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1.
Ann Oncol ; 25(3): 735-742, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24567518

RESUMEN

BACKGROUND: Retroperitoneal sarcomas (RPS) are heterogeneous. No previous study has investigated the impact of specialized surgery, evaluated locoregional relapse (LRR), abdominal sarcomatosis and distant metastatic relapse as separate events, or considered histological subtypes separately. This study addresses these specific points in a homogeneous cohort of patients with completely resected primary RPS. PATIENTS AND METHODS: We conducted a retrospective analysis of adult patients diagnosed with a RPS between 1 January 1988 and 31 December 2008 and eventually referred to one of 12 centers of the French Sarcoma Group. All cases were centrally reviewed by an expert pathologist. RESULTS: Five hundred eighty-six patients were included. Median follow-up was 6.5 years [95% confidence interval (CI) 5.9-7.1]. Five hundred thirty-seven patients had localized disease and 389 patients (76%) had macroscopically complete resection of the tumor. In this latter group, the 5-year LRR-free survival rate was 46% [41-52] and the 5-year overall survival (OS) rate was 66% [61-71]. In multivariate analysis, gender, adjacent organ involvement, specialization of the surgeon, piecemeal resection and perioperative radiotherapy were independently associated with LRR. Specialization of the surgeon and piecemeal resection were independently associated with abdominal sarcomatosis whereas histology and adjacent organ involvement were independently associated with distant metastasis. Age, gender, grade, adjacent organ involvement and piecemeal resection were significantly associated with OS. Prognostic factors for LRR and OS were analyzed in well-differentiated and dedifferentiated liposarcomas and leiomyosarcomas. Grade 3 was an independent prognostic factor for OS of dedifferentiated liposarcomas. CONCLUSION: This study underlines the crucial role of pretherapeutic assessment and meticulous histological examination of RPS as well as the need to consider histological subtypes separately. Surgery in a specialized center and avoidance of piecemeal resection stand out as the two most important prognostic factors for RPS and highlight the importance of treating these patients in specialized centers.


Asunto(s)
Neoplasias Retroperitoneales/radioterapia , Neoplasias Retroperitoneales/cirugía , Sarcoma/radioterapia , Sarcoma/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Femenino , Francia , Humanos , Leiomiosarcoma/diagnóstico , Leiomiosarcoma/mortalidad , Leiomiosarcoma/terapia , Liposarcoma/diagnóstico , Liposarcoma/mortalidad , Liposarcoma/terapia , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia/patología , Metástasis de la Neoplasia/terapia , Recurrencia Local de Neoplasia , Atención Perioperativa , Neoplasias Retroperitoneales/mortalidad , Estudios Retrospectivos , Sarcoma/mortalidad , Tasa de Supervivencia , Resultado del Tratamiento , Adulto Joven
2.
Ann Oncol ; 25(3): 730-734, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24496921

RESUMEN

BACKGROUND: Retroperitoneal sarcomas (RPS) are heterogeneous. Advanced stages include unresectable locoregional (LR) disease, abdominal sarcomatosis and distant metastasis. There is no available report assessing palliative chemotherapy in advanced RPS. This study analyzes management and outcome in a large cohort of patients with advanced RPS, considering main histological subtypes separately. PATIENTS AND METHODS: We conducted a retrospective analysis of adult patients diagnosed with a RPS between 1 January 1988 and 31 December 2008 across 12 centers of the French Sarcoma Group. All cases were centrally reviewed by an expert pathologist. RESULTS: Five-hundred eighty-six patients were included, 299 patients received palliative chemotherapy, with a median of two lines (range 0-8). Fifty patients underwent palliative surgery. Two hundred fifty-five patients (85%) were assessable for response after first line of chemotherapy. Among them, 69 patients (27%) had progressive disease, 145 (57%) had stable disease, 37 (14.5%) had partial response and 4 (1.5%) complete response. Median time from first line of palliative chemotherapy to progression was 5.9 months [4.9-7.3] and median overall survival (OS), 15.8 months [13-18]. In multivariate analysis, prognosis factors independently associated with poor OS were male gender, performance status (PS) >1 and grade >1. There was no difference according to stage of disease. Palliative surgery did not appear to add any survival benefit. CONCLUSION: These results emphasize the scarcity of available options for RPS in the advanced setting and the urgent need to develop new strategies. Patients with good PS should be included in clinical trials and best supportive care should be considered in those with poor PS.


