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Purpose: Radiotherapy (RT) has an established role in the treatment of prostate cancer patients. Despite the large number of patients treated with RT, some issues about optimal techniques, doses, volumes, timing, and association with androgen deprivation are still subject of debate. The aim of this survey was to determine the patterns of choice of Italian radiation oncologists in two different clinical cases of prostate cancer patients treated with radical RT. Study design: During the 2010 Italian Association of Radiation Oncology (AIRO) National congress, four different clinical cases were presented to attending radiation oncologists. Two of them were prostate cancer cases that could be treated by RT +/- hormonal therapy (HT), different for T stage of primary tumour according to TNM, preoperative diagnostic procedures for staging, initial prostate specific antigen (iPSA), and Gleason Score sum of biopsy. For each clinical case, radiation oncologists were asked to: (a) give indication to pretreatment procedures for staging; (b) give indication to treatment; (c) define specifically, where indicated, total dose, type of fractionation, volumes of treatment, type of technique, type of image-guided setup control; (d) indicate if HT should be prescribed; (e) define criteria that particularly influenced prescription. A descriptive statistical analysis was performed. Results: Three hundred questionnaires were given to radiation oncologists attending the congress, 128 questionnaires were completed and considered for this analysis (41%). Some important differences were shown in prescribing and delivering RT, particularly with regards to treatment volumes and fractionation. Conclusions: Despite the results of clinical trials, several differences still exist among Italian radiation oncologists in the treatment of prostate cancer patients. These patients probably deserve a more uniform approach, based on upto-date, detailed, and evidence-based recommendations. © 2013 Springer-Verlag.


Purpose: Radiotherapy (RT) has an established role in the postoperative treatment of prostate cancer patients with extracapsular extension, positive surgical margins or a detectable post-operative prostate-specific antigen (PSA). Despite the large number of patients treated with postoperative RT, some issues about optimal technique, doses, volumes, timing and association with androgen deprivation are still subject of debate. The aim of this survey was to determine the patterns of choice of Italian radiation oncologists in two different clinical cases of postoperative prostate cancer patients. Study design: During the 2010 National Congress of the Italian Association of Radiation Oncology (AIRO), four clinical cases were presented to the attending radiation oncologists. Two of them were cases of postoperative prostate cancer, differing in T stage of the primary tumour according to the TNM classification, preoperative staging procedures, preoperative PSA (iPSA), Gleason score of biopsies and definitive pathological specimen after surgery and postoperative PSA. For each clinical case, the radiation oncologists were asked to: (a) give indication to new pre-treatment procedures for staging; b) give indication to postoperative treatment; (c) to define specifically, where indicated, the total dose, type of fractionation, treatment volumes, type of technique, type of image-guided setup control; (d) indicate whether adjuvant hormonal therapy should be prescribed; (e) define criteria that mostly influenced the prescription. A descriptive statistical analysis was then performed. Results: A total of 300 questionnaires were distributed amongst radiation oncologists attending the congress; 128 were completed and considered for this analysis (41%). Some important differences were shown in prescribing and performing postoperative radiotherapy, and some significant differences with international guidelines and data available from the literature were also reviewed and discussed. Conclusions: Despite the results of clinical trials, significant differences still exist among Italian radiation oncologists in deciding postoperative treatment in prostate cancer patients. These patients probably deserve a more uniform approach based on updated, detailed and evidencebased recommendations. © 2013 Springer-Verlag Italia.


Monsuez J.-J.,Hopitaux Universitaires Of Paris Seine Saint Denis | Gesquiere-Dando A.,Service de Neurologie | Rivera S.,Service dOncologie Radiotherapie
Cardiology Research and Practice | Year: 2011

Midlife cardiovascular risk factors, including diabetes, hypertension, dyslipemia, and an unhealthy lifestyle, have been linked to subsequent incidence, delay of onset, and progression rate of Alzheimer disease and vascular dementia. Conversely, optimal treatment of cardiovascular risk factors prevents and slows down age-related cognitive disorders. The impact of antihypertensive therapy on cognitive outcome in patients with hypertension was assessed in large trials which demonstrated a reduction in progression of MRI white matter hyperintensities, in cognitive decline and in incidence of dementia. Large-scale database correlated statin use and reduction in the incidence of dementia, mainly in patients with documented atherosclerosis, but clinical trials failed to reach similar conclusions. Whether a multitargeted intervention would substantially improve protection, quality of life, and reduce medical cost expenditures in patients with lower risk profile has not been ascertained. This would require appropriately designed trials targeting large populations and focusing on cognitive decline as a primary outcome endpoint. Copyright © 2011 Jean-Jacques Monsuez et al.


