{"id":73,"date":"2012-07-27T08:40:38","date_gmt":"2012-07-27T06:40:38","guid":{"rendered":"http:\/\/arser.org\/?p=73"},"modified":"2019-07-05T19:25:07","modified_gmt":"2019-07-05T17:25:07","slug":"un-article-du-docteur-p-f-pradat-dans-la-revue-neurologique","status":"publish","type":"post","link":"https:\/\/arser.org\/fr\/un-article-du-docteur-p-f-pradat-dans-la-revue-neurologique\/","title":{"rendered":"Les complications neurologiques de la radioth\u00e9rapie. Pr P.F. Pradat dans la \u00ab\u00a0Revue neurologique\u00a0\u00bb"},"content":{"rendered":"

Ne manquez pas de lire l\u2019article que le docteur Pierre-Fran\u00e7ois Pradat vient de publier dans la \u00ab\u00a0Revue neurologique\u00a0\u00bb, principale revue de la neurologie Fran\u00e7aise.<\/p>\n

Membre du comit\u00e9 scientifique de l\u2019ARSER le docteur Pierre-Fran\u00e7ois Pradat fait le point sur les complications neurologique de la radioth\u00e9rapie.<\/p>\n

Certes \u00e9crit \u00e0 l\u2019intention de sp\u00e9cialistes et donc d\u2019un acc\u00e8s difficile pour le profane, cet article contient n\u00e9anmoins une grande quantit\u00e9 d\u2019informations sur ces pathologies mal connues.<\/p>\n

Il a pu \u00eatre \u00e9crit avec le soutien de l\u2019ARSER et de son pr\u00e9sident Herv\u00e9 Lionel-Marie.<\/p>\n

Neuropathies post-radiques : un dommage collat\u00e9ral chez les patients canc\u00e9reux long-survivants – 27\/06\/12<\/strong>
\nRadiation-induced neuropathies: Collateral damage of improved cancer prognosis<\/strong>
\nDoi : 10.1016\/j.neurol.2011.11.013
\nP.-F. Pradat a, \u204e, b , T. Maisonobe c, D. Psimaras d, T. Lenglet c, R. Porcher e, J.-L. Lefaix f, S. Delanian g<\/em><\/p>\n

a D\u00e9partement des maladies du syst\u00e8me nerveux, h\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re, groupe hospitalier Piti\u00e9-Salp\u00eatri\u00e8re, 47, boulevard de l\u2019H\u00f4pital, 75013 Paris, France
\nb UMR 678, Inserm-UPMC, universit\u00e9 Pierre-e-Marie-Curie \u2013 Paris-06, groupe hospitalier Piti\u00e9-Salp\u00eatri\u00e8re, 47, boulevard de l\u2019H\u00f4pital, 75013 Paris, France
\nc D\u00e9partement d\u2019explorations fonctionnelles neurologiques, groupe hospitalier Piti\u00e9-Salp\u00eatri\u00e8re, 47, boulevard de l\u2019H\u00f4pital, 75013 Paris, France
\nd D\u00e9partement de neurologie Mazarin, groupe hospitalier Piti\u00e9-Salp\u00eatri\u00e8re, 47, boulevard de l\u2019H\u00f4pital, 75013 Paris, France
\ne D\u00e9partement de biostatistiques et informatique m\u00e9dicale, h\u00f4pital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
\nf Commissariat \u00e0 l\u2019\u00e9nergie atomique, direction des sciences du vivant, institut de radiobiologie cellulaire et mol\u00e9culaire, LARIA\/CIMAP-GANIL, boulevard Becquerel, 14070 Caen cedex 5, France
\ng Oncologie-radioth\u00e9rapie-radiopathologie, h\u00f4pital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
\n* Auteur correspondant.
\nBienvenue sur EM-consulte, la r\u00e9f\u00e9rence des professionnels de sant\u00e9.
\nSous presse. \u00c9preuves corrig\u00e9es par l’auteur. Disponible en ligne depuis le mercredi 27 juin 2012<\/p>\n

R\u00e9sum\u00e9<\/strong><\/p>\n

Introduction
\nAvec l\u2019am\u00e9lioration du pronostic de nombreux cancers, les complications tardives des traitements deviennent un enjeu de sant\u00e9 publique. Les neuropathies post-radiques, en dehors des plexopathies brachiales faisant suite \u00e0 l\u2019irradiation de cancers du sein, sont toutefois mal connues. Cet article a pour objectif de clarifier, par une revue actualis\u00e9e, les principales atteintes du syst\u00e8me nerveux p\u00e9riph\u00e9rique li\u00e9es \u00e0 la radioth\u00e9rapie.<\/p>\n

