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Introduction Several centers have recently been equipped with MRI-guided radiotherapy systems, including the Paoli-Calmettes Institute which was the first French center to start this activity. We report in this article our early experience. Methods Data related to patients treated on the MRIdian® (Viewray®) were prospectively collected. Procedures concerning the implementation of the system and internal organizational issues were summarized. Results Between February 2019 and March 2020, 201 patients were treated: 40% of treatments were normofractionated (n=70) and 60% used hypofractionation (n=105). The reported monthly occupancy rate at one, six and twelve months was 30%, 62%, and 90%. The distribution of normofractionated treatments was dominated by prostatic (29%) and pancreatic (26%) cancers, followed by abdomino-pelvic irradiations for gynecological cancers (12%) or lymph node diseases (12%) and boosts for rectal or vaginal cancers (11%). Regarding treatments with moderate hypofractionation (dose by fraction between 3 and 5Gy), they corresponded mainly to integrated boost for abdomino-pelvic lymph nodes (38%), while the stereotaxic treatments primarily concerned hepatic lesions (15%), bones (30%). Discussion The MRIdian® was initially used widely in our service corresponding to a learning curve for MRI guidance. This new tool for image-guided radiotherapy helped us to secure our practice providing solutions for both inter and intra-fraction movements making it possible to reduce the additional margin in order to better protect the organs at risk. The main technical difference with conventional accelerators is the possibility of performing adaptive radiotherapy in real time, the start of which was more gradual. more...

Introduction et but de l’etude Des systemes de radiotherapie guides par IRM commencent a etre disponibles sur nos plateaux techniques. En France, plusieurs centres se sont equipes recemment, dont l’institut Paoli-Calmettes (IPC) qui a ete le premier centre francais a demarrer cette activite. Nous rapportons dans cet article notre retour d’experience. Materiel et methodes Un ensemble de donnees relatives a la prise en charge des patients sur l’appareil MRIdian® (ViewRay® Technologies, Inc.) a ete recueilli prospectivement. Les demarches concernant la qualite et les problematiques organisationnelles engagees dans le service ont ete synthetisees. Resultats et analyse statistique L’appareil MRIdian® a ete achete en juin 2017 pour un debut d’installation en juillet 2018. Le premier patient a recu un traitement en fevrier 2019. Entre fevrier 2019 et mars 2020, 201 patients ont recu un traitement sur le MRIdian® a l’IPC. Le Tableau 1 reprend la repartition des patients en fonction du fractionnement. Durant cette periode 1,5 % des patients ayant eu une simulation ont ete recuses du fait d’une mauvaise visualisation lors de la simulation. Le nombre mensuel de debuts de traitement le premier, sixieme et 12e mois etait de 10, 9 et 17 respectivement. Le taux d’occupation mensuel de l’appareil etait au premier, sixieme et 12e mois de 30 %, 62 % et 90 %. Un large panel de localisations a ete traite. La repartition des traitements normofractionnes a ete dominee par les neoplasies prostatiques (29 %) et pancreatiques (26 %) suivis d’irradiations abdominopelviennes pour des cancers gynecologiques (12 %) ou des maladies ganglionnaires (12 %) et de complements d’irradiation pour des cancers du rectum ou du vagin (11 %). En ce qui concerne les traitements en hypofractionnement modere (dose par fraction entre 3 et 5 Gy), ils correspondaient majoritairement a des boosts integres pour des ganglions abdominopelviens (38 %) alors que les traitements stereotaxique concernaient en priorite des lesions hepatiques (15 %), osseuses (15 %) et vertebrales (15 %). Tous les patients beneficiaient d’un controle par imagerie dynamique en temps reel. Le « gating » prenant en compte les mouvements respiratoires a ete utilise des juin 2019 et a concerne 0 %, 44 % et 35 % des traitements au premier, sixieme et 12e mois. L’indication de radiotherapie adaptative sur table a ete retenue pour 15 dossiers depuis son introduction en octobre 2019. L’implementation de cette nouvelle machine a necessite une reorganisation de notre mode de fonctionnement : creation d’une equipe de physiciens et de manipulateurs formes, ajout d’un planning d’astreinte specifique cote physique et cote medecin avec des groupes de travail pluridisciplinaires a toutes les etapes de mise en place. Conclusion Au bilan de cette premiere annee on retient une evolution dans la nature et le nombre de localisations traitees correspondant a une courbe d’apprentissage. Les axes de reflexion principaux actuels portent sur la creation d’outils d’aide a l’homogeneisation de nos pratiques et l’amelioration de la communication des informations entre les differents intervenants. more...

