In parapapillary melanoma patients, radiation-induced optic complications are frequent and visual acuity is often compromised. We investigated dose-effect relationships for the optic nerve with ...respect to visual acuity after proton therapy.
Of 5205 patients treated between 1991 and 2014, those treated using computed tomography (CT)-based planning to 52 Gy (prescribed dose, not accounting for relative biologic effectiveness correction of 1.1) in 4 fractions, with minimal 6-month follow-up and documented initial and last visual acuity, were included. Deterioration of ≥0.3 logMAR between initial and last visual acuity results was reported.
A total of 865 consecutive patients were included. Median follow-up was 69 months, mean age was 61.7 years, tumor abutted the papilla in 35.1% of patients, and tumor-to-fovea distance was ≤3 mm in 74.2% of patients. Five-year relapse-free survival rate was 92.7%. Visual acuity was ≥20/200 in 72.6% of patients initially and 47.2% at last follow-up. A wedge filter was used in 47.8% of the patients, with a positive impact on vision and no impact on relapse. Glaucoma, radiation-induced optic neuropathy, maculopathy were reported in 17.9%, 47.5%, and 33.6% of patients, respectively. On multivariate analysis, age, diabetes, thickness, initial visual acuity and percentage of macula receiving 26 Gy were predictive of visual acuity. Furthermore, patients irradiated to ≥80% of their papilla had better visual acuity when limiting the 50% (30-Gy) and 20% (12-Gy) isodoses to ≤2 mm and 6 mm of optic nerve length, respectively.
A personalized proton therapy plan with optic nerve and macular sparing can be used efficiently with good oncological and functional results in parapapillary melanoma patients.
Riposte postillonnée, riposte pugilistique, riposte a posteriori, riposte de pestiférée, riposte stéréotypée, riposte railleuse – les femmes ripostent à la violence des hommes, seules ou en bande et ...depuis toujours, invisibles à la grande Histoire et à la culture.« Riposter », c’est avoir un comportement qui rompt avec le cadre normatif de la féminité ….Dans le cadre de la réflexion conduite sur les reconfigurations de l’écriture classique dans la littérature contemporaine, j’ai choisi de ...
The eye is an exemplarily challenging organ to treat when considering ocular tumors. It is at the crossroads of several major aims in oncology: tumor control, organ preservation, and functional ...outcomes including vision and quality of life. The proximity between the tumor and organs that are susceptible to radiation damage explain these challenges. Given a high enough dose of radiation, virtually any cancer will be destroyed with radiotherapy. Yet, the doses inevitably absorbed by normal tissues may lead to complications, the likelihood of which increases with the radiation dose and volume of normal tissues irradiated. Precision radiotherapy allows personalized decision-making algorithms based on patient and tumor characteristics by exploiting the full knowledge of the physics, radiobiology, and the modifications made to the radiotherapy equipment to adapt to the various ocular tumors. Anticipation of the spectrum and severity of radiation-induced complications is crucial to the decision of which technique to use for a given tumor. Radiation can damage the lacrimal gland, eyelashes/eyelids, cornea, lens, macula/retina, optic nerves and chiasma, each having specific dose-response characteristics. The present review is a report of non-cancer effects that may occur following ionizing irradiation involving the eye and orbit and their specific patterns of toxicity for a given radiotherapy modality.
Cette contribution poursuit la réflexion entamée avec Francis Grossmann (Grossmann et Rosier 2016) concernant plus spécifiquement la reconfiguration des formes de discours rapportés ...« pré-numériques » à l’ère des technoformes ; elle montre la nécessité d’articuler des descriptions linguistiques « classiques » à des techno-conceptions des formes de DR. Les pratiques socio-numériques s’intègrent à la dimension circulante et messagère des discours qui est en quelque sorte une composante anthropologique de la communication. L’évolution de la pratique du DR comme discours de partage cohabite avec les formes originelles du DR qui se reconfigurent et sont augmentées par les liens hypertextuels à fonctions multiples. Les reprises, les partages, les commentaires polémisent les pratiques mêmes de rapporter/partager. En ce sens, il y a un changement majeur sur l’institutionnalisation et l’autorité de la parole circulante : elle ne va plus de soi, elle est diluée puisque tous les discours peuvent a priori circuler de façon identique, l’énoncé a donc besoin de validation par des remises en circulation qui sont autant de ré-énonciations.
This paper follows previous research with Francis Grossmann (Grossmann and Rosier 2016), focusing on the reshaping of forms of “pre-digital” reported speeches in the age of technoforms; it shows the ...necessity to combine “traditional” linguistic descriptions with techno-conceptions of forms of reported speech. The different uses of social media are intrinsically linked to the circulation of speeches, which can be regarded as an anthropological dimension of communication. The evolution of the use of reported speech as a shared discourse coincides with the original forms of reported speech that are recombined and augmented by hyperlinks with multiple functions. The actions of quoting, sharing and commenting add a polemical dimension to reporting and circulating practices. This means that there is a major change on the institutionalisation and endorsement of circulating discourse, which is undermined as all discourses can normally circulate similarly. Every utterance therefore needs to be validated by various circulations and re-enactments.
Introduction Afin de poursuivre notre travail en cours sur les représentations socio-langagières spontanées des locuteurs, leur validité scientifique et leur portée heuristique, nous partirons de ...quelques définitions en usage d’expressions telles que « posture d’érudit » et « posture de puriste », utilisées dans des productions spontanées d’internautes. Pourquoi ce point de départ ? Nous pensons (et ces positions sont notamment illustrées dans notre ouvrage sur la langue française de 2008 et ...
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