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Environ 10 à 15 % des patientes atteintes d'un cancer du sein seront atteintes d'une récidive locale après un traitement conservateur initial ou une mastectomie. La mastectomie totale est historiquement le traitement de référence en cas de récidive locale. Cependant, la réirradiation peut être une option en cas de second traitement conservateur en association à une segmentectomie ou en cas de récidive sur la paroi thoracique afin d'améliorer le taux de contrôle local. Différentes modalités sont disponibles : la curiethérapie, la radiothérapie externe avec ou sans hyperthermie. Bien que les résultats carcinologiques soient encourageants, cette situation complexe nécessite une sélection rigoureuse des patientes et une maîtrise technique afin d'obtenir le meilleur taux de contrôle local et de limiter la toxicité. Cet article présente une revue des données de la littérature sur les indications et différentes techniques de réirradiation des récidives homolatérales des carcinomes mammaires afin d'apporter une aide à la prise de décision en pratique clinique. Approximately 10 to 15% of patients with breast cancer will have a local recurrence after initial conservative treatment or mastectomy. Total mastectomy has historically been the standard treatment for local recurrence. However, the question of reirradiation may arise as part of a second conservative treatment in conjunction with segmentectomy or in the case of chest wall recurrence to improve local control. Different modalities are available: brachytherapy, external beam radiotherapy with or without hyperthermia. Although the carcinologic results are encouraging, this complex situation requires rigorous patient selection and technical requirements to achieve the best local control and limit toxicity events. This article presents a review of the literature on the different indications and techniques for reirradiation of ipsilateral recurrent breast cancer, with the aim of providing decision support in clinical practice. [ABSTRACT FROM AUTHOR]

Le cancer de la prostate est le plus fréquent chez l'homme et, au stade localisé, les schémas d'hypofractionnement de la radiothérapie sont devenus des standards, mais l'absence de risque aggravé de toxicité aiguë et tardive génito-urinaire et gastro-intestinale de l'escalade de dose reste à prouver. La population étudiée comprenait tous les patients pris en charge à l'institut Curie de février 2016 à mars 2018 pour un adénocarcinome prostatique localisé traité par irradiation externe délivrée par un accélérateur linéaire en technique conformationnelle avec modulation d'intensité guidée par l'image à la dose totale de 75 Gy en 30 fractions de 2,5 Gy dans le volume cible prévisionnel comprenant la prostate et les vésicules séminales proximales, et pouvait associer une radiothérapie prophylactique ganglionnaire de 46 Gy en 23 fractions avec la technique de boost intégré. En tout, 166 patients ont été inclus, dont 114 étaient atteints de cancer de risque au moins intermédiaire défavorable (soit 68,7 %). L'âge et le suivi médians étaient de 71,4 ans et 3,96 ans. Cent quarante-neuf patients ont reçu une radiothérapie ganglionnaire (soit 89,8 %). Cent trente et un patients ont reçu une hormonothérapie (soit 78,9 %). Une toxicité génito-urinaire de grade 2 ou plus a été notée en cours de radiothérapie, à 6 mois, 1 an et 5 ans respectivement dans 36,7 %, 8,8 %, 3,1 % et 4,7 % des cas. Deux patients ont souffert à 5 ans d'une toxicité de grade 4 (soit 1,6 %). Une toxicité gastro-intestinale de grade 2 ou plus a été notée en cours de radiothérapie, à 6 mois, 1 an et 5 ans dans respectivement 15,1 %, 1,9 %, 14,6 % et 9,3 % des cas. Parmi ces derniers, huit patients ont souffert d'une toxicité de grade 3 (soit 6,2 %). Il n'y a eu aucune toxicité de grade 4. Les analyses n'ont pas mis en évidence de facteur prédictif de toxicité. Les taux de survie globale, sans progression et spécifique à 5 ans étaient respectivement de 82,4 %, 85,7 % et 93,3 %. La concentration sérique d'antigène spécifique de la prostate et les facteurs de risque cardiovasculaires ont été retrouvés comme facteurs prédictifs d'une dégradation de la survie globale (p = 0,0028 pour les deux). La radiothérapie externe pour un cancer prostatique localisé avec notre schéma modérément hypofractionné avec escalade de dose est bien tolérée. En l'absence de toxicité tardive majorée, l'analyse des modes de rechutes à long terme sera intéressante pour déterminer l'intérêt de cette escalade de dose sur les rechutes locales et à distance. Prostate cancer is the most frequent cancer among men and radiotherapy hypofractionation regimens have become standard treatments for the localized stages, but the absence of increased risk of acute and late genitourinary or gastrointestinal toxicity of the dose escalation still must be demonstrated. The study population included all patients with localized prostatic adenocarcinoma treated at the institut Curie from February 2016 to March 2018 by external radiation delivered by a linear accelerator using an image-guided conformal intensity modulation technique at a total dose of 75 Gy in 30 fractions of 2.5 Gy in the planning target volume that included the prostate and the proximal seminal vesicles, and could be paired with a prophylactic lymph node radiotherapy at 46 Gy in 23 fractions with simultaneous integrated boost. A total of 166 patients were included. Among them, 68.6% were unfavourable intermediate or (very) high risk. The median age and follow-up were 71.4 years and 3.96 years. One hundred and forty-nine patients received prophylactic lymph node radiotherapy (89.8%). One hundred and thirty-one patients received hormonotherapy (78.9%). Genito-urinary toxicity events of grades 2 or above during radiotherapy, at 6 months, 1 year and 5 years were respectively 36.7%, 8.8%, 3.1% and 4.7%. Two patients had late grade 4 toxicity at 5 years (1.6%). Grade 2 gastrointestinal toxicity events during radiotherapy, 6 months, 1 year and 5 years were respectively 15.1%, 1.9%, 14.6% and 9.3%. Of these, eight patients had grade 3 toxicity (6.2%). There was no grade 4 toxicity. Analyses did not reveal any predictive factor for toxicity. The 5-year overall, progression-free, and specific survival rates were respectively 82.4%, 85.7%, and 93.3%. Serum prostate specific antigen concentration and cardiovascular risk factors were found to be predictive factors of deterioration in overall survival (P = 0.0028 for both). External radiotherapy for localized prostatic cancer with our moderately hypofractionated dose escalation regimen is well tolerated. In the absence of increased late toxicity, the analysis of the modes of long-term relapses will be interesting to determine the benefit of this dose escalation on local and distant relapses. [ABSTRACT FROM AUTHOR]

Breast-conserving surgery followed by reirradiation for a localized ipsilateral breast tumour relapse may increase the radiation dose delivered to the heart and result in a greater risk of cardiac adverse events. This study aimed to compare the incidence of cardiac mortality in patients treated for a localized ipsilateral breast tumour relapse, either with breast-conserving surgery followed by reirradiation or with total mastectomy between 2000 and 2020. All patients treated for a primary non-metastatic breast cancer with breast-conserving surgery and adjuvant radiotherapy were identified in the Surveillance, Epidemiology, and End Results (SEER) program database, and those who subsequently experienced a localized ipsilateral breast tumour relapse treated with breast-conserving surgery and reirradiation ("BCS + ReRT" group, n = 239) or with total mastectomy ("TM" group, n = 3127) were included. The primary objective was to compare the cardiac mortality rate between the patients who underwent breast-conserving surgery followed by reirradiation and total mastectomy. Secondary endpoints were overall survival and cancer specific survival. Cardiac mortality was significantly higher in patients treated with breast-conserving surgery followed by reirradiation (hazard ratio [HR]: 2.40, 95% confidence interval [95% CI]: 1.19–4.86, P = 0.006) in univariate analysis; non-statistically significant differences were observed after adjusting for age, laterality and chemotherapy on multivariate analysis (HR: 1.96, 95% CI: 0.96–3.94, P = 0.067), age being the only confounding factor. A non-statistically significant difference towards lower overall survival was observed in patients who had breast-conserving surgery followed by reirradiation compared with those who underwent total mastectomy (HR: 1.37, 95% CI: 0.98–1.90, P = 0.066), and no differences were observed in terms of cancer specific survival (HR: 1.01, 95% CI: 0.56–1.82, P = 0.965). In this study, the incidence of cardiac mortality was low, and breast-conserving surgery followed by reirradiation did not independently increased the risk of cardiac mortality for a localized ipsilateral breast tumour relapse. [ABSTRACT FROM AUTHOR]

This study aims to perform a comprehensive systematic review of deep learning (DL) models in predicting RT-induced toxicity. A literature review was performed following the PRISMA guidelines. Systematic searches were performed in PubMed, Scopus, Cochrane and Embase databases from the earliest record up to September 2022. Related studies on deep learning models for radiotherapy toxicity prediction were selected based on predefined PICOS criteria. Fourteen studies of radiotherapy-treated patients on different types of cancer [prostate (n = 2), HNC (n = 4), liver (n = 2), lung (n = 4), cervical (n = 1), and oesophagus (n = 1)] were eligible for inclusion in the systematic review. Information regarding patient characteristics and model development was summarized. Several approaches, such as ensemble learning, data augmentation, and transfer learning, that were utilized by selected studies were discussed. Deep learning techniques are able to produce a consistent performance for toxicity prediction. Future research using large and diverse datasets and standardization of the study methodologies are required to improve the consistency of the research output. [ABSTRACT FROM AUTHOR]

To evaluate the long-term tolerance and outcome of patients irradiated with an electron beam technique used since 2007 on the chest wall and lymph node areas after mastectomy for non-metastatic locally advanced breast carcinoma. All patients irradiated with an improved electron beam technique after mastectomy for non-metastatic breast carcinoma between 2007 and 2011 at Institut Curie (France) were included in this descriptive study. The technique has already been described in other studies, as has its 5-year tolerance and non-inferiority compared to photon irradiation. Acute and chronic toxicity were collected using CTCAE v 3.0. A clinical examination was carried out each week during the radiotherapy and at each 6 months consultation with one mammogram per year at the Institut Curie for at least 5 years. The patients then continued to be followed either at the Institut Curie or in private practice with a good transmission of outpatient consultations, thanks to a system of forms to be completed and integrated into the electronic files. Quantitative and qualitative data are defined by mean and proportion. Statistical comparisons were made by computer using the Chi2 test and Fisher's exact test for categorical variables. Recurrence-free survival was defined as the time between the end of treatment and the date of recurrence or death. Overall survival was defined in the same way without taking into account recurrences. Patients who did not report any events were censored at the date of last news. Of the 796 patients included, 51.3% had multifocal lesions, 10.1% had triple negative status, and 18.8% displayed overexpression of the Her2 receptor, 196 (24.6%) patients received neoadjuvant chemotherapy and 208 (26.1%) systemic treatment during radiotherapy (chemotherapy or targeted therapy); 514 (64.6%) had at least one positive lymph node. The internal mammary chain (IMC) was irradiated in 85.6% of cases, the supraclavicular areas in 88.3% of cases, the infraclavicular in 77.9% of cases and the axillary area in 14.9% of cases. With a median follow-up of 113 months (range: 2–164 months), locoregional recurrence-free survival and overall 10-year survival was respectively 94.02%, (95% CI: 92.13–98.94) and 79.84% (95% CI: 76.83–82.97). Median survival was not reached. In the long term, 29.6% of patients had telangiectasias (grade 1: 23.3%, grade 2: 5.2%, grade 3: 1.1%). There were 279 patients (35.1%) with secondary breast reconstruction on average 21 months after all treatments. IMC irradiation was not associated with a majority of pulmonary toxicity. Thirty-five patients developed chronic heart disease after radiotherapy, 30 of whom had received anthracyclines and 9 had received traztuzumab. Three of these reported a coronary ischaemic event, including 2 irradiated on the left and 1 on the right, the 4 were irradiated in the vicinity of the IMC and the other lymph node areas, but presented many other cardiovascular risk factors (between 2 and 4). During follow-up, 4.9% of patients had a contralateral recurrence (n = 39) and 5.5% had a second non-breast cancer (n = 44), of the 6 bronchopulmonary cancers diagnosed, none appeared to be related to chest wall radiotherapy. This study confirms that the improved postmastectomy electron beam radiation therapy technique is well-tolerated after nearly 10 years of follow-up. [ABSTRACT FROM AUTHOR]

