Hypothesis: Despite aggressive approaches, locoregional tumor control and survival rates for patients with cancer of the pancreatic head remain disappointing. In the present study, we address whether intraoperative and adjuvant radiotherapy may improve the prognosis for these patients.

Most pancreatic carcinomas are unresectable at the time of diagnosis; therefore, palliative treatment is very often the main concern of clinicians in this setting. The main symptoms resulting in the need for palliation in pancreatic cancer are obstructive jaundice, duodenal obstruction and pain. Therapeutic endoscopy plays a major role in the palliation of obstructive jaundice by stent placement into the biliary ducts. Initial experience has also been gained recently with endoscopic placement of expandable metallic stents to treat gastric outlet obstruction. Much less is known about the possible role of endoscopic pancreatic stenting in patients with unresectable pancreatic carcinoma. The main indication for pancreatic ductal stenting is 'obstructive' pain related to meals in patients with dilated main pancreatic duct beyond the stricture and intraluminal brachyradiotherapy. The technique of endoscopic pancreatic stenting does not substantially differ from that applied on the biliary tree. When technically possible, placement of 10 French plastic stents is preferred. According to the authors' indications, only about 15% of patients with advanced pancreatic cancer (55 of 355 in the present study) may potentially benefit from this technique. Pancreatic stenting may be obtained in more than 80% of these selected patients, with low morbidity (less than 10%) and no procedure-related mortality. According to the authors of the present and other studies reported in the literature, about 60% of patients treated because of 'obstructive' pain become symptom-free, and another 20% to 25% significantly reduce the amount of analgesic drugs required. Intraluminal brachyradiotherapy with 192iridium in the main pancreatic duct is a feasible and safe method to deliver high radiation doses to the tumour while sparing adjacent organs. Brachyradiotherapy may be performed alone or in conjunction with external beam radiotherapy. Because of the small number of patients suitable for this treatment, only a multicentre study will be able to detect whether intraluminal brachyradiotherapy in pancreatic cancer may have any positive impact on survival.

I Objectives: To evaluate whether a short radiation treatment (30 Gy, 3.0 Gy/fraction) had analgesic efficacy in patients with unresectable pancreatic carcinoma. Methods:Twelve patients were included in this analysis. Before starting and at four weeks after radiation therapy, pain intensity was evaluated and analgesic drug therapy was adjusted until a 0-3 pain score was reached (WHO). Results: No radiotherapy interruptions, no hospitalisation due to toxic reactions, and no severe toxicity were observed. Six patients (50%) had pain control without pharmacological therapy, three patients (25%) reduced their use (35%-72%) of analgesics, while in the remaining three patients (25%) there was no change in analgesic use. Overall, mean reduction in the use of analgesics was 63.1% ± 43.8%. During follow-up (44 months), two patients (16.7%) showed a worsening of pain that required increased analgesia; in one patient, percutaneous splanchnicectomy was necessary. Conclusion: In patients excluded from standard concomitant chemoradiation, hypofractionated-accelerated radiotherapy is feasible and results in pain relief in most patients, documented as a reduced need for analgesics. Resume I Objectif: Evaluer I'efficacite analqeslque d'une breve radlotheraple (30 Gy, 3.0 Gy/fraction) chez les patients atteints d'un cancer du pancreas non resectionable. Methode: 12 patients ont partlcipe a cette etude. L'intensite de la douleur a ete evaluee avant Ie traitement et quatre sernalnes apres la radlotheraple, et la medication a ete reajustee jusqu'a ce que I'on obtienne une cote de 0-3 de controls de la douleur (OMS). Resultats : On a rapporte aucune interruption de radiotheraple, aucune hospitalisation due a des reactions toxiques, ni aucun cas de toxiclte severe. Six patients (50 %) ont obtenu un controle de la douleur sans therapie pharmacologique, trois patients (25 %) ont dirninue I'usage d'analqesiques (35 %-72 %), alors que chez les trois derniers patients (25 %) la medication analqeslque est demeuree la rneme, Dans I'ensemble Ie recours aux analqesiques a diminue en moyenne de 63.1 % ± 43.8 %. Au cours du suivi (44 mois) deux patients ont souffert de douleur accrue laquelle a necessite une augmentation des analqeslques: et un patient a nscessite une splanchnicectomie percutanee. Conclusion: Chez les patients exclus du traitement standard de la radlotheraple assoctee a la chimio-theraple, la radiotheraple hypotractlonne-acceleree est possible et on a note une diminution de la douleur et par Ie fait merne des analqeslques chez la plupart de ces patients.

No abstract

The occurrence of renal carcinoma metastasis to the head and neck region is extremely rare. Some authors have reported metastasis of renal cell carcinoma to the parotid glands, nose and paranasal sinus, tongue, larynx, thyroid and palatine tonsil. In this report we describe a rare case of renal cell cancer metastasized to the right tonsil in a 76-year-old man with previously diagnosed bone and lung metastases. To the best of our knowledge this is the first documented example of radiotherapy treatment in this type of presentation. Radiotherapy was effective in treating the lesion with satisfactory functional results.

When used by trained therapists, ideally, portal imaging may be carried out before each fraction, requiring approximately 10% of LINAC occupation time.

The purpose was to compare the dosimetric results observed in 201 breast cancer patients submitted to tangential forward intensity‐modulated radiation therapy (IMRT) with those observed in 131 patients treated with a standard wedged 3D technique for postoperative treatment of whole breast, according to breast size and supraclavicular node irradiation. Following dosimetric parameters were used for the comparison: Dmax,Dmin,Dmean,V95% and V107% for the irradiated volume; Dmax,Dmean,V80% and V95% for the ipsilateral lung; Dmax,Dmean,V80% and V95% for the heart. Stratification was made according to breast size and supraclavicular (SCV) nodal irradiation. As respect to irradiated volume, a significant reduction of V107% (mean values: 7.0±6.6 versus 2.4±3.7,p<0.001) and Dmax (mean % values:111.2±2.7 versus 107.7±6.3,p<0.001), and an increase of Dmin (mean % values: 65.0±17.4 versus 74.9±12.9,p<0.001) were observed with forward IMRT. The homogeneity of dose distribution to target volume significantly improved with forward IMRT in all patient groups, irrespective of breast size or supraclavicular nodal irradiation. When patients treated with supraclavicular nodal irradiation were excluded from the analysis, forward IMRT slightly reduced V80% (mean values: 3.7±2.6 versus 3.0±2.4,p=0.03) and V95% (mean values 1.9±1.8 versus 1.2%±1.5;p=0.001) of the ipsilateral lung. The dose to the heart tended to be lower with IMRT but this difference was not statistically significant. Tangential forward IMRT in postoperative treatment of whole breast improved dosimetric parameters in terms of homogeneity of dose distribution to the target in a large sample of patients, independent of breast size or supraclavicular nodal irradiation. Lung irradiation was slightly reduced in patients not undergoing to supraclavicular irradiation.PACS numbers: 87.53.Kn; 87.55.de

ILBT is an effective palliative treatment of unresectable extrahepatic bile duct and pancreatic cancers. Results suggest a possible "curative" role in specific clinical settings when properly integrated with other treatments.