[Prevalence of pain in radiotherapy and improvement of its management]. / Prévalence de la douleur en radiothérapie et amélioration de sa prise en charge.

PURPOSE: To assess pain prevalence, its features and its management in a radiotherapy department of a French public general hospital. To highlight strategies to improve pain screening and treatment. METHODS: Designed in conjunction with pain management specialists, a cross-sectional study on pain was carried out. All patients treated in the department being interviewed with a standardised questionnaire during 2 days. RESULTS: Among 91 patients, 63.7% reported pain in daily life. They respectively represented 100%, 85.7% and 83.3% all of the patients treated for brain tumours, for bone metastasis and for head and neck cancers. Only 7.7% of patients reported pain during radiotherapy sessions. Among patients reporting pain, 70.7% received pain relief treatment and 60.8% of them thought this was adequate. While 51.6% of patients knew there was a specialist pain unit in the hospital, only 5.5% were offered a consultation with it. This unit provides non-pharmacological pain management techniques. CONCLUSIONS: This study confirms the importance, the underestimation and undertreatment, of pain management in radiotherapy departments. We recommend using a standardised questionnaire to identify patients at highest risk of pain, and the use of specialised pain relief teams when needed. A radiation therapist could act as a referrer to the pain relief team. Pain management remains teamwork, with links to specialised units.

Influence of Nucleoshuttling of the ATM Protein in the Healthy Tissues Response to Radiation Therapy: Toward a Molecular Classification of Human Radiosensitivity.

PURPOSE: Whereas post-radiation therapy overreactions (OR) represent a clinical and societal issue, there is still no consensual radiobiological endpoint to predict clinical radiosensitivity. Since 2003, skin biopsy specimens have been collected from patients treated by radiation therapy against different tumor localizations and showing a wide range of OR. Here, we aimed to establish quantitative links between radiobiological factors and OR severity grades that would be relevant to radioresistant and genetic hyperradiosensitive cases. METHODS AND MATERIALS: Immunofluorescence experiments were performed on a collection of skin fibroblasts from 12 radioresistant, 5 hyperradiosensitive, and 100 OR patients irradiated at 2 Gy. The numbers of micronuclei, γH2AX, and pATM foci that reflect different steps of DNA double-strand breaks (DSB) recognition and repair were assessed from 10 minutes to 24 hours after irradiation and plotted against the severity grades established by the Common Terminology Criteria for Adverse Events and the Radiation Therapy Oncology Group. RESULTS: OR patients did not necessarily show a gross DSB repair defect but a systematic delay in the nucleoshuttling of the ATM protein required for complete DSB recognition. Among the radiobiological factors, the maximal number of pATM foci provided the best discrimination among OR patients and a significant correlation with each OR severity grade, independently of tumor localization and of the early or late nature of reactions. CONCLUSIONS: Our results are consistent with a general classification of human radiosensitivity based on 3 groups: radioresistance (group I); moderate radiosensitivity caused by delay of nucleoshuttling of ATM, which includes OR patients (group II); and hyperradiosensitivity caused by a gross DSB repair defect, which includes fatal cases (group III).

[Carcinoma of the anal canal: state of art, issues in geriatric oncology and molecular targeted therapies]. / Cancer du canal anal : état des lieux, enjeux en oncogériatrie et thérapies moléculaires ciblées.

Since the 1990, chemoradiation has become the standard treatment for locally advanced anal cancer. Recent progress in molecular biology and the growing number of elderly patients invite the clinicians to personalize the multimodal therapy strategy. However, data about anal cancer and elderly patients or targeted therapy are extremely sparse. Indeed, national or international guidelines don't mention these two subjects. The purpose of this article is to make the state of art of the management of anal cancer and its interferences with geriatrics and molecular targeted therapy.