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Papers by Claude Krzisch

Computer Methods in Biomechanics and Biomedical Engineering, 2020

AMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Introduction : Les carcinomes de primitif inconnu (CAPI) représentent 5% des tumeurs malignes. Av... more Introduction : Les carcinomes de primitif inconnu (CAPI) représentent 5% des tumeurs malignes. Avec une survie médiane de 6 à 15 mois, ils restent un défi diagnostique et thérapeutique. La connaissance des facteurs pronostiques semble capitale pour améliorer leur prise en charge. Matériel et Méthodes : Cinquante patients atteints de CAPI traités au CHU d Amiens entre 1998 et 2009 ont été analysé rétrospectivement. Leurs caractéristiques cliniques et biologiques, le traitement reçu, et d éventuels facteurs pronostiques ont été relevés puis étudiés par des méthodes univariées. Les survies ont été calculées selon la méthode de Kaplan-Meier et comparées en utilisant le test du log-rank. Résultats : Quarante-et-un patients (82%) présentaient un sous-type défavorable, dont 51,2% étaient des adénocarcinomes. Onze patients (26,8%) avaient un PS >= 2. Vingt patients (48,8%) avaient au moins 3 sites métastatiques : polyadénopathies (58,8%), os (53,7%), poumon (46,3%), foie (24,4%). Une chi...

Cette étude rétrospective, portant sur 92 patients traités entre 1992 et 2003 par radiochimiothér... more Cette étude rétrospective, portant sur 92 patients traités entre 1992 et 2003 par radiochimiothérapie concomitante avec escalade de dose par radiothérapie externe ou curiethérapie. La population comportait des patients non métastatiques en majorité T 3 (57,1 %) et N 1 (70,3 %). Nous avons observé une médiane de survie de 10,1 mois, un taux de réponse objective au traitement de 27,1 %, un taux de récidive locorégionale de 23 % et une rechute ou la persistance d'une maladie locorégionale de 56 %. Un boost par curiethérapie a pu être effectué pour 25 patients pour lesquels on retrouve une médiane de survie de 18,1 mois avec une survie à trois ans de 44 %. La médiane de survie constatée pour les patients éligibles pour un protocole d'essai thérapeutique et de 15,6 mois avec une survie à trois ans de 25,1 %. La compliance au traitement a été de 72,8 % pour la radiothérapie et 79,1 % pour la chimiothérapie. La toxicité de grade 3 et 4 de la chimiothérapie a été de 14 % sur le plan...

Cancer/Radiothérapie, 2009

Rare Tumors, 2011

The review covers the current recommendations for Merkel cell carcinoma (MCC), with detailed disc... more The review covers the current recommendations for Merkel cell carcinoma (MCC), with detailed discussion of many controversies. The 2010 AJCC staging system is more in-line with other skin malignancies although more complicated to use. The changes in staging system over time make comparison of studies difficult. A wide excision with margins of 2.5-3 cm is generally recommended. Even for primary </= 1 cm, there is a significant risk of nodal and distant metastases and hence sentinel node biopsy should be done if possible; otherwise adjuvant radiotherapy to the primary and nodal region should be given. Difficulties of setting up trials owing to the rarity of the disease and the mean age of the patient population result in infrequent reports of adjuvant or concurrent chemotherapy in the literature. The benefit, if any, is not great from published studies so far. However, there may be a subgroup of patients with high-risk features, e.g. node-positive and excellent performance status, for whom adjuvant or concurrent chemotherapy may be considered. Since local recurrence and metastases generally occur within 2 years of the initial diagnosis, patients should be followed more frequently in the first 2 years. However delayed recurrence can still occur in a small proportion of patients and long-term follow-up by a specialist is recommended provided that the general condition of the patient allows it. In summary, physician judgment in individual cases of MCC is advisable, to balance the risk of recurrence versus the complications of treatment.

