Radiotherapy is an essential part of the multidisciplinary management of cancer. We will review recent advances in breast cancer radiotherapy, highlighting how modern breast cancer radiotherapy is now an adapted-risk approach based on the individual patient's risk. We will also discuss how advances in technology and clinical research have made it possible to deliver radiotherapy in a less toxic and more comfortable manner for our patients.

Lung cancer is a common disease with a high mortality rate. It is often diagnosed at an advanced stage, with a median survival of 12 to 16 months. Immune checkpoint inhibitors are part of the first-line therapeutic armoury in metastatic stages. They have been shown to improve overall survival, including in patients aged 64 to 75, but the results are less clear in older patients, who are underrepresented in clinical trials. Although the management of adverse events associated with these treatments is now well protocolized, the accumulation of toxicities, even low-grade toxicities, can have an adverse impact on the quality of life of the most frail elderly patients. Geriatric assessment is essential for adapting treatments and anticipating adverse effects.

Pancreatic cancer (PC) is an aggressive disease with a poor prognosis, characterized by a median survival of 6 to 8 months and a 5-year survival rate of approximately 15%. In Switzerland, around 1,700 new cases and 1,400 deaths are reported each year. Late diagnosis- largely due to the absence of specific symptoms and validated biomarkers-limits the availability of curative treatment options. This article summarizes recent advances in the multidisciplinary management of PC, detailing the diagnostic workup and therapeutic approaches: imaging, endoscopic techniques, pathology, minimally invasive surgery, ablative radiotherapy, and standard or molecularly guided systemic therapies. Despite notable progress and promising prospects, PC remains a significant challenge in oncology.

Multiple myeloma (MM) is a malignant bone marrow plasma cell dyscrasia, associated with the secretion of a monoclonal immunoglobulin (Ig). The purpose of this study is to describe the epidemiological, clinical, biological and prognostic features of a cohort of patients with multiple myeloma, whose data were collected at the Laboratory Department of Habib Thameur Hospital in Tunis. We conducted a retrospective descriptive study of patients with MM in the Laboratory Department of Habib Thameur Hospital in Tunis over a period of 10 years (2003-2023). Data collection and analysis were performed using patient records and Microsoft Excel 2010 software. A total of 60 patients were included, with a mean age of 67.61 ± 8.7 years and a male-to-female ratio of 0.76. Bone pain was the most common presenting symptom, occurring in 75% of cases. Radiological abnormalities were identified in 50 patients (83%), predominantly affecting the spine (57%). Laboratory tests showed anemia in 74% of patients, thrombocytopenia in 17% of patients, an elevated erythrocyte sedimentation rate (ESR) in 90% of cases. Myelogram confirmed the diagnosis in 70% of cases. The monoclonal immunoglobulin identified was IgG in 62% of cases, IgA in 22%, IgM in 2%, and light chain in 12%, one patient presented with biclonal MM. According to the Durie and Salmon classification, the majority of patients (74%) were diagnosed at stage III. This study provides a better understanding of the epidemiological, clinical, and biological characteristics of MM. Despite significant advances made over the past two decades, multiple myeloma remains a disease with a poor prognosis.

Plasma cell leukemia (PCL) is a rare lymphoproliferative disorder characterized by clonal proliferation of plasma cells in the bone marrow and peripheral blood. In 2021, the International Myeloma Working Group (IMWG) redefined LCP as the presence of 5% or more circulating plasma cells in patients otherwise diagnosed with multiple myeloma. In this work, we report five cases of PCL collected in the hematology laboratory of the Mohammed VI University Hospital in Oujda. The interest of this work is to elucidate the importance of hematological cytology in diagnostic guidance as well as therapeutic innovation concerning this rare pathology.

Immune checkpoint inhibitors have revolutionized the management of advanced non-small cell lung cancer (NSCLC). While the proportion of "long-term survivors" is estimated to be between 8% and 16%, this population remains poorly understood.

