Detecting Local Clusters of Under-5 Malnutrition in the Province of Marinduque, Philippines Using Spatial Scan Statistic.

Underweight and overweight among under-5 children continue to persist in the island Province of Marinduque, Philippines. Local spatial cluster detection provides a spatial perspective in understanding this phenomenon, specifically in which areas the double burden of malnutrition occurs. Using data from a province-wide census conducted in 2014-2016, we aimed to identify spatial clusters of different forms of malnutrition in the province and determine its relative risk. Weight-for-age z score was used to categorize the malnourished children into severely underweight, moderately underweight, and overweight. We used the multinomial model of Kulldorff's elliptical spatial scan statistic, adjusting for age and socioeconomic status. Four significant clusters across municipalities of Boac, Buenavista, Gasan, and Torrijos were found to have high risk of overweight and underweight simultaneously, indicating existence of double burden of malnutrition within these communities. These clusters should be targeted with tailored plans to respond to malnutrition, at the same time maximizing the resources and benefits.

[Targeted therapies and radiation therapy in non-small cell lung cancer]. / Thérapies ciblées et radiothérapie dans les cancers bronchiques non à petites cellules.

Lung cancer is the leading cause of cancer-related death. Between 80-85% of lung cancers are non-small cell lung carcinomas. One third of the patients are diagnosed with locally advanced stage. In this condition, concomitant radio-chemotherapy is the standard treatment for patients with good performance status. Despite important improvements in the last years, non-small cell lung carcinoma prognosis remains poor, with high rates of both local recurrences and metastases. The heterogeneity of molecular characteristics of non-small cell lung carcinoma cells and a better knowledge of potential targets offer promising developments for new pharmacologic agents. Hereafter we will review the currently most studied pathways and the most promising ones for the treatment of locally advanced unresectable non-small cell lung carcinoma. Two of the most attractive pathways where new agents have been developed and assessed in combination with thoracic radiotherapy or radiochemotherapy are the EGFR pathway (either with the use of monoclonal antibodies or tyrosine kinase inhibitors) and the angiogenesis inhibition. The development of targeted agents could lead to individualized therapeutic combinations taking into account the intrinsic characteristics of tumor cells. Pharmacological modulation of tumour cells radiosensitivity by targeted therapies is only starting, but yet offers promising perspectives.

[Sentinel node biopsy in breast cancer]. / La technique du ganglion sentinelle dans le cancer du sein: quelques considérations récentes.

As compared to conventional axillary dissection, the sentinel node technique is accompanied by reduced morbidity and shorter hospital stay. Based on available data, the use of this technique does not seem to yield higher rates of axillary recurrence. A combination of both radioisotope detection and blue dye increases the identification rate, while also reducing false-negative rate. Surgical results are optimized when preoperative lymphoscintigraphy mapping is obtained in addition to peroperative probe detection. Considering the site of injection, the subareolar injection can be easy to apply even in case of non-palpable tumours, and gives higher count rates. However, the intraparenchymal, peritumoral, injection is necessary to evidence cases of extra-axillary drainage (internal mammary, infra- or supraclavicular) that is present in about 20% of patients. With the advent of hybrid cameras (SPECT-CT), the topography of these extra-axillary nodes can be given with high precision. Use of the sentinel node technique has been accompanied by an increase in the percent of patients with node involvement, due to an increased detection of micrometastases inferior or equal to 2 mm. Following an overview of basic principles, and of the main results with the sentinel node technique we focus the discussion on several points that are still open to debate, such as: 1) which group of patients can benefit from the sentinel node technique? 2) What is the optimal methodology? 3) What is the prognostic significance of micrometastases and of isolated tumour cells? 4) What attention should be given to extra-axillary drainage?

[Salvage radiotherapy for patients with PSA relapse after radical prostatectomy: comparisons among ASTRO and Phoenix biochemical failure definitions]. / Radiothérapie de rattrapage pour récidive biochimique après prostatectomie : comparaison entre les définitions de récidive biochimique de l'Astro et de Phoenix.