Introduction et but de l’etude Le systeme d’imagerie surfacique AlignRT de VisionRT (installe en 11/2016), controle les mouvements pendant et entre les fractions lors des arctherapies volumetriques modulees du sein. La tomographie conique est faite lors des trois premieres seances puis chaque semaine. Des discordances peuvent apparaitre entre le systeme d’imagerie surfacique AlignRT et la tomographie conique du fait de modifications anatomiques. Nous avons analyse le taux d’arret du systeme AlignRT du fait de ces discordances et mesure l’impact de l’introduction en juillet 2018 d’un arbre decisionnel pour les cas complexes. Materiel et methodes De fevrier 2017 a fevrier 2019, 653 patients ont ete prises en charge par arctherapie volumetrique modulee avec le systeme d’imagerie surfacique AlignRT. Nous avons analyse retrospectivement 11375 seances et mesure les taux d’arret du systeme AlignRT du fait de discordances avec la tomographie conique. Ces taux ont ete compares avant et apres la mise en place de l’arbre decisionnel en 07/2018. Resultats et analyse statistique Les patientes ont ete repartie en deux groupes. Le groupe 1 etait constitue de 587 patientes (soit 89,8 %) prises en charge sur toute la duree de la radiotherapie avec le systeme d’imagerie surfacique AlignRT, et le groupe 2, de 66 patientes (soit 10,1 %) pour lesquelles l’utilisation du systeme AlignRT a ete arretee avant la fin de la radiotherapie, et un sous-groupe du groupe 1 (groupe 1bis, comportant 50 patientes, soit 7,6 %) chez lesquelles l’utilisation du systeme AlignRT a ete poursuivie apres la scanographie avec ou sans dosimetrie si besoin. Avant la mise en place de l’arbre decisionnel, 29 des 653 patientes du groupe 2 n’ont pas poursuivi leur traitement avec le systeme AlignRT malgre la scanographie avec ou sans la dosimetrie, contre 50 des 653 du groupe 1bis. ; 37 patientes sur 653 n’ont pas eu de scanographie malgre les discordances entre l’imagerie surfacique AlignRT et la tomographie conique. Apres la mise en place de l’arbre decisionnel, le taux d’arret d’utilisation d’AlignRT a baisse de 11,18 % (52 patientes sur 465) a 7,4 % (14 patientes sur 188). L’augmentation de l’utilisation du systeme AlignRT etait due au recours plus frequent a une scanographie avec ou sans une dosimetrie si necessaire (scanographie avec dosimetrie : 4,94 % contre 18,7 % ; scanographie seule : 2,79 % contre 7,48 %) Conclusion Le systeme d’imagerie surfacique AlignRT permet un controle efficace pour 90 % des traitements. Pour les 10 % restants, l’utilisation du systeme AlignRT a ete arretee du fait de discordances avec la tomographie conique. L’implementation d’un arbre decisionnel a permis de diminuer de facon significative le taux d’arret definitif de l’utilisation du systeme AlignRT. more...

Background and purpose In 2003, the French Authority for Health (HAS) recommended the use of intensity modulated radiotherapy (IMRT) in prospective trial before its routine use. The Oncology and Radiotherapy Group for Head and Neck Cancer (GORTEC) proposed to evaluate prospectively acute and late toxicities, locoregional control and overall survival for patients treated for head and neck cancer (HNC) with IMRT and bilateral neck irradiation. Materials and methods Between 2002 and 2008, 208 patients with HNC were treated with IMRT in 8 centres. There were 38 nasopharynx, 117 oropharynx, 25 pharyngo-larynx, 24 oral cavity and 4 unknown primary (28.5% stage I–II and 71% Stage III–IV). Ninety-three patients (46%) had postoperative IMRT and 78 patients (37.5%) received concurrent chemotherapy. The doses were 70Gy to the gross tumour, 66Gy to the high-risk postoperative sites and 50Gy to the subclinical disease. Toxicities were graded according to the RTOG–EORTC scales. Results The median follow-up was 25.3months (range: 0.4–72months). There were 29 local–regional failures: 24 were in-field, three were marginal and one was out-field. The two-year loco-regional control and overall survival were 86% and 86.7%, respectively. At 18months, grade ⩾2 xerostomia was 16.1%. A mean dose to the spared parotid below 28Gy led to significantly less grade ⩾2 xerostomia (8.5% vs 24%) with a relative risk of 1.2 [95% CI: 1.02–1.41, p =0.03]. Grade ⩾2 xerostomia increased by approximately 3% per Gy of mean parotid dose up to 28, Gy then 7% per Gy above 33Gy. Conclusions IMRT for HN cancer seems to reduce late toxicities without jeopardising local control and overall survival. more...

