[en] The efficiency of the two irradiation modes are similar, but the hyperfractionated irradiation seems superior in term of global and specific survival. The incidence rates of pneumopathies are not different between the two groups but the incidence rate of the liver vein-occlusive illness is superior in the group treated by non fractionated whole body irradiation. The cost of the hyperfractionated whole body irradiation is superior to this one of the non fractionated whole body irradiation around a thousand dollars. (N.C.)

No abstract available

[en] Retrospective study to analyze the results of external beam radiation treatment with or without surgery for loco--regional recurrence of adenocarcinoma of the rectum following previous surgery without pre- or post- operative radiotherapy. Between March 1973 and November 1991, 211 patients with loco-regional recurrence of rectum cancer were treated with external beam radiation treatment. Radical surgery was the only initial treatment modality. Surgical resection of local recurrence was done in 36 patients and only 17 patients could undergo complete resection. Forty-seven patients underwent radiotherapy (RT) combined with surgery and 164 received external beam radiation treatment alone to a mean total dose of 46 Gy. Among the 151 patients whose recurrence was revealed by pain, 64 (42 %) were considered to have a symptomatic response after loco-regional treatment with radiosurgery or RT alone. The mean duration of response was 12 months. The 3-year overall survival rate was 16 %. Five prognostic factors decreased the overall survival rate in multivariate analysis: high age, sex (male), concomitant distant metastasis, no tumor resection, and low total radiation dose with external beam radiation treatment alone. The 3-year survival rate for patients with completely resected recurrence was 9%. External beam RT treatment can only be considered a palliative symptomatic treatment. New techniques of early detection of local recurrence and new combined modalities approaches (radiation sensitizers or intra-operative radiotherapy) with surgical resection in some favorable cases should be studied. (authors)

[en] Purpose. -To identify prognostic factors and treatment toxicity in a series of operable stages IB and II cervical carcinomas. Patients and methods. - Between May 1972 and January 1994, 414 patients (pts) with cervical carcinoma staged according to the 1995 FIGO staging system underwent radical hysterectomy with (n=380) or without (n=34) bilateral pelvic lymph node dissection. Lateral ovarian transposition to preserve ovarian function was performed on 12 pts. The methods of radiation therapy (RT) were not randomized and depended on the usual practices of the surgical teams. Group I:168 pts received postoperative RT (64 pts received vaginal brachytherapy alone (mean total dose (MD): 50 Gy], 93 pts had external beam pelvis RT (EBPRT) [MD: 45 Gy over 5 weeks] followed by vaginal brachytherapy [MD: 20 Gy], and 11 pts had EBPRT alone [MD: 50 Gy over 6 weeks]. Group II: 246 pts received preoperative utero-vaginal brachytherapy [MD: 65 Gy], and 32 of theses 246 pts also received postoperative EBPRT [MD: 45 Gy over 5 weeks] delivered to the parametric and the pelvic lymph nodes with a midline pelvic shield. The mean follow-up was 106 months. Results. - The 10-year disease-free survival (DFS) rate was 80%. From 75 recurrences, 35 were isolated locoregional. Multivariate analysis showed that independent factors decreasing the probability of DFS were: both exo and endo-cervical tumour site (p=0.047), lymph-vascular space invasion (p=0.041), age ≤ 51 yr (p=0.013), 1995 FIGO staging system (stage IB1 vs stage IIA, p=0.004, stage IB1 vs stage IB2, p=0.0009, and stage IB1 vs stage IIB with 1/3 proximal parametrical infiltration, p=0.00002), and histological pelvic involved lymph nodes (p=0.00009). Methods of adjuvant RT did not influence the probability of DFS (group I vs group II, p=0.10). The postoperative complication rate was 10.2% in group I and 8.9% in group II (p=0.7) but the postoperative urethral complication rate necessitating surgical intervention with re-implantation was lower in group I than in group II (0.6% vs 2.3%, respectively, p=0.03). The 10-year rate for grade 3 and 4 late radiation complications according to the LENT-SOMA scoring system was 10.4%. EPRT significantly increased the 10-year rate for grade 3 and 4 late radiation complications (yes vs no: 22% vs 7%, respectively, p=0.0002). Conclusion. - In our series, the methods of adjuvant RT (primary surgery vs preoperative utero-vaginal brachytherapy) do not seem to influence the prognosis of the stage IB, IIA, and IIB - (with 1/3 proximal parametrical involvement only) cervical carcinomas. The postoperative EPRT applied according to histopathological risk factors after surgical treatment increases the risk of late radiation complications. (author)

[en] To identify prognostic actors and treatment toxicity in a series of operable endometrial adenocarcinomas. Between November 1971 and October 1992, 437 patients (pts) with endometrial carcinoma, staged according to the 1988 FIGO staging system, underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy without (n = 140) or with (n = 297) pelvic lymph node dissection. The chronology of RT was not randomized and depended on the usual practices of the surgical teams. Group I: 79 pts received preoperative utero-vaginal brachytherapy (mean total dose [MD]: 57 Gy). Group II: 358 pts received postoperative RT (196 pts received vaginal brachytherapy alone [MD: 50 Gy], 158 pts had external beam pelvis RT [EPRT] [MD: 46 Gy over 5 weeks] followed by vaginal brachytherapy [MD: 17 Gy], and 4 pts had EPRT alone [MD: 46 Gy over 5 weeks]). The mean follow-up was 128 months. The 10-year disease-free survival rate was 86%. From 57 recurrences, 12 were isolated loco-regionally. Multivariate analysis showed that independent factors decreasing the probability of disease-free survival were: histologic type (clear cell carcinoma, p = 0.038), largest histologic tumor diameter > 3 cm (p = 0.015), histologic grade (p = 0.008), myometrial invasion > 1/2 (p 0.0055), and 1988 FIGO staging system (p= 9.10^-8). In group II, the addition of EPRT did not seem to improve locoregional control. The postoperative complication rate was 7%. The independent factors increasing the risk of postoperative complications were FIGO stage (p = 0.02) and pelvic lymph node dissection (p = 0.011). The 10-year rate for grade 3 and 4 late radiation complications according to the LENT-SOMA scoring system was 3.1 %. EPRT independently increased the 10-year rate for grade 3 and 4 late radiation complications (R.R.: 5.6, p = 0.0096). EPRT increases the risk of late radiation complications. After surgical and histopathologic staging with pelvic lymph node dissection, in a subgroup of intermediate risk patients (stage IA grade 3, IB-C and II), postoperative vaginal brachytherapy alone is probably sufficient to obtain a good therapeutic index. Results for patients with stage III tumor are not satisfactory. (author)