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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.

The prognosis of patients with advanced soft-tissue sarcomas (STS) remains dismal, and systemic therapeutic options are limited. Early phase trials are becoming increasingly safe and effective. This study aimed to identify the prognostic factors for progression-free survival (PFS).This retrospective analysis included all STS patients participating in early phase trials at Gustave Roussy and Léon Bérard between 1 January 2012 and 31 December 2020.Overall, 199 patients accounted for 214 inclusions in advanced STS. The most frequent histotypes were well-differentiated/dedifferentiated liposarcomas (n = 55), leiomyosarcomas (n = 53), synovial sarcomas (n = 22), undifferentiated pleomorphic sarcomas (n = 15), angiosarcomas (n = 12), and myxoid liposarcomas (n = 10). The median PFS was 2.8 months (95% confidence interval 2.7-4.1 months). The median PFS in the first, second, and later lines was 8.3, 5.4, and 2.6 months, respectively (P = 0.00015). The median PFS was 2.8 months in case of molecular screening, 4.1 months in case of histology-driven screening, and 1.6 months (P = 0.00014) in the absence of either screening modalities. In univariate analysis, histotype (P = 0.026), complex genomics (P = 0.008), number of prior lines (P0.001), prior anthracyclines (P0.001), number of metastatic sites (P = 0.003), liver metastasis (P0.001), lung metastasis (P0.001), absence of molecular or histology-driven screening (P0.001), first-in-human trials (P0.001), dose-escalation cohorts (P = 0.011), and Royal Marsden Hospital (RMH) score1 (P0.001) were significantly associated with shorter PFS. In multivariate analysis, independent prognostic factors for shorter PFS were myxoid liposarcoma (P = 0.031), ≥2 prior lines of treatment (P = 0.033), liver metastasis (P = 0.007), and RMH score2 (P = 0.006). Factors associated with improved PFS were leiomyosarcomas (P = 0.010), molecular screening (P = 0.025), and histology-driven screening (P = 0.010). The median overall survival rates were 36.3, 12.6, and 9.2 months in the first, second, and later lines, respectively (P = 0.0067). The grade 3-4 toxicity rate was 36%.Early phase trials provide an active therapeutic option for STS, even in first-line settings. Molecular screening and histology-driven trials further improve the clinical benefit.

BACKGROUND: Concurrent chemotherapy and thoracic radiotherapy followed by prophylactic cranial irradiation (PCI) is the standard treatment in limited-disease small-cell lung cancer (LD-SCLC), with 5-year overall survival (OS) of only 25% to 33%. PATIENTS AND METHODS: STIMULI is a 1:1 randomised phase II trial aiming to demonstrate superiority of consolidation combination immunotherapy versus observation after chemo-radiotherapy plus PCI (protocol amendment-1). Consolidation immunotherapy consisted of four cycles of nivolumab [1 mg/kg, every three weeks (Q3W)] plus ipilimumab (3 mg/kg, Q3W), followed by nivolumab monotherapy (240 mg, Q2W) for up to 12 months. Patient recruitment closed prematurely due to slow accrual and the statistical analyses plan was updated to address progression-free survival (PFS) as the only primary endpoint. RESULTS: Of the 222 patients enrolled, 153 were randomised (78: experimental; 75: observation). Among the randomised patients, median age was 62 years, 60% males, 34%/65% current/former smokers, 31%/66% performance status (PS) 0/1. Up to 25 May 2020 (median follow-up 22.4 months), 40 PFS events were observed in the experimental arm, with median PFS 10.7 months [95% confidence interval (CI) 7.0-not estimable (NE)] versus 42 events and median 14.5 months (8.2-NE) in the observation, hazard ratio (HR)= 1.02 (0.66-1.58), two-sided P= 0.93. With updated follow-up (03 June 2021; median: 35 months), median OS was not reached in the experimental arm, while it was 32.1 months (26.1-NE) in observation, with HR= 0.95 (0.59-1.52), P= 0.82. In the experimental arm, median time-to-treatment-discontinuation was only 1.7 months. CTCAE v4 grade =3 adverse events were experienced by 62% of patients in the experimental and 25% in the observation arm, with 4 and 1 fatal, respectively. CONCLUSIONS: The STIMULI trial did not meet its primary endpoint of improving PFS with nivolumab-ipilimumab consolidation after chemo-radiotherapy in LD-SCLC. A short period on active treatment related to toxicity and treatment discontinuation likely affected the efficacy results.

