Fractionated Stereotactic Radiation Therapy for Pituitary Adenomas: An alternative escalating protocol of hypofractionated stereotactic radiotherapy delivering 35Gy in 5 fractions.

PURPOSE: Evaluate efficacy and toxicity of hypofractionated stereotactic radiotherapy (HSRT) for patients treated for pituitary adenoma (PA) with an alternative HSRT escalating protocol delivering 35Gy in 5 fractions. MATERIAL AND METHODS: From June 2007 to March 2017, 29 patients with pituitary adenoma were treated in Antoine Lacassagne Cancer Centre with an alternative HSRT protocol. Prescribed dose was 35Gy in 5 fractions of 7Gy. Radiographic responses were assessed by annual MRI. Hormone blood samples were evaluated each year after HSRT. RESULTS: A total of 29 patients aged between 23 and 86 years (median 54 years) were included. Twelve patients received HSRT for recurrent cases and 12 received postoperative adjuvant HSRT, 5 patients did not have surgery. After a median follow-up period of 47 months local control rate was 96%. One patient presented an out-field tumor regrowth 73 months after HSRT. The majority of PA were endocrine-active (18 patients, 62%). After HSRT, 8 patients (44%) presented complete response on initial secretion, 4 patients (23%) presented partial response on initial secretion. Four patients (14%) presented grade 2 or more acute radiation toxicities. One grade 4 visual disorder was observed for one patient. CONCLUSIONS: HSRT delivering 35Gy in 5 fractions represents a feasible treatment and shows promising results to reduce hormonal overproduction and to improve local control in PA.

[Differences between hypertension in Metropolitan France compared to Overseas France Departments and Regions (DOM-ROM)]. / Différences de prise en charge de l'HTA entre la métropole et les DOM-ROM.

BACKGROUND: High blood pressure (HBP) is the most common chronic disease worldwide. In France, its prevalence varies by region. It is high in most Overseas Departments and Regions (DOM-ROM), at 38.2% in Réunion (1), 44% in Mayotte (2), 28% in the French Antilles, 18% in French Guiana, 25% in French Polynesia (3) and 28% in Saint-Martin (4). PURPOSE: To determinate the differences within the same healthcare system between hypertension in Metropolitan France compared to Overseas France Departments and Regions (DOM-ROM). RESULTS: Sex-based differences. In contrast to Metropolitan France, in Overseas France the prevalence of HBP is higher in women, although women show better rates of care (screening and rates of patients "normalised" under medical treatment). The main explanation for this is the higher prevalence of obesity in women. Obesity multiplies the risk of developing hypertension by 2.5 Obesity in Guadeloupe affects 14% of men compared to 31% of women. Socio-economic particularities of hypertension in Overseas France. The numerous epidemiological surveys carried out in the French Antilles have demonstrated the major role of socio-economic conditions in the occurrence of hypertension, alongside the usual risk factors such as sedentary lifestyle, salt consumption and obesity (7). In the absence of socio-economic disparity, there is no significant disparity in the prevalence of hypertension specially in men. CONCLUSIONS: There are differences between France Overseas Regions and Territories (DOM-ROMs) and Metropolitan France in terms of the prevalence, knowledge, treatment and control of hypertension, and these vary according to sex. For men, the prevalence and treatment of hypertension differ very little when considering a population of workers or employees in both regions. On the other hand, for women, the prevalence of hypertension is higher in the French Antilles-Guiana. This difference is not fully explained by the higher prevalence of obesity observed among female employees in the French Antilles-Guiana. For these patients, we also observe better knowledge and better control of hypertension. Care for men in socio-economically disadvantaged situations of precarity must be improved in terms of screening and adherence to treatment.

Evaluation of acute skin toxicity of breast radiotherapy using thermography: Results of a prospective single-centre trial.

