XXIIe Congrès de la Société Française de Psycho-Oncologie

PROGRAMME

XXII^e Congrès de la Société Fran?aise de Psycho-Oncologie 1^er-2 décembre 2005—Lille Cancers, Croyances & Spiritualités     

L’intégration de la psycho-oncologie dans les formations en cancérologie. Les recommandations de la Société Française de Psycho-Oncologie (SFPO)

As a result of medical progress in cancer treatments, psychosocial care-related aspects also need to be further developed in order to answer growing requests of patients and their families, as well as to deal with oncological healthcare teams greater expectations from mental health specialists. Improving knowledge in psycho-oncology practice among all professionals working in onco-hematology can help to bridge this gap, and this goal can be achieved through the implementation of training. With this aim, the 30th Congress of the SFPO brought together a multidisciplinary expert group for defining psycho-oncology training guidelines based on professional expertise and analysis of literature. All healthcare professionals working in oncological settings are concerned — psychologists, psychiatrists, doctors and nurses; however, each professional has their unique duties, and training can help to identify and clarify their specific role in psychosocial care. Training has to include the specific issues of multidisciplinarity and to be both initial and continuous. For instance a solid training in psychopathology is revealed as a main requirement for psychologists, enabling delivery of well-structured psychological interventions regardless of the specific aspects of each situation. Keeping an up-to-date information level concerning the progress made in cancer treatments is also stressed by these guidelines and so it is the adjustment to the multiple constraints of cancer care organization in order to make psychological care available for all the patients. Training of psychologists and psychiatrists should assure four main axes: clinical practice, institutional work, teaching and research. These guidelines also establish recommendations for training of other healthcare professionals, more precisely about communication skills and screening for patients’ psychosocial needs, distress and vulnerability.     

Arrêt de la commercialisation des fils d’iridium 192 en France : proposition du groupe de curiethérapie de la Société française de radiothérapie oncologique

In 2014, the production of iridium 192 wires in France ended. Thus brachytherapy departments had to move to high-dose rate and pulsed-dose rate afterloading techniques. Most of them had already made this migration for some indications, based on the habits and investments. The brachytherapy group organised meetings and opened discussions to share the clinical knowledge and answer to the questions raised by this migration. This made it possible to resolve and describe quite all the clinical and technical cases of brachytherapy. The development of high technology included the use of 3D dosimetry and optimisation of dose distribution and fractionation. The teaching policy of new technologies contributes to the improvement of treatment quality. Last but not least, a better reimbursement of brachytherapy is necessary and currently negotiated.     

Expérience française de l’irradiation corporelle totale en pédiatrie : étude du comité de radiothérapie de la Société française des cancers de l’enfant (SFCE)

A survey was conducted in 2015 in France on the care of children in radiotherapy services. We present the results for total body irradiation in children, a specific technique of radiation treatment, which needs dedicated controls for this particular population. Of the 17 centres interviewed, 16 responded, and 13 practiced total body irradiation. Patients are positioned in lateral decubitus in 11 centres and supine/prone in two centres. Doses used for total body irradiation in myeloablative bone marrow transplantation are the same in all centres (12 Gy); treatments are always fractionated. Lung shielding is positioned to limit the dose at an average of 8 Gy with extremes ranging from 6 to 10 Gy. The shape of the shieldings varies depending on departments’ protocol, with a smaller size in case of mediastinal mass. Four centres have experience of total body irradiation under general anaesthesia, despite twice-daily fractions. In total, practice is relatively homogeneous throughout France and is inspired by the knowledge obtained in adults.     

Curiethérapie en France en 2020 : synthèse et perspectives du Groupe curiethérapie de la Société française de radiothérapie oncologique

Because of its principle and its high proof level clinical results, brachytherapy represents a specific irradiation technique for the treatment of primary tumors as well as some local relapses in pre-irradiated area. After a glory period between the 80's and 90's, brachytherapy has progressively lost its attractiveness. In order to provide a practical solution to this deleterious situation, it is important that guardianships, health care payers, patient associations, specialist doctors and radiation oncologists understand the reasons leading to this harmful state as well as the risks concerned. A teaching judged insufficient, non-adapted value and an aging image of brachytherapy represent the three main reasons of this degradation and constitute the three most important challenges conditioning its maintain in the anticancer treatment arsenal. An adapted communication with radiation oncologists themselves but also with the other scientific societies remains crucial as well as with guardianship and patient associations. It is central that brachytherapy could be recognized in order to make it stronger and accessible for all the patients who could need it.     

Rapport de la mission confiée par le ministère de la Santé à la Société française de radiothérapie oncologique

Further to the Epinal events, Health Ministers P. Bas then R. Bachelot-Narquin have launched a plan of work devoted to radiotherapy; they have also committed the SFRO President, within the framework of a mission, to make proposals taking into account the demography of professionals and their level of competence, valorization of careers, cooperation with medical oncologists, delegations of authorities, mutualisation of human and material resources. Due to the numerous actions of the roadmap managed by the tutelages, the aim of the mission was focused on the modalities of work of the professionals linked to radiotherapy: radiation oncologists, radiographers and physicists.     

