[Qualitative assessment of the multidisciplinary tumor board in breast cancer]. / Evaluation qualitative de la réunion de concertation pluridisciplinaire de cancérologie mammaire.

The optimal care for breast cancers requires at a given time that several practitioners meet regularly around the file of the patient and attend a multidisciplinary meeting (MDM). Such an initiative is not recent. The multidisciplinary approach has been applied for several years in numerous comprehensive cancer centres, and noteworthy but not exclusively in the 20 regional cancer centres. Recommendations on the organization of the MDM were published by the National Institute of the Cancer and relieved by each regional cancer networks according to the Cancer Plan of 2003. Beyond these general recommendations, the purpose of this work was to analyse the impact of the MDM on the appraisal of the professional practices. Two retrospective surveys were carried out in 2005 and in 2006 at the regional cancer centre of Reims each of them during the first 6 months of the year. They lead to a double evaluation at the same moment of the organization of the MDM (delays, exhaustiveness of the file presentation, multidisciplinary approach, and modalities of application of the clinical recommendations by the MDM). The authors suggest, from the observed results, that MDM in breast cancer research may be strongly adapted for a fine and relevant assessment of the professional practices. The specific indicators presented in this study need further discussions and will probably evolve. However and considering the important improvement observed in the clinical daily practice following the presentation of these data within the Institute Jean Godinot, the authors suggest the implementation of a similar evaluation in a small number of voluntary health care centres in order to share various experiences and validate the process.

Endobronchial brachytherapy in combination with external beam irradiation in obstructing malignant bronchial tumors.

Endobronchial brachytherapy is commonly used in the palliative management of malignant airway obstructions. In the present study, we describe the results of brachytherapy (mean dose of 18 Gy), used in combination with external beam irradiation (mean dose of 50 Gy) in 30 patients who had primary bronchogenic carcinoma of the lung. The extent of airway obstruction was determined according to symptoms and by bronchoscopy. We found symptoms improved in nearly 37% of patients and 21 of 30 patients (70%), evaluated with bronchoscopy, showed a response when evaluated 3 to 6 months after brachytherapy. This endobronchial technique appeared to be a well-tolerated procedure with a low rate of acute toxicity. The immediate complication rate was 13%, during the follow-up 3 deaths were related to treatment, of which 2 were fatal haemoptysis (12 and 18 months after irradiation). We conclude that the combination of endobronchial brachytherapy with external beam irradiation may be useful and needs further comparisons with other irradiation procedures.

[Non-metastatic prostate cancer treated with exclusive radiotherapy: prognosis of patients according to lymph node radiologic or surgical assessment method. Multivariate retrospective analysis]. / Cancers de prostate non métastatiques traités par radiothérapie exclusive: devenir des patients selon la méthode d'évaluation ganglionnaire radiologique ou chirurgicale. Une analyse rétrospective multivariée.

PURPOSE: To compare retrospectively the outcome of localized prostate cancers treated by curative external radiotherapy in which the negative lymphatic status was either surgically or radiologically assessed. METHODS AND MATERIALS: From January 1986 to December 1995, 112 patients with localized prostate cancers were found to have no evidence of lymphatic disease in the pelvis. N0 status was assessed either surgically (61 patients, group pN-) or after a CT scan procedure (51 patients, group cN0). The treatment consisted of conventional external radiotherapy using a four-fields box technique to a total dose of 65 Gy. The pelvis was never irradiated. RESULTS: The two groups did not statistically differ according to age, PSA level, Gleason score, T stage and hormonal therapy. Actuarial NED survival rates were 80% and 60% at five and ten years respectively. At ten years, the actuarial NED survival rates were 78% and 34% in the pN- and cN0 groups respectively (p = 0.003). The multivariate analysis corroborated the positive impact of lymphatic dissection before radiotherapy on disease free survival of T1-T2 patients, but not for T3 stages. CONCLUSIONS: This retrospective study suggests the inability of CT scan to accurately evaluate the lymph node status in carcinoma of the prostate. Systematic ilio-obturator nodal dissection is strongly recommended in early stages before curative radiotherapy. Only pN-patients should be included in high dose conformal irradiation trials.