This prospective study reports the impact of weight loss on setup of head and neck (HN) cancer patients treated by Intensity-Modulated Radiation Therapy (IMRT).Setup errors of HN cancer patients treated by IMRT from January to June 2010 were prospectively analysed and statistically related to weight loss. A mixed linear model was used for statistical evaluations. Setup margins of our institute were also calculated.Twenty-two patients and 128 pairs of Electronic Portal Images (EPI) were analysed. Setup errors varied between -0.6 and +0.6, -0.7 and +0.8 and -0.2 and +0.8 in the anterior-posterior, superior-inferior and right-left direction, respectively. Median and mean weight loss were 2.1 and 3.1 kg (range 0-12 kg), respectively; median and mean percent of weight loss were 2.95% and 4.64% (range 0.3-19.7%), respectively. No statistical relation was seen between weight loss and the setup errors.Weight loss is not a good clinical parameters for predicting an increase of setup errors. Other clinical and/or anthropometrical features should be prospectively evaluated in order to assess the need for re-planning. more...

Allowing cancer patients to hold medical records containing essential information for managing their disease may improve their satisfaction and the coordination of their medical care. Objective. Our aim was to determine breast cancer patients' interest in and expectations of such medical records and the exchange of information during their treatment. Methods. Eighty-six hospital physicians were selected to distribute an anonymous questionnaire to all of the breast cancer patients they saw in consultations. Results. Out of 194 patients asked, 140 (72%) participated in the survey. Forty-eight percent were "highly satisfied", 47% were "quite satisfied" with their involvement in their treatment and 43% preferred to play a relatively passive role in decisions concerning treatments. When offered, 79% agreed to hold paper medical records containing test results, reports and letters. Many found these medical records to be useful and a possible means for improving communication. Others, however, expressed reservations concerning privacy or losing or forgetting the records. Conclusion. The principle of shared medical records could satisfy the majority of breast cancer patients. Experimenting with this concept in the field would enable practitioners to better determine the content of the records and how they can be used on a practical basis. more...

To report our patient experience with squamous cell carcinoma of the anal margin and to evaluate the prognostic factors influencing outcome. Between 1980 and 2001, 26 patients with anal margin squamous cell carcinoma were treated in Lyon-Sud: 7 T1, 14 T2, 4 T3, and 1 T4 with 20 N0, 3 N1, and 3 N2. The anal canal was invaded in five patients. Treatment consisted of definitive external irradiation in 14 patients and adjuvant irradiation (after a local excision) in 12 patients. External irradiation was combined with chemotherapy in seven patients, brachytherapy in four patients, and both brachytherapy and chemotherapy in one patient. The local control rate was initially 61.4%, and it was 80.8% after salvage treatment. The 5-year overall and specific survival rates were 71 and 88.3%, respectively. Three factors correlated with specific survival: cell differentiation (P=0.038) and T (P=0.001) and N category (P=0.0005). A salvage abdominoperineal resection was successfully employed in five of seven local recurrences. Four grade 3 and two grade 4 toxicities were observed. Sphincter preservation was possible in 66% of alive patients. Our results confirm the dominating place of definitive irradiation and radiochemotherapy in the treatment of anal margin squamous cell carcinoma. The indications for abdominoperineal resection must be limited to local relapse. The prognosis of squamous cell carcinoma is correlated to T and N staging and cell differentiation. more...

This article reviews the concept of selectivity in peritumoral microscopic disease to be included in the Clinical Target Volume (CTV) for elective treatment for oral cavity and oropharyngeal squamous cell carcinoma, using the local tumoral spread. The objective of the present article is to present a procedure for the delineation of the target volumes, required for an appropriate application of 3-DCRT and IMRT for head and neck cancers. These propositions are for the delineation of microscopic peritumoral target volumes when external beam irradiation is required. CTVs are illustrated on CT sections. more...

This retrospective 12-year study evaluated the prognostic value of initial and postoperative staging of rectal tumors.Between 1985 and 1996, 297 patients were treated with preoperative radiotherapy (39 Gy in 13 fractions) and surgery for Stage T2-T4N0-N1M0 rectal adenocarcinoma. Pretreatment staging included a clinical examination and endorectal ultrasonography (EUS) since 1988. Clinical staging was performed by digital rectal examination and rigid proctoscopy. EUS was performed in 236 patients. Postoperative staging was performed by examination of the pathologic specimen.The median follow-up was 49 months. The overall 5-year survival rate was 67%, with a local failure rate of 9%. The rate of sphincter preservation was 65%. The clinical examination findings were strong prognostic factor for both cT stage (p0.001) and cN stage (p0.006) but had poor specificity for cN stage (only 25 lymph nodes detected). In both univariate and multivariate analyses, EUS had a statistically significant prognostic value for uT (p0.014) but not for uN (p0.47) stage. In contrast, pT and pN stages were strong prognostic factors (p0.001 and p0.001, respectively).Pretreatment staging, including clinical examination and EUS, seemed accurate enough to present a high prognostic value for the T stage. EUS was insufficient to stage lymph node involvement. Owing to its lack of specificity, uN stage was not a reliable prognostic factor. An improvement in N staging is necessary and essential. Despite downstaging, postoperative staging remained a very strong prognostic factor for both T and N stages. more...