La radiothérapie et les thérapies ciblées occupent une place majeure dans la prise en charge des cancers. Malheureusement, les données de toxicité et d'efficacité concernant leur association sont ténues et non centralisées. Ainsi, nous proposons une revue de la littérature sur les risques et opportunités de l'association de la radiothérapie aux thérapies ciblées. Nous avons cherché dans les bases de données EMBASE, ClinicalTrial.gov, Medline et Web of Science pour les termes « radiotherapy », « radiation therapy », « radiosurgery », « local ablative therapy », « gamma knife » et « stereotactic », combinés avec « cetuximab », « crizotinib », « erlotinib », « gefitinib », « lapatinib » « trastuzumab », "vemurafenib", « panitumumab », « alectinib », « ceritinib », « dabrafenib », « trametinib », « BRAF », « TKI », « MEK », « EGFR », « ALK », « ADC », « trastuzumab », « pertuzumab », « TDM-1 », « trastuzumab emtansine », « TDxd », « trastuzumab deruxtecan », « lorlatinib », « targeted therapy ». Quelques essais ont mis en évidence un effet synergique de la radiothérapie associée aux thérapies ciblées. Les inhibiteurs de m itogen- a ctivated p rotein k inases ont une toxicité prouvée et bien connue, pour laquelle il existe des recommandations de bonne pratique clinique. Cette revue donne un point de vue dans l'état actuel des connaissances, et ses limitations mettent en exergue le besoin de données plus solides dans un domaine plein de promesses. Radiotherapy and targeted therapies play a major role in the management of cancers. Unfortunately, the toxicity and efficacy data regarding their association are tenuous and not centralized. Thus, we propose a literature review about the risks and opportunities of combining radiotherapy with targeted therapies. We searched databases EMBASE, ClinicalTrial.gov, Medline and Web of Science for the terms « radiotherapy », « radiation therapy », « radiosurgery », « local ablative therapy », « gamma knife » et « stereotactic », combinés avec « cetuximab », « crizotinib », « erlotinib », « gefitinib », « lapatinib » « trastuzumab », "vemurafenib", « panitumumab », « alectinib », « ceritinib », « dabrafenib », « trametinib », « BRAF », « TKI », « MEK », « EGFR », « ALK », « ADC », « trastuzumab », « pertuzumab », « TDM-1 », « trastuzumab emtansine », « TDxd », « trastuzumab deruxtecan », « lorlatinib », « targeted therapy ». A few trials have showed a synergistic effect of radiotherapy associated with targeted therapies. MAPK inhibitors provide proven and well-known toxicity, for which clinical practice guidelines exist. This review provides a point of view in the current state of knowledge, and its limitations highlight the need for more solid data in a field full of promise. [ABSTRACT FROM AUTHOR]

Grâce aux succès des inhibiteurs de checkpoint , l'immunothérapie occupe désormais une place majeure dans la prise en charge d'un grand nombre de tumeurs solides, tandis que le nombre des indications continue de croître et que de nouvelles combinaisons pourraient, dans un avenir proche, modifier encore les standards de traitement. Cependant, les taux de réponse des immunothérapies en monothérapie sont modestes et leur utilisation s'envisage de plus en plus au sein de combinaisons avec d'autres traitements anticancéreux (chimiothérapies, chirurgie, radiothérapie ou certaines thérapies ciblées). Les combinaisons avec la radiothérapie semblent particulièrement attractives car il existe un fort rationnel expérimental qui lie une partie de l'efficacité des rayonnements ionisants à une stimulation induite sur le système immunitaire (réponse innée et adaptative). De nombreux essais de phase précoce et un certain nombre de grands essais randomisés de combinaison ont donné des résultats d'efficacité et de tolérance, tandis que des essais importants sont encore en cours et apporteront des réponses dans un avenir proche. Cette revue rapide rappelle le rationnel biologique expérimental de l'immuno-radiothérapie et présente certains axes fondamentaux en cours d'exploration, puis présente les résultats cliniques d'efficacité et de tolérance disponibles à ce jour, ceux qui sont attendus prochainement, et enfin esquisse un tableau des perspectives dans ce domaine en évolution rapide. Thanks to the success of checkpoint inhibitors, immunotherapy now plays a major role in the management of a large number of solid tumors, while the number of indications continues to grow and new combinations could, in the near future, further modify treatment standards. However, the response rates of immunotherapies as monotherapy are modest and their use is increasingly considered in combination with other cancer treatments (chemotherapy, surgery, radiotherapy or certain targeted therapies). Combinations with radiotherapy seem particularly attractive because there is a strong experimental rationale linking part of the efficacy of ionizing radiation to an induced stimulation of both of the innate and adaptive response. Many early phases and a number of large randomized combination trials have published efficacy and safety results, while important trials are still ongoing and will provide answers in the near future. This short review recalls the experimental biological rationale for immuno-radiotherapy and highlights some of the fundamental directions being explored, then presents the clinical efficacy and safety results available to date, those expected in the near future, and finally outlines the outlook in this rapidly evolving field. [ABSTRACT FROM AUTHOR]

The importance of tumoral vascularization as a therapeutic target was first described in 1971 by Folkman. Anarchic vascularization in response to tumour hypoxia, especially mediated by vascular endothelial growth factor, represents a major target in the management of many cancers. The contribution of systemic anti-angiogenic treatments including humanized anti-VEGF monoclonal antibodies (bevacizumab) and tyrosine kinase inhibitors, whose effect on vascular normalization and correction of tumour hypoxia has been shown in preclinical studies to be enhancing the effect of radiotherapy. Early trials combining radiotherapy and antiangiogenics with a small number of patients have contradictory results and tend to put into perspective the opportunity that this synergistic association represents. The efficiency found must be tempered by some toxicity described, especially in association with high doses per fraction. The aim of this article is to present the main studies reporting the efficiency and safety of the combination of antiangiogenic drugs and radiotherapy, as well as the expected opportunities. [ABSTRACT FROM AUTHOR]

CDK4/6 inhibitors are nowadays commonly used in metastatic HR+/HER2− breast cancer. Herein, we report a literature review regarding the benefits and risks of their combination with radiotherapy. Numerous pre-clinical studies have indeed shown a potential synergistic effect of these treatments in combination with radiotherapy in various types of cancers. On the other hand, some retrospective clinical studies have reported increased acute toxicity in case of digestive or pulmonary irradiation; therefore, it is advisable to discontinue CDK4/6 inhibitors before starting irradiation. Several prospective clinical trials are currently ongoing to assess the feasibility of this combination. [ABSTRACT FROM AUTHOR]

La prise en charge standard des tumeurs rectales localement évoluées classées cT3-T4 et/ou atteignant les ganglions repose sur un traitement préopératoire associant une radiothérapie de 45 à 50 Gy et une chimiothérapie à base de 5-fluoro-uracile. La radiothérapie avec modulation d'intensitéa déjà montré son intérêt comparativement à la radiothérapie conformationnelle tridimensionnelle pour d'autres localisations notamment pelviennes. La place de la radiothérapie conformationnelle avec modulation d'intensité dans la prise en charge notamment préopératoire des cancers du rectum se pose. Des études publiées montrent sa faisabilité avec comme objectif de réduire la toxicité pour une efficacité équivalente. The standard management of locally advanced rectal tumors as cT3-T4 and/or N0/N1 is based on preoperative treatment combining radiotherapy of 45 to 50 Gy and chemotherapy based on 5-fluorouracil. Intensity-modulated radiotherapy has already shown its interest compared to conformal radiotherapy in other locations, like in pelvic cancer. The role of intensity-modulated radiotherapy in the pre/postoperative treatment of rectal cancers is not a standard of care. Published studies showed its feasibility with the objective of less toxicity with equivalent efficacy. [ABSTRACT FROM AUTHOR]

Between 10 and 40% of patients with cancer will develop one or more brain metastases (BMs). Stereotactic radiotherapy (SRT) is part of the therapeutic arsenal for the treatment of de novo or recurrent BM. Its main interest is to delay whole brain radiation therapy (WBRT), which may cause cognitive toxicity. However, SRT is not exempt from long-term toxicity, and the most widely known SRT is radionecrosis (RN). The objective of this study was to analyze the occurrence of RN per BM and per patient. Between 2010 and 2020, data from 184 patients treated for 915 BMs by two to six SRT sessions for local or distant brain recurrence without previous or intercurrent WBRT were retrospectively reviewed. RN was examined on trimestral follow-up MRI and potentially confirmed by surgery or nuclear medicine. For each BM and SRT session plan, summation V 12Gy , V 14Gy , V 21Gy and V 23Gy isodoses were collected. Volumes of intersections were created between the 12 Gy isodose at the first SRT and the 18 Gy isodose of the following SRT (V 18-12Gy). At the end of follow-up, 23.0% of patients presented RN, and 6.3% of BM presented RN. Median follow-up of BM was 13.3 months (95%CI 18.3–20.8). The median interval between BM irradiation and RN was 8.7 months (95% CI 9.2–14.7). Six-, 12- and 24-month RN-free survival rates per BM were 75%, 54% and 29%, respectively. The median RN-free survival per patient was 15.3 months (95% CI 13.6–18.1). In multivariate analysis, the occurrence of RN per BM was statistically associated with local reirradiation (P < 0.001) and the number of SRTs (P < 0.001). In univariate analysis, the occurrence of RN per patient was statistically associated with the sum of all V 18-12Gy (P = 0.02). No statistical association was found in multivariate analysis. A sum of all V 18-12 Gy of less than 1.5 ml was associated with a 14.6% risk of RN, compared with 35.6% when the sum of all V 18-12 Gy was superior to 1.5 ml. The sum of all V 18-12Gy larger than 1.5 ml was associated with a 74% specificity and 53% sensitivity of RN (P < 0.001). Based on these results, a small number of BMs show RN during repeated SRT for local or distant recurrent BMs. Local reirradiation was the most predictive factor of brain RN. A V 18-12 Gy larger than 7.6 ml in the case of local reirradiation or larger than 1.5 ml in proximity reirradiation were prognostic factors of RN. The more BM patients need radiation therapy, and the longer they survive after irradiation, the higher their individual risk of developing RN. [ABSTRACT FROM AUTHOR]

