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Resume L’imagerie du cancer du sein a beaucoup evolue au cours des 20 dernieres annees en profitant du developpement incessant de l’informatique. De nouvelles solutions techniques en mammographie (tomosynthese-angiomammographie), en echographie (elastographie, echographie automatisee) et en IRM (diffusion, protocole court) mais egalement en medecine nucleaire vont possiblement remplacer nos outils actuels. Mais la veritable revolution a venir sera certainement l’utilisation des enormes volumes de donnees numeriques actuellement inexploitees dans le cadre des solutions apportees par les techniques d’intelligence artificielle (aide a l’interpretation, radiomiques) ou alors des progres des techniques de biologie (genomique, proteomique) qui permettront de proposer une imagerie veritablement personnalisee aux femmes.

High-risk neuroblastoma is characterized by poor long-term survival, especially for very high-risk (VHR) patients (poor response of metastases after induction therapy). The benefits of a tandem high-dose therapy and hematologic stem cell reinfusion (HSCR) have been shown in these patients. Further dose escalation will be limited by toxicity. It is thus important to evaluate the efficacy and tolerability of the addition of new agents such as I-MIBG (131Iode metaiodobenzylguanidine) to be combined with high-dose therapy in the consolidation phase. We report the feasibility of busulfan/melphalan (BuMel) after I-MIBG therapy with HSCR in patients with refractory or relapsed metastatic neuroblastoma. From November 2008 to March 2015, 9 patients received BuMel after I-MIBG therapy and topotecan. The main toxicity was digestive with only 1 patient developing grade 4 sinusoidal obstructive syndrome. Seven patients are alive at a median follow-up of 25 months. Among them, 2 are in ongoing complete remission and 1 in ongoing stable disease. These results suggest that BuMel with HSCR can be administered safely 2 months after I-MIBG therapy associated with topotecan for VHR patients. This strategy will be compared with tandem high-dose chemotherapy (thiotepa and busulfan-melphalan), followed by HSCR in the upcoming SIOPEN VHR Neuroblastoma Protocol.

The purpose of this study is to assess the efficacy of 153Sm-EDTMP (Quadramet®) in a clinical setting. We have conducted a retrospective study of all consecutive patients (pts) treated with 153Sm-EDTMP for painful bone metastases. At each visit (before and after treatment), four parameters were collected: (i) pain assessment according to the 10-step visual analogue scale (VAS), (ii) sleep disturbance related to pain, (iii) dose of analgesic medication, and (iv) answer to the following closed question “Do you think you obtained a benefit from treatment?” Success of treatment was defined by the combination of these four parameters. Three hundred seventy consecutive 153Sm-EDTMP treatments for painful bone metastases were given. Patients had the following primary tumors: breast carcinoma (153), prostate carcinoma (155), lung carcinoma (27), or other cancers (35). Fifty-eight percent of the patients had received previous external osseous radiotherapy. Ninety-seven percent of the patients were treated with concomitant analgesics and 61% were treated with diphosphonates. A clinical benefit was described in 55.0% of cases at D30. Treatment was more effective in cases of breast and prostate cancers compared with other types of primary cancers. Patients described a benefit at D30 in 62, 58, 6, and 38% of cases of breast, prostate, lung, and other cancers. The subjective efficacy was accompanied by a decrease in analgesic intake in 35.0% of cases. 153Sm-EDTMP therapy is an effective supportive treatment in patients who suffer from bone metastases, especially in patients with breast or prostate cancer.

Breast cancer imaging is always improving for the last 20 years in spite of digitalization and computer development. News tools in mammography (Digital Breast Tomosynthesis, Contrast enhanced mammography), sonography (elastography, Automated echography), MRI (Diffusion, abbreviated MRI) and Nuclear medicine has the great potential to be the future of breats imaging. But true revolution will be to use the huge volume of "hidden" imaging data, by Intelligence Artificial process or Biological progress (in genomics, proteiomics) to purpose to our patient a personalized imaging.