Clémence Guenne,1 Jérôme Fayette,2 Alain Cosmidis,1 Carine Fuchsmann,1 Sophie Tartas,3 Véronique Favrel,4 Philippe Céruse1 1Head and Neck Surgery Department, Lyon-I University, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France; 2Medicine Department, Lyon-I University, Centre Léon Bérard, Lyon, France; 3Medical Oncology Department, Lyon-I University, Hospices Civils de Lyon, Lyon Sud Hospital, 4Radiotherapy Department, Lyon-I University, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France Background: No specific study has focused on patients with metastatic squamous cell carcinoma of the head and neck (SCCHN) at diagnosis. Due to high response rates of induction chemotherapy in chemo-naïve patients with localized disease, their prognosis should be better than patients with recurrent disease.Methods: From January 1, 2008 to July 1, 2012, we retrospectively collected all patients’ records with SCCHN diagnosed as metastatic. Patients, disease, treatment and its results were analyzed. Survival was calculated using the Kaplan–Meier method.Results: Of the 749 new patients treated for SCCHN in our institution, 16 (2.1%) were metastatic at diagnosis, of whom five had cytological results to prove it. Six patients died before treatment or had palliative care and ten received initial chemotherapy and then surgery and/or radiotherapy according to the primary response. Four patients treated with first-line chemotherapy with docetaxel-5FU-cisplatin (TPF) showed a complete response of metastatic lesions allowing locoregional treatment. The overall survival at 1 year and 3 years was 50% and 24%, respectively. The median survival was 7 months (1–72 months). Seven patients (43.7%) had a higher survival at 12 months, including five (31.5%) who are still alive without recurrence with a mean follow-up of 30 months. There was a significant difference in overall survival (P more...

Resume Objectif. – Analyser le processus de soins « radiotherapie externe ambulatoire » en le decomposant en actes elementaires, et determiner des inducteurs de cout (en temps personnel et en temps machine consomme, en materiel), dans un objectif de valorisation de l'activite de radiotherapie. Materiels et methodes. – Le processus de soins a ete analyse en terme de consommation de moyens humains et materiels representant un cout pour l'hopital, du 1er juin 1997 au 1er septembre 1997, dans deux services de radiotherapie, le centre hospitalo-universitaire de Saint-Etienne et le centre de lutte contre le cancer de Lyon. La valorisation a ete faite en unites physiques pour les consommables, et en unites de temps (moyens humains et equipement lourd). Des parametres susceptibles de modifier la consommation de moyens ont ete definis. Les donnees suivantes ont ete recueillies pour chaque activite : caracteristiques du patient, caracteristiques du processus, parametres specifiques de chaque activite, donnees liees au personnel soignant, service d'origine. Resultats. – Il est mis en evidence, d'une part, le poids des variables specifiques de l'activite et, d'autre part, deux criteres : le niveau de complexite de la dosimetrie — seul critere expliquant la dispersion des mesures pour nombre d'activites —, et l'inclusion dans un protocole de recherche. Les modalites d'irradiation corporelle totale et de radiotherapie de conformation sont bien individualisees. Il n'a pas ete constate de differences significatives en consommation de moyens entre les deux services. L'absence d'inducteurs de couts significatifs pour l'activite « contention-simulation » reflete la diversite des pratiques, et necessite une analyse globale du processus « preparation du traitement ». Conclusion. – Les inducteurs de cout retrouves dans cette etude pourraient permettre l'elaboration d'indice de couts relatifs pour la radiotherapie externe, apres avoir valide les resultats obtenus dans d'autres structures de soins. Ces indices de cout relatif decriraient les differentes phases du traitement (« preparation du traitement » ; « dosimetrie » ; « traitement » ; « controle de qualite »). Ce travail est actuellement en cours dans le cadre du PMSI (programme de medicalisation des systemes d'information) et de la revision de la NGAP (nomenclature generale des actes professionnels). more...