Intensity-modulated radiotherapy with helical Tomotherapy is a novel radiation therapy technique, which may be beneficial in several features compared to traditional methods. Our aim was to evaluate the local control, overall survival, progression free survival and adverse events in breast cancer patients treated with this new technique. This is retrospective analysis of patients irradiated with intensity-modulated radiotherapy with helical Tomotherapy. Overall survival and progression free survival curves were plotted with Kaplan-Meier method. We also analysed the overall survival and progression-free survival data by molecular subgroups. Long-term toxicity including skin, cardiac and pulmonary complications were also evaluated. Multivariant logistic regression analysis was performed to determine the predictors of the side effects. Between 2009–2015, 179 consecutive patients with 194 treated breasts were irradiated with intensity-modulated radiotherapy with helical Tomotherapy. The median follow-up were 65 months. The overall survival rate was 89.2% (95% confidence interval [95CI]: 83.5–95.4%), while disease-free survival rate was 85.4% (95CI: 80.2–91%). The Human epidermal growth factor receptor 2-positive patients had the best 5-year overall survival data of 95% (95CI: 85.9–100%). Long-term skin toxicity was the most common, seen in a total of 20.7% of the patients. Intensity-modulated radiotherapy with helical Tomotherapy could be safely used for adjuvant breast cancer irradiation in patients with complex anatomy and provides favourable long-term prognosis with acceptable late toxicity. [ABSTRACT FROM AUTHOR]

L'oncosexualité est récemment devenue une nouvelle mission de soins de support. La morbidité sexuelle est systématiquement sous-estimée et doit être questionnée. Nous faisons ici une mise au point sur les troubles les plus fréquents chez les hommes et les femmes, comment les prévenir et comment les traiter. Oncosexuality has recently become a new supportive care mission. Sexual morbidity is, routinely, underestimated and must be questioned. We report here the most frequent disorders for men and for women, how to prevent them and how to treat them. [ABSTRACT FROM AUTHOR]

Bien que la radiothérapie conformationnelle en trois dimensions (RC3D) reste la référence comme traitement à visée curative des carcinomes bronchiques non à petites cellules (CBNPC) lorsque la chirurgie n'est pas retenue, la radiothérapie conformationnelle avec modulation d'intensité (RCMI ou IMRT) est de plus en plus utilisée en routine. L'objectif de cette étude était d'évaluer l'impact clinique (toxicité immédiate) et dosimétrique de la RCMI par rapport à la radiothérapie conformationnelle en trois dimensions dans le traitement des cancers bronchiques non à petites cellules localement évolués (de stades IIIA à IIIC) pris en charge par chimioradiothérapie concomitante, alors que la RCMI était mise en place dans le cancer du poumon dans le département de radiothérapie du centre Jean-Perrin. Entre mars 2015 et octobre 2019, 64 patients pris en charge par chimioradiothérapie concomitante ont été inclus rétrospectivement. Trente-deux ont bénéficié d'une conformationnelle en trois dimensions et 32 d'une RCMI. La prescription de radiothérapie était de 66 Gy en 33 fractions de 2 Gy. La RCMI a permis une amélioration de la couverture des volumes cibles (volume recevant 95 % de la dose prescrite, V95, augmenté de 14,89 % en RCMI ; p < 0,001) sans augmentation des doses dans les organes à risque et une diminution des dysphagies (relative risk [RR] = 0,67 ; p = 0,027). Les faibles doses au poumon ont été non significativement augmentées en RCMI (volume recevant 5 % de la dose prescrite, V5 pulmonaire, augmenté de 7,46 % en RCMI). La radiothérapie en modulation d'intensité permet, en comparaison à la technique standard en radiothérapie conformationnelle en trois dimensions, une amélioration dosimétrique de la couverture des volumes cibles sans augmenter la dose dans les organes à risque. Elle améliore également la tolérance immédiate du traitement en diminuant le nombre de dysphagies tous grades confondus. Although three-dimensional conformal radiotherapy (3D-CRT) remains the gold standard as a curative treatment for NSCLC when surgery is not possible, intensity modulated radiotherapy (IMRT) is increasingly used routinely. The purpose of this study was to assess the clinical (immediate toxicities) and dosimetric impact of IMRT compared to 3D-CRT in the treatment of locally advanced (stages IIIA to IIIC) non-small cell lung cancer (NSCLC) treated with concomitant radiochemotherapy, while IMRT in lung cancer was implemented in the radiotherapy department of the Jean-Perrin Center. Between March 2015 and October 2019, 64 patients treated with concomitant radiochemotherapy were retrospectively included. Thirty-two received 3D-CRT and 32 IMRT. The radiotherapy prescription was 66 Gy in 33 fractions of 2 Gy. IMRT has improved coverage of target volumes (V95 increased by 14.81% in IMRT; P < 0.001) without increasing doses to OARs and reducing dysphagia (RR = 0.67; P = 0.027). Low doses to the lung were not significantly increased in IMRT (pulmonary V5 increased by 7.46% in IMRT). Intensity modulated radiotherapy, compared with the standard RC3D technique, improve the coverage of target volumes without increasing the dose to the OARs. It also improves the immediate tolerance of the treatment by reducing the number of dysphagia. [ABSTRACT FROM AUTHOR]

Flaps are increasingly used during reconstructive surgery of head and neck cancers to improve functional outcomes. There are no guidelines as to whether the whole flap or its anastomotic border should be included in the primary tumour target volume of postoperative radiotherapy to prevent local relapses. Relapse and toxicity rates can increase substantially if the whole flap received full dose. Our aim was to determine whether flaps were included in the primary tumour target volume and to report the patterns of relapse and toxicity. Consecutive patients in 2014 through 2016, with or without a flap, receiving postoperative radiotherapy were selected in a retrospective monocentric control study. Flaps were homogenously delineated blind to treating radiation oncologists using a flap-specific atlas. Tumour recurrence, acute and late toxicity were evaluated using univariate and propensity score analyses. A hundred patients were included; 54 with a flap. Median flap volume included in the tumour volume was 80.9%. Twelve patients experienced local recurrences: six with a flap, among whom two within their flap (3.7%). Patients with flaps had larger median tumour volumes to be irradiated (25 cm3 versus 58 cm3, p < 0.001) and higher acute/late toxicity rates (p < 0.001) even after adjustment on biases (more advanced T stage, oral cavity, active smoking in patients with flaps). Locoregional recurrence and survival rates were similar between patients with/without a flap. Recurrences within a flap were rare in this series when including the whole flap body in the 60Gy-clinical target volume but inclusion of the flap in the primary tumour target volume increased toxicity. Multicentric studies are warranted. [ABSTRACT FROM AUTHOR]

The optimal management of locally recurrent prostate cancer after curative radiotherapy is still unknown. In this study, we evaluated the preliminary results of reirradiation using stereotactic body radiotherapy for locally recurrent prostate cancer after initial definitive local radiotherapy. Between April 2016 and February 2019, 11 patients with recurrent disease at the previously irradiated prostate were treated. Local recurrence was detected by radiological with or without functional imaging modalities including prostate multiparametric/pelvic MRI or positron-emission tomography–computerised tomography with (68Ga)-labelled prostate-specific membrane antigen performed after rising prostate specific antigen serum level during follow-up. All patients received stereotactic body radiotherapy to the recurrent nodule to a total dose of 30 Gy in five fractions. Hyaluronic acid spacer was injected between prostate and rectum in seven patients to decrease the rectal dose. Acute toxicity was evaluated by using Common Terminology Criteria for Adverse Events version 4.0, and late toxicity was evaluated by using Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring schema. At the diagnosis, the median age was 64 years, and the mean prostate specific antigen serum concentration was 17.7 ng/mL. The median interval time between local recurrence and initial definitive radiotherapy was 63 months. Mean prostate specific antigen concentration nadir value during follow-up was 0.43 ng/mL. With a median follow up of 19 months, three patients developed either local or distant relapse. One patient had grade 3 acute rectal toxicity, and one patient had grade 2 late urinary toxicity. We did not observe any acute or late toxicity due to hyaluronic acid spacer injection. Reirradiation after local recurrence following initial definitive radiotherapy together with hyaluronic acid spacer use seems to be effective and safe. [ABSTRACT FROM AUTHOR]

L'objectif de l'étude était de rechercher des facteurs prédictifs de toxicité de la chimiothérapie d'induction par l'association de docétaxel, platine et 5-fluorouracile (TPF) pour les cancers localement évolués des voies aérodigestives supérieures. De juillet 2009 à mars 2015, 57 patients pris en charge consécutivement par TPF ont été inclus rétrospectivement. Quarante-sept patients (83 %) étaient des hommes ; l'âge médian était de 56 ans [40–71 ans]. Trente-huit patients (67 %) étaient pris en charge pour un cancer inopérable (très symptomatique et/ou forte charge tumorale) et 19 (33 %) en préservation laryngée. Il y avait 47 % cancers de stade IVa, 32 % de stade III et 21 % de stade IVb. Au moment du diagnostic, il y avait 53 % de poids stables, 28 % d'amaigrissements de grade 1, 17 % de grade 2 et 2 % de grade 3. Quarante-sept pour cent des patients étaient en situation de réponse partielle après la chimiothérapie par TPF, 28 % de réponse complète, 7 % de stabilité, 2 % de progression et 2 % de réponse discordante. La possibilité d'alimentation orale sans sonde était prédictive d'une meilleure réponse (p = 0,02). Trente-neuf pour cent des patients ont pris du poids pendant le traitement, 35 % étaient stables et 26 % en perte de poids. Six patients (10,5 %) sont décédés au cours du traitement, quatre de neutropénie fébrile, un de pneumopathie et un de cause inconnue. L'âge de plus de 57 ans était associé à un risque plus élevé d'anémie et de thrombopénie de grade ≥ 3. Il existait un risque plus important d'infection de grade ≥ 3 en cas de perte de poids au moment du diagnostic (p = 0,035) et d'alimentation entérale (p = 0,05). Il existait un risque plus important de neutropénie de grade ≥ 3 en cas de perte de poids pendant la chimiothérapie (p = 0,03). La chimiothérapie d'induction par TPF présente une efficacité antitumorale importante (75 % de réponse objective) mais une forte morbidité avec 10,5 % de décès iatrogéniques dans notre population très symptomatique avec une charge tumorale très importante. Le statut nutritionnel est un facteur important à prendre en compte dans la décision thérapeutique. The objective of this study was to identify predictive factors of toxicity of docetaxel, platin, 5-fluorouracil (TPF) induction chemotherapy for locally advanced head and neck cancers. From July 2009 to March 2015, 57 patients treated consecutively with TPF were included retrospectively. There were 47 males (83%), the median age was 56 years [40–71 years]. Thirty-eight patients (67%) were treated for inoperable cancer (highly symptomatic and/or high tumor burden) and 19 (33%) were treated for laryngeal preservation. There were 47% stage IVa, 32% stage III and 21% stage IVb. At diagnosis, there were 53% stable weight, 28% grade 1 weight loss, 17% grade 2 weight loss and 2% grade 3 weight loss. Forty-seven percent of patients were in partial response after TPF, 28% in complete response, 7% stable, 2% progressing and 2% discordant response. The possibility of oral feeding without a feeding tube was predictive of a better response (P = 0.02). Thirty-nine percent of patients increased weight during TPF, 35% were stable, 18% in grade 1 weight loss, 6% in grade 2 and 2% in grade 3. Six of the patients (10.5%) died during chemotherapy: four from febrile neutropenia, one from pneumopathy and one of unknown cause. Age 57 years and older was associated with a higher risk of grade ≥ 3 anemia and thrombocytopenia. There was a higher risk of grade ≥ 3 infection for weight loss at diagnosis (P = 0.04) and feeding tube (P = 0.05). There was a higher risk of grade ≥ 3 neutropenia for weight loss during TPF (P = 0.03). Induction chemotherapy by TPF has an strong anti-tumor efficacy (75.5% objective response) but an important morbidity with 10% toxic deaths in our very symptomatic population with a very important tumor burden. Age and nutritional status are important factors to consider. [ABSTRACT FROM AUTHOR]

