Safety Margins for the Delineation of the Left Anterior Descending Artery in Patients Treated for Breast Cancer.

PURPOSE: Cardiac toxicity after breast cancer (BC) radiation therapy is partly due to the large radiation doses to coronary arteries. The left anterior descending artery (LAD) is particularly exposed. A first step in achieving robust dose constraints to the LAD during treatment planning is homogeneous delineation based on guidelines. LAD delineation can be problematic due to heart movements. The aim of the study was to establish a safety margin for delineation of the LAD in patients with BC. METHODS AND MATERIALS: We studied 45 patients with left-sided BC who had an indication for adjuvant radiation therapy between 2015 and 2018. They all underwent cardiac-gated computed tomography scan, as well as planning computed tomography scans with or without contrast agents, to assess LAD diameter and movements. Cardiac-gated computed tomography scan was performed during monitoring of the cardiac cycle. Acquisition was launched immediately after contrast injection (arterial sequence), with deep-inspiration breath hold and use of a beta-receptor blocking agent. By manually reviewing each scan, the LAD positions and diameter were defined at 20 different phases of the cardiac cycle at 5 different sites: ostium (OS), circumflex bifurcation (bfc), first diagonal bfc, second diagonal (D2) bfc, and apex (right coronary anastomosis). RESULTS: Movement of the LAD is maximal at the ostium and then constant overall even when far from its origin. The diameter decreases with the distance from ostium: 4.9 mm (OS), 3.9 mm (circumflex), 3.5 mm (D2), and 3.1 mm (D2). CONCLUSIONS: We suggest using a safety delineation margin consisting of a cylinder with a diameter of 10 mm surrounding the LAD. These findings must be validated in independent series of patients treated for BC.

Crossing the perspectives of patients, families, and physicians on cancer treatment: A qualitative study.

PURPOSE: Patients, family members, and physicians participate in cancer care, but their perspectives about what is helpful during cancer treatment have rarely been compared. The aim of this study was to compare these three perspectives. METHODS: Multicenter qualitative study (with previously published protocol) based on 90 semi-structured interviews. Participants (purposively selected until data saturation) came from three different subsamples: (i) patients with cancer (n=30), (ii) their relatives (n=30), and (iii) their referring physicians (n=10, interviewed more than once). RESULTS: Our analysis found 3 main axes (perceived positive effects of cancer treatment, perceived negative effects of cancer treatment, doctor-physician relationship), each composed of 2 main themes. The findings showed that patients, families, and physicians shared the long-term objective of increasing survival (while reducing side effects). However, patients and relatives also pointed out the importance of living with cancer each day and thus of factors helping them to live as well as possible in daily life. The physicians' difficulty in coping with patients' suffering may limit their access to elements that can improve patients' capacity to live as well as possible. CONCLUSIONS: During cancer treatment (and not only at the end of life), attention should be given to enhancing the capacity of patients to live as well as possible (not only as long as possible) to meet the goals of patient-centered care and satisfy this important need of patients and families.

[External beam radiotherapy and brachytherapy in prostate cancer]. / Curiethérapie et radiothérapie des cancers de la prostate.

For the last 10 years, along with surgery, radiotherapy has become a major issue in the curative treatment of prostate cancer. Several radiotherapy techniques can be used. In good prognosis cancers, when the prostate is small, brachytherapy is one of the therapeutic options. By implanting radioactive seeds within the prostate, this technique permits strictly limited intraprostatic irradiation. Conformal external beam (3D) radiotherapy adapts to individual morphology according to dosimetric CT scan data. This is particularly useful to deliver a high dose in the target volume while limiting the dose in surrounding organs. It is indicated either for localised tumours as an alternative solution to surgery, or for tumours with more aggressive patterns or locally advanced that will in both cases require adjuvant hormotherapy; conventional (2D) radiotherapy can be used in case of isolated clinical or biological relapse after prostatectomy. These last two techniques induce two main types of late toxicity: radio-induced rectitis and sexual impotence. Last but not least, radiotherapy as well as nuclear medicine can be used with palliation intent and may be of great help to relieve pain in case of bone metastases.