Analyses of patterns-of-failure and prognostic factors according to radiation fields in early-stage Hodgkin lymphoma.

PURPOSE: Doses and volumes of radiation therapy (RT) for early stages of Hodgkin lymphoma (HL) have been reduced over the last 30 years. Combined modality therapy (CMT) is currently the standard treatment for most patients with early-stage HL. The aim of this study was to analyze the site of relapse after RT according to the extent of radiation fields. PATIENTS AND METHODS: Between 1987 and 2011, 427 patients were treated at our institution with RT ± chemotherapy for stage-I/II HL. Among these, 65 patients who experienced a relapse were retrospectively analyzed. Most patients had nodular sclerosis histology (86 %) and stage-II disease (75.9 %). Bulky disease was present in 21 % and 56 % of patients belonged to the unfavorable risk group according to European Organization for Research and Treatment of Cancer (EORTC)/The Lymphoma Study Association (LYSA) definitions. CMT was delivered to 91 % of patients. All patients received RT with doses ranging from 20 to 45 Gy (mean = 34 ± 5.3 Gy). The involved-field RT technique was used in 59 % of patients. RESULTS: The mean time between diagnosis and relapse was 4.2 years (range 0.3-24.5). Out-of-field relapses were suffered by 53 % of patients. Relapses occurred more frequently at out-of-field sites in patients with a favorable disease status, whereas in-field relapses were associated with bulky mediastinal disease. Relapses occurred later for favorable compared with the unfavorable risk group (3.5 vs. 2.9 years, p = 0.5). From multivariate analyses, neither RT dose nor RT field size were predictive for an in-field relapse (p = 0.25 and p = 0.8, respectively), only bulky disease was predictive (p = 0.018). CONCLUSION: In patients with bulky disease, RT dose and RT field size were not predictive for an in-field relapse. In this subgroup of patients, chemotherapy should be intensified. We confirmed the bad prognosis of early relapses.

[French national standard for the treatment of squamous cell carcinoma of upper aero-digestive tract - General principles of treatment]. / Référentiel national de traitement des carcinomes épidermoïdes des voies aérodigestives supérieures ­ Principes généraux de traitement.

OBJECTIVES: The management of upper aerodigestive tract cancers is a complex specialty. It is essential to provide an update to establish optimal care. At the initiative of the INCa and under the auspices of the SFORL, the scientific committee, led by Professor Béatrix Barry, Dr. Gilles Dolivet, and Dr. Dominique De Raucourt, decided to develop a reference framework aimed at defining, in a scientific and consensus-based manner, the general principles of treatment for upper aerodigestive tract cancers applicable to all sub-locations. METHODOLOGY: To develop this framework, a multidisciplinary team of practitioners was formed. A systematic analysis of the literature was conducted to produce recommendations classified by grades, in accordance with the standards of the French National Authority for Health (HAS). RESULTS: The grading of recommendations according to HAS standards has allowed the establishment of a reference for patient care based on several criteria. In this framework, patients benefit from differentiated care based on prognostic factors they present (age, comorbidities, TNM status, HPV status, etc.), conditions of implementation, and quality criteria for indicated surgery (operability, resectability, margin quality, mutilation, salvage surgery), as well as quality criteria for radiotherapy (target volume, implementation time, etc.). The role of medical and postoperative treatments was also evaluated based on specific criteria. Finally, supportive care must be organized from the beginning and throughout the patients' care journey. CONCLUSION: All collected data have led to the development of a comprehensive framework aimed at harmonizing practices nationally, facilitating decision-making in multidisciplinary consultation meetings, promoting equality in practices, and providing a state-of-the-art and reference practices for assessing the quality of care. This new framework is intended to be updated every 5 years to best reflect the latest advances in the field.

Total radiation dose and overall treatment time are predictive for tumor sterilization in cervical carcinoma treated with chemoradiation and pulsed-dose-rate brachytherapy.

BACKGROUND AND PURPOSE: Treatment of locally advanced cervical cancer involves multidisciplinary care using external beam radiotherapy, chemotherapy, brachytherapy, and surgery. We aimed to compare both tumor and treatment characteristics between patients with complete pathologic response (CR) and patients with residual disease (RD). PATIENTS AND METHODS: This monocentric retrospective study included 40 consecutive patients, treated with external beam radiotherapy, pulsed-dose-rate brachytherapy, and completion surgery. Treatment planning was performed to obtain a cumulative D90 value for the intermediate-risk clinical target volume (CTV) ≥60 Gy(α/ß=10). Different clinical and dosimetric parameters were analyzed and compared between patients with RD and those with CR. RESULTS: We observed 18 (45%) patients with CR and 22 (55%) patients with RD. In univariate analysis, patients with RD had a significantly longer overall treatment time than those with CR (59.5 vs. 53 days, p = 0.0321). The D90 value for the high-risk CTV (HR-CTV) was higher in the group with CR than in the group with RD (65.9 vs. 64.2 Gy(α/ß=10); p = 0.0439). In multivariate analysis, overall treatment time remained the only predictive factor for CR (p = 0.033), even if the difference for D90 HR-CTV kept a trend toward significance (p = 0.057). CONCLUSIONS: This study showed that tumor sterilization is significantly correlated with overall treatment time and probably with cumulative dose delivered to the HR-CTV. These results emphasize the attention that must be given to treatment organization and dosimetry optimization.