Cancer médullaire de la thyroïde familial isolé

The authors describe the cases of two patients from the same family who presented medullary thyroid carcinoma (MTC). Hormone measurement showed a significantly elevated basal calcitonin. The treatment was total thyroidectomy. Histological findings showed multifocal, bilateral MTC. Direct sequencing identified in both patients a heterozygous germline missense mutation TGC-TTC at codon 634 of exon 11 in the RET gene that causes an animosubstitution of cysteine to phenylalanine. The clinical outcome of the cases is considered to be favourable.     

Place de la radiothérapie externe dans les cancers de la thyroïde

Anaplastic thyroid cancers represent 1–2% of all thyroid tumours and are of very poor prognosis even with multimodality treatment including external beam radiation therapy. Conversely, differentiated thyroid carcinomas (at least 80% of thyroid cancers) hamper good prognosis with surgery with or without radioiodine and there is hardly any room for external beam radiation therapy. Insular and medullar carcinomas have intermediary prognosis and are rarely irradiated. We aimed to update recommendations for external beam irradiation in these different clinical situations and put in light the benefits of new irradiations techniques. A search of the French and English literature was performed using the following keywords: thyroid carcinoma, anaplastic, chemoradiation, radiation therapy, surgery, histology and prognostic. Non-mutilating surgery (often limited to debulking) followed by systematic external beam radiation therapy is the standard of care in anaplastic thyroid cancers (hyperfractionated-accelerated radiation therapy with low-dose weekly doxorubicin with or without cisplatin if possible). Given anaplastic thyroid cancers’ median survival of 10 months or less, neoadjuvant and adjuvant chemotherapy may also be discussed. Ten-year survival rates for patients with papillary, follicular and Hürthle-cell carcinomas are 93%, 85%, and 76%, respectively. Massive primary incompletely resected iodine-negative disease indicates external beam radiation therapy. Older age (45 or 60-year-old), poor-prognosis histological variants (including tall cell cancers) and insular cancers are increasingly reported as criteria for external beam radiation therapy. Massive extracapsular incompletely resected nodal medullary disease suggests external beam radiation therapy. Radiation therapy morbidity has been an important limitation. However, intensity modulated radiation therapy (IMRT) offers clear dosimetric advantages on tumour coverage and organ sparing, reducing late toxicities to less than 5%. The role of radiation therapy is evolving for anaplastic thyroid cancers using multimodal strategies and new chemotherapy molecules, and for differentiated cancers using minor criteria, such as histological variants, with IMRT becoming a standard of care.     

Préparer la curiethérapie de demain

For more than a century, brachytherapy has been a treatment of choice for delivering a high dose in a small volume. However, over the past 15 years, this irradiation technique has stalled. Even so, brachytherapy allows the delivery of the right dose at the right place by dispensing with target volume motion and repositioning. The evolution of brachytherapy can be based on a road-map including at least the following three points: the acquisition of clinical evidence, teaching and valuation of the procedures. The evolution of brachytherapy will be also impacted by technological considerations (end of the production of low dose rate 192 iridium wires). Regarding the evolution toward a personalized treatment, brachytherapy of the future should take its place as a partner of other modern external beam radiation techniques, be performed by experimented actors (physicians, physicists, technicians, etc.) who received adequate training, and be valued in proportion to the delivered medical service.     

Représentations sociales du cancer et de la chimiothérapie : enjeux pour la définition de la situation thérapeutique

This research studies social representations of cancer and chemotherapy with patients (N = 62) and of oncologists (N = 26) in a medical oncology unit. The collection of the data was made from free association tasks (concerning cancer and chemotherapy) and attitude questions concerning chemotherapy. Patients also had to produce representations “for” oncologists and conversely. Results indicate a variety of representations marked by the status of sample (patients versus oncologists). The stressful component of the disease is very present. Contrary to the patients, oncologists seize relatively well the representation, which the patients have of concerning cancer and chemotherapy. Patients’ representations are connected with phenomena of belief that give evidence for some process of anticipation and expectation linked to the experience of illness and testify the emotional charge related to it. The study of the representations is particularly relevant to highlight the psychosocial stakes associated with the therapeutic situation.     