Medulloblastoma is the most common primary malignant central nervous system tumour in children. These last decades, treatment modalities have largely evolved resulting in better survival rates. Nevertheless, long-term toxicity is a major concern in this setting. The purpose of this study was to analyse the clinical results and medical outcomes of a cohort of paediatric patients treated for medulloblastoma in Xhinhua Hospital in Shanghai. These results are compared with those from other centres reported in literature. This was a retrospective study conducted at Xhinhua Hospital in Shanghai, China. It included 121 patients treated for medulloblastoma from 1993 to December 2013. Mean age at diagnosis was 6.7 years (range: 1–14.3 years). Total surgical resection was achieved in 60% of the cases. Classic medulloblastoma was found in 59% of the cases. Adjuvant radiotherapy was delivered in all cases and chemotherapy concerned 70.2% of the studied cohort. The median follow-up time of the study was 84 months (range: 24–120 months). Five- and 10 years progression-free survival rates were 83.2%, and 69.5% and 5 years and 10 years. Overall survival rates were 82.5%, and 72.5%. Patient's age significantly influenced survival: patients under 3 years old had the worse outcomes (P = 0.01). T and M stages also significantly impacted survival rates: advanced stages were associated with lower rates (P = 0.08 and 0.05 respectively). Finally, patients receiving temezolomide had bad outcomes when compared to the new standard protocol used in the department (P = 0.03). The most commonly reported late toxicity was growth suppression in 35 patients (52.2%). Hypothyroidism requiring hormone replacement was recorded in 29% of the cases. Hearing loss, and problems including poor concentration, poor memory and learning difficulties were reported in 19% and 25% of the cases respectively. Second cancers were noted in three cases. Overall, our results are comparable to those reported in literature. Nevertheless, efforts should be made to ensure longer follow-ups and correctly assess treatment-related toxicity. [ABSTRACT FROM AUTHOR]

Abstract Purpose Chest wall pain is an uncommon but bothersome late complication following lung stereotactic body radiation therapy. Despite numerous studies investigating predictors of chest wall pain, no clear consensus has been established for a chest wall constraint. The aim of our study was to investigate factors related to chest wall pain in a homogeneous group of patients treated at our institution. Patients and methods All 122 patients were treated with the same stereotactic body radiation therapy regimen of 48 Gy in three fractions, seen for at least 6 months of follow-up, and planned with heterogeneity correction. Chest wall pain was scored according to the Common Terminology Criteria for Adverse Events classification v3.0. Patient (age, sex, diabetes, osteoporosis), tumour (planning target volume, volume of the overlapping region between planning target volume and chest wall) and chest wall dosimetric parameters (volumes receiving at least 30, 40, and 50 Gy, the minimal doses received by the highest irradiated 1, 2, and 5 cm3, and maximum dose) were collected. The correlation between chest wall pain (grade 2 or higher) and the different parameters was evaluated using univariate and multivariate logistic regression. Results Median follow-up was 18 months (range: 6–56 months). Twelve patients out of 122 developed chest wall pain of any grade (seven with grade 1, three with grade 2 and two with grade 3 pain). In univariate analysis, only the volume receiving 30 Gy or more (P = 0.034) and the volume of the overlapping region between the planning target volume and chest wall (P = 0.038) significantly predicted chest wall pain, but these variables were later proved non-significant in multivariate regression. Conclusion Our analysis could not find any correlation between the studied parameters and chest wall pain. Considering our present study and the wide range of differing results from the literature, a reasonable conclusion is that a constraint for chest wall pain is yet to be defined. [ABSTRACT FROM AUTHOR]

Résumé Les irradiations abdominopelviennes tiennent une place importante dans la prise en charge des patients atteints de cancer mais exposent aux risques d'effets secondaires aigus et tardifs, en particulier de complications néphrologiques ou urologiques. Ces effets secondaires peuvent être à l'origine d'une importante altération de la qualité de vie des patients. L'objectif de cette revue de la littérature est de détailler la physiopathologie, la symptomatologie et les principes de la prise en charge préventive et curative de la toxicité radio-induite du système urinaire, incluant les néphropathies, les urétérites, les cystites radiques et les urétrites radiques. Abstract Abdominal and pelvic irradiations play a major place in the management of patients with cancer and present a risk of acute and late side effects. Radiation-induced lesions can affect kidney or urological structures. These side effects can have an impact in the quality of life of patients. The aim of this article is to describe the physiopathology, the symptomatology, and the principles of management of radiation-induced nephropathy, uretheritis, cystitis, and urethritis. [ABSTRACT FROM AUTHOR]

Abstract The purpose of this study was to assess efficacy and tolerance of anti-programmed death (PD)-1 immunotherapy in combination with sequential involved-site radiotherapy in heavily pretreated refractory Hodgkin lymphoma. In this case series, we reported the outcome of four heavily pretreated patients with refractory Hodgkin lymphoma treated by anti-PD-1 immunotherapy and involved site radiation therapy. After a median follow-up of 13-month, all patients were alive with complete metabolic response. After radiotherapy, all four patients experienced lung toxicity, which was resolved after antibiotherapy with or without corticosteroid treatment. Anti-PD-1 immunotherapy followed by involved-site radiotherapy is feasible and showed very encouraging results in heavily pretreated patients. [ABSTRACT FROM AUTHOR]

Purpose To determine the 3 years late toxicity among patients with non-metastatic breast cancer who received concurrent bevacizumab and locoregional radiotherapy. Material and methods This is a single-arm, multicentre, prospective study, of the toxicity of adjuvant concomitant association of bevacizumab and radiotherapy in patients with breast cancer. Toxicity was assessed by the Common Terminology Criteria for Adverse Events version 3.0 during the radiotherapy and follow-up clinics at 12 and 36 months after its completion. The study was designed to evaluate the toxicity at one year, 3 years and 5 years. Results Sixty-four patients were included from October 2007 to August 2010. All of them received concurrent adjuvant radiotherapy and bevacizumab (in 24 cases after primary systemic treatment). All patients received non-fractionated radiotherapy to breast or chest wall with or without irradiation of regional lymph nodes. Early toxicity has been previously reported. Median follow-up was 46.4 months (range: 18–77 months). Median age was 53 years old (range: 23–68 years). The 3-years overall survival was 93% (range: 87–100%). Evaluation of the toxicity at 3 years was available for 67% of the patients. There was a low rate of toxicity: 14% grade 1 pain, 9% grade 1 fibrosis, 2% grade 1 telangiectasia, 2% grade 1 paresis, 7% grade 1 lymphedema and 2% grade 3 lymphedema. No grade 4 toxicity was observed. No patient had a left ventricular ejection fraction below 50% at 3 years. Conclusions Concurrent bevacizumab with locoregional radiotherapy is associated with acceptable 3-years toxicity in patients with breast cancer. [ABSTRACT FROM AUTHOR]

Purpose The main objective of our study is to evaluate response and toxicity profile in patients receiving external beam radiotherapy with concurrent chemotherapy followed by intraluminal brachytherapy boost for a carcinoma of the oesophagus. Material and methods Twenty patients with biopsy-proven carcinoma of the oesophagus received external beam radiotherapy (50 Gy in 25 fractions) with concurrent chemotherapy (cisplatin: 40 mg/m 2 ). After a gap of two to three weeks, intraluminal brachytherapy (10 Gy in two fractions each 1 week apart by a high dose rate 60 Co source) was given. Response was evaluated at 1 month and at 1 year of completion of treatment. In addition, acute and chronic toxicity was evaluated at 1 month and 6 months of treatment. Results Complete response were seen in 80% of patients and partial response in 20% at 1 month. Moreover, there were 65% complete response, 10% local recurrences, 15% patients showed local control with distant metastasis and 10% patients died at 1 year. Grade 1, grade 2 and grade 3 oesophagitis were seen in 10%, 70% and 20% of patients respectively. Stricture was seen in 40% of patients and fistula in 10% of patients. There was no spinal cord, cardiac and nephrotoxicity found. Conclusions With the concept that high tumoricidal dose for adequate tumor control achieved by intraluminal brachytherapy as a mean of dose escalation, while sparing surrounding normal tissue and potentially improving therapeutic ratio, external beam radiotherapy followed by intraluminal brachytherapy could be a better choice for oesophagus carcinoma. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to assess efficacy and safety of proton beam therapy of paragangliomas of the head and neck, rare benign tumours developed close to crucial structures such as cranial nerves and vascular tissues. Patients and methods Ten patients with a paraganglioma of the head and neck were treated from 2001 to 2014 with image-guided proton therapy. Neurological and ear nose throat symptoms were collected in addition to audiometric testing, before and after the treatment. Acute and late toxicities were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v4. Results Median age at diagnosis was 52.6 years (range: 18.2–65.8 years). Proton therapy was the exclusive treatment in six patients and four patients had a postoperative radiotherapy. Median dose was 50.4 Gy relative biological effectiveness (RBE; range: 45.0–67.0 Gy). With a median follow-up of 24.6 months (range: 6.7–46.2 months), local tumour control rate was 100% (stable, n = 10). No upper grade 2 acute toxicity was reported. To the latest news, seven patients had controlled symptoms (improved, n = 1, stabilized, n = 6). One patient out of seven with initial tinnitus had a decrease in his symptoms, while the six other patients had a sustained stabilization. Conclusion Proton beam therapy is an effective and well-tolerated treatment modality of skull base paragangliomas, with documented functional benefit. A longer follow-up is planned in order to assess local control and long-term toxicities. [ABSTRACT FROM AUTHOR]

