[Intensity-modulated radiotherapy and involved-node concept in patients with Hodgkin lymphoma: experience of the Gustave-Roussy Institute]. / Optimisation de l'« involved-node radiotherapy ¼ par l'utilisation de la modulation d'intensité dans le lymphome hodgkinien localisé : expérience de l'institut Gustave-Roussy.

PURPOSE: To assess the clinical outcome of the involved-node radiotherapy concept with the use of intensity modulated radiotherapy (IMRT) in patients with localized supradiaphragmatic Hodgkin lymphoma. PATIENTS AND METHODS: Patients with early-stage supradiaphragmatic Hodgkin lymphoma were treated with chemotherapy prior to irradiation. Radiation treatments were delivered using the involved-node radiotherapy (INRT) concept according to the EORTC guidelines. Intensity modulated radiotherapy was performed free-breathing. RESULTS: Forty-seven patients with Hodgkin lymphoma (44 patients with primary Hodgkin lymphoma and three patients with recurrent disease) entered the study from January 2003 to December 2010. The median age was 31 years (range 17 to 62). Thirty patients had stage I-IIA, 14 had stage I-IIB disease and three had relapse. Forty-two patients received three to six cycles of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). The median radiation dose to patients was 36 Gy (range: 20-40). Protection of various organs at risk was satisfactory. The median follow-up was 57.4 months (range: 5.4-94.3). For patients with primary Hodgkin lymphoma, the 5-year survival and 5-year progression-free survival rates were 96% (95% confidence interval: 80-99) and 92% (95% confidence interval: 78-97), respectively. None of the three patients with recurrent disease has relapsed. Recurrences occurred in three patients: one was in-field relapse and two were visceral recurrences. Grade 3 acute lung toxicity (transient pneumonitis) occurred in one case. CONCLUSION: Our results suggest that patients with localized Hodgkin lymphoma can be safely and efficiently treated using the involved node irradiation concept and intensity modulated irradiation.

[Implementation of GEC-ESTRO recommendations on 3-D based image brachytherapy]. / Imagerie 3D en curiethérapie gynécologique: applications des recommandations du GEC-ESTRO et résultats.

Even if the prognosis of patients with cervical cancer has been dramatically improved with concomitant chemoradiation, brachytherapy still plays fundamental role in the therapeutic approach of patients with Figo stage I-IV cervical carcinoma. The development of imaging with three-dimensional dosimetry has contributed to the improvement in target and organs at risk knowledge. In 2005 and 2006, GEC-ESTRO recommendations on 3-D based image brachytherapy have defined the different volumes of interest. These recommendations have been validated with intercomparison delineation studies. Data on dose to normal tissues are better known with dose volume-histograms analysis. Dose limits to the bladder are high in the range of 90 Gy to the 2 cm3 while 2 cm3 limits to the rectum do not differ from ICRU point. The sigmoid is currently under study as this organ was not extensively studied before the era of imaging. Doses to the tumour (HR-CTV or IR-CTV) are not clearly stated and will likely depend on tumour extension.

[Adjuvant therapy and role of radiation therapy in advanced endometrial cancers]. / Traitements adjuvants et rôle de la radiothérapie dans les formes évoluées de cancer de l'endomètre.

The treatment of patients with endometrial cancer is rapidly evolving. Literature data give more information on prognostic factors, allowing treatment stratification. If treatment has become less heavy in early-stage disease, therapeutic approaches have become more aggressive in more advanced disease. In this situation, treatment combines external irradiation and chemotherapy. Despite these advances, numerous questions remain on the best therapeutic sequence. Optimal chemotherapy regimens remain to be determined. On-going randomized trials will help to answer these questions.

Sound localization in hemispherectomized subjects: the contribution of crossed and uncrossed cortical afferents.

