[Radiotherapy regulatory news in France in 2024: Issues of quality and safety of care].

With numerous clinical, technological or strategic innovations, radiation therapy is constantly evolving, contributing to major quality and safety issues, in a context where new regulatory standards are required. In this article, we will describe the conditions for implementing and applying the requirements for accreditation, periodic certification and peer audit in France.

[Informed consent in radiotherapy care].

Obtaining consent to care requires the radiation oncologist to provide loyal information and to ensure that the patient understands it. Proof of such an approach rests with the practitioner. The French Society for Radiation Oncology (SFRO) does not recommend the signature of a consent form by the patient but recommends that the radiation oncologist be able to provide all the elements demonstrating the reality of a complete information circuit.

[Ethical stakes of information in radiation oncology: Thinking the risk and building the therapeutic alliance].

Informing patients before receiving radiation therapy is a fundamental ethical imperative. As a condition of the possibility of autonomy, information allows people to make health decisions concerning themselves, which is required by French law. This information includes in particular the potential risks due to radiation therapy.

Combined intra-cavitary and interstitial image-guided adaptative brachytherapy for cervical stump carcinomas: technical and clinical results of six patients.

Purpose: According to European guidelines for cervix cancers, the management of cervical stump cancers should follow recommendations for patients without previous sub-total hysterectomy, but may require adaptation of radiotherapy modalities, especially brachytherapy (BT). However, data with modern BT technics are very scarce.

Material And Methods: From May 2013 to March 2020, 6 patients (age range, 71-88 years) with cervical stump squamous cell carcinoma (previously treated by sub-total hysterectomy) have been treated with external beam radiotherapy (intensity-modulated radiation therapy - IMRT, 45 Gy in 25 fractions, 5 patients, or 50.

[Crisis situations: Ethical reflection on prioritization of care access in radiation oncology].

Understood as a disruption of the conditions of care practice according to established protocols or procedures, crisis situations in radiation oncology departments can have multiple causes. Their seriousness can sometimes impose changes in the decision-making, organizational or technical paradigms. A possible consequence may be the need to make prioritization decisions in access to care, when there is a mismatch between the care needs of a population and the available health resources (whether technical or human).

Reproducibility of Deep-Inspiration Breath Hold treatments on Halcyon™ performed using the first clinical version of AlignRT InBore™: Results of CYBORE study.

Background And Purpose: To investigate the reproducibility of deep-inspiration breath hold (DIBH) breast cancer treatments on Halcyon™ performed using the first clinical version of AlignRT InBore™ (Vision RT Ltd., London, UK), a Halcyon's SGRT dedicated solution.

Materials And Methods: The ease and feasibility of DIBH treatments was retrospectively investigated for the initial 22 left breast cancer patients treated on Halcyon™ using AlignRT InBore™.

[Ethical stakes in palliative care in radiation oncology].

In 2021, the Ethics Commission of the SFRO has chosen the issue of the practice of palliative care in radiotherapy oncology. Radiation oncology plays a central role in the care of patients with cancer in palliative phase. But behind the broad name of palliative radiotherapy, we actually find a large variety of situations involving diverse ethical issues.

Efficacy of Surgical Excision and Brachytherapy in the Treatment of Keloids: A Retrospective Cohort Study.

Objective: To demonstrate the efficacy of a protocol combining surgical excision and high-dose-rate brachytherapy for treatment of keloids.

Methods: The authors performed a unicentric retrospective cohort study between 2013 and 2018. The minimum follow-up was 12 months.

[Health democracy: Patient partnership].

In 2019, the scientific committee of the French society of radiation oncology (SFRO) created an ethics committee. Its mission is to provide our professional community with food for thought on ethical issues, and to identify its specificities within the radiation oncology departments. For the 2020 annual conference, the commission looked into the evolution of the patient-carer relationship, and more particularly to the strong idea of patient partnership.

[Radiotherapy for ovarian carcinoma management: Literature review].

Ovarian cancer is the fifth most common cancer in women in France with 4714 new cases in 2017. More than 70% of patients whose disease is initially locally advanced will present locoregional or distant recurrence. Therapeutic options in this situation are not consensual.

Prostate brachytherapy under hypnosedation: A prospective evaluation.

Purpose: Hypnosedation (HS) for brachytherapy has been proposed in patients with prostate cancer and has been evaluated.

Materials And Methods: 79 patients were treated with brachytherapy under HS. The Visual Analog Scale questionnaire was used to assess comfort and anxiety and the lowest, mean, and highest level of pain.

Association of surgical excision and brachytherapy for the management of keloids.

Many techniques have been described to prevent the appearance and relapse of keloids but most of them have an efficacy lower than 50%. Our objective is to describe our standardized management of keloids by associated surgery and brachytherapy. Surgery-brachytherapy is usually given only when less invasive treatments failed.

Pathologic Response, When Increased by Longer Interval, Is a Marker but Not the Cause of Good Prognosis in Rectal Cancer: 17-year Follow-up of the Lyon R90-01 Randomized Trial.

