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1.
Cancer Radiother ; 20(5): 395-9, 2016 Jul.
Article in French | MEDLINE | ID: mdl-27421622

ABSTRACT

PURPOSE: Radiotherapy is a rare indication in paediatric oncology, with 800 to 900 children in treatment per year in France. Child cancers represent approximately 1% of cancers in France and half occur before the age of 5 years. Paediatric radiation requires appropriate tools, local, time and specific training. In France, in 2015, 18 centres are accredited by the French National Cancer Institute (INCa) for this activity. MATERIAL AND METHODS: Survey conducted in February 2015 on the care of children (0 to 18 years) in radiotherapy departments in France. The survey was sent to the radiation oncologists involved in the 18 centres. The questions concerned the qualitative and quantitative aspect, medical and organizational aspects, and the involvement of assistant practitioners in the management of this activity. RESULTS: Seventeen centres responded. In 2014, 889 children under 18 were treated in radiotherapy departments. These departments are working together with one to four paediatric oncology departments. Regarding access to general anaesthesia: three centres perform one to seven treatment(s) under anaesthesia per year, three centres eight to ten treatments under anaesthesia per year, three centres ten to 24 treatments under anaesthesia per year and nine centres out of 17 use hypnosis techniques. In terms of human resources, in 2015, 29 radiation therapists have a paediatric radiotherapy activity. Involvement of assistant practitioners is growing and specific training are desired. Regarding treatment preparation and delivery, 13 centres have specific paediatric contentions, 14 of 16 centres employ radiation intensity modulated if dosimetry is more satisfying with 11 regularly to the craniospinal irradiation. Radiotherapy on moving areas with respiratory gating or hypofractionation is under developed. CONCLUSION: Paediatric radiation therapy is a specific activity requiring a dedicated management, both in human, organizational, medical and scientific aspects.


Subject(s)
Pediatrics , Practice Patterns, Physicians'/statistics & numerical data , Radiotherapy/methods , Radiotherapy/statistics & numerical data , Allied Health Personnel/statistics & numerical data , Anesthesia, General/statistics & numerical data , Child , France , Humans , Neoplasms/radiotherapy , Societies, Medical , Surveys and Questionnaires , Technology, Radiologic , Workforce
2.
Cancer Radiother ; 20(4): 304-7, 2016 Jun.
Article in French | MEDLINE | ID: mdl-27342946

ABSTRACT

A survey was conducted in 2015 in France on the care of children in radiotherapy services. We present the results for total body irradiation in children, a specific technique of radiation treatment, which needs dedicated controls for this particular population. Of the 17 centres interviewed, 16 responded, and 13 practiced total body irradiation. Patients are positioned in lateral decubitus in 11 centres and supine/prone in two centres. Doses used for total body irradiation in myeloablative bone marrow transplantation are the same in all centres (12Gy); treatments are always fractionated. Lung shielding is positioned to limit the dose at an average of 8Gy with extremes ranging from 6 to 10Gy. The shape of the shieldings varies depending on departments' protocol, with a smaller size in case of mediastinal mass. Four centres have experience of total body irradiation under general anaesthesia, despite twice-daily fractions. In total, practice is relatively homogeneous throughout France and is inspired by the knowledge obtained in adults.


Subject(s)
Practice Patterns, Physicians'/statistics & numerical data , Whole-Body Irradiation/statistics & numerical data , Anesthesia, General/statistics & numerical data , Child , France , Humans , Organs at Risk , Patient Positioning/statistics & numerical data , Radiation Protection/statistics & numerical data , Radiotherapy Dosage , Surveys and Questionnaires
3.
Crit Rev Oncol Hematol ; 79(3): 308-14, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21146423

ABSTRACT

The relatively recent introduction of CyberKnife® in the field of radiotherapy has prompted the question of accessibility and usefulness of this technique for seniors. From June 2007 to June 2009, we treated 345 patients of all ages with CyberKnife as part of a single-center study. Median age was 61 years (range, 8-86 years). Ninety-eight patients were over 70 and 17 were older than 80. The treatment could not be completed with 2% (2/98) patients over 70 vs. 3.6% (9/247) among the younger (ns). Physiologic or psychologic problems in maintaining position for a long time were not more frequent among those over 70. The same was true with those over 80. Patients over 70 years old are able to tolerate CyberKnife treatment as efficiently as their younger counterparts. Elderly patients should not be restricted from access to CyberKnife radiosurgery with curative intent.