The association of light-chain (AL) amyloidosis with type B follicular lymphoma is extremely rare, as the clone secreting the amyloidogenic light chain is generally plasmacytic. We here report the case of a 67-year-old patient with no specific pathological history, presenting with a deterioration in general condition, progressively worsening dysphonia and dysphagia, and a large mass in the cavum. Biopsy findings indicated grade 1-2 type-B follicular non-Hodgkin's lymphoma. Cervico-thoraco-abdomino-pelvic computed tomography (CT) scan revealed a nasopharyngeal mass measuring 70 mm x 40 mm and extending over 60 mm. Bone marrow biopsy and pre-therapeutic evaluations were normal. The patient received 4 cycles of rituximab plus CHOP (cyclophosphamide, adriamycine, prednisone and oncovin) with no response, followed by 3 cycles of rituximab plus DHAOX (dexamethasone, high-dose cytarabine and oxalipatin) with persistence of the mass. A subsequent biopsy of the mass revealed the disappearance of B-cell lymphoid infiltration but showed AL kappa chain amyloid deposits. Immunoelectrophoresis of plasma proteins detected the presence of IgM kappa immunoglobulin. Positron emission tomography (PET) imaging identified a hypermetabolic nasopharyngeal process. The patient is currently undergoing treatment with a protocol combining bortezomib, prednisone, and bendamustine.

Marginal zone lymphoma (MZL) is the third most frequent lymphoma in Western countries with an increasing incidence with age. There are different histologic subtypes: Splenic MZL (SMZL), Nodal MZL (NZML), Extranodal MZL (EMZL) or MALT lymphoma and more recently, a novel entity called splenic diffuse red pulp small B-cell lymphoma. The accurate diagnosis relies on morphologic, phenotypic, cytogenetic and molecular features in order to rule out other indolent non-Hodgkin lymphomas. First line treatment depends on MZL subtypes: depending on localized or disseminated disease, MALT lymphoma are managed with radiotherapy on immunochemotherapy. SMZL, when requiring therapy, are treated with splenectomy ore more frequently monotherapy Rituximab or immunochemotherapy depending on age, comorbidities and tumor burden. Management of NMZL is often similar to Follicular lymphoma treatment. Treatment of refractory or relapsed MZL takes into account the time between the diagnosis and the progression, the nature and outcomes of previous therapies and the general condition of the patient. Conventional treatments may be a suitable option but novel therapies are more frequently used. In this review, we focus on the role of Bruton Tyrosine Kinases (where only Zanubrutinib has marketing authorization in France), PI3Kinases, Syk and BCL-2 inhibitors as well as on the results of immunomodulatory drugs and more recently the use of bispecific antibodies and T-cell chimeric antigen receptor (CAR-T cell).

The concept of oligometastatic disease in lung cancer has been the subject of much publication and speculation. Indeed, beyond its definition, which is still a matter of debate, it is a rather broad concept considering synchronous oligometastatic disease but also oligoprogression and oligopersistence concepts. These questions are increasingly common considering the improvement of systemic treatments in recent years. Although no prospective randomized trial has been conducted to date, it would seem appropriate to offer patients local ablative treatment of oligoprogression, especially if symptomatic or in cases of oncogenic addiction. On the other hand, the most recent data do not defend the closure treatment approach for patients who benefit from immunotherapy. All in all, it is important to remember that systemic therapy remains the cornerstone of treatment for metastatic lung cancer, and that further robust randomized studies will be needed to determine the place of local therapy.

The discovery of ALK gene rearrangement in 3 to 5% of non-small cell lung carcinomas has revolutionized our understanding and therapeutic approach of these cancers. This oncogenic driver is associated with specific clinical and biological features is associated with specific clinical and biological features, mainly affecting young and never-smoker patients, with a particular tropism for brain metastases. The development of ALK tyrosine kinase inhibitors has transformed patient outcomes, with remarkable efficacy of latest-generation molecules, particularly in controlling brain metastases. However, the emergence of complex resistance mechanisms, whether ALK-dependent or ALK-independent, remains a major challenge. The comprehensive understanding of these resistance mechanisms now guides the development of next-generation inhibitors and innovative therapeutic strategies, paving the way for increasingly personalized precision medicine.

