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• W2032451953 abstract "La radiothérapie, seule ou combinée à une chimiothérapie, joue un rôle majeur dans le traitement des cancers bronchiques non à petites cellules (CBNPC) localement avancés. Malgré l’optimisation des technologies de radiothérapie et des traitements systémiques, le contrôle local et la survie des CBNPC restent décevants. L’escalade de dose a été testée avec des résultats encourageants dans de nombreux essais précoces mais l’essai de phase III du Radiation Therapy Oncology Group 0617 a démontré un contrôle local et une survie inférieurs dans le bras radiothérapie haute dose. La radiothérapie avec un fractionnement modifié (hyperfractionné et/ou accéléré) est associée à une amélioration de la survie comparée à une radiothérapie conventionnelle mais aussi à l’augmentation des taux d’œsophagite radique aiguë. Les techniques modernes de radiothérapie intégrant le scanner 4D et la TEP pour la planification du traitement, l’IMRT et l’imagerie guidée ont amélioré la précision et la conformité du traitement. Des études sont en cours évaluant le concept d’un traitement de radiothérapie personnalisée (ou isotoxique) reposant sur la dose délivrée aux organes à risque ou sur l’imagerie fonctionnelle. Ce type d’approche combiné au fractionnement modifié devrait permettre une intensification du traitement et potentiellement l’amélioration de la survie des patients atteints d’un CBNPC. Radiotherapy plays a major role in the treatment of patients with locally advanced nonsmall cell lung cancer (NSCLC), particularly since most patients are not suitable for surgery due to the extent of their disease, advanced age and multiple co-morbidities. Despite advances in local and systemic therapies local control and survival remain poor. Strategies for the intensification of radiotherapy such as dose escalation have shown encouraging results in phase I-II trials, but the outcome of the phase III Radiation Therapy Oncology Group 0617 trial was surprisingly disappointing. Hyperfractionated and/or accelerated fractionating schedules have demonstrated superior survival compared to conventional fractionation at the expense of greater oesophageal toxicity. Modern radiotherapy techniques such as the integration of 4 dimensional computed tomography for planning, intensity-modulated radiotherapy and image-guided radiotherapy have substantially enhanced the accuracy of the radiotherapy delivery through improved target conformality and incorporation of tumour respiratory motion. A number of studies are evaluating personalised radiation treatment including the concept of isotoxic radiotherapy and the boosting of the primary tumour based on functional imaging. These approaches, either alone or in combination could potentially allow for further treatment intensification and improvement of the therapeutic ratio and survival for patients with NSCLC." @default.
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• W2032451953 date "2014-09-01" @default.
• W2032451953 modified "2023-10-18" @default.
• W2032451953 title "Cancers bronchiques non à petites cellules localement avancés : quelle radiothérapie en 2014 ?" @default.
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• W2032451953 doi "https://doi.org/10.1016/s1877-1203(14)70597-x" @default.
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