ESTRO consensus guideline for target volume delineation in the setting of postmastectomy radiation therapy after implant-based immediate reconstruction for early stage breast cancer

© 2019 Elsevier B.V. Immediate breast reconstruction (IBR) rates after mastectomy are increasing. Postmastectomy radiation therapy (PMRT) contouring guidelines for target volumes in the setting of IBR are lacking. Therefore, many patients who have had IBR receive PMRT to target volumes similar to conventional simulator-based whole breast irradiation. The aim of this paper is to describe delineation guidelines for PMRT after implant-based IBR based on a thorough understanding of the surgical procedures, disease stage, patterns of recurrence and radiation techniques. They are based on a consensus endorsed by a global multidisciplinary group of breast cancer experts

Radiothérapie par neutrons rapides

Les données radiobiologiques disponibles actuellement indiquent que les rayonnements de transfert linéique d'énergie (TEL) élevé pourraient améliorer le traitement de certaines tumeurs (en particulier, les tumeurs bien différenciées à croissance lente). La radiobiologie a permis d'identifier certains mécanismes responsables de ce gain thérapeutique, comme par exemple la diminution de l'effet oxygène. Panrii les rayonnements de TEL élevé, les neutrons rapides sont les moins coûteux et les plus utilisés en thérapeutique. L'évaluation de l'efficacité de la neutron- thérapie se heurte à deux difficultés: la sélection des patients et la sélectivité physique du faisceau de rayonnement utilisé. Les résultats cliniques actuellement disponibles indiquent cependant que la neutronthérapie constitue une alternative thérapeutique - sinon le meilleur choix - dans les tumeurs bien différenciées à croissance lente, comme les tumeurs des glandes salivaires et les adénocarcinomes prostatiques

Monitoring Surveys in the Context of Covid-19, Published in Belgium and France, in the Light of Health Democracy

Aurore Margat,1 Benoit Pétré,2 Soizic David,1 Daniela Toro Arrocet,1 Vincent de Andrade,1 Cyril Crozet,1 Delphine Kirkove,2 Rémi Gagnayre1 1Education and Health Promotion Laboratory (LEPS), (UR 3412), UFR SMBH, Sorbonne Paris-Nord University, Bobigny, France; 2Department of Public Health, University of Liege, Liège, BelgiumCorrespondence: Aurore Margat, Email [email protected]: The management of a pandemic, such as COVID-19, requires the full participation of citizens. This recent situation has revealed the undermining of user participation in the decision-making process. Thus, this study aims to assess the involvement of users in the design and administration of surveys for health crisis monitoring and to stimulate reflection on information processes shared upstream during the decision-making process.Methods: A literature search was conducted on population monitoring surveys published during the first containment period in Belgium and France between April and May 2020. The selected studies were first analyzed according to a reading grid based on the criteria proposed by the World Health Organization (WHO) for monitoring populations and supplemented by data from a descriptive analysis of the selected studies. Second, with the objective of specifically evaluating the involvement of users in monitoring surveys, this study evaluated the surveys according to the following parameters: content of a study based on themes presented in surveys; inclusion of health literacy (HL); and factors of commitment of the respondents to the survey.Results: A total of 45 studies were selected for final analysis. The majority of the surveys focused on the effect of COVID-19 on well-being. Furthermore, analysis indicated that, in summary, the HL of people concerned as well as the involvement of respondents is poorly considered, which remains limited in terms of the design and administration of the surveys.Discussion: Although the principles of health democracy seemed to have been established, the exceptional regime induced by the epidemic overlooked the observance of such principles. This result indicates the need to reconsider the participation of citizens as real partners in care, including health crisis management.Keywords: COVID-19, health democracy, survey, citizen engagement, health literac

Toxicity at three years with and without irradiation of the internal mammary and medial supraclavicular lymph node chain in stage i to III breast cancer (EORTC trial 22922/10925)

Introduction. The EORTC 22922/10925 trial investigated the potential survival benefit and toxicity of elective irradiation of the internal mammary and medial supraclavicular (IM-MS) nodes Accrual completed in January 2004 and first results are expected in 2012. We present the toxicity reported until year 3 after treatment. Patients and methods. At each visit, toxicity was reported but severity was not graded routinely. Toxicity rates and performance status (PS) changes at three years were compared by χ2 tests and logistic regression models in all the 3 866 of 4 004 patients eligible to the trial who received the allocated treatment. Results. Only lung (fibrosis; dyspnoea; pneumonitis; any lung toxicities) (4.3% vs. 1.3%; p < 0.0001) but not cardiac toxicity (0.3% vs. 0.4%; p = 0.55) significantly increased with IM-MS treatment. No significant worsening of the PS was observed (p = 0.79), suggesting that treatment-related toxicity does not impair patient's daily activities. Conclusions. IM-MS irradiation seems well tolerated and does not significantly impair WHO PS at three years. A follow-up period of at least 10 years is needed to determine whether cardiac toxicity is increased after radiotherapy