Pharmaco-prévention et nutri-prévention des cancers de la prostate

In 2010, in France, 8,790 men died from prostate cancer despite a low and decreasing mortality rate. The individual risk/benefit ratio of prostate cancer screening is the focus of controversy and currently not in favor of a systematic screening program. Therefore, only prevention could reduce incidence, side effects of treatment and related mortality. Interestingly, prostate cancer prevention is also a field of controversy mainly about 5-alpha-reductase inhibitors. However, it could be expected that pharmaco- or diet-based prevention will be a huge tool for cancer control, even more for prostate cancer burden. This review comprehensively analyses which molecules or compounds could be used in preventive trials. With regard to pharmaco-prevention, three different kinds of drugs could be identified. First drugs, which aim at mainly or even solely reduce prostate cancer risk such as 5-alpha-reductase inhibitors and selective estrogen receptor modulators. Drugs, which aim at wider preventive impact such as: nonsteroidal anti-inflammatory drugs or difluoromethylornithine. Lastly, drugs for which reducing prostate cancer incidence is merely a side effect such as statins, metformin or histones desacetylase inhibitors. With regard to diet-based prevention, two main approaches could be identified: aliments and nutriments, on one hand, and vitamin and minerals, on the other. Interestingly if compounds reach experimental plausibility, natural foods or even global diet seem to have a higher impact. Lastly, besides assessment of efficacy, effectiveness required the critical step of compliance, which might actually be the weakest link of the prevention chain.     

Conséquences des traitements des cancers et préservation de la fertilité

Cancer prognosis has considerably improved over recent decades and increasing numbers of young adults live with the long-term consequences of their treatment. Their quality of life is often serious compromised by the inability to conceive a child. As such the recent and rapidly evolving practice of fertility preservation needs to become a standard option in cancer care. Embryos, oocytes, spermatozoa, and germinal tissue can be cryopreserved without damage until such time that the patient, freed from their illness can envisage starting a family. Fertility can be persevered prior to initiation of gonadotoxic treatments by different methods. Some options, in particular in prepubescent boys (and even in adolescents and young adults), though a high research priority and a source of great hope, remain highly experimental. Since the available options combine both validated and experimental methods, it is necessary that care teams are multidisciplinary and that they discuss these choices with the patient and (for children) their family. Even though some patients, through choice or otherwise, are not candidates for Fertility Preservation, their decision, taken in the light of complete, correct and understandable information about the available options, must be respected in accordance with their rights to determine their own reproductive future. The current situation in France needs improvement and multidisciplinary structures are forming where cancer specialists work closely with specialists in reproductive medicine and biology to provide rapid and coordinated patient care. The national cancer institute (INCA) with the Agence de la biomédecine have co-published a report that brings the knowledge of all involved in the care of these patients up to date and makes a series of propositions to improve the situation and notably to guarantee equitable access to quality care for all concerned persons. The principal areas of improvement are:

• — Equitably improve cancer patients’ access to fertility preservation across the country through the regional planning and establishment of multidisciplinary teams, supported by targeted funding and the authorisation of centres.
• — Publish and disseminate professional guidelines and verify that they are taken into account during multidisciplinary decision making.
• — Systematically inform patients and their families about the consequences of cancer therapy on reproductive function.
• — Set up longitudinal cohorts of patients.
• — Promote research into how to prevent or reduce the risk of the attenuation of fertility and into how to restore it.

     

Personnalisation de la dose et du fractionnement de la radiothérapie des cancers de la tête et du cou

Head and neck cancers comprise a variety of tumours depending on the sub-site, for which target volumes and the prescribed doses need to be individualized according to each patient's history and presentation. This article aims at describing the main factors involved in decision-making regarding dose and volume, as well as ongoing research. Contouring and treatment guidelines, use of altered fractionation, major prognostic factors, the role of Human papillomavirus and of functional imaging will be presented and discussed.     

