Locoregional relapses in the ACCORD 12/0405-PRODIGE 02 study: Dosimetric study and risk factors.

PURPOSE: The aim of this study is to correlate locoregional relapse with radiation therapy volumes in patients with rectal cancer treated with neoadjuvant chemoradiation in the ACCORD 12/0405-PRODIGE 02 trial. PATIENTS AND METHODS: We identified patients who had a locoregional relapse included in ACCORD 12's database. We studied their clinical, radiological, and dosimetric data to analyze the dose received by the area of relapse. RESULTS: 39 patients (6.5%) presented 54 locoregional relapses. Most of the relapses were in-field (n = 21, 39%) or marginal (n = 13, 24%) with only six out-of-field (11%), 14 could not be evaluated. Most of them happened in the anastomosis, the perirectal space, and the usual lymphatic drainage areas (presacral and posterior lateral lymph nodes). Only patients treated for a lower rectum adenocarcinoma had a relapse outside of the treated volume. 2 patients with T4 tumors extending into anterior pelvic organs had relapses in anterior lateral and external iliac lymph nodes. CONCLUSIONS: Lowering the upper limit of the treatment field for low rectal tumors increased the risk of out of the field recurrence. For very low tumors, including the inguinal lymph nodes in the treated volume should be considered. Recording locoregional involvement, treated volumes, and relapse areas in future prospective trials would be of paramount interest to refine delineation guidelines.

Prolonged efficacy of mTOR inhibitors in papillary renal cell carcinoma: progression-free survival lasting for over 3 years, a case report and review of the literature.

Treatment of metastatic renal cell carcinoma has radically changed during the last decade with the approval of new drugs, antiangiogenic agents and mammalian targets of rapamycin (m-TOR) inhibitors. The outcome of metastatic clear-cell carcinoma has been significantly improved, while other entities such as metastatic papillary renal cell carcinoma are still associated with a poor prognosis. To date, there is no standard guideline for metastatic non clear cell carcinoma. We report the case of a 68-year-old patient with a pulmonary metastatic evolution of a papillary kidney cancer who has had more than 3 years disease progression-free survival and is under ongoing treatment with m-TOR inhibitors.

[Strategy in advanced castration-resistant prostate cancer]. / Stratégie de prise en charge des cancers de la prostate réfractaires à la castration.

If androgen deprivation, chemical with LH-RH analogs or surgical with bilateral orchiectomy, still remains the stone edge of treatment of prostate cancer, in the metastatic setting, this hormonosensitivity, most of the time long, finally move on in hormonal-failure. If rare changes in the therapeutic strategy have been achieved in this setting since 2004 and the arrival of docetaxel, it is the global perception of the disease that has been modified and the definition of one specific entity: the castrate-resistant prostate cancer. This new definition and the changes of design and end-points of clinical trials testing new agents with strong recruitment during the past years have conducted to a real revolution in the management of castrate-refractory prostate cancer. The place of secondary hormonal manipulations, such as withdrawal of the anti-androgen, oestrogen or ketoconazole, still exists for a selected group of patients. In case of aggressive disease and symptoms, chemotherapy should be selected, docetaxel, in a three weeks schedule, and may be combined with Estracyt. It is time to consider the revolution of the post-chemotherapy setting with the arrival of two new drugs ; a cytotoxic one, the cabazitaxel and hormonal for the second one, the abiraterone acetate. The place of the immunotherapy with the sipuleucel-T may be more difficult to precise, especially in Europe, even if it has been finally indicated in the United States in the metastatic setting. Concerning bone metastasis, zoledronic acid was during a long time the only bone-targeted agent, effective in reducing the incidence of skeletal related events, and was recently exceeded by the denosumab, an anti-RANK ligand. Finally, let us hope that other changes will be achieved in the near future, with the cabazitaxel-docetaxel confrontation in the first-line setting, and the introduction of the abiraterone acetate before chemotherapy with docetaxel, already tested in ongoing trials.

[Renal involvement in cancer and renal paraneoplastic syndromes]. / Syndromes paranéoplasiques à expression rénale et atteintes rénales des cancers.

BACKGROUND: Renal alterations in the context of neoplastic disease are relatively frequent manifestations but are overall poorly reported. MATERIAL AND METHODS: A search in the English and French literature was performed using the following key words: "cancer", "renal", "paraneoplastic syndrome", "glomerulopathy" and "kidney failure". RESULTS: The various renal manifestations can be divided into specific and paraneoplastic. They include paraneoplastic glomerulopathies (membranous glomerulonephristis being the most frequent), direct involvement of the renal parenchyma, hydroelectrolytic abnormalities (hypercalcemia, inappropriate antidiuretic hormone secretion…), retroperitoneal fibrosis, micro-angiothrombotic disease and tumor lysis syndrome. Anticancer and symptomatic treatments do not guaranty complete recovery in all cases. CONCLUSION: The frequency and the severity of some renal manifestations associated with malignant hemopathies and carcinomas indicates a need for initial renal-oriented work-up and follow-up.