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The oligometastatic disease concept suggests that patients with a limited number of metastases have a favorable prognosis. Radical local treatment of oligometastatic patients has then increased given developments in imaging (mainly positron emission tomography and brain magnetic resonance imaging) and access to effective and better tolerated treatments. Stereotactic radiotherapy has the advantage of being noninvasive, allowing a good rate of local control and a limited number of side effects. A better definition of oligometastatic disease, particularly for non-small cell lung cancer (NSCLC), has recently been published. For patients with NSCLC, two randomized phase II trials also suggested that the addition of a radical local treatment results in encouraging survival data, with a good safety profile. A single-arm phase II finally showed a benefit when combining a radical local treatment with an anti-PD1 immunotherapy. This review describes the definitions of oligometastatic disease, the main prospective findings including radiation therapy, and prospects for oligometastatic NSCLC patients.

Introduction Thymomas are rare intrathoracic malignancies that may be aggressive and difficult to treat. Knowledge and level of evidence for treatment strategies are mainly based on retrospective studies or expert opinion. Currently there is no strong evidence that postoperative radiotherapy after complete resection of localized thymoma is associated with survival benefit in patients. RADIORYTHMIC is a phase III, randomized trial aiming at comparing postoperative radiotherapy versus surveillance after complete resection of Masaoka-Koga stage IIb/III thymoma. Systematic central pathologic review will be performed before patient enrollment as per the RYTHMIC network pathway. Patients and Methods Three hundred fourteen patients will be included; randomization 1:1 will attribute either postoperative radiotherapy (50-54 Gy to the mediastinum using intensity-modulated radiation therapy or proton beam therapy) or surveillance. Stratification criteria include histologic grading (thymoma type A, AB, B1 vs B2, B3), stage, and delivery of preoperative chemotherapy. Patient recruitment will be mainly made through the French RYTHMIC network of 15 expert centers participating in a nationwide multidisciplinary tumor board. Follow-up will last 7 years. The primary endpoint is recurrence-free survival. Secondary objectives include overall survival, assessment of acute and late toxicities, and analysis of prognostic and predictive biomarkers. Results The first patient will be enrolled in January 2021, with results expected in 2028.

Sarcomas are rare tumours arising from mesenchymal tissue. A multimodal management in an expert centre combining surgery and radiotherapy is the current standard of care for localized soft-tissue sarcomas of the extremities, to enable limb-sparing strategies. The delivery of pre- radiotherapy or postoperative radiotherapy offers similar local control and survival rates but the toxicity profile is quite different: preoperative radiotherapy increases the risk of wound complications and postoperative radiotherapy affects long-term functional outcomes. While postoperative radiotherapy has long been the rule, especially in Europe, technical improvements with image-guided- and intensity-modulated radiotherapy associated with a better management of postoperative wounds has tended to change practices with more frequent preoperative radiotherapy. More recently the possibilities of a hypofractionated regimen or potentiation by nanoparticles to increase the therapeutic index plead in favour of a preoperative delivery of radiotherapy. The aim of this paper is to report pros and cons of pre- and post-operative radiotherapy for soft-tissue sarcomas.

