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 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.     

Nutrition parentérale à domicile chez la personne âgée atteinte d’un cancer : une étude observationnelle prospective

IntroductionMalnutrition is a bad prognostic factor that reduces the quality of life (QoL) in patients with cancer. The objective was to assess the impact of home parenteral nutrition (HPN) on the QoL of elderly malnourished patients with cancer.Patients and methodsThis French prospective observational study included patients, aged 70 years or older, with cancer, for whom HPN was prescribed for at least 14 days. The patient, the physician and a family member or home caregiver had to fill in a questionnaire at inclusion and 28 days later.ResultsIncluded patients (n=221) were mainly suffering from a digestive cancer. After HPN intake, improved weight was noticed in 68% and 14% of patients had reached the target weight. Improved global QoL was reported in 59% of patients. Physicians noticed a significant improvement for the same compounds.ConclusionThese results suggest a benefit of the HPN on the nutritional status and QoL in elderly patients with cancer. Further controlled randomised trials are needed to prove the benefit of HPN in the routine management of these patients.     

Cancer épithélial évolué de l’ovaire de la patiente âgée: quel état des lieux suite à la Conférence internationale de Vancouver?

Introduction

We have not enough knowledge on the standard treatments of ovarian cancer in the elderly, in terms of feasibility, tolerance and efficacy, because of their relative under representation in clinical trials.

Discussion

The standard treatment of ovarian cancer is radical surgery followed by chemotherapy. However, there is a small proportion of elderly women in clinical trials and the real efficacy of standard, platinum/taxanes-based chemotherapy, is not precisely defined. It is necessary to integrate co-morbidity and vulnerability of the elderly persons, to better anticipate which kind of chemotherapy and surgery should be performed and for which patients, by combining, as in the PACE study for example, tools of evaluation of the surgical risks with components of the geriatric assessment.

Conclusion

Currently available data allows us to discriminate between “fit??and “frail??patients; the former being able to tolerate standard procedures, and the latter being at higher risk of toxicity and impaired life-expectancy. Different questions should be asked in collaborative trials for each population, respectively.     

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.     

Quelle plateforme pour prendre en charge de façon personnalisée le cancer bronchique ?

Considerable progress has been achieved in the understanding of lung cancer biology. Molecular driver mutations have been identified and different targeted therapies have been developed. Thus, the management of small size biopsies is essential and needs a strong collaboration between the different medical partners, particularly pulmonologist, pathologist, molecular biologist and oncologist. The aim is to optimise histological and molecular analyses allowing patients access to novel biotherapies. The French National Cancer Institute set up platforms for molecular genetics at university hospitals with expertise in molecular and pathological analysis. Mutational status of EGFR is analyzed routinely in non-small lung cancer. Treatment with EGFR inhibitors as first line therapy is limited to lung cancer patients harboring an EGFR mutation. More recently, ALK rearrangements have been identified as a rare driver mutation in lung cancer. Crizotinib, an ALK inhibitor is a new therapeutic standard in ALK rearranged tumors. Other biomarkers as RAS, BRAF, HER2 or PIK3CA have potential clinical relevance with possible approval of novel tailored treatment and will be discussed in this report. The project "BIOMARQUEURS France" will underscore the results of the French platform of more than 15 000 French patients.     

Cancer et socio-esthétique: évaluation psychologique des changements de l’image du corps grâce au dessin de la personne

People suffering from cancer often experience a significant deterioration of body image. The purpose of our research is to explore qualitatively the psychological impact of a beauty therapy practice on patients suffering from various types of cancers, especially as far as body image is concerned. This study is illustrated by the case of Annie. We met this patient before she started any beauty therapy practice and we have followed her during her care time (4 cares and 3 meetings altogether). Each meeting is the subject of a partially guided interview and of the realization of drawings of the person answering three different instructions (thus 3 drawings for 3 meetings). The drawing of the person, a real clinical tool, allows comparison of real and unconscious speeches. Our evolutive approach enabled us to address Annie’s feelings about her beauty therapy, in relation to her painful experience of the disease. The impact of such a practice throughout the comprehensive medical care of this patient has been evaluated.     