Cancer/Radiothérapie, 2011

Parmi les 289 patients, 185 (64.0%) ont présenté une RC et 93 (32.2%) une RP. La médiane de survi... more Parmi les 289 patients, 185 (64.0%) ont présenté une RC et 93 (32.2%) une RP. La médiane de survie était de 19.7 mois pour l'ensemble des 289 patients, de 21.6 mois dans le sous-groupe en RC et de 14.3 mois dans le sous-groupe en RP. Sur les 289 patients, 177 (61.2%) ont bénéficié d'une IPC. Sur l'ensemble de la cohorte, les patients ayant bénéficié d'une IPC avaient une survie globale supérieure (p = 0.045). Dans le sous groupe de patients en RP, l'IPC n'a pas amélioré de manière significative la survie globale, mais a permis d'augmenter la survie spécifique (p<0.01). Dans ce sous groupe, le taux de survenue de métastases cérébrales n'était pas influencé par l'IPC mais le délai médian de leur survenue était plus long, tout comme le délai médian de survenue de la 1ère rechute métastatique. MATERIEL & METHODES Une analyse rétrospective a été effectuée sur une série de 289 patients atteints d'un CBPC localisé qui ont été traité par radio-chimiothérapie ± IPC de 1981 à 2007 dans 2 Centres du Saskatchewan, Canada. Les patients ont été répartis en 3 sous-groupes en fonction du niveau de réponse au traitement loco-régional : réponse complète (RC), réponse partielle (RP) et non répondeurs (NR). Dans chaque sous-groupe, le rôle de l'IPC a été étudié. Les taux de survie globale, de survie spécifique, et de survie sans progression ont été analysé à l'aide du test du Logrank et de la méthode de Kaplan-Meier.

International Journal of Radiation Oncology*Biology*Physics, 2006

To compare concomitant and sequential adjuvant chemoradiotherapy regimens in node-positive, opera... more To compare concomitant and sequential adjuvant chemoradiotherapy regimens in node-positive, operable breast cancer patients. This was a randomized, French, multicenter, phase III trial enrolling 638 eligible women with prior breast surgery and positive axillary dissection. Patients in Arm A received 500 mg/m2 5-fluorouracil, 12 mg/m2 mitoxantrone, and 500 mg/m2 cyclophosphamide, with concomitant radiotherapy (50 Gy +/- 10-20-Gy boost). Patients in Arm B received 500 mg/m2 5-fluorouracil, 60 mg/m2 epirubicin, and 500 mg/m2 cyclophosphamide, with subsequent radiotherapy. Chemotherapy was administered on Day 1 every 21 days for 4 cycles. Median treatment durations were 64 and 126 days (Arms A and B, respectively), with no significant difference in overall or disease-free survival. Five-year locoregional relapse-free survival favored patients with conservative surgery (two thirds of the population), with less local and/or regional recurrence in Arm A than in Arm B (3% vs. 9%; p = 0.01). Multivariate analysis in this subgroup showed a 2.8-fold increased risk of locoregional recurrence with sequential chemoradiotherapy, independent of other prognostic factors (p = 0.027). Febrile neutropenia and Grade 3-4 leukopenia were significantly more frequent in Arm A. Subclinical left ventricular ejection fraction events at 1 year were more frequent with concomitant radiotherapy (p = 0.02). Concomitant radiotherapy with adjuvant fluorouracil, mitoxantrone, and cyclophosphamide has significantly better locoregional control in node-positive breast cancer after conservative surgery and 50% shorter treatment, albeit with slightly more acute toxicity. With mitoxantrone no longer available for adjuvant breast cancer treatment, alternative concomitant chemoradiotherapy studies are needed.

Case Reports in Oncology

The survival of patients with head and neck squamous cancer with locoregional recurrence is short... more The survival of patients with head and neck squamous cancer with locoregional recurrence is short if salvage surgery or radiation cannot be performed. Systemic chemotherapy based on platinum salts and cetuximab produces only partial and transient responses. Immune checkpoint inhibitors (i.e., nivolumab) lead to a low complete response rate of only about 10%, but in some cases the effects can be long-lasting. Intratumoral chemotherapy (ITC) has been proposed for patients with local recurrence of head and neck squamous cell carcinoma with an objective response rate of 27–50%. However, it often leads to peritumoral tissue necrosis, and the duration of local control is limited. Here, we present 2 patients with head and neck squamous cell cancer whose local recurrences were refractory to intravenous chemotherapy and nivolumab. ITC using nonnecrotizing molecules, associated with nivolumab, led to complete stable local and distant response. ITC seems to trigger tumor resensitization to pre...

