Les chordomes sont des tumeurs radioresistantes du nevraxe, dont la radiotherapie est delicate du... more Les chordomes sont des tumeurs radioresistantes du nevraxe, dont la radiotherapie est delicate du fait de la proximite de nombreux organes a risque. Pour les chordomes du sacrum non operes, la protontherapie, associee a la radiotherapie conformationnelle avec modulation d’intensite (RCMI), permet de delivrer jusqu’a 74 Gy malgre la proximite immediate des racines sacrees, du rectum et du sillon interfessier. En protontherapie, la methode classique de delivrance du traitement est la diffusion passive ou « double scattering » (DS), avec un double etalement du pic de Bragg assorti d’une collimation du faisceau, comme en radiotherapie conformationnelle. Plus recemment s’est developpee la methode de balayage actif ou « pencil beam scanning » (PBS), permettant de balayer la zone cible point par point, grâce a la deviation laterale et la modulation en profondeur du pic de Bragg non etale. Cette methode permet soit d’optimiser un seul faisceau, point par point (« single field uniform dose », SFUD), soit de combiner les faisceaux optimises comme en RCMI (« IMPT »). En vue de l’installation du PBS au centre de protontherapie d’Orsay, nous avons compare, pour deux cas cliniques de chordome du sacrum non opere, des plans de traitement utilisant la methode actuelle (DS avec complement par RCMI), les deux methodes de PBS (SFUD ou IMPT) avec complement par RCMI, ou l’IMPT seule. Pour les deux cas, les indices d’homogeneite etaient comparables. Les doses delivrees aux organes a risque et la dose integrale etaient nettement inferieures avec les plans utilisant le PBS. L’indice de conformite pour l’IMPT seule etait meilleur sur un cas et moins bon sur le second. La technique du PBS et notamment l’IMPT est utilisable pour l’irradiation des chordomes du sacrum en place. L’IMPT seule pourrait etre utilisee et ainsi eviter un changement de machine en cours de traitement.
International Journal of Radiation Oncology*Biology*Physics, 2019
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Purpose or Objective: The majority of intraprostatic recurrences after radical prostate radiother... more Purpose or Objective: The majority of intraprostatic recurrences after radical prostate radiotherapy occur at the site of initial tumour, in previous reported series. However, there is no published data directly comparing recurrence patterns after different modalities of radiotherapy. The aim of this study was to investigate differences in spatial pattern of intra-prostatic recurrences on multiparametric MRI, after external beam radiotherapy or brachytherapy. Material and Methods: We identified 382 consecutive patients referred for multiparametric MRI after previous prostate cancer treatment. Patients with post-radiotherapy biochemical recurrence and intraprostatic recurrence on MRI were included in the study. Scans were independently reviewed by two radiologists. The location of recurrence was mapped to prostate sectors based on European consensus guidelines. The chi-square test was used to analyse differences in site of recurrence between modalities of radiotherapy. Results: 66 patients who had radical radiotherapy between 1997 and 2013 had intraprostatic recurrence on MRI. The D'Amico risk stratification at initial diagnosis was 14% lowrisk, 34% intermediate-risk and 52% high-risk. The series consisted of 34 patients after external beam radiotherapy (EBRT), 20 patients after low-dose rate brachytherapy (LDR) and 12 after high-dose rate brachytherapy monotherapy (HDR mono). 68% of the EBRT recurrences had received a dosefractionation schedule with an EQD2 less than 74 Gy. The mean time between the end of radiotherapy and imaging recurrence was 77 months (95% CI 68-85 months) with no significant differences between treatment groups. 80% of patients did not have any associated pelvic bony metastasis or nodal disease. 88% of patients had a contiguous intraprostatic recurrence. The median recurrence size detected on MRI was 2.0 cm (range 0.6-4.2 cm). Recurrences after EBRT were more likely to involve multiple sectors of the prostate. 71% of EBRT recurrences involved the apex compared to 30% after LDR and 25% after HDR mono (p = 0.003). In the LDR group, recurrences involved the base of the gland in 60% of cases, compared to 41% after EBRT and 8% after HDR mono (p = 0.016). 21% of patients underwent salvage treatment with cryotherapy, HDR brachytherapy or prostatectomy.
