French multicentre clinical evaluation of helical TomoTherapy for anal cancer in a cohort of 64 consecutive patients.

PURPOSE/OBJECTIVES: To assess feasibility and toxicity of Helical TomoTherapy for treating anal cancer patients. METHODS: From 2007 to 2011, 64 patients were consecutively treated with TomoTherapy in three centres for locally advanced squamous-cell anal carcinoma (T2 > 4 cm or N positive). Prescribed doses were 45 Gy to the pelvis including inguinal nodes and 59.4 Gy to the primary site and involved nodes with fractions of 1.8 Gy, five days a week. A positional Megavoltage Computed Tomography was performed before each treatment session. All acute and late toxicities were graded according to Common Terminology Criteria for Adverse Events version 3.0. Survival analysis was performed using the Kaplan-Meier method. RESULTS: Median follow-up was 22.9 months. Fifty-four women and 10 men were treated (median age: 62 years). Nineteen patients (29.7%) had T2, 16 patients (25.0%) T3, and 27 patients (42.2%) T4 tumours. Thirty-nine patients (60.9%) had nodal involvement. Median tumour size was 45 mm (range, 10-110 mm). Seven patients had a colostomy before treatment initiation. Fifty-seven patients received concomitant chemotherapy (5-FU/cisplatin or 5-FU/mitomycin-based therapy). Forty-seven patients (73.4 %) experienced a complete response, 13 a partial response or local recurrence, and 11 had salvage surgery; among these, six became complete responders, three experienced metastatic failure, and two local failure. At least four patients experienced metastatic recurrence (concomitant to a local failure for one patient). The two-year overall survival was 85.6% (95 %CI [71.1%-93.0%]), and the one-year disease-free survival, and colostomy-free survival were 68.7% (95 %CI [54.4%-79.4]), and 75.5% (95 %CI [60.7%-85.3%]) respectively. Overall survival, disease-free survival and colostomy free-survival were significantly better for women than men (p = 0.002, p = 0.004, and p = 0.002 respectively). Acute grade ≥3 toxicity included dermatologic (46.9% of patients), gastrointestinal (20.3%), and hematologic (17.2%) toxicity. Acute grade 4 hematologic toxicity occurred in one patient. No grade 5 event was observed. CONCLUSIONS: TomoTherapy for locally advanced anal cancer is feasible. In our three centres of expertise, this technique appeared to produce few acute gastrointestinal toxicities. However, high rates of dermatologic toxicity were observed. The therapeutic efficacy was within the range of expectations and similar to previous studies in accordance with the high rates of locally advanced tumours and nodal involvement.

[Guidelines for delineation of pelvic lymph nodes in anal cancer treatment]. / Recommandations pour la délinéation des aires ganglionnaires pelviennes dans le cancer du canal anal.

Squamous cell anal cancer is a rare malignancy, its incidence increases due to higher exposure of the young adults to risk factors. The current management is based on chemoradiotherapy, which is highly effective and achieves locoregional control but causes important morbidity. Improvement of radiation technique such as intensity modulated radiation therapy has led to reduce acute toxicities, but also requires an accurate delineation of the target volumes in order not to underestimate potential and pathological sites resulting in an increase of the locoregional failures. PET scanner has an important place in the pretreatment work-up for staging and targeting the delineation of the volumes, allowing to select patients with localized disease, avoid geographic miss and appropriately boost nodal disease. The study of recurrences sites has not yet provided a real mapping of the recurrences depending on the treatment volumes. Different radiation oncologist cooperative groups have published guidelines and tools for delineation, in order to provide homogeneity but also customize the management of anal carcinoma.

[Stereotactic radiotherapy for intracranial meningioma]. / Radiothérapie stéréotaxique des méningiomes intracrâniens.