Monnier L.,Service dOncologie Radiotherapie | Touboul E.,Service dOncologie Radiotherapie | Durdux C.,University Paris - Sud | Lang P.,University Paris - Sud | And 2 more authors.
Head and Neck | Year: 2013

Background: Standard treatment for unresectable advanced head and neck squamous cell carcinoma is chemoradiotherapy, which can be toxic, particularly among patients with coexisting medical conditions. We report our experience with the hypofractionated radiotherapy regimen Irradiation HypoFractionnée 2 Séances Quotidiennes (IHF2SQ). Methods: We retrospectively reviewed 78 patients treated with the IHF2SQ regimen. Radiotherapy was administrated as 2 fractions of 3 Gy per day (days 1 and 3), during the first, third, fifth, and seventh week of treatment with concurrent platinum-based chemotherapy. Results: Tolerance was excellent. Forty-one patients had complete or partial response. Median overall survival (OS) was 12.9 months and median progression-free survival (PFS) was 10.3 months. One-year OS, specific survival (SS), and PFS were 58%, 71%, 51.5%, respectively. Independent predictive factors increasing the PFS were response to chemoradiotherapy, male sex, and laryngeal tumor location. Conclusions: This regimen is an alternative to conventional chemoradiotherapy with good response rates and acceptable toxicity for selected patients. © 2013 Wiley Periodicals, Inc.


Delanian S.,Service dOncologie Radiotherapie | Chatel C.,Institute Gustave Roussy | Porcher R.,Hopital Saint Louis | Depondt J.,Service de Chirurgie Cervico Faciale | Lefaix J.-L.,French Atomic Energy Commission
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: Osteoradionecrosis (ORN) is a nonhealing wound of the bone that is difficult to manage. Combined treatment with pentoxifylline and vitamin E reduces radiation-induced fibrosis and ORN with a good prognosis. We previously showed that the combination of pentoxifylline and vitamin E with clodronate (PENTOCLO) is useful in healing sternocostal and some mandibular ORN. Is PENTOCLO effective in ORN of poor prognosis? Methods: 54 eligible patients previously irradiated for head and neck cancer (among 72 treated) a mean 5 years previously received exteriorized refractory mandibular ORN for 1.4 ± 1.8 years, mainly after local surgery and hyperbaric oxygen had been ineffective. The mean length of exposed bone (D) was 17 ± 8 mm as primary endpoint, and the mean Subjective, Objective, Management, and Analytic evaluation of injury (SOMA) score was 16 ± 4. Between August 2000 and August 2008, all patients were given daily oral PENTOCLO: 800 mg pentoxifylline, 1,000 IU vitamin E, and 1,600 mg clodronate 5 days per week alternating with 20 mg prednisone and 1,000 mg ciprofloxacin 2 days per week. The duration of treatment was related to consolidated healing. Results: Prolonged treatment (16 ± 9 months) was safe and well tolerated. All patients improved, with an exponential progressive - (f[t] = a.exp(-b.t) - and significant (p < 0.0001) reduction of exposed bone (D), respectively (months): D2 -42%, D4 -62%, D6 -77%, D12 -92%, and D18 -96%, combined with iterative spontaneous sequestrectomies in 36 patients. All patients experienced complete recovery in a median of 9 months. Clinical improvement was measured in terms of discontinuation of analgesics, new fracture, closed skin fistulae, and delayed radiologic improvement: SOMA6 -64%, SOMA 12 -89%, and SOMA30 -96%. Conclusion: Long-term PENTOCLO treatment is effective, safe, and curative for refractory ORN and induces mucosal and bone healing with significant symptom improvement. These findings will need to be confirmed in a randomized trial. © 2011 Elsevier Inc.