Malignant struma ovarii (SO) is a rare tumor, and as a consequence, treatments and follow-up procedures are not clearly established. Presented in this study are two cases of suspicious ovarian masses, resected and corresponding to malignant SO on histopathology. Similar to thyroid cancer, we proposed complementary radioiodine therapy (131I) after total thyroidectomy (no malignancy was observed at this level in our two patients). Patients underwent treatment with 3.7 GBq 131I followed by post-therapy whole-body scintigraphy, which can detect residual disease or occult metastases. Thyroid remnant ablation increases the sensitivity and specificity of follow-up testing using serum thyroglobulin levels as a tumor marker. Our two patients remained disease-free for 3 and 5 years, respectively, after treatment., Highlights • Malignant struma ovarii is a rare ovarian tumor, corresponding to thyroid carcinoma. • It is generally diagnosed after surgical resection of an ovarian mass. • Iodine 131 therapy can be proposed for adjuvant therapy, after total thyroidectomy. • Follow-up must be extended for 20 years, using thyroglobulin level as a tumor marker.

Stereotactic body radiation therapy is the standard treatment for inoperable patients with early-stage lung cancer. Local control rates range from 80 to 90 % 2 years after treatment. The role of positron emission tomography in patient selection is well known, but its use for target definition or therapeutic response evaluation is less clear. We reviewed the literature in order to assess the current state of knowledge in this area.

Introduction L’analyse de texture suscite un interet grandissant en oncologie. Il n’existe cependant que peu de donnees concernant le cancer du sein. Nous avons donc etudie les liens entre les donnees de l’analyse de texture en TEP/TDM au 18F-FDG et les criteres anatomopathologiques etablis sur piece de mastectomie. Materiel et methodes Cent-deux patientes ayant effectue une TEP/TDM au 18F-FDG au cours de leur bilan initial pre-chirurgical de cancer du sein ont ete retrospectivement incluses. L’effectif comportait 97 carcinomes canalaires infiltrants (CCI) et 20 carcinomes lobulaires infiltrants (CLI). Etaient recueillis pour chaque lesion : la Standardized Uptake Value (SUV)max, le volume tumoral metabolique (MTV), le taux de glycolyse totale (TLG) ainsi que 7 parametres de texture : l’homogeneite, l’entropie, le High Grey-level Run Emphasis (HGRE), le Short-Run Emphasis (SRE), le Long-Run Emphasis (LRE), le High Grey-level Zone Emphasis (HGZE) et le Low Grey-level Zone Emphasis (LGZE). Une regression univariee etait utilisee pour identifier l’association entre les parametres TEP (usuels et de texture) et les criteres anatomopathologiques de la piece operatoire : type histologique, recepteurs aux estrogenes (RE), statut HER2, grade histopronostique (GHP) et presence d’emboles vasculaires (EV). La comparaison des parametres TEP au type histologique a ete effectuee sur l’effectif total, le reste des analyses a ete effectue sur le groupe des 97 CCI. Resultats L’homogeneite etait plus basse pour les lesions de GHP 3 (OR : 0,538 [0,368–0,786] ; p = 0,001) ou HER2+++ (OR : 0,517 [0,297–0,901] ; p = 0,02) et plus elevee pour les CLI (OR : 2,14 [1,508–3,039] ; p

The objective of the present multicentric phase II study (MIITOP) was to determine the response rate, survival and toxicity of tandem infusions of 131I-meta-iodobenzylguanidine (mIBG) and topotecan in children with relapsed/refractory neuroblastoma. High-dose 131I-mIBG therapy programme requires a deal of planning, availability of hospital resources and the commitment of individuals with training and expertise in multiple disciplines. Here in the present study, procedures and the results of patient's dosimetry, as well as family and worker's exposures, were reported for the patients treated in Lille. A total of 15 children were treated with 131I-mIBG between 2009 and 2011 according to the MIITOP protocol. High activity of 131I-mIBG (444 MBq kg-1) was administered on Day 0. In vivo dosimetry was used to calculate a second activity, to be given on Day 21, to obtain a total whole body absorbed dose of 4 Gy. Family and worker's exposures were performed too. The injected activity by treatment was from 703 to 11470 MBq. Total whole body absorbed dose by patient ranged from 2.74 to 5.2 Gy. Concerning relatives, whole body exposure ranged from 0.018 to 2.8 mSv. The mean whole body exposure of the radiopharmacist was 4.4 nSv MBq-1, and the mean exposure of fingers ranged from 0.18 to 0.24 µSv MBq-1 according to each finger. The mean whole body exposure was 33.6 and 20.2 µSv d-1 per person, for night nurses and day nurses, respectively. Exposure of doctors was less than 5 µSv d-1. Under strict radiation protection precautions, this study shows the feasibility of high-activity 131I-mIBG therapy in France.