Resume Environ 30 % des cancers bronchiques non a petites cellules (CBNPC) presentent au diagnostic un stade III. Ce stade regroupe des maladies heterogenes en termes de presentation clinique initiale et de strategie therapeutique. Un staging initial optimal integrant une imagerie TEP et une imagerie cerebrale injectee est necessaire. Un bilan fonctionnel respiratoire doit etre realise systematiquement. La strategie therapeutique se decide en reunion de concertation pluridisciplinaire au sein d’une equipe experimentee et fait appel a plusieurs types de traitements. La chirurgie est une option envisageable dans certains stades IIIAN2 et doit alors etre systematiquement precedee d’un traitement neo adjuvant. La majorite des CBNPC de stade IIIB et IIIC releve d’une indication de radio-chimiotherapie. Un schema concomitant est a privilegier a un schema sequentiel. La chimiotherapie consiste en un doublet comprenant un sel de platine et doit etre debutee aussi tot que possible. Pour les patients ne pouvant beneficier d’une chimiotherapie concomitante une radiotherapie sequentielle selon un schema conventionnel ou hypofractionne, voire une chimiotherapie seule sont des alternatives envisageables. Apres radio-chimiotherapie, un traitement de consolidation par durvalumab, un inhibiteur des points de controle immunitaires, est actuellement un standard sur la base des resultats de l’essai PACIFIC.

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.

Resume Les cancers bronchiques non a petite cellules (CBNPC) de stade III regroupent des maladies heterogenes en termes de presentation clinique initiale et d’histologie. En cas d’envahissement ganglionnaire mediastinal minime, la chirurgie est une option soit d’emblee, soit apres traitement neoadjuvant par chimiotherapie a base de sels de platine. Si le patient a ete opere d’emblee et qu’il est de stade III, la chimiotherapie adjuvante est un standard. La radiotherapie post-operatoire est recommandee en cas de resection R1 ou R2 et se discute chez les patients pN2. Si le patient est inoperable, une chimiotherapie (2 a 4 cycles d’un doublet a base de platine) associee de facon concomitante a une radiotherapie (60-66 Gy en 6 semaines) est recommandee preferentiellement a un schema sequentiel. Recemment, l’essai PACIFIC a demontre le benefice en survie globale d’un an de consolidation par Durvalumab , apres radiochimiotherapie (en l’absence de progression). L’association de l’immunotherapie a la radiotherapie selon divers schemas est a l’etude. En cas de contre-indication a la chimiotherapie, des schemas de radiotherapie exclusive hypo ou hyperfractionnee acceleree peuvent etre proposes. La meilleure selection des patients, les ameliorations techniques de la radiotherapie conformationnelle (meilleure prise en compte des mouvements respiratoires, meilleur controle des incertitudes positionnelles, et radiotherapie avec modulation d’intensite permettant d’etendre indications de radiotherapie et de diminuer certaines toxicites) ainsi que l’implementation de l’imagerie metabolique dans les planifications des traitements ont egalement contribue a l’amelioration des resultats.

