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1.
Cancer Radiother ; 28(2): 218-227, 2024 Apr.
Artículo en Francés | MEDLINE | ID: mdl-38599940

RESUMEN

In this article, we propose a consensus delineation of postoperative clinical target volumes for the primary tumour in maxillary sinus and nasal cavity cancers. These guidelines are developed based on radioanatomy and the natural history of those cancers. They require the fusion of the planning CT with preoperative imaging for accurate positioning of the initial GTV and the combined use of the geometric and anatomical concepts for the delineation of clinical target volume for the primary tumour. This article does not discuss the indications of external radiotherapy (nor concurrent systemic treatment) but focuses on target volumes when there is an indication for radiotherapy.


Asunto(s)
Neoplasias de la Boca , Neoplasias de los Senos Paranasales , Humanos , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/cirugía , Seno Maxilar/patología , Cavidad Nasal/diagnóstico por imagen , Planificación de la Radioterapia Asistida por Computador/métodos , Neoplasias de la Boca/patología
2.
Cancer Radiother ; 27(6-7): 648-652, 2023 Sep.
Artículo en Francés | MEDLINE | ID: mdl-37563012

RESUMEN

Standard treatment stage of non-small cell lung cancer is currently surgery. For inoperable patients, stereotactic body radiotherapy is the reference treatment. This non-invasive technique has developed considerably and its excellent results in terms of carcinological control and tolerance raise the question of its indication for operable patients, especially for old patients and/or with comorbidities. This article reviews the available data in the literature of the place of stereotactic body radiotherapy for medically operable patients with stage I non-small cell lung cancer.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Radiocirugia , Humanos , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/patología , Radiocirugia/métodos , Estadificación de Neoplasias , Resultado del Tratamiento
3.
Cancer Radiother ; 27(5): 387-397, 2023 Sep.
Artículo en Francés | MEDLINE | ID: mdl-37537027

RESUMEN

PURPOSE: Search for predictive factors on survival and local control for less than 3 centimeters (cm) (stage I) and 5cm (stage II) inoperable lung tumors treated by Stereotactic Body Radiation Therapy (SBRT) in a retrospective monocentric study from Montpellier Cancer Institute (ICM) PATIENTS AND METHOD: Every patients treated at ICM for a stage I or II inoperable lung tumors from 2009 to 2019 were analyzed. RESULTS: One hundred and seventy nine lesions were treated in 176 patients, with a major part (82,7%) in operated due to chronic obstructive pulmonary disease. Median overall survival for all patients was 71,7 months with a 35 months follow-up and the 2 years loco-regional free survival was 94,0 months. Better associated outcomes were stage I (median overall survival 71,7 versus 29,0 months P=0,004 ; HR=2,37 P=0,005), BED≥150Gy (median time-to-progression not reached versus 76,7 months P=0,025), small size of Planning Target Volume (PTV) (HR=0,42 P=0,032 when PTV<15,6 cc). 7,3% of all patients developed radiation pneumonitis. CONCLUSION: SBRT is associated with an excellent overall survival and a high rate of local control for less than 3cm (stage I) and 5cm (stage II) lung tumors but a low rate of toxicities. For these patients with many comorbidities, BED over 150Gy seems to be associated with a better loco-regional free survival, while cause of death is often other than lung cancer.

4.
Cancer Radiother ; 26(6-7): 755-759, 2022 Oct.
Artículo en Francés | MEDLINE | ID: mdl-36075829

RESUMEN

The historical treatment for stage I non-small cell lung cancer is surgical. Parenchymal amputation is not always possible due to cardiopulmonary comorbidities and stereotactic radiotherapy is one of the alternatives to an invasive procedure. The excellent results observed for inoperable tumors raised the question of this treatment in operable patients. This article presents the data in these two situations and the future perspectives.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Radiocirugia , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Humanos , Pulmón/patología , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirugía , Estadificación de Neoplasias , Radiocirugia/métodos , Resultado del Tratamiento
5.
Cancer Radiother ; 26(6-7): 921-924, 2022 Oct.
Artículo en Francés | MEDLINE | ID: mdl-36030192

RESUMEN

The incidence of HPV-related oropharyngeal cancers has been increasing in Western countries for several decades. If they are individualized within the latest TNM classification, the current standards of management do not authorize the management of these patients to be singled out. However, their distinct oncogenesis and their excellent prognosis compared to other patients has allowed the development of several clinical trials based on the question of therapeutic de-escalation. This review of the literature aims to take stock of the elements provided by clinical research in recent years.


