Personnalisation de la dose et du fractionnement de la radiothérapie des cancers de la tête et du cou

Head and neck cancers comprise a variety of tumours depending on the sub-site, for which target volumes and the prescribed doses need to be individualized according to each patient's history and presentation. This article aims at describing the main factors involved in decision-making regarding dose and volume, as well as ongoing research. Contouring and treatment guidelines, use of altered fractionation, major prognostic factors, the role of Human papillomavirus and of functional imaging will be presented and discussed.     

Place de la prostatectomie radicale dans le traitement curatif du cancer de la prostate: à propos de 91 cas

Objective

To study the role of radical prostatectomy in the treatment of prostate cancer.

Patients and methods

It was a retrospective multicenter study of 5 years on 91 radical prostatectomies performed at Medico-Surgical Center le Bois of Chaumont in France and at Notre-Dame-de-la-Paix in Burkina Faso.

Results

In 5 years, 91 patients underwent radical prostatectomy with curative intent, 85 at Medico-Surgical Center le Bois in France and 6 at Notre-Dame-de-la-Paix in Burkina Faso. Their average age was 66.52 years. Clinically, the patients were classified as stage A (2.2%) or B (98.8%) of Whitemore-Jewett. The average PSA (prostatic specific antigen) was 9.25 ng/ml. Endorectal ultrasound, CTabdominopelvic bone scan, magnetic resonance imaging, and histology of biopsy pieces were able to classify all patients as T1a to T2b N0M0. It was adenocarcinoma, and the average Gleason score was 6. Surgical treatment was radical prostatectomy. After pathologic study of surgical specimens, 2.2% were classified as pT1, 76.92% pT2, 21.92% pT3, and 1.10% pT4. The rate of PSA, six months after radical prostatectomy, was undetectable in 81.32%. In addition to radical prostatectomy, patients received hormone therapy (4 cases), radiation therapy (9 cases), and radiotherapy-hormone therapy (2 cases). The operative mortality was zero. The average length of hospital stay was 8 days. Complications such as seromas (6.60% patients), erectile dysfunction (47.25%), urinary incontinence (32.97%), and acute retention (2.2%) were noted. The 3-year survival rate was 78.33% after radical prostatectomy alone and 100% after radical prostatectomy associated with radiotherapy and/or hormone therapy.

Conclusion

Radical prostatectomy allowed to control prostate cancer, and it requires early diagnosis. The addition of radiotherapy and/or hormone therapy optimizes the prognosis.     

L’évolution de la curiethérapie du cancer de prostate

Curietherapy, more commonly named brachytherapy, is one of the oldest irradiation techniques used for prostate cancer. Prostate brachytherapy evolved according to the scientific and technological progress. After a historical reminder of the evolution of prostate brachytherapy, different technical aspects are discussed: low-dose rate brachytherapy using permanent or temporary implants, high-dose rate brachytherapy as well as new imaging modalities. Prostate brachytherapy indications are listed regarding to the evidence-based medicine data for low, intermediate and high risks prostate cancers. Potential indications and new research programs (focal therapy, high-dose rate, single-dose brachytherapy) are also presented.     

Marges en radiothérapie du cancer de la vessie

Radical cystectomy is the gold standard treatment of invasive bladder carcinoma, but conservative treatment is a serious option for selected patients. It comprises a transurethral resection, as complete as possible, before a radiation therapy of the whole bladder and pelvis, with a concomitant chemotherapy. Bladder wall movements during the treatment course lead to the use of wide margins to cover the clinical target volume. Planning target volume margins must be anisotropic to correspond to the mobility of each bladder zone: 10 mm in the inferior portion, 15 mm in lateral directions, and 20 to 25 mm in anterior and superior directions. The development of image-guided radiotherapy and adaptative radiotherapy should lead to a reduction of these margins. Besides, partial bladder radiotherapy is showing encouraging results, by reducing the clinical target volume in well-selected patients.     

Perspective socio-anthropologique de la prise en charge de la dénutrition du malade cancéreux

The diet of the cancer patient is a major focus of prevention and treatment strategy of the recent plans that fight against cancer. It is sometimes reduced to a rapid series of more or less general advice, often interfered by other sources of information, more or less conventional. In this pathological situation where the nutritional status of the patient is paramount, it seems crucial to understand the different modalities of how the food behavior is implemented. This article describes the construction modalities of the cancer eater decisions. The goal of the socio-anthropological analysis proposed in this article is to initiate a reflection on the under nutrition problem by focusing on the approach of the eater diagnosed with cancer. The aim is to help identify ways of action to fight against under nutrition and improve the quality of life of the patient.     

Expérience guinéenne de la chirurgie conservatrice du cancer du sein

Objective

To evaluate the first results of conservative breast cancer surgery in surgical oncology unit of Donka University Hospital, Conakry, Guinea.

Patients and methods

Between 2007 and 2012, 140 surgical interventions for breast cancer were performed. In the present study, we report the case of 12 patients who underwent conserving breast surgery for breast cancer stages I (4), IIA (2) and IIB (6). The indication was based on the stage and the initial diagnostic procedure. In case of correlation between clinical examination, mammography and pathological review, quadrantectomy axillary dissection (QAD) were performed. If the tripod was discordant, a QAD was indicated in the case of lymphadenopathy or a quadrantectomy in the absence of axillary lymphadenopathy. Depending on the result of the histological examination of the surgical specimen, adjuvant chemotherapy and radiotherapy were recommended. Neoadjuvant chemotherapy was administrated for tumours whose size was greater than 3 cm. Thus, the following treatments were performed: QAD (8 cases), quadrantectomy (4 cases), neoadjuvant chemotherapy (3 cases), adjuvant chemotherapy (7 cases) and radiotherapy (6 cases). Post-operative complications, local control and survival of patients were studied.