Subject(s)
Geriatric Assessment , Neoplasms/surgery , Radiosurgery , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Feasibility Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Radiotherapy Dosage , Retrospective Studies , Treatment Outcome
5.
Article in French | MEDLINE | ID: mdl-8767218

ABSTRACT

OBJECTIVE: A retrospective study of local faiture and cosmetic results after conservative surgery for retroareolar breast cancer. PATIENTS AND RESULTS: Seventy-seven patients underwent a conservative surgical procedure between 1983 and 1994. Median follow-up was 37,5 months. Fourteen patients experienced a recurrence (5 local, 2 local and distant, 7 distant). Only two probably interrelated factors were associated with a risk of local recurrence: nipple-areola complex removed or not, and pathological margins. Cosmetic results were evaluated with patient's questionnaires: 40/47 patients (85%) stated they were satisfied. CONCLUSION: In spite of the short follow-up, conservative surgery is a safe procedure for local control only in cases with negative margins. Procedure for nipple areola complex is now questionable. Cosmetic results are achieved if indication of central lumpectomy are confined to small and limited tumors. For other tumors, plastic remodelling is necessary.


Subject(s)
Breast Neoplasms/surgery , Mastectomy, Segmental/methods , Adult , Aged , Aged, 80 and over , Esthetics , Female , Follow-Up Studies , Humans , Middle Aged , Patient Satisfaction , Retrospective Studies , Surveys and Questionnaires , Survival Analysis , Treatment Outcome
6.
Acta Neurochir Suppl ; 64: 40-4, 1995.
Article in English | MEDLINE | ID: mdl-8748581

ABSTRACT

The authors present a method of stereotaxic localisation using magnetic resonance imaging (MRI) computerized tomography (CT) and digital subtracted angiography (DSA) which does not require localisation frams fixed to the patient's skull, but uses only four cranial landmarks corresponding to the holders of the neurosurgical stereotaxic frame. The method presents no major constraints in routine examinations. The geometrical distortions of the imaging devices are corrected. Three-dimensional localisation is performed using sagittal and axial slices in MRI, axial slices in CT and only two associated frontaly and lateral views in DSA. The images data are transferred to a PC-based system. By locating the landmarks on the images, the transformation matrixes can be computed to obtain the 3D coordinates of a target in the stereotaxic space and in any imaging modality. The results obtained show the precision of the corrections and the millimetre accuracy of pin-point target localisation.


Subject(s)
Angiography, Digital Subtraction/instrumentation , Cerebral Angiography/instrumentation , Image Processing, Computer-Assisted/instrumentation , Magnetic Resonance Imaging/instrumentation , Stereotaxic Techniques/instrumentation , Tomography, X-Ray Computed/instrumentation , Equipment Design , Humans , Microcomputers , Software
7.
Bull Acad Natl Med ; 174(6): 835-43; discussion 844, 1990.
Article in French | MEDLINE | ID: mdl-2271988

ABSTRACT

Stereotactic biopsies, according to the Talairach's system, define the histopathological data (nature, grading, spatial delimitation, evolutive potential) of brain stem lesions, precisely localized by computerized tomography scanner and magnetic resonance imaging. They are the more valued complement of the modern neuro-imaging and they prove the extreme polymorphism of theses lesions. According to this histological analysis and the volume of the lesions, it's possible to choose the best therapeutic procedure.


Subject(s)
Biopsy/methods , Brain Neoplasms/pathology , Brain Stem/pathology , Stereotaxic Techniques , Adult , Brain Diseases/diagnosis , Brain Diseases/diagnostic imaging , Brain Neoplasms/diagnosis , Brain Neoplasms/diagnostic imaging , Child , Humans , Magnetic Resonance Imaging , Tomography, X-Ray Computed
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