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1.
Cancer Radiother ; 22(4): 372-381, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29859761

ABSTRACT

The treatment of local recurrence of a previously irradiated cancer or a second cancer arising in-field remains challenging. Ultimately, the objective of salvage therapy is to control disease while ensuring minimal collateral damage, thereby optimizing both cancer and toxicity outcomes. Reirradiation has historically been associated with unacceptable toxicity and a limited benefit. Brachytherapy offers the best dose distribution and a high radiation dose to the target volume while better protecting surrounding previously irradiated healthy tissues. The management of local cancer recurrence in irradiated areas should be planned through multidisciplinary discussions and patients should be selected carefully. This overview of the literature describes brachytherapy as a reirradiation treatment in local recurrences of previously irradiated prostate, breast, head and neck and rectal cancers, or second primary cancers occurring in-field. For these cancers, the prognosis and therapeutic challenges are quite different and depend on the type of primary cancer. However, current data confirm that brachytherapy reirradiation is feasible and has acceptable toxicity.


Subject(s)
Brachytherapy , Neoplasm Recurrence, Local/radiotherapy , Neoplasms/radiotherapy , Salvage Therapy/methods , Brachytherapy/methods , Humans , Retreatment , Treatment Failure
2.
Cancer Radiother ; 18(5-6): 577-82, 2014 Oct.
Article in French | MEDLINE | ID: mdl-25201634

ABSTRACT

Esophageal cancer has a high likelihood of distant lymphatic spread even at an early stage. Radiotherapy plays a major role in the management of localized or locally-advanced esophageal cancer with a regional or distant lymph node involvement. Radiotherapy can sterilize micrometastatic nodes and cancer cells in transit in the peri-esophageal fat that are not removed by surgery. After preoperative chemoradiotherapy followed by monobloc esophagectomy including lymph node dissection above and below the diaphragm, the locoregional failure rate was around 3% in the Chemoradiotherapy for Esophageal Cancer followed by Surgery Study Group (CROSS) trial. This is significantly lower than that observed with surgery alone or following exclusive chemoradiotherapy delivering 50 Gy over 5 weeks. Patterns of failure usually combine local and nodal failure. These results suggest that: (1) radiotherapy plays a major role in the management of micrometastatic nodes that are not removed by surgery; (2) the total dose of radiotherapy without surgery may be too low to control macroscopic disease. Better knowledge of regional failure sites and the enhancement of clinical practices through homogenized nodal radiotherapy could lead to a decrease in regional relapses, but at the expense of irradiated volumes greater than the macroscopic tumor volume. Intensity-modulated radiotherapy or volumetric modulated arctherapy makes it possible to increase mediastinal irradiated volumes while effectively protecting healthy tissues.


Subject(s)
Adenocarcinoma/secondary , Carcinoma, Squamous Cell/secondary , Chemoradiotherapy/methods , Esophageal Neoplasms/therapy , Lymphatic Irradiation/methods , Lymphatic Metastasis/radiotherapy , Adenocarcinoma/surgery , Adenocarcinoma/therapy , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/therapy , Combined Modality Therapy , Esophageal Neoplasms/surgery , Esophagectomy , Humans , Lymph Node Excision , Lymphatic Metastasis/diagnosis , Lymphatic Metastasis/prevention & control , Multicenter Studies as Topic , Multimodal Imaging , Neoadjuvant Therapy , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/radiotherapy , Practice Guidelines as Topic , Radiotherapy Dosage , Randomized Controlled Trials as Topic , Tumor Burden
3.
Cancer Radiother ; 14 Suppl 1: S103-10, 2010 Nov.
Article in French | MEDLINE | ID: mdl-21129652

ABSTRACT

Due to its increasing incidence and a grim prognosis, primary liver cancer remains a diagnostic and therapeutic challenge. For small localized tumors, surgical resection and liver transplantation are standard treatments with a curative-intent. Therapeutic options for locally advanced or metastatic diseases are limited. Globally, surgery fits less than 20% of patients. Early detection in high-risk patients and prevention of risk factors remain the key points in the standard care. External radiotherapy is a non invasive treatment with encouraging results for non operable patients. Emerging stereotactic radiotherapy yields high rates of local control without compromising toxicity. Tumors with bad prognostic factors could be cured with this approach.


Subject(s)
Liver Neoplasms/radiotherapy , Combined Modality Therapy , Humans , Liver/anatomy & histology , Liver/radiation effects , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Liver Transplantation , Neoplasm Staging , Prognosis , Radiotherapy, Conformal/methods
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