[The challenge of local control in unresectable locally advanced non-small cell lung cancer]. / Le défi du contrôle local dans le cancer pulmonaire, non à petites cellules, localement avancé, non opérable.

Non-small cell lung cancer (NSCLC) is common. Approximately one out of every five patients with NSCLC has locally advanced disease that is surgically unresectable. For these patients, the disease has a poor prognosis characterized by a high rate of local disease progression or recurrence despite attempts at chemo- and radiation therapy. The purpose of this review is to describe the heterogeneity of this group of patients, to clarify the terms of the combination of chemotherapy and radiotherapy and to clarify the efficacy of modern radiotherapy techniques to increase local control.

[Place of radiation-therapy of breast cancer treatment--current and future indications]. / Place de la radiothérapie dans le traitement du cancer du sein. Indications actuelles et perspectives.

Radiotherapy is an important part of breast cancer treatment. After breast conserving surgery, a dose of 50 Grays (Gy) is administered to the entire breast. Boost by external radiotherapy or brachytherapy improves local control especially for women under fifty. For lobular in situ lesions, no additional treatment is required, while intraductal lesions are treated with post-operative radiotherapy in case of Van Nuys score of 7, 8 or 9. After mastectomy, irradiation is proposed in case of skin involvement, invasion of pectoral muscle, positivity of at least 3 axillary lymph nodes, SBR III grade, T3 stage or multifocality where the sum of tumour diameters are >5 cm. Irradiation of the axilla has become exceptional. In node positive patients, the supraclavicular region receives 50 Gy with low energy photons, whereas the internal mammary chain is treated at the same dose but half is administered by low energy photons et half by electrons. Exclusive or preoperative irradiation is rare, because of new chemotherapy schedules, new drugs and hormonotherapy developments. Neoadjuvant chemotherapy enhances possibilities of conservative surgery it is followed by radiotherapy depending on the same indiciations listed above. Re-irradiation is possible but one must be aware of the higher risk of late toxicity. Nowadays, major side-effects are rare but close follow-up during and after treatment is required from the radiation oncologist to detect, evaluate, prevent and even treat possible complications.