État des lieux de la protonthérapie en France en 2019

Among over 100 proton therapy centres worldwide in operation or under construction, French proton therapy is coming to full maturity with the recent opening of the Nice (1991, upgrade in 2016) and Caen (2018) facilities next to the Orsay (1991, upgrade in 2010) centre. Proton therapy is a national priority for children and young adults in all three centres. The patient-related activity of the three French centres is coordinated via the Protonshare portal to optimise referral by type of indication and available expertise in coordination with the French society of radiation oncology SFRO and French radiotherapy centres. The centres are recognised by the French Health Care excellence initiative, promoted by the ministry of Foreign Affairs. The three centres collaborate structurally in terms of clinical research and are engaged at the international level in the participation to European databases and research initiatives. Concerted actions are now also promoted in preclinical research via the Radiotransnet network. Ongoing French developments in proton therapy are well presented in international hadron therapy meetings, including European Proton Therapy Network and Particle Therapy Cooperative Oncology Group. Proton therapy teaching in France is offered at several levels and is open to colleagues from all radiation oncology centres, so that they are fully informed, involved and trained to facility recognition of possible indications and thereby to contribute to appropriate patient referral. This close collaboration between all actors in French radiation oncology facilitates the work to demonstrate the required level of medical and scientific evidence for current and emerging indications for particle therapy. Based on that, the future might entail a possible creation of more proton therapy facilities in France.     

Identification et prise en charge d’un haut risque de cancer du sein. État des lieux 2014

Breast cancer is the most common cancer diagnosed and the first leading cause of cancer death among women in France. A population of women at high risk of breast cancer (more than 3% risk at 5 years and 20–25% lifetime) can nowadays be identified and benefit from an appropriate personalized prevention and monitoring program. The French national health authority (HAS, Haute Autorité de Santé) considers personal germline mutation of BRCA1/2, TP53, PTEN, CDH1 or STK11/LKB1 genes, but also recently personal breast cancer history, personal history of atypical breast lesion, history of high-dose chest irradiation and striking family breast/ovarian cancer history but without identified mutation, as criteria of high breast cancer risk and provides screening recommendations for these women.     

Cancer du sein et creux axillaire: état de l'art et perspectives

A therapeutic surgical de-escalation has been observed since many years with an actual prolongation for axillary lymph node area treatment. Axillary lymph node dissection (ALND) omission has been studied before and after validation of sentinel node (SN) biopsy procedure. A non-inferiority of ALND omission has been reported in case of non-involved SN. ALND omission has been studied in case of SN involvement without consensus in relation with scientific level of proof and with selective indications. The purpose of this work is to make a synthesis of the experiences on this subject then to envisage the current and future perspectives.     

État des lieux de la radiothérapie adaptative en 2019 : de la mise en place à l’utilisation clinique

Intensity modulated radiotherapy combined with image guided radiotherapy has led to increase the precision of external beam radiotherapy. However, intra or inter-fraction anatomical variations are frequent during the treatment course and can cause under-dosing of the target volume and/or over-dosing of the organs at risk. Several adaptive radiotherapy (ART) strategies can be defined to compensate these anatomical variations. The purpose of this article is to provide an overview of available ART strategies: offline, online, hybrid (library of treatment plans) or in real-time, while considering the arrival of MR-Linac devices in radiotherapy departments. The tools required to these ART strategies such as auto-segmentation, deformable image registration, calculation of the daily dose or dose accumulation, are also described. Implementing an ART strategy requires a rigorous quality assurance process, at each stage and on the entire workflow, as well as prior organization and training from of all the trades. A strong multidisciplinary involvement is finally required in order to ensure ART treatments.     

Évaluation de la qualité de vie en oncologie

Sans résumé     

État des lieux et perspectives de la protonthérapie

Proton beam therapy is indicated as a treatment for some rare tumours and paediatric tumours because the technique allows a good local control with minimal toxicity; the growing number of centres that use proton beam therapy is associated with an increase of dosimetric and clinical data for other malignant tumours as well. This paper reviews potential indications of proton beam therapy. A systematic review on Medline was performed with the following keywords proton beam therapy, cancer, heavy particle, charged particle. No phase III trial has been published using proton beam therapy in comparison with the best photon therapy, but numerous retrospective and dosimetric studies have revealed an advantage of proton beam therapy compared to photons, above all in tumours next to parallel organs at risk (thoracic and abdominal tumours). This could be accompanied with a better safety profile and/or a better tumoural control; numerous phase 0, I, II, III and IV studies are ongoing to examine these hypotheses in more common cancers. Use of proton beam therapy is growing for common cancers within clinical trials but some indications could be applied sooner since in silico analysis showed major advantages with this technique.     