Meningiomas are the most common non-malignant tumours of the brain. Gross-total resection remains the preferred treatment, if achievable without morbidity. Radiation therapy is advocated for inoperable, incompletely resected, or recurrent grade 1 tumours, if there is a progressive, symptomatic lesion, or in case of functional impairment. Postoperative radiation therapy is recommended for grade 2 or 3 lesions. Fractionated stereotactic radiotherapy and stereotactic radiosurgery are high precision techniques, allowing good sparing of surrounding tissues. Fractionated stereotactic radiotherapy and stereotactic radiosurgery give comparable results, with excellent 5-year tumour control rates of more than 90% for benign meningiomas. Toxicity is low and seems equivalent, despite a biased use of fractionated stereotactic radiotherapy for larger meningiomas, close to critical structures. Fractionated stereotactic radiotherapy seems to be of special interest in the treatment of cavernous sinus or optic pathways meningiomas. The different therapeutic modalities should be discussed by a multidisciplinary team.

Descriptive epidemiology of CNS tumors in France: results from the Gironde Registry for the period 2000-2007.

An increase in the incidence of CNS tumors has been observed in many countries in the last decades. The reality of this trend has been much debated, as it has happened during a period when computer-assisted tomography and MRI have dramatically improved the detection of these tumors. The Gironde CNS Tumor Registry provides here the first data on CNS tumor incidence and trends in France for all histological types, including benign and malignant tumors, for the period 2000-2007. Incidence rates were calculated globally and for each histological subtype. For trends, a piecewise log-linear model was used. The overall annual incidence rate was found to be 17.6/100 000. Of this rate, 7.9/100 000 were neuroepithelial tumors and 6.0/100 000 were meningiomas. An overall increase in CNS tumor incidence was observed from 2000 to 2007, with an annual percent change (APC) of +2.33%, which was explained mainly by an increase in the incidence of meningiomas over the 8-year period (APC = +5.4%), and also more recently by an increase in neuroepithelial tumors (APC = +7.45% from 2003). The overall increase was more pronounced in women and in the elderly, with an APC peaking at +24.65% in subjects 85 and over. The increase in the incidence rates we observed may have several explanations: not only improvements in registration, diagnosis, and clinical practice, but also changes in potential risk factors.

[Molecular imaging of tumor hypoxia]. / Imagerie moléculaire de l'hypoxie tumorale.

By allowing an earlier diagnosis and a more exhaustive assessment of extension of the disease, the tomography by emission of positrons (TEP) transforms the care of numerous cancers. At present, (18)F-fluorodesoxyglucose ([(18)F]-FDG) imaging appears as the only one available but new molecular markers are being developed. In the next future they would modify the approach of cancers. In this context, the molecular imaging of the hypoxia and especially the (18)Ffluoromisonidazole TEP ([(18)F]-MISO TEP) can give supplementary information allowing the mapping of hypoxic regions within the tumour. Because of the links, which exist between tumour hypoxia and treatment resistance of very numerous cancers, this information can have an interest, for determination of prognosis as well as for the delineation, volumes to be irradiated. Head and neck tumours are doubtless those for which the literature gives the most elements on the therapeutic impact of tumour hypoxia. Targeted therapies, based on hypoxia, already exist and the contribution of the molecular imaging could be decisive in the evaluation of the impact of such treatment. Molecular imaging of brain tumours remains to be developed. The potential contributions of the [(18)F]-MISO TEP for the care of these patients need to be confirmed. In this context, we propose a review of hypoxia molecular imaging taking as examples head and neck tumours and glioblastomas (GB), two tumours for which hypoxia is one of the key factors to overcome in order to increase therapeutics results.

[Radiotherapy of adult glial tumors: new developments and perspectives]. / Radiothérapie des tumeurs gliales de l'adulte : actualités et perspectives.

