[en] Purpose: To evaluate efficacy and tolerance of HFRT (BID) in children treated for Nb with curative intent. Material and method: Retrospective analysis of a series of 29 children treated from July 1989 through March 1995 at the Institut Gustave Roussy. Results: Mean age was 38.4 months (range 3-103) with only 1 patient under 12 months, and M/F sex ratio 1. Initial primary was abdominal in 28 and pelvic in 1. Ten children had limited disease at presentation (stage II = 1, stage III = 9) while 19 had disseminated disease (stage IVs = 1, stage IV = 18). Nmyc expression was assessed in 17 of the latest patients and was found amplified in 13. Initial therapy consisted in induction chemotherapy (CAdO = CPM, ADM, VCR ; VP16 + CDDP or carboplatine) 4-8 cycles, followed by resection of the primary and regional lymphatic drainage. The patient with stage II had primary total tumor resection and no chemotherapy. One patient was inoperable for medical reason. Intensive chemotherapy with autologous or allogenous BMT was conducted in children with metastatic disease. HFRT was administered for gross residual disease in most patients (= 22) or microscopic disease with Nmyc amplification (= 7). Three patients were in local progression before initiation of radiotherapy. Target volume varied throughout the time (postoperative or preoperative tumor volume). Total dose was adapted to the children's age and extension of the disease and 30-35 Gy were generally delivered (range 20-40). Two daily fractions of 1 Gy (range 0.8, 1) with at least a 6 hours interval were delivered 5 days a week using 4.5 MV X-rays (28), 18 MV X-rays (= 1). Gastrointestinal toxicity was very limited and few children experienced mild thombopenia, all of whom had receive intensive chemotherapy before. With a median follow-up of 37 months (range 23-74), 15 children are alive of whom 13 in CR, and 2 with distant metastases. Eight patients (27,5%) failed loco-regionally : 4 (13,7%) in field, 3 marginally and 1 outside the fields. When Nmyc was amplified, local failure rate was (4(13)) (in field = 3). These results can be compared to those of 37 children treated earlier at our institution with conventional fractionation RT and of whom 7 failed locally (in field = 5). This population presented more limited disease with 62% stage II-III. At last follow-up, no major growth impairment or other late sequelae was noted in HFRT group. Conclusion: We conclude that HFRT is probably as effective as conventional RT if the treated volume encompasses the preoperative residual disease. A longer follow-up will tell if HFRT reduces effectively the late morbidity in these children

[en] Among the different kinds of radiations usable for radiotherapy, high energy proton beams exhibit the best ballistic specificity. The development of proton therapy has been hindered by the size, cost and complexity of high energy accelerators. The Orsay synchrocyclotron has been selected to design a complete proton therapy facility. The authors present the accelerator, the small field room for ophthalmologic irradiations, actually in operating, and the large field room, for intracranial irradiations, actually in preparation

[en] In hadron therapy centers that have only fixed horizontal beams (i.e. most carbon ions centers and protons centers of first generation), the angulations of the beam remain technically limited, especially for the treatment of children under general anaesthesia with posterior-oblique (40 degrees C or so) beams in supine position. We have been developing recently an original positioning system allowing for treatment with posterior-oblique beams, either from right or left directions, by keeping the child in the adequate position. (authors)

[en] Children treated for malignant hemopathy have a very good prognosis, yet late effects of the treatments on the length, endocrine function, cognitive function and the risk of secondary malignant tumors must be decreased. These toxicities are described in this article. New protocols and radiation techniques have been developed to reduce these effects. Radiotherapy is prescribed in the treatment of non-Hodgkin lymphoma to prevent high risk of meninges recurrences or to treat meninges disease associated with chemotherapy. Doses of cranial irradiation are limited to 24 Gy. A SFOP trial concluded that does of 20 Gy are sufficient after good responses to chemotherapy for the treatment of Hodgkin's disease. The target volume is reduced to the initial site of the disease. (author)

[en] Ewing sarcoma is an uncommon malignancy that has been frequently managed differently in childhood and adults. This is a review of the international experience that conducted to a common European study called Euro Ewing. This study was launched in 1999. (authors)