Among the oncogenic alterations of non-small cell lung cancer (NSCLC), the EGFR gene mutation is observed in 15% of patients in France, particularly among non-smokers and women. Treatment mainly relies on tyrosine kinase inhibitors (TKIs) targeting EGFR. In first-line metastatic treatment, osimertinib, a third-generation TKI, has become the standard, improving progression-free survival (PFS) and overall survival (OS) compared to first- or second-generation TKIs. The combination of TKI/chemotherapy (osimertinib/carboplatine-pemetrexed) and TKI/bispecific antibodies (e.g., amivantamab/lazertinib) are alternatives under evaluation, with benefits in PFS but increased toxicity. In case of progression under first- or second-generation TKIs, the most common resistance is the T790M mutation, which can be targeted by osimertinib. For other resistances, platinum-based chemotherapy remains an option. Amivantamab combined with chemotherapy has shown an improvement in PFS in the second line and has early access in France. Other emerging approaches include conjugated antibodies (patritumab deruxtecan, datopotamab deruxtecan) and next-generation TKIs. In the future, personalized treatment based on the molecular profile and early response to TKIs could optimize management, particularly by integrating predictive markers such as EGFR clearance under treatment.

Since 2017, anti-PD-(L)1 immunotherapy has been the cornerstone of first-line treatment for stage IV non-oncogene-addicted non-small cell lung cancer. Its phase I development has established that the level of PD-L1 expression by tumor cells is predictive of response rate and progression-free survival. Above 50%, it makes chemotherapy not mandatory, with a median survival for pembrolizumab monotherapy of around 26 months and five-year survival of 32%. Large phase III studies have also validated the combination of anti-PD-(L)1 immunotherapy and platinum-based chemotherapy regardless of PD-L1 level of expression, increasing five-year survival from 10% to 18%. Dual immunotherapy combining anti-CTLA-4 and anti-PD-(L)1 might be interesting, especially in PD-L1 negative tumors, but is not available in France. Treatment personalization, particularly in the case of PD-L 1 expression >50%, should be based on response and non-response factors to immunotherapy, including patient-related factors such as performans status, age, smoking status, as well as tumor-related factors such as disease aggressiveness, tumor volume, mutational profile, along with concomitant medications. The optimal duration of immunotherapy is uncertain and arbitrarily set at two years. Many options are currently being explored to improve first-line treatment outcomes, as the majority of patients experience resistance to immunotherapy.

Non-small cell lung cancers (NSCLC) account for 85 % of bronchopulmonary cancers and are most often diagnosed at an advanced stage. In case of resectable locally advanced NSCLC (LA-NSCLC) in a patient fit, surgery is the cornerstone of treatment in combination with perioperative treatment based on chemotherapy +/- immunotherapy. However, for a large proportion of LA-NSCLC, surgery is not a preferred option because the patient is medically inoperable or because of an unresectable disease. Since the early 2000s, the standard treatment for these patients who cannot benefit from surgical treatment had been a chemoradiotherapy, ideally given concurrently. The recent addition of consolidation immunotherapy following concurrent chemoradiotherapy has led to a clear improvement in median overall survival (OS) in this population. The objective of this article is to detail the standard treatment in 2024 of unresectable (or inoperable) LA-NSCLC and to discuss the main therapeutic perspectives in this indication, both regarding radiotherapy and systemic treatment and especially combination strategies with immunotherapy.

EGFR-mutant and ALK-positive non-small-cell lung cancer derive benefit from adjuvant treatment with tyrosine kinase inhibitors after complete resection. Testing of these alterations is therefore recommended on surgical specimens and, where appropriate, on pre-treatment biopsies. Many questions remain with regards to the implementation of these strategies: duration of treatment, treatment in case of recurrence, impact on molecular evolution.

