Cancer du canal anal : personnalisation de la dose,du volume et du fractionnement

The conservative treatment of squamous cell carcinoma of anal canal by irradiation is recommended as first indication. Despite its rarity, significant improvements were obtained by retrospective or prospective clinical studies these 20 past years, evaluating concomitant chemotherapy and IMRT. Nevertheless, the individualisation of the treatment, over dose distribution, has poor data available. Fractionation remains classic (1.8-2.0 Gy/Fr), but the optimal dose level remains under discussion. The strategy concerning the volumes and doses for the prophylactic volumes remains under discussion. This paper will describe the data published, and the recommendations of working Groups, and the main options under evaluation. To conclude, today only the absence of gap is recommended, the benefit of a one-step schedule reducing the treatment time, then increasing local control and survival, but personalised schedules remain under investigation.     

Split-course hypofractionated radiotherapy for aged and frail patients with head and neck cancers. A retrospective study of 75 cases

PurposeTo assess the efficacy and the tolerance of a split course hypofractionated (SCH) radiotherapy (RT) protocol in head and neck cancer (HNC) for eldery and/or unfit patients (pts).Patients and methodsPts with HNC treated by SCH-RT in two institutions were included retrospectively. The main SCH RT regimen was two courses of 30 grays (Gy)/10 fractions separated by 2–4 weeks, without any systemic therapy.ResultsBetween February 2012 and January 2019, 75 consecutive patients were analyzed. The median age was 80 years (range: 45.7–98.2) and 53 (70.7%) were men. Sixty-one (81.3%) pts had stage III/IV disease and 54 (72%) had at least two comorbidities. All of them were treated with intensity-modulated radiotherapy. Median follow-up was 10.6 months (range: 3.1–58.3). Local control at 12 and 24 months was 72.8% IC95%[62–85.5] and 51.7% IC95%[38.1–70.1] respectively. Progression free survival (PFS) at 12 and 24 months were 47.7% IC95%[37.4–60.8] and 41% IC95%[15–36.4] respectively, with a median of 11.5 months IC95%[8.9–17]. OS at 12 and 24 months were 60.4% IC95%[50–73.1] and 41% IC95%[30.6–54.9] respectively, with a median of 19.3 months IC95%[11.9–25.8]. Acute and late grade 3 or higher toxicities occurred for 6 (8%) and 3 (4%) pts.ConclusionThe present SCH-RT regimen seems effective, well-tolerated and could represent an alternative to palliative strategies for pts deemed unfit for standard exclusive RT.     

IMRT联合TP方案治疗晚期食管鳞癌的临床疗效及对患者血清MMP2、TIMP2、nm23-H1及不良反应的影响

目的分析调强放射治疗(IMRT)联合TP方案治疗晚期食管鳞癌的临床疗效及对患者血清基质金属蛋白酶2(MMP2)、组织金属蛋白酶抑制剂2(TIMP2)、nm23-H1及不良反应的影响。方法选取晚期食管鳞癌患者80例为研究对象,按随机数字表法将其分为观察组(n=40,采用IMRT联合TP方案化疗)、对照组(n=40,单纯采用IMRT治疗),比较2组临床疗效、治疗前后血清MMP2、TIMP2、nm23-H1表达阳性率、局控率与生存情况及不良反应。结果观察组治疗有效率(85.00%)明显高于对照组(65.00%)(P<0.05)。治疗后2组血清MMP2表达阳性率下降,而TIMP2、nm23-H1表达阳性率上升,且观察组治疗后血清MMP2表达阳性率低于对照组,而TIMP2、nm23-H1表达阳性率高于对照组(P<0.05)。观察组治疗后1年、2年局控率高于对照组,但2组治疗后1年、2年生存率差异无统计学意义(P>0.05)。观察组白细胞减少、放射性食管炎发生率高于对照组(P<0.05),2组其他不良反应发生率差异无统计学意义(P>0.05)。结论晚期食管癌患者采用IMRT联合TP方案治疗可获得较好的疗效,对患者血清MMP2、TIMP2、nm23-H1有明显改善,但可能会较单纯IMRT治疗具有更多不良反应,需加以监测。     

MRI Radiomic Analysis of IMRT-Induced Bladder Wall Changes in Prostate Cancer Patients: A Relationship with Radiation Dose and Toxicity

