[Role of local radiotherapy after prostatectomy]. / Indications d'un traitement de radiothérapie locale après prostatectomie radicale.

Different risk factors of biochemical relapse after prostatectomy have been identified: extra-capsular extension, seminal vesicle invasion and/or involved surgical margin. There is enough evidence in the literature that post-operative adjuvant radiation therapy can improve five and ten years local control rate, disease free survival and metastasis-free survival. Nevertheless, radiotherapy treatment is linked to a low risk of low grade toxicity and only 20-40% of biochemical relapse are observed after prostatectomy even if there is one involved surgical margin. So, it could be reasonable to propose a close monitoring of the PSA ("Prostate Specific Antigen") and adjuvant radiotherapy once the PSA is superior to 0 ng/ml. Rising PSA superior to 0.2 ng/ml after radical prostatectomy, corresponding to biochemical recurrence, is defined as a local relapse when the biochemical relapse is late and the PSA doubling time is superior to 6 months. Then, salvage radiotherapy is effective and has to be proposed taking the age of the patient, his comorbidities and his desires in consideration.

[What is the standard treatment approach for a cervical lymph node metastasis from a squamous cell carcinoma of unknown origin?]. / Exploration et traitement d'un carcinome épidermoïde ganglionnaire cervical sans primitif décelé.

The diagnostic work-up of cervical lymph node metastases from an occult primary tumour in the head and neck region is well established. PET-scan, which was controversial, is nowadays an integral part of it. Common therapeutic strategies include neck dissection followed by extensive irradiation of pharyngeal mucosa and bilateral lymph node areas. Chemotherapy is often added to these treatment modalities, especially if negative prognostic factors are present on the pathological specimen. However, its therapeutic benefit is not yet proven. There are numerous phase II studies available in the literature, sometimes with controversial conclusions. Therefore, as long as there are no data issued from randomized controlled trials, the treatment decisions are copied from the ones which are used when the primary tumour is well identified in the head and neck area.

[Conservative treatments for infiltrating bladder cancer]. / Traitement conservateur des cancers infiltrants de la vessie.

Bladder cancer is the 9th most frequent cancer, and the 2nd most frequent cancer in the elderly, just after prostate cancer. Cystectomy is the treatment of choice for infiltrating bladder cancer. However, it generates multiple complications and a worsening of the quality of life, especially in the elderly who suffer from many comorbidities. The aim of this article is to to review the various conservative treatments of bladder cancer and determine in which patient they are indicated. The trimodal approach (transurethral resection and concomitant radio-chemotherapy) and the partial cystectomy preceded by radio-chemotherapy are of particular interest.

[Clinical case of the month. The role of radiotherapy for the treatment of advanced squamous cell carcinoma of the vulva. Case report and review of the literature]. / Place de la radiothérapie dans le traitement des carcinomes épidermoïdes vulvaires. A propos d'un cas et revue de la littérature.

Locally advanced squamous cell carcinoma of the vulva is treated with concomitant chemoradiotherapy if surgery is too mutilating and/or implies the use of stomy. We report in this paper, the unusual case of a young patient treated successfully with this non-surgical approach.

[Radiotherapy and urogenital Paget disease]. / Le cas clinique du mois: Radiothérapie dans le cadre d'une maladie de Paget touchant la région génitale.

Urogenital Paget disease is usually treated by surgery. However, in case of recurrence or if multilating surgery is foreseen, radiotherapy seems to open a reasonable alternative. We report a successful treatment with radiotherapy in a patient with urogenital Paget's disease.

[Head and neck tumors: standards of care and new approaches]. / Les tumeurs de la sphère ORL: standards de traitement et nouvelles approches en radiothérapie.

We intend to review the general value of radiotherapy in the management of head and neck cancer. Our aim is to define a treatment protocol which is evidence-based and therefore of use in daily clinical practice. There is general agreement on the efficacy of the concomitant schedules combining radiotherapy and chemotherapy, both in the adjuvant setting as well as in the exclusive non-surgical approach. This however does not preclude further research aiming at optimizing the therapeutic index. As far as neoadjuvant chemotherapy is concerned, applied prior to radical local treatment, there are no conclusive data available which allows us to implement this treatment option in routine clinical practice. This approach deserves further investigations and patients should be entered in well designed prospective randomized trials.

[How I treat... An hepatocellular carcinoma: role of selective internal radiation therapy with intra-arterial iodine-131]. / Comment je traite... un hépatocarcinome: apport de la curithérapie interstitielle utilisant le Lipiodol couplé à l'Iode 131.

Hepatocellular carcinoma is a frequent disease, of poor prognosis. Its evolution is often fast and fatal. A majority of patients die within the year following the diagnosis. To date, the surgical resection remains the only treatment considered as curative. However, 80% of the patients are inoperable at the time of the diagnosis. Therefore, the intra-arterial injection (this tumour being hypervascularised) of antitumour agents is an interesting therapeutic option, more particularly the injection of Lipiodol coupled with iodine 131. The present paper describes the conditions when the interstitial curietherapy appears to be a valuable treatment to be considered.