Délinéation des cancers de la cavité buccale et de l’oropharynx

The aim of this article is to present the determination and the delineation of target volumes for oral cavity and oropharyngeal carcinomas treated with intensity-modulated irradiation. The delineation on the computerized tomography scanner (CT scan) requires a precise method because of the complexity of the head-and-neck anatomy. Different elements are necessary: clinical examination, diagram of the initial tumor, surgical and pathological reports and medical imaging (CT scan, magnetic resonance imaging and fluorodeoxyglucose positron emission tomography). The clinical target volumes, the planning target volumes, the organs at risk and the planning organs at risk volumes are discussed. The concept of selectivity of the potential subclinical disease near the primary tumour and the selection of neck nodal targets are specified according to the literature.     

Proposition de sélection et délinéation des volumes cibles anatomocliniques tumoraux et ganglionnaire pour la radiothérapie des cancers de la glande sous-mandibulaire

This article provides a proposal for the selection and delineation of clinical target volumes for the treatment with radiation of submandibular glands tumours. This article does not deal with external radiotherapy indications but specifies the volumes to be treated if radiotherapy is chosen. High-risk and low-risk peritumoral clinical target volumes are described based on the probability of local tumoral spread. High-risk and low-risk clinical target volumes are illustrated on CT-scan slices. A proposal for the selection of nodal clinical target volumeis also proposed.     

Proposition de délinéation des volumes cibles tumoraux et sélection des aires ganglionnaires des cancers de la glande parotide

Salivary glands tumours are uncommon tumours showing a large diversity of histological types. This article presents a synthesis of patterns and paths of invasion of parotid glands tumours in order to propose an approach of the delineation of primary tumour clinical target volumes and of the selection of lymph nodes target volumes. This article does not discuss treatment indications but defines clinical target volumes to treat if radiotherapy is indicated. Postoperative situation being the most frequent, the delineation of primary tumour clinical target volume is based on an anatomical approach.     

Dent et irradiation : denture et conséquences sur la denture de la radiothérapie des cancers de la tête et du cou

Pre-irradiation dental care depends on teeth health, fields and dose of irradiation, compliance to fluorides, cessation of tobacco and psychosocial cofactors. Dental care aims at preventing complications and preserving the quality of life (eating, speech and aesthetics). Approximately 11% of patients do not require any pre-irradiation dental care. Dental complications vary from slight colorations of the teeth to major complication such as osteoradionecrosis. Osteoradionecrosis rates vary from 1 to 9%, and may be decreased by using a 21-day delay between extractions and irradiation, provided that it does not postpone cancer treatment, with a dose-dependent risk (<6% if <40 Gy; 14% between 40 et 60 Gy; ≥20% if >60 Gy). Osteoradionecrosis occurs spontaneously (35%), mostly involves the mandibula (85%).     

Les médecins généralistes et la détection précoce des cancers de la peau

Introduction

One of the goals of the French Cancer Plan 2009–2013 is to strengthen the role of the general practitioner at each stage of the patient’s care. As part of its mission in informing health professionals on prevention, the French National Cancer Institute, INCa, implements a barometric survey to better assess the knowledge and practices of GPs on the early detection of skin cancer.

Method

This survey was achieved in two steps, in October 2009 and 2011, by phoning a sample of 600 representative GPs, constructed according to the quota method.

Results

A large majority of the GPs believe they have the necessary knowledge on the prevention and early detection of these cancers (81%) and thus feel comfortable answering questions from patients (87%). However a further analysis reveals that they consider their knowledge to be in need of upgrading. They express a strong demand for information and training. In terms of practice, if the examination of the patient’s skin is usual, it is not always fully carried out by the GP. Self-examination for patients identified at risk is not systematically demonstrated (57%). GPs are especially attentive to the color (83%) or the evolution of a nevus (60%), less to other elements of the ABCDE rule. In case of doubt, when noticing a suspicious skin lesion, the GP addresses his patient to the dermatologist (96%). The care management of patients, as established by the French National Health Insurance, was well accepted and did not change the GPs’ practices.

Conclusions

The results of the 2009 survey are comparable with those of 2011. Current actions, carried out in partnership with GPs on this topic, would benefit from a reinforcement of concerted information actions and continuing education.     