Résumé Objectif de l’étude Évaluer prospectivement la toxicité chronique gastro-intestinale chez les patientes atteintes de cancer du col utérin traité par irradiation classique ou avec modulation d’intensité (RCMI). Patientes et méthodes Entre juin 2005 et septembre 2013, 109 patientes ont bénéficié d’une radiothérapie externe suivie d’une curiethérapie pour un cancer du col utérin à l’institut de cancérologie de Lorraine. Chaque patiente prise en charge par RCMI a été appariée à une patiente traitée par irradiation classique sur les critères suivants : chimiothérapie concomitante, complément de dose ganglionnaire, traitement de l’aire ganglionnaire lombo-aortique, âge. Le recueil de toxicité était prospectif selon la classification du Radiation Therapy Oncology Group. L’objectif principal était de comparer l’incidence de la toxicité digestive chronique entre les deux groupes. L’influence des paramètres dosimétriques sur la toxicité digestive chronique a été étudiée dans un second temps. La comparaison de la toxicité aiguë, la toxicité chronique génito-urinaire, la survie globale et la survie sans récidive constituaient des objectifs secondaires. Résultats Soixante-six patientes ont pu être appariées. La probabilité de survie globale à 36 mois était de 71 % après irradiation classique contre 73 % après RCMI ( p = 0,54). Il n’existait significativement pas de différence entre les deux groupes, en termes de toxicité chronique digestive ( p = 0,17), ni de toxicité aiguë digestive ( p = 0,6445) et génito-urinaire ( p = 0,5724). La RCMI épargnait significativement dès 30 Gy l’intestin grêle ( p = = 0,0006) et le rectum ( p = 0,0046), et la vessie à 45 Gy ( p < 0,001). L’incidence de la toxicité génito-urinaire était significativement différente entre les deux groupes ( p = 0,03), en faveur de la radiothérapie classique. Conclusion Notre étude ne semble pas mettre en évidence de différence significative concernant la survenue de toxicité chronique digestive entre les deux groupes. L’efficacité clinique paraît comparable. Des études avec un effectif plus important et une durée de suivi plus longue doivent être menées. Purpose To evaluate prospectively chronic gastrointestinal toxicity in patients with cervical cancer treated with conventional irradiation or with intensity-modulated irradiation (IMRT). Patients and methods Between June 2005 and September 2013, 109 patients underwent external radiotherapy followed by brachytherapy for cervical cancer at the “Institut de Cancérologie de Lorraine”. Each patient receiving IMRT was paired with a patient receiving conventional radiotherapy on the following criteria: concomitant chemotherapy, additional nodal dose, treatment of para-aortic lymph node area, age. The toxicity collection was prospective using the RTOG scale. The main objective was to compare the incidence of gastrointestinal toxicity chronic between the two groups. In a second time, the influence of dosimetric parameters on chronic GI toxicity was investigated. Comparisons of acute toxicity, chronic genitourinary toxicities, overall survival, disease-free survival were secondary objectives. Results Sixty-six patients were able to be matched. Overall survival at 36 months was 71% in the conventional radiotherapy group against 73% in the IMRT group ( P = 0.54). There was no significant difference between the two groups in terms of digestive chronic toxicity ( P = 0.17), nor in terms acute gastrointestinal toxicities ( P = 0.6445) and genitourinary ( P = 0.5724). IMRT spared significantly small bowel ( P = 0.0006) and rectum ( P = 0.0046) from 30 Gy dose, and bladder from 45 Gy ( P < 0.001). The incidence of genitourinary toxicity was significantly different between the two groups ( P = 0.03) in favor of conventional radiotherapy. Conclusion Our study does not seem to show significant difference in the occurrence of chronic gastrointestinal toxicities between the two groups. Clinical efficacy seems comparable. Larger studies with longer follow-up period should be conducted. [ABSTRACT FROM AUTHOR]

Purpose Conflicting results concerning the toxicity of radiotherapy in the setting of rheumatoid arthritis were reported in literature. This work describes the toxicity profiles of patients with rheumatoid arthritis undergoing pelvic radiotherapy for gynecologic malignancies at our institution. Patients and methods Charts of patients with rheumatoid arthritis who underwent pelvic radiotherapy for cervical or endometrial cancer in a curative intent at the Gustave-Roussy Cancer Campus between 1990 and 2015 were reviewed for treatment-related toxicities. Acute and late effects were graded as per the Common Terminology Criteria for Adverse Events version 4.0 scoring system. Results Eight patients with cervical cancer and three with endometrial cancer were identified. Median follow-up was 56 months. Median external beam radiotherapy dose was 45 Gy. All patients received a brachytherapy boost using either pulse- or low-dose rate technique. Concomitant chemotherapy was used in seven cases. Median time from rheumatoid arthritis diagnosis to external beam radiation therapy was 5 years. No severe acute gastrointestinal or genitourinary toxicity was reported. One patient had grade 3 dermatitis. Any late toxicity occurred in 7 /11 patients, and one patient experienced severe late toxicities. One patient with overt systemic rheumatoid arthritis symptoms at the time of external beam radiation therapy experienced late grade 3 ureteral stenosis, enterocolitis and lumbar myelitis. Conclusion Pelvic radiotherapy, in the setting of rheumatoid arthritis, appears to be feasible, with potentially slight increase in low grade late events compared to other anatomic sites. Patients with overt systemic rheumatoid arthritis manifestation at the time of radiotherapy might be at risk of potential severe toxicities. [ABSTRACT FROM AUTHOR]

Background and purposes We evaluate the early toxicity of concurrent use of radiotherapy, pertuzumab and trastuzumab in patients with HER2-positive metastatic or locally recurrent unresectable breast cancer. Patients and methods A retrospective study was performed in a population of 23 consecutive patients between 2013 and 2015. Radiotherapy was performed on the chest area or metastatic sites during maintenance with pertuzumab and trastuzumab after six cycles of pertuzumab, trastuzumab and docetaxel. Toxicity was assessed according to the National Cancer Institute Common Toxicity Criteria version 4. Results Irradiation volumes were whole breast (8 patients) and chest wall (9 patients) at 50 Gy in 25 fractions, the supraclavicular nodes (16 patients), the axillary area (nine patients) and the internal mammary nodes (9 patients) at 46 Gy in 23 fractions. For five patients, radiotherapy was palliative: bone irradiation (4 patients), whole brain radiotherapy (one patient). Median follow-up was 12.6 months (range: 6.1–21.6 months) since the start of pertuzumab and trastuzumab. One patient presented an asymptomatic decrease of left ventricular ejection fraction below 50%. No symptomatic cardiac events were reported. Two patients presented asymptomatic grade I radiation pneumonitis. Acute skin toxicity was grade III (one patient), grade II (6 patients), and grade I (5 patients). There were two grade II esophagitis. Conclusion Combination of pertuzumab, trastuzumab and radiotherapy was well tolerated, which should be confirmed by the results of larger studies. [ABSTRACT FROM AUTHOR]

Résumé En recherche clinique, la mise en place d’une méthodologie adaptée permettra l’analyse rigoureuse des données collectées et doit intervenir dès la conception de l’essai pour définir la démarche expérimentale appropriée. Ainsi, si le but principal d’une phase I est de déterminer la dose à utiliser en phase II, la méthodologie doit être adaptée finement au(x) traitement(s) testée(s). La méthodologie des essais en chimiothérapie et thérapie ciblée est relativement bien décrite. Les essais de phase I de radiothérapie et chimioradiothérapie sont atypiques et ne peuvent suivre les schémas d’administration d’une molécule pharmacologique. La phase I de ces essais doit refléter à la fois l’efficacité et l’ensemble de la toxicité potentielle liée au traitement. La méthodologie qui en découle doit sans doute être complexe afin de limiter les échecs en phase ultérieure. Cependant, il existe très peu de données méthodologies dans les publications de ces essais. Cet article s’attarde sur ces essais particuliers, aux caractéristiques propres. Il permet ainsi de soulever les lacunes des schémas actuels afin d’inventer de nouveaux schémas méthodologiques plus adaptés. In clinical research, biostatistical methods allow the rigorous analysis of data collection and should be defined from the trial design to obtain the appropriate experimental approach. Thus, if the main purpose of phase I is to determine the dose to use during phase II, methodology should be finely adjusted to experimental treatment(s). Today, the methodology for chemotherapy and targeted therapy is well known. For radiotherapy and chemoradiotherapy phase I trials, the primary endpoint must reflect both effectiveness and potential treatment toxicities. Methodology should probably be complex to limit failures in the following phases. However, there are very few data about methodology design in the literature. The present study focuses on these particular trials and their characteristics. It should help to raise existing methodological patterns shortcomings in order to propose new and better-suited designs. [ABSTRACT FROM AUTHOR]

Résumé Les effets de la dose sur les principales structures orbito-oculopalpébrales (nerf optique, rétine, glande lacrymale principale, cristallin) sont encore décrits très globalement sans analyse des relations dose–volume du fait du volume réduit de la plupart des structures impliquées et des limitations balistiques des techniques d’irradiation. La capacité de techniques de radiothérapie conformationnelle avec modulation d’intensité et de protonthérapie à générer des gradients de dose très abrupts permet d’envisager dans l’avenir des modèles plus précis. La toxicité peut être sévère et irréversible, induisant une perte de vision, comme dans le cas de la neuropathie optique radio-induite, pour laquelle les traitements à visée curative sont peu ou pas efficaces. La toxicité peut aussi induire une perte de vision mais être réversible sans complication, comme dans le cas d’une cataracte radique. Nous résumons dans cet article les effets dose décrits pour les principales structures-oculaires, orbitaires, palpébrales et lacrymales. Radiation-induced damage of ocular, orbital and eyelid structures are mainly reported for the optic nerve, retina, lens and lacrimal gland. Dose–volume relationships are, however, inaccurate due to the small volume of most of the organs at risk involved and limited ability of irradiation techniques to spare these structures in the pre-IMRT (intensity-modulated radiation therapy) era. The ability of newest radiation techniques including IMRT and proton therapy to generate steep dose gradients may yield more accurate models in the future. Some toxicities are severe and irreversible, leading to vision loss, as in the case of radiation-induced optic neuropathy for which curative treatments are suboptimal. Other toxicities can lead to reversible vision loss but can be surgically corrected, as is the case for radiation-induced cataract. In this paper, we will review the dose effects for the ocular; orbital and eyelid structures. [ABSTRACT FROM AUTHOR]

