Current results of neutron therapy at the UCL, for soft tissue sarcomas and prostatic adenocarcinomas. Université Catholique de Louvain

From March 1978 to August 1985, 630 patients were treated with fast neutrons at the UCL cyclotron of Louvain-la-Neuve. Neutrons are produced by bombarding a beryllium target with 65 MeV protons. A CNPF of 2.8 was adopted. As far as soft tissue sarcomas are concerned, 32 patients were irradiated after "radical" surgery: only 2 local recurrences were observed (follow-up from 6 months to more that 5 years). On the other hand, in a group of 26 patients with large inoperable, recurrent of incompletely resected tumours, local control could not be achieved in 14 cases. In the whole group of these 58 patients, 12 severe complications were observed; their frequency increases with field size which in turn reflects tumour extent. Locally extended prostatic adenocarcinomas (stage C) were treated with mixed schedule irradiation (3 neutron and 2 photon fractions per week). A local control rate of 93% at 1 year, of 83% at 2 years, and 90% at 3 years was achieved (28, 23 and 10 patients respectively). The early and late tolerance was excellent; only one complication was observed.     

Autophagy in tumorigenesis and cancer therapy: Dr. Jekyll or Mr. Hyde?

Autophagy is an evolutionarily conserved mechanism for intracellular substance degradation, responsible for the recycling of metabolic substances and the maintenance of intracellular stability. It has early been demonstrated to play a significant role in tumorigenesis, but whether it acts as a promoter or a suppressor during tumorigenesis seems to be context-specific. Moreover, autophagy is also implicated in promoting chemoresistance of cancer cells so as to attenuate therapeutic efficacy of chemotherapy. On the contrary, other reports highlight a tumor-killing role of autophagy during cancer treatment. Herein, this review aims to revisit the key features of autophagy, summarize the seemingly contradictory roles of autophagy during both tumorigenesis and cancer chemotherapy, and evaluate the feasibility of altering the level of cellular autophagy as part of cancer adjuvant treatment.     

Lymphome de type MALT de la prostate : place de la radiothérapie. Observation et discussion

We report the case of a patient presenting with MALT (mucosa-associated lymphoid tissue) lymphoma of the prostate, who received an irradiation delivering 30.6 Gy in 17 fractions after transurethral resection. With a follow-up of 6 years, he remained alive and free of disease. In view of the literature and this case report, definitive local irradiation should be administered in this rare disease.     

Gene therapy for breast cancer. — review of clinical gene therapy trials for breast cancer and mdr1 gene therapy trial in cancer institute hospital

Gene therapy for advanced breast cancer is anticipated to be a useful therapeutic approach. Strategies in ongoing clinical protocols can be divided into four groups: (1) suppression of oncogenes or transfer of tumor-suppressor genes; (2) enhancement of immunological response; (3) transfer of suicide genes; (4) protection of bone marrow using drug resistance genes. We have started a clinical study of multidrug resistance (MDR1) gene therapy. Advanced breast cancer patients received high dose chemotherapy and autologous peripheral blood stem cell transplantation(PBSCT)with MDR1-transduced hematopoietic cells, and then were treated with docetaxel. Two patients have been treated so far, and in vivo enrichment of MDR1-transduced cells with docetaxel treatment has been seen. Both patients are in complete remission and had no apparent adverse effects from the MDR1 gene transfer.     

Molecular aspects of ovarian cancer. Is gene therapy the solution?

Genetic abnormalities of cancer cells are complex and usually nonspecific. Genetic anomalies specific to ovarian cancer have not been reported. This article focuses on what molecular anomalies are known in ovarian cancer and describes the first trials that have used transfer of genes to reestablish a normal cellular function in this disease. Suicide gene therapy has been the prototype of this new therapeutic approach.     

Estudio computarizado de la influencia de la proliferación y de la variación de la radiosensibilidad en un programa de radioterapia fraccionada. Efecto del tiempo total de tratamiento sobre el control tumoral

Propósito

Estudiar, para la radioterapia fraccionada, la influencia que tienen las variaciones de radiosensibilidad y cinética de proliferación a lo largo del tratamiento, así como el efecto del tiempo total de tratamiento, sobre la probabilidad de control tumoral.

Métodos

Partiendo de los datos de la cinética de crecimiento y de la radiosensibilidad de los esferoides multicelulares (MTS) de la línea celular MCF-7 de cáncer de marna, se efectÚa la simulación computarizada de un tratamiento fraccionado de radiosterapia.

