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Schlumberger M.,University Paris - Sud | Catargi B.,Bordeaux University Hospital Center | Borget I.,Institute Gustave Roussy | Deandreis D.,University Paris - Sud | And 14 more authors.
New England Journal of Medicine

BACKGROUND: It is not clear whether the administration of radioiodine provides any benefit to patients with low-risk thyroid cancer after a complete surgical resection. The administration of the smallest possible amount of radioiodine would improve care. METHODS: In our randomized, phase 3 trial, we compared two thyrotropin-stimulation methods (thyroid hormone withdrawal and use of recombinant human thyrotropin) and two radioiodine ( 131I) doses (i.e., administered activities) (1.1 GBq and 3.7 GBq) in a 2-by-2 design. Inclusion criteria were an age of 18 years or older; total thyroidectomy for differentiated thyroid carcinoma; tumor-node-metastasis (TNM) stage, ascertained on pathological examination (p) of a surgical specimen, of pT1 (with tumor diameter ≤1 cm) and N1 or Nx, pT1 (with tumor diameter >1 to 2 cm) and any N stage, or pT2N0; absence of distant metastasis; and no iodine contamination. Thyroid ablation was assessed 8 months after radioiodine administration by neck ultrasonography and measurement of recombinant human thyrotropin-stimulated thyroglobulin. Comparisons were based on an equivalence framework. RESULTS: There were 752 patients enrolled between 2007 and 2010; 92% had papillary cancer. There were no unexpected serious adverse events. In the 684 patients with data that could be evaluated, ultrasonography of the neck was normal in 652 (95%), and the stimulated thyroglobulin level was 1.0 ng per milliliter or less in 621 of the 652 patients (95%) without detectable thyroglobulin antibodies. Thyroid ablation was complete in 631 of the 684 patients (92%). The ablation rate was equivalent between the 131I doses and between the thyrotropin-stimulation methods. CONCLUSIONS: The use of recombinant human thyrotropin and low-dose (1.1 GBq) postoperative radioiodine ablation may be sufficient for the management of low-risk thyroid cancer. (Funded by the French National Cancer Institute [INCa] and the French Ministry of Health; ClinicalTrials.gov number, NCT00435851; INCa number, RECF0447.) Copyright © 2012 Massachusetts Medical Society. All rights reserved. Source

Sun X.S.,Jean Minjoz University Teaching Hospital | Sun X.S.,Center Hospitalier Belfort Montbeliard | Sun S.R.,Center Hospitalier Belfort Montbeliard | Guevara N.,University of Nice Sophia Antipolis | And 9 more authors.
Critical Reviews in Oncology/Hematology

Background: The mainstay of treatment for differentiated thyroid carcinomas is surgery. There is hardly any room for radiation therapy in differentiated thyroid carcinomas. We aimed to update recommendations for RT in the context of histological variants, increased use of radioiodine and new irradiations techniques. Materials and methods: A search of the French and English literature was performed using thyroid carcinoma, radiation therapy, surgery, variants and radioiodine. Results: Papillary, follicular, Hürthle and medullary carcinomas represent about 80%, 11%, 3% and 4% of all thyroid carcinomas, respectively. Ten-year survival rates for patients with papillary, follicular and Hürthle cell carcinomas are 93%, 85%, and 76%, respectively. The occurrence of criteria such as older age (45 or 60 years-old), massive primary disease, extensive extracapsular spread and macroscopic iodine-negative components inconsistently indicate external beam irradiation (EBRT). The impact of EBRT on poorer-prognosis histological variants is an emerging issue. Noteworthy, the incidence of laryngeal and wound healing complications has been an important limitation to EBRT. However, intensity modulated radiation therapy (IMRT) offers clear dosimetric advantages on tumor coverage and organ sparing such as the larynx, thus reducing late toxicities to less than 5%. Iodine contrast agents should be avoided during 4-6 weeks before radioiodine. PET CT is increasingly used in iodine-negative tumors. Conclusion: There are elective indications for EBRT and IMRT has the potential to improve local control. © 2012 Elsevier Ireland Ltd. Source

At the time of diagnosis, around 20% of patients presenting a pancreatic cancer have a resectionable tumour. 50% are metastatic and 30% or locally advanced. In spite of the advances made in chemoradiotherapy and chemotherapy, patients with a locally advanced pancreatic cancer frequently relapse in locoregional or metastatic form, with an average survival rate estimated at between 5 and 11 months. Over the past 30 years, modest improvements in the average survival rate have been gained for patients treated by chemoradiotherapy or chemotherapy. The optimal treatment for locally advanced pancreatic adenocarcinoma remains controversial. The aim of this review is to assess the role of radiotherapy and of combined treatments for these patients. © 2015, Springer-Verlag France. Source

Hrbacek J.,Paul Scherrer Institute | Mishra K.K.,University of California at San Francisco | Kacperek A.,Proton Therapy | Dendale R.,Institute Curie | And 18 more authors.
International Journal of Radiation Oncology Biology Physics

Purpose To assess the planning, treatment, and follow-up strategies worldwide in dedicated proton therapy ocular programs. Methods and Materials Ten centers from 7 countries completed a questionnaire survey with 109 queries on the eye treatment planning system (TPS), hardware/software equipment, image acquisition/registration, patient positioning, eye surveillance, beam delivery, quality assurance (QA), clinical management, and workflow. Results Worldwide, 28,891 eye patients were treated with protons at the 10 centers as of the end of 2014. Most centers treated a vast number of ocular patients (1729 to 6369). Three centers treated fewer than 200 ocular patients. Most commonly, the centers treated uveal melanoma (UM) and other primary ocular malignancies, benign ocular tumors, conjunctival lesions, choroidal metastases, and retinoblastomas. The UM dose fractionation was generally within a standard range, whereas dosing for other ocular conditions was not standardized. The majority (80%) of centers used in common a specific ocular TPS. Variability existed in imaging registration, with magnetic resonance imaging (MRI) rarely being used in routine planning (20%). Increased patient to full-time equivalent ratios were observed by higher accruing centers (P=.0161). Generally, ophthalmologists followed up the post-radiation therapy patients, though in 40% of centers radiation oncologists also followed up the patients. Seven centers had a prospective outcomes database. All centers used a cyclotron to accelerate protons with dedicated horizontal beam lines only. QA checks (range, modulation) varied substantially across centers. Conclusions The first worldwide multi-institutional ophthalmic proton therapy survey of the clinical and technical approach shows areas of substantial overlap and areas of progress needed to achieve sustainable and systematic management. Future international efforts include research and development for imaging and planning software upgrades, increased use of MRI, development of clinical protocols, systematic patient-centered data acquisition, and publishing guidelines on QA, staffing, treatment, and follow-up parameters by dedicated ocular programs to ensure the highest level of care for ocular patients. © 2016 Elsevier Inc. Source

Faure C.,Roche Holding AG | Badoual C.,Hopital Europeen George Pompidou | Badoual C.,University of Paris Descartes | Fleury B.,Center Marie Curie | And 2 more authors.
Bulletin du Cancer

Head and neck malignant tumors diagnosis require both standardized technical and personalized management in order to optimize patient care and therapy. The quality of multidisciplinary discussion for that goal needs common vocabulary. More than morphology, immunohistochemistry and in situ hybridization, additional molecular theranostics approaches are in fast progress in head and neck cancers, as well as their other anatomic counterparts. ©John Libbey Eurotext. Source

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