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The place of personalized treatments is highly increasing in medical and radiation oncology. During the last decades, a huge number of assays have been developed to predict responses of normal tissues and tumours. These tests have not yet been included into daily clinical practice but the recent developments of radiation oncology are paving the way of personalized strategies including the risk of tumour recurrence and normal tissue reactions. Concerning tumor radiosensitivity prediction, no test are currently used, even if the radiosensitivity index and the genome-based model for adjusting radiotherapy dose assays seem the most promising with level II of evidence. Commercial developments are under progress. Concerning normal tissue radiosensitivity prediction, single nucleotide polymorphims of prostate cancer patients and radiation-induced CD8 T-lymphocyte apoptosis breast and prostate assays are of level I of evidence. They can be proposed before the beginning of radiotherapy in order to propose personalized treatments according to both risks of tumour and normal tissue radiosensitivity. Commercial developments are also under way.

The purpose of the first two editions of the guidelines for external radiotherapy procedures, published in 2007 and 2016 respectively, was to issue recommendations aimed at optimising, harmonising and standardising practices. The purpose of this third edition, which includes brachytherapy, is identical while also taking into account recent technological improvements (intensity modulation radiation therapy, stereotactic radiotherapy, and three-dimension brachytherapy) along with findings from literature. Part one describes the daily use of general principles (quality, security, image-guided radiation therapy); part two describes each treatment step for the main types of cancer.

The purpose of this article is to give a summary of the progress of magnetic resonance imaging (MRI) in radiotherapy. MRI is an important imaging modality for treatment planning in radiotherapy. However, the registration step with the simulation scanner can be a source of errors, motivating the implementation of all-MRI simulation methods and new accelerators coupled with on-board MRI. First, practical MRI imaging for radiotherapy is detailed, but also the importance of a coherent imaging workflow incorporating all imaging modalities. Second, future evolutions and research domains such as quantitative imaging biomarkers, MRI-only pseudo computed tomography and radiomics are discussed. Finally, the application of MRI during radiotherapy treatment is reviewed: the use of MR-linear accelerators. MRI is increasingly integrated into radiotherapy. Advances in diagnostic imaging can thus benefit radiotherapy, but specific radiotherapy constraints lead to additional challenges and require close collaboration between radiologists, radiation oncologists, technologists and physicists. The integration of quantitative imaging biomarkers in the radiotherapy process will result in mutual benefit for diagnostic imaging and radiotherapy. MRI-guided radiotherapy has already been used for several years in clinical routine. Abdominopelvic neoplasias (pancreas, liver, prostate) are the preferred locations for treatment because of their favourable contrast in MRI, their movement during irradiation and their proximity to organs at risk of radiation exposure, making the tracking and daily adaptation of the plan essential. MRI has emerged as an increasingly necessary imaging modality for radiotherapy planning. Inclusion of patients in clinical trials evaluating new MRI-guided radiotherapy techniques and associated quantitative imaging biomarkers will be necessary to assess the benefits.

The incidence of primary hepatic tumours is increasing and the reference treatments by liver transplantation or surgical resection do not allow to compensate for this increase because of the lack of grafts, or the low proportion of initially resectable tumours. The challenges for radiotherapy of primary liver tumors are multiple: physical, biological, medical and technological. Liver stereotactic body radiotherapy is sometimes the only local treatment option and is progressively finding its place for these tumors, even if the recognition of the indications would deserve a better standardization of international recommendations. The heterogeneity of practices and techniques is a major obstacle to the development of randomized studies, despite the excellent oncological results published. The latest ASTRO 2022 guidelines, the recent publication of the guidelines from the French society for radiation oncology on external radiotherapy and brachytherapy procedures ("RecoRad™ 2.0"), and the inclusion in prospective clinical trials will help to homogenize protocols and improve recognition of the technique. The first data from the new techniques of adaptive radiotherapy and MR-guided radiotherapy, whose objectives are to improve targeting and reduce liver or gastrointestinal toxicity, confirm the excellent results of liver SBRT and allow the potential indications to be extended to locations that were previously difficult to treat.