Resume La chimioradiotherapie concomitante est le standard therapeutique chez les patients atteints de cancer bronchique non a petites cellules non resecable de stade III, quels que soient leurs sous-types histologiques et leurs caracteristiques moleculaires. Dans ce cadre, seuls 15 a 30 % des patients demeurent en vie cinq ans apres la chimioradiotherapie et ce chiffre n’a pratiquement pas change malgre de multiples essais randomises. Au cours des cinq dernieres annees, le blocage des points de controle immunitaires par anti-PD-(L)1 a revolutionne la prise en charge du cancer bronchique non a petites cellules metastatique, devenant un standard en premiere ligne et deuxieme ligne de traitement. Plusieurs etudes precliniques ont mis en evidence une liberation accrue d’antigenes tumoraux, une presentation amelioree de ces antigenes et l’augmentation de l’infiltration des lymphocytes T dans les tumeurs irradiees. L’immunotherapie a recemment ete evaluee pour les patients atteints de cancer bronchique non a petites cellules localement evolue ayant recu une irradiation thoracique. Suite a l’essai PACIFIC, l’anticorps anti-PD-L1 durvalumab est apparu comme un nouveau standard en consolidation pour les patients atteints de cancer bronchique non a petites cellules de stade III non resecable dont la maladie n’a pas progresse apres une chimioradiotherapie concomitante a base de sels de platine. L’immunoradiotherapie apparait donc comme une nouvelle association encourageante chez les patients atteints de cancer bronchique non a petites cellules localisees. De nombreux essais evaluent donc actuellement l’interet d’une immunotherapie concomitante a la chimioradiotherapie et/ou de l’ajout d’une chimiotherapie associee a l’immunotherapie de consolidation chez les patients atteints de cancer bronchique non a petites cellules localement evolue.

Resume Au cours des vingt dernieres annees, plusieurs evolutions ont revolutionne la prise en charge des cancers du poumon, composes a plus de 85 % de carcinomes bronchiques non a petites cellules et de pres de 15 % de carcinomes bronchiques a petites cellules. La question des volumes cibles ganglionnaires s’est posee lorsqu’est apparue la possibilite d’une plus grande precision des traitements avec la radiotherapie conformationnelle tridimensionnelle. S’appuyant initialement sur des series chirurgicales, de nombreuses etudes retrospectives et prospectives ont evalue le risque de recidive ganglionnaire isolee des traitements ou seules les aires envahies etaient ciblees (involved-field radiotherapy, IFRT) par rapport aux traitements standards de l’epoque, irradiant systematiquement les aires ganglionnaires envahies mais egalement d’autres aires ganglionnaires a risque de recidive, de facon prophylactique (elective nodal irradiation, ENI). Pour ce qui concerne les carcinomes bronchiques non a petites cellules localement evolues, pris en charge par association de chimiotherapie et de radiotherapie ou en situation postoperatoire et pour les carcinomes bronchiques a petites cellules, la grande majorite des publications a retrouve des taux de recidive ganglionnaire isolee inferieurs a 5 % a 2 ans, a condition que le stade pretherapeutique ait ete etabli avec les techniques modernes d’investigations (tomographie par emission de positrons-tomodensitometrie, endoscopie, etc.). L’abandon de l’irradiation prophylactique ganglionnaire est donc devenu un standard, et a permis le developpement des approches avec escalade de dose tout en diminuant la toxicite œsophagienne, cardiaque et pulmonaire de la radiotherapie. En consequence, les grands essais cliniques developpes a partir des annees 2000 impliquant la radiotherapie et les recommandations des differentes societes savantes ont fait le choix d’abandonner les techniques d’irradiation prophylactique ganglionnaire au profit de la radiotherapie limitee aux aires ganglionnaires envahies.

Aims Primary tracheal–bronchial adenoid cystic carcinoma (thoracic adenoid cystic carcinoma; TACC) is a rare and aggressive malignant tumour. Radiotherapy results have not been previously individualised in this setting. Patients and methods Records of 31 patients with TACC (74% tracheal and 26% bronchial) who received radiotherapy between February 1984 and September 2014 were retrospectively analysed. Results Surgical removal of the primary tumour was carried out for most (71%) patients, and 13/22 (59%) had R1 or R2 (1/22) margins. The mean tumour size was 4.1 cm, 10 (32%) had associated lymph node involvement and 13 (41%) had perineural invasion (PNI). Adjuvant and definitive radiotherapy were delivered for 22 (71%) and nine patients, respectively. The mean delivered dose was 62 Gy (40–70 Gy) and eight patients had a radiotherapy boost (mean 19 Gy, range 9–30 Gy, two with endobronchial brachytherapy). At a median follow-up of 5.7 years, the 5 year overall survival and progression-free survival (PFS) rates were 88% and 61%, respectively. There were three local relapses and 10 metastatic relapses (mean delay 3.2 years), resulting in 5 year local and metastatic relapse rates of 10% and 26%, respectively. The prognostic factors in the univariate analysis for both decreased overall survival and PFS were: age ≥50 years (hazard ratio 6.2 and 3.8) and the presence of PNI (hazard ratio 10.3 and 4.1); and for PFS only: a radiotherapy dose ≤ 60 Gy (hazard ratio 3.1). Late toxicities were: tracheotomy due to symptomatic tracheal stenosis ( n = 5), G3 dyspnoea ( n = 4), hypothyroidism ( n = 5) and pericarditis ( n = 4). Conclusion Radiotherapy dose may affect local control and the presence of PNI should be considered as an adverse prognostic factor. TACC irradiation conferred good local control rates, when comparing these results with historical series.

