[Ductal carcinoma in situ: role of the boost]. / Radiothérapie des carcinomes canalaires in situ: impact du complément d'irradiation du lit tumoral.

Ductal carcinoma in situ is defined as breast cancer confined to the ducts of the breast without evidence of penetration of the basement membrane. Local treatment quality represents one of the most prognostic factors as half of recurrences are invasive diseases. The main goal of adjuvant radiotherapy after conservative surgery is to decrease local recurrences and to permit breast conservation with low treatment-induced sequelae. Several randomized trials have established the impact of 50 Gy to the whole breast in terms of local control. Nevertheless, no randomized trial is still available concerning the role of the boost in this disease. In this review, we present updated results of the literature and we detail the French multicentric randomized trial evaluating the impact of a 16 Gy boost after 50 Gy delivered to the whole breast in 25 fractions and 33 days. This protocol will start inclusions in October 2008.

[Recurrence after surgical treatment of epidermoid cancers of the esophagus. Therapeutic approach in 19 patients]. / Récidives après traitement chirurgical des cancers épidermoïdes de l'oesophage. Approche thérapeutique chez 19 malades.

OBJECTIVES: The aim of this study was to report the management of 19 patients with recurrence of esophageal squamous cell carcinoma after surgical treatment. PATIENTS-METHODS: Nineteen patients with loco-regional recurrent invasion (n = 13) or metastasis (n = 6) of esophageal squamous cell carcinoma were included. Four of the 13 patients with loco-regional recurrent invasion had tracheal involvement. The treatment of the recurrence was a combined radiochemotherapy (n = 12) for loco-regional recurrent invasion in 11 cases and for metastasis in 1 case, associated with a tracheal prosthesis in 1 patient. The other treatments were chemotherapy alone (n = 5), esophageal prosthesis (n = 1) and surgical treatment (n = 1). RESULTS: There were 7 objective responses among the 12 patients treated with combined radiochemotherapy and none in the group treated with chemotherapy alone. Grade 3-4 toxicity was noticed in 2 cases (severe mucositis). Survival rate of the 19 patients was 52.6% at 1 year and 13.1% at 2 years; it was linked with general health (P = 0.09) and with tracheal involvement (P = 0.04). Survival rate of the 12 patients treated by combined radiochemotherapy was higher: 66% at 1 year and 22.2% at 2 years (median survival time = 16 months). CONCLUSION: Active medical treatment of recurrence of esophageal squamous cell carcinoma by combined radiochemotherapy can provide a median survival time of 16 months, with a moderate toxicity.

Endoscopic ultrasonography for assessment of the response to combined radiation therapy and chemotherapy in patients with esophageal cancer.

BACKGROUND AND STUDY AIMS: Measuring the response of esophageal cancer to combined chemotherapy and radiotherapy is difficult. Initial results using ultrasonography have been contradictory. The purpose of this study was to correlate the endoscopic ultrasonography (EUS) findings after preoperative chemoradiotherapy with the histology of the resected specimens, and to assess the accuracy of EUS in predicting the response to treatment. PATIENTS AND METHODS: From October 1991 to February 1995, 32 patients with esophageal cancer staged as T3 or T4 on EUS were treated by chemoradiotherapy, followed by surgical resection. There were 28 men and four women, with a mean age of 54 years (range 38-70 years). In 25 cases, the diagnosis was squamous-cell carcinoma, and in seven cases it was adenocarcinoma. EUS was carried out using a curved-array ultrasonic transducer (Pentax FG-32 UA). After two courses of chemoradiotherapy, the wall involvement was classified using the following modified post-chemoradiotherapy classification: T0, complete restitution of wall layers; Tw, echo-poor nodules located in the submucosa or muscularis propria, but with wall layers discernible; T2, echo-poor wall thickening without distinguishable layers, but not infiltrating beyond the fifth hyperechoic layer; T3, thickened hypoechoic or heterogeneous wall, no distinguishable layers, infiltrating beyond the fifth hyperechoic layer; T4: a hypoechoic or heterogeneous mass in contact with a mediastinal structure. RESULTS: Using this post-chemoradiotherapy classification, the sensitivity, specificity, and accuracy of EUS in detecting residual tumor (T0 + Tw versus T2, T3, and T4) were 91.3%, 77.7%, and 77.7%, respectively. The accuracy of EUS, endoscopic, and CT criteria in assessing the parietal response was 81.2%, 56.2%, and 59.3%, respectively. CONCLUSION: Complete restoration of the esophageal wall (T0) and Tw stage corresponded to disease-free histology in 78% of cases, and corresponded in all cases either to disease-free esophageal wall or to microscopic tumor residues in the mucosa. No conclusions could be drawn in the other categories (T2-T4), but residual tumor was detected in 87% of cases.

[Endosonography in the preoperative evaluation of cancers of the esophagus]. / L'endosonographie dans l'évaluation pré-opératoire des cancers de l'oesophage.

OBJECTIVE: To assess the diagnostic accuracy of endoscopic ultrasonography (EUS) for the local and regional staging of esophageal cancer, and its possible alteration resulting from the performance of preoperative chemoradiation. METHODS: Prospective study of 85 consecutive patients with esophageal cancer evaluated by EUS and operated on between January 1992 and December 1995. 28 of these patients had received previous induction therapy. In all cases, EUS examination was performed by the same physician not informed about the results of previous morphological explorations. Histopathological analysis of all operative specimens was performed by the same pathologist, not informed about the results of EUS. Data were collected by another independent observer. RESULTS: EUS examination resulted in incomplete staging in 8 patients (9.5%) with severe stenosis precluding endoscope passage. The accuracy, specificity and sensitivity of EUS in detecting the depth of esophageal involvement (T0-2 vs. T3-4) were 82.3%, 78%, and 86% respectively, and 72%, 70%, and 73% respectively for lymph node metastasis. The overall accuracy of EUS in identifying the preoperative stage was 67%, with a clear-cut alteration when patients had received induction therapy (61% vs 72%). On the other hand, 7 (64%) of the 11 patients thought to have a complete response at endosonography had no residual tumor. CONCLUSION: EUS provides precise information for the preoperative identification of locally advanced esophageal tumor, even after induction therapy. The latter alters the diagnostic accuracy of EUS, although complete responders could be identified in two-thirds of cases.