Facteurs de risque d’asthénie en cours de la radiothérapie des cancers du sein et de la prostate

PurposePatients frequently report asthenia during radiation. The present study aimed at identifying the correlation between numerous clinical and tumoral factors and asthenia in breast and prostate cancer patients treated by curative radiotherapy.Materials and methodsA retrospective study was conducted at the Lucien Neuwirth Cancer Institute (France). All breast and prostate cancer patients undergoing curative radiotherapy during 2015 were screened (n = 806). Patient's self-evaluation of asthenia and radiotherapy tolerance was assessed through verbal analogic scale (0/10 to 10/10). Data about toxicities, travel distance and travel time, tumor's characteristics, radiotherapy treatment planning, previous cancer therapies, were collected from medical records.Results500 patients were included (350 in the breast cancer group and 150 in the prostate cancer group). In all, 86% of patients in the breast cancer group reported asthenia, with a 5/10 median score. In all, 54% of patients in the prostate cancer group reported asthenia, with a 2/10 median score. Univariate analysis showed correlation between asthenia and radiotherapy tolerance as well as tumor staging, in the prostate cancer group. No other correlation was evidenced.ConclusionRadiotherapy-related fatigue is a common side effect. This study showed that most of the factors related to patients or disease that are commonly used to explain fatigue during curative treatments, seem finally to be not correlated with asthenia.     

Enjeux et perspectives de la prévention des cancers dans les pays en développement

Cancer, a devastating disease worldwide, is a global health challenge both in the developed countries and in the developing countries. In low-income nations, epidemiologic data are worsening in terms of incidence and mortality, while the mortality rates are decreasing in high-income nations. Cancer risk factors are also very high in poor countries. The weakness of health systems, lack of infrastructures and limited medical facilities could partially explain these alarming observations. Nevertheless, lack of public health policies targeting these chronic diseases, or more largely non-communicable diseases, might deteriorate the current epidemiologic situation. New public health approaches that take into account the populations social, cultural and economic aspects are needed for an efficient control of these pathologies, especially in Africa.     

Radiothérapie hypofractionnée des cancers du sein chez la femme âgée : état des lieux et perspectives

Adjuvant radiotherapy is the pillar of breast conserving surgery. Its omission is related with a higher risk of local recurrence and of breast cancer related or non-related mortality. It is of paramount importance to guarantee this treatment is fully administered to all patients after breast conserving surgery, including the elderly. In the last three decades several hypofractionated treatment schemes have shown their non-inferiority, allowing for treatment time reduction facilitating adhesion to treatment and reducing radiotherapy burden. This review focuses on the schemes and indications which have been validated by large phase 3 trials and those which are still under evaluation.     

Actualités dans la biologie,l’imagerie et le traitement des gliomes de l’adulte

A better understanding of gliomas biology is now leading to a combined histo-molecular classification of these tumors. In anaplastic gliomas ongoing studies depend on 1 p/19 q codeletion status and in glioblastomas on MGMT methylation status. Advanced brain tumor imaging elicits a better identification of gliomas evolutive potential of. In low-grade gliomas, the importance of maximal resection and the role of chemotherapy are being increasingly recognized. In anaplastic gliomas, phase III studies have clarified the respective roles of chemotherapy and radiotherapy. In glioblastomas concomitant chemoradiotherapy is the standard. Most targeted therapies, namely anti-EGFR therapies have failed to demonstrate efficacy but anti-angiogenics are promising. The aim of this review is to discuss the main advances in adults’ gliomas biology, imaging and treatment.     

Ablation percutanée des métastases : bilan de la décennie et nouvelles technologies

When a metastatic disease is localized and slowly evolving either spontaneously or after a general treatment, a local treatment may be proposed. For about 15 years, image-guided percutaneous ablation has been developed which allows to treat tumors with temperature modifications. These mini-invasive techniques may be repeated in patients whose disease may be chronic. Ablation techniques are also used in a more palliative manner on bone metastases to obtain pain relief.