Results

Postoperative complications observed for 3 cases were as follows: seroma (3 cases), breast lymphedema (2 cases), dysesthesia in the inner face of arm (1 case) and cosmetic sequelae of breast surgery (1 case). The magnetic resonance imaging of the remaining breast showed a residual suspected tumour in only 1 out of 6 cases. This patient underwent a radical mastectomy secondarily. After a median follow up of 32.0 months, all patients were alive without recurrence.

Conclusion

The newly introduced conserving breast surgery in Guinea is an effective alternative for the treatment for early diagnosed breast cancer. It must obey the respect resection margins and consider aesthetic imperatives.     

Place de la prosthodontie maxillo-faciale dans la prévention du patient irradié

Tumors of the upper aerodigestive tract (ADT) are the most frequent tumors in the world, and among the tumors of the ENT sphere, the frequency of cancers of the oral cavity occupies the third place after that of the larynx and oropharynx. The treatment of these pathologies is heavy and complex. It is the result of a combination of several interventions, namely surgery, radiotherapy and chemotherapy. Among the consequences of radiotherapy, we can mention the embrittlement of dental tissues, osteoradionecrosis, stenosis of muscular tissues or radiomucitis of oral mucosal tissues. All these complications encourage the preparation of the patient before radiotherapy in order to mitigate the consequences and prevent complications. Through this work, we illustrate the place of maxillofacial prosthodontics in the prevention of the irradiated patient, through several prosthetic, medical or medicinal means.     

Quelle imagerie pour la prise en charge de la rechute biochimique du cancer de la prostate : TEP ou IRM ?

Major improvements in the field of radiotherapy planning such as stereotactic radiation therapy, have recently been performed, aiming to the development of personalized therapeutic strategies in patients with biochemical failure of prostate cancer. However, this needs an early and accurate location of sites of recurrence. Development of multimodality magnetic resonance imaging (MRI) and positron emission tomography (PET) permits to consider this objective. Thus, it is worthwhile to apprehend the respective performance of these imaging techniques in order to rationalize their use. We propose a review of the recent literature organized by technique and by location, regarding the performance of multimodality MRI and PET for restaging of patients with biochemical failure of prostate cancer initially treated with curative intent.     

Irradiation de la tumeur primitive en cas de cancer du sein métastatique synchrone

Synchronous metastatic breast cancer accounts for 5 to 6% of all breast cancers in Western countries, which corresponds to nearly 2500 new cases per year in France. Irradiation of the primary tumour in cases of metastatic disease at diagnosis was historically reserved for palliative indications. However, progress in systemic treatments, a better understanding of the biological basis of metastatic dissemination, the genesis of the concept of oligometastatic disease and ablative treatments directed towards metastases are revolutionizing the management of patients with de novo stage IV breast cancer. Survival of these patients has improved markedly over the years, and several studies have investigated the carcinological benefit of local treatment of the breast tumour in patients with advanced diseases at diagnosis. This article provides an update on the role of irradiation of the primary tumour in breast cancer with synchronous metastases, and discusses its interest through published or ongoing trials.     

Prise en charge du cancer du sein infiltrant de la femme non ménopausée

Recommandations / Recommendations

Prise en charge du cancer du sein infiltrant de la femme non ménopausée     

Historique de la leucémie myéloïde chronique : un paradigme de traitement du cancer

During two centuries, advances in medicine and medical research have helped to understand the pathophysiology of chronic myelogenous leukemia (CML). This hematologic malignancy is a unique model of oncogenesis where a single molecular hit, causing cell proliferation and survival, was identified. The chromosomal abnormality first highlighted by P. Nowell and D. Hungerford in 1960, and characterized as the reciprocal translocation t(9;22)(q34;q11), the Philadelphia chromosome, discovered in leukemic cells, by J. Rowley in 1973. At the end of the 20th century, the contribution of molecular biology techniques was crucial by the discovery of the BCR-ABL1 hybrid oncogene derived from the t(9;22), responsible for the translation of an aberrant protein tyrosine kinase. This BCR-ABL1 kinase deregulates signaling pathways that control normal cell cycle and survival in primitive hematopoietic cells and is thus responsible for malignant cell accumulation observed in CML. It was then only necessary to develop a targeted treatment adapted to this molecular hit. Recently, tyrosine kinase inhibitors, by their specific inhibitory activity of BCR-ABL, have revolutionized the treatment of CML, allowing rates of haematological, cytogenetic and molecular responses never seen to date, and has significantly improved the overall survival and the quality of life of patients.     

Représentations sociales du cancer et de la chimiothérapie : enjeux pour la définition de la situation thérapeutique

This research studies social representations of cancer and chemotherapy with patients (N = 62) and of oncologists (N = 26) in a medical oncology unit. The collection of the data was made from free association tasks (concerning cancer and chemotherapy) and attitude questions concerning chemotherapy. Patients also had to produce representations “for” oncologists and conversely. Results indicate a variety of representations marked by the status of sample (patients versus oncologists). The stressful component of the disease is very present. Contrary to the patients, oncologists seize relatively well the representation, which the patients have of concerning cancer and chemotherapy. Patients’ representations are connected with phenomena of belief that give evidence for some process of anticipation and expectation linked to the experience of illness and testify the emotional charge related to it. The study of the representations is particularly relevant to highlight the psychosocial stakes associated with the therapeutic situation.