Purpose: The Lyon R90-01 randomized trial investigated whether the interval between preoperative radiation therapy and surgery influenced rectal cancer outcome. Long-term results are reported here after a median follow-up of 17 years.

Methods And Materials: Between February 1991 and December 1995, 210 patients from 29 French centers were randomly assigned (ratio of 1:1) to groups that waited either 2 weeks (short interval [SI]) or 6 to 8 weeks (long interval [LI]) between neoadjuvant radiation therapy and surgery.

[Task sharing with radiotherapy technicians in image-guided radiotherapy].

The development of accelerators with on-board imaging systems now allows better target volumes reset at the time of irradiation (image-guided radiotherapy [IGRT]). However, these technological advances in the control of repositioning led to a multiplication of tasks for each actor in radiotherapy and increase the time available for the treatment, whether for radiotherapy technicians or radiation oncologists. As there is currently no explicit regulatory framework governing the use of IGRT, some institutional experiments show that a transfer is possible between radiation oncologists and radiotherapy technicians for on-line verification of image positioning.

[Pelvic irradiation in prostate cancer: what place for what volumes?].

External beam radiotherapy alone is a standard treatment for prostate cancer. According to clinical, histological and biological characteristics of the tumour, lymph node irradiation can be done in combination with irradiation of the prostate. The completion of pelvic irradiation remains controversial and may cause complications by increasing volumes of irradiated healthy tissues.

[Dosimetric impact of breath-hold in the treatment of hepatocellular carcinoma by conformal radiation therapy].

Objective: To evaluate the dosimetric impact of breath-hold during radiotherapy of hepatocellular carcinoma (HCC) and to determinate the optimal respiratory phase for treatment (exhale or inhale).

Patients And Methods: Two CT scans were performed in inhale and in exhale in 20 patients with HCC. The GTV was delineated slice by slice on the inspiration breath hold acquisition (GTV(insp)) and on the expiration breath hold acquisition (GTV(exp)).

[Irradiation of hepatocellular carcinoma: impact of breathing on motions and variations of volume of the tumor, liver and upper abdominal organs].

Purpose: To evaluate the amplitude of motion and the variations of volume of the tumor, the liver and upper abdominal organs induced by breathing during the irradiation of hepatocellular carcinoma (HCC).

Material And Methods: Two scanners were performed in inhale and in exhale not forced in 20 patients with a HCC. The liver (left/right lobes), the tumor, the duodenum, the two kidneys and the pancreas were delineated on each acquisition.

Dosimetric consequences of breath-hold respiration in conformal radiotherapy of esophageal cancer.

The objective of this paper is to study the dosimetric impact of respiratory gated radiotherapy in locally advanced esophageal carcinomaand to define the optimal respiratory phase for this treatment. The study included 8 consecutive patients with squamous-cell carcinoma (SCC) or histologically proved adenocarcinoma, for both at least T3-T4 NX or TX N1 M0 stage. Informed consent was obtained before beginning the study.

[Practical recommendations for breathing-adapted radiotherapy].

Respiration-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast and liver tumors. An increased conformality of irradiation fields leading to decreased complications rates of organs at risk (lung, heart..

Equivalent uniform dose concept evaluated by theoretical dose volume histograms for thoracic irradiation.

Background And Purpose: The goal of our study was to quantify the limits of the EUD models for use in score functions in inverse planning software, and for clinical application.

Materials And Methods: We focused on oesophagus cancer irradiation. Our evaluation was based on theoretical dose volume histograms (DVH), and we analyzed them using volumetric and linear quadratic EUD models, average and maximum dose concepts, the linear quadratic model and the differential area between each DVH.

Preoperative radiotherapy in elderly patients with rectal cancer.

Purpose: We performed a retrospective analysis in order to evaluate the compliance with preoperative radiotherapy in patients aged>or=70 with locally advanced resectable rectal cancer, and to evaluate the influence of comorbidities on treatment tolerance and oncological results.

Methods: From March 1984 to December 2000, 95 patients with T3-T4 N0 M0 rectal cancer received a preoperative radiotherapy in 2 radiotherapy departments. Nineteen patients received concomitant chemotherapy.

Tumor volume as outcome determinant in patients treated with chemoradiation for locally advanced esophageal cancer.

Objective: The currently used tumor-node metastasis (TNM) staging method is generally not applicable to patients with unresectable esophageal carcinomas. There is a need for both an efficient, easy-to-perform clinical classification and for identification of pretherapeutic prognostic factors that would be useful for oncologists, one of which is tumor volume.

Methods: Records of 148 patients, admitted to hospital during the period January 1993 to December 2001, were evaluated retrospectively.

[Place of neoadjuvant treatments in oesophageal cancers care].

Esophageal cancer has a poor prognosis. Recent epidemiological data has shown a modification of histologic types, as adenocarcinoma represents more than 50% of all patients newly diagnosed. Despite progress of surgery, overall survival at 5 years is still about 20% for resectable tumors, supporting the need for additional therapies.