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

Combination of nivolumab with chemoradiotherapy for locally advanced cervical cancer: NiCOL phase I trial.

5534 Background: Current management of locally-advanced cervical cancers (LACC) relies on chemoradiotherapy (CRT) and brachytherapy. The causal relation between cervical cancer and human papillomavirus infection, which engenders tumor expression of immunoreactive neo-antigens, together with high PD-L1 expression, warrants consideration of immune checkpoint inhibitors (ICI) in the definitive treatment of this disease. We assessed the safety of concurrent and maintenance nivolumab in addition to CRT in patients with LACC. Methods: This prospective, multi-center, dose-confirmation, phase I clinical trial (NiCOL trial; NCT03298893) evaluated the tolerance profile of concurrent and maintenance nivolumab in addition to CRT (45 Gy in 25 fractions with cisplatin 40mg/m² q1w, followed by a brachytherapy boost to 85 Gy) for stage IB3-IVA cervical cancers. Nivolumab was administered at 240 mg q2w starting on day 1 of CRT and in maintenance after CRT completion for up to 6 months (13 cycles). The primary endpoint was the incidence of dose-limiting toxicities (DLT) within 11 weeks after the initiation of treatment (defining the DLT assessment period), corresponding to the first 6 cycles of nivolumab. DLT were defined as grade ≥3 non-hematological toxicities, grade ≥3 immune-related adverse event (irAE), persistent grade ≥2 irAE for ≥1 week despite optimal supportive care, or ≥1-week radiotherapy delay related to treatment toxicity. Secondary endpoints included overall response rate (ORR), progression-free survival (PFS) and treatment tolerance profile. Results: 16 patients (pts) were recruited between 11/2017 and 07/2020. Median age was 46 years [range: 27-77]. Histological types were squamous cell carcinomas (n = 14) and adenocarcinomas (n = 2). Tumors were staged as FIGO IB3 (n = 2), IIB (n = 8), IIIB (n = 1), IIIC1 (n = 4) and IVA (n = 1); 13 tumors were HPV-positive. Three patients experienced DLT, corresponding to grade 3 hypotension (n = 2) and grade 3 acute kidney injury (n = 1). Following the DLT assessment period, while receiving maintenance nivolumab, one patient developed a grade ≥3 irAE corresponding to a grade 3 diarrhea. Two months after brachytherapy completion, ORR was 93.8% [95%CI: 69.8%-99.8%]. With a median follow-up of 16.6 months, three patients experienced disease control failure (at 3,4 and 5 months); site of disease progression was local for two patients, and simultaneously local and distant for one patient. One-year PFS was 81.2% [95% CI: 64.2%-100%]. Conclusions: Concomitant nivolumab with definitive CRT, followed by maintenance nivolumab, appears to be a safe and feasible therapeutic option for LACC, associated with encouraging PFS rates. Further trials evaluating ICI combined with CRT for LACC are warranted in light of these promising results and of those from recent studies evaluating ICI in the metastatic setting. Clinical trial information: NCT03298893. </jats:p

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

Tolerance of concurrent CDK inhibitor and radiation therapy in metastatic breast cancer patients.

e12598 Background: Palbociclib, a small-molecule inhibitor of cyclin-dependent kinases (CDK4 and CDK6), combined with letrozole increases progression-free survival among patients with previously untreated ER-positive, HER2 negative advanced breast cancer. The purpose of our study was to retrospectively evaluate the tolerance of the concomitant association of Palbociclib and radiation therapy (RT) at Curie Institute. Methods: Between April 2017 and August 2019, 30 women with ER-positive, HER2 negative metastatic breast cancer received locoregional (LR) and/or symptomatic irradiation at a metastatic site concurrently with Palbociclib at a daily dose of 125 mg, from d1 to d21 every 28 days. Palbociclib was always associated with endocrine therapy: letrozole (with or without an LHRH analogue) or fulvestrant. Thirty-five sites were irradiated: nine patients received post-operative locoregional RT, including the chest wall or breast and lymph node areas, and 26 sites of metastases were irradiated: 17 at the spine, 7 peripheral skeletal lesions, 1 brain lesion and 1 choroidal lesion. The dose prescribed for locoregional mammary radiotherapy was 50 Gy in 25 fractions and varied for the treatment of metastatic sites: 20 Gy in 5 fractions (n = 13), 30 Gy in 10 fractions (n = 10) and 8 Gy in 1 fraction (n = 2). The brain metastasis was stereotactically treated (1 fraction of 18 Gy). The primary endpoint was toxicity scored according to the common terminology criteria for NCI adverse events, version v5.0. Results: Mean number of days of Palbociclib during RT was 8.8 days (range, 1 to 24 days). The most common acute toxicities were dermatitis (12/35, including 2 grade 2) and neutropenia (12/35, including 9 grade 2). Palbociclib had to be stopped during the RT of two patients (2/30): one patient treated locoregionally (bilateral breast and lymph nodes irradiation) developed a grade 3 dermatitis and febrile neutropenia, another treated locoregionally developed grade 2 dysphagia. After a median follow-up since the end of RT of 17 months (6 – 31 months, SD 8), none of the patients have so far exhibited late toxicity. Conclusions: Concomitant administration of palbociclib with RT was reasonably well tolerated in our series of 30 patients. Given this experience, palbociclib should not be discontinued during radiation therapy. Nevertheless, our findings should be confirmed in prospective registration studies collecting larger number of patients. </jats:p