Incidence of soft tissue sarcoma is low and requires multidisciplinary treatment in specialized centers. The objective of this paper is to report the state of the art regarding indications and treatment techniques of main soft tissue sarcoma localisations.

Soft tissue sarcomas are rare tumours. Conservative surgery followed by postoperative radiation therapy represents the gold standard in the majority of cases. Postoperative radiotherapy improves local control without affecting survival. Besides the quality of surgical excision, which remains the major prognostic factor, the importance of the irradiation volume and particularly margins used in external beam radiotherapy were also found to influence local control of the disease. In this study, we propose to conduct a literature review on the present state of our knowledge on this subject in the form of an articulated controversy: in favour or opposed to large margins in external radiotherapy.

Background This phase I study evaluated the safety and efficacy of the oral mTOR inhibitor everolimus in combination with thoracic radiotherapy followed by consolidation chemotherapy in locally advanced or oligometastatic untreated non-small-cell lung cancer (NSCLC). Patients and methods Everolimus dose was escalated in incremental steps [sequential cohorts of three patients until the occurrence of dose-limiting toxicity (DLT)] and administered orally weekly (weekly group: dose of 10, 20 or 50 mg) or daily (daily group: 2.5, 5 or 10 mg), 1 week before, and during radiotherapy until 3.5 weeks after the end of radiotherapy. Two cycles of chemotherapy (cisplatin–navelbine) were administrated 4.5 weeks after the end of radiotherapy. Results Twenty-six patients were included in two centers, 56% had adenocarcinoma and 84% had stage III disease. In the weekly group (12 assessable patients), everolimus could be administered safely up to the maximum planned weekly dose of 50 mg; however, one patient experienced a DLT of interstitial pneumonitis at the weekly dose level of 20 mg. In the daily group (9 assessable patients): one DLT of interstitial pneumonitis with a fatal outcome was observed at the daily dose level of 2.5 mg; two other DLTs (one grade 3 esophagitis and one bilateral interstitial pneumonitis) were found at the daily dose level of 5 mg. Overall there were five patients with G3–4 interstitial pneumonitis related to treatment. Among 22 assessable patients for response, there were 9 (41%) partial response and 7 (32%) stable disease. At a median follow-up of 29 months, the 2-year overall survival and progression-free survival actuarial rates were 31% and 12%, respectively. Conclusion In previously untreated and unselected NSCLC patients, the recommended phase II dose of everolimus in combination with thoracic radiotherapy is 50 mg/week. Pulmonary toxicity is of concern and should be carefully monitored to establish the potential role of mTOR inhibitor with concomitant radiotherapy. EudraCT N 2007-001698-27.