Merkel cell carcinoma of skin –

Current Cancer Therapy Reviews, 2016

European Journal of Cancer Supplements, 2009

Journal of drugs in dermatology : JDD, 2010

A case series of Merkel cell carcinoma (MCC) is reported here and illustrates some of the current... more A case series of Merkel cell carcinoma (MCC) is reported here and illustrates some of the current controversies in clinical management of this disease. From 1988-2007, 145 cases (74 men and 71 women) were analyzed. These were combined with other cases in the literature, hence the total number of patients was 433. Nodal metastases occurred clinically at presentation in 9/105 (9%) patients with primary tumor size <1 cm. The rate of nodal metastases is too high to obviate sentinel node biopsies even for these small tumors. For the 87 patients with intermediate tumor size (>1 - <2 cm), nodal metastases occurred clinically in 11 of 87 patients (13%) at presentation and 23 of 87 patients (26%) during follow-up. Distant metastases occurred in 20 of 87 patients (23%) only at follow-up. The risks of nodal and distant failures for tumors of intermediate sizes were sufficient to be classified as high-risk for clinical study purposes.

Journal of the American Geriatrics Society, 2000

The results of the multimodality management of 145 cases of cutaneous Merkel cell carcinoma (MCC)... more The results of the multimodality management of 145 cases of cutaneous Merkel cell carcinoma (MCC) are reported herein. Patient information was obtained from medical records of four Canadian institutions and one French institution. These data included ages, pathological stages, disease sites, histological and treatment details. Cause-specific survival (CSS), overall survival (OS) and disease-free survival (DFS) rates were analyzed by the log-rank and Kaplan-Meier methods. From 1988 to 2007, 145 cases were analyzed. There were 74 men and 71 women. Median age was 78 years (range 47-95.2). Median follow-up was 21.5 months (range 0.5-169.1). During the follow-up period, 37 local, 37 regional nodal and 15 distant recurrences were determined to be either solitary or multifocal sites of treatment failure. Relapsing patients were treated with multimodal treatments provided that their general state of health did not preclude this approach. Either initially and/or at relapse, 30 patients were treated with either multiagent (mostly etoposide with cisplatin or carboplatin) or single-agent chemotherapy, including irinotecan, taxotere and topotecan. In conclusion, recurrence should be treated with multimodalities. Our experience of long-term survivors after treatment of recurrence is encouraging.

Radiotherapy and Oncology, 2011

Purpose: Assess prognostic factors for overall survival and the potential benefit of a boost in p... more Purpose: Assess prognostic factors for overall survival and the potential benefit of a boost in patients treated with whole brain radiation therapy (WBRT). Methods and materials: From 2002 to 2006, a retrospective analysis was made from 250 unselected consecutive patients with secondary brain metastases from lung cancer, breast cancer and melanoma. Eighteen patients received surgery and were excluded from analysis. Four potential prognostic factors have been studied: primary tumor type, gender, number of metastases and improvement of neurological symptoms after radiation therapy. A subgroup analysis was performed to determine whether an additional boost could potentially improve outcome in patients who presented with less than three metastases, performance status <2, and no surgical resection of their metastasis. Results: Average follow-up was 10.3 months. Median overall survival was 5.6 months and survival rates at 1 and 2 years were 22.7% and 10%, respectively. Age less than 65 (p < 0.01), neurological improvement after WBRT (p < 0.01), and presence of less than three metastases were significant factors for overall survival in multivariate analysis. When focusing on the selected subgroup (120 assessable patients), median overall survival was 4.0 months in patients with no radiation boost, versus 8.9 months in patients with radiation boost (p = 0.0024). Conclusions: Survival and prognostic factors were similar to those found in the literature. Boost delivered after WBRT by a conventional particle accelerator could provide a benefit in selected patients, especially for centers that do not have radiotherapy techniques in stereotactic conditions. This warrants further prospective assessment.

