[Best practice guide for radiation therapy of non-small cell bronchial cancers]. / Guide de bonne pratique pour la radiothérapie thoracique exclusive ou postopératoire des carcinomes non à petites cellules.

The objective was the drafting of a practical document intended for radiotherapists and radiophysicists, describing the technique of irradiation of a non small cell bronchial cancer. The good practices concern the care of patients affected by bronchial cancer localized in the thorax and inoperable or patients who must undergo postoperative irradiation. The document has been developed according to a methodology aiming to join the current scientific data from an analysis of the literature on the subject and the assessment of radiotherapists, radiophysicists, lung specialists and methodologists from Rhône-Alpes area. From the stages necessary for the good progress of a radiotherapy, the writers of this document proposed common definitions concerning the centering and the location of the zone to be treated, the calculation of the dose distribution, the preparation of the patient for the treatment, the treatment and the surveillance during the treatment. The recommendations of this guide took into account the peculiarities bound to the nature of the treated region and more particularly the lung heterogeneity, respiratory movements and the radiosensibility of healthy lung tissue. Even if the technical aspect of the radiotherapy was particularly developed, the interest accorded to patient information takes on all its importance for a therapeutic coverage of quality. The authors of the document wished that this Guide of Good Practices, which will be regularly updated, helps the radiotherapists and allows them to harmonize their practices.

[Treatment of eyelid carcinomas of 2 cmm or less by contact radiotherapy]. / Traitement des carcinomes de paupière de 2 cm ou moins par radiothérapie de contact.

PURPOSE: Analysis of a series of 50 patients treated by contact x-ray for an eyelid carcinoma. METHODS: From 1980 to 1991, a series of 50 patients with 52 lesions has been included in a protocol of contact x ray for eyelid carcinoma. Median age: 69 years; male: 25; female: 25. Histological or cytological diagnosis showed: basocell carcinoma: 47; squamous cell carcinoma: 5. The site was: lower eyelid; 31, inner canther: 10; outer canther: 5; upper eyelid: 6. Stade was (UICC 1987): T1 (< or = 2 cm): 44; post excision: 8. Treatment was performed on an ambulatory basis with the PHILIPS RT 50 x-ray contact machine (50 KV - 0.5 mm A1). The diameter of the localized was 10 mm: 22; 15 or 20 mm: 30. The standard treatment delivered 42 Gy/7 fractions/4 weeks (1 or 2 fractions of 6 Gy for week). RESULTS: There was no death due to cancer. A complete response was seen 2 months after the end of treatment in 43/44 cases. A long-term local control was obtained in 47 patients. Loss of eyelash was seen in the irradiated area with a supple and no necroses of the tarsal cartilage. The irradiated skin is slightly depigmented. Stenoses of the lower lacrimal duct is unusual and was seen only if it was in the field of irradiation. No cataract was observed. The cosmetic and functional results appeared excellent in the large majority of patients. One local relapse occurred in the irradiated area and two just outside the irradiated area. These 3 relapses were salvaged, two by surgical excision and one by a subsequent irradiation. CONCLUSION: Contact x-ray is a simple technique which requires no hospitalization, neither general anesthesia. It gives excellent local control and good cosmetic results in these small eyelid carcinomas.

[Current treatment of cancers of the anal canal]. / Le traitement actuel des cancers du canal anal.

The major development in the treatment of cancers of the anal canal, over recent years, is the now predominant role of radiotherapy which has replaced amputation surgery as first-line treatment. All stages combined, the average 5-year global survival rate is now 60%, with a local control rate of 70% and good sphincter preservation in the majority of healed patients. However, many questions remain unresolved in these rare cancers: what is the optimal irradiation technique, what is the role of chemotherapy in this very chemosensitive tumour but associated with a low risk of metastases? Amputation surgery still plays an important role, but the exact time at which it should be proposed remains controversial. The rate of inguinal lymph node invasion is approximately 20%. The value of systematic treatment N0 inguinal nodes remains controversial. As for most problems of clinical oncology, only randomized trials rapidly conducted on a large scale will be able to provide an answer to all these questions.

[Evaluation of the consequences of signing a written consent on physician-patient relations. Apropos of Huriet's legislation]. / Evaluation des conséquences de la signature d'un consentement écrit sur la relation médecin-malade. A propos de la loi Huriet.

Whenever an innovative treatment or a research protocol is proposed to a patient, the "loi Huriet" requires a written consent from the patient. This is an important change in the field of the interrelation between the doctor and his patient. To evaluate the impact of this written consent we asked 215 patients who have signed a consent form to answer a questionnaire at the end of their radiation treatment. The signature appears as an important event. The majority of the patients (70%) is not shocked by this procedure. In 97% of cases, in spite of this written relation, the patients keep intact their confidence in their doctor. Sometimes this consent form may improve the information given to the patient and it should not be seen as an obstacle for the development of research trials. There are still many problems to be solved as regards the information of the patient and the application of the "loi Huriet".