Organisation française de la radiothérapie pédiatrique : résultats d’une enquête du comité radiothérapie de la Société française des cancers de l’enfant (SFCE)

PurposeRadiotherapy is a rare indication in paediatric oncology, with 800 to 900 children in treatment per year in France. Child cancers represent approximately 1% of cancers in France and half occur before the age of 5 years. Paediatric radiation requires appropriate tools, local, time and specific training. In France, in 2015, 18 centres are accredited by the French National Cancer Institute (INCa) for this activity.Material and methodsSurvey conducted in February 2015 on the care of children (0 to 18 years) in radiotherapy departments in France. The survey was sent to the radiation oncologists involved in the 18 centres. The questions concerned the qualitative and quantitative aspect, medical and organizational aspects, and the involvement of assistant practitioners in the management of this activity.ResultsSeventeen centres responded. In 2014, 889 children under 18 were treated in radiotherapy departments. These departments are working together with one to four paediatric oncology departments. Regarding access to general anaesthesia: three centres perform one to seven treatment(s) under anaesthesia per year, three centres eight to ten treatments under anaesthesia per year, three centres ten to 24 treatments under anaesthesia per year and nine centres out of 17 use hypnosis techniques. In terms of human resources, in 2015, 29 radiation therapists have a paediatric radiotherapy activity. Involvement of assistant practitioners is growing and specific training are desired. Regarding treatment preparation and delivery, 13 centres have specific paediatric contentions, 14 of 16 centres employ radiation intensity modulated if dosimetry is more satisfying with 11 regularly to the craniospinal irradiation. Radiotherapy on moving areas with respiratory gating or hypofractionation is under developed.ConclusionPaediatric radiation therapy is a specific activity requiring a dedicated management, both in human, organizational, medical and scientific aspects.     

Combined treatment modality for intracranial germinomas: results of a multicentre SFOP experience. Société Française d'Oncologie Pédiatrique

Conventional therapy for intracranial germinomas is craniospinal irradiation. In 1990, the Société Fran?aise d'Oncologie Pédiatrique initiated a study combining chemotherapy (alternating courses of etoposide-carboplatin and etoposide-ifosfamide for a recommended total of four courses) with 40 Gy local irradiation for patients with localized germinomas. Metastatic patients were allocated to receive low-dose craniospinal radiotherapy. Fifty-seven patients were enrolled between 1990 and 1996. Forty-seven had biopsy-proven germinoma. Biopsy was not performed in ten patients (four had diagnostic tumour markers and in six the neurosurgeon felt biopsy was contraindicated). Fifty-one patients had localized disease, and six leptomeningeal dissemination. Seven patients had bifocal tumour. All but one patient received at least four courses of chemotherapy. Toxicity was mainly haematological. Patients with diabetus insipidus (n = 25) commonly developed electrolyte disturbances during chemotherapy. No patient developed tumour progression during chemotherapy. Fifty patients received local radiotherapy with a median dose of 40 Gy to the initial tumour volume. Six metastatic patients, and one patient with localized disease who stopped chemotherapy due to severe toxicity, received craniospinal radiotherapy. The median follow-up for the group was 42 months. Four patients relapsed 9, 10, 38 and 57 months after diagnosis. Three achieved second complete remission following salvage treatment with chemotherapy alone or chemo-radiotherapy. The estimated 3-year survival probability is 98% (CI: 86.6-99.7%) and the estimated 3-year event-free survival is 96.4% (CI: 86.2-99.1%). This study shows that excellent survival rates can be achieved by combining chemotherapy and local radiotherapy in patients with non-metastatic intracranial germinomas.     

La radiothérapie stéréotaxique peut-elle remplacer la curiethérapie pour les cancers du col utérin localement évolués ? Positionnement de la Société française de radiothérapie oncologique

Brachytherapy is part of the treatment of locally advanced cervical cancers, accounting for about half of the total delivered dose. The benefit of dose escalation is the most important in advanced cases or if the tumor has responded poorly. The use of interstitial implantations makes it possible to reach doses of the order of 85 to 90 Gy (including external beam radiotherapy contribution) in most patients, through image-guided approaches. Brachytherapy delivery is one of the quality criteria for patient care. To date, no data allow us to consider as an alternative the use of external boost through intensity-modulated or stereotactic body radiotherapy. Indeed, the doses delivered to the tumor and the capacity to spare normal tissues remains lower, as compared to what is permitted by brachytherapy. It is therefore appropriate for centers that do not have access to the technique to establish networks with centers where brachytherapy is performed, to allow each patient to have access to the technique. It is also necessary to promote brachytherapy teaching. The issue of reimbursement will be crucial in the coming years to maintain expertise that is today insufficiently valued in its financial aspects, but has a very high added value for patients.     

Tumeurs rares en pédiatrie : particularités épidémiologiques et organisation de leur prise en charge dans le cadre de la Société française des cancers et des leucémies de l'enfant et de l'adolescent (SFCE)

Less than 1% of cancer occurs in children. With the progress made by national and international cooperative groups 75% of them are actually cured. However some entities have an incidence so weak that we can't actually establish standardized therapeutics guidelines. To improve our knowledge on these rare tumours a national organisation become necessary as well as an international collaboration. A French rare tumour committee was created within the French Society for Children Cancer (SFCE). Others European countries have such organisation. The objectives of these tasks groups are to enhance our knowledge of the real incidence of these rare tumours, their evolution, and to propose therapeutic recommendations for each of them. This article focuses on the specific French organization for rare tumours treatment. It also describes the draft for the creation of a new data base for prospective registry of clinical, therapeutics and follow up data. To provide a better understanding of these pathologies, the “Bulletin du Cancer's” editorial board decided to regularly publish an update on a rare paediatric tumour in a specific section.