The Youngest Victims: Children and Youth Affected by War

In 1989, the United Nation Convention on the Rights of the Child declared, “[state parties] shall take all feasible measures to ensure protection and care of children who are affected by an armed conflict.” In addition to attempting to secure the welfare of children in armed conflict, the Convention went on to ban the recruitment and deployment of children during armed conflict. Despite the vast majority of sovereign nations signing and ratifying this agreement, this treaty, unfortunately, has not prevented children and youth from witnessing, becoming victims of, or participating in political, ethnic, religious, and cultural violence across the past three decades. This chapter offers an “ecological perspective” on the psychosocial consequences of exposure to the trauma of war-related violence and social disruption

Complications cardiaques de la radiothérapie:thèse présentée pour le diplôme d'État de docteur en médecine, diplôme d'État, mention D.E.S oncologie option radiothérapie

Médecine (oncologie option radiothérapie)La radiothérapie mammaire peut provoquer une cardiopathie radio-induite. Des études récentes suggèrent que cette complication peut survenir précocement et que des lésions cardiaques infracliniques peuvent être détectées, tels qu’un déficit perfusionnel myocardique. La technique la plus utilisée pour l'irradiation du cancer du sein est la radiothérapie à champ tangentiel opposé. Cependant, elle expose l'artère coronaire interventriculaire antérieure à une dose élevée au cours de l'irradiation mammaire gauche. Des techniques d’irradiation permettent de réduire l’exposition cardiaque telles que : - La radiothérapie en inspiration profonde bloquée - La radiothérapie conformationnelle tridimensionnelle avec modulation d'intensité (RCMI). Nous proposons une étude prospective monocentrique incluant 58 patientes pour évaluer l'utilité de l’inspiration bloquée et de la RCMI, comme moyen de prévenir l’apparition de troubles perfusionnels myocardiques chez les patientes traitées pour un cancer du sein gauche, en utilisant la scintigraphie myocardique d'effort et si besoin de repos.Radiation-induced heart disease can occur with breast radiotherapy. Recent studies suggest that this complication may occur early and that subclinical cardiac lesions may be detected, such as myocardial perfusion deficit. The most used technique for breast cancer irradiation is opposite tangential field radiotherapy. However, it exposes the left anterior descending artery to a high dose during left breast irradiation. Irradiation techniques that reduce cardiac exposure include - Deep inspiration breath-hold (DIBH) radiotherapy - Three-dimensional conformal radiotherapy with intensity modulation IMRT. We propose a single-centre prospective study including 58 patients to evaluate the usefulness of DIBH radiotherapy and IMRT as a means of preventing the development of myocardial perfusional disorders in patients treated for left breast cancer, using stress and, if necessary, rest myocardial scintigraphy.Thèses et écrits académique

Should the management of radiation therapy for breast cancer be standardized? Results of a survey on current French practices in breast radiotherapy

Background: Breast cancer is the most frequent cancer in women in France. Its management has evolved considerably in recent years with a focus on reducing iatrogenic toxicity. The radiotherapy indications are validated in multidisciplinary consultation meetings; however, questions remain outstanding, particularly regarding hypofractionated radiotherapy, partial breast irradiation, and irradiation of the internal mammary chain and axillary lymph node area. Materials and methods: An online survey was sent to 47 heads of radiotherapy departments in France. The survey consisted of 22 questions concerning indications for irradiation of the supraclavicular, internal mammary and axillary lymph node areas; irradiation techniques and modalities; prescribed doses; and fractionation. Results: Twenty-four out of 47 centers responded (response rate of 51%). This survey demonstrated a wide variation in the prescribed dose regimen, monoisocentric radiotherapy, and indications of irradiation of the lymph node areas. Conclusion: This survey provides insight into the current radiotherapy practice for breast cancer in France. It shows the need to standardize practices

Proton Therapy and Gliomas: A Systematic Review

Background: Gliomas are primary cerebral tumors. Radiation therapy plays a key role in their treatment but with a risk of toxicity associated with the dose to and volume of normal tissue that is irradiated. With its precision properties allowing for the increased sparing of healthy tissue, proton therapy could be an interesting option for this pathology. Methods: Two reviewers performed a systematic review of original papers published between 2010 and July 2021 following PRISMA guidelines. We analyzed disease outcomes, toxicity outcomes, or dosimetry data in four separate groups: children/adults and individuals with low-/high-grade gliomas. Results: Among 15 studies, 11 concerned clinical and toxicity outcomes, and 4 reported dosimetry data. Proton therapy showed similar disease outcomes with greater tolerance than conventional radiation therapy, partly due to the better dosimetry plans. Conclusions: This review suggests that proton therapy is a promising technique for glioma treatment. However, studies with a high level of evidence are still needed to validate this finding

Nuclear medicine imaging methods of early radiation-induced cardiotoxicity: a ten-year systematic review

International audienceIntroductionRadiotherapy has significantly improved cancer survival rates, but it also comes with certain unavoidable complications. Breast and thoracic irradiation, for instance, can unintentionally expose the heart to radiation, leading to damage at the cellular level within the myocardial structures. Detecting and monitoring radiation-induced heart disease early on is crucial, and several radionuclide imaging techniques have shown promise in this regard. MethodIn this 10-year review, we aimed to identify nuclear medicine imaging modalities that can effectively detect early cardiotoxicity following radiation therapy. Through a systematic search on PubMed, we selected nineteen relevant studies based on predefined criteria. ResultsThe data suggest that incidental irradiation of the heart during breast or thoracic radiotherapy can cause early metabolic and perfusion changes. Nuclear imaging plays a prominent role in detecting these subclinical effects, which could potentially serve as predictors of late cardiac complications.DiscussionHowever, further studies with larger populations, longer follow-up periods, and specific heart dosimetric data are needed to better understand the relationship between early detection of cardiac abnormalities and radiation-induced heart disease.</jats:sec

Efficacity of Deep Inspiration Breath Hold and Intensity-Modulated Radiotherapy in Preventing Perfusion Defect for Left Sided Breast Cancer (EDIPE): A Prospective Cohort Study Protocol

Breast radiotherapy can lead to radiation-induced cardiac disease, particularly in left breast cancers. Recent studies have shown that subclinical cardiac lesions, such as myocardial perfusion deficits, may occur early after radiotherapy. The primary method for irradiating breast cancer, known as opposite tangential field radiotherapy, can cause the anterior interventricular coronary artery to receive a high dose of radiation during left breast irradiation. To explore alternative approaches that could reduce the risk of myocardial perfusion defects in patients with left breast cancer, we plan to conduct a prospective single-center study using a combination of deep inspiration breath hold radiotherapy and intensity modulated radiation therapy. The study will use stress and, if necessary, resting myocardial scintigraphy to assess myocardial perfusion. The trial aims to show that reducing the cardiac dose with these techniques can prevent the appearance of early (3-month) and medium-term (6- and 12-month) perfusion disorders