Cancer du sein traité par chirurgie conservatrice et radiothérapie : représentation de la maladie et image corporelle

This research examines the experience of breast cancer treated by conservative surgery and radiotherapy, since this experience has not been much examined by literature. Our study relied on the Common Sense Model by Leventhal, and particularly aimed at analyzing the illness representations of these patients and their mechanisms by which they evaluate their situation. We led a qualitative analysis of interviews and answers to Brief Illness Perception Questionnaire and Body Image Scale and showed that the subjective illness perception is indeed distinct from the cancer social representation. Social comparison seems to play a key role in elaborating the illness representation as well as in evaluating body image after tumorectomy and radiotherapy. This comparison process and the consequent minimization of the illness experience question the patients’ ability to access support care.     

Étude des facteurs pronostiques de radiodermite aiguë dans le cancer du sein traité par irradiation conformationnelle adjuvante avec ou sans modulation d’intensité

PurposeReal life study of prognostic factors of acute radiodermatitis in a monocentric cohort of 200 patients with breast cancer treated with RT3D or IMRT for adjuvant radiotherapy.Patients and methodsThis study comprises 200 patients with breast cancer treated with adjuvant radiotherapy, included consecutively. For each patient, their clinical and tumoral characteristics and the irradiation schedule was retrospectively collected. The severity of acute radiodermatitis was also collected, during the treatment and 6 weeks after the end of irradiation. The objective was to identify risk factors for acute radiodermatitis grade ≥ 2.ResultsThe univariate analysis found that a more important BMI (p < 0.001), a more important volume of PTV (p < 0.001) a normofractionated schedule (p = 0.002) were statistically associated to a greater risk of occurrence of grade ≥ 2 acute radiodermatitis. The multivariate analysis found BMI > 30 (OR = 9.31, p = 0.04), light phototype (OR = 0.04, p = 0.02) and histology other than invasive breast carcinomas (OR = 0.07, p = 0.04) to be statistically associated to the occurrence of grade ≥ 2 acute radiodermatitis.ConclusionIn this monocentric retrospective study, with a prospective collection of the severity of acute radiodermatitis, no grade 3 radiodermatitis has been observed and the frequency of occurrence of grade 2 radiodermatitis was lower than previously published. In contrast to previously published results, IMRT was not associated to a lower risk of grade ≥ 2 acute radiodermatitis. Multivariate analysis found BMI, phototype, and histology to be risk factors of grade ≥ 2 acute radiodermatitis.     

Délinéation du lit opératoire des métastases cérébrales opérées traitées par irradiation en conditions stéréotaxiques adjuvante : revue de la littérature

Stereotactic radiotherapy of the surgical bed of brain metastases is a technique that comes supplant indications of adjuvant whole brain radiotherapy after surgery. After a growing number of retrospective studies, a phase III trial has been presented and validated this indication. However, several criteria such as the dose, the fractionation, the use of a margin and definition of volumes remain to be defined. Our study consisted in making a literature review in order to provide a guideline of delineation of surgical beds of brain metastases, as well as the different modalities of their implementation process.     

Bénéfices de la radiothérapie avec asservissement respiratoire dans le traitement du cancer du sein

