Critères de qualité en radiothérapie des cancers de la tête et du cou sous l’égide de l’Intergroupe ORL

The aim of radiotherapy is to deliver enough radiation to the tumor in order to achieve maximum tumour control in the irradiated volume with as few serious complications as possible with an irradiation dose as low as possible to normal tissue. The quality of radiotherapy is essential for optimal treatment and quality control is to reduce the bias in clinical trials avoiding possible major deviations. The assurance and quality control programs have been developed in large european (EORTC, GORTEC) and american cooperative groups (RTOG) of radiation oncology since the 1980s. We insist here on the importance of quality assurance in radiotherapy and the current status in this domain and the criteria for quality control especially for current clinical trials within GORTEC are discussed here.     

Mise au point sur l’inhibition de la voie Ras-MAPK : les inhibiteurs de Mek

The Ras/Raf/Mek/Erk pathway is a key component of tumor progression and modulates proliferation, survival, differenciation and angiogenesis. Hyperactivation of this pathway is highly implicated in tumorigenesis especially by gain of function mutation of Kras or Braf. Mek position at the end of the pathway seems to be a promising new therapeutic target in the Kras or Braf mutated cancers. In this review, we aimed at describing the Ras/Raf/Mek/Erk pathway, the new therapeutic approaches in solid tumors and their toxicities. However, there seems to be predictives factors of tumor responses to these new agents and mechanisms of resistance that we will tend to analyse.     

Délinéation des cancers de la cavité buccale et de l’oropharynx

The aim of this article is to present the determination and the delineation of target volumes for oral cavity and oropharyngeal carcinomas treated with intensity-modulated irradiation. The delineation on the computerized tomography scanner (CT scan) requires a precise method because of the complexity of the head-and-neck anatomy. Different elements are necessary: clinical examination, diagram of the initial tumor, surgical and pathological reports and medical imaging (CT scan, magnetic resonance imaging and fluorodeoxyglucose positron emission tomography). The clinical target volumes, the planning target volumes, the organs at risk and the planning organs at risk volumes are discussed. The concept of selectivity of the potential subclinical disease near the primary tumour and the selection of neck nodal targets are specified according to the literature.     

Mise au point sur les tumeurs non urothéliales de la vessie

Nonurothelial bladder tumors frequently present a diagnostic and therapeutic challenge. This is due to the rarity of this histological type of tumors representing less than 5% of all bladder lesions combined. A large number of risk factors have been implicated in the etiology of squamous cell carcinoma, yet their pathomechanism remains poorly defined. Treatment is usually based on surgery. We report a literature review summarizing the available evidence on the etiology, diagnosis, and optimal management of malignant nonurothelial tumors.     

Cancers de l’ovaire : la biologie moléculaire

Ovarian tumours comprise a heterogeneous group of lesions, initially classified on morphological bases. We report herein the newly described molecular abnormalities in carcinomas and sex cord stromal tumours of the ovary. Molecular findings corroborate the morphological classification, leading to a phenotypic/genotypic classification of these tumours. Biomarkers such as immunohistochemical antibodies and molecular testing help pathologists in their everyday practice. Our better understanding of molecular bases of ovarian tumours represents the first step in the development of targeted therapies, in near future.     

Mise en place de l’audit patient traceur au sein d’un centre privé de radiothérapie

The “tracer patient” audit is an evaluation method introduced by the French health authority in the V2014 certification. This is not mandatory in private radiotherapy centres. In our continuous quality improvement approach and in order to improve the management of patient care, the management of our radiation therapy centre has decided to use this method to evaluate our medical practice and to engage healthcare professionals at the core of this approach.     

Cancers de la sphère ORL chez les patients séropositifs pour le virus de l’immunodéficience humaine

Among HIV-infected patients, head and neck cancer incidence has increased over the last few years. Head and neck cancer treatment in HIV-infected patients does not differ from the general population but those patients are exposed more frequently to radiation severe toxic effects and need close monitoring during chemoradiotherapy treatment. Close cooperation between oncologist and infectiologist is crucial to eventually adjust antiretroviral therapy. Like general population, HIV-infected patients should be advised to avoid excessive alcohol consumption and tobacco smoking.     

Évolution des concepts dans les cancers des voies aérodigestives supérieures,sous l’égide de l’Intergroupe ORL (GORTEC,GETTEC, GERCOR)

Head and neck cancers are the fifth among the most common cancers in France. Two thirds of cases occur at an advanced stage. For advanced disease, progression-free survival, despite undeniable progress, remains below 50% at three years. The last 20 years have been marked by the necessity to identify situations where less intense surgery and/or radiotherapy and/or chemotherapy is possible without jeopardizing the prognosis, and situations where a therapeutic intensification is necessary and results in a gain in survival while better preserving function with less toxicity. French cooperative groups gathering radiation oncologists (GORTEC), surgeons (GETTEC) and medical oncologists or physicians involved in the management of systemic treatments in head and neck cancers (GERCOR) are now belonging to the INCa-labelled Intergroup ORL to deal with the challenges of head and neck cancers.     

