Traitement du cancer pulmonaire non à petites cellules par radiothérapie stéréotaxique d’ablation

Les néoplasies pulmonaires demeurent la première cause de décès par cancer au Québec représentant près de 6000 décès par année. Au cours des dernières années, la radiothérapie stéréotaxique d’ablation (SABR) s’est imposée comme un traitement alternatif à la résection anatomique pour les patients inopérables atteints d’un cancer pulmonaire non à petites cellules de stade précoce. Il s’agit d’une modalité de traitement qui permet d’administrer des doses élevées, typiquement 30-60 Gy en 1-8 fractions, dans le but de cibler précisément le volume de traitement tout en épargnant les tissus sains. Le Centre Hospitalier de l’Université de Montréal s’est muni en 2009 d’un appareil de SABR de fine pointe, le CyberKnife™ (CK), un accélérateur linéaire produisant un faisceau de photons de 6 MV dirigé par un bras robotisé, permettant d’administrer des traitements non-coplanaires avec une précision infra-millimétrique. Ce mémoire est dédié à la caractérisation de certains enjeux cliniques et physiques associés au traitement par CK. Il s’articule autour de deux articles scientifiques revus par les pairs. D’une part, une étude prospective clinique présentant les avantages de la SABR pulmonaire, une technique qui offre un excellent contrôle tumoral à long terme et aide au maintien de la qualité de vie et de la fonction pulmonaire. D’autre part, une étude de physique médicale illustrant les limites de l’acquisition d’images tomodensitométriques en auto-rétention respiratoire lors de la planification de traitement par CK.

spotlight europe # 2014/01 — Februar 2014 - Nordafrika zwischen Krise und Konsens = North Africa between crisis and consensus

No abstract.

spotlight europe # 2014/01 — February 2014: North Africa - Crisis and Consensus

The Arabellion is now in its fourth year. There is more freedom today, but less security. There are far more opportunities, but fewer jobs. And there is a patchwork of conflicts. In many places though the Arab world is tentatively moving towards democracy and the social market economy. Although there have been some difficulties along the way, European assistance for the transformation process is moving in the right direction. Still, the EU could certainly do more on the political level.

Shaping the emerging consensus on Syria. CEPS Commentaries, 26 February 2014

Notwithstanding the failure on February 15th of the second round of the Geneva II talks on Syria, Luigi Scazzieri and Steven Blockmans take note in this CEPS commentary of several welcome signs that the international community as a whole is starting to move in a more coordinated manner on the Syrian peace process.

Consensus, contradiction, and conciliation of interests: the geo-economics of the Energy Union. EPC Policy Brief, 8 July 2015

European Union energy policy calls for nothing less than a profound transformation of the EU's energy system: by 2050 decarbonised electricity generation with 80-95% fewer greenhouse gas emissions, increased use of renewables, more energy efficiency, a functioning energy market and increased security of supply are to be achieved. Different EU policies (e.g., EU climate and energy package for 2020) are intended to create the political and regulatory framework for this transformation. The sectorial dynamics resulting from these EU policies already affect the systems of electricity generation, transportation and storage in Europe, and the more effective the implementation of new measures the more the structure of Europe's power system will change in the years to come. Recent initiatives such as the 2030 climate/energy package and the Energy Union are supposed to keep this dynamic up. Setting new EU targets, however, is not necessarily the same as meeting them. The impact of EU energy policy is likely to have considerable geo-economic implications for individual member states: with increasing market integration come new competitors; coal and gas power plants face new renewable challengers domestically and abroad; and diversification towards new suppliers will result in new trade routes, entry points and infrastructure. Where these implications are at odds with powerful national interests, any member state may point to Article 194, 2 of the Lisbon Treaty and argue that the EU's energy policy agenda interferes with its given right to determine the conditions for exploiting its energy resources, the choice between different energy sources and the general structure of its energy supply. The implementation of new policy initiatives therefore involves intense negotiations to conciliate contradicting interests, something that traditionally has been far from easy to achieve. In areas where this process runs into difficulties, the transfer of sovereignty to the European level is usually to be found amongst the suggested solutions. Pooling sovereignty on a new level, however, does not automatically result in a consensus, i.e., conciliate contradicting interests. Rather than focussing on the right level of decision making, European policy makers need to face the (inconvenient truth of) geo-economical frictions within the Union that make it difficult to come to an arrangement. The reminder of this text explains these latter, more structural and sector-related challenges for European energy policy in more detail, and develops some concrete steps towards a political and regulatory framework necessary to overcome them.

Social Rights in Post-Revolutionary Tunisia: Is a Consensus-driven Policy Still on The table? EUSpring Policy Brief/Citizenship Review No. 17, June 2016

The immolation of street vendor Mohamed Bouazizi and the demonstrations that followed in December 2010 triggered the Tunisian revolution. But there were more deep-seated issues at stake: unemployment, poverty and exclusion, coupled with a deep sense of injustice, humiliation and helplessness of the peripheries to influence the political centre. Five years after the revolution, the social and economic problems are still persistent and arguably worse. Many people believe Tunisians are facing a distorted revolution; political progress has not coincided with reforms leading to welfare.

