Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 28
Filter
1.
Cancer Radiother ; 28(1): 93-102, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38212215

ABSTRACT

Soft tissue sarcomas are a rare and heterogeneous disease. For localized disease, treatment is based on surgery and radiotherapy with or without chemotherapy depending on risk factors. Upfront metastases are present in 7 to 20% of cases, and are localized to the lungs in most of cases. Disseminated disease is generally considered incurable but in selected cases, aggressive local treatment of metastases allowed long survival. Treatment of primary tumour is often debated. Our purpose is to evaluate the literature concerning the role of radiotherapy in the management of primary metastatic soft tissue sarcomas.


Subject(s)
Sarcoma , Soft Tissue Neoplasms , Humans , Sarcoma/radiotherapy , Sarcoma/pathology , Combined Modality Therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Soft Tissue Neoplasms/surgery
2.
Eur J Surg Oncol ; 46(7): 1277-1286, 2020 07.
Article in English | MEDLINE | ID: mdl-31839437

ABSTRACT

BACKGROUND: Outcomes for adults with soft tissue sarcoma are better when managed at referral centers. Care guidelines advise for 5 main criteria: 1-Imaging before biopsy; 2-Tumor biopsy before surgery; 3-Multidiscipinary team discussion (MTD) before biopsy; 4-Biopsy in "expert centers"; 5-Somatic molecular biology feasible. The aim is to describe and assess the prognostic impact of initial management of STS according to the type of referring centers and the number of optimal criteria. METHODS: Monocentric retrospective analysis of the management of 127 youths (0-25 years) with localized STS treated from 2006 to 2015. RESULTS: Median age at diagnosis was 9.6 years (range: 025). Overall, only 41% patients had 5/5, 28% 3-4, 31% ≤2. No adequate imaging was performed before surgery/biopsy for 18% patients, no biopsy before treatment for 29%. Patients referred by "expert centers" had higher compliance to guidelines (P = 0.025). Upfront surgery was performed in 59/127 patients. Immediate re-operation was inversely related to the number of criteria (0% when 5 criteria vs. 14% for 3-4, 46% if ≤ 2; P < 0.001). For malignant tumors, outcome was better when 5 criteria were reached: 5 year EFS 90.8% (81.4-100.0%) vs. 71.6 for (60.4-84.9%; ≤4 criteria; p = 0.033), OS 93.6% (85.5-100%) vs. 79.5% (68.9-91.8%; p = 0.11), and LRFFS 90.6% (81.0-100.0) vs. 73.1% (62.0-86.3%; p = 0.047). CONCLUSION: Less than half of the youths with STS are initially managed according to international guidelines, highlighting the need for better information about optimal management. These results plead for immediate management in reference centers to reduce initial burden of therapy.


Subject(s)
Guideline Adherence , Neoplasm Recurrence, Local , Sarcoma/diagnostic imaging , Sarcoma/pathology , Soft Tissue Neoplasms/diagnostic imaging , Soft Tissue Neoplasms/pathology , Adolescent , Adult , Biopsy , Cancer Care Facilities , Chemotherapy, Adjuvant , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Neoadjuvant Therapy , Neoplasm Recurrence, Local/pathology , Patient Care Team , Practice Guidelines as Topic , Radiotherapy, Adjuvant , Referral and Consultation , Reoperation , Retrospective Studies , Sarcoma/surgery , Soft Tissue Neoplasms/surgery , Survival Rate , Treatment Outcome , Young Adult
3.
Radiother Oncol ; 124(2): 200-203, 2017 08.
Article in English | MEDLINE | ID: mdl-28733054