PURPOSE: Radiotherapy is a common adjuvant treatment of breast cancer. Acute radiation-induced dermatitis is a frequent side effect. We hypothesized whether it is possible to capture the increase of local temperature as a surrogate of the inflammatory state induced by radiotherapy. We designed a prospective, observational, single-centre study to acquire data on temperature rise in the treated breast during the course of radiotherapy, establish a possible association with the occurrence of dermatitis and investigate the predictive value of temperature increase in future occurrences of radiation-induced dermatitis. PATIENTS AND METHODS: All patients presenting for neoadjuvant or adjuvant radiotherapy during the course of breast cancer treatment at the university hospital of Martinique were considered for inclusion. Every week, patients were examined by two trained investigators for the occurrence of radiation-induced dermatitis, graded based on Radiotherapy Oncology Group, Common Terminology Criteria for Adverse Events v.4.0 and Wright scales. A frontal thermal image of torso was taken in strictly controlled conditions, with a calibrated TE-Q1 camera (Thermal Expert, i3systems, Daejeon, Korea). We studied temperature differences between the irradiated breast or thoracic wall and the contralateral area. For each thermal picture, we measured the difference in maximum temperature as well as the difference in minimum temperature and the difference in the average temperature in the considered area. We studied the evolution of these parameters over time week after week, measuring the maximum recorded difference and its correlation to acute radiation dermatitis intensity. RESULTS: Sixty-four consecutive patients were included. For all patients, we noticed an increase of temperature during the course of radiotherapy. Difference in maximum, minimum and average temperature was higher between the two breasts of patients with a radiation-induced dermatitis grade 2 or above compared to patients with no or mild dermatitis. Higher temperatures were also significantly associated with an increased sensation of discomfort, as recorded by questionnaire (P<0.05). CONCLUSION: As expected from the inflammatory phenomena involved in radiation-induced dermatitis, a noticeable increase in temperature during the course of radiotherapy was seen in all patients. Furthermore, high-grade radiation-induced dermatitis was strongly associated with an additional increase in local temperature, which is probably linked to the intense inflammatory reaction. Lastly, with a 1.4°C threshold set beforehand, it is possible to anticipate the occurrence of radiation-induced dermatitis, with interesting positive and negative predictive values of 70% and 77%, respectively in our population. We note that these results need to be confirmed in a dedicated study.

Abdominal desmoplastic small round cell tumor without extraperitoneal metastases: Is there a benefit for HIPEC after macroscopically complete cytoreductive surgery?

BACKGROUND: Desmoplastic Small Round Cell Tumor (DSRCT) is a rare disease affecting predominantly children and young adults and for which the benefit of hyperthermic intraperitoneal chemotherapy (HIPEC) after complete cytoreductive surgery (CCRS) remains unknown. METHODS: To identify patients with DSRCT without extraperitoneal metastases (EPM) who underwent CCRS between 1991 and 2015, a retrospective nation-wide survey was conducted by crossing the prospective and retrospective databases of the French Network for Rare Peritoneal Malignancies, French Reference Network in Sarcoma Pathology, French Sarcoma Clinical Network and French Pediatric Cancer Society. RESULTS: Among the 107 patients with DSRCT, 48 had no EPM and underwent CCRS. The median peritoneal cancer index (PCI) was 9 (range: 2-27). Among these 48 patients, 38 (79%) had pre- and/or postoperative chemotherapy and 23 (48%) postoperative whole abdominopelvic radiotherapy (WAP-RT). Intraperitoneal chemotherapy was administered to 11 patients (23%): two received early postoperative intraperitoneal chemotherapy (EPIC) and nine HIPEC. After a median follow-up of 30 months, the median overall survival (OS) of the entire cohort was 42 months. The 2-y and 5-y OS were 72% and 19%. The 2-y and 5-y disease-free survival (DFS) were 30% and 12%. WAP-RT was the only variable associated with longer peritoneal recurrence-free survival and DFS after CCRS. The influence of HIPEC/EPIC on OS and DFS was not statistically conclusive. CONCLUSION: The benefit of HIPEC is still unknown and should be evaluated in a prospective trial. The value of postoperative WAP-RT seems to be confirmed.