Place de la chimiothérapie et de la chimioradiothérapie dans le cancer de l’estomac localement évolué

Currently, there is no international consensus on the best treatment regimen for patients with advanced resectable gastric carcinoma. Three approaches exist abroad continents. In France and Europe, perioperative chemotherapy and gastrectomy with D1.5 lymph-node dissection is the current standard. In Japan and South Korea, postoperative adjuvant chemotherapy after surgery with D2 lymph-node dissection is the standard treatment. In the United States, where limited lymph-node dissection is frequently performed, adjuvant chemoradiotherapy after surgery is the standard treatment. In France, postoperative chemoradiotherapy indications are discussed in limited settings: patients with locally advanced gastric cancer or lymph node involvement discovered on the pathologic report of the gastrectomy without preoperative chemotherapy delivery or in case of non-carcinologic resection (R1). Exclusive chemoradiotherapy can be proposed in patients unfit for surgery.     

Impact de la radiothérapie sur la vie sexuelle

The aim of this study was to evaluate the impact of radiation therapy on sexual life. The analysis was based on a Pubmed literature review. The keywords used for this research were “sexual, radiation, oncology, and cancer”. After a brief reminder on the anatomy and physiology, we explained the main complications of radiation oncology and their impact on sexual life. Preventive measures and therapeutic possibilities were discussed. Radiation therapy entails local, systematic and psychological after-effects. For women, vaginal stenosis and dyspareunia represent the most frequent side effects. For men, radiation therapy leads to erectile disorders for 25 to 75% of the patients. These complications have an echo often mattering on the patient quality of life of and on their sexual life post-treatment reconstruction. The knowledge of the indications and the various techniques of irradiation allow reducing its potential sexual morbidity. The information and the education of patients are essential, although often neglected. In conclusion, radiation therapy impacts in variable degrees on the sexual life of the patients. Currently, there are not enough preventive and therapeutic means. Patient information and the early screening of the sexual complications are at stake in the support of patients in the reconstruction of their sexual life.     

L’évolution de la curiethérapie du cancer de prostate

Curietherapy, more commonly named brachytherapy, is one of the oldest irradiation techniques used for prostate cancer. Prostate brachytherapy evolved according to the scientific and technological progress. After a historical reminder of the evolution of prostate brachytherapy, different technical aspects are discussed: low-dose rate brachytherapy using permanent or temporary implants, high-dose rate brachytherapy as well as new imaging modalities. Prostate brachytherapy indications are listed regarding to the evidence-based medicine data for low, intermediate and high risks prostate cancers. Potential indications and new research programs (focal therapy, high-dose rate, single-dose brachytherapy) are also presented.     

Place de la radiochirurgie et de la radiothérapie stéréotaxique hypofractionnée dans la prise en charge des métastases cérébrales

Brain metastases management is still controversial even though many trials are trying to define the respective roles of neurosurgery, whole-brain radiotherapy, single-dose stereotactic radiotherapy and fractionated stereotactic radiotherapy. In this article, we review data from trials that examine the role of radiosurgery and fractionated stereotactic radiotherapy in the management of brain metastases.     

Perspective socio-anthropologique de la prise en charge de la dénutrition du malade cancéreux

The diet of the cancer patient is a major focus of prevention and treatment strategy of the recent plans that fight against cancer. It is sometimes reduced to a rapid series of more or less general advice, often interfered by other sources of information, more or less conventional. In this pathological situation where the nutritional status of the patient is paramount, it seems crucial to understand the different modalities of how the food behavior is implemented. This article describes the construction modalities of the cancer eater decisions. The goal of the socio-anthropological analysis proposed in this article is to initiate a reflection on the under nutrition problem by focusing on the approach of the eater diagnosed with cancer. The aim is to help identify ways of action to fight against under nutrition and improve the quality of life of the patient.     

Leiomyosarcome primitif de la surrénale

Leiomyosarcoma of the adrenal gland is an extremely rare tumour originating from the central adrenal vein or its tributaries. Patients with human immunodeficiency virus (HIV) and Epstein-Barr infection have a higher incidence of these tumours, but even in those individuals, the overall incidence is very low. In this paper, we report a case of adrenal leiomyosarcoma in a 20-year-old man who presented with a high occlusive syndrome through duodenal compression, developing over the course of one week. The imagery showed a malignant adrenal tumour. A resection was successfully performed. The patient has been in recession for 55 months. Despite the rarity of this tumour, leiomyosarcoma of the adrenal gland has an aggressive behaviour. Adrenalectomy is the primary treatment, while chemotherapy or radiotherapy is not prescribed except in metastatic or bulky and non-operative disease.