International comparison of cosmetic outcomes of breast conserving surgery and radiation therapy for women with ductal carcinoma in situ of the breast

Purpose: To assess the cosmetic impact of breast conserving surgery (BCS), whole breast irradiation (WBI) fractionation and tumour bed boost (TBB) use in a phase III trial for women with ductal carcinoma in situ (DCIS) of the breast. Materials and methods: Baseline and 3-year cosmesis were assessed using the European Organization for Research and Treatment of Cancer (EORTC) Cosmetic Rating System and digital images in a randomised trial of non-low risk DCIS treated with postoperative WBI +/- TBB. Baseline cosmesis was assessed for four geographic clusters of treating centres. Cosmetic failure was a global score of fair or poor. Cosmetic deterioration was a score change from excellent or good at baseline to fair or poor at three years. Odds ratios for cosmetic deterioration by WBI dose-fractionation and TBB use were calculated for both scoring systems. Results: 1608 women were enrolled from 11 countries between 2007 and 2014. 85-90% had excellent or good baseline cosmesis independent of geography or assessment method. TBB (16 Gy in 8 fractions) was associated with a >2-fold risk of cosmetic deterioration (p

[Neutron Therapy - From Radiobiological Expectation To Clinical Reality]

The radiobiological data presently available indicate that high linear energy transfer (LET) radiation could bring a benefit in the treatment of some types of rumours (typically, slowly-growing, well-differentiated tumours). Radiobiology also suggests some mechanisms through which this benefit could be achieved: hypoxic gain factor, kinetic gain factor, etc. Among the high-LET radiations, fast neutrons are the least expensive and the most widely used in therapy. Two main difficulties are encountered when reviewing the clinical results of fast neutron therapy: patient selection and physical selectivity. Despite these caveats, the currently available clinical results indicate that neutrontherapy is an alternative treatment - if not the best choice - for well-differentiated, slowly-growing rumours, such as salivary gland rumours and prostatic adenocarcinomas

Breast cancer in elderly women: can radiotherapy be omitted?

It is tempting to spare elderly women the burden of adjuvant radiotherapy after breast cancer surgery, even if such a treatment would be justified in light of the available clinical evidence. The reason is that evidence-based radiotherapy derives from clinical trials that excluded elderly women, and that breast cancer is often believed to be more indolent at advanced ages. Unfortunately, the epidemiological evidence, and the few clinical trials recruiting patients over 65 or 70 year of age, all point to the need for postoperative irradiation in a similar set-up as in younger patients. So far, there is no evidence that a subgroup exists in which radiotherapy can be safely omitted. Therefore, the decision to treat or not to treat should be openly discussed with the patient, addressing risks and benefits of both attitudes. Only in frail patients, with an obviously limited life expectancy (months or at most a few years), can omission of radiotherapy be considered, as the burden of local recurrence is likely not to appear before the patient dies from an other cause

Traitement par radiothérapie des néo-vaisseaux sous-rétiniens rétrofovéolaires liés à l'âge

Thirty-three patients who underwent low dose of radiation therapy for subfoveal choroidal membranes were studied after a mean follow-up of 16 months. The evaluated parameters were the visual outcome and the choroidal neovascularization evolution. In this study, the efficacy of low-dose radiation delivered to the macular region as an alternative treatment in subfoveal membrane was limited

Dramatic response of recurrent invasive thymoma to high doses of corticosteroids.

We report the case of a widely invasive thymoma non-associated with myasthenia gravis which responded only to high doses of corticosteroids. We review the other few reported cases of complete response achieved by this treatment and we stress the possible use of high doses of corticosteroids in the management of recurrent invasive thymoma

Malignant lymphoma in systemic rheumatic diseases. A report of five cases.

We describe five patients suffering from systemic rheumatic diseases who developed a malignant lymphoma. Two patients, one with systemic lupus erythematosus and another with systemic necrotizing vasculitis, suffered from Hodgkin's disease and three other patients, one with lupus and two with Sjögren's syndrome, developed non-Hodgkin's lymphoma. Only one of these patients had been treated with immunosuppressive drugs before the onset of the lymphoproliferative malignancy. Four patients were given combination chemotherapy and complete remission was achieved in the three patients for whom follow-up data were available. We discuss the relationships between systemic rheumatic diseases and lymphoma