[Preoperative chemotherapy and chemoradiotherapy for non-small-cell bronchial cancers]. / La chimiothérapie et la chimioradiothérapie préopératoires des cancers bronchiques non à petites cellules.

The very disappointing results obtained by surgery in resectable non-small-cell lung cancer have led to a high active clinical research concerning pre- or postoperative treatment. Preoperative treatment has several distincts goals: to increase survival for patients suitable for surgery, to limit surgery or transform borderline or non resectable cancer into resectable tumors. Available datas on preoperative treatments for non-small-cell lung cancer provide from three types of therapeutics trials: 1/Some phase II studies of neoadjuvant chemotherapy have demonstrated that the neoadjuvant approach was feasible, and didn't compromise surgery. 2/Phase II trials of neoadjuvant chemoradiotherapy, performed for the majority on more extensive cancers, have demonstrated that this approach was also feasible at the expense of higher but still tolerable toxicity. 3/Phase III randomised published trials exclusively deal with preoperative chemotherapy with different results: two of them concerned a small number of patients presenting with non-small-cell lung stage IIIA cancer: they are positive. The third concerned 373 patients presenting with stage I, II, IIIA cancer: the three-year survival was increased by 11%, but this difference is not yet significant. The benefit essentially appeared for stage I and II. One trial comparing preoperative chemotherapy and radiochemotherapy has been reported, concluding to the superiority of the association. These observations suggest that the clinical research should now be different for stages I and II, and stage IIIA.

[Spontaneous idiopathic chylothorax. Case report and review of the literature]. / Chylothorax spontané idiopathique. Revue de la littèrature á propos d'un cas.

We present a new case of bilateral spontaneous idiopathic pneumothorax, occurring in a 52-year-old woman. A literature review of similar cases shows a quite reproducible picture, consisting in the occurrence of supraclavicular swelling and left or bilateral chylothorax after a mild effort in a woman in her fifties.

[Retrotracheal cystic mass in the mediastinum]. / Masse médiastinale kystique rétro-trachéale.

We describe a case of retro-tracheal mass of the visceral compartment of the mediastinun in a 79-year-old woman revealed by signs of tracheal compression. Visualization of a vascular image coming from the cervical zone on reconstructed injected CT, and biological demonstration of a primary hyperparathyroidism led to the diagnosis of ectopic parathyroid adenoma, in spite of the cystic aspect of that tissular mass. Surgery by cervical approach was able to remove this mass without any problem. Pathological examination confirmed that it was a parathyroid adenoma with necrotic modifications. Follow up show a clinical and a biological improvement.

[Intrapulmonary rupture of a dermoid cyst: MRI findings]. / Rupture intra-pulmonaire d'un kyste dermoïde du médiastin: aspect IRM.

We report a case of dermoid cyst of the mediastinum ruptured into the lung. Only a few reports of ruptured mediastinal dermoid cyst have appeared in the literature. A 18-year-old female patient developed a tumor in the anterior mediastinum, which was coincidentally detected by a conventional chest X-ray. CT and MRI demonstrated two components: a cystic mediastinal mass and adjacent parenchymatous condensation. The cystic mass (no enhancement during or after injection) had a fatty structure: high-intensity T1 signal and low-intensity T2 signal. The thin wall (low-intensity signal on T1 and T2) was strongly enhanced during the systemic time and was ruptured. The parenchymatous condensation included a fatty effusion and an inflammatory reaction with the same T1 signal as the cyst, remaining slightly hyperintense on T2 with enhancement after injection. Cine-MRI demonstrated that the mass and the compressed right atrium were independent.

[New radiotherapy techniques for non-small-cell lung cancer]. / Nouveautés techniques pour une radiothérapie thoracique moderne des carcinomes bronchiques non à petites cellules.

Lung cancer is one of the most difficult challenges for radiotherapy. Problems include ballistic targeting compromised by respiratory movements, poor tolerance of neighboring healthy tissues and difficult dosimetry due to the heterogeneous nature of the thoracic tIssues. New perspectives are offered by recent developments allowing a more comprehensive approach to thoracic radiotherapy integrating new advances in imaging techniques, contention, dosimetry, and treatment devices. Two techniques are particularly promising: conformal radiotherapy and respiration-gated radiotherapy. Conformal radiotherapy, a three-dimensional conformal mode of irradiation with or without intensity modulation, is designed to achieve high-precision dose delivery by integrating advanced imaging techniques into the irradiation protocol. These tools are used to optimize irradiation of target Volumes and avoid recurrence while sparing as much as possible healthy tissues. If healthy tissue can be correctly protected, increased doses can be delivered to the target tumor. Respiration-gated techniques offer promising prospects for the treatment of tumors which are displaced by respiratory movements. These techniques allow better adaptation of the irradiation fields to the target tumor and better protection of healthy tissues (lung, heart...). These new approaches are now routine practices in many centers. Early results have been very promising. We describe here the currently available techniques for thoracic radiotherapy.