[en] Introduction: Endometrial carcinoma is the most frequent gynecological cancer in developed countries. Until the latest FIGO classification on 1988, the times of BT and surgery were uncertain for early stages. This paper reviews the results of the retrospective analysis of patients with early endometrial carcinoma (stages I and II) treated with pre- or postoperative BT +/- external radiotherapy (ERT) at the Institute Gustave Roussy from january 1985 to december 1989. Materials and Methods: 220 patients stage I and 21 patients stage II were eligible. The protocol was primary BT (106 patients) 50 Gy to the upper third of the vagina, an immediate radical hysterectomy with pelvic lymph node picking and according to the histological results, ERT (33 patients). After the surgical classification, postop BT was performed in 47 patients. 55 patients received another radiosurgical treatment. Results: With a follow-up of 3 years, the results were: after primary BT, the dose to pelvic walls, the kerma, the volume thickness and the reference isodose volume were higher. Surgery post BT was performed on a mean of 12 days, and postop BT on a mean of 97 days. Among 181 lymph node dissections, only 5 patients had N+, 38 histologies showed no myometrial invasion: 112, (1(3)); 64, (2(2)); and 20, (3(3)). The differentiation of the tumor was indirectly correlated with myometrial invasion. 88 patients received ERT, to a mean dose of 45 Gy. The overall survival was 91% at 2 years and 81% at 5 years. For patients with primary BT, the survival was 96% at 2 and 5 years. For primary surgery was 98 and 88% at 2 and 5 years DFS at 2 and 5 years for preop BT was 85% and 76%, for postop BT 95% and 92%, 5 patients had grade 3 complications. The metastases, including paraaortic lymph nodes were 6. 14 recurrences occurred, in external iliac nodes, common iliacs, pelvis, abdomen, and 4 in vagina. The prognostic factors were in univariate study, the surgical stage. In multivariate, myometrial invasion > (1(3)). (RR 3.9), histological grade 3 to 1 (RR 4.3.). Conclusion: this study does not show any statistical difference according to results in terms of survival, recurrences or complications if BT is performed before or after surgery. This results correlate with those of literature as well as prognostic factors

[en] Brachytherapy plays an important role in the treatment of patients with gynaecological cancers. At the Institut Gustave-Roussy, the technique of vaginal mould applicator has been used for decades. This technique allows a personalized tailored irradiation, integrating tumour shape, size and extension and vaginal anatomy. Vaginal expansion reduces the dose to the vaginal mucosa and to the organs at risk. We report a modification of the material used for vaginal mould manufacture. The advantages of the new material are a lighter weight, and transparency allowing a better accuracy in the placement of catheters for radioactive sources. This material is applicable for low dose-rate, pulse dose-rate and high dose-rate brachytherapy. Since 2001, more than 700 vaginal moulds have been manufactured with this new approach without any intolerance. (authors)

[en] The authors isolated 28 mutants of Bacillus subtilis deficient in the development of competence by using the transposon Tn917lacZ as a mutagen. The mutant strains were poorly transformable with plasmid and chromosomal DNAs but were normally transducible and exhibited wild-type resistance to DNA-damaging agents. The mutations were genetically mapped, and the mutants were characterized with respect to their abilities to bind and take up radiolabeled DNA. All were defective in uptake, and some failed to bind significantly amounts of DNA. The abilities of the mutant strains to resolve into two buoyant density classes on Renografin gradients were studied. Most resolved normally, but several banded in Renografin only at the buoyant density of noncompetent cells. The genetic mapping studies and the other analyses suggested that the mutations define a minimum of seven distinct com genes