The aim of the present study was to evaluate how hemispherectomized subjects localize sounds in free field using residual auditory structures under monaural testing conditions. The main objective of using a monaural condition with these subjects, who lack the terminal fields of auditory projections on one side, was to evaluate how the crossed and uncrossed pathways compare, with the aim of resolving this biologically critical function. In this model, crossed and uncrossed inputs refer to auditory stimulation presented to the unobstructed ear on the contralateral and the ipsilateral side of the intact hemisphere, respectively. Three hemispherectomized subjects (Hs) and ten control subjects (Cs) were tested for their accuracy to localize broad band noise bursts (BBNBs) of fixed intensity presented on the horizontal plane. BBNBs were delivered randomly through 16 loudspeakers mounted at 10 degrees intervals on a calibrated perimeter frame located inside an anechoic chamber. Subjects had to report the apparent stimulus location by pointing to its perceived position on the perimeter. Hs were less accurate than Cs in the baseline binaural condition, confirming the finding that with a single hemisphere and/or residual (subcortical) structures they cannot analyze binaural cues to sound localization as efficiently as with two fully functional hemispheres. In the monaural condition, Hs localized poorly when they had to depend on the uncrossed input, but performed as well or even better than the Cs with the crossed input. These findings suggest that monaural spectral cues, which constitute the only residual cue to localization under the monaural testing condition, are treated more efficiently, that is, they lead to better localization performance when relayed to the cortex via crossed pathways than through uncrossed pathways.

Localization of moving sounds by hemispherectomized subjects.

The objective of the present study was to evaluate the localization abilities of the residual auditory structures in hemispherectomized subjects (Hs) during monaural and binaural listening. The monaural stimulus presentations were aimed at evaluating the relative contribution of crossed and uncrossed afferents to the perception of a moving auditory target. Three Hs and ten control subjects (Cs) were asked to localize a simulated moving sound source of fixed intensity presented on the horizontal plane. The moving stimulus was delivered randomly through 16 loudspeakers which were mounted at 10 degree intervals on a calibrated perimeter frame located inside an anechoic chamber. The apparent movement traveled in either direction over three different distances in the peri-central and lateral fields. Listeners had to report the movement trajectory by pointing with the index finger where they thought the beginning and the ending of the stimulus occurred on the perimeter. Hs were less accurate than Cs in the binaural condition, suggesting that the residual hemisphere and/or subcortical structures are not by themselves as efficient to accurately analyze motion as when the two hemispheres are present. In the monaural testing conditions, most of the subjects showed a prominent lateral displacement of the perceived localization towards the functional ear. However, all subjects, particularly the Cs, were able to perceive different lengths of trajectories although they did not discriminate the direction of the motion. For the Hs, the pattern of performance differed for each subject. One right Hs was more accurate for localizing the sources delivered on the side of the functional ear when relying on crossed-input. A left Hs was able to detect the appropriate side of the moving sound source even when it was presented on the side to the obstructed ear. The other left Hs who had developed normally until the age of 5, was more affected by the hemidecortication in both the binaural and the monaural listening conditions. These findings suggest that it is possible to detect moving sounds in the absence of binaural cues and without the integration carried out by both cerebral hemispheres. However it appears that interaural disparities and bihemispheric integration are required for finer analysis.

Early-blind human subjects localize sound sources better than sighted subjects.

Do blind persons develop capacities of their remaining senses that exceed those of sighted individuals? Besides anecdotal suggestions, two views based on experimental studies have been advanced. The first proposes that blind individuals should be severely impaired, given that vision is essential to develop spatial concepts. The second suggests that compensation occurs through the remaining senses, allowing them to develop an accurate concept of space. Here we investigate how an ecologically critical function, namely three-dimensional spatial mapping, is carried out by early-blind individuals with or without residual vision. Subjects were tested under monaural and binaural listening conditions. We find that early-blind subjects can map the auditory environment with equal or better accuracy than sighted subjects. Furthermore, unlike sighted subjects, they can correctly localize sounds monaurally. Surprisingly, blind individuals with residual peripheral vision localized sounds less precisely than sighted or totally blind subjects, confirming that compensation varies according to the aetiology and extent of blindness. Our results resolve a long-standing controversy in that they provide behavioural evidence that totally blind individuals have better auditory ability than sighted subjects, enabling them to compensate for their loss of vision.