[Role of immunotherapy in locally advanced non-small cell lung cancer]. / Place de l'immunothérapie dans le cancer bronchique non à petites cellules localement avancé.

Concomitant radiochemotherapy has been the standard of care for unresectable stage III non-small cell lung cancer (NSCLC), irrespective of histological sub-type or molecular characteristics. Currently, only 15-30 % of patients are alive five years after radiochemotherapy, and this figure remains largely unchanged despite multiple phase III randomised trials. In recent years, immune-checkpoint blockades with anti-PD-(L)1 have revolutionised the care of metastatic NSCLC, becoming the standard front- and second-line strategy. Several preclinical studies reported an increased tumour antigen release, improved antigen presentation, and T-cell infiltration in irradiated tumours. Immunotherapy has therefore recently been evaluated for patients with locally advanced stage III NSCLC. Following the PACIFIC trial, the anti-PD-L1 durvalumab antibody has emerged as a new standard consolidative treatment for patients with unresectable stage III NSCLC whose disease has not progressed following concomitant platinum-based chemoradiotherapy. Immunoradiotherapy therefore appears to be a promising association in patients with localised NSCLC. Many trials are currently evaluating the value of concomitant immunotherapy and chemoradiotherapy and/or consolidative chemotherapy with immunotherapy in patients with locally advanced unresectable NSCLC.

Preoperative MR imaging for ESMO-ESGO-ESTRO classification of endometrial cancer.

OBJECTIVE: To retrospectively investigate whether magnetic resonance imaging (MRI) findings could contribute to predict histologic type, tumor grade and lymphovascular space invasion (LVSI) to improve preoperative assessment of endometrial cancer using the European Society for Medical Oncology (ESMO) European Society for Radiotherapy & Oncology (ESTRO) and European Society of Gynecological Oncology (ESGO) classification. METHODS: Between January 2008 and August 2014, 104 women (mean age, 65±11 [SD] years; range, 32-84 years) with International Federation of Gynecology and Obstetrics (FIGO) stage I endometrial cancer underwent preoperative MRI of the pelvis. Two independent readers evaluated tumor heterogeneity and measured tumor size on T2-weighted, diffusion-weighted and T1-weighted images obtained after gadolinium chelate administration at 2minutes. The apparent diffusion coefficient (ADC) was generated from pixel ADC from the whole tumor volume. RESULTS: A short axis>24mm on MRI was associated with histopathologic type 2, grade 3 tumor and presence of LVSI (P<0.01). There were no significant differences in minimum, mean and maximum ADC between presence/absence of LVSI. In 9.1% women (9/99), the accuracy of the ESMO-ESGO-ESTRO classification with the inclusion of the MRI short-axis criterion was higher than that of the conventional ESMO classification to predict high-risk recurrence endometrial cancer (P=0.02). CONCLUSION: Tumor size reflects histologic type, tumor grade and LVSI in endometrial cancer. FIGO stage 1 endometrial cancer>24mm should be classified preoperatively in the high-intermediate or high-risk recurrence risk groups.

[Pain management in radiation oncology]. / Situations difficiles lors d'une irradiation : la douleur.

The goal of this article is to propose some practical means of pain management in radiation departments. Pain management in radiation oncology is difficult because of the high proportion of painful patients, underestimation by medical teams, and limited therapeutic options. Pain can cause mobilization difficulties, set-up errors, treatment interruption. According to procedure steps, a preventive attitude (for pre-radiation consultation) or an active attitude (for treatment) to quickly relieve the patient can be planned. This work is a brain storming about pain management. It is not a review about analgesic radiotherapy. The practical situations apply to patients to whom radiotherapy is indicated. Teamwork and anticipation are keywords to relieve patients. All proposed means are not always available for different reasons (time, finance, staff, training). The idea is to establish simple procedures that are appropriate to each center to fluidify acts, to optimize time for a successful irradiation.

Transfer of IgG from serum to lachrymal fluid in chickens.

Pure 125I-radiolabeled chicken IgG was inoculated intravenously into 2-week old chickens. Radioactivity in lachrymal fluid samples was first detected 10 minutes postinoculation (PI). Radioactivity levels declined up to day 20 PI, when they reached marginal levels. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) followed by autoradiography of lachrymal fluid samples, taken daily for 16 days, showed the presence of radioactive polypeptides in the same positions as their stained control counterparts at molecular weights corresponding to heavy and light chains of immunoglobulins. Radiolabeled IgG also was detected in serum samples of the inoculated chickens. SDS-PAGE followed by autoradiography of lachrymal samples taken until day 16 PI showed similar results. These results demonstrate that transfer of IgG from serum to lachrymal fluid does occur in chickens.

Progestin treatment depresses estrogen receptor but not cathepsin D levels in needle aspirates of benign breast disease.

We studied the effect of a progestin (lynestrenol) on estrogen receptors (ER) and cathepsin D (cath-D) levels immunochemically in successive fine needle aspirates of benign breast disease. Fibrocystic disease was the main pathology (43 out of 47 patients). Thirty-one patients were treated with 10 mg of lynestrenol daily from the fifth to the twenty-fifth day of the menstrual cycle for 1 to 3 months. Sixteen untreated patients were used as controls. Lynestrenol significantly decreased the percentage of ER stained cells. This is in agreement with the antiestrogenic effect of progestin and, for the first time, indicates that in vivo progestin may decrease the stimulatory effect of estrogens on mammary cells by decreasing their estrogen receptor content. No effect of progestin on cath-D level was found throughout the whole population. However, this level varied more between aspirates of each patient in the treated group than in the control group, suggesting heterogeneity in patient responses to progestin. Since cath-D may have a role in carcinogenesis, clinical follow-up of these patients and more detailed studies are required to determine whether this progestin-challenge test has any value for detecting high risk mastopathies and for predicting effectiveness of treatment.

Modulation of leucocyte activation in the early phase of the rabbit burn injury.

Previous studies in burned patients have shown an early enhanced polymorphonuclear leucocyte (PMN) generating capacity for superoxide radical (O2.-), for the arachidonic acid (AA) lipoxygenase metabolite leukotriene B4 (LTB4) and for platelet activating factor-acether (PAF). These findings have been confirmed on a burn injury rabbit model. As we have suggested a pivotal role for an exaggerated initial (less than 36-48 h) neutrophil stimulation leading to a later (greater than 72 h) immuno-depression and anergy, we tried to modulate the early phase by drug therapy. A Ginkgo biloba extract (IPS200) injected i.v. in burned rabbits greatly reduced O2.- and LTB4 generation on A23187 challenge. IPS200 includes flavonoids and other polyphenols, inhibiting either arachidonic acid metabolism or PAF receptors, and may thus exert their modulating effect on PMN function in thermal injury.