Asunto(s)
Neoplasias Orofaríngeas , Infecciones por Papillomavirus , Humanos , Estadificación de Neoplasias , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/terapia , Papillomaviridae , Infecciones por Papillomavirus/complicaciones , Pronóstico
6.
Cancer Radiother ; 25(2): 200-205, 2021 Apr.
Artículo en Francés | MEDLINE | ID: mdl-33546996

RESUMEN

It is proposed to delineate the anatomo-clinical target volumes of primary tumor (CTV-P) in ethmoid cancers treated with post-operative radiotherapy. This concept is based on the use of radioanatomy and the natural history of cancer. It is supported by the repositioning of the planning scanner with preoperative imaging for the replacement of the initial GTV and the creation of margins around it extended to the microscopic risk zones according to the anatomical concept. This article does not discuss the indications of external radiotherapy but specifies the volumes to be delineated if radiotherapy is considered.


Asunto(s)
Hueso Etmoides , Planificación de la Radioterapia Asistida por Computador/métodos , Neoplasias Craneales/radioterapia , Hueso Etmoides/anatomía & histología , Hueso Etmoides/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Cuidados Posoperatorios/métodos , Neoplasias Craneales/diagnóstico por imagen , Neoplasias Craneales/cirugía , Tomografía Computarizada por Rayos X
8.
Eur Ann Otorhinolaryngol Head Neck Dis ; 136(3): 185-192, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31005456

RESUMEN

In adult cervicofacial pathology, carcinoma of unknown primary is defined as lymph-node metastasis the anatomic origin of which is not known at the time of initial management. It constitutes up to 5% of head and neck cancers. Presentation may suggest benign pathology, delaying and confusing oncologic treatment. Diagnostic strategy in cervical lymph node with suspicion of neoplasia requires exhaustive work-up to diagnose malignancy and, in 45% to 80% of cases, depending on the series, to identify the primary site. Histologic types comprise squamous cell carcinoma, thyroid carcinoma, adenocarcinoma, neuroendocrine carcinoma and undifferentiated carcinoma. Association is sometimes found with human papilloma virus or Epstein Barr virus, guiding treatment. The objective of the present study was to provide clinicians with the necessary diagnostic tools, based on the current state of clinical, imaging and pathologic knowledge, and to detail treatment options.


Asunto(s)
Adenocarcinoma/secundario , Carcinoma de Células Escamosas/secundario , Neoplasias de Cabeza y Cuello/secundario , Neoplasias Primarias Desconocidas/patología , Adenocarcinoma/patología , Adenocarcinoma/virología , Adulto , Carcinoma Neuroendocrino/patología , Carcinoma Neuroendocrino/secundario , Carcinoma Neuroendocrino/virología , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/virología , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/virología , Herpesvirus Humano 4 , Humanos , Metástasis Linfática , Neoplasias Nasofaríngeas/patología , Neoplasias Nasofaríngeas/virología , Cuello , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/virología , Papillomaviridae , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/virología
9.
Cancer Radiother ; 20(6-7): 467-74, 2016 Oct.
Artículo en Francés | MEDLINE | ID: mdl-27614507

RESUMEN

Radiation-induced damage of ocular, orbital and eyelid structures are mainly reported for the optic nerve, retina, lens and lacrimal gland. Dose-volume relationships are, however, inaccurate due to the small volume of most of the organs at risk involved and limited ability of irradiation techniques to spare these structures in the pre-IMRT (intensity-modulated radiation therapy) era. The ability of newest radiation techniques including IMRT and proton therapy to generate steep dose gradients may yield more accurate models in the future. Some toxicities are severe and irreversible, leading to vision loss, as in the case of radiation-induced optic neuropathy for which curative treatments are suboptimal. Other toxicities can lead to reversible vision loss but can be surgically corrected, as is the case for radiation-induced cataract. In this paper, we will review the dose effects for the ocular; orbital and eyelid structures.


Asunto(s)
Ojo/efectos de la radiación , Neoplasias de Cabeza y Cuello/radioterapia , Órganos en Riesgo , Dosificación Radioterapéutica , Radioterapia de Intensidad Modulada , Ceguera/etiología , Ceguera/prevención & control , Catarata/etiología , Catarata/prevención & control , Relación Dosis-Respuesta en la Radiación , Humanos , Enfermedades del Nervio Óptico/etiología , Enfermedades del Nervio Óptico/prevención & control
10.
Cancer Radiother ; 20(6-7): 475-83, 2016 Oct.
Artículo en Francés | MEDLINE | ID: mdl-27614519

