Préservation de la fertilité masculine

The incidence of cancer increases and affects more and more young patients. On the other hand, survival rates also increase, but often at the price of infertility induced by the gonadal toxicity of many treatments and a risk of mutagenicity. The techniques of semen cryopreservation are easy and results obtained after utilization of cryopreserved semen for assisted reproduction (IUI, IVF, or intracytoplasmic sperm injection [ICSI]) are satisfactory. The information of a patient about the possibilities of cryopreservation of fertility prior to the use of potentially sterilizing treatment is a legal obligation for every physician. The improvement of quality of life after healing must encourage oncologists to propose fertility preservation to their patients, which offers a very reasonable chance of later paternity.     

Préservation de la fertilité féminine en oncologie

Physicians taking care of young women with cancer have two problems to solve: fight against the disease and improve the patient’s quality of life after cancer. To manage this “after cancer period,” they should consider preservation of fertility. This may influence the choice of oncologic treatments and also the specific use of techniques used in the field of assisted reproductive medicine. We describe here the main current techniques of conservation of the feminine fertility in oncology.     

Vers une définition de la «qualité de vie»?

Résumé:   Lobjectif du travail est de contribuer, à partir danalyses linguistiques de lexpression «qualité de la vie», à identifier les contours du concept quil représente chez les patients et les médecins. Ces réflexions sappuient sur une approche de type lexicographique de la «qualité de vie» dans des textes de source médicale et sur une précédente étude des perceptions de «qualité» chez les professionnels de la santé, en vue didentifier, à titre dhypothèse, les définitions de la «qualité de vie».Dossier: «Évaluation de la qualité de vie»     

Rapport de la mission confiée par le ministère de la Santé à la Société française de radiothérapie oncologique

Further to the Epinal events, Health Ministers P. Bas then R. Bachelot-Narquin have launched a plan of work devoted to radiotherapy; they have also committed the SFRO President, within the framework of a mission, to make proposals taking into account the demography of professionals and their level of competence, valorization of careers, cooperation with medical oncologists, delegations of authorities, mutualisation of human and material resources. Due to the numerous actions of the roadmap managed by the tutelages, the aim of the mission was focused on the modalities of work of the professionals linked to radiotherapy: radiation oncologists, radiographers and physicists.     

Étude prospective monocentrique de la toxicité et de l’efficacité du trastuzumab concomitant à la radiothérapie

PurposeProspective monocentric study of the toxicities related to concurrent administration of trastuzumab to breast radiotherapy.Patients and methodsOne hundred and seventy-three patients were treated between June 2003 and March 2009 by concurrent trastuzumab with normofractionated radiotherapy. Trastuzumab was delivered every 3 weeks (8 mg/kg in the first infusion then 6 mg/kg) during a median time of 12 months (2–62). Left ventricular ejection fraction was assessed by echocardiography or cardiac scintigraphy at baseline, before and after radiotherapy, every 3 months for 1 year and annually. A left ventricular ejection fraction strictly lower than 55% was considered as altered. All toxicities were evaluated using Common Terminology Criteria for Adverse Effects version 3.0.ResultsMedian follow-up was 52 months (17–88). Median age was 52 years (25–83). One hundred and thirty-four patients (77.5%) received radiotherapy to the internal mammary chain. Acute grade 1, 2 and 3 epithelitis was described in 132 (76.3%), 32 (18.5%) and six patients (3.4%), respectively. At 23 months, grade 1 and 2 fibrosis was observed in 31 and eight patients, respectively (18.8 and 4.6%). Left ventricular ejection fraction remained normal for 159 patients (91.9%) before radiotherapy. Among them, 18 (11.3%) experienced a left ventricular ejection fraction alteration, eight (5.0%) at the completion of radiotherapy. Congestive heart failure occurred in one patient (0.6%).ConclusionsToxicities related to the association of trastuzumab to breast radiotherapy were mild. Further follow-up is warranted.     