Resultados

Cuando se progresa en la terapia, aumenta la tasa de proliferación, lo que explica el fenómeno de repoblación acelerada. Sólo si aumenta la radiosensibilidad a lo largo del tratamiento, un agregado celular con las características proliferativas de los MTS puede ser esterilizado. Una demora en el inicio del tratamiento o una interrupción del mismo producen un empeoramiento de la probabilidad de control tumoral, que es más acusado en el caso de una interrupción y cuanto más tarde se produce ésta. El aumento de la dosis para el control del 50% de los tumores cuando se prolonga el tiempo total de tratamiento alcanza valores de 0,5–1,14 Gy por día de aumento en el tiempo total.

Conclusiones

En otros trabajos, cuando se analizan datos clínicos mediante modelos de probabilidad de control, los valores obtenidos para los parámetros puede que ajusten los datos, pero quizás no muestren las verdaderas características histológicas de los tumores correspondientes. En la situación aquí presentada, al igual que para otros tipos de tumores como los de cabeza y cuello, el aumento del tiempo total de tratamiento hace necesario corregir la dosis total para mantener los nivelés de control previstos.     

Cancer de l’endomètre. Application des recommandations de 2010 : étude multicentrique

ObjectiveThe endometrial cancer is the most frequent gynecological cancer. To improve and homogenize the professional practices of endometrial cancer, guidelines were developed in November 2010. The aim of this study is to estimate the implementation of these recommendations.MethodsThis is a retrospective multicentre study, using the databases of three French centers made between November 2010 and December 2012: the university hospital in Reims, the Tenon hospital in Paris and the Cancer Center Georges-François-Leclerc in Dijon. This study consists in the evaluation of the diagnoses and therapeutic assessment modalities for women with endometrial cancer and the concordance with the INCa guidelines.ResultsDuring this study, 161 patients were treated for an endometrial cancer. A histological and radiological preoperative assessment was respectively made in 92.5% and 73.3% of the cases. It revealed an agreement between anatomo-radiologic pre- and postoperative in 62.3% and 53.4% of the cases for myometrial invasion and the International Federation of Gynecology and Obstetric classification. The surgical modalities were in agreement with the guidelines in 64.6% (n = 104) and 60.3% (n = 97) of the cases. The discrepancy of the guidelines resulted from the absence or the excess realization of a lymphadenectomy. An adjuvant therapy was administered in 67.1% (n = 108) of the cases and was in agreement with the guidelines in 62.3% of the cases.Discussions The pre- and postoperative discordance between histological and radiological results are at the origin of a default in treatment for certain patients. This discordance leads to excess or lack of nodes exploration.     

Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis.

PURPOSE: Recent randomized trials in women with node-positive breast cancer who received systemic treatment report that locoregional radiation therapy improves survival. Previous trials failed to detect a difference in survival that results from its use. A systematic review of randomized trials that examine the effectiveness of locoregional radiation therapy in patients treated by definitive surgery and adjuvant systemic therapy was conducted. METHODS: Randomized trials published between 1967 and 1999 were identified through MEDLINE database, CancerLit database, and reference lists of relevant articles. Relevant data was abstracted. The results of randomized trials were pooled using meta-analyses to estimate the effect of treatment on any recurrence, locoregional recurrence, and mortality. RESULTS: Eighteen trials that involved a total of 6,367 patients were identified. Most trials included both pre- and postmenopausal women with node-positive breast cancer treated with modified radical mastectomy. The type of systemic therapy received, sites irradiated, techniques used, and doses of radiation delivered varied between trials. Data on toxicity were infrequently reported. Radiation was shown to reduce the risk of any recurrence (odds ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.83), local recurrence (odds ratio, 0.25; 95% CI, 0.19 to 0.34), and mortality (odds ratio, 0.83; 95% CI, 0.74 to 0.94). CONCLUSION: Locoregional radiation after surgery in patients treated with systemic therapy reduced mortality. Several questions remain on how these results should be translated into current-day clinical practice.     

Proton-beam vs intensity-modulated radiation therapy. Which is best for treating prostate cancer?

There is a growing interest in the use of proton therapy for the treatment of many cancers. With its unique dose-distribution properties, proton therapy has the potential to improve the therapeutic ratio of prostate radiation by allowing for an increase in dose without a substantial increase in side effects. While much evidence supports this notion in the context of many oncologic sites, only limited clinical data have compared protons to photons in prostate cancer. Therefore, the increasing enthusiasm for the use of protons in prostate cancer has aroused considerable concern. Some have questioned its ability to limit morbidity, and others have questioned its value relative to the cost. In addition, theoretical concerns have been raised about a potential additional risk for secondary malignancies. In this article, we review the current status of the evidence supporting the use of protons in prostate cancer and discuss the active controversies that surround this modality.     