PURPOSE: Study about the efficacy of salvage radiotherapy (RT), in terms of biochemical disease free survival (bDFS), according to ASTRO and Phoenix (nadir+2) definitions, for persistent or rising PSA after radical prostatectomy. PATIENTS AND METHODS: Retrospective analysis of 59 patients who underwent RT between 1990 and 2003 for PSA recurrence after radical prostatectomy. Patients received a median of 66Gy to the prostate bed with 3D or 2D RT. The main end point was bDFS according to ASTRO and Phoenix (nadir+2) definitions. Different criterion sets were analysed to calculate bDFS and pretreatment factors that might predict biochemical relapse were sought for each. RESULTS: After a 38-month median follow-up, the 3-year bDFS rates were: 60 and 72% for ASTRO and Phoenix (nadir+2 ng/ml) definitions respectively. According to univariate analysis, pre-RT PSA> or =1 ng/ml and seminal vesicle involvement were associated with biochemical relapse. Multivariate analysis retained only pre-RT PSA> or =1 ng/ml as an independent predictor of biochemical relapse for the two definitions. CONCLUSION: Salvage RT is an effective treatment after radical prostatectomy according to ASTRO or Phoenix definitions. Only pre-RT PSA> or =1 ng/ml predicted relapse.

[Do locally advanced esophageal cancer still need surgery?]. / Faut-il encore opérer les cancers de l'oesophage localement évolués?

Results of surgery in locally advanced esophageal carcinomas (T3 and/or N1) are disappointing. Concomitant chemoradiotherapy (RTCT) gave equivalent survival results in many phase II studies. Two randomized trials (French and German) compared surgery or additional RTCT after a first phase of RTCT. Both drew the same conclusions, that is surgery did not improve overall survival but increased postoperative mortality. However, local control was found better in the surgical arms, and in some subgroups, esophagectomy improved disease-free survival suggesting that some patients may benefit from surgery. After preoperative RTCT, absence of residual disease in the surgical specimen (pathological complete response) occurs in 15 to 30%; these patients underwent a radical surgery without any benefit but with high risk of morbidity and mortality. Nevertheless, it is still difficult to select this sub-population: CT-scan or endoscopy with biopsies have a low sensitivity and specificity. 18-FDG-PET-scan, performed after or during the RTCT, is able to increase sensitivity, but only preliminary results with small populations are available. No biological factor of chemoradiosensitivity (p53, NfkappaB, p21...) could predict who will respond or not. Another approach is to reserve surgery only to patients with a demonstrated local failure (salvage surgery) but the feasibility of this technique is still debated. Finally, local relapses are frequent after RTCT and optimisation of the current schedules is mandatory to improve oncologic results. Unfortunately, increasing the radiation dose did not improve local control and showed more toxicities. New drugs as taxanes, oxaliplatine, or targeted therapies are tested in on-going phase III trial.

[Irradiation of lymph nodes areas in breast cancer]. / Irradiation des aires ganglionnaires dans le cancer du sein.

Postoperative radiotherapy after breast surgery increases overall survival by decreasing the local relapse rate. The main site of relapse is the breast or the chest wall. The value of irradiation of the nodal basins is still discussed. It must be emphasized that nodal areas were systematically irradiated in the postmastectomy randomized trials demonstrating a benefit in survival for adjuvant radiotherapy. Axillary relapses are infrequent in case of complete axillary dissection; complementary irradiation could be proposed if the axillary dissection is incomplete or if there is a massive pathologic involvement of the axilla. Its main complication is lymphoedema, which remains the most frequent sequellae of the treatment of breast cancer. Supraclavicular irradiation is logical in case of axillary involvement. Internal mammary nodes are involved in 20 to 40% of the patients, depending of the axillary involvement and location of the tumor inside the breast. Irradiation of the internal mammary basin is difficult: optimal dosimetry required a CT-based simulation. Its benefit remains to be proved. Internal mammary nodes irradiation probably increased cardiovascular mortality. Sophisticated techniques are needed to spare the heart from irradiation. Two large randomized trials (French group, European Organization for Research and Treatment of Cancer [EORTC]) are currently evaluating the possible benefit of internal mammary irradiation.

[Adjuvant chemotherapy followed by conformal chemoradiotherapy in gastric carcinoma]. / Chimiothérapie adjuvante suivie d'une chimioradiothérapie conformationnelle dans les cancers de l'estomac.

