Quality of life in ENT cancers

Head and neck cancer carcinomas have poor prognosis and their treatment yield heavy sequellae. Specific psychological features enhance difficulties occurring in the improvement of quality of life during and after treatment. Physicians and nurses must inform both patient and his family before treatment. After treatment of advanced tumors, respiration, swallowing are often impaired and cosmetic results in face and neck may be poor. When possible, rehabilitation as acquiring oesophageal speech for laryngectomees improve quality of life. When palliative treatment is only possible, quality of life is deeply damaged: difficulty of medical care, lack of communication, worsening lead to loneliness and sometimes rejection.     

Ongoing Protocols for Non-AIDS Primary Central Nervous System Lymphoma

The optimal treatment for primary central nervous system lymphoma (PCNSL) remains undefined. In this paper, we review the main multi-institutional ongoing protocols for PCNSL. Most of the current protocols evaluate the efficacy of combination high-dose methotrexate-based chemotherapy and brain irradiation in phase II studies. Some trials focus on chemotherapy alone as initial treatment, in order to minimize long-term cognitive sequellae. Because old age appears as a major predisposing factor for combined RT and CT neurotoxicity some specific protocols have been proposed to this particular population.     

Measuring economic outcomes of cancer

Economic outcomes are increasingly important in cancer research. This article provides an introduction to the nature and measurement of economic outcomes in cancer and gives the reader entry points to a considerable literature on measuring economic endpoints in health and medicine. Economic outcomes data are defined here as measures of resources consumed in prevention, detection, and treatment of cancer and its sequellae. Part I of this essay discusses the questions addressed by economic outcomes. Part II presents a typology of and introduction to measurement of economic outcomes. Part III discusses important measurement issues and calls for development and validation of standardized protocols and questionnaires to measure economic outcomes, especially at the patient level.     

Le contrôle local de la tumeur primitive. Étape indispensable de la guérison des cancers

There is clear evidence for a cancer cure. The hypothesis behind a treatment with curative intent is the ability to eradicate all the cancer cells of a tumour. Out of three cancer deaths, one is related to local failure. In some cancers like breast carcinoma, death is mainly in relation with the development of distant metastases. Even in such a tumour, an improvement in local control can translate as better survival. Radiationtherapy, often in association with surgery, is playing a major role in tumour local control. Such a local control is mandatory if cure is at aim. One of the main goals of clinical research is to find a good compromise between local control of the disease and a non mutilating surgical approach.     

Long-term survival of patients treated for small cell bronchial cancers

Three to 15% of the whole population of patients with small cell lung carcinoma are long-term survivors. In a view of preventing iatrogenic sequellae and obtaining a better definition of therapeutic indications, the prognostic factors in this population will be defined.     

Effets tardifs des radiations ionisantes sur le testicule

Most of the basic data regarding the effect of radiation on the testis are issued from animal studies. They demonstrate the extreme radiosensitivity on the germ cell lineage but little is known about the reversible or definitive aspects of these radiation induced effects. In man, the late non stochastic effects of radiation to the testicule are mainly related to persisting spermatogenesis disturbances or/and hormone related problems. Morphological, physiological, radiobiological specificities of the human testis along with numerous parameters depending on radiation conditions make it difficult to evaluate the late effects and radiation tolerance doses. Evaluation of such effects based on a common scale for therapeutic radiation schedules would improve the present understanding and possibly prevent the occurrence of these delayed effects, for the benefit of patients.     

Hormonoradiothérapie exclusive dans la prise en charge du cancer du sein de la personne âgée : cas clinique et revue de la littérature des schémas hypofractionnés

Normofractionated radiotherapy is standard for adjuvant management of patients treated with breast conservative surgery for breast cancer. However, many elderly patients are not eligible to such strategy, either because of concurrent diseases, or because the tumor is inoperable. Several protocols of exclusive radiotherapy have been reported in the literature, frequently using hypofractionated radiotherapy and endocrine therapy. We report a case of a patient treated with exclusive endocrine and radiotherapy and address the state of the art on hypofractionated schemes for the management of elderly breast cancer patients. While hypofractionated radiotherapy does not compromise the oncologic or cosmetic outcome, there is no prospective data that assesses the place of radiotherapy for the exclusive treatment of elderly patients. This strategy should be further assessed in clinical randomized trial.     

Radiotherapy of sarcomas of the soft tissue in the adult

Clinical experience has proved henceforth that radiotherapy must be considered as an integral part of the treatment of adult soft tissue sarcomas. When combined with surgery, it considerably reduces the local recurrence rate and increases the long term cure rate to about 70%. Such results can be achieved with the minimal impeding sequellae when the dose of irradiation is adjusted following the quality of the surgical excision. A dose of 50 Gy is sufficient when no microscopic tumoral foci are left in the tumor bed by the surgeon. It must be higher when it is not the case. The residual metastatic risk is about 30%. We begin to know better which factors are linked to this risk. Clinical research is under way to assess the value of adding chemotherapy in the protocol of high risk patients.     

