Search

The optimal schedule for palliative external beam radiotherapy (EBRT) in patients with bladder tumors with hematuria unfit for surgery remains undefined. This study aimed to assess the clinical hemostatic efficacy and safety of two EBRT hypofractionated schedules.From February 2008 to October 2017, 31 patients were referred to our department for palliative hemostatic bladder irradiation. EBRT consisted of two schedules: "continuous" treatment (CRT) was delivered following consecutive 3-10 weekdays (3-6Gy/fraction (fr), to a total dose of 18-30Gy) (n=14); the "discontinuous" schedule (DRT) consisted of 23Gy in 4fr (6.5Gy/fr on days 1 and 3, followed by 5Gy/fr on days 15 and 17; n=12). The primary endpoint was the rate of hemostatic control (HC) at the end of the radiation course. Other endpoints included mid-term HC, toxicities and overall survival. Comparative analyses were performed by exact Fisher test with a cut-off of 0.05 for statistical significance.The rate of HC at the end of EBRT was 92% (n=24) with no differences between CRT and DRT (100% vs 86%; p=0.48). The median follow-up was 6 months, HC was achieved in 15/26 (58%) patients at the last follow-up, without meaningful differences between CRT and DRT (50% vs 67%; p=0.45). Three and two patients developed acute grade ≤2 diarrhea in CRT and DRT groups, respectively.Our study suggests that both hypofractionated "continuous" and "discontinuous" EBRT are well tolerated and represent acceptable schedules for patients with limited life expectancy. DRT schedule could be preferred for departments' organization to increase the slots for the treatment of other referred patients for radiotherapy.

Purpose After radiation therapy (RT), various radiation-induced toxicities can develop in about one-fourth of patients. An international interest in using morbidity and mortality rates to monitor the quality of care and integrate morbidity and mortality review (MMR) meetings into organizations' governance processes has arisen. We report the first results of patients included in our MMR procedure that included biological assays for individual intrinsic radiosensitivity (IIRS). Methods and Materials Twenty-three patients were prospectively included in the MMR database. Twenty-two were evaluable for IIRS. Prostate (n=10) and breast (n=8) cancers were the most frequent disease types. The total dose delivered, determined according to the type of disease, ranged from 30 to 74 Gy. Our MMR procedure requires strict criteria: patients with unresolved toxicity of grade 3 or higher with availability of clinical (photographic) data, IIRS results obtained from skin biopsy assays, treatment modalities, and follow-up data. The RT technique and dosimetry were reviewed. Results Our prospective registration of toxicities showed mainly rectitis, occurring in 7 cases, and skin toxicities, occurring in 9. Of the 7 patients with rectitis, 5 received 66 Gy of post-prostatectomy RT with V50 (rectum volume receiving 50 Gy) ranging from 45% to 75% and a mean maximal dose of 66.5 Gy. For dermatitis and cystitis, the mean maximal doses were in the range of classical constraints without any overdosage or dose heterogeneity. No errors were found in the review of treatment planning and positioning. Conversely, all the patients were considered biologically as radiosensitive with genomic instability and ATM (ataxia telangiectasia mutated)-dependent DNA double-strand break repair impairments. Conclusions The MMR review of files allowed clear answers for patients on the relationship between clinical events and their IIRS. Our procedure has allowed education of all our staff to monitor, identify, and document clinical, physical, and biological aspects of radiation-induced toxicities. Thus we recommend the introduction of the MMR procedure in RT departments.

Objectif de l’etude L’objectif de notre etude etait d’evaluer l’efficacite hemostatique a court et a long termes de deux schemas de fractionnement de radiotherapie externe pour le cancer de la vessie inoperable. Materiel et methode Du 2008 au 2017, 31 patients ont ete irradies dans notre service. La radiotherapie ete delivree selon deux schemas : « continu » (delivre en 3 a 10 jours, 3 a 6 Gy par fraction, pour une dose totale de 18 a 30 Gy) (groupe 1, n = 14) ou « discontinu » (23 Gy delivres en quatre fractions de 6,5 Gy, j1 a j3 suivi par 5 Gy par fractions, j15 a j17 ; groupe 2, n = 12). Dans les deux groupes, le volume cible correspondait a la vessie avec des marges. Les criteres de jugement etaient le controle hemostatique en fin d’irradiation et au dernier suivi et la survie globale, et la toxicite. Resultats Les donnees de vingt-six patients etaient exploitables. L’âge median etait de 78 ans (extremes : 38–99 ans), avec une nette predominance masculine (n = 22 ; 84 %). L’indice de performance selon l’OMS etait de 0–1 pour neuf patients (35 %), de 2–4 pour 17 (65 %). Le taux de controle hemostatique a la fin de radiotherapie etait de 92 % (n = 24) sans difference significative entre le groupe 1 (100 %) et le groupe 2 (86 % ; p = 0,48). Avec un suivi median de six mois, le controle hemostatique etait observe chez 15 patients (58 %) au dernier suivi, sans difference significative entre les deux groupes : groupe 1 contre groupe 2 : 50 % contre 67 % ; p = 0,45. Trois patients du groupe 2 avaient une reponse hemostatique complete a la fin de la premiere sequence de radiotherapie. Trois et deux patients ont souffert d’une diarrhee aigue de grade 2 ou moins respectivement dans les groupes 1 et 2. La survie mediane globale etait de six mois. Seulement trois patients (11 %) etaient toujours en vie a 2 ans. Conclusion Notre etude suggere que les schemas continu et discontinu seraient equivalents en termes de controle hemostatique et de tolerance. L’avantage du schema discontinu est logistique et organisationnel. Des etudes prospectives sont necessaires pour valider le meilleur schema de radiotherapie a visee hemostatique.

Radiotherapy has been used for skin cancers since early after the discovery of X-rays. The introduction of sophisticated surgery techniques and information of the general population on potential late radiation-induced toxicity and carcinogenesis have led to limiting indications in the dermatologist community. However, radiotherapy (RT) has undergone considerable developments, essentially including technological advances, to sculpt radiation delivery, with demonstration of the benefit either alone or after adding concomitant cytotoxic agents or targeted therapies. Although side effects due to high doses and/or the use of old RT techniques have been significantly decreased, the risk of atrophic scars, ulcerations or secondary cancers persist. In this systematic review, we aim to discuss indications for RT in melanomas with focus on new advances that may lead to rehabilitating this treatment option according to the tumor radiosensitivity and clinical benefit/risk ratio. Melanomas have been considered as radioresistant tumors for many years.