ABSTRACT

PURPOSE: Irradiation (>3Gy) to the breast or axillae before 30years of age increases the risk of secondary breast cancer (SBC). The purpose of this article is to describe the clinical characteristics of SBC and the way of diagnosis in young women (before the age of national screening) in France who had received previous radiotherapy for a childhood or a young adulthood cancer. PATIENTS AND METHODS: This retrospective, multicentre study reviewed the medical records of women with SBC before the age of the national screening who had received irradiation (≥3Gy) on part or all of the breast before 30years of age, for any type of tumour except BC. RESULTS: A total of 121 SBC were detected in 104 women with previous radiotherapy. Twenty percent of SBC were detected during regular breast screening and 16% of the women had a regular radiological follow-up. CONCLUSION: Our results points out that the main proportion of childhood cancer survivors did not benefit from the recommended breast cancer screening. This result is comparable to other previously published studies in other countries. A national screening programme is necessary and should take into account the patient's age, family history, personal medical history and previous radiotherapy to reduce the number of SBC diagnosed at an advanced stage.


Subject(s)
Breast Neoplasms/diagnosis , Breast Neoplasms/etiology , Neoplasms, Radiation-Induced/diagnosis , Neoplasms, Second Primary/diagnosis , Neoplasms/radiotherapy , Adult , Breast/radiation effects , Breast Neoplasms/pathology , Early Detection of Cancer , Female , France , Humans , Mammary Glands, Human/radiation effects , Mammography , Middle Aged , Neoplasms, Radiation-Induced/etiology , Neoplasms, Radiation-Induced/pathology , Neoplasms, Second Primary/etiology , Neoplasms, Second Primary/pathology , Radiotherapy/adverse effects , Retrospective Studies , Survivors , Young Adult
4.
Pediatr Hematol Oncol ; 33(7-8): 423-437, 2016.
Article in English | MEDLINE | ID: mdl-27960645

ABSTRACT

Hodgkin's lymphoma (HL) in children and adolescents is highly curable, but children are at risk of long-term toxicity. The MDH-03 guidelines were established in order to decrease the burden of treatment in good-responder patients, and this report should be considered a step toward further optimization of treatment within large collaborative trials. We report the therapy and long-term outcomes of 417 children and adolescents treated according to the national guidelines, which were applied between 2003 and 2007 in France. The patients were stratified into three groups according to disease extension. Chemotherapy consisted of four cycles of VBVP (vinblastine, bleomycin, VP16, prednisone) in localized stages (G1/95 pts/23%), four cycles of COPP/ABV (cyclophosphamide, vincristine, procarbazine, prednisone, adriamycin, bleomycin, vinblastine) cycles in intermediate stages (G2/184 pts/44%) and three cycles of OPPA (vincristine, procarbazine, prednisone, adriamycin) plus three cycles of COPP in advanced stages (G3/138 pts/33%). Radiation therapy of the involved field was given to 97% of the patients, with the dose limited to 20 Gy in good responders (88%). With a median follow-up of 6.6 years, the 5-year event-free survival (EFS) and overall survival (OS) were 86.7% (83.1-89.7%) and 97% (94.5-98.1%), respectively. EFS and OS for G1, G2, and G3 were 98% and 100%, 81% and 97%, and 87% and 95%, respectively. Low-risk patients treated without alkylating agents and anthracycline had excellent outcomes and a low expected incidence of late effects. Intensification with a third OPPA cycle in high-risk group patients, including stage IV patients, allowed for very good outcomes, without increased toxicity.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Hodgkin Disease/drug therapy , Hodgkin Disease/mortality , Adolescent , Child , Child, Preschool , Disease-Free Survival , Female , Follow-Up Studies , France , Hodgkin Disease/pathology , Humans , Male , Neoplasm Staging , Practice Guidelines as Topic , Survival Rate
5.
Cancer Radiother ; 20 Suppl: S61-8, 2016 Sep.
Article in French | MEDLINE | ID: mdl-27523416