PurposeThe purpose of this study was to compare free-breathing radiotherapy, end-expiration gating and end-inspiration gating for left breast cancer, with respect to the target volume coverage and dose to organs at risk.Patients and methodsSixteen patients underwent 3D and 4D simulation CT. For each patient, five dosimetric plans were compared: free breathing, end-inspiration gating, end-expiration gating, and two optimised plans with a 3 mm reduction of the posterior field edge to create optimised end-inspiration and end-expiration plans. Dose–volume parameters, including planning target volume coverage and dose to lung, heart and left anterior descending coronary artery were analysed.ResultsPlanning target volume coverage was adequate and similar in the five dosimetric plans (P = 0.49). Significant advantage was found for end-inspiration gating in sparing the ipsilateral lung, heart and left anterior descending coronary artery compared to free-breathing 3D radiotherapy. Optimised end-inspiration was even more favourable than end-inspiration gating (P < 0.05), with less dose delivered to the ipsilateral lung, heart and left anterior descending coronary artery. When compared to end-expiration gating, end-inspiration gating dosimetric outcomes were similar regarding lung and left anterior descending coronary artery doses, but the heart dose was inferior on the end-inspiration gating compared to end-expiration gating.ConclusionBreathing-adapted radiation therapy allowed for dose reduction to organs at risk (left lung, heart and left anterior descending coronary artery), while keeping the same planning target volume coverage. Therefore it can be considered as an interesting option for left breast cancer radiation treatment.     

Impact dosimétrique du blocage respiratoire dans le traitement du carcinome hépatocellulaire par irradiation de conformation

ObjectiveTo evaluate the dosimetric impact of breath-hold during radiotherapy of hepatocellular carcinoma (HCC) and to determinate the optimal respiratory phase for treatment (exhale or inhale).Patients and methodsTwo CT scans were performed in inhale and in exhale in 20 patients with HCC. The GTV was delineated slice by slice on the inspiration breath hold acquisition (GTV_insp) and on the expiration breath hold acquisition (GTV_exp). The superposition of two GTV allowed to obtain the global GTV (free respiration). PTV was defined by adding a margin of 1 cm around each GTV. The liver, the duodenum, the two kidneys, the stomach and the spinal cord were delineated on each acquisition as organs at risk (OAR). Three dosimetric plans were created on inspiration, expiration and on global PTV.ResultsThe mean reduction in the volume of PTV with conformal radiation therapy (3D-CRT) in the hold-breath group compared to the free respiration group was of 33.5 ± 11.9%. The average difference of V50%, V20, V30, V40 and V50 were around 4% in favor of the breath hold. The average value of NTCP was 8.9% in free respiration, 4.5% in expiration and 3.2% in inspiration. Further improvement in the OARs dosimetric parameters for the breath hold was observed.ConclusionCompared to the conformal radiotherapy with free respiration, the breath-hold allows reducing the volume of the PTV and the doses to the healthy liver and organs at risk. The use of this modality during different radiotherapy techniques (3D-CRT, IMRT and stereotactic) may be recommended. No difference in dosimetric value has been observed between the breath hold in expiratory and inspiratory phases.     

Carcinomes canalaires in situ (CCIS). Caractéristiques histopathologiques et traitement : analyse de 1 289 cas

From March 2003 to April 2004, were prospectively collected in France 1,289 ductal carcinoma in situ (DCIS) with data on diagnosis, patient and tumour characteristics, and treatments. Median age was 56 years (range, 30-84). DCIS was diagnosed by mammography in 87.6% of patients. Mastectomy (M), conservative surgery alone (CS) and conservative surgery with radiotherapy (CS + RT) were performed in 30.5, 7.8 and 61.7% of patients, respectively. Sentinel node biopsy (SNB) and axillary dissection (AD) were performed in 21.3 and 10.4% of patients, respectively. Hormone therapy was administered to 13.4% of the patients. Nuclear grade was low in 21% of patients, intermediate in 38.5% and high in 40.5%. Excision was considered complete in 92% (CS) and 88.3% (CS + RT) of patients. Treatment modalities varied widely according to region: mastectomy rate, 20-37%; adjuvant RT, 84-96%; hormone treatment, 6-34%. Our survey on current DCIS management in France has highlighted correlations between pathological features (tumour size, margin, grade) and treatment options, with several similar variations to those observed in recent UK and US studies.     

Valeur diagnostique des microcalcifications ACR3 et ACR4 dans le dépistage du cancer du sein

Objective

To evaluate the risk of cancer associated with ACR3 and ACR4 microcalcifications.