Asunto(s)
Atención a la Salud , Cuidados Paliativos , Neoplasias Retroperitoneales/mortalidad , Sarcoma/mortalidad , Adulto , Antraciclinas/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Progresión de la Enfermedad , Femenino , Francia , Humanos , Leiomiosarcoma/diagnóstico , Leiomiosarcoma/mortalidad , Leiomiosarcoma/terapia , Liposarcoma/diagnóstico , Liposarcoma/mortalidad , Liposarcoma/terapia , Masculino , Metástasis de la Neoplasia/patología , Metástasis de la Neoplasia/terapia , Pronóstico , Neoplasias Retroperitoneales/tratamiento farmacológico , Neoplasias Retroperitoneales/radioterapia , Neoplasias Retroperitoneales/cirugía , Estudios Retrospectivos , Sarcoma/tratamiento farmacológico , Sarcoma/radioterapia , Sarcoma/cirugía , Tasa de Supervivencia , Resultado del Tratamiento
3.
Cancer Radiother ; 28(1): 75-82, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37865603

RESUMEN

Oligometastatic cancers designate cancers in which the number of metastases is less than five, corresponding to a particular biological entity whose prognosis is situated between a localized and metastatic disease. The liver is one of the main sites of metastases. When patients are not suitable for surgery, stereotactic body radiotherapy provides high local control rate, although these data come mainly from retrospective studies, with no phase III study results. The need for a high therapeutic dose (biologically effective dose greater than 100Gy) while respecting the constraints on the organs at risk, and the management of respiratory movements require expertise and sufficient technical prerequisites. The emergence of new techniques such as MRI-guided radiotherapy could further increase the effectiveness of stereotactic radiotherapy of liver metastases, and thus improve the prognosis of these oligometastatic cancers.


Asunto(s)
Neoplasias Hepáticas , Radiocirugia , Humanos , Radiocirugia/métodos , Estudios Retrospectivos , Pronóstico , Neoplasias Hepáticas/radioterapia
4.
Cancer Radiother ; 28(1): 66-74, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37806823

RESUMEN

Metastatic gastrointestinal cancer is not an uncommon situation, especially for pancreatic, gastric, and colorectal cancers. In this setting, few data are available on the impact of the treatment of the primary tumour. Oligometastatic disease is associated with longer survival in comparison with more advanced disease. Metastasis-directed therapy, such as stereotactic body radiotherapy, seems related to better outcomes, but the level of evidence is low. In most tumour locations, prospective data are very scarce and inclusion in ongoing trials is strongly recommended.


Asunto(s)
Neoplasias Gastrointestinales , Radiocirugia , Humanos , Estudios Prospectivos , Neoplasias Gastrointestinales/radioterapia
5.
Cancer Radiother ; 28(1): 49-55, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37827959

RESUMEN

Prostate cancer is the most common cancer and the third leading cause of cancer mortality in men. Each year, approximately 10% of prostate cancers are diagnosed metastatic at initial presentation. The standard treatment option for de-novo metastatic prostate cancer is androgen deprivation therapy with novel hormonal agent or with chemotherapy. Recently, PEACE-1 trial highlighted the benefit of triplet therapy resulting in the combination of androgen deprivation therapy combined with docetaxel and abiraterone. Radiotherapy can be proposed in a curative intent or to treat local symptomatic disease. Nowadays, radiotherapy of the primary disease is only recommended for de novo low-burden/low-volume metastatic prostate cancer, as defined in the CHAARTED criteria. However, studies on stereotactic radiotherapy on oligometastases have shown that this therapeutic approach is feasible and well tolerated. Prospective research currently focuses on the benefit of intensification by combining treatment of the metastatic sites and the primary all together. The contribution of metabolic imaging to better define the target volumes and specify the oligometastatic character allows a better selection of patients. This article aims to define indications of radiotherapy and perspectives of this therapeutic option for de-novo metastatic prostate cancer.


Asunto(s)
Neoplasias de la Próstata , Humanos , Masculino , Antagonistas de Andrógenos/uso terapéutico , Docetaxel , Estudios Prospectivos , Neoplasias de la Próstata/patología , Ensayos Clínicos como Asunto
6.
Cancer Radiother ; 27(5): 387-397, 2023 Sep.
Artículo en Francés | MEDLINE | ID: mdl-37537027

