To determine the indications for radiotherapy in salivary gland cancer and to specify the modalities and target radiation volumes.
The French Network of Rare Head and Neck Tumors (REFCOR) formed a ...steering group which drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method.
Postoperatively, radiotherapy to the primary tumor site±to the lymph nodes is indicated if one or more of the following adverse histoprognostic factors are present (risk>10% of locoregional recurrence): T3–T4 category, lymph node invasion, extraglandular invasion, close or positive surgical margins, high tumor grade, perineural invasion, vascular emboli, and/or bone invasion. Intensity-modulated radiation therapy (IMRT) is the gold standard. For unresectable cancers or inoperable patients, carbon ion hadrontherapy may be considered.
Radiotherapy in salivary gland cancer is indicated in postoperative situations in case of adverse histoprognostic factors and for inoperable tumors.
Les causes les plus fréquentes de sécrétion ectopique d’ACTH (SEA) sont les tumeurs neuroendocrines. Nous rapportons le cas original d’une patiente avec une SEA apparue au cours de la prise en charge ...d’un cancer à cellules acineuses (CCA) parotidien, métastatique, exprimant sur le plan morphologique et histologique des récepteurs à la somatostatine. Une patiente de 70 ans a été admise pour hypercortisolisme ACTH-dépendant, diagnostiqué devant l’association d’une hypokaliémie sévère et d’une hypertension artérielle. Elle était traitée par Nivolumab depuis 2 mois, en seconde ligne d’un CCA parotidien multimétastatique connu depuis 2 ans. De rares cas de SEA par des cancers parotidiens avaient été rapportés, ainsi qu’un cas de maladie de Cushing transitoire sous Nivolumab. La présentation clinique brutale, le taux élevé d’ACTH (80pmol/L), l’absence de réponse au CRF et à la Desmopressine, l’IRM hypophysaire normale et le contexte tumoral progressif sur le plan morphologique étaient en faveur d’une SEA. Les métastases pleurales, hépatiques et ganglionnaires étaient hypermétaboliques au DOTATOC-68Ga. La relecture histologique de la biopsie récente a identifié un contingent cellulaire exprimant l’ACTH avec un sous-contingent exprimant les récepteurs de la somatostatine de type 2. Rétrospectivement, la tumeur initiale exprimait également ces contingents de manière minoritaire. La progression tumorale rapide n’a pas permis de tester l’efficacité des analogues de la somatostatine ou de la lutathérapie. Cette histoire illustre l’hétérogénéité tumorale avec l’apparition possible d’une SEA lors d’un cancer non endocrine à partir d’un contingent cellulaire initialement minoritaire et l’utilité possible du DOTATOC-68Ga dans les SEA.
To determine the therapeutic indications for systemic medical treatment in the management of adenoid cystic carcinoma (ACC) according to the clinical situation.
The French Network of Rare Head and ...Neck Tumors (REFCOR) formed a steering group, which drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method.
ACCs are rare tumors and there is currently insufficient evidence to indicate chemotherapy at the localized stage. At the metastatic stage, progression is often slow. In case of oligometastatic ACC, local treatment should be discussed. The most often indolent nature of polymetastatic ACC can allow management by active surveillance. Molecular screening is recommended, for abnormalities potentially accessible to targeted therapy.
ACCs are rare tumors for which there are currently few effective medical treatments. It is therefore recommended to include patients in clinical trials.
OBJECTIVETo determine the therapeutic indications for systemic medical treatment in the management of salivary gland carcinoma (excluding adenoid cystic carcinoma) according to the clinical ...situation.MATERIALS AND METHODSThe French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method.RESULTSSalivary gland carcinoma is rare and there is currently insufficient evidence to indicate chemotherapy at the localized stage. At the metastatic stage, initial management can be based on a phase of monitoring for indolent disease. Some histological subtypes (salivary duct carcinoma and adenocarcinoma) are more aggressive and require systemic treatment from the outset. To guide systemic treatment, it is recommended to perform immunohistochemistry and molecular biology analyses (overexpression of HER2 and androgen receptors, NTRK fusion, next-generation sequencing).CONCLUSIONSalivary gland carcinoma is a rare tumor for which there are currently few effective medical treatments. It is therefore recommended to include patients in clinical trials.
Background and purpose
Positron emission tomography (PET) with
18
F-fluoromisonidazole (
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F-FMISO) provides a non-invasive assessment of hypoxia. The aim of this study is to assess the feasibility ...of a dose escalation with volumetric modulated arc therapy (VMAT) guided by
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F-FMISO-PET for head-and-neck cancers (HNC).
Patients and methods
Ten patients with inoperable stages III–IV HNC underwent
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F-FMISO-PET before radiotherapy. Hypoxic target volumes (HTV) were segmented automatically by using the fuzzy locally adaptive Bayesian method. Retrospectively, two VMAT plans were generated delivering 70 Gy to the gross tumour volume (GTV) defined on computed tomography simulation or 79.8 Gy to the HTV. A dosimetric comparison was performed, based on calculations of tumour control probability (TCP), normal tissue complication probability (NTCP) for the parotid glands and uncomplicated tumour control probability (UTCP).
Results
The mean hypoxic fraction, defined as the ratio between the HTV and the GTV, was 0.18. The mean average dose for both parotids was 22.7 Gy and 25.5 Gy without and with dose escalation respectively. FMISO-guided dose escalation led to a mean increase of TCP, NTCP for both parotids and UTCP by 18.1, 4.6 and 8 % respectively.
Conclusion
A dose escalation up to 79.8 Gy guided by
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F-FMISO-PET with VMAT seems feasible with improvement of TCP and without excessive increase of NTCP for parotids.
Studies have shown clinical practices variation between centers in colorectal cancer (CRC) management. After the implementation of national cancer plans, we tested for differences in center and ...patients' socioeconomic position (SEP)-related variation in CRC guidelines.
All patients aged 18 years and over, cared for a first CRC in 2010 in Southwest of France. We used mixed effect model to test for center-related heterogeneity (CRH) in recommendation, from the oldest to the more recent: (1) at least 12 lymph nodes analysed for stage II, (2) the prescription of adjuvant chemotherapy stage III and (3) the assessment of CRC molecular phenotype regarding KRAS status for stage IV. Patients' SEP was approached by an ecological social deprivation index.
We found: higher adherence for the oldest than for the most recent recommendations; no CRH in recommendation No. 2 but lower adherence in academic centers; a CRH for recommendations No. 1 and 3; no SEP-related differences in clinical practices.
Results showed that older recommendations have higher adherence but did not support increasing influence of centers characteristics and CRH as recommendations are more recent.
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