J.-J. Bretel

Local relapse and contralateral tumor rates in patients with breast cancer treated with conservative surgery and radiotherapy (institut gustave roussy 1970–1982)

Background. Breast conservation is now established treatment for patients with small breast cancers. The authors reviewed a large series of patients with long term follow‐up who underwent conservative treatment. Clinical and pathologic factors were analyzed to identify patients at an increased risk of relapse in the breast (local relapse) or development of a contralateral tumor.

Invasive carcinoma of the thymus. A multicenter retrospective review of 56 cases

This multicenter retrospective study included 56 cases of histologically reviewed invasive epithelial thymic tumors. All these patients underwent surgical treatment or exploration and were referred for complementary radiotherapy. The majority received a dose higher than 4000 rad. Twenty-three out of 50 patients (46%) with incomplete resection received some chemotherapy. The local recurrence rate at 2 yr was 34%. The overall 5-yr actuarial survival was 46%. There was no evidence of any relationship between radiation dose and local control. No difference in survival was observed with or without chemotherapy, nor according to histological type or lymphocytic infiltration, except cases with very undifferentiated carcinomas which presented a worse prognosis. Nor was any difference in survival observed between patients benefiting from incomplete resection and those only having undergone exploratory thoracotomy and biopsy. Radiotherapy seems to decrease the rate of local recurrence in invasive carcinoma of the thymus. The role of chemotherapy is still debatable, but it could have a role in decreasing tumor volume before radiotherapy. This study has shown the necessity of histological review by a panel of histopathologists in an attempt to better define terminology and diagnosis. A prospective study is necessary in order to solve the problems of concepts and management in epithelial thymic tumors.

Combined Etoposide, Ifosfamide, and Cisplatin in the Treatment of Patients with Advanced Thymoma and Thymic Carcinoma. A French Experience

Introduction: The value of a nonanthracyclin regimen in thymic carcinoma and malignant thymoma is not well defined. These regimens may be useful in some patients, particularly with cardiac diseases. The objective of this study is to evaluate the response rate, progression free survival, overall survival and toxicity of combined etoposide, ifosfamide, and cisplatin in patients with advanced thymoma and thymic carcinoma. Methods: From October 1995 to April 2001, 18 patients with advanced thymoma or thymic carcinoma were entered on trial, and receive etoposide (100 mg/m2 on days 1–3), ifosfamide (1500 mg/m2 on days 1–3), s and cisplatin (30 mg/m2 on days 1–3). Cycles were repeated every 3 weeks for a total of six cycles. Results: Among 16 evaluable patients, there were no complete responses and four partial responses (complete and partial responses rate, 25%; confidence interval [CI] 95, 7–48%). The median follow-up was 32.6 months (range, <9–84 months), and the median overall survival has not yet been reached because more than 50% of patients are still alive. Based on Kaplan-Meier estimates, the 1-year and 2-year survival rates were 93.8 and 78.1%, respectively. The toxicity was predominantly myelosuppresion and alopecia. Conclusions: The combined etoposide, ifosfamide, and cisplatin regimen has moderate activity in patients with advanced thymic tumors. Our results confirm the Eastern Cooperative Oncology Group trial published in 2001. Response rates appear to be lower to many phase II trials, but survival seems similar.

Concurrent cisplatin-vindesine and hyperfractionated thoracic radiotherapy in locally advanced nonsmall cell lung cancer

PURPOSE Local failure is a major problem in locally advanced nonsmall cell lung cancer. The main objective of this Phase II trial was to test the feasibility of a combined concurrent radiotherapy and chemotherapy approach in an attempt to improve local control. METHODS AND MATERIALS From December 1989 to December 1992, 34 patients were included. The treatment schedule consisted of hyperfractionated radiotherapy (60 Gy in 48 fractions and 6 weeks with two daily sessions of 1.25 Gy), cisplatin (6 mg/m2 every day of radiotherapy), and vindesine (2.5 mg/m2 once weekly). After a 3-week rest period, two full cycles of cisplatin (120 mg/m2 on weeks 10 and 14) and vindesine (2.5 mg/m2 on weeks 11, 12, and 13) were given. Treatment evaluation with thoracic computed scan, bronchoscopy, and bronchial biopsies was performed 3 months after completion of radiation therapy. Failure rates were estimated using a competing risk approach. RESULTS The complete response rate was 50%. Local failure rates at 1 and 3 years were 53 and 56%, respectively. Distant metastases rates at 1 and 3 years were 26.5 and 29%. Overall survival rates at 1, 2, and 3 years were respectively 53, 33, and 12%. Severe esophagitis was observed in three patients (9%). Lethal toxicity was observed in two patients. CONCLUSION This Phase II trial confirms the feasibility of this type of approach with specific dose reduction and suggests that it may improve local control compared to conventional approaches.

