ABSTRACT
Considering recent phase III trials results, moderate hypofractionated radiotherapy can be considered as a standard treatment for low and intermediate risk prostate cancer management. This assessment call for a framework allowing homogeneous and reproducible practices in the different centers using this radiotherapy schedule. The French Genito-Urinary Group (GETUG) provides here recommendations for daily practice of moderate hypofractionated radiotherapy for prostate cancer, with indications, dose, fractionation, pre-treatment planning, volume of interest delineation (target volume and organs at risk) and margins, dose constraints and radiotherapy techniques.
Subject(s)
Prostatic Neoplasms/radiotherapy , Radiation Dose Hypofractionation , France , Humans , Magnetic Resonance Imaging , Male , Organs at Risk , Prostatic Neoplasms/diagnostic imaging , Radiotherapy Planning, Computer-Assisted , Radiotherapy, Image-Guided , Radiotherapy, Intensity-Modulated , Tomography, X-Ray ComputedABSTRACT
Radiotherapy plays a central role in the management of localized prostate cancer, but the total duration of treatment of nearly 2 months poses not only problems of fatigue related to repetitive transports, especially for older patients, but also increases the overall cost of treatment including linear accelerators occupancy and patient transportation. To address this problem, various teams have developed hypofractionated radiotherapy protocols seeking to maintain the same efficacy and toxicity while reducing the total duration of treatment. These hypofractionated protocols require recent techniques such as image-guided radiation therapy (IGRT) and intensity-modulated radiation therapy (IMRT). Single centre series have validated the feasibility of "light" hypofractionation schemes at doses per fraction less than 6 Gy Similarly, different teams have shown the possibility of stereotactic irradiation for delivering "severe" hypofractionation schemes at doses greater than 6 Gy per fraction. Whatever the dose per fraction, the current clinical data support the conclusion that hypofractionated radiotherapy does not increase mid-term toxicity and could even improve biochemical control. Studies with the objective of demonstrating non-inferiority are expected to definitively validate the role of hypofractionated irradiation in the treatment of prostate cancer.
Subject(s)
Dose Fractionation, Radiation , Prostatic Neoplasms/radiotherapy , Dose-Response Relationship, Radiation , Humans , Male , Prostatic Neoplasms/surgery , Radiosurgery , Radiotherapy, Image-Guided , Radiotherapy, Intensity-Modulated , Randomized Controlled Trials as TopicABSTRACT
BACKGROUND: In routine practice, the evaluation of the nutritional status of patients with cancer is not always performed although there is frequent modification as disease progresses. The validated screening and evaluation tools currently available are time-consuming and costly. In this study we analysed factors that could be used to identify patients likely to need nutritional surveillance or intervention. PATIENTS AND METHODS: A cross-sectional survey was carried out for 2 weeks in June 2006 on 477 patients with cancer. RESULTS: 30.2% of the patients had lost more than 10% of their body weight since the start of the illness. After adjustment, the factors significantly associated with weight loss were: depressive state (OR = 3.49; P = 0.002), digestive or ENT tumours (OR = 3.20; P = <0.001), chemotherapy (OR = 2.66; P = 0.011), male gender (OR = 2.30; P = 0.001) and professional status (OR = 2.08; P = 0.02). Using a logistic model, we calculated the risk of weight loss as a function of the presence of the identified predictive factors. CONCLUSION: We report a simple screening tool, which will not replace the available evaluation methods but will enable targeting of the patients most likely, after a specific evaluation, to benefit from nutritional intervention. This remains to be validated in further prospective studies.
Subject(s)
Malnutrition/diagnosis , Malnutrition/epidemiology , Neoplasms/epidemiology , Nutritional Support/methods , Wasting Syndrome/epidemiology , Age Distribution , Aged , Analysis of Variance , Causality , Comorbidity , Cross-Sectional Studies , Disease Progression , Female , Follow-Up Studies , Humans , Logistic Models , Male , Malnutrition/therapy , Mass Screening/methods , Middle Aged , Neoplasms/diagnosis , Neoplasms/therapy , Nutrition Assessment , Nutritional Status , Prevalence , ROC Curve , Risk Assessment , Sex Distribution , Wasting Syndrome/physiopathology , Weight LossABSTRACT
100 cases of uveal melanomas, were treated with 106RU 106RH beta-brachytherapy, between June 1983 and September 1987. 82 eyes having a follow-up superior or equal to 12 months, were analysed. 13 of these 82 eyes have been enucleated. 4 patients have died. 3 have at this time, hepatic dissemination. The first 43 patients were analysed at the 18th month after irradiation. The majority of tumors with initial thickness inferior to 5 mm had a regression superior to 50%, at the 18th month. The majority of tumors with initial thickness superior to 5 mm, had a regression inferior to 50%, at the same time. Functional results have also been noticed in this series of 43 eyes, and were satisfactory.
Subject(s)
Brachytherapy , Choroid Neoplasms/radiotherapy , Ciliary Body , Melanoma/radiotherapy , Uveal Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Choroid Neoplasms/pathology , Choroid Neoplasms/surgery , Eye Enucleation , Humans , Melanoma/pathology , Melanoma/surgery , Middle Aged , Radiation Dosage , Uveal Neoplasms/pathology , Uveal Neoplasms/surgeryABSTRACT
100 cases of uveal melanomas, were treated with 106 RU 106 RH beta-brachytherapy, between June 1983 and September 1987. 82 eyes having a follow-up superior or equal to 6 months, were analysed. 13 of these 82 eyes have been enucleated. 2 patients, have died, 2 have at this time, hepatic dissemination. The first 43 patients were analysed at the 18th month after irradiation. The majority of tumors with initial thickness inferior to 5 mm had a regression superior to 50%, at the 18th month. The majority of tumors with initial thickness superior to 5 mm, had a regression inferior to 50%, at the same time. Functional results have also been noticed in this series of 43 eyes, and were satisfactory.
Subject(s)
Brachytherapy , Ciliary Body , Melanoma/radiotherapy , Ruthenium Radioisotopes/therapeutic use , Uveal Neoplasms/radiotherapy , Adult , Aged , Choroid Neoplasms/radiotherapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
One hundred and ninety five patients with T1T2 less than 3 cm N0 infiltrating carcinomas of the breast have been treated between 1973 and 1982 with local excision followed by cobalt irradiation and iridium boost. One hundred and sixty five underwent an elective axillary dissection. The overall survival at 5 years is 87% and the NED survival 81%. The size of the tumor on the mammogram and on the operative specimen is of significant prognostic value. At 5 years the probability of local relapse in the breast is 4% and the probability of axillary recurrence is 1.2% after axillary dissection. Comparison of these results with those of an historical group of 300 patients treated between 1950 and 1973 indicates an improvement in the local control with good cosmetic results and no obvious change in axillary recurrence and overall survival.
