Efficacité et tolérance à long terme d'une technique de radiothérapie par faisceau d’électrons après une mastectomie sans reconstruction de la paroi thoracique et des ganglions lymphatiques pour les cancers du sein non métastatiques

International audiencePurpose: To evaluate the long-term tolerance and outcome of patients irradiated with an electron beam technique used since 2007 on the chest wall and lymph node areas after mastectomy for non-metastatic locally advanced breast carcinoma. Patients and methods: All patients irradiated with an improved electron beam technique after mastectomy for non-metastatic breast carcinoma between 2007 and 2011 at Institut Curie (France) were included in this descriptive study. The technique has already been described in other studies, as has its 5-year tolerance and non-inferiority compared to photon irradiation. Acute and chronic toxicity were collected using CTCAE v 3.0. A clinical examination was carried out each week during the radiotherapy and at each 6 months consultation with one mammogram per year at the Institut Curie for at least 5 years. The patients then continued to be followed either at the Institut Curie or in private practice with a good transmission of outpatient consultations, thanks to a system of forms to be completed and integrated into the electronic files. Quantitative and qualitative data are defined by mean and proportion. Statistical comparisons were made by computer using the Chi2 test and Fisher's exact test for categorical variables. Recurrence-free survival was defined as the time between the end of treatment and the date of recurrence or death. Overall survival was defined in the same way without taking into account recurrences. Patients who did not report any events were censored at the date of last news. Results: Of the 796 patients included, 51.3% had multifocal lesions, 10.1% had triple negative status, and 18.8% displayed overexpression of the Her2 receptor, 196 (24.6%) patients received neoadjuvant chemotherapy and 208 (26.1%) systemic treatment during radiotherapy (chemotherapy or targeted therapy); 514 (64.6%) had at least one positive lymph node. The internal mammary chain (IMC) was irradiated in 85.6% of cases, the supraclavicular areas in 88.3% of cases, the infraclavicular in 77.9% of cases and the axillary area in 14.9% of cases. With a median follow-up of 113 months (range: 2–164 months), locoregional recurrence-free survival and overall 10-year survival was respectively 94.02%, (95% CI: 92.13–98.94) and 79.84% (95% CI: 76.83–82.97). Median survival was not reached. In the long term, 29.6% of patients had telangiectasias (grade 1: 23.3%, grade 2: 5.2%, grade 3: 1.1%). There were 279 patients (35.1%) with secondary breast reconstruction on average 21 months after all treatments. IMC irradiation was not associated with a majority of pulmonary toxicity. Thirty-five patients developed chronic heart disease after radiotherapy, 30 of whom had received anthracyclines and 9 had received traztuzumab. Three of these reported a coronary ischaemic event, including 2 irradiated on the left and 1 on the right, the 4 were irradiated in the vicinity of the IMC and the other lymph node areas, but presented many other cardiovascular risk factors (between 2 and 4). During follow-up, 4.9% of patients had a contralateral recurrence (n = 39) and 5.5% had a second non-breast cancer (n = 44), of the 6 bronchopulmonary cancers diagnosed, none appeared to be related to chest wall radiotherapy. Conclusion: This study confirms that the improved postmastectomy electron beam radiation therapy technique is well-tolerated after nearly 10 years of follow-up

Optimisation of microencapsulation efficiency of propolis phenolic compounds by double emulsion method using response surface methodology

Abstract The aim of this study was to optimise the microencapsulation efficiency of propolis phenolic compounds by double emulsion solvent evaporation technique (W 1 /O/W 2 ). The solvent/sample ratio and the polymer and surfactant concentration parameters were optimised using response surface methodology (RSM) through Box–Behnken Design (BBD). For each parameter studied, total phenolic content encapsulation efficiency (TPCEE), free radical scavenging activity (DPPH), and ferric reducing antioxidant power (FRAP) were evaluated. The results showed that the optimal parameters were: 31.60 mg mL −1 for sample/solvent ratio, 606.28 mg mL −1 for poly(ε-caprolactone) (PCL) concentrations, and 2.05 g mL −1 for poly(vinyl alcohol) (PVA) concentration. The optimum values obtained were: 84.62% for encapsulation efficiency of phenolic content, 51.89% for DPPH, and 48,733 mg Trolox Equivalent/100 g dry weight for FRAP. The experimental checking of results revealed the validity of elaborated models and their suitability for the prediction of both responses. The developed mathematical models have expressed a high level of significance through RSM optimisation processes for phenolic antioxidants of propolis

Helical Tomotherapy for Inoperable Breast Cancer: A New Promising Tool

Background. We investigated the feasibility of helical tomotherapy (HT) for inoperable large breast tumors, after failing to achieve adequate treatment planning with conformal radiation techniques. Material and Methods. Five consecutive patients with locally advanced breast cancer (LABC) were treated by preoperative HT. All patients received up-front chemotherapy before HT. Irradiated volumes included breast and nodal areas (45–50 Gy) in 4 patients. One patient received a simultaneous integrated boost (55 Gy) to gross tumor volume (GTV) without lymph node irradiation. Acute toxicity was assessed with Common Toxicity Criteria for Adverse Events v.4. Patients were evaluated for surgery at the end of treatment. Results. Patients were staged IIB to IIIC (according to the AJCC staging system 2010). HT was associated in 4 patients with concomitant chemotherapy (5-fluorouracil and vinorelbine). Two patients were scored with grade 3 skin toxicity (had not completed HT) and one with grade 3 febrile neutropenia. One patient stopped HT with grade 2 skin toxicity. All patients were able to undergo mastectomy at a median interval of 43 days (31–52) from HT. Pathological partial response was seen in all patients. Conclusions. HT is feasible with acceptable toxicity profiles, potentially increased by chemotherapy. These preliminary results prompt us to consider a phase II study