RESUMEN

Modern techniques such as intensity modulated radiation therapy (IMRT) have been proven to significantly decrease the dose delivered to the cochleovestibular apparatus, limiting consecutive toxicity especially for sensorineural hearing loss. However, recent data still report a 42% rate of radio-induced hypoacusia underscoring the need to protect the cochleovestibular apparatus. Due to the small size of the cochlea, a precise dose-volume analysis could not be performed, and recommendations only refer to the mean dose. Confusing factors such as age, concomitant chemotherapy, primary site and tumor stage should be taken into account at the time of treatment planning. (Non-coplanar) VMAT and tomotherapy have been proven better at sparing the cochlea in comparison with 3D CRT. Brainstem radio-induced injuries were poorly studied because of their infrequency and the difficulty of distinguishing between necrosis and tumor progression in the case of a primary tumor located at the base of skull. The following toxicities have been described: brainstem focal radionecrosis, cognitive disorders without dementia, cranial nerve injuries and sensori motor disability. Maximal dose to the brainstem should be kept to < 54Gy for conventional fractionation. This dose could be exceeded (no more than 10mL should receive more than 59Gy), provided this hot spot is located in the peripheral area of the organ.


Asunto(s)
Tronco Encefálico/efectos de la radiación , Cóclea/efectos de la radiación , Neoplasias de Cabeza y Cuello/radioterapia , Órganos en Riesgo , Dosificación Radioterapéutica , Radioterapia de Intensidad Modulada , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/prevención & control , Traumatismos del Nervio Craneal/etiología , Traumatismos del Nervio Craneal/prevención & control , Relación Dosis-Respuesta en la Radiación , Pérdida Auditiva Sensorineural/etiología , Pérdida Auditiva Sensorineural/prevención & control , Humanos , Trastornos Motores/etiología , Trastornos Motores/prevención & control , Necrosis/etiología , Necrosis/prevención & control
11.
Cancer Radiother ; 20(6-7): 445-51, 2016 Oct.
Artículo en Francés | MEDLINE | ID: mdl-27614524

RESUMEN

Intensity-modulated radiation therapy (IMRT) is the gold standard for head and neck irradiation. It allows better protection to the organs at risk such as salivary glands and mandible, and can reduce the frequency of xerostomia, trismus and osteoradionecrosis. At the time of treatment planning, the mean dose to a single parotid gland should be kept below 26Gy, the mean dose to a single submandibular gland below 39Gy, the mean dose to the mandible below 60 to 65Gy and the D2% to a single temporomandibular joint below 65Gy. These dose constraints could be further improved with data extracted from cohorts of patients receiving IMRT exclusively. The dose administered to the target volumes should not be lessened to spare the salivary glands or mandible.


Asunto(s)
Neoplasias de Cabeza y Cuello/radioterapia , Órganos en Riesgo , Dosificación Radioterapéutica , Radioterapia de Intensidad Modulada , Relación Dosis-Respuesta en la Radiación , Humanos , Mandíbula/efectos de la radiación , Osteorradionecrosis/etiología , Osteorradionecrosis/prevención & control , Glándulas Salivales/efectos de la radiación , Articulación Temporomandibular/efectos de la radiación , Trismo/etiología , Trismo/prevención & control , Xerostomía/etiología , Xerostomía/prevención & control
12.
Cancer Radiother ; 20(6-7): 459-66, 2016 Oct.
Artículo en Francés | MEDLINE | ID: mdl-27614529

RESUMEN

Given the ballistic opportunities it offers, intensity-modulated radiotherapy has emerged as the gold standard treatment for head and neck cancers. Protection of organs at risk is one of the objectives of optimization during the planning process. The compliance of dose constraints to the nervous system must be prioritized over all others. To avoid complications, it is recommended to respect a maximum dose of 50Gy to the spinal cord, and 60Gy to the brachial plexus using conventional fractionation of 2Gy per fraction. These constraints can be adapted depending on the clinical situation; they will probably be refocused by the follow-up of the IMRT studies.