Background To analyse the natural history of extra-abdominal wall desmoid-type fibromatosis (DF) and compare outcome in patients who underwent initial surgery with those who did not. Patients and methods All consecutive patients affected by primary sporadic extra-abdominal wall DF observed between January 1992 and December 2012 were included. Patients were divided into surgical (SG) or non-surgical groups (NSG) according to initial treatment. Relapse free survival was calculated for SG, and crude cumulative incidence (CCI) of switching to surgery or other treatments for NSG. Results 216 patients were identified, 94 in SG (43%), 122 in NSG (57%). A shift towards a more systematic use of a conservative approach (78% of all comers) was observed in the latter years (2006–2012), although a small proportion of patients (28%) had been offered the conservative strategy even in the early period (1992–2005). Median follow-up (FU) was 49 mo. (interquartile (IQ), 20–89 mo.), 76 months for SG and 39 months for NSG. 5-year relapse-free survival (RFS) for SG was 80% (95% confidence interval (CI), 72–89%). For the NSG, 5-year CCI of switching to surgery was 5% (95% CI: 1.7%, 14%), and 51% to other treatments (95% CI: 41%, 65%). 27 (20%) NSG patients underwent spontaneous regression. Conclusion A non-surgical approach to extra-abdominal wall DF allowed surgery to be avoided in the majority of patients. This approach can be safely proposed and surgery offered as an option in selected cases.

BACKGROUND The role of adjuvant radiotherapy (RT) in the management of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WD-LPS) remains controversial. METHODS Two hundred eighty-three patients with operable ALT/WD-LPS, no history of previous cancer, chemotherapy (CT) or RT, treated between 1984 and 2011 registered in the Conticabase database were included and described. Overall (OS), progression-free survival (PFS) and time to local relapse (TTLR) were evaluated from the time of first treatment. RESULTS Three of 20 centers enrolled 58% of the patients. Median age at diagnosis was 61 (range 25-94) years, 147 patients (52%) were males, 222 (78%) patients had their primary tumor located in an extremity while 36 (13%) and 25 (9%) had tumors involving the girdle and the trunk wall, respectively. The median size of primary tumors was 17 cm (range 2-48 cm). Adjuvant RT was given to 132 patients (47%). Patients who received adjuvant RT had larger tumors (P = 0.005), involving more often the distal limbs (P < 0.001). Use of adjuvant RT varied across centers and along the study period. Other characteristics were balanced between the two groups. Median follow-up was 61.7 months. None of the patients developed metastasis during follow-up. The 5-year local relapse-free survival rates were 98.3% versus 80.3% with and without adjuvant RT, respectively (P < 0.001). Once stratified on time period (before/after 2003), adjuvant RT, tumor site and margin status (R0 versus other) were independently associated with TTLR. No OS difference was observed (P = 0.105). CONCLUSION In this study, adjuvant RT following resection of ALT/WD-LPS was associated with a reduction of LR risk.

Resume Objectif de l’etude Les sarcomes en territoire irradie sont des maladies rares de pronostic defavorable. Si la resection tumorale complete represente le traitement de premiere intention, la place de la radiotherapie dans le cadre d’une approche curative n’est pas clairement definie. Nous rapportons les resultats carcinologiques et fonctionnels d’une cohorte de patients atteints d’un sarcome en territoire irradie localise pris en charge par l’association de plusieurs modalites therapeutiques, dont la radiotherapie, a l’institut Claudius-Regaud, Toulouse. Patients et methodes Les donnees demographiques, therapeutiques et le suivi issus du dossier informatise de chaque patient traite pour un sarcome en territoire irradie entre janvier 2000 et octobre 2011 ont ete retrospectivement analyses. Les resultats obtenus chez les patients ayant beneficie d’une radiotherapie exclusive ou adjuvante ont ete compares a ceux obtenus chez les patients qui n’ont pas ete re-irradies. Resultats Parmi les 27 patients eligibles a cette etude, dix patients ont ete re-irradies. La proportion de maladie non operable ou en situation de resection incomplete etait significativement plus importante dans le groupe des patients re-irradies que dans celui des patients non re-irradies : 90 % contre 12 % ; p Conclusion Une exerese tumorale complete est souvent difficile a obtenir en territoire irradie, ce qui augmente le risque de rechute des sarcomes en territoire irradie. La radiotherapie devrait etre discutee systematiquement en cas de tumeur localisee non resecable, ou apres une chirurgie suboptimale. Si l’indication est retenue, la radiotherapie devrait idealement etre delivree avec les techniques les plus modernes de facon a minimiser le risque de sequelles tardives.