RESUMEN

PURPOSE: Search for predictive factors on survival and local control for less than 3 centimeters (cm) (stage I) and 5cm (stage II) inoperable lung tumors treated by Stereotactic Body Radiation Therapy (SBRT) in a retrospective monocentric study from Montpellier Cancer Institute (ICM) PATIENTS AND METHOD: Every patients treated at ICM for a stage I or II inoperable lung tumors from 2009 to 2019 were analyzed. RESULTS: One hundred and seventy nine lesions were treated in 176 patients, with a major part (82,7%) in operated due to chronic obstructive pulmonary disease. Median overall survival for all patients was 71,7 months with a 35 months follow-up and the 2 years loco-regional free survival was 94,0 months. Better associated outcomes were stage I (median overall survival 71,7 versus 29,0 months P=0,004 ; HR=2,37 P=0,005), BED≥150Gy (median time-to-progression not reached versus 76,7 months P=0,025), small size of Planning Target Volume (PTV) (HR=0,42 P=0,032 when PTV<15,6 cc). 7,3% of all patients developed radiation pneumonitis. CONCLUSION: SBRT is associated with an excellent overall survival and a high rate of local control for less than 3cm (stage I) and 5cm (stage II) lung tumors but a low rate of toxicities. For these patients with many comorbidities, BED over 150Gy seems to be associated with a better loco-regional free survival, while cause of death is often other than lung cancer.

7.
Cancer Radiother ; 27(4): 303-311, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37149464

RESUMEN

PURPOSE: This study presents the methodology and results of the acceptance and periodical quality controls on the MRIdian®. MATERIALS AND METHODS: The impact of the magnetic field on other machines was investigated by controlling nearby linacs dose profiles. The image quality of the 0.345T MR scanner was evaluated, also assessing the integrated linear accelerator influence. The photon beams lateral and depth dose profiles were measured in motorized water tanks, along dose rate and output factors, and compared to Monte Carlo (MC) calculations. The isocenter position, gantry angles and multi-leaf collimator (MLC) position were controlled using film dosimetry. Gating latency and dosimetric accuracy were controlled with a dynamic phantom. RESULTS: The magnetic field had no significant impact on other nearby linacs. Image quality was within tolerances and did not vary over time. Dose profiles measured showed good agreement with MC data, with maximum differences of 1.3% in-field. Output factors were within 0.8% of calculated values. Imaging and radiative isocenter matched within 0.9±0.4mm over all monthly controls. Gantry rotation was precise within -0.1±0.2°, with an isocenter variation of 1.4±0.3mm diameter. The average MLC position was within 0.4±0.1mm of theoretical value. Finally, the gating latency was 0.14±0.07sec and the gated dose within 0.3% of base value. CONCLUSION: All results are within the tolerances fixed by ViewRay® and show low variations over 2 years, comforting the use of small margins and gating for high-dose adaptive treatments.


Asunto(s)
Fotones , Radiometría , Humanos , Estudios de Seguimiento , Radiometría/métodos , Rotación , Fantasmas de Imagen , Aceleradores de Partículas , Planificación de la Radioterapia Asistida por Computador
8.
Cancer Radiother ; 27(8): 689-697, 2023 Dec.
Artículo en Francés | MEDLINE | ID: mdl-37813717

RESUMEN

PURPOSE: Conserving surgery combined with radiotherapy in presence of local recurrence risk factors is standard treatment of soft tissue sarcomas, a group of rare and heterogeneous tumours. Radiotherapy is performed before or after surgery. In neoadjuvant setting, late radiation-induced toxicity is reduced and pathological response to radiotherapy could be achieved. A complete pathological response to radiotherapy has recently been shown to predict better survival. Our study aims at identifying predictive factors of pathological response to neoadjuvant radiotherapy (clinical, radiological or histological) of soft tissue sarcomas. PATIENTS AND METHODS: Clinical, imaging (MRI: perilesional oedema, necrosis, tumour heterogeneity, vasculonervous relationships) and pathological (pathological subtype, tumour grade, anticipated/obtained resection quality) data were retrospectively collected. Tumour response (imaging and pathological), patient outcome, acute and late radiation-induced toxicity, predictive factors of pathological response to neoadjuvant radiotherapy were studied. The 2-test or exact-Fisher test (qualitative variables) and by Student's t-test or Kruskal-Wallis test (quantitative variables) were used for statistical analysis. RESULTS: From April 2017 to April 2021, neoadjuvant radiotherapy (50Gy in 25 fractions) followed by surgical excision was performed to 36 consecutive patients with liposarcomas (n=17/36), or undifferentiated sarcomas (n=8/36). MRI response was complete in 1 patient, partial in 9 patients (n=9/36, 25%), stable in 21 patients (n=21/36, 58%) or in progression in 5 patients (n=5/36, 14%). Pathological response was observed in 22 patients (61%). No grade 3-4 acute radiation-induced toxicity was observed. Regarding late toxicity, 28% of patients had grade 1-2 oedema (n=10/36), 39% had a grade 1 fibrosis (n=14/36), and 30% grade 1 pain (n=11/36). No predictive factors of response to radiotherapy was statistically significant. CONCLUSIONS: Neoadjuvant radiotherapy is well-tolerated. No clinical, radiological or pathological predictive factors was identified for radiotherapy tumour response.