Cancer/Radiothérapie, 2009

Abstracts / Cancer/Radiothérapie 13 (2009) 644-697 des tumeurs pulmonaires. Le système Synchrony ... more Abstracts / Cancer/Radiothérapie 13 (2009) 644-697 des tumeurs pulmonaires. Le système Synchrony TM permet de suivre la lésion durant les mouvements respiratoires. Ainsi, la dose délivrée sur celle-ci est plus importante qu'en radiothérapie classique et le fractionnement est moindre, or il existe une relation dose-réponse pour certaines tumeurs pulmonaires. Nous présentons ici les résultats chez les patients âgés de plus de 77 ans à Nice et Nancy. Patients et méthodes.-Du 29 novembre 2006 au 28 février 2009, 21 patients (17 à Nice et quatre à Nancy) atteints d'une tumeur pulmonaire unique à type de carcinome épidermoïde pour 12, adénocarcinome pour huit, tumeur pulmonaire non à petites cellules pour un ont été traités par Cyberknife ® . La moyenne d'âge était de 80 ans (77 à 95 ans). Il y avait 16 hommes et cinq femmes. Nous avons également évalué les complications secondaires à la mise en place des fiduciels. Résultats.-La dose moyenne délivrée était de 58 Gy (médiane : 60 Gy ; min : 30 Gy ; max : 75 Gy), par fractions en moyenne (2-5). Le volume tumoral macroscopique (GTV) moyen était de 61 cm 3 (min : 3,87 cm 3 ; max : 246,67 cm 3 ). L'isodose de traitement était comprise entre 64 et 84 % (médiane : 80 %). Le nombre de faisceaux moyen était de 173 (72-158). Les couvertures moyennes du volume tumoral macroscopique et du volume cible prévisionnel (PTV) étaient respectivement de 94 et 90 %.

Computer Methods in Biomechanics and Biomedical Engineering, 2020

AMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Introduction : Les carcinomes de primitif inconnu (CAPI) représentent 5% des tumeurs malignes. Av... more Introduction : Les carcinomes de primitif inconnu (CAPI) représentent 5% des tumeurs malignes. Avec une survie médiane de 6 à 15 mois, ils restent un défi diagnostique et thérapeutique. La connaissance des facteurs pronostiques semble capitale pour améliorer leur prise en charge. Matériel et Méthodes : Cinquante patients atteints de CAPI traités au CHU d Amiens entre 1998 et 2009 ont été analysé rétrospectivement. Leurs caractéristiques cliniques et biologiques, le traitement reçu, et d éventuels facteurs pronostiques ont été relevés puis étudiés par des méthodes univariées. Les survies ont été calculées selon la méthode de Kaplan-Meier et comparées en utilisant le test du log-rank. Résultats : Quarante-et-un patients (82%) présentaient un sous-type défavorable, dont 51,2% étaient des adénocarcinomes. Onze patients (26,8%) avaient un PS >= 2. Vingt patients (48,8%) avaient au moins 3 sites métastatiques : polyadénopathies (58,8%), os (53,7%), poumon (46,3%), foie (24,4%). Une chi...

Cette étude rétrospective, portant sur 92 patients traités entre 1992 et 2003 par radiochimiothér... more Cette étude rétrospective, portant sur 92 patients traités entre 1992 et 2003 par radiochimiothérapie concomitante avec escalade de dose par radiothérapie externe ou curiethérapie. La population comportait des patients non métastatiques en majorité T 3 (57,1 %) et N 1 (70,3 %). Nous avons observé une médiane de survie de 10,1 mois, un taux de réponse objective au traitement de 27,1 %, un taux de récidive locorégionale de 23 % et une rechute ou la persistance d'une maladie locorégionale de 56 %. Un boost par curiethérapie a pu être effectué pour 25 patients pour lesquels on retrouve une médiane de survie de 18,1 mois avec une survie à trois ans de 44 %. La médiane de survie constatée pour les patients éligibles pour un protocole d'essai thérapeutique et de 15,6 mois avec une survie à trois ans de 25,1 %. La compliance au traitement a été de 72,8 % pour la radiothérapie et 79,1 % pour la chimiothérapie. La toxicité de grade 3 et 4 de la chimiothérapie a été de 14 % sur le plan...