BackgroundThe main purpose of this study was to assess the structural changes in the bladder wall of prostate cancer patients treated with intensity-modulated radiation therapy using magnetic resonance imaging texture features analysis and to correlate image texture changes with radiation dose and urinary toxicity.MethodsEthical clearance was granted to enroll 33 patients into this study who were treated with intensity-modulated radiation therapy for prostate cancer. All patients underwent two magnetic resonance imagings before and after radiation therapy (RT). A total of 274 radiomic features were extracted from MR-T2W–weighted images. Wilcoxon singed rank-test was performed to assess significance of the change in mean radiomic features post-RT relative to pre-RT values. The relationship between radiation dose and feature changes was assessed and depicted. Cystitis was recorded as urinary toxicity. Area under receiver operating characteristic curve of a logistic regression–based classifier was used to find correlation between radiomic features with significant changes and radiation toxicity.ResultsThirty-three bladder walls were analyzed, with 11 patients developing grade ≥2 urinary toxicity. We showed that radiomic features may predict radiation toxicity and features including S5.0SumVarnc, S2.2SumVarnc, S1.0AngScMom, S0.4SumAverg, and S5. _5InvDfMom with area under receiver operating characteristic curve 0.75, 0.69, 0.65, 0.63, and 0.62 had highest correlation with toxicity, respectively. The results showed that most of the radiomic features were changed with radiation dose.ConclusionFeature changes have a good correlation with radiation dose and radiation-induced urinary toxicity. These radiomic features can be identified as being potentially important imaging biomarkers and also assessing mechanisms of radiation-induced bladder injuries.     

Helical Radiotherapy in Early Laryngeal Cancers Could Lead to Excess Local Recurrence: Lessons From a Phase II Prospective Study

AimsA prospective study was conducted to investigate the feasibility and efficacy of carotid-sparing intensity-modulated radiotherapy (CSIMRT) in early glottic cancers (EGC).Materials and methodsEighteen patients underwent CSIMRT using helical tomotherapy to a dose of 55 Gy/20 fractions/4 weeks. Carotid intimal thickness (CIT) at prespecified carotid levels was measured using B-mode ultrasound at 6, 18 and 36 months. Serial changes in CIT were also measured in a control prospective cohort of 18 patients with head and neck cancers receiving bilateral neck nodal radiation over the same time period (54–60 Gy/30 fraction/6 weeks). The outcomes of 18 patients undergoing CSIMRT were compared against a retrospective consecutive cohort of 41 patients with EGC to confirm comparable local control.ResultsNo significant CIT differences were identified between patients undergoing CSIMRT versus the control group. However, four patients in the CSIMRT group had a local recurrence between 8 and 39 months. In all patients the epicentre of the recurrence was noted at the anterior part of the larynx. The 5-year local recurrence-free survival was 75.1% (95% confidence interval 56.6–99.7%). By contrast, in the group of EGC patients treated without carotid sparing, local recurrence was noted only in a single patient (patient treated with helical tomotherapy) and the 5-year local recurrence-free survival was 97.1% (95% confidence interval 91.8–100%) (Log-rank P = 0.01).ConclusionWe failed to show the safety of CSIMRT using helical tomotherapy in this population of EGC patients. Use of CSIMRT also did not translate into a substantial reduction in CIT until 36 months. Use of CSIMRT using rotational arc techniques such as helical tomotherapy may be associated with a greater risk of local recurrence due to intrafractional motion interplay effects.     

Reduced toxicity with three‐dimensional conformal radiotherapy or intensity‐modulated radiotherapy compared with conventional two‐dimensional radiotherapy for esophageal squamous cell carcinoma: a secondary analysis of data from four prospective clinical trials

We conducted a retrospective analysis to assess the toxicity and long‐term survival of esophageal squamous cell carcinoma patients treated with three‐dimensional conformal radiotherapy (3DCRT) or intensity‐modulated radiotherapy (IMRT) versus conventional two‐dimensional radiotherapy (2DRT). All data in the present study were based on four prospective clinical trials conducted at our institution from 1996 to 2004 and included 308 esophageal squamous cell carcinoma patients treated with 2DRT or 3DCRT/IMRT. Based on the inclusion and exclusion criteria, 254 patients were included in the analysis. Of these patients, 158 were treated with 2DRT, whereas 96 were treated with 3DCRT/IMRT. The rates of ≥Grade3 acute toxicity of the esophagus and lung were 11.5% versus 28.5% (P = 0.002) and 5.2% versus 10.8% (P = 0.127) in the 3DCRT/IMRT and 2DRT groups, respectively. The incidences of ≥Grade 3 late toxicity of the esophagus and lungs were 3.1% versus 10.7% (P = 0.028) and 3.1% versus 5.7% (P = 0.127) in the 3DCRT/IMRT and 2DRT groups, respectively. The 1‐year, 3‐year and 5‐year estimated overall survival rates were 81%, 38% and 34% in the 3DCRT/IMRT group and 79%, 44% and 31% in the 2DRT group, respectively (P = 0.628). The 1‐year, 3‐year and 5‐year local control rates were 88%, 71% and 66% in the 3DCRT/IMRT group and 84%, 66% and 60% in the 2DRT group, respectively (P = 0.412). Fewer incidences of acute and late toxicities were observed in esophageal squamous cell carcinoma patients treated with 3DCRT/IMRT compared with those treated with 2DRT. No significant survival benefit was observed with the use of 3DCRT/IMRT.