Asunto(s)
Neoplasias de Cabeza y Cuello/radioterapia , Órganos en Riesgo , Dosificación Radioterapéutica , Radioterapia de Intensidad Modulada , Plexo Braquial/efectos de la radiación , Neuropatías del Plexo Braquial/etiología , Neuropatías del Plexo Braquial/prevención & control , Relación Dosis-Respuesta en la Radiación , Humanos , Médula Espinal/efectos de la radiación , Enfermedades de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/prevención & control
13.
Cancer Radiother ; 20(5): 357-61, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27345843

RESUMEN

PURPOSE: Intensity-modulated radiation therapy (IMRT) has shown its interest for head and neck cancer treatment. In parallel, cetuximab has demonstrated its superiority against exclusive radiotherapy. The objective of this study was to assess the acute toxicity, local control and overall survival of cetuximab associated with different IMRT modalities compared to platinum-based chemotherapy and IMRT in the ARTORL study (NCT02024035). PATIENTS AND METHOD: This prospective, multicenter study included patients with epidermoid or undifferentiated nasopharyngeal carcinoma, epidermoid carcinoma of oropharynx and oral cavity (T1-T4, M0, N0-N3). Acute toxicity, local control and overall survival were compared between groups (patients receiving cetuximab or not). Propensity score analysis at the ratio 1:1 was undertaken in an effort to adjust for potential bias between groups due to non-randomization. RESULTS: From the 180 patients included in the ARTORL study, 29 patients receiving cetuximab and 29 patients treated without cetuximab were matched for the analysis. Ten patients (34.5%) reported acute dermal toxicity of grade 3 in the cetuximab group versus three (10.3%) in the non-cetuximab group obtained after matching (P=0.0275). Cetuximab was not significantly associated with more grade 3 mucositis (P=0.2563). There were no significant differences in cutaneous or oral toxicity for patients treated with cetuximab between the different IMRT modalities (P=1.000 and P=0.5731, respectively). There was no significant difference in local relapse-free survival (P=0.0920) or overall survival (P=0.4575) between patients treated with or without cetuximab. CONCLUSION: Patients treated with cetuximab had more cutaneous toxicities, but oral toxicity was similar between groups. The different IMRT modalities did not induce different toxicity profiles.


Asunto(s)
Antineoplásicos/uso terapéutico , Cetuximab/uso terapéutico , Erupciones por Medicamentos/etiología , Neoplasias de Cabeza y Cuello/terapia , Mucositis/etiología , Radioterapia de Intensidad Modulada , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Quimioterapia Adyuvante , Femenino , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Puntaje de Propensión , Estudios Prospectivos
14.
Cancer Radiother ; 19(6-7): 458-62, 2015 Oct.
Artículo en Francés | MEDLINE | ID: mdl-26337476

RESUMEN

Anatomical changes and tumor regression during thoracic radiotherapy may alter the treatment volumes. These modifications are not taken into account into set-up or motion margins used for treatment planning. Their dosimetric impact could be significant and a better understanding of the changes occurring during the 6 to 7 weeks of treatment could be useful in order to define quantitative thresholds before a new treatment planning is needed. Margins could also be reduced in order to better spare organs at risk and perform targeted dose escalation. This review assesses the potential of morphologic and metabolic imaging during treatment for adaptive radiotherapy in non-small cell lung cancer.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/radioterapia , Planificación de la Radioterapia Asistida por Computador , Humanos
15.
Cancer Radiother ; 19(6-7): 442-5, 2015 Oct.
Artículo en Francés | MEDLINE | ID: mdl-26344442

RESUMEN

Palliative radiation therapy is well-known in the setting of metastatic lesions (haemostatic, analgesic, anti-inflammatory aims, etc.). Palliative primary tumour radiotherapy is less studied. Here we propose a review of palliative indications of primary tumours, the most studied in the literature, and their radiotherapy modalities (target volumes and fractionation).


Asunto(s)
Neoplasias/radioterapia , Hipofraccionamiento de la Dosis de Radiación , Neoplasias Encefálicas/radioterapia , Humanos , Neoplasias de Oído, Nariz y Garganta/radioterapia , Cuidados Paliativos , Radioterapia/métodos
17.
Bull Cancer ; 100(10): 983-97, 2013 Oct.
Artículo en Francés | MEDLINE | ID: mdl-24126183

RESUMEN

Head and neck cancers are the fifth among the most common cancers in France. Two thirds of cases occur at an advanced stage. For advanced disease, progression-free survival, despite undeniable progress, remains below 50% at three years. The last 20 years have been marked by the necessity to identify situations where less intense surgery and/or radiotherapy and/or chemotherapy is possible without jeopardizing the prognosis, and situations where a therapeutic intensification is necessary and results in a gain in survival while better preserving function with less toxicity. French cooperative groups gathering radiation oncologists (GORTEC), surgeons (GETTEC) and medical oncologists or physicians involved in the management of systemic treatments in head and neck cancers (GERCOR) are now belonging to the INCa-labelled Intergroup ORL to deal with the challenges of head and neck cancers.