[en] 102 patients presenting with soft tissue sarcomas (STS) were treated with LDR interstitial brachytherapy (IBT) at IGR. Among them, 50 adults, from 1972 to 1995, above 15 years of age, are reported. Patient characteristics: * age distribution: 15-30 yr 30 %; 30-50 yr 38 %; > 50 yr 32 %, * male 38 %, * tumor site: H and N 2 %; trunk 24.5 %; upper limb 44.9 %; lower limb 28 % * tumor size: 2-5 cm 52 %; 5-8 cm 38 %; > 8 cm 16 %. * Pathology: 10 histologic types with Grade I: 18 %; II: 40 %; III: 42 %. Treatment: IBT was a part of initial treatment in 15 cases (Group A) and for salvage in 35 cases (Group B). The BT technique using Paris system rules, was uniform: plastic tubes were implanted intra-operatively then afterloaded with iridium 192 wires. BT was combined with external beam radiotherapy in 2 cases and with chemotherapy in 10 cases. IBT technical aspects: delay from surgery to loading > 2 days: 48 %; doses: 55 - 75 Gy: 86 %; number of sources: 2-5: 28 %, 6 - 10: 66 %, > 10: 6 %, single or dual plane implants were used in 98 % of cases.; dose rate: 2.5 - 50 cGyh^-1: 62 %; reference volume < 35 cc: 20 %, 35-65 cc: 40 %, > 65 cc m 40 %. Results: 1) Overall survival (OS): 68 %, local failures (LF): 18 %, (50 % within or at lateral border of reference volume): distant metastasis (DM): 32 %, necrosis (NEC): 38 %. 2) Group A: LF: 4 %, DM: 20 %, NEC: 33 %. 3) Group B: LF: 36 %, DM: 48 %, NEC: 44 %. Conclusion: If the role of conservative surgery is essential, pathological findings (residual disease, grading) provide the indications for IBT: 1) prophylactic treatment: +/- IBT (Gr I), IBT (Gr II, III). 2) positive margin: microscopic: IBT; macroscopic: IBT boost + external beam radiotherapy

No abstract available

[en] Background: For patients with localized non operable bronchial carcinoma, combination of radiotherapy and chemotherapy can achieve only a 15 to 20 % local control rate. For some selected cases, high dose rate brachytherapy (HDRB) could be added to external beam radiotherapy to increase local tumour control. The risk of such a combined treatment is of increased toxicity. A feasibility study was developed in our Department. Methods: The HDRB is given once a week (I¹⁹² source) during the last four weeks of a conventional radiotherapy giving 60 Gy in 6 Weeks (4 x 2.5 Gy/week). A dose escalation study was planned with 4 x 3 Gy HDRB, then 4 x 4 Gy and 4 x 5Gy. Five patients have been treated at a dose of 4 x 3 Gy and two at 4 x 4 Gy. The given dose was prescribed according to the target volume and the physical dose was specified at 1 cm. The treatment catheter was positioned by the pneumologist (P.B.), and the treatment volume defined according to the endoscopy and to pre-treatment CT scanner, with a 2 cm safety margin on each extremity of the macroscopic tumour. The catheter was checked by X rays before any HDR treatment. Results: Median age of the patients was 65 year, with an OMS status <2. The location of the tumour was an upper lobe in 4 cases and a lower lobe in 3 cases. The mean treated volume was 14 cm3. With a mean follow up time of 6 months one fistulae, one pneumothorax and one radiation induced pneumonitis have been observed. Four patients have died: two from distant metastases with local tumour control, one from a myocardial infarct and one from local recurrence. Conclusion: In this feasibility study, some toxicity of combined external beam irradiation and HDRB has been found. The role of such a combined approach has to be very carefully assessed in the future

[en] Brachytherapy plays an important role in the treatment of patients with cervical carcinoma. Technical modalities have evolved during the last years and have benefited from imaging modalities development, specially MRI. Imaging modalities contribute to a better knowledge of tumoral extension and critical organs. Ultrasound during brachytherapy has led to the almost complete eradication of uterine perforation. In the future, a more systematic use of systems allowing optimization may induce a better dose distribution in the tumor as well as in the critical organs. Recent data provided information in favor of a better analysis in the relative role of dose-rate, total dose and treated volume and their influence on the local control and complication incidence. Concomitant radio-chemotherapy represents a standard in the treatment of patients with tumoral size exceeding 4 cm. Some questions still remain: is concomitant chemotherapy of benefit during brachytherapy? Is there any place for complementary surgery, specially in patients with complete response after external irradiation with concomitant chemotherapy and brachytherapy? In order to answer the former question, a phase III randomized trial is going to start, with the Federation Nationale des Centres de Lutte Contre le Cancer as a promoter. (authors)