Introduction et but de l’etude Dans le contexte de carcinome bronchique oligometastatique, l’irradiation stereotaxique des metastases cerebrales est devenue un standard mais elle reste controversee pour les lesions extracerebrales. Materiel et methodes Cette etude retrospective multicentrique sur quatre centres de lutte contre le cancer francais a inclus de 2012 a 2016 les patients atteints d’un carcinome bronchique oligometastatique, oligorecurrent, oligoprogressif ou oligopersistant (« spectre oligo ») extracerebral traites par une strategie d’irradiation stereotaxique avec ou sans traitement systemique. Resultats et analyse statistique Sur 91 cancers (99 metastases chez des patients d’âge median de 63 ans, 65 % d’adenocarcinomes, 20 % d’alterations moleculaires), 11 % etaient oligometastatiques, 49 % oligorecurrents, 20 % oligopersistants et 20 % oligoprogresseurs. Parmi les 36 % des patients qui avaient un traitement systemique au moment de la radiotherapie stereotaxique, 58 % ont pu l’arreter. Avec un suivi median de 15,3 mois, le taux de controle local etait de 91 %, la survie sans progression a distance de 6,3 mois et la survie globale de 28,4 mois. Le groupe d’indication dans le « spectre oligo » et la localisation du site metastatique etaient des facteurs pronostiques. Les patients qui ont ete atteints de nouveau des rechutes « oligo » apres la radiotherapie stereotaxique ont pu beneficier de retraitements locaux dans 80 % des cas. La toxicite aigue etait moderee (5,5 % de cas de grade 3) et un deces iatrogenique tardif est survenu. Conclusion Nos resultats en survie globale (28 mois) et a 5 ans (23 %) semblent coherents par rapport a la litterature. Toutefois la survie sans progression a distance etait plus courte que dans l’etude de De Ruysscher ou de Iyengar et al., probablement du fait de l’inclusion dans notre etude de cancers oligoprogresseurs qui avaient un pronostic moins favorable. Le profil de tolerance excellent de la radiotherapie stereotaxique, son potentiel d’epargne therapeutique et sa repetabilite la rend tres competitive dans la strategie de prise en charge multimodale des patients porteurs d’un cancer bronchique oligometastatique. Son impact medicoeconomique et en termes de qualite de vie reste a evaluer.

To report on clinical outcome and toxicity profile after combined treatment that included radiation therapy (RT) in patients with localized sarcoma within an irradiated field.Individual clinical data from all consecutive patients diagnosed and treated for a localized SIF between January 2000 and October 2011 at the Institut Claudius Regaud, Toulouse, France, were retrospectively reviewed. Outcomes of patients with SIF who underwent adjuvant or definitive radiotherapy were compared with patients who did not receive further RT.Of the 27 patients eligible for this study: surgery alone (S), surgery followed by RT (S + RT) or definitive RT (RT) was performed in 16, 8 and 2 cases respectively. The rate of unresectable, gross or microscopically positive margin disease among the 10 re-irradiated patients was significantly higher than the non re-irradiated group (90% vs. 12% p0.001). After a median follow-up of 3.8 years, there was a trend toward longer survival and better local control in the subgroup of patients who received adjuvant or definitive RT compared to the rest of the cohort with an acceptable toxicity profile. The 4-year relapse free survival rates of patients treated with and without RT were 53% and 27% respectively (p = 0.09).SIF complete surgical resection is often difficult to achieve, enhancing the risk of relapse. RT should be discussed in case of unresectable tumor or after suboptimal surgery as part of intensified local management that has a curative intent.

