[Normal tissue tolerance to external beam radiation therapy: skin]. / Dose de tolérance des tissus sains: la peau et les phanères.

Acute skin toxicity is frequent during radiation therapy and can lead to temporary arrest of the treatment. Chronic toxicity can occur and conduct to cosmetic problems. Alopecia is the most frequent toxicity concerning hair and is most of the time reversible. Several factors linked to patients influence skin toxicity, such as undernutrition, old age, obesity, smoking, skin diseases, autoimmune diseases, failure of DNA reparation. Skin, hair and nail toxicities depend also on radiation schedule. Acute toxicity is greater when dose per fraction increases. Chronic and acute toxicities are more often when total dose increases. Under 45 Gy, the risk of severe skin toxicity is low, and begins above 50 Gy. Skin toxicity depends also on the duration of radiotherapy and split course schedules are associated with less toxicities. Irradiation surface seems to influence skin toxicity but interaction is more complex. Reirradiation is often feasible in case of cancer recurrence but with a risk of grade 3-4 toxicity above all in head and neck cancer. The benefit/risk ratio has to be always precisely evaluated. Permanent alopecia is correlated with the follicle dose. Modern techniques of radiation therapy allow to spare skin.

[Iodine 125 prostate brachytherapy: prognostic factors for long-term urinary, digestive and sexual toxicities]. / Curiethérapie de prostate par iode 125 : facteurs pronostiques de longue durée de toxicité urinaire, digestive et sexuelle.

PURPOSE: For patients with good urinary function and presenting with a low risk prostate cancer, prostate brachytherapy using iodine implants represents one of the techniques of reference. This retrospective analysis investigates urinary (U), digestive (D) and sexual (S) toxicities and their prognostic factors of duration. MATERIAL AND METHODS: From August 2000 to November 2007, 176 patients presenting with prostate adenocarcinoma underwent interstitial brachytherapy. Urinary, digestive and sexual toxicities were classified according to Common toxicities criteria for adverse events, version 3.0 (CTCAE V3.0). For each toxicity (U, D, S), the number of complications U (dysuria, nicturia...), D (proctitis, diarrhea...) and S (sexual dysfunction, loss of libido, ...) was listed and analyzed according to criteria related to the patient, implant, dosimetric data and characteristics of the toxicity. Prognostic factors identified in univariate analysis (UVA) (Log Rank) were further analyzed in multivariate analysis (MVA) (Cox model). RESULTS: With a median follow-up of 26 months (1-87), 147 patients (83.5 %) presented urinary toxicities. Among them, 29.5 % (86 patients) and 2.4 % (seven patients) presented grade 2 and 3 U toxicity respectively. In UVA, urinary grade toxicity greater than or equal to 2 (p=0.037), the presence of initial U symptoms (p=0.027) and more than two urinary toxicities (p=0.00032) were recognized as prognostic factors. The number of U toxicities was the only prognostic factor in MVA (p=0.04). D toxicity accounted for 40.6 % (71 patients). Among them, 3 % (six patients) were grade 2. None were grade 3. Two factors were identified as prognostic factors either in UVA and MVA: the number of D toxicities greater than or equal to 2 (univariate analysis: p=0,00129, multivariate analysis: p=0,002) and age less than or equal to 65 years (univariate analysis: p=0,004, multivariate analysis: p=0,007). Eighty-three patients (47.4 %) presented a sexual toxicity; 26.9 % (49 patients) and 5 % (nine patients) were scored as grade 2 and 3 respectively. A number of seeds greater than 75 (p=0.032) and S grade greater than or equal to 2 (p<0.0001) were recognized as prognostic factors in UVA. S grade was the only prognostic factor in MVA (p=0.0015). CONCLUSION: The duration of U, D and S toxicity is strongly correlated with a high number of toxicities and the grade of toxicity. This analysis allows for better information given to the patient regarding the duration of the post-treatment complications.

[State of the art and advances in radiotherapy for bladder cancer]. / Techniques et innovations en radiothérapie pour le traitement conservateur des cancers infiltrants localisés de vessie.

Radical cystectomy is the treatment of choice for nonmetastatic, muscle-infiltrating bladder cancer. However, bladder-sparing approaches can be discussed in carefully selected patients. Bladder-preservation protocols aim to guaranty local control and survival with a functional bladder and a good quality of life. Such strategies include combinations of transurethral resection and radiochemotherapy, partial cystectomy and brachytherapy, radiotherapy-cystotomy and electrontherapy. Strict selection criteria and close follow-up are mandatory. New irradiation techniques hold the promise to improve local control by selectively boosting the dose to the tumor while better sparing the organs at risk. Such advances include the use of multimodal imaging, image-guided radiotherapy, concomitant boost with conformal irradiation+/-intensity modulated radiation therapy. Brachytherapy, either high-dose or pulsed-rate, is a promising technique for selected cases. Highly-conformal irradiation with tumor tracking using the Cyberknifetrade mark technology may also provide opportunities to boost the tumor while reducing toxicities. Specific innovative irradiation techniques are discussed.

[Prostate specific antigen: utilization modalities and interpretation]. / L'antigène spécifique de prostate: modalités d'utilisation et interprétation.

The prostate specific antigen test has become one of the most popular blood test. However, its result should be analyzed with caution due to physiologic variability. The PSA test is performed for prostate cancer (PC) screening or for post-treatment PC surveillance. According to the applied treatment (surgery or radiation therapy with or without hormonal therapy), PSA analysis can confirm biochemical control or relapse. New PSA data regarding the evolution of this biomarker during the surveillance (PSA doubling time and PSA velocity) are now important to consider in case of biochemical relapse.