Background: To assess the local control, survival, and toxicity in symptomatic and/or progressive... more Background: To assess the local control, survival, and toxicity in symptomatic and/or progressive gliomas treated with sophisticated 3D Photon /proton conformal radiotherapy. Material and methods: From 08/1994 through 05/2008, 18 children (Med. 10 years, range 6–16 ) [for full text, please go to the a.m. URL]
Intracranial-Germinoma demonstrates excellent long-term survival after Craniospinal-irradiation p... more Intracranial-Germinoma demonstrates excellent long-term survival after Craniospinal-irradiation plus Tumor-Bed Boost. Recent studies have examined combined approach with reduced radiation volume and/or dose. SFOP-90 study delivered primary chemotherapy followed by 40 Gy to tumour-bed. At median[for full text, please go to the a.m. URL]
присвячена дослідженню ультраструктури підшлункової залози білого щура за умов впливу опіоїду. В ... more присвячена дослідженню ультраструктури підшлункової залози білого щура за умов впливу опіоїду. В роботі наведені нові данні щодо особливостей змін ультраструктури ендокриноцитів та ланок гемомікроциркуляторного русла через 2, 4 і 6 тижнів впливу опіоїду. Перші зміни ультраструктурної організації ланок гемомікроциркуляторного русла ендокринної частини підшлункової залози спостерігаються вже через 2 тижні введення щурам налбуфіну і наростають впродовж наступних термінів експерименту. Довготривалий вплив опіоїду зумовлює значні дистрофічні зміни інсулоцитів, зокрема, втрату правильної форми, каріопікноз та каріорексис ядер, набряк та просвітлення цитоплазми, розвиток мікрокістозної дегенерації клітин, розпушення та дезорганізацію базальної мембрани, що може призводити до порушення функції ендокринної частини підшлункової залози. Введення налбуфіну щурам впродовж 6 тижнів призводить до розвитку процесів, що є підґрунтям патологічних змін, які характерні для склерозу судин, циркуляторної гіпоксії, порушень в коагуляційній та фібринолітичній системах, розвитку навколокапілярного набряку і розростання сполучної тканини, порушення трансендотеліального транспорту. Робота є основою для подальших досліджень морфологів і клініцистів щодо розробки в перспективі нових методів діагностики, профілактики та лікування захворювань підшлункової залози у наркозалежних та пацієнтів, які змушені впродовж тривалого часу приймати опіоїди. Ключові слова: ендокринна частина підшлункової залози, ультраструктура, щур, опіоїд.
Journal of Nuclear Medicine & Radiation Therapy, 2012
Purpose: According to preliminary clinical experience, craniospinal irradiation (CSI) may be cons... more Purpose: According to preliminary clinical experience, craniospinal irradiation (CSI) may be considered as a treatment option in patients with recurrent leukemia involving the central nervous system (CNS). Field matching poses challenges as it leads to a risk of underdosage or overdosage in the junctional area. We investigated the feasibility of CSI using helical tomotherapy (HT). Patients and methods: Four patients presenting with CNS recurrences of leukemia were referred to our department for salvage radiation therapy. Treatment planning was conducted by the Eclipse TM system for 3D-CRT and IMRT, and with the Tomotherapy ® software for HT. Acute adverse events were monitored weekly using the Common Terminology Criteria for Adverse Events v 4.0. Results: Using HT, highly conformal irradiation could be delivered to CNS. Average doses to the encephalon were 25.1 Gy, 15.5 Gy, and 23.3 Gy using 3D-CRT, IMRT, and HT respectively. Spinal cord received an average dose of 18.9 Gy with 3D-CRT, 15.7 Gy with IMRT and 23.4 Gy with HT. Areas of overdosage to the brain or the spinal cord were also significantly decreased with HT. With HT, average doses to critical organs were also significantly decreased. No acute toxicity was reported with HT, whereas the patients treated by 3D-CRT and IMRT presented with grade II vomiting and asthenia. Conclusion: HT may optimize CSI in the treatment of CNS hematological recurrences by homogenously covering target volumes and improve clinical acute tolerance by more effectively sparing critical organs for preserving the quality of life. Further prospective assessments are warranted. Patients and Methods Case No.1 A thirty-two-year-old woman was diagnosed with ALL in December 2007 characterized by the presence of the CALM/AF10 transcript [10,11] (p13,q14) and normal karyotype. She was first treated with chemotherapy (Table 1) followed by an autologous bone marrow transplantation, leading to a complete remission. Due to her altered general status, the patient was administered fewer intrathecal injections for CNS prophylaxis (methotrexate, cytarabine, depomedrol) (Table 2) and no total body irradiation (TBI) during the conditioning of the autograft.