Cancer/Radiothérapie, 2009

Rare Tumors, 2011

The review covers the current recommendations for Merkel cell carcinoma (MCC), with detailed disc... more The review covers the current recommendations for Merkel cell carcinoma (MCC), with detailed discussion of many controversies. The 2010 AJCC staging system is more in-line with other skin malignancies although more complicated to use. The changes in staging system over time make comparison of studies difficult. A wide excision with margins of 2.5-3 cm is generally recommended. Even for primary </= 1 cm, there is a significant risk of nodal and distant metastases and hence sentinel node biopsy should be done if possible; otherwise adjuvant radiotherapy to the primary and nodal region should be given. Difficulties of setting up trials owing to the rarity of the disease and the mean age of the patient population result in infrequent reports of adjuvant or concurrent chemotherapy in the literature. The benefit, if any, is not great from published studies so far. However, there may be a subgroup of patients with high-risk features, e.g. node-positive and excellent performance status, for whom adjuvant or concurrent chemotherapy may be considered. Since local recurrence and metastases generally occur within 2 years of the initial diagnosis, patients should be followed more frequently in the first 2 years. However delayed recurrence can still occur in a small proportion of patients and long-term follow-up by a specialist is recommended provided that the general condition of the patient allows it. In summary, physician judgment in individual cases of MCC is advisable, to balance the risk of recurrence versus the complications of treatment.

Cancer/Radiothérapie, 2011

Parmi les 289 patients, 185 (64.0%) ont présenté une RC et 93 (32.2%) une RP. La médiane de survi... more Parmi les 289 patients, 185 (64.0%) ont présenté une RC et 93 (32.2%) une RP. La médiane de survie était de 19.7 mois pour l'ensemble des 289 patients, de 21.6 mois dans le sous-groupe en RC et de 14.3 mois dans le sous-groupe en RP. Sur les 289 patients, 177 (61.2%) ont bénéficié d'une IPC. Sur l'ensemble de la cohorte, les patients ayant bénéficié d'une IPC avaient une survie globale supérieure (p = 0.045). Dans le sous groupe de patients en RP, l'IPC n'a pas amélioré de manière significative la survie globale, mais a permis d'augmenter la survie spécifique (p<0.01). Dans ce sous groupe, le taux de survenue de métastases cérébrales n'était pas influencé par l'IPC mais le délai médian de leur survenue était plus long, tout comme le délai médian de survenue de la 1ère rechute métastatique. MATERIEL & METHODES Une analyse rétrospective a été effectuée sur une série de 289 patients atteints d'un CBPC localisé qui ont été traité par radio-chimiothérapie ± IPC de 1981 à 2007 dans 2 Centres du Saskatchewan, Canada. Les patients ont été répartis en 3 sous-groupes en fonction du niveau de réponse au traitement loco-régional : réponse complète (RC), réponse partielle (RP) et non répondeurs (NR). Dans chaque sous-groupe, le rôle de l'IPC a été étudié. Les taux de survie globale, de survie spécifique, et de survie sans progression ont été analysé à l'aide du test du Logrank et de la méthode de Kaplan-Meier.