Purpose/Objective(s) NBTXR3, a novel radioenhancer activated by radiotherapy (RT) demonstrated superior efficacy, as preoperative treatment in patients with locally advanced soft tissue sarcoma (LA STS) compared to RT alone. Primary endpoint of pCR rate (16% vs 8%; P = 0.044) and main secondary endpoint of R0 margin rate (16% vs 8%; P = 0.042) were met while no modification of the early RT-associated safety profile was observed, leading to market authorization. Here we report on the long-term safety, limb function and quality of life. Materials/Methods This phase II/III randomized (1:1), international trial included adult patients with LA STS of the extremity or trunk wall, requiring preoperative RT. Patients received either a single intratumoral injection of NBTXR3 (equivalent to 10% of tumor volume, at 53.3g/L), plus EBRT (arm A) or EBRT alone (arm B) (50 Gy in 25 fractions), followed by surgery. Here we report on safety of NBTXR3+RT which was evaluated as secondary endpoint. Data were recorded on the “all treated population” during at least a two-year follow-up. Important parameters related to HR-QoL including functional outcome were studied using the EQ-5D, RNLI, TESS and MSTS questionnaires. Results Patients had at least two-year follow-up and the lost to follow-up rate was very low (1.9%). RT-related SAEs were observed in 11.2% (10/89) vs 13.3% (12/90) in A vs B. Post-treatment AEs, any grade, were observed in 51.7% (46/89) vs 57.8% (52/90) and serious post-treatment AEs in 13.5% (12/89) vs 24.4% (22/90) of patients in A vs B. Long-term safety continues to demonstrate that NBTXR3 plus RT has no impact on post-surgical wound complications (24.7% vs 36.7%, A vs B). Furthermore, the evaluation of radiation late toxicities in limbs such as fibrosis, arthrosis and edema that may alter limb function showed no difference between arms (4.5% vs 7.7%, 2.2% vs 0.0% and 6.7% vs 2.2% respectively in A vs B). In addition, sequelae or chronic tissue disturbances at the former tumor localization were similar in both treatment arms, confirming that the increase of energy dose deposit and the physical presence of NBTXR3 did not impact post-treatment limb functions. Accordingly, HR-QoL evaluation yielded no difference in functional outcome. Finally, second primary cancer was observed in 1 patient in arm A and 6 patients in arm B and the intratumoral injection of NBTXR3 did not induce cancer cell seeding at the former tumor site. Conclusion These results demonstrate that the use of NBTXR3 did not change the late onset toxicity profile of EBRT, nor modified its bystander effect. Taken together, the long-term safety data presented here, and the previously published efficacy data reinforce the favorable benefit-risk ratio of the use of NBTXR3 in patients with LA STS. NCT02379845

The purpose of this study was to compare efficacy and tolerance between radiofrequency ablation (RFA) and surgery for the treatment of oligometastatic lung disease.This retrospective study reviewed patients treated in two institutions for up to 5 pulmonary metastases with a maximal diameter of 4cm and without associated pleural involvement or thoracic lymphadenopathy. Patient demographics, tumor characteristics, treatment outcome, and length of hospital stay were compared between the two groups. Efficacy endpoints were overall survival (OS), progression-free survival (PFS) and pulmonary or local tumor progression rates.Among 204 patients identified, 78 patients (42 men, 36 women; mean age, 53.3±14.9 [SD]; age range: 15-81 years) were treated surgically, while 126 patients (59 men, 67 women; mean age, 62.2±10.8 [SD]; age range: 33-80 years) were treated by RFA. In the RFA cohort, patients were significantly older (P0.0001), with more extra-thoracic localisation (P=0.015) and bilateral tumour burden (P=0.0014). In comparison between surgery and RFA cohorts, respectively, the 1- and 3-year OS were 94.8 and 67.2% vs. 94 and 72.1% (P=0.46), the 1- and 3-year PFS were 49.4% and 26.1% vs. 38.9% and 14.8% (P=0.12), the pulmonary progression rates were 39.1% and 56% vs. 41.2% and 65.3% (P0.99), and the local tumour progression rates were 5.4% and 10.6% vs. 4.8% and 18.6% (P=0.07). Tumour size2cm was associated with a significantly higher local tumor progression in the RFA group (P=0.010). Hospitalisation stay was significantly shorter in the RFA group (median of 3 days; IQR=2 days; range: 2-12 days) than in the surgery group (median of 9 days; IQR=2 days; range: 6-21 days) (P0.01).RFA should be considered a minimally-invasive alternative with similar OS and PFS to surgery in the treatment of solitary or multiple lung metastases measuring less than 4cm in diameter without associated pleural involvement or thoracic lymphadenopathy.