Resume Les essais randomises de la litterature ne permettent pas de demontrer clairement que la radiotherapie preoperatoire augmente les chances de conservation sphincterienne dans le cancer du rectum. Il est possible qu'un delai de quatre a six semaines entre la radiotherapie et la chirurgie permette pour les cancers tres bas situes d'ameliorer les chances de conservation. Il faut s'assurer que cette conservation preserve un anus reellement fonctionnel et n'expose pas a un taux de rechute locale plus eleve. Les essais en cours d'escalade de dose et de chimioradiotherapie apporteront des donnees interessantes pour repondre a cette question complexe. more...

No specific study has evaluated the role of neoadjuvant DCF (docetaxel, cisplatin, 5-fluorouracil) followed by radiotherapy in pyriform sinus cancer, which are often included in studies focusing on laryngeal and hypopharyngeal cancer. We assessed the proportion of patients treated sequentially for a pyriform sinus cancer with a preserved larynx. Overall survival, event-free survival (EFS), survival with 'local control', and treatment tolerance were assessed as well. We retrospectively reviewed 88 patients with advanced pyriform sinus squamous cell carcinoma treated with DCF between 2005 and 2010. After induction, radiation could be potentiated with cetuximab or cisplatin. Most patients (82%) had been treated with organ preservation intent. The response rate to DCF was 85%, including 42% with complete response. Primary tumor was operated in 13 patients (eight with total laryngectomy). Radiotherapy had been delivered to 78 (89%) patients (30 with cisplatin, 39 with cetuximab). Potentiation had been achieved as planned in 52 and 79% of patients treated with cisplatin and cetuximab, respectively. Twenty-three local and three neck recurrences were found. Median overall survival was 16.8 months and 38.3% at 3 years. EFS at 3 years was 29.1% with a hazard ratio for partial responders versus nonresponders of 0.18 (P more...

Neoadjuvant TPF (docetaxel, cisplatin, 5-fluorouracil), followed by radiotherapy or chemoradiotherapy with weekly carboplatin, increases overall survival and organ preservation. We assessed whether TPF could be used in routine practice and whether radiotherapy potentiated with cisplatin or cetuximab was feasible and could increase survival. We retrospectively reviewed 157 patients with advanced head and neck squamous cell carcinoma treated with TPF in four French institutions between May 2005 and March 2009. After induction, operable patients had undergone surgery and were irradiated, and potentiated in some cases with cetuximab or cisplatin. Most patients (79%) had been treated with organ preservation strategies. The two most common sites were the hypopharynx (34%) and the oropharynx (30%). The response rate to TPF was 84%, including 26% with a complete response. Radiotherapy had been provided to 144 (92%) patients (of whom 17 had received radiotherapy alone, 46 had received q3w cisplatin, 30 had received q1w cisplatin, and 37 had received cetuximab). Potentiation had been achieved as planned in 59, 63, and 62% of patients treated with q3w cisplatin, q1w cisplatin, and cetuximab, respectively. After a median follow-up of 39.9 months, the median overall survival was 43 months. No significant difference was observed in progression-free survival or overall survival according to the type of potentiation. This study confirms the efficacy and tolerability of TPF induction, followed by chemoradiation, with outcomes similar to those for patients irradiated without induction. The best potentiation of radiotherapy after induction has not yet been determined. more...