Chimioradiothérapie concomitante dans la stratégie thérapeutique des adénocarcinomes du pancréas exocrine et de l'estomac

The prognosis of pancreatic adenocarcinoma remains poor, with a 5-year survival rate lower than 5%. Resection, the gold standard treatment, can be performed in less than 10% of patients. Following surgery, the median survival is 12 months for the most favorable cancer patients. Concomitant chemoradiation, as an adjuvant treatment is superior to surgery alone, in terms of survival; controlled trials are currently performed. Neoadjuvant chemoradiation is a new approach, potentially able to increase survival and resection rate. This work justifies the role of these schemes, in terms of modalities and potential advantages. A second part is dedicated to gastric carcinoma, with a review of the current results of chemoradiation, whose efficiency, even though a trend can be observed, remains to be proven. Prospective adjuvant combined treatments are ongoing, in France and in the States.     

La protonthérapie : avenir de la radiothérapie ? Première partie : aspects cliniques

Proton beam therapy uses positively charged particles, protons, whose physical properties improve dose-distribution (Bragg peak characterized by a sharp distal and lateral penumbra) compared with conventional photon-based radiation therapy (X-ray). These ballistic advantages apply to the treatment of deep-sited tumours located close to critical structures and requiring high-dose levels. [60–250 MeV] proton-beam therapy is now widely accepted as the “gold standard” in specific indications in adults – ocular melanoma, chordoma and chondrosarcoma of the base of skull – and is regarded as a highly promising treatment modality in the treatment of paediatric malignancies (brain tumours, sarcomas…). This includes the relative sparing of surrounding normal organs from low and mid-doses that can cause deleterious side-effects such as radiation-induced secondary malignancies. Other clinical studies are currently testing proton beam in dose-escalation evaluations, in prostate, lung, hepatocellular cancers, etc. Clinical validation of these new indications appears necessary. To date, over 60,000 patients worldwide have received part or all of their radiation therapy program by proton beams, in approximately 30 treatment facilities.     

La nutrition dans la prise en charge des cancers ORL

The nutritional care of patients suffering from cancer of the aerodigestive tract is essential from diagnosis through to any possible sequellae. Before treatment, screening for severe malnutrition must take place, based on simple clinical and biological tests, so as to identify patients presenting nutritional risk factors, which require special care. Enteral nutrition during the postoperative period should cover the needs of the patient: 35 kcal/kg per day including 0.2 g of nitrogen/kg per day, but often these guidelines are not properly followed. The benefits of immunonutrition are yet to be demonstrated in head and neck cancer, both in surgery and radiochemotherapy. All patients treated with radiotherapy should be monitored with respect to diet from the very beginning: food tips and oral supplements can prevent or delay the necessity for a gastrostomy tube for enteral nutrition at home, without which treatment program is not feasible if there is any weight loss. Finally, functional disorders resulting from treatment, with nutritional impact and significant consequences on quality of life, can persist once treatment ends and lasts for long periods, sometimes even indefinitely. Prospective studies are underway to improve their management or even prevent these repercussions.     

Chimioradiothérapie des carcinomes des voies aérodigestives supérieures

The objective of this study was to review randomized trials which evaluated the effect of the radio-chemotherapy in head and neck carcinoma, and which compared radiotherapy alone vs the same local treatment plus chemotherapy. Over 40 such randomized trials have been performed, which generally showed no statistical difference between both arms. However few trials showed a benefit which is almost always in favor of the CT arm. Indeed, some trials of concomitant chemoradiotherapy have shown a statistically significant benefit in favor of the combined treatment. On the contrary, neoadjuvant chemotherapy generally leads to no detectable benefit compared to radiotherapy alone. These results have been reinforced by those of four randomized trials comparing neoadjuvant chemoradiotherapy and the same chemotherapy but given concomitantly with radiotherapy. The global effect of chemotherapy on survival of patients with head & neck sqamous cell carcinoma has been recently evaluated by a meta-analysis based on individual patient data which included more than 10,000 patients from 63 randomized trials. The absolute survival rate benefit at 5 years is 4%, but is more pronounced in the concomitant combinations (8% at 5 years). In tumors classified as “T3” of the pharyngo-larynx, neoadjuvant chemotherapy followed by radiotherapy in good responders can avoid a total laryngectomy without significantly compromised survival. In the nasopharynx carcinoma, a few randomized studies have been performed, suggesting a benefit in favor of chemoradiotherapy. Finally, future randomized trials will determine what are the optimal chemoradiotherapy schedules, as well as determining what is the best radiotherapy (accelerated, hyperfractionated) to use in combination with chemotherapy.     