Soft tissue sarcoma is a rare entity and heterogeneous disease and its management therefore requires an experienced multidisciplinary team in an expert center. Standard treatment for grade 2 and 3 sarcomas is a conservative, extended surgery planned according to the results of the biopsy, and radiotherapy usually administered postoperatively (or pre-operatively). The indications for preoperative radiotherapy are discussed in a multidisciplinary meeting for locally advanced tumours. The definition of target volumes for conformal radiation therapy requires a good knowledge of the patient record, radioanatomy, as well as a careful reading of surgical and histological reports. The definitions of target volumes combine anatomical and geometrical approach. The gross tumour volume is the visible tumour on MRI preoperatively. The corresponding clinical target volume is defined by a larger longitudinal automatic extension than the radial extension. It is manually corrected taking into account the anatomical barriers to tumour spread. The planning target volume is a concentric automatic margin that may vary from one institution to another, depending on the immobilisation devices and verification of repositioning. Innovative radiotherapy techniques may be used to reduce the size of the margins around target volumes and better protect the organs at risk.

Aggressive fibromatosis (AF) is a monoclonal proliferative disease but does not metastasize and does not dedifferentiate to a high-grade malignancy in case of recurrence. Biopsy is usually necessary to confirm the diagnosis. A hallmark is its apparent unpredictable clinical course producing a large heterogeneity even with an indistinguishable morphology. Additional studies of the molecular determinants of desmoid behavior are needed to guide selection of the various therapeutic modalities. During the last 10 years, the treatment of AF has evolved and the role of routine, aggressive first-line treatment (radiotherapy and surgery) is now debated. If a wait-and-see policy is used at initial presentation, it is observed that >50% of patients will have relatively indolent disease. Aggressive treatments that take their indications from retrospective studies should be re-evaluated in the light of new data. The objective of this article is to propose an algorithm that commences with more conservative approaches before treatments that have associated long-term morbidity, the more aggressive therapies being reserved only for those who really need it.

Resume Objectif Comparer la radiotherapie conformationnelle asservie a la respiration et la radiotherapie conformationnelle classique pour l’irradiation des cancers du poumon non a petites cellules et des cancers du sein. Patients et methodes Le projet du programme de Soutien aux techniques innovantes couteuses (Stic) de 2003 etait une etude comparative, non randomisee, multicentrique et prospective qui a inclus entre avril 2004 et juin 2008 dans 20 centres francais, un total de 634 patients, 401 atteints de cancer du poumon non a petites cellules et 233 de cancer du sein. Resultats L’analyse des resultats definitifs a confirme la faisabilite et la bonne reproductibilite des differents systemes de radiotherapie asservie a la respiration. Il a ete observe dans le groupe traite par irradiation asservie a la respiration une diminution des parametres dosimetriques predictifs d’une toxicite pulmonaire, cardiaque et œsophagienne, notamment pour les cancers du poumon non a petites cellules. Ces benefices dosimetriques ont ete surtout rapportes avec les techniques de blocage proche de l’inspiration maximum actif Active Breath Control (ABC, Eleckta™) ou volontaire SDX (Dyn’R™) par rapport au systeme de synchronisation respiratoire (RPM). Pour les cancers du poumon non a petites cellules, ces benefices dosimetriques theoriques etaient correles avec une diminution significative de la toxicite clinique aigue et tardive, notamment pulmonaire. Pour les cancers du sein, bien que moins evident compte tenu de la plus faible dose totale, il a ete retrouve une reduction de la dose au cœur diminuant potentiellement le risque de toxicite cardiaque a long terme, particulierement lors de l’irradiation du sein gauche, et une reduction de la dose delivree au sein controlateral. Conclusion La radiotherapie asservie a la respiration apparait essentielle pour reduire le risque de toxicite aigue et tardive, notamment pulmonaire et cardiaque, lors des irradiations des cancers du poumon non a petites cellules et des cancers mammaires.