[en] Purpose: Since 1984, SIOP has conducted 2 successive studies in which the mainstay of treatment has been represented by polychemotherapy and local treatment, especially RT, confined to 'high risks' groups of children. This strategy has been conditioned by the high chemo sensitivity of most STS in this age group, along with their propensity for rapid dissemination and the substantial risk of deleterious side effects induced by high dose RT. This is a report on the role of RT in the second MMT 89 study. Materials and Methods: >From January 1989 through November 1995, (308(813)) children (38 %) received RT as part of their treatment. RT was administered 1/ systematically following 3 courses of the IVA regimen (Ifosfamide, Vincristin, Actinomycin D) in parameningeal sites (126 patients) and 2/ at completion of chemotherapy (generally 6 IVA) in other children if residual disease was still present (182 patients). Total median dose was 45 Gy ± boost administered either with a conventional regimen (QD = 5 daily sessions of 1.8 to 2 Gy = 77 % cases) or, optionally, with an hyperfractionated accelerated one (BID = 10 daily sessions of 1.5 Gy = 15 % cases). The BID fractionation was expected to improve local control without increasing long term toxicity. LDR brachytherapy (BT) was also used in selected sites (8 % cases). Clinical and technical informations were centrally collected. Results: Sites irradiated concerned the parameningeal (PM) area (51 %), extremities (12 %) orbit (10 %), Head and Neck non PM (7 %), GU (6 %), others (13 %). 75 % sarcomas were of the Rhabdomyosarcoma (RMS) histological type (embryonal mainly). Median dose for QD was 46 Gy and BID 45 Gy, protraction 37 and 25 days respectively. A severe immediate toxicity was significantly correlated with the BID regimen (cutaneous 36 %, mucosal 50 %), compared with QD (15 and 13 %) (p 0.001). Despite a median 12 day-gain in the BID regimen, and after adjustment for site, no advantage was recorded at 4 years for this regimen in terms of survival (QD = 67 %, BID 55 % pNS) or EFS (QD = 57 %, BID = 48 % pNS). Local regional failures represented 14 % ((42(308))) patients either local (28), nodal (10) or both (4). Significant risk factors for local failure were the inadequate coverage of the primary in PM sites (p 0.01) and for nodal failure the alveolar subtype of RMS (p 0.03). According to the site, extremities failed in 25 % cases, Head-Neck non PM in 21 %, PM in 15 %, orbit in 8 %, GU in 7 % and 'others' in 11 % (pNS). According to the histology, alveolar RMS failed in 19 %, embryonal RMS in 15 % and non RMS in 14 % (pNS). Although it didn't reach statistical significance, a dose effect relationship was suspected at the 50 Gy level (LRF = < 50 Gy = 15 %, > 50 Gy = 9 %). Conclusion: Although directed to unfavorable cases, RT in the SIOP MMT 89 protocol, has provided an excellent survival. HART failed to improve the outcome at the price of an increased acute toxicity but concerned a small subset of patients only. In our approach PM sites outcome has dramatically improved for the past decade mainly due to the administration of early irradiation to a carefully designed target volume (initial primary ± base of the skull). Future evaluations should explore sites at higher risks like extremities, and alveolar subtypes, also a possible dose-effect relationship and new strategies for quality control

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No abstract available

[en] Intra-operative radiotherapy (IORT) is a technique developed since the early 60s mainly in Japan and in the U.S.A. It usually consists of a single fraction of electrons given intra-operatively. Doses range from 10 to 35 Gy and may be combined with external beam irradiation. The salient advantages are: 1) a better target volume definition with the surgeon; 2) the possibility of removing normal structures (such as the small bowel) from the beam and of so delivering a much higher tumor dose. The disadvantages are: 1) theoretically, a lesser effect on hypoxic cells compared with a fractionated regimen; 2) a requirement for perfect cooperation between surgeon and radiotherapist; 3) a cumbersome apparatus. From pilot studies conducted so far, it appears that advanced poorly or unresectable rectal carcinomas, retroperitoneal soft tissue sarcomas and gastric carcinomas may benefit from such an approach while resected or unresectable pancreatic carcinomas, in spite of extensive evaluation, do not. The management of prostatic, bladder, cerebral, intrathoracic and gynecologic malignancies with IORT is undergoing active prospective studies in some 60 Japanese, American (and in 1986, 7 French) centers. The major technical issues and drawbacks of this technique will also be discussed

[en] Published in summary form only