Impact pronostique et thérapeutique de la différenciation neuroendocrine au sein de l’adénocarcinome prostatique: mise au point

Neuroendocrine prostate cancer is a histologically rare variant. Neuroendocrine differentiation in prostate cancer has received an increasing amount of attention over the last few years due to its prognostic and therapeutic implications. Neuroendocrine differentiation is present in at least 10% of all prostate adenocarcinomas. Yet today, its impact on the prognosis and the treatment of prostate cancer is still the subject of great debate. Currently, it is considered as a poor prognosis factor, involved in hormone resistance. Hormone resistance transition mechanisms are extremely complex and the tumour develops in a microenvironment. Neuroendocrine differentiation is currently considered as a poor prognosis factor, involved in this hormone resistance. Treatment of this hormone resistant disease is likely to combine several approaches. The understanding of these different mechanisms is the key to the development of more effective therapies for hormono-resistant prostate cancers.     

Cancers de la cavité buccale chez les sujets jeunes : résultats thérapeutiques et analyse de facteurs pronostiques

PurposeSquamous cell carcinomas of the oral cavity occurring in young people represent a specific entity. Its management and prognosis are controversial. We performed a retrospective chart review of all patients aged less than 40 years old and treated at Gustave-Roussy Cancer Centre for a squamous cell carcinomas of the oral cavity between 1999 and 2011.MethodsPatients and tumour characteristics, type of treatment and follow-up data were collected. Survival data were analysed according to the methods of Kaplan-Meier and both univariate and multivariate analyses were performed to look for prognostic factors regarding overall survival and progression-free survival.ResultsSixty-three patients were identified. Median follow-up was 64 months. Most of the tumours were initially located in the mobile tongue (n = 54, 85.7%). Overall 17 patients had died, including 15 from the treated cancer. Overall and progression-free survival rates at 5 years were respectively 79.6% and 68.6%. The corresponding 5 years local, regional and metastatic relapse free survival rates were 80%, 91% and 89% respectively. In the multivariate analysis only the absence of initial surgery (hazard ratio [HR]: 13.5 [2.0; 90.5]; P = 0.007) was prognostic for overall survival, while alcohol abuse (HR: 0.37 [0.15; 0.9]; P = 0.03) and the absence of surgery (HR: 13.6 [2.5; 74.2]; P = 0.002) were associated with a decreased progression-free survival. A younger age (less than 30 year old) was not associated with the risk of recurrence or death.ConclusionSurvival rates and tumour control probabilities are relatively high among young patients suffering from squamous cell carcinomas of the oral cavity treated at a tertiary centre. The early identification of patients at risk of relapse is currently difficult. The balance between recurrence and treatment toxicity warrants further studies, both on the clinical level and for the development of prognostic biomarkers.     

Le cancer au risque de l’éthique

In our western countries, medically, the cancer was taken care probably never as well as today. The cancer is less and less a fatal disease, more and more a chronic disease. Who will complain about it? Probably not the patient, but maybe society, confronted with impossible economic choices, and which could be well tried by the appeal to the euthanasia when it will be legalized. From then on, that there will stay some ethics of the care? Will it be necessary a next day to choose between cancer and ethics?     

Cancer differencié de la thyroïde de l’enfant

Thyroid carcinoma is a rare disease in children, and is mostly of the papillary histological type. Lymph node metastases are frequent at diagnosis, being present in 23 to 74% of the cases and can reveal the cancer in about one fourth of cases. Lung metastases are present at initial diagnosis in 6 to 20% of cases. The main known risk factor for thyroid cancer is a previous history of radiation exposure. Treatment includes surgery with total thyroidectomy and lymph node dissection and radioiodine therapy in case of extensive disease and distant metastases. Life-long thyroxine treatment is given to all patients. Long term prognosis is favourable, but thyroid cancer related deaths have been reported some decades after initial treatment.     

Cancers solides de l’enfant au Togo: aspects épidémiologiques et histopathologiques à propos de 365 cas observés au CHU Tokoin de Lomé

Childhood cancers are rare. The aim of our work was to describe the epidemiological and histological aspects of these tumors in Togo. We made a retrospective review of the epidemiologic and pathologic features of solid cancers in childhood (less than 15 years), observed from 1984 to 2008 at the laboratory of pathology of the Tokoin Teaching Hospital in Lomé, Togo. During our study period, we observed 365 cases of childhood solid cancers that represent 7% of all cancers. The average age of occurring was 8.1 years and the sex-ratio was 1.5. Histologically, it was non-Hodgkin lymphomas in 51.5% of cases (including 27.9% of Burkitt lymphoma), Hodgkin disease in 9.3% of cases, and retinoblastoma in 8.5% of cases. This study showed that childhood solid cancers are frequents in Togo dominated by Burkitt lymphoma.