[Are extensive fields useful for radiotherapy of esophageal cancer?]. / Des marges extensives sont-elles nécessaires pour la radiothérapie du cancer de l'œsophage ?

PURPOSE: Study of the pattern of relapse for locally advanced oesophageal cancer and analysis of the local recurrences according to irradiated volume. PATIENTS AND METHODS: We performed a monocentric retrospective study of patients treated in the integrated centre of oncology (Angers, France). Two treatment strategies were used: concurrent chemoradiation alone or followed by surgery. Recurrences were classified as: locoregional, either isolated or associated with distant metastasis, and metastatic only. Locoregional relapses were subclassified as in-field, out-field, or mixed. RESULTS: Between March 2004 and October 2011, 168 patients were treated: 130 by chemoradiation, and 38 by chemoradiation followed by surgery. The median supero-inferior margins added to the gross tumour volume in order to create the planning tumour volume was 5cm (range: 0.5-21). Sixty-two percent of patients (n=104) relapsed: 82 locoregional relapses (49%), including 45 isolated relapses (27%) and 37 associated with distant metastasis relapses (22%), and 22 metastatic relapses (13%). From the 82 locoregional relapses, only four isolated relapses were exclusively out-field. CONCLUSION: With 5cm supero-inferior margins added to gross tumour volume, less than 3% of patients had an isolated out-field recurrence. However, half of the patients suffered in-field local recurrence and one third had metastases. These findings advocate for a limited prophylactic nodal irradiation. Trials are ongoing to assess dose escalation or surgery in order to increase local control.

[Cerebral monitoring with somatosensory evoked potentials in carotid surgery. A review of 141 carotids]. / Monitorage cérébral par potentiels évoqués somesthésiques en chirurgie carotidienne. A propos d'une série de 141 carotides opérées.

OBJECTIVE: To evaluate postoperative and mid-term results of carotid surgery (CS) with somatosensory evoked potentials (SEP) monitoring. METHODS: Between 1998 and 2006, 141 CS in 124 patients were performed under general anesthesia. Selective shunting was based on SEP abnormality. Shunting criteria were: reduction up to 50% of the amplitude or latency increasing up to 10%. Early results and follow-up data are analyzed retrospectively. RESULTS: Shunting rate was 6%, 3 strokes (two transient strokes) occurred and one patient died of perioperative myocardial ischemia. The cumulative stroke and death rate at 30 days was 1.4%. CONCLUSIONS: Intra-operative SEP monitoring with selective shunting may be safely performed in carotid surgery.

[Malignant hereditary paraganglioma: problems raised by non-functional forms management]. / Paragangliomes malins héréditaires: problèmes liés à la prise en charge des formes non sécrétantes.

Non-functional paraganglioma have not clinical or biological characteristics, so that the diagnostic is most of the time delayed and made on the occasion of advanced abdominal tumor or symptomatic metastasis management. Hereditary forms, notably those with SDHB mutation, seem to have a poor prognosis. On the other hand, and on the oposite to sporadic forms, they are the only ones to benefit from genetic testing which make possible, if positive, an earlier diagnostic, before apparition of symptoms, recurrence or metastasis. We report a case of non-functional malignant hereditary paraganglioma diagnosed belatedly and we will consider management problems raised by non-functional forms.

Necrotizing pancreatitis after radiofrequency destruction of pancreatic tumours.

BACKGROUND: Intraoperative radiofrequency (RF) can be used to treat multiple small pancreatic tumours. PATIENTS AND METHODS: Two patients with multiple pancreatic metastases from renal cancer were treated with RF destruction of the pancreatic tumours. The first was treated with a monopolar device and the second with a bipolar device. A high temperature (>90 degrees C) was used, and one patient underwent cooling of the intrapancreatic common bile duct. RESULTS: The destruction of tumours was effective. However, the two patients presented post-operatively a severe necrotizing pancreatitis, with life-threatening hemorrhagic complications. CONCLUSION: RF destruction of pancreatic tumours is dangerous with current devices.