Imagerie protonique pour la protonthérapie : état de l’art

Proton therapy allows a highly precise tumour volume irradiation with a low dose delivered to the healthy tissues. The steep dose gradients observed and the high treatment conformity require a precise knowledge of the proton range in matter and the target volume position relative to the beam. Thus, proton imaging allows an improvement of the treatment accuracy, and thereby, in treatment quality. Initially suggested in 1963, radiographic imaging with proton is still not used in clinical routine. The principal difficulty is the lack of spatial resolution, induced by the multiple Coulomb scattering of protons with nuclei. Moreover, its realization for all clinical locations requires relatively high energies that are previously not considered for clinical routine. Abandoned for some time in favor of X-ray technologies, research into new imaging methods using protons is back in the news because of the increase of proton radiation therapy centers in the world. This article exhibits a non-exhaustive state of the art in proton imaging.     

État des lieux des organisations de la prise en charge psychologique dans les réseaux et recommandations de la SFPO

In 2007, the SFPO (French Psycho-Oncological Society) created a Care Network Commission, which was to conduct a two-year survey regarding the organization of psychological management within 148 oncology and palliative care networks in France. The results demonstrate the need for trained psychologists. We here present some of the SFPO recommendations on this topic.     

Les soins de support: état de la réflexion en France

Le développement progressif des Soins de Support en France, notamment en cancérologie, appelle à la coordination déquipes, parfois existantes depuis de nombreuses années, mais trop peu nombreuses et souvent très fragiles en raison de leur isolement, de leur rattachement administratif aléatoire et du sous-effectif. Cette structuration apparaît nécessaire en raison de la diversité et de la complexité des besoins, dont lévaluation systématique est difficile, pour assurer une véritable prise en charge continue et globale de la personne malade. Les propositions dorganisation des soins de support doivent être adaptées aux dispositifs de soins existants, lanalyse du fonctionnement de ceux-ci constituant le préalable à leur développement et à leur coordination. Cet article non exhaustif vise à décrire létat des lieux actuel des possibilités et des projets dorganisation des soins oncologiques de support en France.     

État de l’art de l’irradiation des ganglions de la chaîne mammaire interne

In the adjuvant breast cancer treatment, postoperative radiotherapy plays a principal part with an action against the microscopic residual disease in the lymph nodes after mastectomy as well as after breast conserving surgery. This positive effect is observed also in the case of small inner lesions in patients without lymph node involvement. At the same time, there is a recognized risk of cardiac toxicity directly related to the irradiation of internal mammary nodes. This paper is a report on the current available techniques to irradiate the internal mammary nodes, including promising new technology that may help limiting the risk of cardiac toxicity.     

État de l’art et perspectives de l’irradiation partielle et accélérée du sein en 2014

In the frame of treatment de-escalation and personalization, accelerated partial breast irradiation is taking its place in the breast cancer therapeutic options. This study analyzed the results of phase III randomized trials having compared accelerated partial breast irradiation versus whole breast irradiation. Currently, among those trails, six proposed some results regarding efficacy and/or toxicity. Globally, the non-randomized studies confirmed the expected results showing a low rate of local recurrence and toxicity. The first results of the phase III randomized trials showed encouraging data in terms of local control while the toxicity varied mainly according to the accelerated partial breast irradiation technique used. However, the follow-up of the majority of these studies remains insufficient. The strict respect of accelerated partial breast irradiation indications likely represents one of the key factors of the therapeutic success. The next results could allow proposing a better definition of the accelerated partial breast irradiation selection criteria.     