Asunto(s)
Sarcoma , Neoplasias de los Tejidos Blandos , Humanos , Terapia Neoadyuvante , Estudios Retrospectivos , Radioterapia Adyuvante/efectos adversos , Sarcoma/diagnóstico por imagen , Sarcoma/radioterapia , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/radioterapia , Edema
10.
Cancer Radiother ; 26(6-7): 784-788, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-36031496

RESUMEN

The purpose of this article is to give a summary of the progress of magnetic resonance imaging (MRI) in radiotherapy. MRI is an important imaging modality for treatment planning in radiotherapy. However, the registration step with the simulation scanner can be a source of errors, motivating the implementation of all-MRI simulation methods and new accelerators coupled with on-board MRI. First, practical MRI imaging for radiotherapy is detailed, but also the importance of a coherent imaging workflow incorporating all imaging modalities. Second, future evolutions and research domains such as quantitative imaging biomarkers, MRI-only pseudo computed tomography and radiomics are discussed. Finally, the application of MRI during radiotherapy treatment is reviewed: the use of MR-linear accelerators. MRI is increasingly integrated into radiotherapy. Advances in diagnostic imaging can thus benefit radiotherapy, but specific radiotherapy constraints lead to additional challenges and require close collaboration between radiologists, radiation oncologists, technologists and physicists. The integration of quantitative imaging biomarkers in the radiotherapy process will result in mutual benefit for diagnostic imaging and radiotherapy. MRI-guided radiotherapy has already been used for several years in clinical routine. Abdominopelvic neoplasias (pancreas, liver, prostate) are the preferred locations for treatment because of their favourable contrast in MRI, their movement during irradiation and their proximity to organs at risk of radiation exposure, making the tracking and daily adaptation of the plan essential. MRI has emerged as an increasingly necessary imaging modality for radiotherapy planning. Inclusion of patients in clinical trials evaluating new MRI-guided radiotherapy techniques and associated quantitative imaging biomarkers will be necessary to assess the benefits.


Asunto(s)
Oncología por Radiación , Radioterapia Guiada por Imagen , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Aceleradores de Partículas , Oncología por Radiación/métodos , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia Guiada por Imagen/métodos
11.
Cancer Radiother ; 26(1-2): 96-103, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-34953704

RESUMEN

The place of personalized treatments is highly increasing in medical and radiation oncology. During the last decades, a huge number of assays have been developed to predict responses of normal tissues and tumours. These tests have not yet been included into daily clinical practice but the recent developments of radiation oncology are paving the way of personalized strategies including the risk of tumour recurrence and normal tissue reactions. Concerning tumor radiosensitivity prediction, no test are currently used, even if the radiosensitivity index and the genome-based model for adjusting radiotherapy dose assays seem the most promising with level II of evidence. Commercial developments are under progress. Concerning normal tissue radiosensitivity prediction, single nucleotide polymorphims of prostate cancer patients and radiation-induced CD8 T-lymphocyte apoptosis breast and prostate assays are of level I of evidence. They can be proposed before the beginning of radiotherapy in order to propose personalized treatments according to both risks of tumour and normal tissue radiosensitivity. Commercial developments are also under way.


Asunto(s)
Neoplasias/radioterapia , Órganos en Riesgo/efectos de la radiación , Medicina de Precisión/métodos , Tolerancia a Radiación/genética , Reparación del ADN , Fibroblastos/efectos de la radiación , Expresión Génica , Marcadores Genéticos , Humanos , Neoplasias/genética , Neoplasias/inmunología , Polimorfismo de Nucleótido Simple , Pronóstico , Resultado del Tratamiento
12.
Cancer Radiother ; 26(6-7): 851-857, 2022 Oct.
Artículo en Francés | MEDLINE | ID: mdl-36055909