PURPOSE: Analysis of the feasibility and results of adjuvant chemotherapy followed by conformal chemoradiotherapy after surgery for gastric carcinoma. PATIENTS AND METHODS: Twenty-six patients (R0 or R1) were treated postoperatively by three cycles of 5-fluorouracil (5-FU) and cisplatin, followed by a concomitant association of LV5FU2 chemotherapy with a conformal radiotherapy of 45 Gy. RESULTS: The tumor was classified pT3-T4 in 77% of the patients and 92.5% had a nodal involvement (pN1: 54%; pN2: 31%). FEASIBILITY: (1) Adjuvant chemotherapy: nausea/vomiting grade II/III: 12 patients (48%); neutropenia grade III/IV: two patients; completed in all patients, except one. (2) Chemoradiotherapy: nausea/vomiting grade II/III: 10 patients; diarrhea grade II/3: two patients; oesophagitis grade II/III: two patients; myocardial infarction/pulmonary embolism: two patients. All patients except one received the planned dose of 45Gy. Radiotherapy was interrupted in six cases, with a median duration of 14 days. Survival: with a median follow-up of 30 months, 65% of the patients were alive without disease; median survival was 32 months. CONCLUSION: This postoperative schedule was judged feasible. It allowed the deliverance of a more intensified chemotherapy than the classical schedule. Its clinical benefit must be evaluated in a phase III trial.

[Conformal radiotherapy of prostate cancer]. / Radiothérapie conformationnelle du cancer de la prostate: technique et résultats.

A number of retrospective and prospective studies have demonstrated that radiotherapy of prostate cancer must be actually conformal. Three-dimensional (3D) treatment planning consists in an as accurate as possible definition of target-volume, usually by CT-scan, and design of radiation fields shaped to this target-volume. Several steps are required, each step being important for the overall quality of the treatment. Conformal radiotherapy is better tolerated than conventional irradiation, with significantly less rectal toxicity. It allows dose-escalation up to 80 Gy. It is now possible to go beyond this dose with intensity-modulated radiotherapy. The benefit of these high doses was demonstrated by some large retrospective studies and some prospective dose-escalation trials. Several randomized trials are in progress, preliminary results of two of them have been published, both showing an improvement in disease control with the higher doses. The advantage of higher doses is clearly evident for patients in the intermediate prognostic group, but is still discussed for patients with a low risk tumour or treated in combination with hormone therapy. Late proctitis is the main toxicity of these high doses. Some volume constraints have been defined during the last years and will allow a decrease of the rate of rectal toxicity. Because of these technological improvements, results of radiation therapy are now similar to those of surgery: no direct comparison with a randomized trial is available, but large comparative studies show that long-term disease control are identical with both techniques. Radiation therapy must be proposed to all patients with a prostate carcinoma as an alternative to surgery.

[Does primary chemotherapy really increase the rate of breast conserving treatments?]. / La chimiothérapie première permet-elle réellement d'augmenter le taux de conservation mammaire?

Initially, preoperative chemotherapy had three aims, to improve the overall survival by an early exposure to systemic therapy, to evaluate in vivo the efficacy of chemotherapy and to monitor post-operative treatment, and to increase the rate of breast-conserving treatments. Eight randomised trials have been published. The general consensus about the results of these trials is that neoadjuvant chemotherapy did not improve overall survival, in comparison with an adjuvant treatment. Clinical and especially pathological complete response rates were correlated with the outcome of the patients and could be considered as an independent prognostic factor. Primary chemotherapy is a powerful tool to study the predictive factors, especially biological factors, of chemosensitivity. However, the usefulness of this approach to adjust post-operative treatments remains to be demonstrated. Finally, primary chemotherapy slightly increased the rate of breast conserving treatments, but is accompanied by a small increase in the risk of local recurrence. To propose a conservative treatment to a woman initially not suitable for a lumpectomy needs clear information about this enhanced risk.

[Endobronchial brachytherapy: technique and indications]. / Curiethérapie endobronchique: technique et indications.

