Split-course hypofractionated radiotherapy for aged and frail patients with head and neck cancers. A retrospective study of 75 cases.

PURPOSE: To assess the efficacy and the tolerance of a split course hypofractionated (SCH) radiotherapy (RT) protocol in head and neck cancer (HNC) for eldery and/or unfit patients (pts). PATIENTS AND METHODS: Pts with HNC treated by SCH-RT in two institutions were included retrospectively. The main SCH RT regimen was two courses of 30 grays (Gy)/10 fractions separated by 2-4 weeks, without any systemic therapy. RESULTS: Between February 2012 and January 2019, 75 consecutive patients were analyzed. The median age was 80 years (range: 45.7-98.2) and 53 (70.7%) were men. Sixty-one (81.3%) pts had stage III/IV disease and 54 (72%) had at least two comorbidities. All of them were treated with intensity-modulated radiotherapy. Median follow-up was 10.6 months (range: 3.1-58.3). Local control at 12 and 24 months was 72.8% IC95%[62-85.5] and 51.7% IC95%[38.1-70.1] respectively. Progression free survival (PFS) at 12 and 24 months were 47.7% IC95%[37.4-60.8] and 41% IC95%[15-36.4] respectively, with a median of 11.5 months IC95%[8.9-17]. OS at 12 and 24 months were 60.4% IC95%[50-73.1] and 41% IC95%[30.6-54.9] respectively, with a median of 19.3 months IC95%[11.9-25.8]. Acute and late grade 3 or higher toxicities occurred for 6 (8%) and 3 (4%) pts. CONCLUSION: The present SCH-RT regimen seems effective, well-tolerated and could represent an alternative to palliative strategies for pts deemed unfit for standard exclusive RT.

Early-stage Favourable Anal Cancer: A Retrospective Analysis of Clinical Outcomes of a Moderately Low Dose Elective Nodal Intensity-modulated Radiotherapy Schedule.

In this retrospective study we evaluated the long-term results of 35 early-stage favourable T1-2 N0 M0 anal cancer patients treated with intensity-modulated radiotherapy techniques combining low dose prophylactic inguinal-pelvic irradiation with dose-escalated boost. Optimal locoregional control and good tolerance makes this treatment a valuable alternative to brachytherapy boost and involved-field radiotherapy plans.

Setup margins and geometric uncertainties in intensity-modulated radiation therapy in treating pituitary adenomas: the experience of Lyon Sud Hospital.

PURPOSE: The authors retrospectively evaluated the setup uncertainties in Intensity-Modulated Radiation Therapy (IMRT) for pituitary adenomas and verified the margins used in daily practice (3 mm). MATERIALS AND METHODS: Craniocaudal (CC), anteroposterior (AP) and laterolateral (LL) displacements were measured during the first 3 days of treatment and then weekly by comparing two orthogonal images obtained by an electronic system of portal imaging with Digitally Reconstructed Radiographs (DRRs). Setup Margins (SM) were defined according to the International Commission on Radiation Units (ICRU)-62 formula, the Stroom equation and the van Herk equation. The systematic (Σ) and random (σ) errors of the population were calculated as standard deviation (SD) of the population mean and the mean of SDs for every patient, respectively. RESULTS: Twenty patients were treated by IMRT for pituitary adenomas, and a total of 231 measurements were obtained. Σ and σ were 0.6 and 1.3 mm, 0.8 and 1 mm, 1.2 and 1.5 mm in the AP, LL and CC direction, respectively. Larger setup margin was 2.4, 2.7 and 4 mm in the AP, LL and CC direction, respectively (van Herk formula). CONCLUSIONS: IMRT is a highly sophisticated treatment technique that requires precise definition and optimisation of local setup errors and, finally, of the irradiated volumes. The role of image-guided RT in these kinds of treatments should be prospectively evaluated.

[Single French centre retrospective analysis of local control after high dose radiotherapy with or without chemotherapy and local control for Pancoast tumours]. / Analyse rétrospective monocentrique française du contrôle local des cancers bronchiques non à petites cellules de l'apex après radiothérapie de haute dose avec ou sans chimiothérapie.

