Judith A. Long

Results of a cohort of 200 hormone-naïve consecutive patients with prostate cancer treated with iodine 125 permanent interstitial brachytherapy by the same multidisciplinary team

PURPOSEnTo report survival and morbidity of a cohort of 200 hormone-naïve consecutive patients with localized prostate cancer, treated by low-dose rate brachytherapy within the frame of multidisciplinary approach.nnnPATIENTS AND METHODSnBetween 2001 and 2011, 200 patients were treated by the same team with 125 iodine seeds: 167 low-risk and 33 intermediate risk according to the dAmico classification; eligible patients had clinical stage T1/T2a-b, Gleason score 3+3 or 3+4, baseline prostate-specific antigen level below 15ng/mL, prostate volume less than 60cm(3). The median number of random biopsies was 12 (range 6-32) and the breakdown of positive cores was as follows: 1 (29%), 2 (35%), 3 or more (36%). Acute morbidity was assessed according to the Common Terminology Criteria for Adverse Events and late toxicity according to the EORTC/RTOG scale. Data were prospectively collected.nnnRESULTSnThe median follow-up was 69 months (range 16 to 135). The 5- and 10-year biochemical relapse free survivals were 95.6% (95% confidence interval [CI]: 91-98) and 89.7% (95% CI: 79.4-95.0). The 5-year and 10-year overall survival were respectively 96.4% (95% CI: 92-98.4) and 89.7% (95% CI: 80.8-94.6%) and the 10-year disease specific survival, 99.1% (95% CI: 93.0-99.9). The 5- and 10-year grade 3 acute toxicity cumulative rate were respectively 3.3% (95% CI: 1.4-6.6) and 4% (95% CI: 1.4-6.6) and the 5- and 10-year grades 3 cumulative late toxicity 2.5% (95% CI: 2.0-5.9) and 4% (95% CI: 2.0-5.9).nnnCONCLUSIONnBrachytherapy managed within the frame of a multidisciplinary approach - from diagnosis to evaluation - may offer optimized results with a reduced late toxicity rate, while remaining opened to dosimetry and technical improvements.

Traitement du cancer du rein métastatique chez les sujets âgés

Resume Le traitement du CRM chez les sujets âges est identique a celui des patients plus jeunes. Alors que les cytokines etaient classiquement contrindiquees chez les patients de plus de 70 ou 75 ans (notamment l’IL2), les nouvelles therapeutiques ciblees ont ete evaluees sans limitation d’âge et l’ensemble des etudes de phase III a inclus des patients de plus de 80 ans. Globalement, il ne semble pas y avoir de difference d’efficacite en fonction de l’âge (sauf peut-etre pour le temsirolimus). Concernant la tolerance, elle est satisfaisante avec l’ensemble des therapeutiques. La diminution de doses est un peu plus frequente, ce qui doit rendre prudent, notamment avec le sunitinib pour lequel une correlation directe entre la dose administree et l’efficacite a ete rapportee. Compte-tenu des donnees disponibles, aucune adaptation de dose en fonction de l’âge n’est recommandee dans le CRM.