Les lymphomes gastriques : place du traitement conservateur (étude rétrospective d'une série de 109 patients traités àl'Institut Bergonié de 1970 à 2000)

Préciser à partir d'une étude rétrospective et d'une revue de la littérature, les facteurs pronostics des lymphomes gastriques et évaluer l'efficacité ainsi que la toxicité aiguë et tardive de la radiothérapie dans le traitement conservateur des lumphomes gastriques. De 1970 à 2000, 109 patients ont été traités à l'Institut Bergonié pour un lumphome gastrique, par traitement conservateur associant chimiothérapie et radiothérapie. Le stade a été défini selon la classification d'Ann-Arbor modifiée par Musshoff. Tous les examens anathomo-pathologiques ont été classés selon la classification de l'OMS et de la classification des lymphomes extra-ganlionnaires de la zone marginale de type MALT d'Isaacson, 36 patients avaient un lymphomes de MALT de faible malignité et il était localisé pour 32 patients et disséminé pour 4 patients. Les lymphomes de haute malignité représentent 52 patients dont le stade était localisé pour 33 patients et disséminé pour 19 patients. Un groupe de 21 patients à été constitué, il rassemble les histologies rares. Il est composé de 10 stades localisés et 11 stades disséminés. Dans notre série, tous les patients ont reçu une chimiothérapie de type CHOP ou CVP, 73 patients ont été traités par radiothérapie complémentaire avec une dose médiane de 40 Gy. 19 patients ont été opérés par gastrectomie. Pour l'ensemble de la population, le taux de rémission complète est de 68,8% et la survie globale est 59,8% à 5 ans. En analyse univariée, les facteurs pronostics statistiquement significatifs sont pour la rémission complète comme pour la survie : le stade de type histologique, l'index de Karnofsky, le nombre de localisation extra glanglionnaire, l'IPI, le taux de LDH et le taux de Bêta-2microglobuline. La survie globale à 5 ans des lymphomes de faible malignité est de 93,7% et 69,4% pour les lymphomes de haute malignité. La radiothérapie n'entraîne aucune roxicité aiguë dans 18,5% des cas. Elle est de grade 1-2 pour 41,5% des patients. Les complications de grade3-4 surviennent dans 15,4% des cas. Seulement 3% des patients ont présenté une hémorragie digestive ou une perforation gastrique. 7 patients ont eu une toxicité tardive grade 3-4. 5 d'entre eux ont été opérés par préalablement par gastrectiomie. En comparaison aux données de la littérature, le traitement conservateur a toute sa place dans le traitement des lymphomes gastrique du fait de son efficacité. La toxicité aiguë de la radiothérpie est modérée. La toxicité tardive est rare et en rapport pour les grades 3-4 avec la gastrectomie réalisée avant la radiothérapie.BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La radiothérapie des affections bénignes: Quelles indications huit ans plus tard?

The authors present an update version of the indications for radiotherapy in the management of benign diseases. This is based on available randomized trials and recent international meetings. Validated indications remain the prevention of resected heterotopic bone ossifications, keloïds scars and pterygium and also treatment of arteriovenous malformations; the place of radiotherapy for malignant exophtalmia is more and more restricted. Randomized trials have demonstrated the efficacy of endobrachytherapy in the prevention of restenosis after angioplasty but the use of embedded stent has replaced this indication. Macular degeneration is no more an indication of radiotherapy. Quality requirements for radiotherapy are identical for benign or malignant indications. © 2005 Elsevier SAS. Tous droits resérvés.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Acute and late toxicities of patients infected with SARS-CoV-2 and treated for cancer with radiation therapy during the COVID-19 pandemic

International audienc

Clinical and technical challenges of cancer reirradiation: Words of wisdom

International audienceSince the development of new radiotherapy techniques that have improved healthy tissue sparing, reirradiation (reRT) has become possible. The selection of patients eligible for reRT is complex given that it can induce severe or even fatal side effects. The first step should therefore be to assess, in the context of multidisciplinary staff meeting, the patient's physical status, the presence of sequelae resulting from the first irradiation and the best treatment option available. ReRT can be performed either curatively or palliatively to treat a cancer-related symptom that is detrimental to the patient's quality of life. The selected techniques for reRT should provide the best protection of healthy tissue. The construction of target volumes and the evaluation of constraints regarding the doses that can be used in this context have not yet been fully codified. These points raised in the literature suggest that randomized studies should be undertaken to answer pending questions