Background: Brain metastases (BM) are common in patients with small cell lung cancer (SCLC). In recent years, the role of whole brain radiotherapy (WBRT) for brain metastases in lung cancer is being reevaluated, especially in the context of new systemic treatments available for SCLC. With this analysis, we investigate decision-making in SCLC patients with BM among European experts in medical oncology and radiation oncology.Methods: We analyzed decision-making from 13 medical oncologists (selected by IASLC) and 13 radiation oncologists (selected by ESTRO) specialized in SCLC. Management strategies of individual experts were converted into decision trees and analyzed for consensus.Results and conclusion: In asymptomatic patients, chemotherapy alone is the most commonly recommended first line treatment. In asymptomatic patients with limited volume of brain metastases, a higher preference for chemotherapy without WBRT among medical oncologists compared to radiation oncologists was observed.For symptomatic patients, WBRT followed by chemotherapy was recommended most commonly. For limited extent of BM in symptomatic patients, some experts chose stereotactic radiotherapy as an alternative to WBRT.Significant variation in clinical decision-making was observed among European SCLC experts for the first line treatment of patients with SCLC and BM. (C) 2020 Published by Elsevier B.V.

Resume Environ un quart des cancers bronchiques non a petite cellules (CBNPC) presentent au diagnostic un stade localement avance (III). Ce stade regroupe des maladies heterogenes en terme de presentation clinique initiale (tumeurs localement avancees T4 et/ou atteinte ganglionnaire mediastinale controlaterale N3) et d’histologie. Un staging initial optimal integrant une imagerie TEP et une imagerie cerebrale injectee est necessaire. Des EFR sont a realiser systematiquement des lors qu’un geste chirurgical est envisageable mais egalement prealablement a la realisation de la radiotherapie. La strategie therapeutique se decide en reunion de concertation pluridisciplinaire au sein d’une equipe experimentee. La chirurgie est une option envisageable dans certains stades T4 et est en general precedee d’un traitement neo adjuvant. La majorite des CBNPC de stade IIIB et IIIC releve d’une indication de radiochimiotherapie, un schema concomitant est a privilegier a un schema sequentiel si l’etat general du patient le permet. La chimiotherapie consiste en un doublet comprenant un sel de platine et doit etre debutee aussi tot que possible. Pour les patients ne pouvant beneficier d’une chimiotherapie concomitante, une radiotherapie sequentielle selon un schema conventionnel ou hypofractionne, voire une chimiotherapie seule sont des alternatives envisageables a discuter. Un traitement de consolidation apres radiochimiotherapie par durvalumab, un inhibiteur des checkpoint immunitaires deviendra probablement un standard sur la base des resultats de l’essai PACIFIC.

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.

Introduction La radiotherapie post-operatoire (RPO) est un sujet de discussion depuis la meta-analyse montrant que la RPO pouvait etre deletere en particulier chez les patients (pts) pN0 et pN1. Cependant, la question restait ouverte pour les pts pN2, d’autant que de nombreux changements ont eu lieu dans la prise en charge des pts traites pour un carcinome bronchique non a petites cellules (CBNPC) de stade IIIAN2. Methodes Lung ART est un essai de phase III randomise europeen comparant une RPO mediastinale (54 Gy/27–30 fractions) a l’absence de RPO. Les pts etaient eligibles s’ils etaient PS 0-2, avaient une resection complete avec exploration nodale, une maladie N2 averee; la CT (neo) adjuvante etait autorisee. Le critere principal etait la survie sans maladie (DFS). Les criteres d’evaluation secondaires comprenaient la toxicite, le controle local, les modalites de rechute, la survie globale (SG), et les seconds cancers. Resultats Entre aout 2007 et juillet 2018, 501 patients ont ete randomises apres chirurgie ou apres CT adjuvante, dont 427 dans IFCT-0503: 252 pts ont ete alloues au bras RPO, et 244 pts au bras temoin. L’âge median etait de 61 ans (intervalle = 36–85), 66 % d’hommes, adenocarcinome (73 %). La plupart des pts ont recu une CT (post-operatoire 77 %, pre-operatoire 18 %). Le suivi median est de 4,8 ans. La compliance en terme de RPO etait bonne: 7 pts l’ont interrompu. Une toxicite cardio-pulmonaire tardive de grade 3-5 a ete rapportee chez 47 pts (19,5 %) dans le bras RPO vs 19 (7,7 %) dans le bras controle: il n’y avait pas de difference en ce qui concerne les toxicites de grade 5. Le «Hasard Ratio (HR))» pour la DFS etait de 0,847 (IC a 95 % 0,67; 1,07); p = 0,156; la DFS mediane etait de 30,5 mois dans le bras RPO [24; 48] et de 22,8 mois dans le bras controle [17; 37]; La DFS a 3 ans etait de 47,11 % avec la RPO contre 43,8 % sans RPO. Le risque de rechute mediastinale est reduit de pres de moitie avec la RPO (46 % dans le bras controle versus 25 % dans le bras RPO). Le taux de SG a 3 ans etait de 66,48 % avec PORT contre 68,53 % sans PORT. Conclusion Lung ART est la premiere etude randomisee europeenne evaluant une RPO 3D apres resection complete, chez des patients selectionnes principalement par TEP et ayant recu une CT (neo) adjuvante. Le taux de DFS a 3 ans etait plus eleve que prevu dans les deux bras et la RPO etait associee a une augmentation non statistiquement significative de 15 % de la DFS parmi les pts operes de facon complete d’un CPNPC de stade IIIAN2.