Summary Background Concomitant chemoradiotherapy and accelerated radiotherapy independently improve outcomes for patients with locally advanced head and neck squamous-cell carcinoma (HNSCC). We aimed to assess the efficacy and safety of a combination of these approaches. Methods In our open-label phase 3 randomised trial, we enrolled patients with locally advanced, stage III and IV (non-metastatic) HNSCC and an Eastern Cooperative Oncology Group performance status of 0–2. We randomly allocated patients centrally with a computer program (with centre, T stage, N stage, and localisation as minimisation factors) in a 1:1:1 ratio to receive conventional chemoradiotherapy (70 Gy in 7 weeks plus three cycles of 4 days' concomitant carboplatin-fluorouracil), accelerated radiotherapy-chemotherapy (70 Gy in 6 weeks plus two cycles of 5 days' concomitant carboplatin-fluorouracil), or very accelerated radiotherapy alone (64·8 Gy [1·8 Gy twice daily] in 3·5 weeks). The primary endpoint, progression-free survival (PFS), was assessed in all enrolled patients. This trial is completed. The trial is registered with ClinicalTrials.gov, number NCT00828386. Findings Between Feb 29, 2000, and May 9, 2007, we randomly allocated 279 patients to receive conventional chemoradiotherapy, 280 to accelerated radiotherapy-chemotherapy, and 281 to very accelerated radiotherapy. Median follow-up was 5·2 years (IQR 4·9–6·2); rates of chemotherapy and radiotherapy compliance were good in all groups. Accelerated radiotherapy-chemotherapy offered no PFS benefit compared with conventional chemoradiotherapy (HR 1·02, 95% CI 0·84–1·23; p=0·88) or very accelerated radiotherapy (0·83, 0·69–1·01; p=0·060); conventional chemoradiotherapy improved PFS compared with very accelerated radiotherapy (0·82, 0·67–0·99; p=0·041). 3-year PFS was 37·6% (95% CI 32·1–43·4) after conventional chemoradiotherapy, 34·1% (28·7–39·8) after accelerated radiotherapy-chemotherapy, and 32·2% (27·0–37·9) after very accelerated radiotherapy. More patients in the very accelerated radiotherapy group had RTOG grade 3–4 acute mucosal toxicity (226 [84%] of 268 patients) compared with accelerated radiotherapy-chemotherapy (205 [76%] of 271 patients) or conventional chemoradiotherapy (180 [69%] of 262; p=0·0001). 158 (60%) of 265 patients in the conventional chemoradiotherapy group, 176 (64%) of 276 patients in the accelerated radiotherapy-chemotherapy group, and 190 (70%) of 272 patients in the very accelerated radiotherapy group were intubated with feeding tubes during treatment (p=0·045). Interpretation Chemotherapy has a substantial treatment effect given concomitantly with radiotherapy and acceleration of radiotherapy cannot compensate for the absence of chemotherapy. We noted the most favourable outcomes for conventional chemoradiotherapy, suggesting that acceleration of radiotherapy is probably not beneficial in concomitant chemoradiotherapy schedules. Funding French Ministry of Health. more...

International audience; BACKGROUND AND PURPOSE: Post-operative radiotherapy is indicated for the treatment of head and neck cancers. In vitro, chemotherapy potentiates the cytotoxic effects of radiation. We report the results of a randomized trial testing post-operative radiotherapy alone versus concomitant carboplatin and radiotherapy for head and neck cancers with lymph node involvement. MATERIALS AND METHODS: The study involved patients undergoing curative-intent surgery for head and neck cancers with histological evidence of lymph node involvement. Patients were randomly assigned to receive radiotherapy alone (54-72Gy, 30-40 fractions, 6-8 weeks) or identical treatment plus concomitant Carboplatin (50mg/m(2) administered by IV infusion twice weekly). RESULTS: Between February 1994 and June 2002, 144 patients were included. With a median follow-up of 106 months (95% confidence interval (CI) [92-119]), the 2-year rate of loco-regional control was 73% (95% CI: 0.61-0.84) in the combined treatment group and 68% (95% CI: 0.57-0.80) in the radiotherapy group (p=0.26). Overall survival did not differ significantly between groups (hazard ratio for death, 1.05; 95% CI: 0.69-1.60; p=0.81). CONCLUSIONS: Twice-weekly administration of carboplatin concomitant to post-operative radiotherapy did not improve local control or overall survival rates in this population of patients with node-positive head and neck cancers. more...

This article reviews the concept of selectivity in peritumoral microscopic disease to be included in the Clinical Target Volume (CTV) for elective treatment for oral cavity and oropharyngeal squamous cell carcinoma, using the local tumoral spread. The objective of the present article is to present a procedure for the delineation of the target volumes, required for an appropriate application of 3-DCRT and IMRT for head and neck cancers. These propositions are for the delineation of microscopic peritumoral target volumes when external beam irradiation is required. CTVs are illustrated on CT sections. more...

Purpose: To evaluate the role of interstitial brachytherapy as an exclusive radiotherapy modality for primary T1-T2 squamous cell carcinomas (SCC) of the velotonsillar area. Methods and Materials: Between 1992 and 2000, 44 patients with T1-T2 SCC of the tonsil (n = 36) and soft palate (n = 8) were treated to the primary with brachytherapy alone (37 patients) or after a limited resection (7 patients). Eight patients had prior external beam radiation therapy (EBRT) for previous head-and-neck carcinoma. Nineteen patients had initial neck dissection. The mean brachytherapy dose was 58.7 Gy, and the mean reference dose rate and Ir-192 linear activity were 58.2 cGy/h and 1.51 mCi/cm respectively. Results: With a 75-month median follow-up, 1 patient recurred locally. Isolated nodal relapses occurred in 4 patients, none of whom had initial neck dissection, and salvage therapy was successful in 2. Five-year overall and progression-free survival rates were 76% and 68%, respectively. Full-course radiation therapy was possible in 7 of 12 patients who developed a second primary head-and-neck carcinoma. Late toxicity was limited to 6 mild soft-tissue necroses, and was significantly associated with previous surgery to the primary and high linear activity. Conclusions: Exclusive brachytherapy for T1-T2 velotonsillar carcinomas is safe and effective, and permits definitive reirradiation for a second head-and-neck cancer. Initial neck dissection should be performed for optimal selection for exclusive brachytherapy. more...

