[Chimo-radiotherapie dans les lymphomes de hodgin-stades precoces]

To evaluate the response to and toxicities of chemo-radiotherapy [CT-RT] in patients with early stage Hodgkin lymphoma treated in our institution. Retrospective study of 42 patients with early stage Hodgkin lymphoma treated between 2002 and 2007. The age of patients ranges from 11 to 57 with a mean of 30.7 years ; the sex-ratio is 0.8 [19 males and 23 females]. There are 33 cases of nodular-sclerosing Hodgkin lymphoma, 6 of mixed cellularity, one lymphocyte-rich, one interfollicular and one granulomatous. As for the stages, 31 Hodgkin lymphomas are stage IIA, 6 stage IA, 3 bulky and 2 stage IAe. The ABVD protocol was given to 38 patients, the VBVP to 3 patients and the ABV to one patient. IFRT was used with dose ranging from 19.8 to 39.6 Gy. The acute toxicity of chemotherapy was hematologic only, grade 1 anemia accounting for 11.1% and grade 2 anemia for 14.8%, grade 1 leukopenia for 51.8%, grade 2 leukopenia for 33.3% and grade 3 leukopenia for 14.8%. Dysphagia, radiodermitis and radiomucositis were seen after radiotherapy, accounting for 16.5%, 4.6% and 9.1% respectively. No long-term toxicity of the combined therapy was found. During the follow-up period, one relapse occurred and no death was reported. The overall survival [OS], the disease free survival [DFS] and the toxicities of the combined therapy CT-RT of the patients with early stage Hodgkin lymphoma stage IA and IIA treated in our institution were similar to those seen in the literature

[ role of radiotherapy in the treatment of ductal carcinoma in situ of the breast]

The incidence of ductal carcinoma in situ [DCIS] of the breast discovered during screening mammography is rising. This finding has led to the possibility of further breast conservation. We reviewed in this article the role of radiotherapy in the context of breast conservation. Randomized and non-randomized trials as well as meta-analyses and textbooks dealing with radiotherapy for DCIS have been retrieved from the published literature. Databases for ongoing trials have also been checked. Non randomized studies showed a poor local control with surgery alone, with local recurrences varying between 20 and 40% at 10 years. The use of radiotherapy led to a significant decrease in local relapse thus giving the rationale for phase III trials evaluating the role of radiotherapy. To date there are four trials published dealing with radiotherapy for DCIS: EORTC 10853, NSABP B-17, SweDCIS and UKCCCR. All these studies showed a significant decrease in the local relapse to values around 15% at 10 years. This benefit did not however translate into any survival gain. The effect of radiotherapy was seen in all patients sub-groups. However, controversies about the necessity of irradiating all patients and about the dose of the radiation to deliver remain present. Ongoing trials trying to provide answers to these controversies are reviewed. Conservative surgery followed by radiotherapy to the whole breast to a dose of 50 Gy remains the standard for breast DCIS discovered with screening mammography. This treatment should be discussed with all patients until randomized data provide evidence of a low risk category that should not have adjuvant radiation. The use of a boost on the tumor bed remains to be discussed for young patients who have positive margins only until data derived from phase III trials are available

Evaluation de la toxicite aigue chez 50 patients atteints de cancer de la prostate traites par radiotherapie conformationnelle

Purpose: To report our experience with 3D conformal radiotherapy for prostate cancer material and methods: We reviewed our first 50 patients diagnosed with prostate cancer. Median follow-up was 27 months [16-40 m]. Median age 68 [52-74] T stage was T1c = 12 T2a = 14 T2b = 10 T2c = 2 T3a = 10 T3b = 1 and T3c = 1. Gleason score [GS] 4-6 50% and GS 7-8 50%. Pretreatment PSA.value of < 10 ng/ml 36%, 10-20 ng/ml 32% and >20 ng/ml 32%. Forty patients received androgen ablation therapy 2 to 6 months before radiation. 3D conformal radiotherapy was used to allow a smaller amount of rectum and bladder to be in the high dose volume. An 18 Mv linear accelerator was used. The first 21 patients received 66 Gy, 28 patients received 70 Gy and one 74 Gy.The mean prostate volume was 45 cc for patients who received androgen ablation and 54 for the others [p = 0.02]. The percentage of volume receiving more than 50 Gy [V50] was calculated for the rectum and bladder. The median V50 was 30% [10-55] for the rectum and 36% [5-70] for the bladder. Based on the RTOG grading [gr] for acute toxicity, there was no gr 3 gastrointestinal [GI] toxicity and only 1 gr 3 genitourinary [GU] toxicity. There were 9 gr 1 and 5 gr 2 GI toxicity, 10 gr 1 and 5 gr 2 GU toxicity. With our actual follow-up we have 2 late morbidities: gr 2 GLI and one erectile failure.3D conformal radiotherapy for prostate cancer has a good toxicity profile. Longer follow-up is needed to assess late toxicity and clinical outcome in this series