaluation medicoeconomique est egalement programmee, permettant une evaluation du cout reel de l'approche la plus sophistiquee (curietherapie pulsee) par comparaison a un systeme dosimetrique historique.

Resume Les adenocarcinomes de l’endometre sont au troisieme rang des sites tumoraux chez la femme en France. Au terme du bilan pretherapeutique, 80 % apparaissent confines a l’uterus. La curietherapie a une place importante dans la strategie therapeutique. Le traitement principal reste l’hysterectomie totale extrafaciale avec annexectomie bilaterale et prelevement ganglionnaire sous-veineux iliaque bilateral. Cependant, apres chirurgie seule, le taux de recidive locoregionale est de 4 a 20 %, reduit de 0 a 5 % apres curietherapie postoperatoire du fond vaginal. La curietherapie postoperatoire est realisee le plus souvent en ambulatoire par trois ou quatre fractions, a haut debit de dose. La curietherapie uterovaginale preoperatoire reste adaptee aux tumeurs localisees envahissant le col. Les patientes atteintes de tumeur localisee mais inoperable pour des raisons generales (

En ciertos paises europeos, los adenocarcinomas de endometrio ocupan el tercer lugar entre las localizaciones tumorales de la mujer en cuanto a su frecuencia. Al finalizar el estudio preterapeutico, el 80% esta confinado en el utero. La braquiterapia ocupa un lugar significativo en la estrategia terapeutica. El principal tratamiento sigue siendo la histerectomia total extrafascial con anexectomia bilateral y extraccion de muestras ganglionares subvenosas iliacas bilaterales. Sin embargo, tras la cirugia aislada, la tasa de recidiva locorregional es del 4-20%, y se reduce al 0-5% despues de braquiterapia postoperatoria del fondo vaginal. Lo mas habitual es que la braquiterapia postoperatoria se realice de forma ambulatoria mediante tres o cuatro fracciones a altas dosis. La braquiterapia uterovaginal preoperatoria se adapta a los tumores localizados que invaden el cuello. Las pacientes afectadas por un tumor localizado, pero inoperables por motivos generales (