Second St. Gallen European Organisation for Research and Treatment of Cancer Gastrointestinal Cancer Conference: consensus recommendations on controversial issues in the primary treatment of rectal cancer

Primary treatment of rectal cancer was the focus of the second St. Gallen European Organisation for Research and Treatment of Cancer (EORTC) Gastrointestinal Cancer Conference. In the context of the conference, a multidisciplinary international expert panel discussed and voted on controversial issues which could not be easily answered using published evidence. Main topics included optimal pretherapeutic imaging, indication and type of neoadjuvant treatment, and the treatment strategies in advanced tumours. Here we report the key recommendations and summarise the related evidence. The treatment strategy for localised rectal cancer varies from local excision in early tumours to neoadjuvant radiochemotherapy (RCT) in combination with extended surgery in locally advanced disease. Optimal pretherapeutic staging is a key to any treatment decision. The panel recommended magnetic resonance imaging (MRI) or MRI + endoscopic ultrasonography (EUS) as mandatory staging modalities, except for early T1 cancers with an option for local excision, where EUS in addition to MRI was considered to be most important because of its superior near-field resolution. Primary surgery with total mesorectal excision was recommended by most panellists for some early tumours with limited risk of recurrence (i.e. cT1-2 or cT3a N0 with clear mesorectal fascia on MRI and clearly above the levator muscles), whereas all other stages were considered for multimodal treatment. The consensus panel recommended long-course RCT over short-course radiotherapy for most clinical situations where neoadjuvant treatment is indicated, with the exception of T3a/b N0 tumours where short-course radiotherapy or even no neoadjuvant therapy were regarded to be an option. In patients with potentially resectable tumours and synchronous liver metastases, most panel members did not see an indication to start with classical fluoropyrimidine-based RCT but rather favoured preoperative short-course radiotherapy with systemic combination chemotherapy or alternatively a liver-first resection approach in resectable metastases, which both allow optimal systemic therapy for the metastatic disease. In general, proper patient selection and discussion in an experienced multidisciplinary team was considered as crucial component of care.

ESMO consensus guidelines for the management of patients with metastatic colorectal cancer

Colorectal cancer (CRC) is one of the most common malignancies in Western countries. Over the last 20 years, and the last decade in particular, the clinical outcome for patients with metastatic CRC (mCRC) has improved greatly due not only to an increase in the number of patients being referred for and undergoing surgical resection of their localised metastatic disease but also to a more strategic approach to the delivery of systemic therapy and an expansion in the use of ablative techniques. This reflects the increase in the number of patients that are being managed within a multidisciplinary team environment and specialist cancer centres, and the emergence over the same time period not only of improved imaging techniques but also prognostic and predictive molecular markers. Treatment decisions for patients with mCRC must be evidence-based. Thus, these ESMO consensus guidelines have been developed based on the current available evidence to provide a series of evidence-based recommendations to assist in the treatment and management of patients with mCRC in this rapidly evolving treatment setting.

COPD control: Can a consensus be found?

There are currently no reliable instruments for assessing the onset and progression of chronic obstructive pulmonary disease (COPD) or predicting its prognosis. Currently, a comprehensive assessment of COPD including several objective and subjective parameters is recommended. However, the lack of biomarkers precludes a correct assessment of COPD severity, which consequently hampers adequate therapeutic approaches and COPD control. In the absence of a definition of "well-controlled disease", a consensus regarding COPD control will be difficult to reach. However, COPD patient assessment should be multidimensional, and anchored in five points: control of symptoms, decline of pulmonary function, levels of physical activity, exacerbations, and Quality of Life. Several non-pharmacological and pharmacological measures are currently available to achieve disease control. Smoking cessation, vaccination, exercise training programs and pulmonary rehabilitation are recognized as important non-pharmacological measures but bronchodilators are the pivotal therapy in the control of COPD. This paper discusses several objective and subjective parameters that may bridge the gap between disease assessment and disease control. The authors conclude that, at present, it is not possible to reach a consensus regarding COPD control, essentially due to the lack of objective instruments to measure it. Some recommendations are set forth, but true COPD control awaits further objective assessments.

Dominance, Competition, Compromise or Consensus? Explaining Decision-Making Structures

The previous chapter uncovered important differences between decision-making structures across the 11 processes investigated by this study. As we have noted, both historically and in much contemporary literature, the Swiss political system has been described as highly consensual. And yet, when we focus on differences between decision-making structures across different policy domains, important elements appear that point toward a more conflictual style of decision-making. Both when there is a power balance between coalitions and in the presence of a dominant coalition, coalition interactions are conflictual in the majority of cases. Based on the descriptive account of these differences in Chapter 4, the present chapter studies the conditions under which given decision-making structures emerge. Under which circumstances are actors able to form a dominant coalition, and which conditions lead to a situation where power is more evenly balanced between coalitions? Which conditions lead actors to develop a conflictual rather than a consensual type of interaction? Answering these questions can give us some indication of the factors responsible for different types of decision-making structures.

Political Decision-Making in Switzerland. The Consensus Model under Pressure

This in-depth study of the decision-making processes of the early 2000s shows that the Swiss consensus democracy has changed considerably. Power relations have transformed, conflict has increased, coalitions have become more unstable and outputs less predictable. Yet these challenges to consensus politics provide opportunities for innovation.

Beschreibung der Gemälde des Polygnotos von Thasos in der Lesche zu Delphi /

Mode of access: Internet.

Reading framework for the National Assessment of Educational Progress, 1992-1998 : NAEP reading consensus project /

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