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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
UICC
HPV andCERVICALCANCERCURRICULUM
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
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01 Chapitre 6.c.3
Méthodes de traitement – Radiation
Prof. Achim Schneider, MD, MPHCharité Universitätsmedizin Berlin, Germany
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
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02 Cervical cancer
• Diagnostic
• Staging
• Thérapie
-Chirurgie
-Radiation
-Chimiothérapie
• Prognostic
• Suivi
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
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03 Radiothérapie
Radiothérapie externe = téléthérapie
Radiothérapie combinée avec la chimiothérapie = chimioradiation
Radiothérapie interne= brachythérapie ou endocuriethérapie
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
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04 Indications de la radiothérapie
• Radiothérapie initiale
- Irradiation associée à la chimiothérapie
-Brachythérapie et téléthérapie associées donnent de meilleur résultats
Radiothérapie post opératoire
-Seulement en cas de facteurs de risque tels que une tumeur de grande taille, des paramètres infiltrés des ganglions positifs ...
-Si possible on associera à l’irradiation une chimiothérapie simultanée
• Radiothérapie des récidives
-Efficace en absence de radiothérapie préalable
-Toujours si possible en association avec une chimiothérapie simultanée
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
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05 Chimioradiation
• Survie globale dans 11 essais randomisés: radiothérapie vs. chimioradiation en traitement primaire
• et en adjuvant chez 2856 patientes atteintes de cancer du col
• La chimioradiation est supérieure à la radiothérapie seule, dans les deux cas
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
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06 Préservation d’organe sparing
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
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07 Systèmes de brachythérapie
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
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08 Brachythérapie
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
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09 Chimioradiation adjuvante après chirurgie • Indication pour:
-R1 (envahissement microscopique des marges d’exérèse)
-pN1 (envahissement ganglionnaire)
-pT2b
-V1 and L1 (envahissement des espaces lympho-vasculaires)
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
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10 Toxicité
• Toxicité aigue
-Dans les 90 jours après le début du traitement
-Peut être efficacement traité
• Toxicité tardive
-Au de là de 90 jours après le début du traitement
-Souvent chronique
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
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11 Toxicité aigue
• Erythéme
• Hyperpigmentation
• Pollakiurie
• Mucite
• Diarrhée
• Fistule
• anémie
• Toxicité rénale
• surdité
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
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12 Toxicité tardive
• Rectite chronique
• Cystite
• Rétrécissement vésical
• Sténoses du rectosigmoide, de l’urètre, des uretères et/ou du vagin
• Défaut auditif
• Insuffisance rénale
• Lymphoedème
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UICC HPV and Cervical Cancer Curriculum Chapter 6.c.3. Methods of treatment - RadiationProf. Achim Schneider, MD, MPH
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13
Merci
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