The endobronchial brachytherapy procedure involves the insertion of an afterloading catheter into bronchus in close proximity to an endoluminal lesion, and to perform limited irradiation sparing as much as possible normal health tissues. The catheter is inserted during a classical flexible bronchoscopy. Three types of indications have been discussed: (i) palliative treatment of lung carcinoma, with or without laser desobstruction: an improvement in respiratory symptoms was observed in 60 to 80% of the cases; (ii) curative treatment for localised endobronchial carcinomas, in previously irradiated patients, or in case of contraindication of surgery or external beam irradiation; local control rate range from 60 to 70% at 2 years; (iii) combination of external irradiation and brachytherapy in the first line treatment of lung cancers. Two randomised trials did not show any improvement in survival for this approach; however, they have included advanced diseases. In the opposite, this association seems very effective for early stage lung carcinomas. Two major complications were regularly reported, haemoptysis and radiation bronchitis. Predictive factors for these toxicities are actually better known: haemoptysis could be due to a progressive disease more often than to brachytherapy itself; technical factors (dose, volume, fractionation), however, could explain a number of radiation bronchitis, and their incidence could decrease in the future.

[Post-prostatectomy radiotherapy: for which patients and when?]. / Radiothérapie post-prostatectomie: pour quels patients et quand?

Biochemical relapse after radical prostatectomy is not exceptional, ranging from 10 to 40% in the literature. To prevent this biochemical failure, adjuvant radiotherapy was proposed to patients with a high risk of relapse. No phase III trial has actually validated this attitude. Best indications for adjuvant irradiation seem to be patients with an extensive extracapsular extension or multiple positive margins. Historical comparisons seems to confer, in these case, a benefit in biochemical control for adjuvant irradiation versus observation. Others authors prefer immediate post-operative irradiation, a delayed treatment, when biochemical relapse has occurred. This attitude has spared some patients irradiation useless. This salvage irradiation lowered the PSA level in 40 to 70% of the cases, but long-term efficiency is obtained only in the case of a low value of the PSA before irradiation. Delayed radiotherapy is, therefore, justified only if a close follow-up is performed, with repeated dosage of PSA. Whatever the case, it is important to differentiate between local and distant relapse: patients with positive nodes at the time of surgery are most likely at risk of distant relapse. It seems that patients with seminal vesicles involvement are also at high risk for distant relapse, but this must be confirmed.

[Chemotherapy with cisplatinum, carboplatin and 5FU-folinic acid, followed by concomitant chemo-radiotherapy in unresectable esophageal carcinomas]. / Chimiothérapie par une association de cisplatine, carboplatine et 5-fluoro-uracile-acide folinique, suivie de chimio-radiothérapie dans les cancers de l'oesophage inopérables.

UNLABELLED: The best chemotherapeutic regimen for advanced carcinoma of the esophagus remains to be determined. We have evaluated a combination of carboplatin, cisplatin and 5FU modulated by folinic acid. Patients. Twenty-seven patients (median age 57 yrs) with an unresectable carcinoma of the esophagus were included in this trial: 9 patients with a local relapse after surgery, 6 patients with a locally advanced (T4) tumor, and 12 patients with metastasis. Treatment schedule. Initial chemotherapy : carboplatine IV d1, AUC4; 5FU: bolus injection of 400 mg/m2 d1, followed by a continuous infusion of 600 mg/m2/24 h, d1 and d2; folinic acid (200 mg/m2) IV, before the 5FU bolus, d1 and d2; cisplatine 80 mg/m2, d3; on d15 and d16, 5FU and folinic acid were repeated with the same schedule. The second cycle began on d28. Concomitant chemo-radiotherapy with 5FU (1,000 mg/m2 d1 to d3), cisplatine (50 mg/m2 d1 and d2) and external irradiation (20 Gy in 10 fractions from d1 to d12) was then performed, for three cycles (until a total dose of 60 Gy). Results. TOXICITY: neutropenia grade 3-4 (32%), thrombopenia grade 3-4 (18%). More important, a lymphopenia (< 500/mm3) was noted in 12 patients (43%). Accordingly, 4 serious infectious complications were observed, with three toxic deaths. Objective response rate: 44% after initial chemotherapy; 75% after chemoradiotherapy, with 8 complete responses (38%). Median survival was 7.4 months, with a one- and two-year survival of 33% and 17,8%, respectively. Conclusion. This association of cisplatin, carboplatin, and 5FU did not offer a better response rate than the classical 5FU-cisplatinum association. But serious infectious complications occurred during the trial. We do not recommended further evaluation of this biplatinum therapy with 5FU in advanced esophageal carcinomas.