Radiotherapy-chemotherapy combinations

The combination of radiotherapy (RT) and chemotherapy (CT) has markedly improved the therapeutic results for those tumors which are both chemosensitive and radiosensitive, such as lymphomas, embryonal tumors, small cell lung carcinomas, breast cancers, etc. Despite some spectacular results reported following non-controlled studies, a significant increase in the total survival or the relapse free survival has never been documented in controlled trials in head and neck, anal, ovarian carcinomas. However, in these tumors, a combination of RT and CT may reduce the mutilations and sequellae caused by the treatment and may induce an increase in the survival in some subsets of patients. Further clinical research is needed along these lines. Cross resistance between ionizing radiation and cytotoxic drugs has recently become an important area for experimental research. This cross resistance appears to be relatively infrequent but possible, the best method for circumventing its occurrence is the delivery of both modalities as early as possible during the course of the treatment. This early administration is one of the aims of the integrated alternating regimen which has been developed in Villejuif since 1980. The results obtained in small cell lung carcinoma and non-Hodgkin lymphomas of a poor histologic type are remarkable. In cervix cancers and inflammatory breast cancers, no significant improvement in survival has yet been observed. In those four types of cancers, the early and late tolerance is acceptable and no untoward toxic effect has been identified.     

Fibromatosis of Thyroid Gland-A Case Report

Fibromatosis covers a broad group of benign fibrous tissue proliferations of varied microscopic appearances that are intermediate in their biological behaviour between bengin fibrous tumour and fibrosarcoma, Extra abdominal fibromatosis in the neck occassionally cause serious sequellae when aggressive invasion of vital structure occurs. However, the principle of wide excision is difficult to apply in some patients because of the important organs surrounding the tumour. We describe a primary spindle cell tumour of thyroid that raised initial diagnostic problems and was eventually diagnosed as fibromatosis of thyroid gland.     

Prognostic role of ERCC1 in advanced non-small-cell lung cancer: a systematic review and meta-analysis

Background

Observational studies have demonstrated an association between excision repair cross-complementation group 1 (ERCC1) expression level and health outcomes in patients with advanced non–small-cell lung cancer (NSCLC) treated with platinum-based regimens. This analysis presents pooled estimates of association from these studies to better elucidate the prognostic role of ERCC1 in advanced NSCLC.

Methods

A systematic literature search was conducted using the MEDLINE, EMBASE, and American Society of Clinical Oncology (ASCO) annual meeting databases from June 1995 to December 2010. Included studies were evaluated for clinical, methodological, and statistical heterogeneity. Pooled analyses were conducted using fixed and random effects models.

Results

In high ERCC1 expression versus low ERCC1 expression patients, pooled analysis results demonstrated a significantly lower response (risk ratio [RR], 0.80, 0.66-0.98) and significantly higher risk of death (hazard ratio [HR], 2.04, (1.48-2.80)), respectively. Subgroup analyses demonstrated significant heterogeneity in outcomes by ERCC1 measurement method (I²: 90.7%, P = 0.001) and patient population ethnicity (I²: 66%, P = 0.003).

Conclusion

This study's findings support the hypothesis that ERCC1 expression is associated with response rate and overall survival (OS) in patients with advanced NSCLC treated with platinum-based chemotherapy. Heterogeneity in subgroup analyses demonstrates the need for standardized methods to classify ERCC1 expression level, studies evaluating the association between ERCC1 expression and OS in non-Asian populations, and studies evaluating interaction between ERCC1 and other known prognostic factors in advanced NSCLC.     

Effets tardifs des radiations ionisantes sur la vulve, le vagin et l'utérus

Reporting and scoring complications after radiotherapy of gynaecological cancers is difficult because of the variety of treatment techniques involved. Use of an international classification is necessary to compare results obtained in series of patients treated in different institutions. An international group of experts designed in the early nineties the so-called French-Italian glossary. This classification of late effects is now completed with the new LENT SOMA scales. This paper contains details of these late changes, including their pathophysiology, clinical syndromes, potential treatment, and prevention.     

Respiratory sequellae after alternated chemotherapy and radiotherapy for small cell anaplastic cancer

The authors analyze the respiratory sequelae in 19 patients with limited small cell lung carcinoma who survived for more than 30 months following an alternating chemo-radiotherapeutic combined regimen. The clinical tolerance measured with respiratory functional test is acceptable. In two patients an effort dyspnea is increased by evolutive, chronic obstructive bronchopneumopathy. Radiologic sequellae are constant and correlated with the volume of irradiation and cumulative etoposide doses. The role of a combined chemo-radiotherapeutic in pulmonary toxicity is discussed.     

Glioblastome et myxome radio-induits après traitement d’un carcinome indiffencié du nasopharynx

Radio-induced tumor have been known for a long time to occur after treatment of cancer during childhood. This entity is exceptional following radiotherapy of the cavum. Skull and facial osteosarcoma were described after treatment of UCNT. We report two observations of radio-induced tumors arising, respectively three and seven years after treatment of UCNT. The first one is a temporoparietal glioblastoma and the second is a rhino- and pharyngeal myxoma. The two patients are alive after treatment of the second tumor. The delay of appearance of these tumors, their situation in the field's irradiated and dose received suggests their radio-induced nature. However, the cytogenetic study is necessary to confirm the implication of radiotherapy in the genesis of these cancers.     

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.