Introduction L’adenome hypophysaire gonadotrope est tres rare chez l’enfant avec comme option the... more Introduction L’adenome hypophysaire gonadotrope est tres rare chez l’enfant avec comme option therapeutique la chirurgie et la radiotherapie. La protontherapie, aux proprietes balistiques ultra precises, permet une radiotherapie focalisee, meme des lesions profondes avec peu d’atteinte des tissus traverses et environnants. Observation Garcon de 10 ans, sans antecedent, presentant une baisse de l’acuite visuelle soudaine avec hemianopsie bilaterale. Examen normal (P1G1). Sur l’IRM hypophysaire : volumineuse tumeur (3,5 cm) intra et suprasellaire, avec compression du chiasma et envahissement du sinus caverneux droit. L’exploration hormonale met en evidence un deficit partiel GH/TSH alors que les concentrations de prolactine, FSH et sous-unite α sont normales ; absence de mutation germinale des genes NEM1, AIP, GNAS. Chirurgie initiale de decompression puis 9 mois plus tard resection partielle pour rechute visuelle et progression tumorale a l’IRM. L’etude histologique objective un adenome gonadotrope [bFSH (4–20 %), sous unite α (40 %)] et agressif [P53 (3 %), MIB1 (6 %)]. Compte tenu du jeune âge de l’enfant, une radiotherapie par protontherapie (54 Gy) est proposee. Avec un recul de 24 mois, aucune progression tumorale est observee sur la surveillance IRM ; recuperation visuelle complete et pas d’autre deficit hypophysaire. Un traitement par GH a ete initie 1 an apres la fin de la protontherapie avec un excellent rattrapage statural. Discussion L’adenome hypophysaire gonadotrope agressif est une tumeur exceptionnelle chez l’enfant, dont la prise en charge est difficile. La protontherapie apparait une option therapeutique en postoperatoire en cas de recidive pour controler la croissance tumorale et limiter les effets secondaires iatrogenes.
cancer du rein, et une survie sans progression allongée chez des patients sélectionnés. Déclarati... more cancer du rein, et une survie sans progression allongée chez des patients sélectionnés. Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.
In this chapter we present: I. The physical bases of proton therapy, going from microscopic conce... more In this chapter we present: I. The physical bases of proton therapy, going from microscopic concepts to macroscopic features II. The technology and the logistics, which evolve to more and more compact and cheaper facilities with the capability to perform adaptive radiation therapy III. The most usual clinical indications, moving toward (nearly) all indications of radiation therapy IV. Some research orientations, rediscovering physics, and radiation biology V. Basic elements to conceive and build a clinical center VI. Conclusions: The need to learn from others and also to innovate
In the SFOP protocol TGM-TC90 for localised tumours, craniospinal (CS) prophylactic radiotherapy ... more In the SFOP protocol TGM-TC90 for localised tumours, craniospinal (CS) prophylactic radiotherapy fields were replaced by carboplatin-based chemotherapy together with focal irradiation of the initial tumour volume (40 Gy). Metastatic tumours received CS irradiation and a local boost. In order to refine radiation-treatment volumes, patterns of relapse with respect to radiation technique were documented.
Improvement of EFS of children older than 3 years with high risk medulloblastoma. Methods: Betwee... more Improvement of EFS of children older than 3 years with high risk medulloblastoma. Methods: Between 1993 and 1999, 115 patients (3-18 years, mean 8 years) with high risk medulloblastoma were included. After surgery treatment consisted of chemotherapy ('8in1' and etoposide/carboplatin) before and after craniospinal radiotherapy. Results: Patients were staged using Chang-criteria (PF residue only, M1 and M2/M3) by local investigator as well as by central review panel (82.4% concordance). Chemotherapy was well tolerated without major delays in radiotherapy. With a mean follow up of 81 months (9-119), 5-year EFS was 49.8% and OS 60.1%. In detail according to subgroups EFS was 68.8% for PF residue only, 58.8% for M1 disease and 43.1% for M2/M3. Conclusion: M1 patients are legitimate high risk patients. Survival rates are still very low for high risk medulloblastoma patients and future trials should therefore focus on more intensive (chemotherapy/radiotherapy) treatment.
