Complementary and alternative medicine use in glioma patients in France.

PURPOSE: Complementary and alternative medicine (CAM) use increases in cancer patients, including adult patients with diffuse gliomas. METHODS: Questionnaires addressing CAM use were distributed to adult patients with gliomas of WHO grades II-IV and ECOG performance score of 0-2 during hospital visits and filled in anonymously. The study was conducted in nine centers in France from May 2017 to May 2018. Descriptive cohort analyses and comparative analyses according to gender, age, WHO grade, and recurrent versus newly diagnosed disease were conducted. RESULTS: Two hundred twenty-seven questionnaires were collected; 135 patients (59%) were male. Median age was 48 years, 105 patients (46%) declared having glioblastoma, 99 patients (43%) declared having recurrent disease. Hundred-three patients (45%) had modified their alimentary habits after the glioma diagnosis. At the time of the questionnaire, 100 patients (44%) were on complementary treatment, mainly vitamins and food supplements, and 73 patients (32%) used alternative medicine approaches, mainly magnetism and acupuncture. In total, 154 patients (68%) declared using at least one of these approaches. Expenditures exceeding 100 € per month were reported by users in 14% for modification of alimentary habits, in 25% for complementary treatment, and in 18% for alternative medicines. All approaches were commonly considered as improving quality of life and experienced as efficient, notably those associated with more expenditures. CONCLUSIONS: CAM are frequently used by glioma patients in France. Underlying needs and expectations, as well as potential interactions with tumor-specific treatments, and financial and quality of life burden, should be discussed with patients and caregivers.

Helical tomotherapy of spinal chordomas: French Multicentric, retrospective study of a cohort of 30 cases.

PURPOSE: To evaluate the efficacy and toxicity of helical tomotherapy (HT) in the management of spine chordomas when proton therapy is unavailable or non-feasible. METHODS AND MATERIALS: Between 2007 and 2013, 30 patients with biopsy-proven chordomas were treated by HT in five French institutions. Information regarding local control (LC), overall survival (OS), progression-free survival (PFS) and metastasis-free survival (MFS) was collected. Clinical efficacy, toxicity and treatment quality were evaluated. RESULTS: Two-year actuarial LC, OS, PFS and MFS were 69.9%, 96.7%, 61.2% and 76.4%, respectively. HT treatments were well tolerated and no Grade 4-5 toxicities were observed. HT permitted the delivery of a mean dose of 68 Gy while respecting organ at risk (OAR) dose constraints, in particular in the spinal cord and cauda equina. CONCLUSIONS: This multicentric, retrospective study demonstrated the feasibility of HT in the treatment of spine chordomas, in the absence of hadron therapy.

Management of neoplastic spinal tumors in a spine surgery care unit.

BACKGROUND CONTEXT: Spinal cord compression and fracture are possible complications of spine metastasis and multiple myeloma. Prompt diagnosis and treatment of threatening lesions are likely to reduce the frequency of these dreaded complications. PURPOSE: To evaluate the proportion of neoplastic spine lesions operated on emergency. STUDY DESIGN: Retrospective study. PATIENT SAMPLE: All patients who underwent palliative surgery for the treatment of a neoplastic spine lesion in our institution between 2005 and 2012. OUTCOME MEASURES: Percentage of patients who underwent surgery as an emergency for acute fracture or rapid neurological decline. METHODS: We retrospectively reviewed the data of all patients who underwent palliative surgery for the treatment of a neoplastic spine lesion from solid cancer or multiple myeloma, in our institution between January 2005 and December 2012. The study was supported by grant from our institution. RESULTS: A total of 317 patients were included in the study. There were 166 men and 151 women and the mean age was 57.97 years (range 26-88; SD 12.45). The cancer was known for 224 patients, while the lesion revealed the disease for the other 93 patients. The percentage of patients with known cancer operated as an emergency in our institution decreased significantly between 2005 and 2012 (p = 0.0006). CONCLUSION: Due to the variability of clinical and radiological presentations, best care requires a truly multidisciplinary approach, to offer each patient a prompt and individualized treatment option, which is likely to reduce the incidence of emergency surgeries.

Evidence based and new developments in re-irradiation for recurrent or second primary head and neck cancers.

PURPOSE OF REVIEW: The standard treatment for recurrent or second primary head and neck cancers is surgery which can only be performed in 25% of the patients. For inoperable patients, three options can be discussed: supportive care only, chemotherapy or radiotherapy with or without chemotherapy. The goal of this article is to review the indications and new developments in re-irradiation for recurrent or second primary head and neck cancers. RECENT FINDINGS: The le Groupe d'Etude des Tumeurs de la Tête et du Cou (GETTEC)-le Groupe d'Oncologie et de Radiothérapie Tête et Cou (GORTEC) (99-01) trial showed that radio-chemotherapy improved disease-free survival for a highly selected population. All conventional and conformational radiotherapy series showed improved local control and disease-free survival rates, but at the expense of acute and late toxicities demanding a drastic patients selection. New radiotherapy techniques such as intensity modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT) have improved oncological results with reduced toxicities, offering treatments which are spread over six to seven weeks for IMRT and two weeks for SBRT. SUMMARY: Re-irradiation is an attractive alternative treatment for selected inoperable patients and its effectiveness can be potentiated by systemic treatments such as chemotherapy or targeted therapy. The development of new radiotherapy techniques such as IMRT and SBRT has improved healthy tissues tolerance and future studies should help define the specific IMRT and SBRT indications.

[Reirradiation for recurrent or second primary head and neck cancers]. / La radiothérapie en territoire irradié des tumeurs de la tête et du cou.

Recurrences or second primary head and neck cancers meant, for a long time, therapeutic dead ends. Surgery was the standard treatment, but could only be achieved in 25% of the patients. The GETTEC-GORTEC (99-01) randomized trial showed that radiochemotherapy improved disease-free survival for a highly selected population. For inoperable patients, three options can be discussed: supportive care only, chemotherapy or radiotherapy with or without chemotherapy. The EXTREME protocol showed that combining platinum, 5FU and cetuximab improved overall survival for recurrent or metastatic forms. This is certainly the best option for advanced forms, which are not accessible to radiotherapy. Concerning radiotherapy, only one randomized trial compared chemoradiotherapy to chemotherapy alone using methotrexate. The overall survival, the main objective in this study, was not improved, however, the enrollment was incomplete and included many advanced stage tumors. Other articles are based on Vokes' initial work of radiochemotherapy delivered in split-course over a period of 11 weeks. All conventional and conformational radiotherapy series showed improved local control and disease-free survival rates, but at the expense of acute and late toxicities demanding a drastic patients selection. New radiotherapy techniques such as intensity modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT) have reduced toxicities with a likely oncological results improvement, offering treatments which are spread over six to seven weeks for IMRT and two weeks for SBRT. The better treatment tolerance allows an increasing number of eligible patients. The main future objective will be to define the specific IMRT and SBRT indications.