Résumé Le traitement standard des sarcomes des membres repose sur l’association d’une chirurgie conservatrice et une radiothérapie. Cette stratégie permet d’optimiser le contrôle local, mais au prix d’un risque de développement de toxicité tardive liés à la radiothérapie. De ce fait, il y a un intérêt croissant à différencier les patients qui ont besoin d’une radiothérapie de ceux pour qui le taux de contrôle local est bon sans traitement complémentaire. D’autre part, la toxicité a été corrélée avec l’étendue du volume irradié et le volume exposé aux fortes doses. L’évolution technique avec le développement de la radiothérapie conformationelle avec modulation d’intensité (RCMI) guidée par l’image permet de limiter le volume irradié avec une meilleure protection des organes à risque et potentiellement un impact sur la toxicité tardive. Des efforts sont actuellement réalisés pour tenter d’améliorer le taux de contrôle local dans le sous-groupe de patients atteints de sarcome à haut risque de récidive locale. Nous discutons tous ces aspects dans cet article. The standard treatment for extremity soft tissue sarcomas is based on the association of surgery and radiotherapy. This strategy allows local control improvement with the risk of increased toxicity. There is therefore a growing interest to identify those patients who will benefit from radiotherapy and those who will have the same local control with surgery alone. Furthermore, the development of toxicity has been correlated with the extension of the irradiated volume and the volume receiving high doses. Technological development as intensity modulated radiotherapy and image-guided radiotherapy allows limited irradiated volume improving the protection of the organs at risk leading to clinical benefit improvement. Moreover, efforts are being done to improve local control for the patients at high risk of local relapse. In this paper, we discuss all these mentioned aspects. [ABSTRACT FROM AUTHOR]

Résumé La chirurgie conservatrice, suivie d’une radiothérapie externe mammaire, est considérée comme le traitement standard du cancer du sein localisé. Elle permet un excellent taux de contrôle local à 10 ans, avec un taux de rechute de 6 %. Depuis ces dernières années l’irradiation partielle accélérée s’est développée pour réduire la durée et le volume d’irradiation. La radiothérapie peropératoire en fait partie et offre une excellente adaptation au volume cible tumoral tout en épargnant de façon importante l’irradiation des tissus sains. Cette revue a pour objectif de décrire les différentes techniques de radiothérapie peropératoire, d’en évaluer l’efficacité clinique et la tolérance, de montrer sa potentielle indication pour une population de patientes très sélectionnée et d’évoquer enfin son avenir dans le cadre de la recherche clinique. Breast-conserving surgery followed by whole breast postoperative irradiation is considered to be the current standard treatment for patients with early stage breast cancer. It allows an excellent local tumour control with 6% of local recurrence. Over the last years, partial breast radiotherapy has been developed to reduce treatment volume and duration. Intraoperative radiotherapy is one of the techniques. It offers an excellent delineation of the tumour bed and high normal tissue sparing. This purpose of this review is to describe the different intraoperative radiotherapy techniques available, to assess their potential clinical efficiency and tolerance, the recommendations for new practice with a selected population of patients and for future research. [ABSTRACT FROM AUTHOR]

Purpose Intensity-modulated radiation therapy (IMRT) has shown its interest for head and neck cancer treatment. In parallel, cetuximab has demonstrated its superiority against exclusive radiotherapy. The objective of this study was to assess the acute toxicity, local control and overall survival of cetuximab associated with different IMRT modalities compared to platinum-based chemotherapy and IMRT in the ARTORL study ( NCT02024035 ). Patients and method This prospective, multicenter study included patients with epidermoid or undifferentiated nasopharyngeal carcinoma, epidermoid carcinoma of oropharynx and oral cavity (T1–T4, M0, N0–N3). Acute toxicity, local control and overall survival were compared between groups (patients receiving cetuximab or not). Propensity score analysis at the ratio 1:1 was undertaken in an effort to adjust for potential bias between groups due to non-randomization. Results From the 180 patients included in the ARTORL study, 29 patients receiving cetuximab and 29 patients treated without cetuximab were matched for the analysis. Ten patients (34.5%) reported acute dermal toxicity of grade 3 in the cetuximab group versus three (10.3%) in the non-cetuximab group obtained after matching ( P = 0.0275). Cetuximab was not significantly associated with more grade 3 mucositis ( P = 0.2563). There were no significant differences in cutaneous or oral toxicity for patients treated with cetuximab between the different IMRT modalities ( P = 1.000 and P = 0.5731, respectively). There was no significant difference in local relapse-free survival ( P = 0.0920) or overall survival ( P = 0.4575) between patients treated with or without cetuximab. Conclusion Patients treated with cetuximab had more cutaneous toxicities, but oral toxicity was similar between groups. The different IMRT modalities did not induce different toxicity profiles. [ABSTRACT FROM AUTHOR]

Purpose To analyse long-term overall survival, relapse-free survival and late toxicities in a series of 675 patients treated between 1999 and 2003, with a median follow-up of 132 months. Patients and methods The cohort included low-risk patients and a selection of “favourable-intermediate” risk patients. All patients were homogeneously treated using an intraoperative dynamic planning prostate brachytherapy technique, with loose 125 iodine seeds. Hormone therapy, consisting most often of an anti-androgen alone, was given in 393 patients (58%). Results The 10-year overall survival was 92% (95% confidence interval [CI]: 90–94) without a significant difference between the low and the select intermediate-risk groups ( P = 0.17). The 10-year relapse-free survival rate for the entire cohort was 82% (95% CI: 79–85), and was significantly higher in the low-risk group than in the intermediate one (87 vs 71%; P < 0.0001). Twenty-six percent of the relapses observed in this series occurred after more than 10 years of follow-up. The 10-year cumulative incidence of grade 3–4 urinary toxicity (whatever the delay and the recovery) was 5.78%. The cumulative incidence of grades 3–4 rectal toxicity in the present series was 1.65% at 10 years. As for sexual toxicity, 61% of our patients retained an erectile capacity at 10 years (with or without oral medication), with age being a major factor. Conclusion With a median follow-up of more than 11 years, this series appears to confirm the excellent long-term results of low-dose rate prostate brachytherapy, both in terms of survival and in terms of toxicity. [ABSTRACT FROM AUTHOR]

Résumé Les cancers bronchiques non à petites cellules de stade IIIA-N2 exposent à un risque de récidive locale de 20 à 40 %, même après chirurgie et chimiothérapie adjuvante. La radiothérapie postopératoire médiastinale a démontré son intérêt en termes de contrôle local, mais jusqu’alors sans bénéfice prouvé de survie. Considérée depuis plusieurs années comme une option comme traitement adjuvant des cancers de stade pN2, elle reste néanmoins jugée trop toxique. Qu’en est-il actuellement de sa place ? L’essai contrôlé randomisé de phase III Lung Adjuvant Radiotherapy Trial (Lung ART) doit permettre d’apporter une réponse objective. Cependant, cette étude rencontre des difficultés d’inclusion. Nous abordons dans cet article pourquoi la radiothérapie postopératoire n’est pas encore admise, quels sont ses résultats en termes d’efficacité et de tolérance, quels sont les volumes à traiter et les doses à délivrer. The rate of local failure of stage IIIA-N2 non-small cell lung cancer is 20 to 40%, even if they are managed with surgery and adjuvant chemotherapy. Postoperative radiotherapy improves local control, but its benefit on global survival remains to be demonstrated. Considered for many years as an adjuvant treatment option for pN2 cancers, it continues nevertheless to be deemed too toxic. What is the current status of postoperative radiotherapy? The Lung Adjuvant Radiotherapy Trial (Lung ART) phase III trial should give us a definitive, objective response on global survival, but inclusion of patients is difficult. The results are consequently delayed. The aim of this review is to show all the results about efficacy and tolerance of postoperative radiotherapy and to define the target volume and dose to prescribe. [ABSTRACT FROM AUTHOR]

Purpose There is a sound theoretical basis but little clinical evidence substantiating the benefits of concurrent chemoradiotherapy with two-drug chemotherapy for locally advanced soft tissue sarcomas. Our five-year data on the feasibility and effectiveness of neoadjuvant chemoradiotherapy with systemically effective doses of adriamycin and ifosfamide combined is presented here. Patients and methods Between 2000 and 2011, 53 patients with UICC (2010) stage I ( n = 1, 1.9%), II ( n = 12, 22.7%) or III ( n = 40, 75.5%) nonmetastatic soft tissue sarcoma received neoadjuvant chemoradiotherapy with ifosfamide (1.5 g/m 2 /day, d1–5, q28) and doxorubicin (50 mg/m 2 /day, d3, q28) plus concurrent radiotherapy with a target dose of 50–64 Gy (median 60 Gy). The treatment of 34 patients (64.2%) was combined with hyperthermia. Results At five years, the local control rate was 89.9% (± 5.7%), distant metastasis-free survival 66.6% (± 7.6%), and survival 83.3% (± 6%). The R0 resection rate was 81.1%. Radiotherapy was completed as planned in all patients and chemotherapy in 42/53 (70.2%). Grades III ( n = 21, 29.6%) and IV ( n = 18, 34%) leukopenia was the main acute adverse event. All acute and chronic non-hematologic toxicities were moderate. Conclusion Neoadjuvant chemoradiotherapy for soft tissue sarcoma is associated with good feasibility, manageable acute and late toxicities, and high local efficacy. [ABSTRACT FROM AUTHOR]

Résumé Le traitement des lymphomes de Hodgkin de stades I/II repose sur la chimiothérapie et la radiothérapie. Ces associations thérapeutiques ont changé le pronostic et la survie des patients. Actuellement, la problématique est de diminuer leur toxicité. Grâce à la tomographie par émission de positons, essentielle dans la prise en charge initiale de ces lymphomes, la définition des volumes cibles en radiothérapie est devenue plus précise, ce qui a pu permettre une radiothérapie plus ciblée de type « involved node » ou « involved site ». Abstract Treatment for stage I and II Hodgkin lymphoma is based on a combination of chemotherapy and radiotherapy, with a high successful cure rate. Now, the aim is to decrease toxicity rates. Positron-emission tomography scan is recommended as pretreatment baseline and is very useful to define precisely target volumes for planning radiation therapy. Based on these changes were developed guidelines for modern radiation therapy called involved node and « involved site ». [ABSTRACT FROM AUTHOR]

Résumé Les cancers de l’enfant sont rares, puisqu’ils représentent environ 1 % de tous les cancers. Le taux de survie globale à 5 ans est de 75 % toutes localisations confondues. La diminution des doses de radiothérapie et les améliorations balistiques ont permis de diminuer la toxicité dans certaines maladies. La toxicité tardive reste toutefois fréquente, est souvent spécifique de la pédiatrie et est liée à une survie de longue durée. Il s’agit principalement de séquelles cognitives, sensorielles, endocriniennes, de retards de croissance ou encore de complications cardiopulmonaires et de cancers radio-induits. Les doses aux organes critiques habituellement recommandées en pédiatrie sont présentées dans cette mise au point, de même que les principales séquelles spécifiques de l’irradiation en pédiatrie, en dehors des cancers secondaires qui ne sont pas inclus dans cette mise au point. Cancers in childhood are rare, representing 1% of all the cancers in developing countries. On the whole, the overall survival approaches 75% at 5 years. The radiation dose decrease in lots of indications as well as better optimized planning treatments lead to decrease the long-term toxicities in some indications. However, the radiation toxicity remains frequent, often specific of pediatric situations. Long-term toxicities are mainly neurologic, sensitive, endocrine, or linked to growth impairment (bones or muscular). Radio-induced second-cancers are also frequent after a long follow-up after cancer in childhood but will not be discussed here. Doses to critical organs as well as the most frequent radio-induced late-effects will be discussed in this paper. [ABSTRACT FROM AUTHOR]