RESUMEN

The incidence of primary hepatic tumours is increasing and the reference treatments by liver transplantation or surgical resection do not allow to compensate for this increase because of the lack of grafts, or the low proportion of initially resectable tumours. The challenges for radiotherapy of primary liver tumors are multiple: physical, biological, medical and technological. Liver stereotactic body radiotherapy is sometimes the only local treatment option and is progressively finding its place for these tumors, even if the recognition of the indications would deserve a better standardization of international recommendations. The heterogeneity of practices and techniques is a major obstacle to the development of randomized studies, despite the excellent oncological results published. The latest ASTRO 2022 guidelines, the recent publication of the guidelines from the French society for radiation oncology on external radiotherapy and brachytherapy procedures ("RecoRad™ 2.0"), and the inclusion in prospective clinical trials will help to homogenize protocols and improve recognition of the technique. The first data from the new techniques of adaptive radiotherapy and MR-guided radiotherapy, whose objectives are to improve targeting and reduce liver or gastrointestinal toxicity, confirm the excellent results of liver SBRT and allow the potential indications to be extended to locations that were previously difficult to treat.


Asunto(s)
Braquiterapia , Neoplasias Hepáticas , Radiocirugia , Humanos , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/cirugía , Estudios Prospectivos , Radiocirugia/métodos
14.
Cancer Radiother ; 23(6-7): 636-650, 2019 Oct.
Artículo en Francés | MEDLINE | ID: mdl-31444078

RESUMEN

Liver stereotactic body radiotherapy is a developing technique for the treatment of primary tumours and metastases. Its implementation is complex because of the particularities of the treated organ and the comorbidities of the patients. However, this technique is a treatment opportunity for patients otherwise in therapeutic impasse. The scientific evidence of liver stereotactic body radiotherapy has been considered by the French health authority as insufficient for its widespread use outside specialized and experienced centers, despite a growing and important number of retrospective and prospective studies, but few comparative data. This article focuses on the specific features of stereotactic body radiotherapy for liver treatments and the results of published studies of liver stereotactic body radiotherapy performed with classic linear accelerators and dedicated radiosurgery units.


Asunto(s)
Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Radiocirugia/instrumentación , Carcinoma Hepatocelular/diagnóstico por imagen , Humanos , Hígado/efectos de la radiación , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Movimientos de los Órganos , Aceleradores de Partículas , Guías de Práctica Clínica como Asunto , Tolerancia a Radiación , Radiocirugia/métodos , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia Guiada por Imagen/métodos , Respiración , Resultado del Tratamiento
16.
Cancer Radiother ; 23(6-7): 666-673, 2019 Oct.
Artículo en Francés | MEDLINE | ID: mdl-31451357

RESUMEN

The impact of curative radiotherapy depends mainly on the total dose delivered homogenously in the target volume. Tumor sensitivity to radiotherapy may be particularly inconstant depending on location, histology, somatic genetic parameters and the capacity of the immune system to infiltrate the tumor. In addition, the dose delivered to the surrounding healthy tissues may reduce the therapeutic ratio of many radiation treatments. In a same population treated in one center with the same technique, it appears that individual radiosensitivity clearly exists, namely in terms of late side effects that are in principle non-reversible. This review details the different radiobiological approaches that have been developed to better predict the tumor response but also the radiation-induced late effects.


Asunto(s)
Neoplasias/radioterapia , Órganos en Riesgo/efectos de la radiación , Tolerancia a Radiación , Biomarcadores de Tumor , Células Sanguíneas/efectos de la radiación , Reparación del ADN/genética , Humanos , Neoplasias/genética , Especificidad de Órganos , Pronóstico , Proteómica , Traumatismos por Radiación/etiología , Dosificación Radioterapéutica , Sensibilidad y Especificidad , Resultado del Tratamiento
17.
Cancer Radiother ; 22(1): 25-30, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29221676

RESUMEN

PURPOSE: Radiation oncologists are responsible for deciding which day-to-day variations are acceptable or not in the treatment setup. However, properly qualified and trained radiation therapists might be capable to perform image registration. We evaluated in our centre the capability and accuracy of radiation therapists to validate positioning images in a prospective study. METHODS AND PATIENTS: A total of 84 patients treated for prostate, head and neck, lung or breast cancer was prospectively and randomly included from July 2011 to July 2013 in radiotherapy unit of our institution. For each patient, three positioning images were randomly analysed. Two radiation oncologists analysed all positioning images and shifts decided by the radiation therapists in an independent and blinded way. The radiation oncologists had to decide whether to validate or not this shift and give a corresponding additional shift, if any. A theoretical disagreement rate less than 5% between radiation therapists and radiation oncologists was planned. RESULTS: A total of 240 images were analysed (head and neck: 15.0%; prostate: 14.2%; breast: 55.0%; lung: 15.8%). The global disagreement between radiation oncologists and radiation therapists for all the images analysed was 2.5% 95% confidence interval (95% CI) [1.0-5.0], corresponding to six images out of 240. A 100% agreement was reached for prostate and lung images, a 97.2% agreement for head and neck images and a 96.2% agreement for breast images. CONCLUSIONS: The radiation therapist validation for repositioning images seemed accurate for image-guided radiotherapy in our institution. Periodic evaluation and in-house training are warranted when routine delegation of image registration to radiation therapists is considered.


