[Radiation induced side effects]. / Effets indésirables de la radiothérapie.

More than half of all people with cancer are treated with radiation therapy. Over the last decade the technical advances, both in therapy beam precision and imaging, have greatly improved the therapeutic ratio and accuracy of modern radiotherapy. However, damaging healthy tissues near the tumor leads to radiation induced injury that develops immediately and continue to progress long after exposure to radiation. Recently dramatic advances have been made in understanding the determinant of tissue response to radiation exposure.

Selecting patients for exclusive permanent implant prostate brachytherapy: the experience of the Paris Institut Curie/Cochin Hospital/Necker Hospital group on 809 patients.

PURPOSE: The aim of this study was to analyze overall and relapse-free survival in a cohort of 809 patients, 34% of whom corresponded to a higher-risk group than American Brachytherapy Society (ABS) criteria. METHODS AND MATERIALS: Between January 1999 and September 2004, 809 patients were treated with permanent loose 125 iodine seed implantation (IsoSeed Bebig, Eckert and Ziegler) by the Paris Institut Curie, Cochin Hospital, and Necker Hospital group. Of these 809 patients, 533 (65.9%) corresponded exactly to ABS criteria. Two hundred and seventy-six patients (34.1%) had a prostate-specific antigen (PSA) level between 10 and 15, or a Gleason score of 7, or both (non-ABS group). RESULTS: Overall 5-year survival was 98%, with no difference between the ABS group and the non-ABS patient subgroups (p = 0.62).Five-year relapse-free survival was 97% in the ABS group; it was significantly lower (p = 0.001) in the non-ABS group but remained satisfactory at 94%. On subgroup analysis, the results appeared to be better for the subgroup of patients with PSA 10-15 than for the subgroup with a Gleason score of 7. CONCLUSIONS: Our results suggest that selected patients in the intermediate-risk group of localized prostate cancers can be safely proposed as recipients of permanent implant brachytherapy as monotherapy.

[Modern methods for cancer external radiation therapies]. / Méthodes modernes d'irradiation externe des cancers.

Radiotherapy has been in constant progress for the past century. New technologies are based on modern imaging modalities, efficient 3D treatment planning systems, sophisticated immobilization systems and rigorous quality assurance and treatment verification. The central objective of conformal radiotherapy is to ensure a high dose distribution tailored to the limits of the target volume while reducing exposure of healthy tissues. These techniques would then allow a further tumor dose escalation. New systems like CyberKnife, tomotherapy and hadrontherapy represent major potential progress for the treatment of complex tumours that are very difficult to treat with conventional radiotherapy techniques.

[Chylous ascitis revealing a non-Hodgkin lymphoma]. / Ascite chyleuse révélatrice d'un lymphome non hodgkinien.

INTRODUCTION: Chylous ascitis is a rare form of ascitis, characterised by a milky, triglyceride-rich, liquid. It is due to an interruption in the lymphatic system due either to an obstruction or to a post-traumatic wound. We report a case of revealing a non-Hodgkin lymphoma. OBSERVATION: A 71 Year-old man consulted for abdominal distension attributed to a chylous ascitis. Peripheral adenopathies were palpable. The abdominal scan revealed voluminous lumbar-aortal adenopathies. The diagnosis of grade IV (Ann Arbor classification) centro-follicular non-Hodgkin lymphoma was retained. The ascitis disappeared following chemotherapy. COMMENTS: Chylous ascitis is an uncommon complication of lymphomas, although representing the main cause in adults in developed countries. The underlying mechanism is an obstruction to sub-diaphragmatic draining lymphatic due to lymphomatous infiltration. Hyperalimentation, a low, dietary restriction of long-chain triglycerides or peritoneovenous shuntings are ineffective. CONCLUSION: Chylous ascitis is a rare complication of lymphomas, secondary to the obstruction of the abdominal draining lymphatics. Treatment is the same as that of a hematologic malignancy.

Should all cases of lung cancer be presented at Tumor Board Conferences?

Tumor Board Conferences (TBCs) have been associated with higher adherence of staging and treatment to guidelines. The influence of TBCs on the rate of curative treatments has been established. Patients with lung nodules and tumors of unknown histology should not be presented before surgery, but every patient with malignant histology should be declared to the TBC coordinator and registered at the time of histologic confirmation. This approach allows physicians to deal rapidly with simple cases on a systematic basis, to give more attention to the most complicated situations, and to offer every patient the benefit of a multidisciplinary approach.

Prevalence and treatment management of oropharyngeal candidiasis in cancer patients: results of the French CANDIDOSCOPE study.

PURPOSE: The aim of this pharmaco-epidemiological study was to evaluate the prevalence of oropharyngeal candidiasis (OPC) in cancer patients treated with chemotherapy and/or radiotherapy. METHODS AND MATERIALS: Signs and symptoms of OPC were noted for all patients. Antifungal therapeutic management was recorded in OPC patients. Patients receiving local antifungal treatments were monitored until the end of treatment. RESULTS: Enrolled in the study were 2,042 patients with solid tumor and/or lymphoma treated with chemotherapy and/or another systemic cancer treatment and/or radiotherapy. The overall prevalence of OPC was 9.6% (95% confidence interval, 8.4%-11.0%] in this population. It was most frequent in patients treated with combined chemoradiotherapy (22.0%) or with more than two cytotoxic agents (16.9%). Local antifungal treatments were prescribed in 75.0% of OPC patients as recommended by guidelines. The compliance to treatment was higher in patients receiving once-daily miconazole mucoadhesive buccal tablet (MBT; 88.2%) than in those treated with several daily mouthwashes of amphotericin B (40%) or nystatin (18.8%). CONCLUSION: OPC prevalence in treated cancer patients was high. Local treatments were usually prescribed as per guidelines. Compliance to local treatments was better with once-daily drugs.

[Risks of irradiation in hepatogastroenterology]. / Risques de l'irradiation en hépato-gastro-entérologie.

The side effects of ionizing radiation are real and we now have very extensive data about them. It is increasingly important to take them into account in medical practice, especially in view of the increased number of diagnostic procedures that involve irradiation, such as computed tomography (CT), and more specifically in hepatogastroenterology, in virtual colonoscopy. There are two types of risks associated with ionizing radiation: a direct deterministic risk and a random, or stochastic, risk. The deterministic risk appears inevitably above a given threshold, which depends on the effect and tissue considered. Its severity increase with the dose. Only the high doses delivered in radiation therapy and in interventional radiology expose patients to these effects. The stochastic risk may occur after any irradiation regardless of dose and is analyzed in terms of probability. Its severity is independent of the dose. It includes three complications: induction of secondary cancers, increased risk of malformations, and genetic risks. The evaluation of these risks has been determined on the basis of observations of very high doses at high dose rates. There remain numerous questions about the extrapolation of these data to very low doses at very low dose rates, such as those received during conventional radiology examinations. The precautionary principle requires that the most harmful hypothesis be applied for setting a linear no-threshold relation between received dose and risk of complication. In practice, irradiating examinations must be justified, optimized, and limited.