ABSTRACT

The article deals with the prevention of cancers only directly related to therapeutic radiation which are distinguished from "secondary cancer". The consideration of the risk of radiation-induced cancers after radiation therapy, although it is fortunately rare events, has become indispensable today. With a review of the literature, are detailed the various involved parameters. The age of the irradiated patient is one of the main parameters. The impact of the dose is also discussed based on the model used, and based on clinical data. Other parameters defining a radiation treatment are discussed one after the other: field with the example of Hodgkin's disease, the type of radiation and the participation of secondary neutrons, spreading and splitting. All these parameters are discussed according to each organ whose sensitivity is different. The article concludes with a list of recommendations to reduce the risk of radio-induced cancers. Even with the advent of conformal radiotherapy, intensity modulation, the modulated volume arctherapy, and the development of specific machinery for the extra-cranial stereotactic, the radiation therapist must consider this risk and use of reasonable and justified control imaging. Although they constitute a small percentage of cancers that occur secondarily after a first malignant tumor, radiation-induced cancers, can not and must not be concealed or ignored and justify regular monitoring over the long term, precisely adapted on the described parameters.


Subject(s)
Neoplasms, Radiation-Induced/prevention & control , Radiotherapy/adverse effects , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Hodgkin Disease/radiotherapy , Humans , Infant , Infant, Newborn , Male , Middle Aged , Neoplasms/radiotherapy , Neoplasms, Second Primary/etiology , Neoplasms, Second Primary/prevention & control , Organ Specificity , Organs at Risk , Prostatic Neoplasms/radiotherapy , Radiation Tolerance , Radiotherapy/methods , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted , Risk , Young Adult
6.
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
7.
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
8.
Cancer Radiother ; 19(5): 347-57; quiz 358-9, 362, 2015 Aug.
Article in French | MEDLINE | ID: mdl-26141663

ABSTRACT

Medulloblastoma are cerebellar tumours belonging to the group of primitive neuroectodermal tumours (PNET) and are the most common malignant brain tumours of childhood. These tumours are rare and heterogeneous, requiring some multicentric prospective studies and multidisciplinary care. The classical therapeutic approaches are based on clinical, radiological and surgical data. They involve surgery, radiation therapy and chemotherapy. Some histological features were added to characterize risk. More recently, molecular knowledge has allowed to devise risk-adapted strategies and helped to define groups with good outcome and reduce long-term sequelae, improve the prognostic of high-risk medulloblastoma and develop new therapeutic tools.


Subject(s)
Cerebellar Neoplasms/therapy , Medulloblastoma/therapy , Adult , Cerebellar Neoplasms/classification , Cerebellar Neoplasms/diagnosis , Cerebellar Neoplasms/metabolism , Chemotherapy, Adjuvant , Child , Developmental Disabilities/etiology , Genetic Predisposition to Disease , Hedgehog Proteins/metabolism , Humans , Magnetic Resonance Imaging , Medulloblastoma/classification , Medulloblastoma/diagnosis , Medulloblastoma/metabolism , Mutism/etiology , Neoplasm Recurrence, Local , Postoperative Care , Prognosis , Radiotherapy, Adjuvant , Randomized Controlled Trials as Topic , Risk Assessment , Wnt Proteins/metabolism
9.
Cancer Radiother ; 17(5-6): 400-6, 2013 Oct.
Article in French | MEDLINE | ID: mdl-24007956

ABSTRACT

Hadrontherapy, a type of radiation therapy dealing with heavy charged particles, has become for the past decade one of the most sophisticated and attractive approach in the management of cancer. This is related with major technological innovations that have made available, at a relatively cheap cost, compact proton accelerators equipped with rotational gantries. The implementation of pencil beam scanning should also make treatment planning and delivery much easier and faster than conventional approaches. Until now, approximately 100,000 patients have been treated with protons worldwide. Due to more complex technological and biological challenges, light ion therapy - mainly carbon ions - has developed at a lower pace, except in Japan where most of the 15,000 treated patients have been enrolled. Current indications for protons include firstly, locally aggressive tumours non or incompletely resected, that are located close to critical normal structures: ocular melanomas, skull base and spinal canal low grade sarcomas, selected ENT carcinomas (like adenoid cystic); secondly, improvement of tolerance to radiations: delayed, mainly in paediatric malignancies, due to the exquisite sensitivity of organs under development (including to carcinogenesis); immediate, on bone marrow, mucosae… mainly in concomitant radiation-chemotherapy interactions (tested in esophagus, and lung). Most promising indications for carbon ions include inoperable highly radioresistant primaries, such as mucosal melanomas, high grade bone and soft part sarcomas, and pancreatic carcinomas. Altered fractionations are also of interests that could translate in clinical and economical benefits. Controversies have risen whether more common indications, like prostate, should also be explored.


