[Radiation-induced sarcoma of the head and neck]. / Sarcomes radio-induits de la tête et du cou.

INTRODUCTION: Radiation-induced sarcoma (RIS) of the head and neck is a late and rare complication of cancer treatment by radiation therapy. It occurs mostly within the limits of the irradiated area. Its incidence is increasing and related to an improved survival rate of treated patients. But it does not rule out the use of radiotherapy in the treatment of this cancer. OBSERVATION: We report two cases of sarcoma having appeared in the irradiated area, in patients treated by adjuvant radiotherapy for head and neck neoplasm. DISCUSSION: The prognosis for this sarcoma depends mainly on how early the diagnosis is made and the quality of surgical resection. Adjuvant chemotherapy or radiotherapy can be considered. Ongoing research on the expression of RIS genes could soon lead to new treatments.

[Treatment of primary disease (breast, non-small cell lung and prostate cancers) with irradiation in case of de novo metastatic cancer]. / Traitement de la maladie primitive (cancers du sein, du poumon non à petites cellules et de la prostate), par irradiation, au stade d'emblée métastatique.

The basis of treatment of primary disease in case of metastatic cancer at diagnosis is based on the knowledge of the natural history of the disease, the biology of the primary tumour and its metastases, advances in modern radiotherapy techniques (modulated intensity, stereotactic radiotherapy) in order to improve the survival of patients with advanced disease. The clinical concept of oligometastatic disease at diagnosis has repositioned the interest of local treatment for primitive disease because these patients have a slower evolutionary profile than metastatic disease extended from the outset. This article reviews the indication of radiotherapy as a local treatment for primary cancer in a de novo metastatic diagnosed disease in the case of breast cancer, non-small cell lung cancer and prostate cancer.

Radiotherapy of pituitary adenomas: state of the art.

Pituitary adenomas represent approximately 12% of intracranial tumors. They are defined as tumors that are functional or nonfunctional and invasive or noninvasive. Therapeutic strategies rely on surgery, medical treatment, and radiotherapy depending on histology. Neither the role of external radiotherapy nor the technique to be used are firmly established. Nonfunctioning adenomas must be operated on to relieve the compression. Prolactin-secreting adenomas are first treated with dopamine agonists, and GH-secreting adenomas are first treated by surgery if excising the complete tumor is possible; otherwise medical treatment is started. The first-line treatment of ACTH-secreting adenomas is surgery; however, in many cases, insufficient control of either secretion or tumoral volume leads to consideration of irradiation. Complications of conventional radiotherapy are well known and fractionated stereotactic radiotherapy appears to be as safe as radiosurgery. The volume to irradiate is still difficult to define, and this parameter can influence the technique chosen for treatment. Because the indications of radiotherapy are still debated, irradiation of pituitary adenomas must be decided by the complete team of endocrinologists, neurosurgeons, radiologists and radiotherapists.