Adult gliomas (WHO grade II, III and IV) are heterogeneous primitive brain tumors. The prognosis of these tumors depends on multiple factors such as age at diagnosis, Karnofsky score, histopathology, biology and treatments. Radiotherapy (RT) plays an important role in the treatment strategy, after surgery. RT has been evaluated in terms of survival, median time to progression and toxicity. Techniques of RT have improved, during the last two decades: neuro-imaging (CT-scan, MRI and PET) and dedicated computers for dosimetry make it possible to deliver an homogeneous dose in the target volume while sparing normal tissues. Photons X are usually delivered with stereotactic or conformational noncoplanar techniques. Total doses delivered range from 50.4 to 60 Gy (1.8-2 Gy/fraction). Median survivals are different with regard to the tumor grade. However, genetic and biological factors also are important prognostic factors such as inactivation of the MGMT gene for glioblastomas and loss of heterozygosity (LOH) 1p/19q, usually associated with pure oligodendroglioma. During the 1990s, temozolomide (TMZ) was specifically developed as a chemotherapy agent against primary brain tumors. The current TMZ/RT regimen in newly diagnosed GBM has been proposed as a standard treatment. The optimal treatment strategy is not known. New clinical trials are needed to assess new techniques of RT; a further improvement in medical treatment requires novel agents.

[Bevacizumab/irinotecan. An active treatment for recurrent high grade gliomas: preliminary results of an ANOCEF Multicenter Study]. / Bevacizumab/irinotecan. Un nouveau traitement actif dans les gliomes de haut grade récidivants: résultats préliminaires d'une étude multicentrique de l'Anocef.

RATIONALE: Second-line chemotherapy is disappointing in recurrent high-grade gliomas. Dramatic responses in recurrent high-grade gliomas have been reported in a recent monocentric trial with a novel association combining bevacizumab (anti-VEGF monoclonal antibody agent) and irinitecan. OBJECTIVE: To report the experience of the ANOCEF group (French speaking neuro-oncology association) using the bevacizumab-irinotecan combination in recurrent high-grade gliomas. METHODS: Eight centers were involved in this retrospective multicenter study. Bevacizumab-irinotecan was delivered as previously described in a compassional setting to non-selected patients suffering from a high-grade glioma (WHO grade III and IV). Response rate at two months of the onset of the treatment was analyzed using the Macdonald criteria. The toxicity profile of the treatment was also investigated. RESULTS: From 2006 to 2007, 77 patients were treated (median age: 52 years; median Karnofsky score: 70) for a recurrent high-grade glioma (49 grade IV, 28 grade III). At two months, the response rates were objective response=36% (54% in grade III and 27% in grade IV); stable disease=39%; progressive disease=13%; patients not evaluable because of a rapid fatal clinical deterioration=12%. Improvement was noted in 49% of patients. Among the main toxicities, we noted; intratumoral hemorrage (n=5 with spontaneous regression in three) and thromboembolic complications including venous thrombophlebitis (n=4), pulmonary embolism (n=2), myocardial infarction (n=1), grade III-IV hematotoxicity (n=2), reversible leukoencephalopathy (n=1). CONCLUSION: This retrospective multicenter study adds further arguments in favor of the promising results of this new combination and its potential rapidity of action in recurrent high-grade gliomas. Antiangiogenic agents expose the patients to a well-known risk of thromboembolic and hemorragic complications, necessitating careful follow-up and patient selection in light of the cardiovascular contraindications.

[Interest of radiotherapy of rectal cancer with synchronous metastases]. / Intérêt de la radiothérapie dans le traitement de la tumeur primitive rectale lorsque sont associées des métastases synchrones.

PURPOSE: There is no consensus about the treatment of rectal tumour when there are synchronous metastases. The interest of radiotherapy is debated. PATIENTS AND METHODS: Thirty-seven patients with rectal tumour and synchronous metastases were treated with radiotherapy first between September 1994 and December 2004. We analysed the tolerance, local control, resecability, overall survival of such a therapeutic strategy. RESULTS: The mean follow-up was 30 months. Twenty-four tumors were resecable for both the primary site and the metastases. Thirteen were unresecable at the time of diagnosis. Thirty-three patients were treated with radiochemotherapy, ten with radiotherapy alone. Eighty-six decimal five percent of them had no pelvic symptom six weeks after the treatment. Twenty-one rectal tumours were finally resected. The disease progressed in six cases during the radiotherapy. Surgery of the metastases was possible for 12 patients with tumour initially resecable. CONCLUSION: Radiochemotherapy is a "tolerable" treatment, in spite of more frequent urinary or digestive side-effects. But, if there is no surgery, palliative effect of radiotherapy is limited.