Subject(s)
Heavy Ion Radiotherapy/methods , Neoplasms/radiotherapy , Adult , Carbon/therapeutic use , Child , Heavy Ion Radiotherapy/statistics & numerical data , Humans , Radiation Tolerance
10.
Cancer Radiother ; 17(1): 26-33, 2013 Feb.
Article in French | MEDLINE | ID: mdl-23333459

ABSTRACT

PURPOSE: Although radiosensitive, spinal locations of Ewing's sarcomas are challenging for the radiation oncologist due to poor radiation tolerance of the spinal cord. However, some favorable anatomical compartments - that may represent more than 20% - were associated with a better outcome and could benefit from a radiation dose escalation using the most recent radiation therapy techniques. MATERIALS AND METHODS: We performed a dose escalation study on one patient, declined in two scenarios: (1) a tumour located within a single vertebral body and (2) a locally advanced disease involving the vertebral foramen and paraspinal soft tissues. Five dose-levels are proposed: 44.8Gy, 54.4Gy, 59.2Gy, 65.6Gy and 70.4Gy (1.6Gy per session, 8Gy per week). The 3D-conformational technique is compared with static intensity modulated radiation therapy (IMRT), helical tomotherapy, volumetric modulated arc therapy (VMAT), stereotactic body robotic radiation therapy (SBRT) and protontherapy (passive scattering). Two constraints had to be respected in order to skip to the next level: the planned target volume (PTV) coverage must exceed 95% and the D(2%) on the spinal cord shall not exceed a given constraint set at 50Gy in case 1 and 44Gy in case 2 due to initial neurological sufferance. RESULTS: Only protontherapy, SBRT, helical tomotherapy and VMAT appear able to reach the last dose level while respecting the constraints in case 1. On the other hand, only helical tomotherapy seems capable of reaching 59.2Gy on the PTV in case 2. CONCLUSION: With the most recent radiation therapy techniques, it becomes possible to deliver up to 70.4Gy in a favorable compartment in this sham patient. Unfavorable compartments can receive up to 59.2Gy. Definitive radiation therapy may be an interesting local treatment option to be validated in an early phase trial.


Subject(s)
Proton Therapy , Radiosurgery/methods , Radiotherapy Planning, Computer-Assisted , Radiotherapy, Conformal/methods , Sarcoma, Ewing/radiotherapy , Spinal Neoplasms/radiotherapy , Thoracic Vertebrae , Adolescent , Combined Modality Therapy , Dose Fractionation, Radiation , Heart/radiation effects , Humans , Kidney/radiation effects , Lung/radiation effects , Male , Organ Sparing Treatments , Organs at Risk , Radiosurgery/instrumentation , Radiotherapy Dosage , Radiotherapy, Conformal/instrumentation , Radiotherapy, High-Energy/methods , Radiotherapy, Intensity-Modulated/instrumentation , Radiotherapy, Intensity-Modulated/methods , Robotics , Sarcoma, Ewing/drug therapy , Sarcoma, Ewing/surgery , Spinal Cord/radiation effects , Spinal Neoplasms/drug therapy , Spinal Neoplasms/surgery , Thoracic Vertebrae/surgery
11.
Cancer Radiother ; 16 Suppl: S111-5, 2012 Jun.
Article in French | MEDLINE | ID: mdl-22658965

ABSTRACT

Stereotactic radiotherapy is a very high precision procedure, which has been limited to radiosurgery for a long time. Technological improvements allowed the development of radiotherapy in stereotactic conditions, leading to a lot of innovations. Previously indicated for cerebral pathologies, this procedure is now developed for extracerebral locations. In paediatrics, stereotactic radiotherapy is still limited, delivered precociously, due to the possibility of long-term late effects that needs to be addressed. This review reports the different useful conditions, technical evolutions, and the current validated paediatric indications, with differences from adults, and future directions.