Resume Les cancers bronchiques non a petite cellules (CBNPC) de stade III regroupent des maladies heterogenes en termes de presentation clinique initiale et d’histologie. En cas d’envahissement ganglionnaire mediastinal minime, la chirurgie est une option soit d’emblee, soit apres traitement neoadjuvant par chimiotherapie a base de sels de platine. Si le patient a ete opere d’emblee et qu’il est de stade III, la chimiotherapie adjuvante est un standard. La radiotherapie post-operatoire est recommandee en cas de resection R1 ou R2, mais l’evidence recente n’a pas pu demontrer un benefice en termes de survie globale pour les patients pN2. Si le patient est inoperable, une chimiotherapie (2 a 4 cycles d’un doublet a base de platine) associee de facon concomitante a une radiotherapie (60-66 Gy en 6 semaines) est recommandee preferentiellement a un schema sequentiel. Recemment, l’essai PACIFIC a demontre le benefice en survie globale d’un an de consolidation par Durvalumab, apres radiochimiotherapie (en l’absence de progression). L’association de l’immunotherapie a la radiotherapie selon divers schemas est a l’etude. En cas de contre-indication a la chimiotherapie, des schemas de radiotherapie exclusive hypo ou hyperfractionnee acceleree peuvent etre proposes. La meilleure selection des patients, les ameliorations techniques de la radiotherapie conformationnelle (la meilleure prise en compte des mouvements respiratoires, le meilleur controle des incertitudes positionnelles, et la modulation d’intensite permettent d’etendre les indications de radiotherapie et de diminuer certaines toxicites) ainsi que l’implementation de l’imagerie metabolique dans les planifications des traitements ont egalement contribue a l’amelioration des resultats. © 2021 SPLF. Publie par Elsevier Masson SAS. Tous droits reserves.

Resume Les cancers bronchiques a petites cellules (CBPC) representent environ 13 % des cancers bronchiques. Avec une incidence en baisse ces vingt dernieres annees, le CBPC reste un cancer au pronostic particulierement sombre du fait notamment d’un temps de doublement court qui explique la presentation metastatique dans pres de deux tiers des cas au diagnostic. Si la chimiotherapie reste la pierre angulaire du traitement des CBPC, depuis les annees 1980 la radiotherapie a pris une place croissante dans la prise en charge multidisciplinaire. Le traitement des formes localisees (stade I a III) repose sur l’association radiochimiotherapie. Si l’association concomitante de la radiotherapie et de la chimiotherapie fait aujourd’hui consensus, des questions demeurent concernant la dose optimale, le fractionnement et le traitement systemique a associer a la radiotherapie. Le traitement des formes metastatiques repose essentiellement sur une poly-chimiotherapie a base de sels de platine et d’etoposide. Le benefice d’un traitement local de la maladie intrathoracique au stade metastatique par l’irradiation thoracique de consolidation semble se preciser mais necessite des etudes de confirmation. L’irradiation prophylactique cerebrale (IPC) reste un standard dans les formes localisees chez les bons repondeurs mais sa place est plus controversee dans les stades metastatiques.