Repérage, clinique et évaluation de la dépression en oncologie: collaboration psychiatre, psychologue et cancérologue

Depression is often encountered in oncology with practical clinical implications and yet remains underestimated. Its impact on patient’s quality of life and coping with the disease and its treatment are not to be neglected. A specific symptomatology of depression in oncology makes its screening more uncertain and advocates for a rigorous assessment. The objectives of this workshop, through clinical vignettes, will be to better grasp the specific semiology of depressive disorders in the oncologic field. Communication and interview skills allowing detection and depression screening will be proposed. A pluridisciplinary approach of this disorder will be illustrated by confronting psychiatrist, psychologist, and oncologist point of view. A reflection about how to optimize depression screening will be done in order to make the caregivers aware of this problem.     

Spécificités de la prise en charge du CBNPC chez les sujets âgés

Non-small cell lung cancer (NSCLC) is a very common disease of the elderly, and its incidence is expected to increase in Western countries because of the ageing of the population. Despite this, data available to challenge elderly patients with NSCLC are limited compared to younger patients. International recommendations have been published but they are difficult to apply because of the lack of consensual definition of frailties relevant to make decision of treatment and to adapt it. The purpose of this article is to synthesize the published data available to challenge elderly patients with NSCLC at various stages: early, locally advanced and inoperable, and metastatic. We also discuss data about the use of comprehensive geriatric assessment.     

Radiothérapie en conditions stéréotaxiques : étude prospective évaluant la fatigue et la qualité de vie

PurposeTo evaluate prospectively asthenia and the quality of life in patients treated by stereotactic body irradiation and to determine their predictive factors.Methods and materialsQuality of life was assessed by the EORTC QLQ-C30 and asthenia was evaluated with the Brief Fatigue Inventory (BFI), on the first day (T1), last day (T2) and 1–3 weeks after the end of treatment (T3).ResultsSixty-three patients were treated with stereotactic body irradiation from February 2017 to May 2017 and 41 were included in the analysis (22 patients excluded for lack of understanding, organization, psychologic disorders or refusal). The mean number of fractions was 5 (± 2). The compliance to quality of life assessment was 98%, 95% was 81% at T1, T2 and T3, respectively. An increase of asthenia and a worsened quality of life were found in 12 (29%) and 14 (34%) patients between T1 and T2. Univariate analysis demonstrated a correlation between asthenia and quality of life were correlated with performans status (P = 0.03 and 0.05 respectively), hemoglobin level (p = 0.01 and 0.004), albumin level (P = 0.01 and 0.06), distance between home and radiotherapy department (P = 0.05 and 0.02). Multivariate analysis demonstrated a correlation between female gender (P = 0.012), albumin level (P < 0.001), distance over 25 km (P < 0.001) with asthenia, and albumin level (P = 0.003), hemoglobin level (P = 0.004) and previous chemotherapy (P = 0.003) with quality of life. No influence of stereotactic body ratiotherapy parameters was seen.ConclusionDespite hypofractionation, stereotactic body radiotherapy induced asthenia and deterioration of quality of life.     

Trouble bipolaire et cancer : particularités de la prise en charge

Bipolar disorder is a common psychiatric disorder characterized by mood fluctuations. Bipolar disorder is not a risk factor of cancer but bipolar patients often have lifestyle and daily habits that can increase the risk for cancer. When bipolar patients have been diagnosed with cancer, they need a sustained psychiatric follow-up and support because of the distress due to the diagnosis of cancer or to the side effects of some treatments used in oncology (corticotherapy, chemotherapy, interferon...), which can lead to a destabilization of mood and alter the treatment of cancer. Most people with bipolar disorder are prescribed psychoregulators, but these treatments have to be used with caution in the case of cancer comorbidity, keeping in mind their interferences and the cumulative effects with current cancer treatments. Consultation-Liaison psychiatrists play a major role in the follow-up and the surveillance of these patients, in collaboration with oncologists, general practitioners, and also patient’s families.