Stereotactic body radiation therapy for liver metastases in oligometastatic disease.

Oligometastatic cancers designate cancers in which the number of metastases is less than five, corresponding to a particular biological entity whose prognosis is situated between a localized and metastatic disease. The liver is one of the main sites of metastases. When patients are not suitable for surgery, stereotactic body radiotherapy provides high local control rate, although these data come mainly from retrospective studies, with no phase III study results. The need for a high therapeutic dose (biologically effective dose greater than 100Gy) while respecting the constraints on the organs at risk, and the management of respiratory movements require expertise and sufficient technical prerequisites. The emergence of new techniques such as MRI-guided radiotherapy could further increase the effectiveness of stereotactic radiotherapy of liver metastases, and thus improve the prognosis of these oligometastatic cancers.

Radiation therapy of the primary tumour and/or metastases of digestive metastatic cancers.

Metastatic gastrointestinal cancer is not an uncommon situation, especially for pancreatic, gastric, and colorectal cancers. In this setting, few data are available on the impact of the treatment of the primary tumour. Oligometastatic disease is associated with longer survival in comparison with more advanced disease. Metastasis-directed therapy, such as stereotactic body radiotherapy, seems related to better outcomes, but the level of evidence is low. In most tumour locations, prospective data are very scarce and inclusion in ongoing trials is strongly recommended.

Image-guided radiotherapy.

We present the updated recommendations of the French society for oncological radiotherapy on image-guided radiotherapy (IGRT). The objective of the IGRT is to take into account the anatomical variations of the target volume occurring between or during the irradiation fractions, such as displacements and/or deformations, so that the delivered dose corresponds to the planned dose. This article presents the different IGRT devices, their use and quality control, and quantify the possible additional dose generated by each of them. The practical implementation of IGRT in various tumour locations is summarised, from the different "RecoRad™" guideline articles. Adaptive radiotherapy is then detailed, due to its complexity and its probable development in the next years. The place of radiation technologist in the practice of IGRT is then specified. Finally, a brief update is proposed on the delicate question of the additional dose linked to the in-room imaging, which must be estimated and documented at a minimum, as long as it is difficult to integrate it into the calculation of the dose distribution.

[Adaptive radiotherapy: Strategies and benefits depending on tumor localization]. / Radiothérapie adaptative : stratégies et bénéfices selon les localisations tumorales.

Adaptive radiotherapy (ART) is a complexe image-guided radiotherapy modality that comprises multiple planning to account for anatomical variations occurring during irradiation. Schematically, two strategies of RTA can be distinguished and combined according to tumor locations. One or more replanning can be proposed to correct systematic variations such as tumor shrinkage. A library of treatment plans with day-to-day plan selection from cone-beam CT imaging can also be proposed to correct random variations such as uterine motion or bladder/rectum volume changes. Because of strong anatomical variations occurring during irradiation, RTA appears therefore particularly justified in head and neck, lung, bladder, cervical and rectum and pancreas tumors, and to a lesser extent for prostate tumors and other digestive tumors. For these tumor locations, ART provides a fairly clear dosimetric benefit but a clinical benefit not yet formally demonstrated. ART cannot be proposed in a routine practice but must be evaluated medico-economically in the context of prospective trials. A rigorous quality control must be associated.

[Dose constraints to organs at risk for conformational and stereotactic radiotherapy: Small bowel and duodenum]. / Contraintes de doses aux organes à risque en radiothérapie conformationnelle et stéréotaxique : intestin grêle et duodénum.

Radiotherapy of abdominopelvic primary or secondary lesions in conformational or stereotactic techniques is in full development. The small bowel is highly sensitive to irradiation and is the main organ at risk limiting prescription doses. This literature review aims to define the dose constraints to the small bowel and the duodenum in conformational and stereotactic body radiotherapy. The small bowel including the duodenum, jejunum and ileum is delineated on the simulation scanner. The radio-induced intestinal toxicities are acute related to the cellular depopulation of the intestinal mucosa, and late of more complex pathophysiology associating depletion in stem cells, microangiopathy, chronic inflammation and fibrosis. The main predictive factor of intestinal toxicity is the dose-volume ratio. In conformational radiotherapy, the dose constraints to the duodenum are: V25Gy<45% and V35Gy<20%. The jejunum and ileum dose constraints are for delineation by intestinal loop or peritoneal cavity respectively: V15Gy<275mL or V15Gy<830mL and V45Gy<150mL. In stereotactic body radiotherapy, small bowel dose constraints depend on fractionation and are defined on a small volume and on a maximum dose at one point. Intestinal toxicity is also dependent on factors intrinsic to the patient and radiosensitizers such as targeted therapies or chemotherapies. With the development of new techniques allowing dose escalation on the tumour and the development of inverse planning, the definition of dose constraints to the small bowel is essential for current practice.

Predicting depression with temperament and character in lung cancer patients.