[French national evaluation for helicoidal tomotherapy: description of indications, dose constraints and set-up margins]. / Evaluation nationale de la tomothérapie hélicoïdale: description des indications, des contraintes de dose et des seuils de repositionnement.

After a request for proposal initiated by National Institute against cancer (INCa) in 2005, three French centers in France started tomotherapy in the first semester of 2007. A national policy of evaluation was performed to study the feasibility of this innovative technique and to compare the interest of helicoidal tomotherapy with other modalities of conformal therapy. Common protocols have been designed to facilitate this evaluation. Description of dose, IMRT levels and constraints are achieved according to each selected indication as: sarcoma, head and neck tumors, lung cancer, mesothelioma, bone metastases, anal carcinoma and craniospinal irradiation.

[Volume-effect and radiotherapy [II]. Part II: volume-effect and normal tissue]. / Effet volume en radiothérapie [II]. Deuxième partie : volume et tolérance des tissus sains.

The first part of our work has focused on the relationship between tumor volume and tumor control. Indeed, it is well known that the importance of irradiated volume could be a main parameter of radiation-induced complications. Numerous mathematical models have described the correlation between the irradiated volume and the risk of adverse effects. These models should predict the complication rate of each treatment planning. At the present time late effects have been the most studied. In this report we firstly propose a review of different mathematical models described for volume effect. Secondly, we will discuss whether these theoretical considerations can influence our view of radiation treatment planning optimization.

[Volume-effect in radiation therapy part one: volume-effect and tumour]. / L'effet volume en radiothérapie première partie: effet volume et tumeur.

Volume is an important parameter of radiation therapy. Local control is inversely related to tumor size and the complication rate increases with the importance of the irradiated volume. Although the effect of irradiated volume has been widely reported since the beginning of radiotherapy, it has been less studied than other radiation parameters such as dose, fractionation, or treatment duration. One of the first organ system in which the adverse effect of increased volume was well defined is the skin. Over the last twenty years, numerous mathematical models have been developed for different organs. In this report we will discuss the relation between irradiated volume and tumor control. In a second article we will study the impact of irradiated volume on radiation adverse effects.

[Conformal therapy of locally advanced cholangiocarcinoma of the main bile ducts]. / Radiothérapie conformationnelle des cholangiocarcinomes de la voie biliaire principale localement évolués.

PURPOSE: Retrospective study of 23 patients treated with conformal radiotherapy for a locally advanced bile duct carcinoma. PATIENTS AND METHODS: Eight cases were irradiated after a radical resection (R0), because they were N+; seven after microscopically incomplete resection (R1); seven were not resected (R2). A dose of 45 of 50 Gy was delivered, followed by a boost up to 60 Gy in R1 and R2 groups. Concomitant chemotherapy was given in 15 cases. RESULTS: Late toxicity included a stenosis of the duodenum, and one of the biliary anastomosis. Two patients died from cholangitis, the mechanism of which remains unclear. Five patients are in complete remission, six had a local relapse, four developed a peritoneal carcinosis, and six distant metastases. Actuarial survival rate is 75%, 28% and 7% at 1, 3 and 5 years, respectively (median: 16.5 months). Seven patients are still alive with a 4 to 70 months follow-up. Survival is similar in the 3 small subgroups. The poor local control among R0N+ cases might be related to the absence of a boost to the "tumor bed". In R1 patients, relapses were mainly distant metastases, whereas local and peritoneal recurrences predominated in R2. CONCLUSION: Conformal radiochemotherapy delivering 60 Gy represents a valuable palliative approach in locally advanced biliary carcinoma.