Background The recent identification of molecular alterations in some lung adenocarcinomas has led to the emergence of effective targeted therapies thus drastically improving their prognosis.The aim of our study was to investigate the association between driver oncogene alterations and metastatic patterns on imaging assessment, in a large cohort of metastatic lung adenocarcinoma patients. Methods From January 2010 to May 2017, 656 patients with stage IV lung adenocarcinoma with molecular analysis were studied retrospectively including 135 EGFR, 81 ALK, 47 BRAF, 141 KRAS, and 146 negative tumors for these 4 mutations (4N). After review of the complete imaging report by two radiologists (junior and senior) to identify metastatic sites, univariate correlation analyzes were performed. Results We found differences in metastatic tropism depending on the molecular alteration type when compared to the non-mutated 4N group: in the EGFR group, pleural metastases were more frequent (32% versus 20%; p = 0.021), and adrenal and node metastases less common (6% versus 23%; p Conclusions The application of these correlations between molecular status and metastatic tropism in clinical practice may lead to earlier and more accurate identification of patients for targeted therapy, savings in iterative biopsies, as well as improved and personalized imaging interpretation. Legal entity responsible for the study Alison Dormieux. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

International audience; BackgroundNETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry.Patients and methodsPatients’ characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N = 35 784) and in the subgroup of incident patient population (N = 29 497).ResultsAmong the 35 784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li–Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29 497 incident patients, 25 851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS [P

International audience; Lung cancer is the leading cause of cancer-related mortality and more than half of the cases are diagnosed at a metastatic stage. Major progress in terms of systemic treatments has been achieved in recent decades. Access to new anti-PD-(L) 1 immunotherapies and targeted therapies for non-small cell lung cancer (NSCLC) with oncogenic addiction such as EGFR mutation or ALK rearrangement have led to improved outcomes. Patients with limited progression of their disease during systemic treatment may be a particular subgroup. This oligoprogressive state is characterized by a limited number of sites in progression, implying that the other sites remain controlled and therefore sensitive to systemic treatments. The advent of non-invasive techniques such as stereotactic radiotherapy, radiofrequency, and mini-invasive surgery has led to a precise re-evaluation of local ablative treatments in this situation. Local treatment of the oligoprogressive lesion(s) may allow modification of the natural history of the disease, maintenance of effective systemic targeted treatment and, ultimately, to improved survival. Data validating an aggressive local therapeutic approach in oligoprogressive NSCLC patients are currently limited and essentially retrospective. Several international trials are underway that could confirm the clinical benefit of radical local treatment in oligoprogressive advanced NSCLC patients.

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.

Purpose The purpose of this study was to evaluate, during a national workshop, the inter-observer variability in target volume delineation for primary extremity soft tissue sarcoma radiation therapy. Methods and materials Six expert sarcoma radiation oncologists (members of French Sarcoma Group) received two extremity soft tissue sarcoma radiation therapy cases 1: one preoperative and one postoperative. They were distributed with instructions for contouring gross tumour volume or reconstructed gross tumour volume, clinical target volume and to propose a planning target volume. The preoperative radiation therapy case was a patient with a grade 1 extraskeletal myxoid chondrosarcoma of the thigh. The postoperative case was a patient with a grade 3 pleomorphic undifferentiated sarcoma of the thigh. Contour agreement analysis was performed using kappa statistics. Results For the preoperative case, contouring agreement regarding GTV, gross tumour volume GTV, clinical target volume and planning target volume were substantial (kappa between 0.68 and 0.77). In the postoperative case, the agreement was only fair for reconstructed gross tumour volume (kappa: 0.38) but moderate for clinical target volume and planning target volume (kappa: 0.42). During the workshop discussion, consensus was reached on most of the contour divergences especially clinical target volume longitudinal extension. The determination of a limited cutaneous cover was also discussed. Conclusion Accurate delineation of target volume appears to be a crucial element to ensure multicenter clinical trial quality assessment, reproducibility and homogeneity in delivering RT. radiation therapy RT. Quality assessment process should be proposed in this setting. We have shown in our study that preoperative radiation therapy of extremity soft tissue sarcoma has less inter-observer contouring variability.