Purpose In 2002, at the McGill University Health Centre, we began a program of hypofractionated radiotherapy for patients with low risk prostate cancer as an alternative to conventionally fractionated radiotherapy. Material and methods Our initial hypofractionation regimen was 66 Gy given in 22 fractions, prescribed to the isocenter, delivered with 3D-conformal radiotherapy plan. The clinical target volume was the prostate gland and the planning target volume consisted of the clinical target volume plus a 7-mm margin in all directions. Hormonal therapy was not given to any patient. Results The long-term results for this group of patients confirmed the feasibility, good tolerance and excellent disease control of the regimen with the extra-benefit of being convenient to both patients and the health system by shortening treatment duration. The outcomes of this approach stimulated us to use hypofractionation in patients with intermediate-risk. Analysis of 100 intermediate-risk patients receiving our hypofractionated radiotherapy regimen (no hormones) shows, at median follow-up of 75 months, 8-year biochemical recurrence free and cancer specific survival rates of 90% and 95%, respectively, with acceptable toxicity. Discussion Our technique changed from 3D to intensity modulated radiotherapy with the dose adjusted to 60 Gy in 20 fractions. Lastly, we have expanded the program to high-risk patients where IMRT treatments are given to the pelvic nodes (44 Gy in 20 fractions) with a simultaneous integrated boost delivery to the prostate (60 Gy in the same 20 fractions). Our long-term results have shown that moderate hypofractionated radiotherapy for prostate cancer is safe and provides good tumor control comparable to high-dose conventionally fractionated radiotherapy. This hypofractionated regimen has been routinely used in our institution. [ABSTRACT FROM AUTHOR]

Résumé Le cancer de la prostate est le cancer le plus fréquent chez les hommes en Europe avec un taux de survie moyen très élevé à long terme. L’impact médico-économique est majeur, de même que les chances de guérison. L’intérêt de la surveillance est triple : diagnostiquer et traiter les effets secondaires à court et long termes, détecter précocement une récidive biochimique pour augmenter la probabilité de survie ou la qualité de vie et assurer un retour d’expérience pour améliorer les techniques de traitement. Nous rapportons tout d’abord l’incidence de la principale toxicité (digestive, rectale et sexuelle) et son traitement, puis les principales modalités de suivi clinique et biologique avec les stratégies d’imagerie adaptées en cas de récidive et les principaux traitements de rattrapage. Prostate cancer is the most frequent cancer among European males with a high survival rate. The economic impact of treatments and follow-up are significant. The objectives of the follow-up after prostate radiotherapy is multiple: diagnosis and treatment of side-effects, early detection of biochemical recurrence, with the aim of proposing a second local treatment to improve quality of life or overall survival and feedback of the treatment results to better inform patients at the beginning of the disease. This article reports incidence of main side-effects (digestive, urinary and sexual) with their treatments and guidelines for clinical and biological follow-up with strategies of imaging studies and salvage treatments. [ABSTRACT FROM AUTHOR]

Purpose To investigate the feasibility and tolerance in the use of adjuvant intensity modulated radiation therapy (IMRT) and simultaneous integrated boost in patients with a diagnosis of breast cancer after breast-conserving surgery. Patients and methods Between September 2011 to February 2013, 112 women with a diagnosis of early breast cancer (T1-2, N0-1, M0) were treated with IMRT and simultaneous integrated boost after breast-conserving surgery in our institution. A dose of 50 Gy in 25 fractions was prescribed to the whole breast and an additional dose of radiation was prescribed on the tumour bed. A dose prescription of 60 Gy in 25 fractions to the tumour bed was used in patients with negative margins after surgery, whereas if the margins were close (< 1 mm) or positive (without a new surgical resection) a dose of 64 Gy was prescribed. All patients were followed with periodic clinical evaluation. Acute and late toxicity were scored using the EORTC/RTOG radiation morbidity score system. Both patient and physician recorded cosmetic outcome evaluation with a subjective judgment scale at the time of scheduled follow-up. Results The median follow-up was 28 months (range 24–40 months). The acute skin grade toxicity during the treatment was grade 0 in 8 patients (7%), grade 1 in 80 (72%), grade 2 in 24 cases (21%). No grade 3 or higher acute skin toxicity was observed. At 12 months, skin toxicity was grade 0 in 78 patients (70%), grade 1 in 34 patients (30%). No toxicity grade 2 or higher was registered. At 24 months, skin toxicity was grade 0 in 79 patients (71%), grade 1 in 33 patients (29%). No case of grade 2 toxicity or higher was registered. The pretreatment variables correlated with skin grade 2 acute toxicity were adjuvant chemotherapy ( P = 0.01) and breast volume ≥ 700 cm 3 ( P = 0.001). Patients with an acute skin toxicity grade 2 had a higher probability to develop late skin toxicity ( P < 0.0001). In the 98% of cases, patients were judged to have a good or excellent cosmetic outcome. The 2-year-overall survival and 2-year-local control were 100%. Conclusion These data support the feasibility and safety of IMRT with simultaneous integrated boost in patients with a diagnosis of early breast cancer following breast-conserving surgery with acceptable acute and late treatment-related toxicity. A longer follow-up is needed to define the efficacy on outcomes. [ABSTRACT FROM AUTHOR]

Résumé Objectif La technique d’optimisation avec pré-segmentation (Dosisoft™) utilisée lors de l’irradiation des cancers mammaires permet de faciliter la délivrance des traitements et d’offrir une meilleure radioprotection. L’objectif de l’étude était d’évaluer le gain de cette technique sur taux d’épithéliite exsudative observée après irradiation du sein en totalité après chirurgie conservatrice. Patientes et méthodes Les scores de toxicité cutanée observés à 50 Gy, chez 103 patientes recevant une irradiation mammaire avec la technique d’optimisation avec pré-segmentation ont été comparés avec ceux de 101 patientes ayant un volume mammaire comparable, recevant une irradiation mammaire avec une technique tridimensionnelle classique. Toutes les patientes ont reçu une dose de 50 Gy en 25 fractions et 5 semaines par des photons de 4 MV. La toxicité cutanée a été recueillie prospectivement lors des consultations hebdomadaires selon la Common Terminology Criteria for Adverse Events, version 4.0 (CTCAE V4). Les facteurs suivants ont été étudiés : le volume mammaire, l’indice de masse corporelle, l’âge, la réalisation d’une chimiothérapie, l’utilisation de trastuzumab, l’hypertension artérielle, le diabète, le tabagisme et la prise de statine. Résultats L’incidence des épithéliites exsudatives a été de 9,8 % avec l’optimisation avec pré-segmentation, contre 16,8 % dans le groupe témoin sans que la différence ne soit significative : odds ratio (OR) = 0,53 [0,23 ; 1,22] ( p = 0,13). En analyse unifactorielle, la technique d’optimisation avec pré-segmentation a permis de diminuer l’intensité du maximum de dose (point chaud) de 4,4 Gy en moyenne ( p = 0,001). Les autres facteurs de risque de toxicité cutanée étaient un grand volume mammaire ( p < 0,001), un indice de masse corporelle élevé ( p < 0,001), l’hypertension artérielle ( p = 0,03) et le trastuzumab ( p = 0,07). En analyse multifactorielle, les deux facteurs significatifs étaient le volume mammaire avec un OR de 1,004 [1,002 ; 1,006] et le trastuzumab avec un OR de 4,95 [1,17 ; 20,79]. Conclusion La comparaison de la toxicité cutanée aiguë induite par la technique d’optimisation avec pré-segmentation ou par la technique classique a montré une tendance à l’amélioration de la tolérance cutanée grâce à l’utilisation de la technique d’optimisation avec pré-segmentation, plaidant pour son utilisation compte tenu de ses autres avantages dosimétriques et de radioprotection. L’étape ultérieure consistera à réaliser le complément dans le lit tumoral par cette technique sous la forme de boost intégré. Purpose The optimization with presegmentation irradiation technique (Dosisoft™), used in treatment of breast carcinomas, facilitates the treatment delivery and improves radioprotection. The objective of our study was to evaluate the potential impact of this innovative technique on the acute skin toxicity especially on the rate of moist desquamation during irradiation of the whole breast after conservative surgery. Patients and methods The scores of acute skin toxicity observed at 50 Gy in 103 patients treated with the presegmentation technique were compared to those of 101 patients with similar breast size treated with a classic 3D technique. All patients received 50 Gy/2 Gy per fraction, 5 days a week using 4 MV photon beam. The boost on the tumoural bed was realized according to conventional technique. Using the NCI-CTCAE V4, the skin toxicity was recorded every week during the medical visit. Moreover, the following factors that could induce skin toxicity have been studied: breast size, body mass index, age, prior chemotherapy, concurrent administration of trastuzumab, hypertension, diabetes, smoking habits and statin uptake. Results The incidence of moist desquamation observed in all sites, has been decreased to only 9.8% in the presegmentation group versus 16.8% in the test group, the difference being not statistically significant OR = 0.53 [0.23; 1.22] ( P = 0.13). In univariate analysis the presegmentation technique enabled a significant decrease of 4.4 Gy in mean, of the value of maximum dose ( P = 0.001). The other risk factors of skin toxicity are the increase of breast size ( P < 0.001), a high body mass index ( P < 0.001), hypertension ( P = 0.03) and concurrent administration of trastuzumab ( P = 0.07). In multivariate analysis, the two remaining significant factors are breast size (OR = 1.004 [1.002; 1.006]) and trastuzumab administration (OR = 4.95 [1.17; 20.79]). Conclusion The comparison of the skin toxicity induced by the presegmentation or the reference technique shows a trend regarding the improvement of the skin tolerance when using the presegmentation technique, thus pleading in favour of its use considering its dosimetric interest and the improvement of radioprotection of the patient. The next step will consist to experiment the simultaneous boost on tumoural bed using this technique. [ABSTRACT FROM AUTHOR]

Résumé L’irradiation partielle et accélérée du sein se positionne dans l’arsenal thérapeutique du cancer du sein dans un processus de désescalade thérapeutique et de projet de personnalisation des soins. Cette étude fait le point sur les données actuellement disponibles et notamment les résultats des essais de phase III randomisés ayant comparé irradiation partielle et accélérée du sein et irradiation totale du sein. Actuellement, six de ces essais proposent des résultats sur l’efficacité et/ou sur la toxicité. Les études non randomisées ont globalement montré les résultats escomptés : faibles taux de rechute et de toxicité locales. Les premiers résultats des études randomisées de phase III ont montré des résultats encourageants en termes de contrôle local alors que la toxicité est variable en fonction de la technique d’irradiation partielle et accélérée du sein utilisée. Cependant, le suivi de la majorité des études reste insuffisant. Le strict respect des indications d’irradiation partielle et accélérée du sein est vraisemblablement un point-clé du succès thérapeutique et les résultats à venir devraient permettre de mieux définir ces critères de sélection. In the frame of treatment de-escalation and personalization, accelerated partial breast irradiation is taking its place in the breast cancer therapeutic options. This study analyzed the results of phase III randomized trials having compared accelerated partial breast irradiation versus whole breast irradiation. Currently, among those trails, six proposed some results regarding efficacy and/or toxicity. Globally, the non-randomized studies confirmed the expected results showing a low rate of local recurrence and toxicity. The first results of the phase III randomized trials showed encouraging data in terms of local control while the toxicity varied mainly according to the accelerated partial breast irradiation technique used. However, the follow-up of the majority of these studies remains insufficient. The strict respect of accelerated partial breast irradiation indications likely represents one of the key factors of the therapeutic success. The next results could allow proposing a better definition of the accelerated partial breast irradiation selection criteria. [ABSTRACT FROM AUTHOR]