Patients and methods

A retrospective study of 96 out of 5204 patients who underwent mammography was conducted for 5 years (January 2008 to December 2012). We confronted cancer lesions with ACR3 and ACR4 microcalcifications.

Results

Cancer was detected in 201 women,with a prevalence of 3.8%. Among the 96 cases of ACR3 and ACR4 microcalcifications detected, 56 cases (58%) were classified as ACR3, and 40 cases (42%) as ACR4. For all ACR3 and ACR4 microcalcifications, it was noted 30% of them represented cancerous lesions against 70% of benign lesions. The sensitivity (Se) was 14.4%, specificity (Sp) was 98.66 %, positive predictive value (PPV) was 30% and negative predictive value (NPV) was 96.63%. For ACR3 microcalcifications, cancerous lesions represented for 11 against 89% of benign lesions. The Se was 3%, Sp was 99%, PPV was 11% and NPV was 96%. For ACR4 microcalcifications, cancerous lesions were noted in 57.5% against 42.5% of benign lesions. The Se was 11.4%, Sp was 99.6%, PPV was 57.5% and NPV was 96.5%.

Conclusion

In our study, the risk of cancer associated with ACR3 microcalcifications was 11% against 57.5% ACR4 microcalcifications.     

Fracture de côte suite à la radiothérapie peropératoire dans le cancer du sein. Cas clinique et expérience locale

Intra-operative radiotherapy for breast cancer has been developed throughout the last two decades. It is already well-established regarding local control and toxicity for intra-operative radiotherapy using electrons as we now have the necessary background knowledge. However, very few data on later toxicity are available for intra-operative radiotherapy using low-energy photons. We report here the case of a 36-year-old woman who experienced rib fracture following intra-operative and external radiotherapy. This patient has been included in the Targit-boost trial. The intra-operative irradiation has been operated with an INTRABEAM device delivering low-energy photons of 50-kV.     

Analyse de l’état du stress oxydatif dans le cancer du sein à l’Ouest algérien via les tests FORD et FORT et corrélation avec le grade histopronostique SBR

Breast cancer is a major public health concern. Our work aims to study the role of oxidative stress in the mammary physiopathology. It is a case-control study; it included 62 women with breast cancer and 21 controls. The classification of patients according to the histopronostic grade SBR shows a predominance of grade III with 53% of cases. The determination of oxidative status (FORT test) and antioxidant capacity (FORD test) in the plasma are carried out by the photometer FORM plus. Following this analysis we found that values obtained of the FORTand FORD are included within limits of normal values for controls and above the upper limit for the FORT of patients. According to our study, it appears that Free radicals are excessively produced in breast cancer with SBR grade III.     

Thérapeutiques dans le cancer du sein métastatique HER2-positif : présent et futur

HER2-positive breast cancer accounts for 20 to 25% of breast cancers. The surexpression of this tyrosine-kinase receptor is often associated with a poor prognosis. However, the management and the outcome of these patients have changed these last ten years with trastuzumab. Despite the encouraging results obtained with this humanized monoclonal antibody directed against the HER2-receptor, used alone or in association with chemotherapy in metastatic patients, progression under trastuzumab are usually observed and resistances to this treatment are described. Thus, many other monoclonal antibodies and tyrosine-kinase inhibitors emerged. These therapeutics, used alone or in association with chemotherapy or trastuzumab have variable properties: anti-HER2 and anti-EGFR such as lapatinib, pertuzumab and neratinib; anti-EGFR such as erlotinib and gefitinib; antiangiogenesis (bevacizumab, pazopanib); anti-mTOR pathway (temsirolimus, everolimus) or inhibitor of HSP90 (tanespimycine). In this paper, we present an overview on validated targeted therapies and those which are currently under investigation and seem promising in first line or after progression under trastuzumab. Data regarding cardiotoxicity and the use of trastuzumab under particular clinical circumstances (brain metastases, pregnancy) are also reviewed.