Les chordomes sont des tumeurs radioresistantes du nevraxe, dont la radiotherapie est delicate du... more Les chordomes sont des tumeurs radioresistantes du nevraxe, dont la radiotherapie est delicate du fait de la proximite de nombreux organes a risque. Pour les chordomes du sacrum non operes, la protontherapie, associee a la radiotherapie conformationnelle avec modulation d’intensite (RCMI), permet de delivrer jusqu’a 74 Gy malgre la proximite immediate des racines sacrees, du rectum et du sillon interfessier. En protontherapie, la methode classique de delivrance du traitement est la diffusion passive ou « double scattering » (DS), avec un double etalement du pic de Bragg assorti d’une collimation du faisceau, comme en radiotherapie conformationnelle. Plus recemment s’est developpee la methode de balayage actif ou « pencil beam scanning » (PBS), permettant de balayer la zone cible point par point, grâce a la deviation laterale et la modulation en profondeur du pic de Bragg non etale. Cette methode permet soit d’optimiser un seul faisceau, point par point (« single field uniform dose », SFUD), soit de combiner les faisceaux optimises comme en RCMI (« IMPT »). En vue de l’installation du PBS au centre de protontherapie d’Orsay, nous avons compare, pour deux cas cliniques de chordome du sacrum non opere, des plans de traitement utilisant la methode actuelle (DS avec complement par RCMI), les deux methodes de PBS (SFUD ou IMPT) avec complement par RCMI, ou l’IMPT seule. Pour les deux cas, les indices d’homogeneite etaient comparables. Les doses delivrees aux organes a risque et la dose integrale etaient nettement inferieures avec les plans utilisant le PBS. L’indice de conformite pour l’IMPT seule etait meilleur sur un cas et moins bon sur le second. La technique du PBS et notamment l’IMPT est utilisable pour l’irradiation des chordomes du sacrum en place. L’IMPT seule pourrait etre utilisee et ainsi eviter un changement de machine en cours de traitement.
International Journal of Radiation Oncology*Biology*Physics, 2019
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Purpose or Objective: The majority of intraprostatic recurrences after radical prostate radiother... more Purpose or Objective: The majority of intraprostatic recurrences after radical prostate radiotherapy occur at the site of initial tumour, in previous reported series. However, there is no published data directly comparing recurrence patterns after different modalities of radiotherapy. The aim of this study was to investigate differences in spatial pattern of intra-prostatic recurrences on multiparametric MRI, after external beam radiotherapy or brachytherapy. Material and Methods: We identified 382 consecutive patients referred for multiparametric MRI after previous prostate cancer treatment. Patients with post-radiotherapy biochemical recurrence and intraprostatic recurrence on MRI were included in the study. Scans were independently reviewed by two radiologists. The location of recurrence was mapped to prostate sectors based on European consensus guidelines. The chi-square test was used to analyse differences in site of recurrence between modalities of radiotherapy. Results: 66 patients who had radical radiotherapy between 1997 and 2013 had intraprostatic recurrence on MRI. The D'Amico risk stratification at initial diagnosis was 14% lowrisk, 34% intermediate-risk and 52% high-risk. The series consisted of 34 patients after external beam radiotherapy (EBRT), 20 patients after low-dose rate brachytherapy (LDR) and 12 after high-dose rate brachytherapy monotherapy (HDR mono). 68% of the EBRT recurrences had received a dosefractionation schedule with an EQD2 less than 74 Gy. The mean time between the end of radiotherapy and imaging recurrence was 77 months (95% CI 68-85 months) with no significant differences between treatment groups. 80% of patients did not have any associated pelvic bony metastasis or nodal disease. 88% of patients had a contiguous intraprostatic recurrence. The median recurrence size detected on MRI was 2.0 cm (range 0.6-4.2 cm). Recurrences after EBRT were more likely to involve multiple sectors of the prostate. 71% of EBRT recurrences involved the apex compared to 30% after LDR and 25% after HDR mono (p = 0.003). In the LDR group, recurrences involved the base of the gland in 60% of cases, compared to 41% after EBRT and 8% after HDR mono (p = 0.016). 21% of patients underwent salvage treatment with cryotherapy, HDR brachytherapy or prostatectomy.