[Target volume in radiotherapy of gastric adenocarcinoma]. / Les volumes-cibles de la radiothérapie des adénocarcinomes gastriques.

UNLABELLED: The spread of gastric adenocarcinoma may follow three main patterns: hematogenic, lymphatic and intraperitoneal. A GTV should be considered in preoperative or exclusive radiation therapy. After non-radical surgery, a "residual GTV" will be defined with the help of the surgeon. The CTV encompasses three intricated volumes. a) A "tumor bed" volume. After radical surgery, local recurrences appear as frequent as distant metastases. The risk depends upon the depth of parietal invasion and the nodal status. Parietal infiltration may extend beyond macroscopic limits of the tumor, especially in "linitis plastica". Therefore this volume will include: the tumor and the remaining stomach or their "bed of resection", a part of the transverse colon, the duodenum, the pancreas and the truncus of the portal vein. In postoperative RT, this CTV also includes the jejuno-gastric or jejuno-esophageal anastomosis. b) A peritoneal volume. For practical purposes, two degrees of spread must be considered: (1) contiguous microscopic extension from deeply invasive T3 and T4 tumors, that remain amenable to local sterilization with doses of 45-50 Gy, delivered in a CTV including the peritoneal cavity at the level of the gastric bed, and under the parietal incision; (2) true "peritoneal carcinomatosis", with widespread seeds, where chemotherapy (systemic or intraperitoneal) is more appropriate. c) A lymphatic volume including the lymph node groups 1 to 16 of the Japanese classification. This volume must encompass the hepatic pedicle and the splenic hilum. In proximal tumors, it is possible to restrict the lower part of the CTV to the lymphatic volume, and therefore to avoid irradiation of large intestinal and renal volumes. In distal and proximal tumors, involvement of resection margins is of poor prognosis--a radiation boost must be delivered at this level. The CTV in tumors of the cardia should encompass the lower part of the thoracic esophagus and the corresponding posterior mediastinum. In tumors invading the distal esophagus, a more complete coverage of mediastinal lymph nodes should be considered, especially in patients in good general condition. In tumors of the gastric fundus, most of the left hemidiaphragm should be included, as well as the spleen and its hilum (or their resection bed). In proximal tumors without involvement of the lesser curvature, a full coverage of the hepatic pedicle is not necessary. In contrast, for distal tumors, the hepatic pedicle and the hepatoduodenal ligament should be included whereas the splenic area could be spared. CONCLUSION: Planning the treatment of gastric cancer remains difficult; target volumes must be customized by experienced radiation oncologists according to tumoral and clinical situation.

[Gross tumor volume (GTV) and clinical target volume (CTV) in radiotherapy of benign skull base tumors]. / Volume tumoral macroscopique (GTV) et volume-cible anatomoclinique (CTV) dans la radiothérapie des tumeurs bénignes de la base du crâne.

Skull base tumours represent about 35 to 40% of all intracranial tumours. There are now many reports in the literature confirming the fact that about 80 to 90% of such tumours are controlled with fractionated radiotherapy. Stereotactic and 3-dimensional treatment planning techniques increase local control and central nervous system tolerance. Definition of the gross tumor volume (GTV) is generally easy with currently available medical imaging systems and computers for 3-dimensional dosimetry. The definition of the clinical target volume (CTV) is more difficult to appreciate; it is defined from the CTV plus a margin, which depends on the histology and anterior therapeutic history of the tumour. It is important to take into account the visible tumour and its possible extension pathways (adjacent bone, holes at the base of skull) and/or an anatomic region (sella turcica + adjacent cavernous sinus). It is necessary to evaluate these volumes with CT Scan and MRI to appreciate tumor extension in a 3-dimentional approach, in order to reduce the risk of marginal recurrences. The aim of this paper is to discuss volume definition as a function of tumour site and tumour type to be irradiated.