Depression is highly prevalent in cancer patients. Variations in intensity and frequency of depression in cancer patients may be attributed, in part, to differences in personality dimensions. Our aim was to asses if dimensions of temperament and character could predict depression in lung cancer patients. Ninety newly diagnosed non-small cell lung cancer patients were assessed in the oncology unit with the Centre for Epidemiologic Studies Depression Scale (CES-D), pain subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30 and the Temperament and Character Inventory (TCI). Fifty out of 90 patients (55.6%) fulfilled the cut-off criteria for depression on the CES-D scale. Logistic regression performed to assess if depression was predicted by personality dimensions, revealed dimension of temperament Harm Avoidance and pain as significant predictors of depression. Depressive reactions are highly prevalent in lung cancer patients and related to patients' personality. These findings may be helpful in planning preventive, as well as psychoeducational and treatment programmes for newly diagnosed, and depression prone patients.

Mesiodistal size of deciduous teeth in subjects with unilateral cleft lip and palate.

The aim of this study was to investigate whether there was an association between presence of a cleft and reduced size of deciduous tooth on the cleft side. In this investigation, 58 study models of patients with unilateral cleft lip and palate with deciduous dentition were analyzed. The largest mesiodistal dimension of deciduous teeth was measured by a sliding caliper. The size of the same teeth on the side of the cleft and on the non-cleft side was compared. The results of the investigation were statistically analyzed. A difference between the genders was found. In the sample of boys the lateral deciduous incisor and the second deciduous molars on the cleft side were smaller than those on the non-cleft side, while in girls the central and lateral deciduous incisors were smaller on the cleft side than on the non-cleft side. It was concluded that the presence of a unilateral cleft lip and palate was associated with smaller tooth size.

[Craniofacial characteristics of children affected with juvenile rheumatoid arthritis]. / Kraniofacijalne karakteristike dece obolele od juvenilnog reumatoidnog artritisa.

The aim of this investigation was to determine the craniofacial characteristics of children affected with juvenile rheumatoid arthritis. The analysis concerned the profile cephalometric roentgenograms of 11 children of both sexes aged between five and ten years. Statistically significant differences between affected and healthy children were found for saddle angle, articular angle, Björk's sum of posterior angles and maxillo-mandibular angle.

[Craniofacial dimensions and growth. Longitudinal study]. / Kraniofacijalne dimenzije i rast. Longitudinalno ispitivanje.

On a sample od 13 children of both sexes, aged 5-7 years, the longitudinal investigation of eight angular and five linear dimensions was carried out. Lateral cephalometric roentgenograms were used for the analyses. It was found that during the investigated period maxillary and mandibularly prognathism increased, maxillary plane inclination increased, and mandibular plane inclination decreased. None of the examined angular measurements showed a statistically significant difference in the age between five and seven year. All linear measurements increased with the age and grown. Statistically significant differences were found only for maxillary base length and upper face height.

An extra X chromosome effect on craniofacial morphogenesis in men.

A comparative study of the craniofacial complex in men with an extra X chromosome, and normal male and female individuals was carried out using cephalometric radiography. The anterior cranial base, anterior and posterior facial height, maxillary base and ascending ramus were found to be significantly decreased in men with Klinefelter syndrome when compared to the male control group. Significant differences in the lengths of mandibular base and posterior cranial base were not found. When compared to the female control, all structures examined were significantly increased, except for the maxillary base.

[Variations of sagittal skeletal relationships in cases with normal occlusion]. / Analiza sagitalnih skeletnih odnosa kod osoba sa normalnom okluzijom.

Cephalometric radiographs of a sample of 92 cases with normal occlusion were used to study variations in the sagittal jaw relationship. The Schwarz's and Steiner's cephalometric methods of analysis were employed. Results obtained by the Schwarz's method showed that 58.7% of cases had Class I, 16.3% Class II and 25% Class III skeletal relationship. On the other hand, the Steiner's method demonstrated Class I skeletal relationship in 59.8% cases, Class II skeletal relationship in 8.7% of cases and Class III skeletal relationship in 31.5% of cases. Both cephalometric methods indicated Class I skeletal relationship in 39.1% of all cases investigated. In addition, both methods showed the same skeletal relationship (Class I, Class II or Class III) in 58.6% of all cases investigated.

[Growth changes of some craniofacial dimensions]. / Promene nekih kraniofacijalnih promera tokom rasta.

A longitudinal investigation was done on the sample of 14 children, both sexes between seven and ten years of age. Lateral cephalometric roentgenograms, taken once a year under the same conditions, were used for this analysis. It was found that SNA angle decreased, and SNB angle increased during the growth period investigated. The maxillary plane inclination increased and the mandibular plane inclination decreased during this period. According to the Björk's poligon analyses anterior growth rotation was found. All the linear measurements investigated increased with the age, but statistically significant difference was found only for the length of maxillary base and the upper face height.