Background: To assess the local control, survival, and toxicity in symptomatic and/or progressive... more Background: To assess the local control, survival, and toxicity in symptomatic and/or progressive gliomas treated with sophisticated 3D Photon /proton conformal radiotherapy. Material and methods: From 08/1994 through 05/2008, 18 children (Med. 10 years, range 6–16 ) [for full text, please go to the a.m. URL]
Intracranial-Germinoma demonstrates excellent long-term survival after Craniospinal-irradiation p... more Intracranial-Germinoma demonstrates excellent long-term survival after Craniospinal-irradiation plus Tumor-Bed Boost. Recent studies have examined combined approach with reduced radiation volume and/or dose. SFOP-90 study delivered primary chemotherapy followed by 40 Gy to tumour-bed. At median[for full text, please go to the a.m. URL]
присвячена дослідженню ультраструктури підшлункової залози білого щура за умов впливу опіоїду. В ... more присвячена дослідженню ультраструктури підшлункової залози білого щура за умов впливу опіоїду. В роботі наведені нові данні щодо особливостей змін ультраструктури ендокриноцитів та ланок гемомікроциркуляторного русла через 2, 4 і 6 тижнів впливу опіоїду. Перші зміни ультраструктурної організації ланок гемомікроциркуляторного русла ендокринної частини підшлункової залози спостерігаються вже через 2 тижні введення щурам налбуфіну і наростають впродовж наступних термінів експерименту. Довготривалий вплив опіоїду зумовлює значні дистрофічні зміни інсулоцитів, зокрема, втрату правильної форми, каріопікноз та каріорексис ядер, набряк та просвітлення цитоплазми, розвиток мікрокістозної дегенерації клітин, розпушення та дезорганізацію базальної мембрани, що може призводити до порушення функції ендокринної частини підшлункової залози. Введення налбуфіну щурам впродовж 6 тижнів призводить до розвитку процесів, що є підґрунтям патологічних змін, які характерні для склерозу судин, циркуляторної гіпоксії, порушень в коагуляційній та фібринолітичній системах, розвитку навколокапілярного набряку і розростання сполучної тканини, порушення трансендотеліального транспорту. Робота є основою для подальших досліджень морфологів і клініцистів щодо розробки в перспективі нових методів діагностики, профілактики та лікування захворювань підшлункової залози у наркозалежних та пацієнтів, які змушені впродовж тривалого часу приймати опіоїди. Ключові слова: ендокринна частина підшлункової залози, ультраструктура, щур, опіоїд.
Journal of Nuclear Medicine & Radiation Therapy, 2012
Purpose: According to preliminary clinical experience, craniospinal irradiation (CSI) may be cons... more Purpose: According to preliminary clinical experience, craniospinal irradiation (CSI) may be considered as a treatment option in patients with recurrent leukemia involving the central nervous system (CNS). Field matching poses challenges as it leads to a risk of underdosage or overdosage in the junctional area. We investigated the feasibility of CSI using helical tomotherapy (HT). Patients and methods: Four patients presenting with CNS recurrences of leukemia were referred to our department for salvage radiation therapy. Treatment planning was conducted by the Eclipse TM system for 3D-CRT and IMRT, and with the Tomotherapy ® software for HT. Acute adverse events were monitored weekly using the Common Terminology Criteria for Adverse Events v 4.0. Results: Using HT, highly conformal irradiation could be delivered to CNS. Average doses to the encephalon were 25.1 Gy, 15.5 Gy, and 23.3 Gy using 3D-CRT, IMRT, and HT respectively. Spinal cord received an average dose of 18.9 Gy with 3D-CRT, 15.7 Gy with IMRT and 23.4 Gy with HT. Areas of overdosage to the brain or the spinal cord were also significantly decreased with HT. With HT, average doses to critical organs were also significantly decreased. No acute toxicity was reported with HT, whereas the patients treated by 3D-CRT and IMRT presented with grade II vomiting and asthenia. Conclusion: HT may optimize CSI in the treatment of CNS hematological recurrences by homogenously covering target volumes and improve clinical acute tolerance by more effectively sparing critical organs for preserving the quality of life. Further prospective assessments are warranted. Patients and Methods Case No.1 A thirty-two-year-old woman was diagnosed with ALL in December 2007 characterized by the presence of the CALM/AF10 transcript [10,11] (p13,q14) and normal karyotype. She was first treated with chemotherapy (Table 1) followed by an autologous bone marrow transplantation, leading to a complete remission. Due to her altered general status, the patient was administered fewer intrathecal injections for CNS prophylaxis (methotrexate, cytarabine, depomedrol) (Table 2) and no total body irradiation (TBI) during the conditioning of the autograft.