[Fractionated radiation therapy long-term effectiveness in the treatment of cerebello-pontine angle schwannomas: 12 years of experience in 30 cases]. / Efficacité à long terme de la radiothérapie fractionnée dans le traitement des schwannomes de l'angle ponto-cérébelleux : expérience de 12 ans sur 30 cas.

UNLABELLED: The purpose of this research was to evaluate long-term results of fractionated radiation therapy (RT) in the treatment of cerebello-pontine angle schwannomas. METHODS: from January 1986 to October 1995, 29 patients with stage III and IV scwhannomas were treated with external fractionated RT. One patient was irradiated on both sides and indication for RT was as follows: a) poor general condition or old age contraindicating surgery, 16 cases; b) hearing preservation in bilateral tumors after contralateral tumor removal, 6 cases; c) partial resection or high risk of recurrence after subsequent surgery for relapse, 5 cases; d) non surgical relapse, 3 cases. Most patients were irradiated with 6 to 10 MV photons. A three- to four-field technique with coplanar static beams and conformal blocks was used. Doses were calculated on a 95 % isodose and were given 5 days a week for a mean total dose of 51 Gy (1.8 Gy/fraction). RESULTS: Median follow-up from RT was 66 months (7 to 120); seven patients died, two with progressive disease, five from non tumoral cause. Two patients underwent total removal after RT (1 stable and 1 growing tumor). On the whole, tumor shrinkage was observed in 13 patients (43.3 %), stable disease in 14 (46.6 %), and tumor progression in three. Hearing was preserved in 4 out of 6 hearing patients (1 class A hearing, 2 class B and 1 class C). No patient experienced CN5 or CN7 neuropathy. CONCLUSION: long-term efficacy or fractionated RT is well documented in this series. Acute and delayed tolerance was excellent. Hearing can be preserved for a long time.

[Fractionated radiotherapy of intracranial meningiomas and neurinomas]. / Radiothérapie fractionnée des méningiomes et des neurinomes intracrâniens.

In most institutions, surgical excision remains the standard treatment of meningiomas and neurinomas; the aim of surgery is complete resection. However, total removal is not always feasible without significant morbidity and in some cases, the patient's condition contraindicates surgery. For incompletely excised tumors, recurrences will have consequences on neurological functions. There are now many reports in the literature confirming the fact that radiotherapy significantly decreases the incidence of recurrence of incompletely resected benign tumors and that it can replace surgery in some situations where an operation would involve considerable danger or permanent neurological damage: about 80 to 90% of such tumors are controlled with fractionated radiotherapy. Stereotaxic and three-dimensional treatment planning techniques increase local control and central nervous system tolerance so that the respective place of surgery and radiotherapy needs to be redefined, considering efficacy and morbidity of these two therapeutic means. In this article, we limit our remarks to fractionated radiotherapy and, after a review of the literature, we discuss the indications, volume evaluations and the techniques currently used.

[Fractionated radiotherapy of intracranial meningiomas: 15 years' experience at the Bordeaux University Hospital Center]. / Radiothérapie fractionnée des méningiomes intracrâniens: 15 ans d'expérience au centre hospitalier universitaire de Bordeaux.