Metabolic imaging by positrons emission tomography (PET) offers new perspectives in the field of non-small-cell lung cancer radiation therapy. First, it can be used to refine the way nodal and primary tumour target volumes are selected and delineated, in better agreement with the underlying tumour reality. In addition, the non-invasive spatiotemporal mapping of the tumour biology and the organs at risk function might be further used to steer radiation dose distribution. Delivering higher dose to low responsive tumour area, in a way that better preserves the normal tissue function, should thus reconcile the tumour radiobiological imperatives (maximising tumour local control) with dose related to the treatment safety (minimising late toxicity). By predicting response early in the course of radiation therapy, PET may also participate to better select patients who are believed to benefit most from treatment intensification. Altogether, these technological advances open avenues to in-depth modify the way the treatment plan is designed and the dose is delivered, in better accordance with the radiobiology of individual solid cancers and normal tissues. [ABSTRACT FROM AUTHOR]

Résumé La radiothérapie conformationnelle avec modulation d’intensité (RCMI) n’est pas une technique validée pour les cancers bronchiques non à petites cellules. Cependant, la proportion de patients irradiés avec modulation d’intensité est croissante. Une revue de la littérature a été réalisée. Les incertitudes physiques et dosimétriques ne sont actuellement pas parfaitement maîtrisées. Des méthodes permettant de prendre en compte ces limitations et de réaliser des contrôles qualité sont en cours de développement. Dans plusieurs études rétrospectives, les survies rapportées après RCMI semblent au moins identiques à celles rapportées après irradiation classique. La RCMI peut être autorisée dans des situations anatomiques spécifiques où la dégradation de la distribution de dose constitue un excès de risque d’échec local. Ce sont les cas des tumeurs de faible mobilité et situées à proximité d’organes critiques tels que la moelle (tumeurs de Pancoast-Tobias, paracardiaques ou paraspinales). La diminution des doses intermédiaires à élevées dans les organes à risque est en faveur de la RCMI mais l’effet des faibles doses dans de larges volumes (poumon, os, tissus non spécifiés le long du trajet des faisceaux) et l’effet de l’augmentation de la dose intégrale sont encore mal connus. En conclusion, des corrélations dose–volume mieux documentées sont indispensables à moyen et long terme. Des études cliniques prospectives sont nécessaires pour évaluer l’impact de la RCMI dans le traitement en routine des cancers bronchiques non à petites cellules en termes d’efficacité et de toxicité notamment respiratoire. Intensity modulated radiotherapy is increasingly used in non-small-cell lung cancers despite a low level of evidence. A literature review was conducted. Several critical physical and dosimetric uncertainties are however unsolved. Methods to circumvent these limitations are being developed. In several retrospective studies, survival rates were at least similar with intensity-modulated radiotherapy as those reported with three-dimensional irradiation. To date, intensity modulated radiotherapy might be authorized in complex anatomical situations such as tumours close to the spinal cord (such as Pancoast Tobias, paraspinal and paracardiac tumours) or with limited motion amplitudes. Dosimetric benefits should also account for 4D dose distribution issues. The reduction of intermediate and high doses in the organs at risk with intensity modulated radiotherapy is advantageous. However, the effect of low doses in large volumes (lung, bone, unspecified tissues along beam paths) and the effect of increasing integral dose are still poorly known. In conclusion, dose–volume correlations need to be better documented and prospective randomized trials should be encouraged. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs de l’étude: Évaluation des résultats d’une radiothérapie de rattrapage à visée curative dans le cadre du traitement des rechutes pelviennes isolées de cancers du col utérin. Patientes et méthodes: Quatorze patientes atteintes d’une rechute pelvienne d’un cancer du col utérin ont été prises en charge dans notre service de 1982 à 2009. Cinq rechutes étaient centropelviennes, quatre vaginales et cinq ganglionnaires pelviennes. Quatre patientes ont eu une exérèse chirurgicale première de la rechute. Les 14 patientes ont reçu une radiothérapie pelvienne de dose médiane de 55Gy en fractionnement classique. Une chimiothérapie concomitante a été administrée à 13 patientes. Une curiethérapie vaginale de complément de bas débit de dose médiane de 20Gy a été réalisée chez trois patientes. Le recul médian était de 39mois. Résultats: La tolérance de la radiothérapie était acceptable avec 29 % de cas de toxicité aiguë digestive ou urinaire de grade 3. Le contrôle tumoral a été obtenu chez dix patientes (71 %). Quatre patientes ont présenté une poursuite évolutive locorégionale. Au moment de l’analyse, trois patientes étaient décédées de leur cancer. Les taux de survie globale à deux et cinq ans étaient respectivement de 84 % et 74 %. Huit patientes ont souffert d’effets secondaires tardifs, sévères dans trois cas (21 %). Conclusion: Dans notre expérience, une chimioradiothérapie permet d’obtenir un taux élevé de rémission chez les patientes atteintes d’une rechute pelvienne isolée d’un cancer du col utérin. Celle-ci n’est réalisable qu’en l’absence de radiothérapie externe pelvienne lors du traitement initial de la tumeur ou en cas de rechute tumorale localisée en dehors du volume précédemment irradié. [ABSTRACT FROM AUTHOR]

Résumé: Objectif de l’étude: Les sarcomes cardiaques primitifs représentent moins de dix cas par an en France. La durée médiane de survie des patients survie est de l’ordre de 18mois. Le traitement repose sur la chirurgie lorsqu’elle est possible. La place de la chimiothérapie et de la radiothérapie est controversée. La stratégie thérapeutique est d’autant plus complexe en ce qui concerne la radiothérapie que la dose limitante au cœur est théoriquement peu compatible avec la prescription d’une dose tumoricide pour un sarcome. L’analyse d’une série récente de 124 cas du groupe sarcome français a suggéré un bénéfice de la radiothérapie sur la survie sans progression. Patients et méthodes: Une analyse de 12 dosimétries a été réalisée. Résultats: Il existe une importante disparité dans la définition des volumes cibles, des doses et les techniques évoluent vers des irradiations plus conformationnelles. Une irradiation apparaissait faisable au vu de la toxicité rapportée (néanmoins probablement sous-estimée en raison un recul court et du pronostic défavorable) et du bénéfice démontré de la radiothérapie pour des sarcomes cardiaques primitifs. Conclusion: Un schéma de 45Gy en 25 fractions dans un volume établi sur l’imagerie préopératoire avec un complément de dose de 14Gy en sept fractions dans une zone à risque ou un reliquat macroscopique, avec des marges de 1cm, pourrait être proposé. Les résultats d’une irradiation conformationnelle avec modulation d’intensité et tomographie conique quotidienne devront être évalués. [ABSTRACT FROM AUTHOR]

Résumé: Le nombre de patients atteints d’obésité est en augmentation en France depuis deux décennies, avec des conséquences sur l’incidence de nombreux cancers. L’obésité a un impact sur la prise en charge des cancers par radiothérapie, du fait des contraintes matérielles, techniques et dosimétriques qu’elle implique, ainsi que sur la toxicité aiguë et tardive, le contrôle local et la survie des patients. [ABSTRACT FROM AUTHOR]

Résumé: L’hadronthérapie, radiothérapie par les particules lourdes chargées, bénéficie depuis une dizaine d’années d’un engouement sans précédent, tant sur le plan technologique que clinique. Le premier est lié au développement commercial d’installations de protons compactes, relativement bon marché, et équipées de source rotatives isocentriques. L’arrivée du pencil beam scanning devrait simplifier et accélérer les procédures de traitement. Le second est lié aux succès rapportés dans, premièrement, le traitement de tumeurs localement agressives, non ou peu résécables, et placées au voisinage immédiat de structures saines radiosensibles : mélanomes oculaires, sarcomes de bas grade de la base du crâne et du rachis, carcinomes de la sphère ORL évolués (cylindromes) ; secondement, la protection des tissus sains : à long terme, particulièrement dans les tumeurs pédiatriques, en raison de la grande radiosensibilité des tissus en croissance (incluant le risque carcinogène) ; immédiate, sur la moelle osseuse, les muqueuses… notamment dans les associations concomitantes chimioradiothérapiques (étudiées dans les cancer du poumon et de l’œsophage). Les patients irradiés par ions carbone ne représentent qu’une minorité des 115 000 traités dans le monde mais, dans les mains des équipes japonaises, entraînent des résultats surprenants dans les formes les plus résistantes, telles que le mélanome muqueux, les sarcomes de haut grade, le cancer du pancréas. Les modifications du fractionnement utilisées, posent d’intéressantes questions biologiques et économiques. Une vive polémique s’est récemment développée autour d’une expansion des indications vers des maladies communes (cancer de la prostate). [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Étude prospective monocentrique de la toxicité liée à l’administration concomitante du trastuzumab à la radiothérapie mammaire. Patientes et méthodes: Cent soixante-treize patientes ont été traitées entre juin 2003 et mars 2009 par trastuzumab concomitant à une radiothérapie normofractionnée. Le trastuzumab était délivré toutes les trois semaines (8mg/kg à la première injection puis 6mg/kg) pendant une durée médiane de 12 mois (2–62). La fraction d’éjection ventriculaire gauche a été mesurée par échocardiographie ou scintigraphie cardiaque au moment du diagnostic, avant et après la radiothérapie, tous les trois mois pendant un an puis annuellement. Une fraction d’éjection ventriculaire gauche strictement inférieure à 55 % était considérée comme altérée. La toxicité a été évaluée selon la Common Terminology Criteria for Adverse Effects version 3.0. Résultats: Le suivi médian était de 52 mois (17–88). L’âge médian était de 52ans (25–83). Cent trente-quatre patientes (77,5 %) ont reçu une radiothérapie de la chaîne mammaire interne. Une épithéliite aiguë de grades 1, 2 et 3 a été décrite chez respectivement 132 (76,3 %), 32 (18,5 %) et six patientes (3,4 %). Avec un recul médian de 23 mois, une fibrose de grades 1 et 2 a été observée chez respectivement 31 et huit patientes (18,8 et 4,6 %). La fraction d’éjection ventriculaire gauche était normale pour 159 patientes (91,9 %) avant la radiothérapie. Elle était altérée chez ces patientes 18 fois (11,3 %), dont huit (5,0 %) au terme de la radiothérapie. Une insuffisance cardiaque congestive symptomatique est survenue chez une patiente (0,6 %). Conclusion: La toxicité en rapport avec l’association du trastuzumab à la radiothérapie mammaire s’est avérée modérée. Un suivi prolongé est nécessaire. [ABSTRACT FROM AUTHOR]