High-dose-rate vs. low-dose-rate interstitial brachytherapy boost for anal canal cancers

International audienceThe purpose of this study was to analyze and compare clinical outcomes of low-dose-rate (LDR) and high-dose-rate (HDR) interstitial brachytherapy boost (ISBT) after EBRT or radio chemotherapy for the treatment of anal canal cancers

Lessons from radiochemotherapy and modern image-guided adaptive brachytherapy followed by hysterectomy

International audiencePurpose: To analyze the clinical outcomes and the safety of radiochemotherapy (RCT) and image-guided adaptive brachytherapy (IGABT) and to evaluate the impact of hysterectomy (HT) as completion of treatment for cervical cancer.Methods and materials: 145 patients with locally advanced cervical cancer were treated at our institution. Patients underwent RCT and IGABT, then hysterectomy (HT) as completion of treatment was performed, with the exception of patients with surgical contraindications, para aortic metastatic disease or patients who refused surgery. Clinical outcomes and morbidity were retrospectively reviewed in both groups. Local relapse free survival (LRFS), pelvic relapse free survival (PRFS) and overall survival (OS) were analyzed.Results: Completion HT was performed in 90 (62.1%) patients. Complete histological response and microscopic disease were found in 77 patients (85.6%). Local relapse was observed in 14 patients (9.6%) without differences between completion HT group and the definitive RCT and IGABT group (Odds Ratio OR = 1.73 [0.57-5.23], p = 0.33). The estimated 3-year LRFS and PRFS for the entire population were respectively 90% [84%-94%] and 93% [87%-96%], with no significant differences between them (respectively Hazard Ratio HR = 0.57 [0.20-1.64], p = 0.30 and HR = 0.37 [0.10-1.31], p = 0.12). The estimated 3-year OS rate for the whole population was 84% [75%-91%] with no significant differences between groups (HR = 0.81 [0.32-2.06], p = 0.65). Regarding morbidity, grade ≥ 2 vaginal toxicity was more frequent in the definitive RCT and IGABT group (43.6% vs 26.7%, p = 0.04). All grade 4 toxicity events were reported in the completion HT group.Conclusions: Due to high severe toxicity, RCT and IGABT with dose escalation followed by completion hysterectomy don't seem compatible. No benefit and increased severe late morbidity were observed. Combined intracavitary/interstitial technique is mandatory in large target volume at brachytherapy

Post-lockdown management of oncological priorities and postponed radiation therapy following the COVID-19 pandemic: Experience of the Institut Curie

International audienc

Efficacy and Safety of Combined Brain Stereotactic Radiotherapy and Immune Checkpoint Inhibitors in Non-Small-Cell Lung Cancer with Brain Metastases

Background: To analyze the outcomes of patients with brain metastases (BM) from non-small cell lung cancer (NSCLC) treated with immunotherapy (IT) and stereotactic radiotherapy (SRT) and to study the impact of the sequence between the two modalities. Methods: The authors reviewed the records of 51 patients with 84 BM from NSCLC treated at Institut Curie with IT and SRT. BM were categorized into three groups: ‘SRT before IT’, ‘concurrent SRT and IT’, and ‘SRT after IT.’ Regional progression-free interval (R-PFI) and overall survival (OS) were estimated using the Kaplan–Meier method. Results: After a median follow-up from SRT of 22.5 months (2.7–47.3), the 1-year and 2-year OS were 69.7% (95%CI [58.0–83.8]) and 44.0% [30.6–63.2], respectively. Concerning distant intracranial control, the 1-year and 2-year R-PFI were 40.1% [30.1–53.3] and 35.2% [25.1–49.4], respectively. Moreover, one-year R-PFI in ‘SRT before IT’, ‘concurrent SRT and IT’, and ‘SRT after IT’ groups were 24.1%, 49.6%, and 34.2%, respectively (p = 0.094). The type of therapeutic sequence did not appear to impact the risk of brain necrosis. Conclusions: The concurrent administration of SRT and IT appeared to offer the best locoregional control, without increasing the risk of toxicity, compared to patients treated with SRT before or after IT