Subject(s)
Radiosurgery , Brain Neoplasms/pathology , Brain Neoplasms/surgery , Child , Craniopharyngioma/pathology , Craniopharyngioma/surgery , Glioma/pathology , Glioma/surgery , Humans , Intracranial Arteriovenous Malformations/pathology , Intracranial Arteriovenous Malformations/surgery , Medulloblastoma/pathology , Medulloblastoma/surgery , Radiotherapy Dosage
12.
Cancer Radiother ; 14(8): 727-38, 2010 Dec.
Article in French | MEDLINE | ID: mdl-20427218

ABSTRACT

Proton beam therapy uses positively charged particles, protons, whose physical properties improve dose-distribution (Bragg peak characterized by a sharp distal and lateral penumbra) compared with conventional photon-based radiation therapy (X-ray). These ballistic advantages apply to the treatment of deep-sited tumours located close to critical structures and requiring high-dose levels. [60-250 MeV] proton-beam therapy is now widely accepted as the "gold standard" in specific indications in adults--ocular melanoma, chordoma and chondrosarcoma of the base of skull --and is regarded as a highly promising treatment modality in the treatment of paediatric malignancies (brain tumours, sarcomas…). This includes the relative sparing of surrounding normal organs from low and mid-doses that can cause deleterious side-effects such as radiation-induced secondary malignancies. Other clinical studies are currently testing proton beam in dose-escalation evaluations, in prostate, lung, hepatocellular cancers, etc. Clinical validation of these new indications appears necessary. To date, over 60,000 patients worldwide have received part or all of their radiation therapy program by proton beams, in approximately 30 treatment facilities.


Subject(s)
Neoplasms/radiotherapy , Proton Therapy , Radiotherapy, High-Energy/methods , Adult , Age Factors , Carcinoma/radiotherapy , Child , Clinical Trials as Topic , Female , Forecasting , Humans , Male , Organ Specificity , Organs at Risk , Radiotherapy Dosage , Radiotherapy, High-Energy/economics , Radiotherapy, High-Energy/statistics & numerical data , Radiotherapy, High-Energy/trends , Sarcoma/radiotherapy
13.
Cancer Radiother ; 13(6-7): 550-5, 2009 Oct.
Article in French | MEDLINE | ID: mdl-19692282

ABSTRACT

Pediatric tumors still represent a formidable challenge despite the considerable therapeutical advances that have been reported for the past 30 years. This is largely related with the untowards side-effects of local therapy that are still acknowledged as the "price for cure". In this setting, Proton therapy a sophisticated radiotherapeutical modality seems to represent a real breakthrough due to its unique ability to spare close and distant normal organs compared with modern photons techniques. We summarize in this paper current clinical and dosimetrical evidences including an update of the Orsay series on 108 children.


Subject(s)
Brain Neoplasms/radiotherapy , Glioma/radiotherapy , Neoplasms/radiotherapy , Radiotherapy/methods , Bone Neoplasms/mortality , Bone Neoplasms/radiotherapy , Brain Neoplasms/mortality , Child , Ependymoma/mortality , Ependymoma/radiotherapy , Glioma/mortality , Humans , Neoplasms/mortality , Photons/therapeutic use , Proton Therapy , Radiotherapy/adverse effects , Radiotherapy/instrumentation , Radiotherapy Dosage , Sarcoma/mortality , Sarcoma/radiotherapy , Survival Rate
14.
Eur J Cancer ; 40(18): 2659-66, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15571949

ABSTRACT

We report five paediatric cases of portal vein thrombosis (PVT) occurring during chemotherapy, observed in two institutions over an 8-year time period. These children aged 2.5-15 years were treated for Burkitt's lymphoma, Ewing's tumour, small cell bone tumour or medulloblastoma. PVT was diagnosed on colour Doppler ultrasonography (US). In four patients, thrombosis occurred 2-45 days after severe hepatic veno-occlusive disease (HVOD) secondary to intensive chemotherapy containing busulfan. In one case, PVT occurred in the absence of HVOD in a patient with pre-existing periportal lymphomatous infiltration. Four patients experienced persistent portal hypertension, which resulted in death in one. PVT during chemotherapy in children is a rare event and appears to be closely related to intensive chemotherapy containing busulfan and to be associated with HVOD.


