[Is proton beam therapy the future of radiotherapy? Part I: clinical aspects]. / La protonthérapie: avenir de la radiothérapie? Première partie: aspects cliniques.

Proton beam therapy uses positively charged particles, protons, whose physical properties improve dose-distribution (Bragg peak characterized by a sharp distal and lateral penumbra) compared with conventional photon-based radiation therapy (X-ray). These ballistic advantages apply to the treatment of deep-sited tumours located close to critical structures and requiring high-dose levels. [60-250 MeV] proton-beam therapy is now widely accepted as the "gold standard" in specific indications in adults--ocular melanoma, chordoma and chondrosarcoma of the base of skull --and is regarded as a highly promising treatment modality in the treatment of paediatric malignancies (brain tumours, sarcomas…). This includes the relative sparing of surrounding normal organs from low and mid-doses that can cause deleterious side-effects such as radiation-induced secondary malignancies. Other clinical studies are currently testing proton beam in dose-escalation evaluations, in prostate, lung, hepatocellular cancers, etc. Clinical validation of these new indications appears necessary. To date, over 60,000 patients worldwide have received part or all of their radiation therapy program by proton beams, in approximately 30 treatment facilities.

Why do residents choose the medical oncology specialty? Implications for future recruitment--results of the 2007 French Association of Residents in Oncology (AERIO) Survey.

BACKGROUND: The aim of this study was to analyze demography, motivation behind the choice of the medical oncology specialty, career plans, and the quality of training in medical oncology and to provide guidance to candidates for boosting the number of oncologists. METHODS: In 2007, the French Association of Residents in Oncology conducted a nationwide study of all medical oncology residents in France. RESULTS: The strongest factors that had influenced their decision to become a medical oncology specialist were an interest in medical oncology (98%), exposure to this branch of medicine during graduate training as a medical student (83%), interest in research (81%), and the diversity of the activity (75%). The mean score for the quality of training was 6 (0-10). More time for reading during working hours as well as for attending staff meetings and greater availability of teaching oncologists would improve the quality of training. The most popular career choice was working in a public hospital but most residents stated that they had not received adequate information about the different career plans. CONCLUSIONS: No data are available regarding how training in medical oncology is perceived. This study provides useful data for future policies to boost the number of oncologists.

[Proton beam therapy in pediatric radiotherapy]. / La protonthérapie en radiothérapie pédiatrique.

Pediatric tumors still represent a formidable challenge despite the considerable therapeutical advances that have been reported for the past 30 years. This is largely related with the untowards side-effects of local therapy that are still acknowledged as the "price for cure". In this setting, Proton therapy a sophisticated radiotherapeutical modality seems to represent a real breakthrough due to its unique ability to spare close and distant normal organs compared with modern photons techniques. We summarize in this paper current clinical and dosimetrical evidences including an update of the Orsay series on 108 children.