International Journal of Radiation Oncology*Biology*Physics, 2006

To compare concomitant and sequential adjuvant chemoradiotherapy regimens in node-positive, opera... more To compare concomitant and sequential adjuvant chemoradiotherapy regimens in node-positive, operable breast cancer patients. This was a randomized, French, multicenter, phase III trial enrolling 638 eligible women with prior breast surgery and positive axillary dissection. Patients in Arm A received 500 mg/m2 5-fluorouracil, 12 mg/m2 mitoxantrone, and 500 mg/m2 cyclophosphamide, with concomitant radiotherapy (50 Gy +/- 10-20-Gy boost). Patients in Arm B received 500 mg/m2 5-fluorouracil, 60 mg/m2 epirubicin, and 500 mg/m2 cyclophosphamide, with subsequent radiotherapy. Chemotherapy was administered on Day 1 every 21 days for 4 cycles. Median treatment durations were 64 and 126 days (Arms A and B, respectively), with no significant difference in overall or disease-free survival. Five-year locoregional relapse-free survival favored patients with conservative surgery (two thirds of the population), with less local and/or regional recurrence in Arm A than in Arm B (3% vs. 9%; p = 0.01). Multivariate analysis in this subgroup showed a 2.8-fold increased risk of locoregional recurrence with sequential chemoradiotherapy, independent of other prognostic factors (p = 0.027). Febrile neutropenia and Grade 3-4 leukopenia were significantly more frequent in Arm A. Subclinical left ventricular ejection fraction events at 1 year were more frequent with concomitant radiotherapy (p = 0.02). Concomitant radiotherapy with adjuvant fluorouracil, mitoxantrone, and cyclophosphamide has significantly better locoregional control in node-positive breast cancer after conservative surgery and 50% shorter treatment, albeit with slightly more acute toxicity. With mitoxantrone no longer available for adjuvant breast cancer treatment, alternative concomitant chemoradiotherapy studies are needed.

Case Reports in Oncology

The survival of patients with head and neck squamous cancer with locoregional recurrence is short... more The survival of patients with head and neck squamous cancer with locoregional recurrence is short if salvage surgery or radiation cannot be performed. Systemic chemotherapy based on platinum salts and cetuximab produces only partial and transient responses. Immune checkpoint inhibitors (i.e., nivolumab) lead to a low complete response rate of only about 10%, but in some cases the effects can be long-lasting. Intratumoral chemotherapy (ITC) has been proposed for patients with local recurrence of head and neck squamous cell carcinoma with an objective response rate of 27–50%. However, it often leads to peritumoral tissue necrosis, and the duration of local control is limited. Here, we present 2 patients with head and neck squamous cell cancer whose local recurrences were refractory to intravenous chemotherapy and nivolumab. ITC using nonnecrotizing molecules, associated with nivolumab, led to complete stable local and distant response. ITC seems to trigger tumor resensitization to pre...

Merkel cell carcinoma of skin –

Current Cancer Therapy Reviews, 2016

European Journal of Cancer Supplements, 2009

Journal of drugs in dermatology : JDD, 2010

A case series of Merkel cell carcinoma (MCC) is reported here and illustrates some of the current... more A case series of Merkel cell carcinoma (MCC) is reported here and illustrates some of the current controversies in clinical management of this disease. From 1988-2007, 145 cases (74 men and 71 women) were analyzed. These were combined with other cases in the literature, hence the total number of patients was 433. Nodal metastases occurred clinically at presentation in 9/105 (9%) patients with primary tumor size <1 cm. The rate of nodal metastases is too high to obviate sentinel node biopsies even for these small tumors. For the 87 patients with intermediate tumor size (>1 - <2 cm), nodal metastases occurred clinically in 11 of 87 patients (13%) at presentation and 23 of 87 patients (26%) during follow-up. Distant metastases occurred in 20 of 87 patients (23%) only at follow-up. The risks of nodal and distant failures for tumors of intermediate sizes were sufficient to be classified as high-risk for clinical study purposes.