Subject(s)
Antineoplastic Agents/adverse effects , Neoplasms/drug therapy , Portal Vein , Venous Thrombosis/chemically induced , Adolescent , Anticoagulants/therapeutic use , Child , Child, Preschool , Female , Heparin/therapeutic use , Humans , Male , Risk Factors , Treatment Outcome , Venous Thrombosis/drug therapy
15.
Rev Pneumol Clin ; 60(1): 22-8, 2004 Feb.
Article in French | MEDLINE | ID: mdl-15107665

ABSTRACT

Lung cancer is one of the most difficult challenges for radiotherapy. Problems include ballistic targeting compromised by respiratory movements, poor tolerance of neighboring healthy tissues and difficult dosimetry due to the heterogeneous nature of the thoracic tIssues. New perspectives are offered by recent developments allowing a more comprehensive approach to thoracic radiotherapy integrating new advances in imaging techniques, contention, dosimetry, and treatment devices. Two techniques are particularly promising: conformal radiotherapy and respiration-gated radiotherapy. Conformal radiotherapy, a three-dimensional conformal mode of irradiation with or without intensity modulation, is designed to achieve high-precision dose delivery by integrating advanced imaging techniques into the irradiation protocol. These tools are used to optimize irradiation of target Volumes and avoid recurrence while sparing as much as possible healthy tissues. If healthy tissue can be correctly protected, increased doses can be delivered to the target tumor. Respiration-gated techniques offer promising prospects for the treatment of tumors which are displaced by respiratory movements. These techniques allow better adaptation of the irradiation fields to the target tumor and better protection of healthy tissues (lung, heart...). These new approaches are now routine practices in many centers. Early results have been very promising. We describe here the currently available techniques for thoracic radiotherapy.


Subject(s)
Carcinoma, Non-Small-Cell Lung/radiotherapy , Lung Neoplasms/radiotherapy , Radiotherapy, Conformal , Dose Fractionation, Radiation , Humans , Respiration
16.
Cancer Radiother ; 6 Suppl 1: 37s-48s, 2002 Nov.
Article in French | MEDLINE | ID: mdl-12587382

ABSTRACT

The conformal radiotherapy approach, three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT), is based on modern imaging modalities, efficient 3D treatment planning systems, sophisticated immobilization systems and rigorous quality assurance and treatment verification. The central objective of conformal radiotherapy is to ensure a high dose distribution tailored to the limits of the target volume while reducing exposure of normal tissues. These techniques would then allow further tumor dose escalation. Head-and-neck tumors are some of the most attractive localizations to test conformal radiotherapy. They combine ballistic difficulties due to particularly complex shapes (nasopharynx, ethmoid) and problems due to the number and low tolerance of neighbouring organs like parotids, eyes, brainstem and spinal cord. The therapeutic irradiation of head-and-neck tumors thus remains a challenge for the radiation oncologist. Conformal radiotherapy does have a significant potential for improving local control and reducing toxicity when compared to standard radiotherapy. However, in the absence of prospective randomized trials, it is somewhat difficult at present to evaluate the real benefits drawn from 3DCRT and IMRT. The published clinical reports on the use of conformal radiotherapy are essentially dealing with dosimetric comparisons on relatively small numbers of patients. Recently, a few publications have emphasized the clinical experience of several precursor teams with a suitable follow-up. This paper describes the current state-of-the-art of 3DCRT and IMRT in order to evaluate the impact of these techniques on head-and-neck cancers irradiation.