Curative brachytherapy for prostate cancer in African-Caribbean patients: A retrospective analysis of 370 consecutive cases.

PURPOSE: Prostate cancer is the most frequent malignancy in African-Caribbean men, a population sharing common genetic traits with African-American (AA) but presenting also genomic and epidemiologic specificities. Despite socioeconomic disparities with French mainland, all patients were treated within the French state-financed equal-access health care system. In this study, we report biochemical outcomes of patients treated by brachytherapy in our department from 2005 to 2014 in an African-Caribbean population. METHODS AND MATERIALS: Three hundred seventy consecutive patients receiving 125I brachytherapy as a curative treatment for early-stage (localized) disease between 2005 and 2014 were recorded. Selected patients presented with low-risk disease: initial prostate-specific antigen (PSA) <10 ng/mL, clinical stage ≤ T2c, and Gleason score <7. Patients with intermediate risk of recurrence were also included on a case-to-case basis with prostate-specific antigen <15 or Gleason score 7 (3 + 4). Biochemical failure free-survival was defined according to the American Society for Radiation Oncology nadir+2 definition. RESULTS: The 3-year and 5-year biochemical failure free-survival for the entire cohort were 98.3% and 91.6%, respectively. For patients with low- and intermediate-risk disease, the 5-year BBFS rates were 92.1% and 90.8%, respectively. In univariate and multivariate analyses, only Gleason score (<7 vs. 7; p =  0.030 vs. p < 0.05) was a significant predictor of biochemical failure. The overall rate of late and acute Grade 2 or higher genitourinary toxicity was 12.6% and 10.3%. CONCLUSIONS: In this large single-center series, brachytherapy achieved excellent rates of medium-term biochemical control in both low and selected intermediate-risk localized prostate cancer in African-Caribbean patients. Brachytherapy seems to be an excellent choice of treatment, with excellent outcomes and limited morbidity for African-Caribbean populations.

[Precariousness, cardiovascular risk in the afro-Caribbean population of Saint-Martin. Data from the study CONSANT-SM]. / Précarité, risque cardiovasculaire dans une population afrocaribéenne de Saint-Martin. Données de l'étude CONSANT-SM.

OBJECTIVE: The objective is to describe the prevalence of arterial hypertension (hypertension) and cardiovascular risk factors (FDR) and specify their association with the socio-economic factors in a collectivity of Saint-Martin. MATERIAL AND METHODS: CONSANT-SM is a cross-sectional descriptive study carried out on a representative sample of 400 people. The data collection was conducted by investigators at home. RESULTS: The low income level is significantly associated with abdominal obesity (OR=2.3), with cardiovascular FDR accumulated (OR=3.58). Low level of education (OR=2.86) and abdominal obesity (OR=3.73) are significantly associated with hypertension. DISCUSSION: The link between cardiovascular FDR and precariousness (in our study represented by the variable low levels of income and education) is found in this study carried out on a representative sample of the population of the community of Saint-Martin. CONCLUSION: The strong link between hypertension, obesity and others cardiovascular risk factors (FDR) with precariousness (in our study represented by the variable low levels of income and education) is found in this afro-Caribbean population. This data is an important information for the health program developed by the healthy system.

Prostate-specific antigen bounce after curative brachytherapy for early-stage prostate cancer: A study of 274 African-Caribbean patients.