Journal of the American Geriatrics Society, 2000

The results of the multimodality management of 145 cases of cutaneous Merkel cell carcinoma (MCC)... more The results of the multimodality management of 145 cases of cutaneous Merkel cell carcinoma (MCC) are reported herein. Patient information was obtained from medical records of four Canadian institutions and one French institution. These data included ages, pathological stages, disease sites, histological and treatment details. Cause-specific survival (CSS), overall survival (OS) and disease-free survival (DFS) rates were analyzed by the log-rank and Kaplan-Meier methods. From 1988 to 2007, 145 cases were analyzed. There were 74 men and 71 women. Median age was 78 years (range 47-95.2). Median follow-up was 21.5 months (range 0.5-169.1). During the follow-up period, 37 local, 37 regional nodal and 15 distant recurrences were determined to be either solitary or multifocal sites of treatment failure. Relapsing patients were treated with multimodal treatments provided that their general state of health did not preclude this approach. Either initially and/or at relapse, 30 patients were treated with either multiagent (mostly etoposide with cisplatin or carboplatin) or single-agent chemotherapy, including irinotecan, taxotere and topotecan. In conclusion, recurrence should be treated with multimodalities. Our experience of long-term survivors after treatment of recurrence is encouraging.

Radiotherapy and Oncology, 2011

Purpose: Assess prognostic factors for overall survival and the potential benefit of a boost in p... more Purpose: Assess prognostic factors for overall survival and the potential benefit of a boost in patients treated with whole brain radiation therapy (WBRT). Methods and materials: From 2002 to 2006, a retrospective analysis was made from 250 unselected consecutive patients with secondary brain metastases from lung cancer, breast cancer and melanoma. Eighteen patients received surgery and were excluded from analysis. Four potential prognostic factors have been studied: primary tumor type, gender, number of metastases and improvement of neurological symptoms after radiation therapy. A subgroup analysis was performed to determine whether an additional boost could potentially improve outcome in patients who presented with less than three metastases, performance status <2, and no surgical resection of their metastasis. Results: Average follow-up was 10.3 months. Median overall survival was 5.6 months and survival rates at 1 and 2 years were 22.7% and 10%, respectively. Age less than 65 (p < 0.01), neurological improvement after WBRT (p < 0.01), and presence of less than three metastases were significant factors for overall survival in multivariate analysis. When focusing on the selected subgroup (120 assessable patients), median overall survival was 4.0 months in patients with no radiation boost, versus 8.9 months in patients with radiation boost (p = 0.0024). Conclusions: Survival and prognostic factors were similar to those found in the literature. Boost delivered after WBRT by a conventional particle accelerator could provide a benefit in selected patients, especially for centers that do not have radiotherapy techniques in stereotactic conditions. This warrants further prospective assessment.

Cancer/Radiothérapie, 2009

Abstracts / Cancer/Radiothérapie 13 (2009) 644-697 des tumeurs pulmonaires. Le système Synchrony ... more Abstracts / Cancer/Radiothérapie 13 (2009) 644-697 des tumeurs pulmonaires. Le système Synchrony TM permet de suivre la lésion durant les mouvements respiratoires. Ainsi, la dose délivrée sur celle-ci est plus importante qu'en radiothérapie classique et le fractionnement est moindre, or il existe une relation dose-réponse pour certaines tumeurs pulmonaires. Nous présentons ici les résultats chez les patients âgés de plus de 77 ans à Nice et Nancy. Patients et méthodes.-Du 29 novembre 2006 au 28 février 2009, 21 patients (17 à Nice et quatre à Nancy) atteints d'une tumeur pulmonaire unique à type de carcinome épidermoïde pour 12, adénocarcinome pour huit, tumeur pulmonaire non à petites cellules pour un ont été traités par Cyberknife ® . La moyenne d'âge était de 80 ans (77 à 95 ans). Il y avait 16 hommes et cinq femmes. Nous avons également évalué les complications secondaires à la mise en place des fiduciels. Résultats.-La dose moyenne délivrée était de 58 Gy (médiane : 60 Gy ; min : 30 Gy ; max : 75 Gy), par fractions en moyenne (2-5). Le volume tumoral macroscopique (GTV) moyen était de 61 cm 3 (min : 3,87 cm 3 ; max : 246,67 cm 3 ). L'isodose de traitement était comprise entre 64 et 84 % (médiane : 80 %). Le nombre de faisceaux moyen était de 173 (72-158). Les couvertures moyennes du volume tumoral macroscopique et du volume cible prévisionnel (PTV) étaient respectivement de 94 et 90 %.