Subject(s)
Head and Neck Neoplasms/radiotherapy , Imaging, Three-Dimensional , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy, Conformal , Central Nervous System/radiation effects , Central Nervous System Diseases/etiology , Central Nervous System Diseases/prevention & control , Clinical Trials as Topic , Dose Fractionation, Radiation , Eye/radiation effects , Eye Diseases/etiology , Eye Diseases/prevention & control , Humans , Parotid Gland/radiation effects , Radiation Tolerance , Radiometry , Radiotherapy, Conformal/adverse effects , Radiotherapy, Conformal/methods , Xerostomia/etiology , Xerostomia/prevention & control
17.
Cancer Radiother ; 6 Suppl 1: 125s-134s, 2002 Nov.
Article in French | MEDLINE | ID: mdl-12587391

ABSTRACT

The conformal radiotherapy approach, three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT), is based on modern imaging modalities, efficient 3D treatment planning systems, sophisticated immobilization devices and demanding quality assurance and treatment verification. The main goal of conformal radiotherapy is to ensure a high dose distribution tailored to the limits of the target volume while reducing exposure of healthy tissues. These techniques would then allow a further dose escalation increasing local control and survival. Non-small cell lung cancer (NSCLC) is one of the most difficult malignant tumors to be treated. It combines geometrical difficulties due to respiratory motion, and number of low tolerance neighboring organs, and dosimetric difficulties because of the presence of huge inhomogeneities. This localization is an attractive and ambitious example for the evaluation of new techniques. However, the published clinical reports in the last years described very heterogeneous techniques and, in the absence of prospective randomized trials, it is somewhat difficult at present to evaluate the real benefits drawn from those conformal radiotherapy techniques. After reviewing the rationale for 3DCRT for NSCLC, this paper will describe the main studies of 3DCRT, in order to evaluate its impact on lung cancer treatment. Then, the current state-of-the-art of IMRT and the last technical and therapeutic innovations in NSCLC will be discussed.


Subject(s)
Carcinoma, Non-Small-Cell Lung/radiotherapy , Lung Neoplasms/radiotherapy , Radiotherapy, Conformal , Carcinoma, Non-Small-Cell Lung/mortality , Clinical Trials as Topic , Combined Modality Therapy , Dose-Response Relationship, Radiation , Feasibility Studies , Humans , Imaging, Three-Dimensional , Lung Neoplasms/mortality , Prognosis , Radiation Injuries/epidemiology , Radiation Injuries/etiology , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted , Radiotherapy, Conformal/adverse effects , Randomized Controlled Trials as Topic , Survival Rate , Treatment Outcome
18.
Int J Radiat Oncol Biol Phys ; 51(4): 1081-92, 2001 Nov 15.
Article in English | MEDLINE | ID: mdl-11704333

ABSTRACT

PURPOSE: Conformal radiotherapy beams are defined on the basis of static computed tomography acquisitions by taking into account setup errors and organ/tumor motion during breathing. In the absence of precise data, the size of the margins is estimated arbitrarily. The objective of this study was to evaluate the amplitude of maximum intrathoracic organ motion during breathing. METHODS AND MATERIALS: Twenty patients treated for non-small-cell lung cancer were included in the study: 10 patients at the Institut Curie with a personalized alpha cradle immobilization and 10 patients at Tenon Hospital with just the Posirest device below their arms. Three computed tomography acquisitions were performed in the treatment position: the first during free breathing and the other two during deep breath-hold inspiration and expiration. For each acquisition, the displacements of the various intrathoracic structures were measured in three dimensions. RESULTS: Patients from the two centers were comparable in terms of age, weight, height, tumor site, and stage. In the overall population, the greatest displacements were observed for the diaphragm, and the smallest displacements were observed for the lung apices and carina. The relative amplitude of motion was comparable between the two centers. The use of a personalized immobilization device reduced lateral thoracic movements (p < 0.02) and lung apex movements (p < 0.02). CONCLUSION: Intrathoracic organ movements during extreme phases of breathing are considerable. Quantification of organ motion is necessary for definition of the safety margins. A personalized immobilization device appears to effectively reduce apical and lateral displacement.