Chargari C.,Service doncologie radiotherapie | Chargari C.,French Institute of Health and Medical Research | Cosset J.-M.,University Pierre and Marie Curie | Cosset J.-M.,Place Of Labbe Georges Henocque
Bulletin du Cancer | Year: 2013

Several studies have well documented that the risk of secondary neoplasms is increasing among patients having received radiation therapy as part of their primary anticancer treatment. Most frequently, radiation-induced neoplasms occur in volume exposed to high doses. However, the impact of "low" doses (<5 Gy) in radiation-induced carcinogenesis should be clinically considered because modern techniques of intensity-modulated radiation therapy (IMRT) or stereotactic irradiation significantly increase tissue volumes receiving low doses. The risk inherent to these technologies remains uncertain and estimates closely depend on the chosen risk model. According to the (debated) linear no-threshold model, the risk of secondary neoplasms could be twice higher with IMRT, as compared to conformal radiation therapy. It seems that only proton therapy could decrease both high and low doses delivered to non-target volumes. Except for pediatric tumors, for which the unequivocal risk of second malignancies (much higher than in adults) should be taken into account, epidemiological data suggest that the risk of secondary cancer related to low doses could be very low, even negligible in some cases. However, clinical followup remains insufficient and a marginal increase in secondary tumors could counterbalance the benefit of a highly sophisticated irradiation technique. It therefore remains necessary to integrate the potential risk of new irradiation modalities in arisk-adapted strategy taking into account therapeutic objectives but also associated risk factors, such as age (essentially), chemotherapy, or life style. Copyright © 2007 John Libbey Eurotext.


Chargari C.,Service dOncologie Radiotherapie | Kirov K.M.,Institute Curie | Bollet M.A.,Institute Curie | Magne N.,Institute Of Cancerologie Of La Loire | And 5 more authors.
Cancer Treatment Reviews | Year: 2011

When focusing on heart disease, most available studies split the two different parts of the adjuvant treatment, i.e., systemic therapies and radiation therapy, making it difficult to implement efficient strategies for preventing treatment-induced cardiac toxicity. This paper reviews the current understanding of treatments-induced cardiac toxicity in a global approach. Many factors should be considered when assessing the cardiac hazard. Treatment-related risk factors include heart dose exposure, chemotherapy, targeted agents such as HER2 inhibitors, but also endocrine agents, or anesthetic procedure. Patients' characteristics should also be taken into account. Age, menopausal status, stress, previous history of cardiac disease, genetic profile, and body mass index could all impact on cardiac function after adjuvant therapies. Cardiac toxicity should not be analyzed as the consequence of a specific therapy, but should be considered as the result of additive or supra-additive toxicities. By this way, it will be possible to implement new strategies for preventing treatment-induced cardiac toxicity. © 2010 Elsevier Ltd.


Durdux C.,Service dOncologie radiotherapie | Durdux C.,University of Paris Descartes
Psycho-Oncologie | Year: 2010

Clinical depression is a relatively common source of suffering among patients with cancer. Depression should not be neglected by oncologists but clearly integrated in global project of cure with an active participation of psychologists and psychiatrists. This article reviews the key notions that may be helpful for oncologists in identifying patients with depression. Depression risk appears greater during months following diagnosis of cancer or recurrence in patients with psychiatric history, in patients with advanced cancer, or in patients with uncontrolled somatic symptoms as pain or dyspnoea. Antidepressants combined with psychotherapy or psychological support can also improve patient's compliance with cancer care and provide him/her with a better quality of life. © 2010 Springer Verlag France.


Leignel Argo D.,Service doncologie radiotherapie | Giraud P.,University of Paris Descartes
Cancer/Radiotherapie | Year: 2010

The objective was the drafting of a document describing the technique of tridimensional conformal irradiation of a non small cell lung cancer (NSCLC). Principles and recommendations concern patients affected by lung cancer localized in the thorax and inoperable or patients who must undergo postoperative irradiation. They have been developed according to the current scientific data from an analysis of the literature and professional agreements. Principles and recommendations describe: the centering and the contouring of tumor volumes and organs at risk, the calculation of the dose distribution, the treatment and the surveillance during the treatment. © 2010 Elsevier Masson SAS.


Head and neck squamous cell carcinoma (HNSCC) are common for men with a poor prognosis in case of recurrent or metastatic disease. There are several rationales for the use of immunotherapies in this indication. Indeed, human papilloma virus-related cancers are particularly immunogenic and provide many interesting therapeutic targets. The vaccination, as developed in cervical cancer, may be very effective in the prevention of HNSCC dysplasia. There is currently no data for curative vaccination. The rapid immune checkpoints inhibitors development in other cancers seem to arise in HNSCC also. Some trials are recruiting to evaluate anti-PD-1 in association with chemoradiotherapy for advanced tumors. In recurrent or metastatic HNSCC, the results presented in international meetings are overwhelmingly in favor of nivolumab with a significative improvement of overall survival in second line of treatment. The association with cetuximab is also studied but the skin toxicity seems to be limiting. © 2016 Lavoisier

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