[en] Objective: High dose rate brachytherapy (HDRB) is an effective palliative treatment for bronchial carcinoma with an obstructive component. Patients with previous radiotherapy may be at risk of morbidity. We have studied the toxicity and efficacy of palliative HDRB for endobronchial tumors in areas both previously irradiated and unirradiated. Protocole: HDRB (I192 source) delivered a total dose of 24 Gy, given as 6 x 4 Gy over 36 days for patients with previous irradiation (group A), or 3 x 8 Gy over 15 days for patients without previous irradiation (group B). The dose was prescribed according to the target volume, and the physical dose was specified at 1 cm depth. The treatment catheter was positioned by the pulmonologist and the treatment volume defined according to the endoscopy, with a 2 cm margin proximal and distal to the macroscopic tumor. The catheter position was verified by radiographic films before any HDR treatment. Population: 20 patients were included in group A, and 10 in group B. With a mean follow-up time of 9 months, 5 patients out of 10 in group B developed lethal hemoptysis (toxicity grade V) and 3 patients several necrosis (toxicity grade III). No toxicity was found in group A. Results: 80 % symptomatic respiratory response Conclusion: HDBR is a safe and effective palliative treatment in patients without previous irradiation. For patients with previous irradiation, we document severe complications even with protracted treatment using low dose per fraction

[en] Aims: to evaluate the toxicity and the efficacy of HDR brachytherapy for inoperable limited stage carcinomas. Population: 36 patients (mean age: 62yrs, OMS:2). Sites: 15 upper lobe bronchus, 19 mainstem bronchus, 2 tracheas. TNM:21 T1, 11 T2, 2 T4, 2 Tx. N0 M0. Mean size: 1.5 cm. Mean clinical volume of the tumor: 0.8 cm³. Previous surgery for 12 patients (pneumonectomy or lobectomy) and 24 medically inoperable patients. Protocol: HDR brachytherapy: 6 x 5 Gy once the week. Bronchoscopic follow-up at 2, 6, 12 and 18 months. One to three catheter(s) for treatment and one to three spacing catheter(s) are inserted under endoscopic guidance. Chest X Ray and CT scan are used for dosimetry. A single source of Iridium 192 with a nominal activity of 370 Gbq is remotely afterloaded. Mean distance of catheter to deepest aspect of the tumor: 5 mm. Mean distance of catheter to vessels: 6 mm. Mean distance of catheter to bronchial wall with and without spacing catheter: 1.5 mm and 3 mm, respectively. Mean active length is 5 cm. Mean prescribed dose at 8 mm. Mean volume of prescription 100 %: 10 cm³, 200 %: 3 cm³. Specified dose at 1 cm. Mean volume of specification 100 %: 12 cm³, 200 %: 4 cm³. Median ratio treated volume/tumor volume: 30. Mean overall treatment time: 34 days. As a result, the mean follow-up is 2 years. The 2-year local regional control rates is 83 %: one late failure (at 22 months) and one local regional progression 2 months after treatment. The 2-year overall survival and the disease specific survival is 78 % and 97 % respectively. All the acute and late toxicities were limited to Grade I. Conclusion: Overall survival and local-regional control after HDR brachytherapy appear improved at 2 years compared to historic controls using external beam radiotherapy (2-3 year OS 36-56%). In light of these results; a multicenter study is proposed with an overall treatment time accelerated to three weeks (6 x 5 Gy) to increase the biologic effect of the total dose

[en] From February 1968 to February 1988, 50 patients above 10 years of age with a soft tissue sarcoma were treated with interstitial brachytherapy, combined with a wide excision. After pathologic review, 48 were included in the final analysis. A pathological grading was made possible in 41, which showed a majority of high grades (2 + 3 = 86%). Patients presented mainly with small or mid-size lesions. The tumor was located in the limbs (32), trunk (9), and head and neck (7). Four patients had metastases at the time of treatment. Brachytherapy was part of the initial treatment in 22 cases, and of a salvage procedure after previous excision(s) combined or not with another form of treatment in 26. A uniform technique of iridium 192 wires after-loaded in plastic tubing was used. Sixty Gy median doses were delivered with brachytherapy alone (44) or combined with external beam (4). Sixteen patients also received an adjuvant chemotherapy. Follow up ranged from 16 months to 20 years. At the time of analysis, two patients (4%) only had failed in the irradiated volume, but the marginal failures rate (14:31%) was unexpectedly high. Seven of the patients who failed (43%) were salvaged by a second similar procedure. The 5-year survival was 62% in non-previously treated patients and 56.5% in previously treated ones (pNS). By multivariate analysis, only the tumor location appeared predictive of LF, which in turn was strongly correlated with the metastatic outcome. Necroses were observed in 17 cases (35%) and associated with a benign course in most of them. High dose brachytherapy combined with conservative surgery is highly effective in small and mid-size soft tissue sarcomas located in the extremities and head and neck, whereas in trunk and in recurrent tumors, the adjunction of large fields external radiotherapy and/or possibly polychemotherapy appears necessary