Introduction L’adenome hypophysaire gonadotrope est tres rare chez l’enfant avec comme option the... more Introduction L’adenome hypophysaire gonadotrope est tres rare chez l’enfant avec comme option therapeutique la chirurgie et la radiotherapie. La protontherapie, aux proprietes balistiques ultra precises, permet une radiotherapie focalisee, meme des lesions profondes avec peu d’atteinte des tissus traverses et environnants. Observation Garcon de 10 ans, sans antecedent, presentant une baisse de l’acuite visuelle soudaine avec hemianopsie bilaterale. Examen normal (P1G1). Sur l’IRM hypophysaire : volumineuse tumeur (3,5 cm) intra et suprasellaire, avec compression du chiasma et envahissement du sinus caverneux droit. L’exploration hormonale met en evidence un deficit partiel GH/TSH alors que les concentrations de prolactine, FSH et sous-unite α sont normales ; absence de mutation germinale des genes NEM1, AIP, GNAS. Chirurgie initiale de decompression puis 9 mois plus tard resection partielle pour rechute visuelle et progression tumorale a l’IRM. L’etude histologique objective un adenome gonadotrope [bFSH (4–20 %), sous unite α (40 %)] et agressif [P53 (3 %), MIB1 (6 %)]. Compte tenu du jeune âge de l’enfant, une radiotherapie par protontherapie (54 Gy) est proposee. Avec un recul de 24 mois, aucune progression tumorale est observee sur la surveillance IRM ; recuperation visuelle complete et pas d’autre deficit hypophysaire. Un traitement par GH a ete initie 1 an apres la fin de la protontherapie avec un excellent rattrapage statural. Discussion L’adenome hypophysaire gonadotrope agressif est une tumeur exceptionnelle chez l’enfant, dont la prise en charge est difficile. La protontherapie apparait une option therapeutique en postoperatoire en cas de recidive pour controler la croissance tumorale et limiter les effets secondaires iatrogenes.
cancer du rein, et une survie sans progression allongée chez des patients sélectionnés. Déclarati... more cancer du rein, et une survie sans progression allongée chez des patients sélectionnés. Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.
In this chapter we present: I. The physical bases of proton therapy, going from microscopic conce... more In this chapter we present: I. The physical bases of proton therapy, going from microscopic concepts to macroscopic features II. The technology and the logistics, which evolve to more and more compact and cheaper facilities with the capability to perform adaptive radiation therapy III. The most usual clinical indications, moving toward (nearly) all indications of radiation therapy IV. Some research orientations, rediscovering physics, and radiation biology V. Basic elements to conceive and build a clinical center VI. Conclusions: The need to learn from others and also to innovate
In the SFOP protocol TGM-TC90 for localised tumours, craniospinal (CS) prophylactic radiotherapy ... more In the SFOP protocol TGM-TC90 for localised tumours, craniospinal (CS) prophylactic radiotherapy fields were replaced by carboplatin-based chemotherapy together with focal irradiation of the initial tumour volume (40 Gy). Metastatic tumours received CS irradiation and a local boost. In order to refine radiation-treatment volumes, patterns of relapse with respect to radiation technique were documented.
Improvement of EFS of children older than 3 years with high risk medulloblastoma. Methods: Betwee... more Improvement of EFS of children older than 3 years with high risk medulloblastoma. Methods: Between 1993 and 1999, 115 patients (3-18 years, mean 8 years) with high risk medulloblastoma were included. After surgery treatment consisted of chemotherapy ('8in1' and etoposide/carboplatin) before and after craniospinal radiotherapy. Results: Patients were staged using Chang-criteria (PF residue only, M1 and M2/M3) by local investigator as well as by central review panel (82.4% concordance). Chemotherapy was well tolerated without major delays in radiotherapy. With a mean follow up of 81 months (9-119), 5-year EFS was 49.8% and OS 60.1%. In detail according to subgroups EFS was 68.8% for PF residue only, 58.8% for M1 disease and 43.1% for M2/M3. Conclusion: M1 patients are legitimate high risk patients. Survival rates are still very low for high risk medulloblastoma patients and future trials should therefore focus on more intensive (chemotherapy/radiotherapy) treatment.
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