Impact on survival of surgery after concomitant chemoradiotherapy for locally advanced cancers of the esophagus.

BACKGROUND: To evaluate the results of chemoradiotherapy with or without surgery in locally-advanced esophageal carcinomas (T3 and/or nodal involvement). METHODS: One hundred twelve patients with locally-advanced carcinoma of the esophagus without histologically proven invasion of the tracheobronchial tree or distant visceral metastases were treated with concomitant chemoradiotherapy followed by re-evaluation; surgery was performed or chemoradiotherapy continued, based on tumor regression and the patient's general status. Chemoradiotherapy consisted of concomitant 5-fluorouracil (5FU)(1 g/m(2) day 1-3), cisplatinum (50 mg/m(2) day 1 and 2), and external beam irradiation up to a dose of 40 or 43.2 Gy. After a 4-week rest period, radical esophagectomy or a new cycle of chemoradiotherapy (up to a total dose of 65 Gy) was performed. RESULTS: A complete clinical response was obtained in 25.7% of the patients and a partial response in 45.9%. Fifty patients underwent surgery, but only 38 patients had an esophagectomy. Post-esophagectomy mortality was 5.3%. A complete histologic response rate of 23.7% was obtained. Two- and 5-year survival rates were, respectively, 41.5% and 28.6% for the whole population. According to multivariate analysis, prognostic factors for survival were Karnofsky index, esophagectomy, and response to chemoradiotherapy. Five-year survival for patients who experienced a partial response to radiation and chemotherapy was 49.1% for those who had surgery and 23.5% for those treated without surgery (p = 0.003). There was no obvious benefit for the small number of patients treated surgically after complete response to radiation and chemotherapy. Toxicity, essentially hematologic, was moderate. CONCLUSION: For locally-advanced esophageal carcinomas, esophagectomy, after concomitant chemoradiotherapy, could improve the survival rate, especially for patients who responded partially to the latter.

High-dose-rate brachytherapy for early breast cancer: an ambulatory technique.

PURPOSE: To evaluate tolerance and efficiency of a boost dose delivered by high-dose-rate brachytherapy (HDRB) in conservative treatment of breast cancer. To evaluate the feasibility of brachytherapy on an out-patient basis. METHODS: One hundred and six patients with T1-T2, N0-N1 breast cancers (108 breasts) have been treated with lumpectomy, external irradiation (45 Gy in 5 weeks), and a boost dose on the tumor bed with HDR iridium brachytherapy. Two fractions of 5 Gy were delivered 6 or 24 hours apart. Implantation was done during the lumpectomy (group A: 24 cases) or 3 to 4 weeks after the end of external irradiation (group B: 84 cases). For group B, the application was performed on local anesthesia, and did not require hospitalization. Characteristics of the population were as follows: T1: 77 (71.3%); T2: 31 (28.7%); median tumor size: 1.5 cm; histology: intraductal carcinomas (DCIS): 14 (13%); infiltrative ductal carcinomas (IDC): 84 (77.8%); others: 10 (9.2%). For IDC, surgical margins were found positive in 15 cases, and an extensive intraductal component was present in 22 cases. RESULTS: All ambulatory HDR implants were performed as planned. No immediate toxicity was noticed, except 5 local hematomas. With a median follow-up of 45 months, 5 local relapses were observed (5-year local relapse rate: 5.1%). Only histological grade III was significantly correlated with local relapse. The 5-year disease-free survival and overall survival were respectively 93.8% and 93.3%. Cosmetic result was evaluated in 87 cases, and was good or excellent in 48 cases (63.2%), acceptable in 27 cases, and poor in 5 cases. CONCLUSION: HDRB allows the boost dose to be performed on an out-patient basis. It seems to offer the same local control as other boost techniques for localized breast cancer with acceptable cosmetic results.

[Continuous radiosensitizing chemotherapy]. / Chimiothérapies continues à visée radiosensibilisante.