BACKGROUND: Prostate cancer incidence in the African-Caribbean population ranks among the highest worldwide. We aim to evaluate the prostate-specific antigen (PSA) kinetics after brachytherapy, which so far remains unknown in this population. METHODS AND MATERIALS: From 2005 to 2013, 371 patients received (125)I brachytherapy of 145 Gy for early-stage prostate cancer. Eligibility criteria were cTNM ≤T2c, Gleason score ≤7, and initial PSA ≤15 ng/mL. Pretreatment androgen deprivation therapy was allowed. PSA bounce was defined as an increase of ≥0.4 ng/mL, lasting ≥6 months, followed by a decrease without any anticancer therapy. We examined PSA kinetics during followup. RESULTS: For the 274 patients with at least 24 months followup, median age was 62 years old (range, 45-76). Initial PSA was <10 ng/mL in 244 and 10-15 ng/mL in 30 patients; 40 received androgen deprivation therapy. With a median followup of 50 months (range, 24-125), PSA declined continuously in 168 (61%) patients, bounced in 87 (31%), and initially declined and then rose in 22 (8%) patients. Among these latter patients, 18 presented clinical recurrence. Mean bounce intensity was 2.0 ng/mL (median, 1.2; range, 0.4-12.4). Bounces occurred in average 12 months after brachytherapy. Patients with bounce were significantly younger: mean age 59 vs. 63 years old in patients without bounce, p <0.001. Bounce was also significantly associated with the immediate post-brachytherapy PSA, mean 4.0 among bounce cases vs. 2.9 among non-bounce cases, p < 0.001. Bounce was not associated with recurrence. CONCLUSIONS: PSA bounce in our African-Caribbean population seemed earlier and was more intense than described in other populations. Early increase of PSA should not be ascribed to treatment failure.

[Radiotherapy for gliomas in adults: What are the stakes of the follow-up?]. / Radiothérapie des gliomes chez l'adulte : quels sont les enjeux de la surveillance ?

Linked to the difference of prognosis, the terms and conditions of the follow-up of low-grade and high-grade gliomas treated by irradiation differ highly. Patients treated for a low-grade glioma have prolonged survival. In this case, monitoring of toxicities linked to the treatment is a major objective. Opportunistic infections and depression are corticosteroids side effects widely underestimated. Radionecrosis search and differentiation with recurrent disease are done by MRI. Perfusion and spectroscopy showing a choline/creatine ratio increase are in favour of disease recurrence. Cognitive status and quality of life must be evaluated during the follow-up. They have to be evaluated by adapted scales. Cognitive rehabilitation improves interestingly the post-treatment cognitive status. Pseudoprogression rates for high-grade gliomas are near 20%. MRI is the benchmark imaging for its diagnosis. Diffusion weight imaging and spectroscopy are actually the most interesting techniques.

[High blood pressure and obesity: disparities among four French overseas territories]. / Hypertension artérielle et obésité : disparités entre quatre régions d'Outre-mer.

BACKGROUND AND PURPOSE: The epidemiological characteristics of hypertension and obesity in French overseas territories (FOTs) have never been compared. METHODS: This cross-sectional survey included representative population-based samples of 602, 601, 620 and 605 men and women aged more than 15 years, respectively, from four FOTs of Guadeloupe, Martinique, French Guiana, and French Polynesia. Hypertension was defined as blood pressure (BP) at least 140/90mmHg or the current use of antihypertensive treatment. RESULTS: The prevalence of hypertension was 29.2% in Guadeloupe, 17.9% in French Guiana, 27.6% in Martinique and 24.5% in French Polynesia. Considering the Guadeloupe population as the reference group, prevalence of hypertension was significantly lower in French Guiana (P<0.001), even after controlling for age and sex (PU0.006). Awareness and treatment of hypertension were similar in French Guiana, Martinique and Guadeloupe (68.8-75.1% and 69.0-73.4%, respectively). Awareness was lower in French Polynesia (50.0%, adjusted P value U0.04), as was treatment of hypertension (32.4%, adjusted P value U0.001). Control of hypertension was also lower in French Polynesia (8.8%, adjusted P value U0.001) compared with the other territories (29.7-31.8%). French Polynesia had the highest prevalence of obesity (33.1%, adjusted P value<0.001) as compared with the other territories (17.9-22.8%). It had also the largest population attributable fraction of hypertension due to obesity (35.5%) compared with Guadeloupe (13.3%), Martinique (12.3%) and French Guiana (23.6%). CONCLUSION: Wide variations were observed in the prevalence and the management of hypertension between these FOTs, and an especially challenging low control of hypertension was found in French Polynesia. Obesity appears a key target to prevent hypertension, particularly in French Polynesia.