État des lieux de la formation des internes français d’oncologie radiothérapie en curiethérapie

PurposeThe goal of this study was to evaluate the interest of the members of the French society of young radiation oncologists (SFjRO) for brachytherapy as well as their theoretical and practical level in this radiation technique.Materials and methodsAn anonymous survey was conducted regarding practical and theoretical teaching of brachytherapy before the French national courses on brachytherapy.ResultsAmong the 106 residents attending this teaching course, 99 (93%) answered the survey. Most of them were interested in brachytherapy but 82% considered they had not received sufficient teaching. Relevant indications of brachytherapy were known by 76% of the residents for gynaecological malignancies and 70% for prostate. Seventy-one percent of the residents have seen at least one gynecological brachytherapy but only 12% knew how to deal with this technique. Fifty-six percent have seen vaginal high dose rate brachytherapy and 21% had acquired the technique. For prostate brachytherapy, 65% had seen and done an implant and only 4% had acquired the technique. Fifty percent have performed at least one brachytherapy treatment during their residency. Residents expressed a strong wish for more courses about dosimetry (82%), technique (75%) and treatment planning (90%).ConclusionOur study shows the interest of French residents for brachytherapy but suggests that practical teaching courses and an evaluation of the existing theoretical courses are warranted.     

Évolution de la curiethérapie en France et perspectives

During the last decade, the organization of brachytherapy in France moved to 62 units in 173 radiotherapy centres in 2009. More than 7500 patients were treated in 2009, quite exclusively with curative intent, for 80% in public or associated hospitals. The techniques improved to high tech 3D dosimetry and optimization of the dose distribution. Brachytherapy, despite representing only 5% of the treatments by irradiation, is a reference treatment for several tumors.     

Évaluation et prise en charge de la toxicité cutanée en cours de radiothérapie

Acute radiation dermatitis remains one of the most commonly observed side effect during radiation therapy leading to complication such as superinfection or treatment disruption. Its management is characterized by a great heterogeneity. Few strategies have demonstrated a benefit in preventing radiation dermatitis, which relies mostly on decreasing dose delivered to the skin and skin care practices. Simple emollients and use of topical steroids can be useful in early stages. The singularity of the skin toxicity seen with cetuximab and radiotherapy warrants a specific grading system and distinctive clinical treatment with use of antibiotics.     

Évolution de la prise en charge des sarcomes de l’enfant et de l’adolescent

Sarcomas in the pediatric and adolescent population are rare. They include “pediatric” sarcomas (e.g., rhabdmyosarcomas), “adult type” soft part sarcomas and bone tumors with a pic incidence around adolescence. Most of them are chemosensitive. Multidisciplinary discussion with pediatric expertise is required before biopsy (INCa recommendations). Local treatment and reconstruction can be challenging in a growing person. Collaboration between pediatric and medical oncologists is fundamental to frontier sarcomas. International collaborations have already increased clinical and therapeutic knowledge for these diseases. Progress remains to be made in biological collections, translation of biological knowledge in adapted clinical trials regardless of age, and early access to new drugs.     

Carcinomes du nasopharynx Aspects cliniques,indications et résultats de la radiothérapie transcutanée et de la curiethérapie État de la question en 2001

Nasopharynx carcinomas (NPC) are a very special head and neck cancer, in term of epidemiology, clinic and pathology. Endemic disease in South East Asia, undifferentiated nasopharynx carcinoma are very frequent CT scan and NMR allow a better knowledge of the modalities of the clinical presentation. Prognostic factors include local and regional extension, NPC is a wellknown radiosensitive disease with a dose-response curve well established. Modern imaging modalities and modification of the ballistic explain the amelioration of the local control and the diminution of therapeutic sequellae. Brachytherapy is an interesting modalities for the boost and the treatment of recurrent disease. The exact place of 3 D CRT and IMRT is not yet known as modifications of fractionation. Local control for T1T2 tumor is excellent but is related to clinical extension (cranial and neurologic involvement) and nodal extension (supra clavicular N3) and show the interest of combined chemo-radiotherapy protocols.     

Évaluation de la qualité de vie en oncologie: II—Méthodes

Résumé: Cet article présente les différentes méthodes dévaluation de la qualité de vie: lentretien ouvert, la mesure standardisée au moyen de questionnaires, lévaluation personnalisée, et évoque les avantages et les inconvénients de chacune dentre elles. Dans une deuxième partie est abordée la longue succession détapes indispensables à la construction et à la validation dun questionnaire standardisé de qualité de vie, montrant la nécessité de toujours recourir à lexpertise des patients concernés par la problématique et celle des soignants familiers du domaine. Les problèmes dadaptation et de validation transculturelle de ces outils sont envisagés. Outre lintérêt de ces instruments pour la recherche clinique est envisagée ici la possibilité de recourir aux outils de qualité de vie pour affiner la démarche clinique individuelle, dans le souci permanent dapprofondir notre compréhension des difficultés et des besoins du patient atteint de cancer.Dossier: «Évaluation de la qualité de vie»