[Role of French teams in the development of clinical and translational research in radiation oncology]. / Implications récentes des équipes françaises en oncologie radiothérapie et radiobiologie clinique.

Many clinical studies have showed the key role of radiotherapy in anticancer treatment strategy. Radiations are delivered alone or in combination with systemic therapies. In recent years, the main goal of all clinical developments has focused on improving clinical benefit, with an increased tumour control and a higher normal tissue protection. This research was designed to reduce local recurrences, to increase recurrence-free or overall survival and to decrease acute and late effects. Technological and biological evolutions (or revolutions) accompanied clinicians to improve clinical benefit, namely with strong progress in radiology and better understanding of radiobiology, particularly at the molecular level. Differences in tumour and normal tissues radiosensitivity are nowadays integrated in daily clinical practice of radiation oncologists. The current report details the last 5-year developments of clinical and translational research in radiation oncology, especially the role of French teams in the development of personalized treatment.

[Quality control in pulsed dose rate brachytherapy]. / Contrôle de qualité en curiethérapie de débit de dose pulsé

A prospective multicenter study (PDR) was leaded on pulsed dose rate brachytherapy over 2 years (2005/2006) in 20 French centres, as part of a programme entitled Stic-PDR and supported by the French ministry of health. Eight hundred and fifty patients were treated for cervix carcinoma with 2D classic or 3D innovative brachytherapy (425 in each arm). The main objectives of this study were to assess the cost of PDR brachytherapy with dose optimization compared to traditional treatments, and to evaluate the complications and local control. A joint programme of quality control was established by the physicists of the different centres, concerning the software treatment planning, the source replacement, the projector and the technical parameters of the course of patient treatment. This technical note lists these controls, and their frequency.

[Pulse dose-rate brachytherapy and treatment of uterine cervix cancer: impact of a 3D or a 2D dosimetric support]. / Curiethérapie utérovaginale de bas débit pulsé: influence du support dosimétrique.

PURPOSE: To evaluate two dosimetric supports used in pulse dose rate brachytherapy (PDR): coverage of target volumes, dose to organs at risk, residual tumor after surgery, survival. PATIENTS AND METHODS: Twenty patients treated for uterine cervix tumor first by brachytherapy PDR had a dosimetric CT-scan after implantation. For 9 patients, the treatment was planned from standard radiographies and then reported on CT-scan images. For 11 patients, it was directly planned from CT-scan. Six weeks after, 18 patients underwent surgery. RESULTS: With a median follow-up of 22 months, 2 year actuarial survival was 89%. Six patients developed grade II urinary or gynecological complications (LENT SOMA scale). No residual tumor was found for 12 patients (7 with a 3D treatment and 5 a 2 D treatment). Ninety-five percent of CTVHR received 53 Gy (2D treatment) or 63 Gy (3D treatment). Two cm3 of bladder wall received 63 Gy (2D) or 74 Gy (3D) although 2 cm3 of rectal wall received 37 Gy (2D) and 35 Gy (3D). CONCLUSION: Using CT-scan made us improve the coverage of the uterine cervix but increase the dose received by the bladder, without increasing the rate of histological remission after surgery. We should be prudent before changing our practice.

[Long-term results and prognostic factors of squamous cell carcinoma of the anal canal treated by irradiation]. / Résultats à long terme et facteurs pronostiques des carcinomes épidermoïdes du canal anal traités par irradiation.

PURPOSE: To analyze the prognostic factors of loco regional control (LRC), specific survival (SS) and sphincter conservation (SC) of patients treated by curative and conservative irradiation for an epidermoid cancer of anal canal in our institution. PATIENTS AND METHODS: From 1976 to 2005, 286 patients (pts) were treated by exclusive radiotherapy (180 pts) or chemo-radiotherapy (106 pts) followed by a brachytherapy boost (233 pts) or external beam radiotherapy boost (24 pts). Forty-three pts were stage I, 154 stage II, 31 stage IIIA and 53 stage IIIB. RESULTS: The mean follow-up was 65 months (range: 1.3-250 months). The 5-years-overall survival and SS rates were 66.4% and 78.1% respectively. In multivariate analysis, tumor size (>or=40 mm) [RR=2.1], node involvement (RR=2.4), and poor response (<75%) to first course irradiation [RR=1.9], local relapse (RR=4.5) and distant metastases were factors of poor prognosis for SS. Five-years-LRC were 71.5% (88% for stage I, 69% for stage II, 77%, for stage IIIA and 60% for stage IIIB). Prognosis factors of LCR were tumor size (RR=2.5), response to first course of irradiation (RR=2.9). SC was 71% at 5 years. Prognosis factors of SC were tumor size (RR=1.9) and response to first course of irradiation (RR=2.4). CONCLUSION: The results of this series are similar to those of the literature. As well as initial tumor extension, response to first course of irradiation was found as prognostic factor on LCR, SS, SC. Our results are similar to other series and brachytherapy seems not to be deleterious. Its impact to local control remains to be evaluated.

[Cardiac tamponade and central venous catheterization]. / Tamponnade et cathétérisme veineux central.

A 32-year-old female patient was operated on for a residual colonic stricture occurring after hemicolectomy. A right internal jugular central venous catheter was inserted during the anaesthetic for postoperative parenteral feeding. The anaesthetic combined both general and epidural anaesthesia, the latter being continued for postoperative analgesia (10 ml.h-1 of 0.125% bupivacaine). Two days later, the patient complained of sudden chest pain, with restlessness, tachycardia, cyanosis, resulting in ventricular tachycardia and cardiac arrest. When admitted to the surgical intensive care unit, the patient was in deep coma and had nonsustained ventricular tachycardia, a left haemopneumothorax and a pneumopericardium. The patient died before a definitive diagnosis was made. Postmortem examination revealed an ulcerated anterior pillar of the tricuspid valve, as well as a perforation of the right ventricle and a communication between the pericardium and the left pleural cavity. The diagnosis and treatment of this rare life-threatening complication may be very difficult. It prevention consists in using short catheters for internal jugular venous access, and checking the tip's position radiologically by opacifying the catheter.