Modalités de la radiothérapie dans les carcinomes bronchiques à petites cellules : radiothérapie thoracique et irradiation prophylactique cérébrale

Resume Les cancers bronchiques a petites cellules (CPC) representent 20 % de l’ensemble des cancers bronchiques. Apres le bilan d’extension initial, seul un tiers de ces patients aura finalement une forme limitee. Le traitement des CPC limites repose actuellement sur les associations chimiotherapie-radiotherapie qui ont permis une amelioration de la survie globale et de la survie sans metastases au cours des dernieres annees. Neanmoins, meme dans les formes limitees, la survie a 5 ans varie entre 10 et 15 % et ne depasse guere 25 % dans les meilleures series. Le risque de rechute est en effet eleve : si pres de 70 % des patients avec une forme limitee parviennent a une reponse complete, seul 15 a 20 % d’entre eux survivront de facon prolongee. En effet, la plupart rechutent, et le risque de dissemination cerebrale par exemple est particulierement eleve, puisqu’il atteint pres de 50 % a 2 ans meme chez des patients mis en reponse complete. Ainsi, l’irradiation prophylactique cerebrale a egalement pris place dans la prise en charge standard des patients ayant un CPC en reponse complete suite aux resultats d’une meta-analyse ayant montre que la survie a 3 ans etait amelioree de 5 %. Malgre l’amelioration de la survie globale grâce aux traitements combines, les resultats mediocres observes en termes de survie a long terme devraient stimuler plus d’essais therapeutiques, afin de trouver les chimiotherapies et les modalites de radiotherapie optimales, la meilleure facon d’associer ces deux traitements ainsi que la place de nouvelles therapeutiques.

Alternating radiotherapy and chemotherapy in limited disease small cell lung cancer

In a pilot study of 29 patients treated for localized small cell lung cancer, three new approaches were introduced, i.e. an increased initial drug dose, an early alternation of chemotherapy and thoracic radiotherapy and initial accelerated and hyperfractionated irradiation. The results were interesting. However, a high rate of fatal toxicity (21%) was observed.

Les cancers à petites cellules (CPC). Modalités actuelles de la prise en charge des patients présentant un carcinome bronchique à petites cellules localisé

Resume Les cancers bronchiques a petites cellules (CPC) representent moins de 20 % de l’ensemble des cancers bronchiques. Seul un tiers de ces patients presente une forme localisee. Leur traitement repose actuellement sur les associations CT-RT comportant des sels de platine et etoposide ± autres drogues et une radiotherapie thoracique plus conformationnelle avec un fractionnement classique ou accelere ainsi qu’une meilleure integration de l’irradiation prophylactique cerebrale chez les bons repondeurs. Une amelioration des resultats a donc ete obtenue. Neanmoins, dans les formes limitees, la survie a 5 ans varie autour de 25 % dans les meilleures series. En effet, la plupart des patients rechutent, et le risque de dissemination cerebrale par exemple est particulierement eleve, puisqu’il atteint pres de 50 % a 2 ans, meme chez des patients mis en reponse complete. L’irradiation prophylactique cerebrale a donc pris place dans la prise en charge standard des patients en reponse complete suite aux resultats d’une meta-analyse ayant montre que la survie a 3 ans etait amelioree de 5 %. Meme si l’amelioration de la survie globale grâce aux traitements combines est sensible, il y a encore de nombreuses questions et cela devrait stimuler plus d’essais therapeutiques afin d’optimiser les modalites de polychimiotherapies et de radiotherapie, la meilleure facon d’associer ces deux traitements ainsi que l’eventuelle place de therapeutiques ciblees.