I. Barillot

Carcinoma of the intact uterine cervix treated with radiotherapy alone: a French cooperative study: update and multivariate analysis of prognostics factors.

PURPOSE To determine independent prognostic factors in a group of 1875 patients with invasive carcinoma of the intact uterine cervix treated with radiotherapy alone in a French cooperative study from 1970 to 1993. MATERIALS AND METHODS Patients were staged according to the UICC-FIGO and MDAH substaging. The distribution per FIGO stage was Ia-Ib: 25.5%; IIa: 12%; IIb: 29%; IIIa: 5%; IIIb: 25%, and IV: 3.5%. Ninety-two percent had squamous cell carcinoma. The maximum diameter of the clinically detectable cervical disease was less than 3 cm in 24.5% of Stages I-II and in 10% of Stages III-IV, more than 5 cm in 13.5% of Stages I-II, and in 16% of Stages III-IV. Nodal involvement was shown on lymphangiogram in 16% of Stages I-II and in 32.5% of Stages III-IV. RESULTS 1) Univariate analysis of Stages I and II: stage, cervical disease diameter, and nodal involvement are significant prognostic factors. Five-year specific survival rate (5ySS) is 83.5% in Stage Ib, 81% in IIa and 71% in IIb. Five-year disease-free survival rate (5yDFS) is 86% in tumors less of 3 cm, 76% in tumors of 3 to 5 cm, and 61.5% in tumor larger than 5 cm. Lymphangiogram strongly influences the 5-year pelvic disease-free survival rate (5yPDFS): respectively, 90% in nonpositive lymphangiogram vs. 65% when positive. A significant drop in specific and disease-free survival is observed (10 and 14%, respectively (p = 0.04) when comparing adenocarcinoma and squamous cell carcinoma. Age is a significant prognostic factor for specific survival because patients aged less than 30 years old have 91% vs. about 75% for patients over 30 years (p = 0.03). 2) Univariate analysis of Stages III-IV: Stage and positive lymphangiogram are predictive factors for relapse and death. The MDAH substaging is more reliable to predict the probability of pelvic disease-free survival in Stage III. At 5 years, the FIGO Stages IIIa and IIIb have a rather similar PDFS (65% vs. 59%). Conversely, the difference of survival rates between MDAH Stage IIIA and Stage IIIB is more demonstrative (69% vs. 47.5%). 3) Multivariate analysis (Cox P. H. R. model). Nodal involvement and stage remain significant for all three models in all stages (p < 0.0001). Age above 70 years influences specific survival for Stage I-II (p = 0.01). Tumors larger than 5 cm and adenocarcinoma also appear to be independent prognostic factors for specific and disease-free survival in Stage I-II (p = 0.05 and p = 0.005, respectively). CONCLUSIONS The relevance of tumor size (less or greater than 4 cm) is now recognized in the 1995 revised FIGO staging in Stage Ib but unfortunately not in other stages. Tumor size per stage and nodal status should be systematically recorded to allow a better prediction of failure rates and to compare literature reports.

Radiotherapy for head and neck cancers including chemoradiotherapy.

After two decades of clinical investigations on hyperfractionation, a 10% local control gain at 5 years was finally demonstrated by a large, randomized trial in oropharyngeal carcinoma, which confirms promising data from numerous uncontrolled studies. Moreover, this progress was achieved without additional late morbidity, in agreement with radiobiology predictions of the linear quadratic model. Data from in vivo measures of the survival fraction after 2 Gy and potential doubling time show a trend for a poorer prognosis in rapidly proliferating tumors, however, unequivocal evidence does not yet exist. Retrospective studies document the detrimental effect of prolonged overall treatment time and support investigations on accelerated radiotherapy as a priority. Reports on the combination of chemotherapy and radiotherapy (mostly concomitantly) still leave the reader with a feeling of frustration. All reports, except one, have a poor methodology without a control arm to use the best-known regimens of radiotherapy and surgery. Nasopharyngeal tumors should not be mixed up with other head and neck sites because impressive responses can follow adequate combination strategies of chemoradiotherapy. Xerostomia is no longer an unavoidable and hopeless side-effect of radiotherapy; individualized treatment planning and stimulation of remaining salivary glands by pilocarpine can improve the comfort in about 50% of irradiated patients.

Intravascular radiation and stenting: absence of efficacy on intimal proliferation in a rabbit model.

David Busseuil1, Marianne Zeller 2, Yves Cottin2, Philippe Allouch2, Philippe Maingon3, Isabelle Barillot3, Suzanne Naudy3, Laurent Arnould4, Gabrielle Michalowicz5, Maryvonne Moisant6, Jean-Claude Horiot3, Jean-Eric Wolf2, and Luc Rochette1 1LPPCE, Faculty of Medicine, University of Burgundy; 2Cardiology Department, University, Hospital, Dijon; 3Radiotherapy Department, CGFL, Dijon; 4Pathology Department, CGFL, Dijon; 5Genetics Department, University Hospital, Grenoble, France; Histology Department, Faculty of Medicine, University of Burgundy

Les chimioradiothérapies dans les cancers du col utérin

Treatment of uterine cervix carcinomas is based on radiotherapy and surgery. Prognosis of advanced carcinoma leads to the proposal of many combinations. Only concurrent radio-chemotherapy demonstrated some interests. Combination of radiotherapy and radiosensitisers failed to demonstrate any advantage and in some instances was associated with an adverse effect. Hydroxyurea and mitomycin C alone or associated were extensively tested without benefit. From modern combinations and recent studies, we could conclude that only cisplatin (and probably its derivates) can be included in future trials.