Subject(s)
Carcinoma, Non-Small-Cell Lung/radiotherapy , Lung Neoplasms/radiotherapy , Movement , Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy, Conformal , Respiration , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Diaphragm , Female , Humans , Lung , Lung Neoplasms/diagnostic imaging , Male , Middle Aged , Posture , Tomography, X-Ray Computed
19.
Cancer Radiother ; 5(6): 725-36, 2001 Dec.
Article in French | MEDLINE | ID: mdl-11797293

ABSTRACT

PURPOSE: Conformal irradiation of non-small cell lung carcinoma (NSCLC) is largely based on a precise definition of the nodal clinical target volume (CTVn). The reduction of the number of nodal stations to be irradiated would render tumor dose escalation more achievable. The aim of this work was to design an mathematical tool based on documented data, that would predict the risk of metastatic involvement for each nodal station. METHODS AND MATERIAL: From the large surgical series published in the literature we looked at the main pre-treatment parameters that modify the risk of nodal invasion. The probability of involvement for the 17 nodal stations described by the American Thoracic Society (ATS) was computed from all these publications and then weighted according to the French epidemiological data. Starting from the primitive location of the tumour as the main characteristic, we built a probabilistic tree for each nodal station representing the risk distribution as a function of each tumor feature. From the statistical point of view, we used the inversion of probability trees method described by Weinstein and Feinberg. RESULTS: Taking into account all the different parameters of the pre-treatment staging relative to each level of the ATS map brings up to 20,000 different combinations. The first chosen parameters in the tree were, depending on the tumour location, the histological classification, the metastatic stage, the nodal stage weighted in function of the sensitivity and specificity of the diagnostic examination used (PET scan, CAT scan) and the tumoral stage. A software is proposed to compute a predicted probability of involvement of each nodal station for any given clinical presentation. CONCLUSION: To better define the CTVn in NSCLC 3DRT, we propose a software that evaluates the mediastinal nodal involvement risk from easily accessible individual pre-treatment parameters.


Subject(s)
Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/radiotherapy , Lung Neoplasms/pathology , Lung Neoplasms/radiotherapy , Lymphatic Metastasis , Mediastinum/pathology , Models, Theoretical , Radiotherapy, Conformal/methods , Dose Fractionation, Radiation , Forecasting , Humans , Risk Assessment
20.
Cancer Radiother ; 3(2): 154-61, 1999.
Article in French | MEDLINE | ID: mdl-10230375

ABSTRACT

A comprehensive understanding of the radiobiological bases of total body irradiation (TBI) is made difficult by the large number of normal and malignant tissues that must be taken into account. In addition, tissue responses to irradiation are also sensitive to associated treatments, type of graft and a number of patient characteristics. Experimental studies have yielded a large body of data, the clinical relevance of which still requires definite validation through randomized trials. Fractionated TBI schemes are able to reduce late normal tissue toxicity, but the ultimate consequences of the fractional dose reduction do not appear to be equivocal. Thus, leukemia and lymphoma cells are probably more radiobiologically heterogeneous than previously thought, with several cell lines displaying relatively high radioresistance and repair capability patterns. The most primitive host-type hematopoietic stem cells are likely to be at least partly protected by TBI fractionation and may hamper late engraftment. Similarly, but with possibly conflicting consequences on the probability of engraftment, the persistence of a functional marrow stroma may also be fractionation-sensitive, while higher rejection rates have been reported after T-depletion grafts and fractionated TBI. In clinical practice (as for the performance of relevant clinical trials), the influence of these results are rather limited by the heavy logistic constraints created by a sophisticated and time-consuming procedure. Lastly, clinicians are now facing an increasing incidence of second cancers, at least partly induced by irradiation, which jeopardize the long-term prospects of otherwise cured patients.


Subject(s)
Hematopoietic Stem Cell Transplantation , Neoplasms, Radiation-Induced , Whole-Body Irradiation , Graft Survival , Humans , Leukemia/therapy , Lymphoma/therapy , Radiotherapy Dosage
SELECTION OF CITATIONS
SEARCH DETAIL
...