Radiothérapie guidée par l’image dans le cancer du poumon

Image-guided radiotherapy takes place at every step of the treatment in lung cancer, from treatment planning, with fusion imaging, to daily in-room repositioning. Managing tumoral and surrounding thoracic structures motion has been allowed since the routine use of 4D computed tomography (4DCT). The integration of respiratory motion has been made with “passive” techniques based on reconstruction images from 4DCT planning, or “active” techniques adapted to the patient's breathing. Daily repositioning is based on regular images, weekly or daily, low (kV) or high (MV) energy. MRI and functional imaging also play an important part in lung cancer radiation and open the way for adaptative radiotherapy.     

Radiothérapie stéréotaxique et radiofréquence dans le traitement du cancer bronchopulmonaire

Surgery is the standard treatment of early-stage non-small cell lung cancer (NSCLC). However, all patients do not undergo radical resection because of the very frequent co-morbidities occurring in smokers. Recently, new therapeutic options have emerged for limited-size (less than 4 cm) NSCLC tumors. Stereotactic radiotherapy consists of the use of multiple radiation micro-beams, allowing high doses of radiation to be delivered to the tumor in a small number of fractions. Radiofrequency ablation delivers high frequency electromagnetic waves through a needle-like probe, that produces ionic agitation, increase of the temperature in the tumor tissue, and ultimately leads to coagulation necrosis of the tumor. Several studies have been reported, that show the efficacy of these treatment modalities to control stage I/II NSCLC in medically inoperable patients. Local control rates are consistently reported to be above 90 %. Stereotactic radiation therapy and radiofrequency ablation are now being evaluated prospectively; namely, stereotactic radiotherapy is being compared to surgery in operable patients in several randomized trials. Overall, from a technical concept to the availability of specific treatment devices and the publication of clinical results, stereotactic radiotherapy and radiofrequency ablation are paradigms of implementation in thoracic oncology.     

Radiothérapie partielle du sein

Owing to breast cancer screening, breast cancer is more and more diagnosed at early stage. For those breast cancer women, breast conserving treatment (breast conserving surgery followed by whole breast irradiation) is commonly used since many years. New radiation modalities have been recently developed in early breast cancers particularly accelerated partial breast irradiation (APBI). Among all techniques of radiotherapy, 3D-conformal APBI and intraoperative radiotherapy (IORT) are the main modalities of radiotherapy used. The present review states on indications, treatment modalities and updated results of local control and side effects of partial breast irradiation.     

Radiothérapie hypofractionnée dans le glioblastome de la personne âgée

Glioblastoma is the most frequent primary brain tumor, with more than half of all patients being at least 65 years old. The treatment of the elderly in this pathology represents therefore a considerable challenge for oncologists and radiation therapists. However, in most clinical trials, age is a non-eligible criterial. In the last ten years, geriatric therapeutic trials have been multiplied. The treatment of glioblastoma consists of adjuvant chemoradiotherapy. In elderly patients, the evaluation of performans status and the molecular characteristics of the tumor are important factors in order to propose the appropriate treatment in terms of efficacy and toxicity.     

Radiothérapie hypofractionnée des cancers du rectum chez le sujet âgé

Rectal cancer is a common pathology in the elderly. The standard for advanced rectal tumors is a chemoradiotherapy regimen combined 50 Gy with concomitant chemotherapy followed by a surgery. This treatment induces interruptions of chemoradiotherapy and toxicities G3–4 more important in people over 70 years of age. Hypofractionated radiotherapy 5 × 5 Gy with surgery following week is an alternative. All retrospective studies on this fractionation report an excellent immediate and chronic tolerance. The randomized phase III NACRE trial, comparing these 2 radiotherapy, followed by surgery at 6–8 week, established a standard in the management of the elderly patients.     

Chimiothérapie néo–adjuvante dans le cancer du sein

Sans résumé     

Radiothérapie axillaire prophylactique des cancers du sein

Adjuvant radiotherapy, after breast conserving surgery or mastectomy for breast cancer, improves overall survival while decreasing the risk of recurrence. However, prophylactic postoperative radiotherapy of locoregional lymph nodes for breast cancer, particularly of the axillary region, is still controversial since the benefits and the risks due to axillary irradiation have not been well defined. To begin with, when performing conformal radiotherapy, volume definition is crucial for the analysis of the risk–benefit balance of any radiation treatment. Definition and contouring of the axillary lymph node region is discussed in this work, as per the recommendations of the European Society for Radiotherapy and Oncology (ESTRO). Axillary recurrences are rare, and the recent trend leads toward less aggressive surgery with regard to the axilla. In this literature review we present the data that lead us to avoid adjuvant axillary radiotherapy in pN0, pN0i+ and pN1mi patients even without axillary clearance and to perform it in some other situations. Finally, we propose an update about the potential toxicity of adjuvant axillary irradiation, which is essential for therapeutic decision-making based on current evidence, and to guide us in the evolution of our techniques and indications of axillary radiotherapy.     

Radiothérapie stéréotaxique dans le cancer du pancréas localement avancé : revue de la littérature

Stereotactic body radiation therapy (SBRT) for locally advanced pancreatic cancer (LAPC) is an emerging treatment option. Most studies showed local control of approximately 75% with no evidence of improved overall survival. Gastrointestinal toxicities could be significant, ranging up to 22% for acute toxicities ≥ grade 3+ and 44% for late toxicities ≥ grade 3+. Currently, no standardized guidelines for treatment and management scheme. We conducted a systemic review of published prospective and retrospective trials to evaluate the efficacy, safety, technical data, and discuss future directions.     

L’association hormonothérapie-thérapie ciblée dans le cancer du sein

Approximately 70–80% of breast cancers expressed estrogen receptors (ER). Endocrine therapy is the main pillar of the medical management of women with ER+ breast cancer. Since its use, endocrine treatment has radically changed the fate of breast cancer ER + with marked improvement of progression-free survival and overall survival. However, the benefits of the endocrine therapy are limited by the development of resistance. Experimental studies concluded that resistance to the endocrine therapy occurs at least in part via activation of several intracellular signal transduction pathways of cell proliferation. These observations have encouraged a number of phase II/III clinical trials evaluating different approaches of using the signal transduction inhibitors (STI) in combination with endocrine agents. These trials evaluated the feasibility and the capacity of these combinations to delay or to prevent endocrine resistance and are reviewed hereunder.