Les associations chimioradiothérapiques dans les tumeurs de lʹenfant

Summary gh chemosensitivity of pediatric tumors along with their natural propensity for an early distant disseminationhave stimulated the interest for chemo-radiationcombinations in children since the mid 50s. Following theearly experiments in nephroblastomas on the interaction ofActinomycin-D and radiotherapy, multiple national andinternational studies have been conducted since the mid70s with considerable success: nowadays most pediatrictumors enjoy a long term survival in excess of 70%. Liketheir adult counterparts, these associations aim to inducean early control of the primary tumor and distant spreading(spatial cooperation) but also, more specifically in children,to limit the toxicity on normal tissues when treatmentintensity can be further reduced. The association of aninitial chemotherapy followed by local radiation at adose and in a volume adapted to the response tochemotherapy along with associated prognostic factorshas become widely tested in national and internationalstudies conducted in Hodgkinʹs disease, Ewingʹssarcoma, medulloblastomas, and brain tumors in thevery young. Conversely, concomitant associations haveremained limited to high-risk subgroups (parameningealrhabdomyosarcomas for example) due to their potentialhazards.