For decades, early-stage, resecable, although potentially curable, non-small cell lung cancer (NSCLC) has been marred by unacceptably high recurrence rates. Anti-PD(L)1 immune checkpoint inhibitors have revolutionized the treatment of advanced NSCLC; the recent approvals of these drugs in the perioperative setting will now transform the paradigm therapeutics of localized NSCLC. In this review, we focus on the role of perioperatively administered immune checkpoint inhibitors in resectable NSCLC, synthesizing the results of early clinical trials, and discussing future directions.

The treatment of early stage T1-T2N0M0 non-small cell lung cancers (NSCLC) was previously based on surgery. However, 20 to 25% of patients are inoperable due to their age, comorbidities or refuse surgery. Since 2018, stereotactic body radiation therapy (SBRT) has become the standard treatment for these patients. For operable patients, the comparison surgery - SBRT is difficult without a clear conclusion, the different phase III trials have not yet permitted to provide a formal answer in terms of local control and survival by default of inclusion. Dose and fractionation need to be selected according to tumor location. Tolerance is usually good, with few grade ≥3 toxicities; however, caution is advised for ultra-central tumors and in case of interstitial pneumonia. Post-therapeutic imaging monitoring is complex, sometimes with uncertainties between radiation-induced pneumonitis and relapse. This complexity may increase in ongoing trials combining SBRT and immunotherapy.

Lung Cancer is the second most common cancer in the world but the leading cause of cancer death for both sexes in many countries. Nearly 53,000 new cases were expected in France in 2023, representing 12% of all new cases of cancer, and 33,000 deaths were reported in 2018, representing 21% of all cancer deaths. The KBP studies conducted by the College of General Hospital Pulmonologists (CPHG) for 20 years constitute an excellent barometer of the evolution of the Lung Cancer in France. Lung Cancer is becoming more feminine but still remains a male cancer with a narrowing gap between the two sexes: 65,4% of incident cases are men in the overall population in 2020 but only 58,9% among young subjects (<50 years old). The average age at diagnosis is increasing (67.8 years). The most common histological subtype is adenocarcinoma. Smoking remains the main risk factor but the proportion of non-smokers is increasing (12,6%) due to the impact of air pollution, passive smoking and the aging of the population. The impact of COVID-19 on Lung Cancer mortality in 2020 was significant. Despite the diagnosis which remains mostly late in France, there has been a significant improvement in the prognosis over the past twenty years (reduction in early mortality and increase in median survival) due to therapeutic progress.

Until now, the gold standard surgical treatment for early-stage non-small-cell lung cancer (NSCLC) has been pulmonary lobectomy with lymph node dissection. However, several cohort studies have suggested that infra-lobar resection may provide equivalent survival while better preserving quality of life and lung function. The results of two prospective randomized phase III studies comparing sublobar resection (segmentectomy or wedge resection) have recently been published. The JCOG 0802 trial focused on cT1a-b NSCLC and showed significantly better survival in the segmentectomy group, but a higher rate of local recurrence. The CALGB 140503 trial involving stage Ia NSCLC showed no difference in survival and recurrence rate between the two groups. Some questions remain unanswered in these studies, particularly in the CALGB 140503 trial where a majority of patients had an atypical resection. Pending clarification, the complexity of this new surgery calls for oncological rigor in terms of indications and technique, as well as compliance with quality criteria.

In Europe, a rare cancer is defined as having an incidence rate of less than 6/100,000. Rare lung cancers encompass many entities defined by the 2021 WHO classification of thoracic tumors, and represent around 10% of all lung cancers. Rare lung cancers involve several histological types (carcinoma, sarcoma and lymphoma), each of which comprises several entities. The management of these patients with rare cancers requires specific medical expertise at every level (diagnosis, treatment and follow-up). These patients should therefore be referred to expert centers affiliated with national networks, giving them appropriate care and better access to innovative treatments. The deployment of systematic molecular characterization of these tumors has allowed for the identification and better characterization of specific entities. Some entities are specific to the lung, while others are more commonly found in other organs. In this review, we will only consider malignant lung tumors with an incidence of less than 1%.