Braquiterapia en neoplasias de labio. La experiencia del instituto catalán de oncología (ICO)

A retrospective analysis of the overall survival and prognosis factors of patients treated from lip neoplasms with brachytherapy in the ICO was carried out. Sixty-six patients with lip neoplasms, being 89.5% squamous cell carcinomas and 79% early stages (T1 and T2) were included in the study. Previous surgical treatment was not performed in 82% of the cases. The brachytherapy was made in 91% with vector needles and in 100% with¹⁹²Ir with lineal activities between 4.60 and 9.09 µy/h·m²·cm. The doses varied from 60 to 70 Gy being 65 Gy in 71% of the cases. Total remission was obtained in 100% of the cases. Relapses took place in 9%, being local 2 and ganglionary 4. Overall survival of 93% and 73%, disease free survival was 94.5% and 84% and cause especific survival was 97% and 94% at 2 and 5 years, respectively. We find results similar to those described in the literature. We could not identify prognostic factors in our group.     

Cancers de la cavité orale. Mise au point Sous l’égide de l’Intergroupe ORL

Oral cavity cancers are frequent: 6,600 cases per year are diagnosed in France. Age of occurrence is around 60. Tobacco is the main risk factor, especially when associated with alcohol. They occur de novo or by evolution of a precancerous lesion. Diagnosis is late in 70% of cases. They must be treated in specialized centers. Pretreatment check-up has to be done according to national guidelines. Treatment often implies primary surgery. Reconstructive surgery progresses allow for wide excisions and still acceptable quality of life. Radiotherapy, eventually potentialized, is usually performed post-operatively. Induction chemotherapy still needs to be evaluated in oral cancers, especially in an organ preservation purpose.     

Le ganglion sentinelle dans le cancer du sein. Expérience de l’institut Salah-Azaïz de Tunis

IntroductionBreast cancer screening increased the ratio of small tumours. These tumours have a low lymph node metastatic potential. Sentinel node detection allows detecting axillary lymph node invasion without the morbidity of complete axillary lymph node dissection.ObjectivesIn this study we report the results of the learning curve of sentinel node detection in the Institut Salah-Azaïz of Tunis.Materials and methodsIt is a prospective study between January 2004 and December 2005 in which 115 patients were included with breast cancer less than 3 cm without antecedents of breast surgery. All these women had sentinel node dissection by a colorimetric method and 30% had a combined method (colorimetric and isotopic).ResultsThe rate of detection was 97.3% (n = 112). An extemporaneous examination was performed in 91 patients. The rate of negative forgery of the extemporaneous examination was 4.3% and the sensitivity of 95.7%. There are no false positive with the extemporaneous exam. The sentinel lymph node was the only node invaded in 15 patients (44%). In 3 patients, the sentinel node was healthy whereas the axillary dissection was positive, so the false negative rate is about 2.6%.ConclusionSentinel node dissection is a reliable and feasible technique. It however requires a training of the surgeon, the pathologist and the nuclear doctor. It allows to reduce the morbidity of the treatment of the breast cancer by avoiding “useless” axillary dissection out in patients without node invasion. The increase in the number of the small cancers discovered during screening makes it possible to increase the number of patients who can profit from this technique.     

Tumeurs à cellules géantes de l’os. Particularités anatomocliniques: à propos de 14 cas

Introduction

Giant cell tumors of the bone have specific morphologic features and a progressive course pattern but they lack accurate prognostic criteria.

Patients and method

We report a retrospective study of fourteen cases of giant cell tumor of the bone diagnosed in the pathology department of the Farhat-Hached hospital, Sousse city, between 1990 and 2007. The radiological and histological images were reviewed and compared with the clinical and therapeutic data from the patients’ follow-up.

Results

Our results were as follows: five patients out of seven with grade I tumour had a local recurrence; one patient out of seven with a grade II tumour had a local recurrence with synchronous pulmonary metastases; eight patients had a favourable outcome without any recurrence or metastasis.

Conclusion

The histological parameters only may not predict the propensity for a giant cell tumor to induce recurrence or metastasis; the clinical, radiological and biological features must be always taken in consideration.