Asunto(s)
Otolaringología/organización & administración , Neoplasias de Oído, Nariz y Garganta/terapia , Oncología por Radiación/organización & administración , Quimioradioterapia/métodos , Quimioradioterapia/tendencias , Supervivencia sin Enfermedad , Francia , Humanos , Quimioterapia de Inducción/métodos , Láseres de Gas/uso terapéutico , Oncología Médica/organización & administración , Tratamientos Conservadores del Órgano/métodos , Otolaringología/métodos , Otolaringología/tendencias , Neoplasias de Oído, Nariz y Garganta/mortalidad , Neoplasias de Oído, Nariz y Garganta/patología , Neoplasias de Oído, Nariz y Garganta/virología , Infecciones por Papillomavirus/complicaciones , Neoplasias de los Senos Paranasales/cirugía , Fototerapia/métodos , Oncología por Radiación/métodos , Oncología por Radiación/tendencias , Retratamiento/métodos , Robótica/métodos , Biopsia del Ganglio Linfático Centinela
18.
Cancer Radiother ; 17(7): 715-23, 2013 Nov.
Artículo en Francés | MEDLINE | ID: mdl-24709383

RESUMEN

Rhinopharyngeal cancer is one of the best indications for conformal radiotherapy with modulated intensity. Due to the high dose gradient, accurate delineation of target volumes and organs at risk is a critical success factor with this technology. This requires a good knowledge of rhinopharyngeal radioanatomy and optimal imaging techniques.


Asunto(s)
Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/radioterapia , Carcinoma , Diagnóstico por Imagen , Humanos , Carcinoma Nasofaríngeo , Radioterapia Conformacional
19.
Cancer Radiother ; 16(4): 272-81, 2012.
Artículo en Francés | MEDLINE | ID: mdl-22721757

RESUMEN

PURPOSE: To compare respiratory-gated conformal radiotherapy versus conventional conformal radiotherapy for the irradiation of non-small cells lung cancer and breast cancer. PATIENTS AND METHODS: The STIC 2003 project was a comparative, non-randomized, multicenter and prospective study that included in 20 French centers between April 2004 and June 2008, 634 evaluable patients, 401 non-small cells lung cancer and 233 breast cancers. RESULTS: The final results confirmed the feasibility and good reproducibility of the various respiratory-gated conformal radiotherapy systems regardless of tumour location. The results of this study demonstrated a marked reduction of dosimetric parameters predictive of pulmonary, cardiac and esophageal toxicity, especially for non-small cells lung cancer, as a result of the various respiratory gating techniques. These dosimetric benefits were mainly observed with deep inspiration breath-hold techniques (ABC and SDX), which markedly increased the total lung volume compared to the inspiration-synchronized system based on tidal volume (RPM). For non-small cells lung cancer, these theoretical dosimetric benefits were correlated with a significant reduction in clinically acute and late toxicities, especially the pulmonary. For breast cancer, although less clear due to the lower total dose, there was a decrease in the dose delivered to the heart, potentially reducing the risk of cardiac toxicity in the long-term, especially during the irradiation of the left breast, and a reduction in dose to the contra lateral breast. CONCLUSION: Respiratory-gated radiotherapy appears to be essential to reduce the risk of acute and late toxicities, especially for lungs and heart, during irradiation of non-small cells lung cancer and breast cancers.


Asunto(s)
Neoplasias de la Mama/radioterapia , Neoplasias Pulmonares/radioterapia , Radioterapia Conformacional/métodos , Técnicas de Imagen Sincronizada Respiratorias , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Dosificación Radioterapéutica
20.
Cancer Radiother ; 14 Suppl 1: S52-60, 2010 Nov.
Artículo en Francés | MEDLINE | ID: mdl-21129670

RESUMEN

Cancers of the paranasal sinuses are rare tumors, with treatment based on a multidisciplinary approach. Surgery and radiation therapy, possibly associated with chemotherapy are used to obtain 5 years specific survival rate of 60-70 %. Advances in radiotherapy, including the use of imaging for 3D conformal approach require precise knowledge of the radioanatomy for this type of tumor to determine the different volumes of interest. Purpose of this study was to specify radioanatomy and conformal radiation modalities for cancers of the sinuses, and is illustrated by a case report.


Asunto(s)
Neoplasias de los Senos Paranasales/radioterapia , Senos Paranasales/anatomía & histología , Antineoplásicos/uso terapéutico , Terapia Combinada , Humanos , Neoplasias de los Senos Paranasales/tratamiento farmacológico , Neoplasias de los Senos Paranasales/epidemiología , Neoplasias de los Senos Paranasales/cirugía , Senos Paranasales/diagnóstico por imagen , Radiografía , Radioterapia Conformacional/métodos
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