Asunto(s)
Técnicos Medios en Salud , Neoplasias/radioterapia , Variaciones Dependientes del Observador , Posicionamiento del Paciente , Oncólogos de Radiación , Radioterapia Guiada por Imagen , Femenino , Francia , Humanos , Masculino , Estudios Prospectivos
18.
Cancer Radiother ; 21(6-7): 563-573, 2017 Oct.
Artículo en Francés | MEDLINE | ID: mdl-28888744

RESUMEN

Thanks to the improvement in radiotherapy physics, biology, computing and imaging, patients presenting with liver tumors can be efficiently treated by radiation. Radiotherapy has been included in liver tumors treatment guidelines at all disease stages. Liver stereotactic radiotherapy has to be preferred to standard fractionated radiotherapy whenever possible, as potentially more efficient because of higher biological equivalent dose. Liver stereotactic radiotherapy planning and delivery require extensive experience and optimal treatment quality at every step, thus limiting its availability to specialized centres. Multicentre studies are difficult to develop due to a large technical heterogeneity. Respiratory management, image guidance and immobilization are considerations as important as machine type. The use of multimodal planning imaging is compulsory to achieve expected contouring quality. Treatment efficacy is difficult to assess following liver stereotactic radiotherapy, but local control is high and toxicity unusual. As a consequence, liver stereotactic radiotherapy is part of multimodal and multidisciplinary management of liver tumors.


Asunto(s)
Neoplasias Hepáticas/radioterapia , Radiocirugia , Humanos , Radiocirugia/métodos
19.
Cancer Radiother ; 21(2): 134-137, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28411892

RESUMEN

Penile cancer is a rare entity with only 2000 new cases a year in the United States. Even though early stage penile cancer has an excellent prognosis, patients with positive pelvic lymph nodes have an overall 5-year survival rate under 10%. There is no consensus for the management of pelvic node-positive patients, although most guidelines are in favour of pelvic lymph node dissection for patients with two or more positive nodes, followed by adjuvant chemotherapy. We describe here the case of a patient with numerous metastatic lymph nodes at diagnosis, treated with chemoradiation (66Gy with concurrent gemcitabine) after failure of first-line chemotherapy and still alive and disease-free 7 years after diagnosis.


Asunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Desoxicitidina/análogos & derivados , Neoplasias del Pene/tratamiento farmacológico , Neoplasias del Pene/radioterapia , Adulto , Terapia Combinada , Desoxicitidina/uso terapéutico , Humanos , Metástasis Linfática , Masculino , Pelvis , Neoplasias del Pene/patología , Gemcitabina
20.
Cancer Radiother ; 20 Suppl: S196-9, 2016 Sep.
Artículo en Francés | MEDLINE | ID: mdl-27521030

RESUMEN

Surgery (radical cystectomy) is the standard treatment of muscle-invasive bladder cancer. Radiochemotherapy has risen as an alternative treatment option to surgery as part as organ-sparing combined modality treatment or for patients unfit for surgery. Radiochemotherapy achieves 5-year bladder intact survival of 40 to 65% and 5-year overall survival of 40 to 50% with excellent quality of life. This article introduces the French recommendations for radiotherapy of bladder cancer: indications, exams, technique, dosimetry, delivery and image guidance.


Asunto(s)
Carcinoma de Células Transicionales/radioterapia , Neoplasias de la Vejiga Urinaria/radioterapia , Carcinoma de Células Transicionales/cirugía , Terapia Combinada , Cistectomía , Fraccionamiento de la Dosis de Radiación , Humanos , Irradiación Linfática , Metástasis Linfática , Órganos en Riesgo , Traumatismos por Radiación/prevención & control , Radioterapia/efectos adversos , Radioterapia/métodos , Radioterapia/normas , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador , Radioterapia Adyuvante/métodos , Radioterapia Guiada por Imagen/métodos , Neoplasias de la Vejiga Urinaria/cirugía
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