Resume Objectif de l’etude Evaluer la toxicite aigue de la radiotherapie conformationnelle avec modulation d’intensite dans le traitement adjuvant postoperatoire des sarcomes retroperitoneaux. Patients et methodes Les dossiers des patients operes d’un sarcome retroperitoneal puis irradies avec modulation d’intensite ont ete retrospectivement revus. Resultats Les patients etaient atteints de lesions primitives pour sept et de rechutes pour sept. Tous ont beneficie d’une resection macroscopiquement complete. Toutes les tumeurs etaient des liposarcomes, de taille mediane de 21 cm (extremes : 15–45), le volume cible previsionnel median etait de 580 cm 3 (extremes : 329–1172) et la dose mediane prescrite de 50,4 Gy (extremes : 45–54). Le suivi median est de 11,5 mois (extremes : 2–21,4). La toxicite aigue a ete moderee : une toxicite digestive aigue de grade 1–2 est survenue chez 12 des 14 patients (86 %), mais il n’y a eu aucune perte de poids de plus de 5 % et aucune interruption de traitement. Sur le plan digestif, deux mois apres la fin de la radiotherapie, il n’etait plus releve qu’un cas de toxicite de grade 1 (7 %). Il n’y a eu qu’un cas de toxicite de grade 3 (douleur abdominale transitoire) pendant le suivi. Trois tumeurs ont rechute, deux uniquement en dehors de la region irradiee et une a la fois en zone irradiee et non irradiee. Conclusion La toxicite aigue de la radiotherapie conformationnelle avec modulation d’intensite est faible. Un suivi plus long est necessaire pour evaluer la toxicite a long terme, principalement digestive et renale, et le risque de cancer radio-induit.

Objectif de l’etude Les chondrosarcomes de la base du crâne sont une indication validee de radiotherapie mais ceux des autres sites anatomiques sont systematiquement recuses quel que soient le grade et la qualite de la resection. L’objectif de notre etude etait d’evaluer l’impact de la radiotherapie sur les chondrosarcomes extracrâniens. Materiel et methode Les patients etaient issus de la Conticabase (Groupe sarcome francais) et du Rare Cancer Network. Tous les cas de chondrosarcome extracrânien non metastatique traite avec intention curative avec ou sans radiotherapie ont ete inclus. Resultats Entre 2005 et 2014, 226 patients (125 hommes, 55 % ; âge median : 52) ont ete inclus. L’indice de performance selon l’OMS etait 0–1 dans 96 %. Le site du chondrosarcome etait un membre dans 57 % des cas, le thorax/rachis dans 24 %, la tete/cou dans 10 %, l abdomen/pelvis dans 9 %. Le grade etait de 1, 2, et 3 dans respectivement 43 %, 42 %, et 15 % des cas. Le chondrosarcome etait myxoide, mesenchymateux, dedifferencie, periostique dans respectivement 28 %, 10 %, 5 % ou 4 % des cas, NOS/autre dans 53 %. La chirurgie a ete realisee dans 89 % des cas avec resection en bloc, 76 % etaient R0. Une radiotherapie a ete delivree chez 85 (38 %) patients, avec ou sans chirurgie. Parmi les chondrosarcomes irradies 46 (54 %), 18 (21 %), 15 (18 %) et 6 (7 %) etaient respectivement de grade 2, 1, 3 et inclassables. La dose moyenne etait 54 Gy (26–70 Gy) par une technique conformationnelle tridimensionnelle dans 71 % des cas. Trente-neuf (17 %) patients ont recu une chimiotherapie adjuvante. Apres un suivi median de 54,5 mois, 84 rechutes ont ete observees : 49 rechutes locales en 49 mois, 13 regionales en 71 mois, 65 metastatiques en 42 mois en mediane. Parmi les 62 rechutes locoregionales, 15 (24 %) sont survenues chez les patients irradies contre 47 (76 %) chez les non-irradies. En analyse unifactorielle, il y avait une difference significative du taux de controle local a 10 ans entre les deux groupes en faveur de la radiotherapie (82 % contre 60 %, p = 0,0135). Trois patients ont souffert d’une toxicite tardive de grade 3. Conclusion Les chondrosarcomes extracrâniens beneficient de la radiotherapie en termes de controle local en analyse unifactorielle. Une analyse multifactorielle avec score de propension est en cours.