Concomitant use of radiation therapy and chemotherapy is increasing steadily in the treatment of locally-advanced epithelial tumors. This approach has been proved effective in head and neck, esophageal, and canal and nonsmall-cell lung cancers. One of the best radiation sensitizers known to date is 5FU. In vitro cell model have demonstrated the importance of continuous exposure to the drug during 12 to 24 hours after the radiation session. These biological data have been confirmed by a randomized study in rectal cancer comparing 5FU bolus therapy versus 5FU given continuously during irradiation. Disease-free survival and overall survival were longer in the continuous infusion group. Cisplatin is being increasingly used in moderate but repeated doses, a regimen that requires central venous access. Similarly, etoposide, whose venotoxicity is well known, is an excellent radiation sensitizer that is gaining ground, most notably in the treatment of lung cancer. Nutritional support is a key component of all radiochemotherapy regimens used to treat digestive tract cancers and usually requires parenteral nutrition via a central venous access.

Predictive factors for late toxicity after endobronchial brachytherapy: a multivariate analysis.

PURPOSE: To determine the predictive factors associated with hemoptysis and radiation bronchitis after endobronchial brachytherapy by univariate and multivariate analyses METHODS AND MATERIALS: One hundred forty-nine patients underwent endobronchial brachytherapy and were divided into three therapeutic groups: group 1: patients treated with palliative intent (n=47); group 2: patients treated with curative intent (small endobronchial tumors without mediastinal or general dissemination: n=73); group 3: patients also receiving external irradiation (n=29). One hundred twelve patients had previously received external irradiation. Brachytherapy was delivered with a dose per fraction ranging from 4 to 7 Gy and a prescription point between 0.5 and 1.5 cm, usually 1 cm from the source center. Two to six fractions were delivered according to the therapeutic group and clinical situation. The influence of the following variables on the incidence of hemoptysis or radiation bronchitis was studied: age, sex, Karnofsky score, therapeutic group, histologic type, endoscopic tumor length, dose per fraction, total brachytherapy dose, total external beam irradiation dose, total dose (brachytherapy dose plus external irradiation dose), volumes of the 100% and 200% isodoses, and volumes of the 7 and 14 Gy isodoses. RESULTS: We observed 11 hemoptyses (7.4%), 10 were lethal. All but one occurred in patients with progressive disease. Two clinical factors were significantly associated with hemoptysis by univariate analysis: palliative group (p=0.009) and endobronchial tumor length (p=0.004). No technical factors seem to be implicated in the occurrence of hemoptysis. Only endobronchial tumor length remained in the multivariate model (p=0.02). Radiation bronchitis was observed in 13 cases (8.7%). By univariate analysis, a good Karnofsky score (p=0.02), curative treatment (p=0.02), and tumor location on trachea and main stem bronchus (p=0.002) were significantly associated with this complication. Two technical factors were also incriminated: the total dose (p=0.04) and the 100% isodose volume (p=0.02). By multivariate analysis, only the tumor location retained statistical significance (p=0.009). CONCLUSION: Hemoptysis is most likely due to disease progression, with the bleeding being facilitated by brachytherapy. Some rare cases could be a direct complication of brachytherapy itself, particularly when tumors are located in the upper lobes. In contrast, radiation bronchitis occurred more frequently in patients with controlled disease, and was significantly influenced by tumor location and technical factors (dose and volumes treated). Technical improvements should increase the therapeutic ratio.

Lack of correlation between the location of choroidal melanoma and ultraviolet-radiation dose distribution.

Ocular melanomas arise from the choroid. The results of our study of a total of 92 ocular melanomas would indicate that there is no preferential location for tumors on the eye. We estimated the ultraviolet (UV) radiation dose distribution using data available in the literature. We then compared tumor location and UV-radiation dose distribution. UVC and UVB do not reach the choroid, and UVA is filtered by the cornea and the lens. Only a small percentage of the incoming rays reach the posterior and inferior part of the retina, but none reach the superior and anterior part of the eye. We concluded that it is therefore very unlikely that UV-radiation exposure is responsible for choroidal melanoma.

[Concomitant radiochemotherapy in inoperable non-small cell lung cancer]. / Radio-chimiothérapie concomitante dans les cancers bronchiques non à petites cellules inopérables.