Avis du groupe de travail missionné par l’Autorité de sûreté nucléaire concernant la radiothérapie stéréotaxique

PurposeAt the request of the French nuclear safety authority (Autorité de Sûreté Nucléaire, ASN) a working party of multidisciplinary experts was initiated to elaborate a report regarding propositions for the clinical practice of stereotactic radiation therapy and the related medical physics.Material and methodsSeveral stereotactic radiation therapy experts were audited by the working party, especially neurosurgeons and neuroradiologists, as well as radiation oncologists, medical physicists and radiation technologists. An international survey was conducted looking at legal requirements and guidelines concerning stereotactic radiation therapy. A national survey was conducted in France among 29 departments performing stereotactic radiation therapy. The working party report was submitted for advice to the permanent group of medical experts of ASN.ResultsAmong the 13 countries who responded, very few have legal documents. Some of them are stating that stereotactic radiation therapy must be performed in a radiotherapy department and only by well-trained professionals. Guidelines describing the role of each participant have been published in the USA. In France, stereotactic radiation therapy is performed with dedicated machines or adapted linear accelerators. In 2009, within the 29 departments, 4247 patients were treated with stereotactic radiation therapy representing 4% of the patients treated with external beam radiation therapy. Intracranial lesions were: 3383 and extracranial: 864. The working party of multidisciplinary experts made 7 recommendations. The first one saying that stereotactic radiation therapy must be considered as a radiotherapy. The permanent group of medical experts is asking to modify the “décret du 19 mars 2007” regarding “radiosurgery”.ConclusionThe medical benefit of stereotactic radiation therapy is well admitted and it is an increasingly used technique. This work through practical guidelines and legal propositions intends to promote a well-controlled development of this radiotherapy technique.     

Fin de vie à domicile dans la dignité et la sérénité : contributions du médecin généraliste

A general practitioner is sometimes with a patient up to the end of their life, when this occurs at home. This is the case of a patient with pancreatic cancer, diagnosed with liver, bone and pulmonary metastases. She wished to die at home, with the support of her children and an old friend. Treatment was greatly facilitated through frank exchanges between all those concerned, and the few healthcare providers involved. The philosophy of life that the patient had shaped over the years, her hopes and her determination turned her death into a necessary passage, accepted with grace. The state of her body was less significant than her social and spiritual well being, which she was keen to preserve until the very last day. She remained lucid up to the very last moment of her life. We are analysing the different elements that facilitated this optimal care, from the perspective of the patient, her family and her treating physician. A discussion on the role of the healthcare providers allows the place of each of them to be determined, when dealing with a death at home. Should this social, philosophical and spiritual dimension of the dying be reserved for healthcare providers specialized in these fields? Can we direct patients towards a spirituality, a philosophy of life that makes death a less harsh reality? We will question the role society has to play in negating death.     

Faisabilité et toxicité d’une séance unique de curiethérapie de haut débit de dose suivie d’une irradiation externe dans le cancer localisé de la prostate : étude rétrospective de la polyclinique de Courlancy

PurposeEvaluate the feasibility and toxicity of radiation dose escalation delivered with a single fraction high-dose-rate (HDR) brachytherapy boost followed by external beam radiotherapy for intermediate and high risk localized prostate cancer – a retrospective study.Patients and methodsBetween December 2004 and December 2008, 61 patients with intermediate risk or high-risk localized prostate cancer received a single 10 Gy fraction of interstitial HDR brachytherapy followed by a 64 Gy course of external beam radiation therapy. Dose volume histograms, conformity index and side effects were systematically analyzed.ResultsHDR brachytherapy dosimetric criteria were respected. Early side effects (≤ 3 months after full treatment): 30 % reported grade 2 or grade 3 urinary toxicity and 26 % reported grade 2 or grade 3 bowel toxicity were reported. Late side effects (> 3 months): 12 % reported grade 2 or grade 3 urinary toxicity and 5 % reported grade 2 or grade 3 bowel toxicity were reported. No patients reported any grade 4 late toxicity events. Three months after treatment, 7 % grade 1, 25 % grade 2 and 39 % grade 3 erectile dysfunction were reported.ConclusionOur monofractionation protocol is an easy technique to implement logistically. Acute and late toxicities are acceptable and comparable to those published by various teams mostly using multifractionation protocols. A longer follow-up is required to assess the effect of this dose escalation protocol on long-term biological control.     

Les mesures de la qualité de vie en cancérologie peuvent-elles hanger la pratique des cliniciens?