International audience; To estimate the real figure of the potential patient recruitment for hadrontherapy we carried out a survey directly in 5 radiation therapy departments of the East of France as a "one-day survey". The results presented account for 77 cases of potential indications among 532 evaluated medical records. more...

But de la presentation En 2011, la Haute Autorite de sante (HAS) a preconise la mise en place d’une Reunion de concertation pluridisciplinaire (RCP) dans la prise en charge des schwannomes vestibulaires. Nous avons effectue une mise au point 29 mois apres le lancement d’une RCP des tumeurs de la base du crâne dans notre centre hospitalo-universitaire. Les objectifs de l’etude etaient d’evaluer la concordance entre la decision RCP et le traitement final, et, parmi les patients presentant un schwannome vestibulaire, de comparer nos decisions au referentiel. Enfin nous avons etudie le devenir des patients dont la decision de la RCP etait une surveillance radiologique. Materiel et methodes Il s’agit d’une etude retrospective descriptive de l’ensemble des dossiers valides en RCP de janvier 2011 a mai 2013. Resultats 455 dossiers ont ete valides en RCP durant cette periode. La concordance globale entre la decision de la RCP et le traitement final etait de 93 %. Il s’agissait pour une grande majorite (79,8 %) de schwannomes vestibulaires pour lesquels les propositions therapeutiques etaient dans 81,8 % des cas conformes au referentiel propose par l’IRSA. Les causes de discordance etaient principalement la surveillance des schwannomes vestibulaires debordant legerement dans l’angle ponto-cerebelleux (stade II) ou de reoperer par voie translabyrinthique des residus evolutifs, initialement operes par voie retro sigmoidienne. Dans 53,4 % des cas, le traitement choisi etait une surveillance radiologique mais parmi les 104 dossiers surveilles entre janvier 2011 et juillet 2012, nous avons mis en evidence un taux de perdus de vue de 23 %. Conclusion La prise en charge des schwannomes vestibulaires reste discutee mais elle est le plus souvent intimement liee a son evolutivite. La mise en place d’une RCP permet d’ameliorer notre pratique professionnelle et de mettre en place un registre local qui permettrait de limiter les perdus de vue parmi les patients presentant un schwannome vestibulaire potentiellement evolutif. more...

Cancer is still considered from a physiopathological point of view as a disease of the cell. This concept is underlying the idea of cure. Treatment with curative intent should aim at eradicating all the tumoral cells. Local control is mandatory and essential in cancers localized in organ with vital function. In breast cancer a complex and controversial relationship exists between local relapse and increased risk of fatal distant metastasis. In case of organ preserving treatment, a complete local control is necessary from the start. If a too high risk of local relapse is foreseable, conservative treatment should not be recommended. more...

To study retrospectively the relapse rate, the functional results and the survival rate in patients with rectal carcinoma treated with local excision and adjuvant radiotherapy.Between 1980 and 1995, 43 patients were treated. All cancers were infiltrating tumours except 4 high grade dysplasias with positive margins. The pT classification was: pT1 (n=34), pT2 (n=4), pT3 (n=1). In 4 cases the depth of penetration of the tumor into the bowel wall was not evaluable. The endo-anal excision was performed by surgery (n=20) or by endoscopy (n=23). Only the tumor bed was irradiated in 35 cases (contact x-ray therapy: 30, interstitial iridium implant: 5) and in 8 cases the whole rectum was irradiated with external beam radiotherapy (+/- endocavitary irradiation).Median follow-up was 72 months. Four malignant relapses were observed (local: 1, perirectal lymphatic: 2, distant metastasis: 1). The overall 5- and 10-year survival rates were 80 and 68%, respectively. A total of 41 patients preserved a normal sphincter (95%). The anal function was evaluated as excellent or good in all the cases. No severe radiation toxicity was observed.Small rectal carcinomas T1 N0 can be effectively treated in most cases by local excision and postoperative radiation therapy. A close multidisciplinary collaboration is necessary to achieve an optimal result. more...

