[Partial breast irradiation technique with external beam radiation therapy and brachytherapy]. / Technique d'irradiation partielle du sein : radiothérapie externe et curiethérapie.

Accelerated Partial Breast Irradiation (APBI) appears to be an efficient therapeutic modality provided that it uses strict selection criteria and a reliable and well-managed technique. The techniques that enable to deliver postoperative APBI are interstitial brachytherapy, endocavitary brachytherapy and external beam radiation therapy. Once an appropriate selection of the candidates is made, each radiation technique needs an exact target volume definition and a strict compliance with its own dosimetric constraints. Results of ongoing randomized trials should increase our knowledge of all these parameters, and give us responses about the comparison of the different techniques.

[State of the art and perspectives of accelerated partial breast irradiation in 2014]. / État de l'art et perspectives de l'irradiation partielle et accélérée du sein en 2014.

In the frame of treatment de-escalation and personalization, accelerated partial breast irradiation is taking its place in the breast cancer therapeutic options. This study analyzed the results of phase III randomized trials having compared accelerated partial breast irradiation versus whole breast irradiation. Currently, among those trails, six proposed some results regarding efficacy and/or toxicity. Globally, the non-randomized studies confirmed the expected results showing a low rate of local recurrence and toxicity. The first results of the phase III randomized trials showed encouraging data in terms of local control while the toxicity varied mainly according to the accelerated partial breast irradiation technique used. However, the follow-up of the majority of these studies remains insufficient. The strict respect of accelerated partial breast irradiation indications likely represents one of the key factors of the therapeutic success. The next results could allow proposing a better definition of the accelerated partial breast irradiation selection criteria.

[Pituitary adenomas: multimodal management and modern irradiation techniques]. / Adénomes hypophysaires: mise au point sur la pathologie et les techniques d'irradiation modernes.

Pituitary adenomas represent 10 to 20% of all primary brain tumours. The main classifications consider their size, micro- and macroadenomas, and their properties, secreting or non-functioning. These characteristics determine the choice of treatment, surgery and medical therapy on first line in many cases. Conventional radiotherapy, whose efficiency has been demonstrated, is indicated in the post-operative setting for lesions at high risk of relapse, recurrences, contra-indications to surgery and intolerance or resistance to medical therapies. Optimal target volume delineation is critical, owing to the proximity of organs at risk and a risk of late toxicity for these patients who have normal life expectancy. Technological, computering and imaging advances have led to conformal radiotherapy, intensity-modulated treatment and stereotaxy. These new techniques are reviewed through a recent literature search. Local control rates are high, although follow-up is still short. Indications for radiosurgery are restricted by the size of the lesions. Fractionated stereotactic radiotherapy potentially reduces late toxicity, but longer follow-up is necessary.