PURPOSE: To evaluate the long-term results of external fractionated radiation therapy (RT) in the treatment of intracranial meningiomas. PATIENTS AND METHODS: From January 1981 to December 1996, 156 patients with intracranial meningiomas were treated with external fractionated RT. Median age was 57. Indications for radiation therapy were as follows: (1) completely excised histologically aggressive tumors (12 patients); (2) incomplete surgical resection (37 patients); (3) medically inoperable or basilar tumors where operation would involve considerable danger or permanent neurological damage (77 patients); and, (4) tumor recurrences (30 patients). Most patients were irradiated with 6 to 9 MV photon beams. A three to four-field technique with coned-down portals was used. Since 1993, 71 patients had a three dimensional dosimetry. Doses were calculated on the 95% or 98% isodoses, all fields were treated every day, five days a week, for a median total dose of 50 Gy (1.8 Gy/Fraction). RESULTS: Median follow-up from radiation therapy was 40 months. Acute tolerance was excellent; an early clinical improvement during radiation therapy was noted in 19 patients (17.8%). Clinical improvement or stabilization was observed in 130 patients (83.4%). Radiologically, local control was obtained in 124 cases (79.4%) and tumor recurrences occurred in 21 cases (ten progressions in the treated volume, five borderline, six new locations). Overall and cause specific-survival rates were 75% and 89% at five years, and 45 and 76% at 10 years, respectively. CONCLUSION: These results reassess the role of fractionated RT in the treatment of intracranial meningiomas. Long-term tolerance is excellent for a majority of patients. The study of recurrences confirms the importance of the definition of the target volume, and asks questions about total given doses.

[Central nervous system. Experience of the Bordeaux University Hospital Center and review of the literature]. / Les dysgerminomes du système nerveux central. Expérience du Centre Hospitalier Universitaire de Bordeaux et analyse de la littérature.

PURPOSE: Retrospective analysis of 17 patients with intracranial germ cell tumors treated in a multidisciplinary consultation at the Bordeaux University Hospital a and literature review. MATERIALS AND METHODS: Seventeen consecutive patients were treated from 1978 to 1995 for a primary intracranial germ cell tumor. Median age was 14 (range 3-29 years). There were two malignant teratoma, six proved germinoma and nine presumed germinoma (diagnostic based on biological, radiological and treatment criteria). All received radiotherapy from 30 to 60 Gy (median 40 Gy) in different volumes. Chemotherapy was administered in 15 cases, three after surgery and 12 after radiotherapy. RESULTS: All tumours were in complete remission after initial treatment. The two malignant teratomas recurred in non-irradiated area after nine and 48 months, and the patients died. None of the germinoma recurred within a follow-up period of two to 17 years (median 65 months). Five and 10 year actuarial overall survival rates were the same: 84% for all histologies and 100% for germinomas. Only two patients developed school difficulties and six presented an hypopituitarism, of which one was consecutive to radiotherapy. Chemotherapy was well tolerated. CONCLUSION: This retrospective study and literature analysis are in favor of limited dose and volume of radiation therapy associated with chemotherapy.

[Fractionated irradiation of cerebellopontine angle neurinoma: 12 years' experience of the Bordeaux University Hospital Center]. / Irradiation fractionnée des neurinomes de l'angle pontocérébelleux: 12 ans d'expérience au centre hospitalier universitaire de Bordeaux.

PURPOSE: To evaluate retrospectively the long-term results of fractionated radiation therapy (RT) in cerebello-pontine angle neurinomas (CPA). METHODS AND MATERIAL: From January 1986 to October 1995, 29 patients with stage III and IV neurinomas were treated with external fractionated RT. One patient was irradiated on both sides and indications for RT were as follows: (1) general contraindications for surgery (16 patients); (2) hearing preservation in bilateral neurinomas after controlateral tumor exeresis (six patients); (3) partial tumor removal (five patients); and, (4) non-surgical recurrence (three patients). A three to four fields technique with coplanar static beams and conformal cerobend blocks was used; doses were calculated on a 95 to 98% isodoses and were given five days a week for a median total dose of 51 Gy (1.8 Gy/fraction). Most patients were irradiated with 6 to 10 MV photons). RESULTS: Median follow-up was 66 months (seven to 120 months). Seven patients died, two with progressive disease, five from non-tumoral causes. Tumor shrinkage was observed in 13 patients (43.3%), stable disease in 14 (46.6%), and tumor progression in three. Two patients underwent total tumor removal after RT (one stable and one growing tumor). Hearing was preserved in four out of six patients. No patient experienced facial or trigeminal neuropathy. CONCLUSION: Fractionated RT is a well tolerated and efficacious treatment of large non-surgical CPA neurinomas.