Two sequences of concomitant chemotherapy with 5-FU + cisplatin and hyperfractionated radiotherapy (67.2 Gy/56 fractions/38 days, two fractions of 1.2 Gy per day spaced to 6 hours) in the bladder volume were administered to 17 patients with infiltrative carcinoma of the bladder (1 pT1, 6 pT2, 8 pT3a, 2 pT3b or pT4, 8/17 N0-2). They were separated by an interval of 21 days with an intermediate bladder tumor evaluation. A complete histological response was observed in 69% (11 of 16 evaluable patients). With a mean follow-up of 21 months, the bladder preservation was stated in 8/11 (73%) of patients treated, of whom 6 with a complete tumor response, and 2 with a pTa recurrence; these results are similar to other series reported with conventional radiation therapy. No deficit in the bladder was observed in these eight patients. more...

e17011 Background: Only few studies report organ preservation in piriform sinus carcinomas (PSC), with no publication on induction chemotherapy (IC) with docetaxel, cisplatine, 5FU (DCF) followed by radiotherapy plus cisplatin (RTCis) or cetuximab (RTCet). We assessed compliance, survival and organ preservation after IC by DCF followed by RTCis or RTCet in a retrospective multicentric review of patients (pts) with advanced PSC. Methods: We analyzed retrospectively 88 pts with advanced PSC treated between 2005 and 2011 in 3 tertiary care centers with organ preservation protocol strategy ongoing in each center. DCF was followed by RTCet (56.5%) in 1 center and by RTCis(42%) in the 2 others. Primary endpoints were acute toxicity and compliance to IC and RTCis compliance compared with RTCet. Secondary endpoints were overall survival (OS), disease free survival (DFS) and laryngectomy free survival (LFS). Results: Within the 88 pts, 21.6% were stage III and 72.7% stage IV; 81% completed the full course of IC. For 64.8% of pts no toxicity was reported. The main side effect observed was neutropenia (18.2%). Two deaths (2%) were directly related to the IC. Concerning the radiotherapy, 59% of the pts had full dose concomitant cisplatin versus 85% with cetuximab (pstage IV, p more...

e17012 Background: This study aimed to assess compliance and survival after induction chemotherapy (IC) with docetaxel, cisplatin, fluorouracil (DCF) followed by radiotherapy plus cisplatin (RTCis) or radiotherapy plus cetuximab (RTCet) in a retrospective multicentric series of 121 patients with locally advanced oropharyngeal cancer. One of the issues of these chemotherapy regimens is the toxicity that adversely affects the compliance to the concomitant radiochemotherapy treatment. We also evaluated feasibility and completion of radiochemotherapy treatment comparing efficacy and toxicity between RTCet and RTCis. Methods: Multicentric retrospective review of 121 consecutive patients with non resectable or non operable oropharyngeal carcinomas treated between 2005 and 2011 in 3 tertiary care centers with protocol ongoing in each center. In one center DCF, is followed by RTCet, in the 2 other centers, DCF is followed by RTCis. Primary endpoints were acute toxicity of IC and compliance to the RTCis compared with RTCet. Secondary endpoints were overall survival, disease free survival and locoregional control. Results: Within the 121 patients, 20.7% were stage III and 79.3% were stage IV. 81.8% of the patients completed the full course of IC. 50% of the patients had full dose concomitant cisplatin versus 77% of the patients that had full dose concomitant cetuximab (p=0.017). Mean follow up was 23.5 months. Median overal survival was 20.7 months, median disease free survival was 18.6 months. The 3 and 5 year overall survival rates were respectively 52.5% and 46.4%. The 3 and 5 year disease free survival rates were 44.2% and 38.3%. The only significant factor affecting survival was IC response (p more...

6074 Background: nTPF, followed by RT or radiochemotherapy (CRT) with weekly carboplatin (N Engl J Med 2007;357: 1695 and 1705) increased overall survival (OS) and organ preservation. We determine toxicity and efficacy of nTPF in unselected pts, then CRT with P or cetuximab (Cx). Methods: We retrospectively reviewed 123 pts with head and neck cancer (5 M+) treated with nTPF (T and P 75 mg/m2, both d1, F 750 mg/m2/d, d1–5) q 3 wks, for 3 or 4 cycles in three institutions in Lyon (France) between May 2005 and August 2007. Surgery was performed for operable patients in case of PD or insufficient response. Results: Median age was 56 years [32–78]. Localizations: oral cavity (9%), oropharynx (27%), hypopharynx (33%) larynx (19%), rhinopharynx (5%) or other (7%). Two pts died after 1st cycle of nTPF, 1 after 2nd and 2 during RT. After the first cycle, despite systematic use of G-CSF, 23% of pts displayed grade 3–4 neutropenia, with 14% of febrile neutropenia; 24% reversible elevation of creatinine, 7% grade 3–4... more...