PURPOSE: Superior sulcus non-small cell lung cancer represents less than 5% of all lung cancers and is a challenge for the physicians because of clinical presentation, treatments related toxicities and poor prognosis. The aim of this preliminary retrospective report is to present outcomes of patients affected by a superior sulcus non-small cell lung cancer, treated by high dose radiotherapy (>60 Gy) with or with our chemotherapy. PATIENTS AND METHODS: All adult inoperable or unresectable patients (≥18 years) with a clinical and radiological diagnosis of superior sulcus non-small cell lung cancer treated in our department by radiotherapy with or without chemotherapy were retrospectively analysed. Primary endpoint was the local control. Overall survival, metastasis free survival and toxicity rates were also analysed and reported. RESULTS: From January 1999 to June 2009, 12 patients were treated by exclusive high-dose radiochemotherapy. Median age was 53 years (range: 33-64 years); mean follow-up time was 20 months (range: 2-75 months). Mean local control, overall survival and metastasis free survival were 20.2, 22 and 20 months, respectively. At the time of this analysis, seven patients died of cancer and three of them presented only a metastatic disease progression. One patient died of acute cardiac failure 36 months after the end of radiochemotherapy and was disease free. Treatment was well tolerated and any acute and/or late G3-4 toxicity was recorded (NCI-CTC v 3.0 score). CONCLUSION: This analysis confirms the interest of exclusive high-dose radiochemotherapy in treating inoperable superior sulcus non-small cell lung cancer patients, in achieving good local control and overall survival rates.

[Should the treatment of anal carcinoma be adapted in the elderly? A retrospective analysis of acute toxicities in a French centre and a review of the literature]. / Faut-il adapter le traitement du carcinome du canal anal pour les patients âgés? Analyse rétrospective de la toxicité dans un centre français et revue de la littérature.

PURPOSE: To study the tolerance to radiotherapy, with or without chemotherapy, followed by brachytherapy, in elderly patients (75 years or older) suffering from anal cancer. PATIENTS AND METHODS: We treated 12 elderly patients with a curative intent. Median age was 78 years (range: 75-90). Ten patients had a stage II or IIIA (UICC 2009) tumour and six out of 12 were N+. Taking into account the age, the Eastern Cooperative Oncology Group (ECOG) performance status and comorbidities, five patients received exclusive radiotherapy ("RT group") and seven a concomitant radiochemotherapy ("RT-CT group"). All patients received a boost by interstitial brachytherapy. One patient of the "RT-CT group" presented rectorragies during brachytherapy. The irradiation was completed by external beam radiotherapy focalized on the tumour volume. RESULTS: Grade 3 acute reactions (Radiation Therapy Oncology Group [RTOG]) were reported in three out of 12 patients. One grade 2-3 leucopoenia was observed in one out of 7 patients ("RT-CT group"). After brachytherapy, one grade 3 rectal toxicity (rectorragia) (in "RT group") and one grade 4 (in "RT-CT group") were observed. One patient ("RT-CT group") presented a late grade 3 rectal toxicity (evaluated only for patients with at least 12 months of follow-up). CONCLUSIONS: Concomitant radiochemotherapy followed by brachytherapy showed an acceptable toxicity profile, and seems to be adapted in selected elderly patients. It could be recommended as reference treatment in elderly patients with a good physiological status.

ISfinder: the reference centre for bacterial insertion sequences.

ISfinder (www-is.biotoul.fr) is a dedicated database for bacterial insertion sequences (ISs). It has superseded the Stanford reference center. One of its functions is to assign IS names and to provide a focal point for a coherent nomenclature. It is also the repository for ISs. Each new IS is indexed together with information such as its DNA sequence and open reading frames or potential coding sequences, the sequence of the ends of the element and target sites, its origin and distribution together with a bibliography where available. Another objective is to continuously monitor ISs to provide updated comprehensive groupings or families and to provide some insight into their phylogenies. The site also contains extensive background information on ISs and transposons in general. Online tools are gradually being added. At present an online Blast facility against the entire bank is available. But additional features will include alignment capability, PsiBLAST and HMM profiles. ISfinder also includes a section on bacterial genomes and is involved in annotating the IS content of these genomes. Finally, this database is currently recommended by several microbiology journals for registration of new IS elements before their publication.