Résumé: Les mesures de la qualité de vie sont susceptibles de modifier la pratique des cliniciens impliqués dans le domaine du cancer, car elles les aident à choisir un traitement ou une procédure médicale en prenant en compte le point de vue des patients, à mieux informer leurs malades à partir des expériences acquises par dautres, à les faire accéder au traitement qui leur est le mieux adapté (ou quils préfèrent) et à leur assurer un suivi de routine plus approprié. Plus généralement, lévaluation de la qualité de vie peut modifier la pratique médicale traditionnelle, dans le sens où elle participe à un processus tendant globalement à replacer le malade au centre du système de soins. Nous illustrerons ce qui est énoncé ci-dessus en prenant des exemples tirés de la littérature ou de notre propre expérience, en particulier, dans le cancer du sein.     

Toxicité aiguë de la tomothérapie des cancers mammaires

Purpose

Helical radiation intensity modulated by tomotherapy improves dose distribution to complex and large volumes. The aim of the study was to assess acute toxicity of this technique during breast cancer irradiation after conserving surgery or mastectomy.

XXIIe Congrès de la Société Française de Psycho-Oncologie

PROGRAMME

XXII^e Congrès de la Société Fran?aise de Psycho-Oncologie 1^er-2 décembre 2005—Lille Cancers, Croyances & Spiritualités     

Évaluation de la qualité de vie en oncologie: II—Méthodes

Résumé: Cet article présente les différentes méthodes dévaluation de la qualité de vie: lentretien ouvert, la mesure standardisée au moyen de questionnaires, lévaluation personnalisée, et évoque les avantages et les inconvénients de chacune dentre elles. Dans une deuxième partie est abordée la longue succession détapes indispensables à la construction et à la validation dun questionnaire standardisé de qualité de vie, montrant la nécessité de toujours recourir à lexpertise des patients concernés par la problématique et celle des soignants familiers du domaine. Les problèmes dadaptation et de validation transculturelle de ces outils sont envisagés. Outre lintérêt de ces instruments pour la recherche clinique est envisagée ici la possibilité de recourir aux outils de qualité de vie pour affiner la démarche clinique individuelle, dans le souci permanent dapprofondir notre compréhension des difficultés et des besoins du patient atteint de cancer.Dossier: «Évaluation de la qualité de vie»     

Éléments de qualité de vie individuelle pour une amélioration de la prise en charge en psycho-oncologie pédiatrique

This study examines the perceived relationships between satisfaction in the areas of life patients consider most important and the constraints imposed on them by the disease and treatment (45 patients with leukemia aged 7–16 years; tools: SEIQoL-DW and the PedsQL cancer module). For children aged 7–11, health-related quality of life is associated with satisfaction in relation to family and physical activity. For adolescents, the relationships are more complex. In conclusion, the study highlights the need to vary management strategies according to age.     

Impact dosimétrique de la pose d’un espaceur rectal dans le traitement de cancer de la prostate localisé par irradiation en conditions stéréotaxiques

PurposeStereotactic body radiotherapy (SBRT) of prostate cancer is associated with rectal toxicities, which can be reduced by using a hydrogel spacer. The object of this retrospective study was to show the feasibility of spacer placement under local anesthesia and utility of hydrogel spacer to reduce the dose to the rectal wall.Material and methodsWe collected data from all patients with localised prostate cancer treated with SBRT (40 Gy in 5 fractions) between 2018 and 2020. A hydrogel spacer (SpaceOAR®) was placed depending on the availability of the product. We collected dosimetric data for target volumes and organs at risk. We calculated mean values, which were compared using non-parametric tests.ResultsAmong 35 patients, mean age was 75 years. Seventeen had a spacer placed, with a mean space created of 10 mm. No complication was reported during the intervention. High doses to the rectal wall were significantly lower in spacer group (V38: 0.39 cm³ vs. 0.72 cm³; P = 0.02). PTV were better covered in spacer group (P = 0.07). Doses to the bladder wall were similar in both groups.ConclusionSpacer procedure under local anesthesia was well tolerated. Hydrogel spacer allowed to reduce doses to the rectum while improving PTV coverage.