\u00c9tat des connaissances
\nDes formes cliniques nouvelles de neuropathies post-radiques ont \u00e9t\u00e9 d\u00e9crites, soulignant leur h\u00e9t\u00e9rog\u00e9n\u00e9it\u00e9. Cette h\u00e9t\u00e9rog\u00e9n\u00e9it\u00e9 est topographique, li\u00e9e \u00e0 la diversit\u00e9 des sites anatomiques irradi\u00e9s qui peuvent inclure les racines, plexus ou troncs nerveux. Elle est \u00e9galement \u00e9volutive avec une diff\u00e9rence entre des formes pr\u00e9coces d\u2019\u00e9volution souvent favorable et des formes tardives progressives. L\u2019am\u00e9lioration des m\u00e9thodes d\u2019investigation constitue un progr\u00e8s majeur pour le diagnostic diff\u00e9rentiel gr\u00e2ce \u00e0 l\u2019apport de l\u2019IRM, du PET-scan et plus r\u00e9cemment, de la radioth\u00e9rapie conformationnelle a posteriori.<\/p>\n

Perspectives et conclusions
\nL\u2019importance de diagnostiquer pr\u00e9cocement les complications tardives de la radioth\u00e9rapie est soulign\u00e9e par l\u2019\u00e9mergence de nouveaux traitements, agissant notamment sur le processus fibrotique. C\u2019est le cas de l\u2019association pentoxyfilline-tocoph\u00e9rol-clodronate (PENTOCLO, NCT01291433) pour laquelle un essai de phase III dans les neuropathies post-radiques est en cours.<\/p>\n

Abstract<\/strong><\/em><\/p>\n

Introduction
\nBecause of the improvement of cancer prognosis, long-term damages of treatments become a medical and public health problem. Among the iatrogenic complications, neurological impairment is crucial to consider since motor disability and pain have a considerable impact on quality of life of long cancer survivors. However, radiation-induced neuropathies have not been the focus of great attention. The objective of this paper is to provide an updated review about the radiation-induced lesions of the peripheral nerve system.<\/p>\n

State of the art
\nRadiation-induced neuropathies are characterized by their heterogeneity in both symptoms and disease course. Signs and symptoms depend on the affected structures of the peripheral nerve system (nerve roots, nerve plexus or nerve trunks). Early-onset complications are often transient and late complications are usually progressive and associated with a poor prognosis. The most frequent and well known is delayed radiation-induced brachial plexopathy, which may follow breast cancer irradiation. Radiation-induced lumbosacral radiculoplexopathy is characterized by pure or predominant lower motor neuron signs. They can be misdiagnosed, confused with amyotrophic lateral sclerosis (ALS) or with leptomeningeal metastases since nodular MRI enhancement of the nerve roots of the cauda equina and increased cerebrospinal fluid protein content can be observed. In the absence of specific markers of the link with radiotherapy, the diagnosis of post-radiation neuropathy may be difficult. Recently, a posteriori conformal radiotherapy with 3D dosimetric reconstitution has been developed to link a precise anatomical site to unexpected excess irradiation.<\/p>\n

Perspectives and conclusion
\nThe importance of early diagnosis of radiation-induced neuropathies is underscored by the emergence of new disease-modifying treatments. Although the pathophysiology is not fully understood, it is already possible to target radiation-induced fibrosis but also associated factors such as ischemia, oxidative stress and inflammation. A phase III trial evaluating the association of pentoxifylline, tocopherol and clodronate (PENTOCLO, NCT01291433) in radiation-induced neuropathies is now recruiting.<\/p>\n

\u00a9 2012 Elsevier Masson SAS. Tous droits r\u00e9serv\u00e9s.<\/em><\/p>\n

Vous pouvez retrouver ci-dessous le texte complet de cet article.<\/strong><\/p>\n

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Ne manquez pas de lire l\u2019article que le docteur Pierre-Fran\u00e7ois Pradat vient de publier dans la \u00ab\u00a0Revue neurologique\u00a0\u00bb, principale revue de la neurologie Fran\u00e7aise. Membre du comit\u00e9 scientifique de l\u2019ARSER le docteur Pierre-Fran\u00e7ois Pradat fait le point sur les complications neurologique de la radioth\u00e9rapie. Certes \u00e9crit \u00e0 l\u2019intention de sp\u00e9cialistes et donc d\u2019un acc\u00e8s difficile … Continuer la lecture de « Les complications neurologiques de la radioth\u00e9rapie. Pr P.F. 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