Réirradiations des carcinomes épidermoïdes des voies aérodigestives supérieures : indications et résultats

International audienceDespite progress in the management of head and neck squamous cell carcinoma (HNSCC), a significant proportion of patients previously irradiated for head-and-neck cancer will develop locoregional recurrence or a second primary. Because of the heterogeneity of this population with respect to disease-related factors (localization, volume, recurrence or second primary, time interval from previous irradiation.. .) and patient-related factors (comorbidities, sequelae of previous irradiation.. .), the optimal reirradiation treatment remains to be defined. Salvage therapy using reirradiation, despite some encouraging results, has historically been avoided because of concerns regarding toxicity. The results of more recent studies using contemporary treatment techniques and conformal delivery methods such as intensity modulated radiation therapy (IMRT) or stereotactic radiotherapy (SBRT) have been somewhat more promising. The aim of this review is to discuss the reirradiation of HNSCC in terms of patient selection and modern radiotherapy techniques.Malgré les progrès dans la prise en charge des carcinomes épidermoïdes des voies aérodigestives supé-rieures (VADS), de nombreux patients vont développer une récidive en territoire irradié ou un second primitif. Devant la très grande hétérogénéité de ces patients, des facteurs liés à la maladie (localisa-tion, volume, récidive ou second primitif, intervalle depuis la première irradiation, etc.), des facteurs liés au patient (comorbidités, séquelles de la première irradiation.. .), les indications sont posées au cas par cas. Les données historiques de réirradiation, bien que rapportant des données d'efficacité parfois encourageantes, font état de taux de toxicité de grades 4 et 5 importants. Avec la généralisation récente des techniques de radiothérapie plus précises et mieux conformées comme la radiothérapie confor-mationnelle avec modulation d'intensité (RCMI) ou la radiothérapie stéréotaxique (SBRT), le rapport bénéfice/risque de la réirradiation a évolué ces dernières années. L'objectif de cette revue est de faire le point sur les réirradiations des carcinomes épidermoïdes des voies aérodigestives supérieures en termes de sélection de patients, et de techniques modernes de radiothérapie. © 2019 Société franç aise de radiothérapie oncologique (SFRO)

The effects of hurricane Lothar on habitat use of roe deer

6 pagesInternational audienceHurricanes profoundly modify the structure of forests, affecting the habitat quality of forest dwelling ungulates. For browsers in European forests the effects are expected to be positive in the short-term due to increased availability of browse, but the data to test this prediction are rarely available. In this study, data on home ranges and habitat use were collected both before and after the passage of the hurricane Lothar for six female roe deer. Deer switched from using both coppice- and timber stands to living almost only in timber stands, where most of the damage occurred. Sizes of their home ranges declined sharply (on average by >50%). These results suggest that the effect of this winter hurricane was short-term improvement in the quality of deer habitat

Aging characterization of different nitrile butadiene rubbers for sealing in a pneumatic system: Linking the change of the physicochemical state to the mechanical properties

International audienceNitrile butadiene rubbers (NBR) are widely used in sealing applications, such as O-rings inside the pneumatic system of the French high-speed train (TGV). In this application, a strong hardening of the NBRs alters the sealing function. Predicting the evolution of the mechanical properties during service life, especially the material hardening, is therefore a strategic issue to optimize time in maintenance operations of the TGV's pneumatic system. The main goal of this study is to reproduce the aging observed on a train's pneumatic system by performing thermo-oxidative accelerated aging tests with different commercial nitrile rubbers at several temperatures and up to 2016 h. After achieving similar degradation to specimens aged on trains, aging mechanisms and effects have been investigated through different characterization techniques: infrared spectroscopy, swelling tests, X-ray fluorescence spectrometry, differential scanning calorimetry, thermogravimetric analysis, and micro-hardness measurements. The results obtained enabled us to identify and to relate aging mechanisms to aging conditions and to precisely determine and quantify the effects of physicochemical state evolution on the mechanical properties of each NBR considered. Extra crosslinks and oxidative functionalities form in the different elastomers, making them hard and brittle, and thus impacting the sealing function

Thermo-mechanical aging of NBR: application to O-rings used in the braking system of the French high-speed train

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Chimioradiothérapie concomitante des cancers des voies aérodigestives supérieures. Faut-il revoir les contraintes de dose dans les organes à risque ?

International audienceConcurrent chemoradiotherapy improves the outcome of locally advanced head and neck cancers and the current reference chemotherapy is cisplatin. These results are obtained at the cost of increased toxicities. To limit the risk of toxicity, organ at riskdose constraints have been established starting with 2D radiotherapy, then 3D radiotherapy and intensity-modulated radiotherapy. Regarding grade ≥3 acute toxicities, the scientific literature attests that concurrent chemoradiotherapy significantly increases risks of mucositis and dysphagia. Constraints applied to the oral mucosa volume excluding the planning target volume, the pharyngeal constrictor muscles and the larynx limit this adverse impact. Regarding late toxicity, concurrent chemoradiotherapy increases significantly the risk of postoperative neck fibrosis and hearing loss. However, for some organs at risk, concurrent chemotherapy appears to increase late radiation induced effect, even though the results are less marked (brachial plexus, mandible, pharyngeal constrictor muscles, parotid gland). This additional adverse impact of concomitant chemotherapy may be notable only when organs at risk receive less than their usual dose thresholds and this would be vanished when those thresholds are exceeded as seems to be the situation for the parotid glands. Until the availability of more robust data, it seems appropriate to apply the principle of delivering dose to organs at risk as low as reasonably achievable

Impact of the method chosen for the analysis of recurrences after radiotherapy for head and neck cancers: volume-based, point-based and combined methods

International audienc

Proposition de sélection et délinéation des volumes cibles anatomocliniques tumoraux et ganglionnaire pour la radiothérapie des cancers de la glande sous-mandibulaire

International audienc

Proposition de délinéation des volumes cibles tumoraux et sélection des aires ganglionnaires des cancers de la glande parotide

International audienceSalivary glands tumours are uncommon tumours showing a large diversity of histological types. This article presents a synthesis of patterns and paths of invasion of parotid glands tumours in order to propose an approach of the delineation of primary tumour clinical target volumes and of the selection of lymph nodes target volumes. This article does not discuss treatment indications but defines clinical target volumes to treat if radiotherapy is indicated. Postoperative situation being the most frequent, the delineation of primary tumour clinical target volume is based on an anatomical approach.Les cancers des glandes parotides sont des tumeurs rares, comprenant une grande diversité de formes histologiques. Cet article propose une synthèse des voies d’extension de ces tumeurs afin de proposer une approche de la délinéation des volumes cibles tumoraux anatomocliniques à haut et faible risques et de la sélections des aires ganglionnaires à traiter. Il ne traite pas des indications de radiothérapie mais des volumes à traiter si celle-ci est retenue. La délinéation du volume cible anatomoclinique péritumoral repose sur une approche principalement anatomique du fait de la situation postopératoire, qui est la plus fréquente