PURPOSE: As locally advanced and inoperable non-small cell lung cancers still have a poor prognosis, the present phase II study focused on the administration of concomitant chemotherapy and radiotherapy and was aimed at increasing both local and metastatic controls. MATERIALS AND METHODS: Thirty-nine patients (36 male and three female patients, mean age, 56 years) were included into the study. Ninety five percent of them had a good performance status (OMS status 0 or 1). The histopathological analysis showed the existence of squamous cell in 64% of the cases. There was one stage I tumor, nine stage IIIA tumors and 24 stage IIIB tumors. In two cases, the tumor stage was unknown. The duration of each cycle of the protocol was 3 weeks and included the administration of cisplatin (50 mg/m2 at d1 and d2) and fluorouracil (5-FU) (1 gr/m2 in continuous infusion at d1, d2, and d3), and external beam irradiation (20 Gy subdivided into 2 Gy-fractions that were administered from d1 to d12); the 3rd week was a resting period. RESULTS: The tolerance to the treatment was good. Fifteen per cent grade 3-4 leucopenia, 3% grade 3-4 thrombopenia and 15% grade 3-4 nausea with vomiting were observed. No serious esophagitis was recorded. Chemotherapy was completed in more than 90% of the cycles. An objective response was described in 56% of the cases, with only 3% of complete responses. However, evaluation was done on average 6 weeks after radiotherapy, at a time where post-irradiation fibrosis could hamper radiological assessment. Median survival and 2- and 3-year survivals were 11.4 months, 27% and 14%, respectively. The only significant prognostic factor was the OMS performance status index, while the radiological response was particularly non-predictive of survival. Failure patterns were analyzed in 20 patients and consisted of the following: local relapse only, six cases; metastatic relapse only, 13 cases; both local and metastatic relapse, one case. CONCLUSION: The concomitant administration of 5-FU, cisplatin and external irradiation seems feasible in current clinical practice. Survival but not radiological response should be the only criteria to evaluate this type of association. Improvement in local control is not unlikely with this type of association.

[Endobronchial brachytherapy: the Saint-Louis Hospital experience]. / Curiethérapie endobronchique: l'expérience de l'hôpital Saint-Louis.

PURPOSE: During the evolution of lung cancer, bronchial obstruction is often noticed and is sometimes responsible for serious symptoms. Several methods of desobstruction can be proposed, including brachytherapy. MATERIALS AND METHODS: One hundred forty-nine patients presenting with endobronchial brachytherapy were included into the study. Seventy-three were treated with curative intent, 47 with palliative intent and 29 with a combination of external irradiation and brachytherapy. We usually delivered a series of two 7-Gy fractions (1 cm from the catheter), the treatment being repeated one, two or three times. RESULTS: When all symptoms were taken into account, respiratory function improvement was present in 79% of the patients. Among the 132 tumors that could be evaluated via a new endoscopy 2 months after treatment, 64 (48.5%) were in complete histological remission. The median survival was 14.4 months for the patients treated with curative intent. Eleven massive hemoptysies and 13 radiation bronchitis were observed. CONCLUSION: These results confirm the feasibility and good results related to endobronchial brachytherapy, though controlled studies are needed to better define its place in the therapeutic strategy of bronchial carcinomas.

[Intrabronchial curietherapy. Experiences at Hôpital Saint-Louis after the treatment of 149 patients]. / Curiethérapie endobronchique. L'expérience de l'Hôpital Saint-Louis après le traitement de 149 patients.

Endobronchial tumour obstruction threatens to occur in cases of carcinoma of the bronchus throughout the course of the disease. Such patients can benefit from relief of the bronchial obstruction by several techniques which are currently available. We have treated 149 patients with endobronchial radiotherapy. Seventy three patients were treated with a view to cure, 47 with a palliative dose and 29 received endobronchial radiation in complement with external irradiation. The treatment was carried out in series repeated every 15 days until a maximum of three treatments, consisting of two sessions at 24 hour intervals delivering at each session and irradiating of 7 Gy with a 1 cm catheter. All the clinical signs were relieved and in 79% of patients there was a symptomatic benefit. One hundred and thirty two patients were evaluated by control endoscopy two months after the treatment and 64 had a complete histological remission. The median survival was 14.4 months for patients treated with intent to cure. Obtaining a histological remission was a gauge for prolonged survival (median survival 26.5 months), 11 (7.4%) had massive hemoptysis and 13 (8%) irradiation pneumonitis, all of which occurred some time after the therapeutic procedure. The results confirm the feasibility and the good results of endobronchial irradiation in this field and encourage the idea of controlled multi-centre trials in order to assess a placed of endobronchial radiotherapy in the therapeutic strategy of bronchial cancer.