[Tolerance of adjuvant radiotherapy in the treatment of stage I seminoma]. / Tolérance de la radiothérapie dans le traitement adjuvant des séminomes testiculaires stade I.

OBJECTIVE: To assess the tolerance of adjuvant radiotherapy in the treatment of stage I seminoma post-orchiectomy. MATERIAL AND METHODS: Between 2001 and 2006, 21 men with stage I seminoma underwent 3D conformal radiotherapy 3 to 4 weeks post-orchiectomy. The total radiation dose was 2490 cGy divided into 15 sessions. Radiation was delivered by 2 antero-posterior fields using X-ray photons of 18 MV. Two types of radiation fields were used : para-aortic and ipsilateral iliac (dog leg) or para-aortic only. The average followup was 2 years 4 months with an interval of 4 to 58 months. Tolerance of treatment was evaluated according to criteria of the RTOG. RESULTS: Median follow-up time is 30 months. Disease-free survival was 100%. The most frequently encountered acute toxicity was gastrointestinal; mainly nausea and vomiting. Tolerance to treatment was better in the group receiving para-aortic radiotherapy alone (37% of grade II gastrointestinal toxicity vs 62%) CONCLUSION: The para-aortic irradiation for stage I seminoma gave satisfactory results with a better toxicity profile than the dogleg irradiation.

[Corticosteroids and radiotherapy in the treatment of Graves' ophthalmopathy]. / Efficacité de la radiothérapie orbitaire combinée a la corticothérapie dans la prise en charge de l'ophtalmopathie, basedowienne.

Graves' ophthalmopathy is a debilitating disease impairing the quality of life of affected individuals. The management of moderate-to-severe active Graves' ophthalmopathy is a major therapeutic challenge, and the treatment outcome is often unsatisfactory. We have carried out a retrospective study to assess the efficacy of combined orbital irradiation and systemic corticosteroids. Ten patients were included; all patients had received 20 Grays to the retrobulbar tissues in ten fractions, and oral or intravenous glucocorticoids. The main therapeutic outcome measures were the criteria of Donaldson and co-workers and a self-assessment evaluation. The quality of life outcome was also evaluated by the GO-QOL (Graves' ophthalmopathy quality of life) questionnaire. Seven patients (70%) demonstrated improvement in ocular parameters; the response was excellent in three cases, good in three cases and fair in one case. Three patients showed no response to the treatment. The self-assessment evaluation showed that 75% of patients were satisfied with the results of the treatment. Proptosis was the most responsive sign to radiation and steroids. A duration of the eye disease of more than 18 months was associated with less improvement and a higher failure of the treatment. Concerning the quality of life, the score for visual fonctionning was 882 +/- 18.2 after treatment, while the score for appearance was 63.3 +/- 23.3. In conclusion, a combination of orbital irradiation and systemic steroids is associated with 70% of favorable responses, but the quality of life is not restored in the same proportions and remains impaired after treatment.

[The role of radiotherapy in the treatment of ductal carcinoma in situ of the breast]. / Role de la radiothérapie dans le traitement des carcinomes canalaires in situ du sein.

INTRODUCTION: The incidence of ductal carcinoma in situ (DCIS) of the breast discovered during screening mammography is rising. This finding has led to the possibility of further breast conservation. We reviewed in this article the role of radiotherapy in the context of breast conservation. MATERIAL AND METHODS: Randomized and nonrandomized trials as well as meta-analyses and textbooks dealing with radiotherapy for DCIS have been retrieved from the published literature. Databases for ongoing trials have also been checked. RESULTS: Non randomized studies showed a poor local control with surgery alone, with local recurrences varying between 20 and 40% at 10 years. The use of radiotherapy led to a significant decrease in local relapse thus giving the rationale for phase III trials evaluating the role of radiotherapy. To date there are four trials published dealing with radiotherapy for DCIS:EORTC 10853, NSABP B-17, SweDCIS and UKCCCR. All these studies showed a significant decrease in the local relapse to values around 15% at 10 years. This benefit did not however translate into any survival gain. The effect of radiotherapy was seen in all patients sub-groups. However, controversies about the necessity of irradiating all patients and about the dose of the radiation to deliver remain present. Ongoing trials trying to provide answers to these controversies are reviewed. CONCLUSIONS: Conservative surgery followed by radiotherapy to the whole breast to a dose of 50 Gy remains the standard for breast DCIS discovered with screening mammography. This treatment should be discussed with all patients until randomized data provide evidence of a low risk category that should not have adjuvant radiation. The use of a boost on the tumor bed remains to be discussed for young patients who have positive margins only until data derived from phase III trials are available.

[A five-year experience in conformational radiotherapy in the treatment of prostate cancer. Evaluation of acute toxicity in 131 patients]. / Radiothérapie conformationnelle dans le traitement du cancer de la prostate. Evaluation de la toxicité aiguë chez 131 patients.

PURPOSE: To evaluate the urinary and rectal toxicity secondary to 3D conformal radiotherapy for prostate cancer. MATERIAL AND METHODS: Between 1998 and 2003, 131 men with prostate cancer underwent 3D conformal radiotherapy with or without androgen deprivation. The different stages were: 2 T1b ; 40 T1c; 19 T2a; 16 T2b; 18 T2c; 33 T3a; 1 T3b and 2 T3c with Gleason score: 4-6 = 47%, 7 = 36% and 8-9 in 17% of the cases. The median patient age was 66 (48-87). Pretreatment PSA level was respectively < 10 ng/ml (41%). 10-20 ng/ml (30%) and > 20 ng/ml (29%). Of the 131 patients, 98 received androgen ablation therapy before radiation. The total radiation dose varied between 66 and 74 Gy, delivered with 18MV photons of the linear accelerator, the median follow up was 33 months (5-67). RESULTS: According to the RTOG grading (gr) for acute toxicity, we noticed 3gr 3 genitourinary (GU) toxicity and no gr3 gastro intestinal (GI) toxicity. There were 36 gr 1 and 12 gr 2 GI toxicity, 41 gr 1 and 22 gr 2 GU toxicity. The mean prostate volume was 41 cc for patients who received androgen ablation and 56 cc for the others (p < 0.002). The percentage of volume receiving more than 50 Gy (V50) was calculated, the median V50 was 32% (5-67) for the rectum and 35% (5-79) for the bladder CONCLUSION: The toxicity profile in this study is in the same range than those of the literature and of our previous study concerning our first 50 patients with prostate cancer treated with 3D conformal radiotherapy.