Summary Purpose The intermediate-risk (IR) prostate cancer (PCa) group is heterogeneous in terms of prognosis. For unfavorable or favorable IR PCa treated by radiotherapy, the optimal strategy remains to be defined. In routine practice, the physician's decision to propose hormonal therapy (HT) is controversial. The PROACT survey aimed to evaluate pattern and preferences of daily practice in France in this IR population. Materials and methods A web questionnaire was distributed to French radiotherapy members of 91 centers of the Groupe d’Etude des Tumeurs Uro-Genitales (GETUG). The questionnaire included four sections concerning: (i) the specialists who prescribe treatments and multidisciplinary decisions (MTD) validation; (ii) the definition of IR subsets of patients; (iii) radiotherapy parameters; (iv) the pattern of practice regarding cardiovascular (CV) and (iv) metabolic evaluation. A descriptive presentation of the results was used. Results Among the 82 responses (90% of the centers), HT schedules and irradiation techniques were validated by specific board meetings in 54% and 45% of the centers, respectively. Three-fourths (76%) of the centers identified a subset of IR patients for a dedicated strategy. The majority of centers consider PSA > 15 (77%) and/or Gleason 7 (4 + 3) (87%) for an unfavorable IR definition. Overall, 41% of the centers performed systematically a CV evaluation before HT prescription while 61% consider only CV history/status in defining the type of HT. LHRH agonists are more frequently prescribed in both favorable (70%) and unfavorable (98%) IR patients. Finally, weight (80%), metabolic profile (70%) and CV status (77%) of patients are considered for follow-up under HT. Conclusion To the best of our knowledge, this is the first survey on HT practice in IR PCa. The PROACT survey indicates that three-quarters of the respondents identify subsets of IR-patients in tailoring therapy. The CV status of the patient is considered in guiding the HT decision, its duration and type of drug.

The French Society of Young Radiation Oncologists (SFjRO), the National Union of Radiation Oncologists (SNRO) and the French Society of Oncological Radiotherapy (SFRO) aim to reconcile career opportunities and demographic needs in oncology. In 2021, 932 radiation oncologists (RO) are in regular activity in France, this represents an increase of more than 20% in ten years. Physician distribution is changing in public hospitals, cancer centers and private clinics. Currently one third of ROs works in each sector. In addition, fifteen percent of ROs have a mixed activity. In 2021, 180 young RO (trainees and residents) were questioned by SFjRO board about their training, internship, coaching and career guidance. An interactive communication was organized during the 32nd SFRO Meeting in 2021. It was an opportunity to bring the results of this study. More than 70% RO interviewed answered to the survey, for 55% among them, career choice was difficult. In order to help young ROs in their professional approach, three RO made an oral presentation during this session, about radiotherapy in public hospitals, private centers or with a mixed practice. The aim of this article is to summarize the highlights of the last SFjRO/SFRO session: expectations of young RO, career prospects and trends.

The purpose of this article is to describe the external irradiation process and updated recommendations of the French society for radiation oncology for patient follow-up.

The aim of this review is to present the specificities of clinical research in radiation oncology. Objectives are similar to all research in oncology: to improve the efficacy and to decrease toxic effects. Phase III trials remain the main methodology to demonstrate an improvement in efficiency, but phase I-II and registers are also important tools to validate an improvement in the therapeutic index with new technologies. In this article we discuss the special features of end-points, selection of population, and design for radiation oncology clinical trials. Quality control of delivered treatments is an important component of these protocols. Financial issues are also discussed, in the particular context of France.

The literature review shows a low adhesion of urologists to the recommendations of learned societies in the imaging work-up of localized prostate cancer (CaP), especially for low and intermediate risks of the D'Amico classification. We analyzed the adhesion of urologists in the Hérault region (France) to the CCAFU 2016/2018, 2018/2020 recommendations.From the Hérault Onco Urology Registry (RHESOU) database, we identified localized CaP diagnosed between 01/01/2017 and 31/12/2019, and then classified them into 3 distinct risk groups according to the D'Amico classification. We compared the imaging workup performed by each patient to the CCAFU 2016/2018, 2018/2020 recommendations, according to the risk group.Of the 2,049 localized CaPs included in our study, 591 belonged to the low-risk group, 1059 to the intermediate-risk group, and 399 to the high-risk group. In the low-risk group 45.2% of the cases did not follow the CCAFU 2016/2018, 2018/2020 recommendations in the imaging workup, 77.3% in the intermediate-risk group and 80.9% in the high-risk group. For our entire study, 1,408 patients (68.7%) had an imaging workup that did not follow the CCAFU recommendations.Our results show a low adhesion of urologists to the CCAFU recommendations in the imaging assessment of localized CaP. The causes of this non-adhesion are multifactorial and difficult to analyze.

The ambition of the RADIOTRANSNET network, launched by the INCa at the end of 2018, is to create a French research consortium dedicated to preclinical radiotherapy to foster scientific and clinical interactions at the interface of radiotherapy and radiobiology, and to identify research priorities dedicated to innovation in radiotherapy. The activities of the network are organized around four major axes that are target definition, normal tissue, combined treatments and dose modelling. Under the supervision of the Scientific Council, headed by a coordinator designated by the SFRO and a co-coordinator designated by the SFPM, three leaders coordinate each axis: a radiation-oncologist, a medical physicist and a biologist, who are responsible for organizing a scientific meeting based on the consensus conference methodology to identify priority issues. The selected themes will be the basis for the establishment of a strategic research agenda and a roadmap to help coordinate national basic and translational research efforts in oncological radiotherapy. This work will be published and will be transmitted to the funding institutions and bodies with the aim of opening dedicated calls to finance the necessary human and technical resources. Structuration of a preclinical research network will allow coordinating the efforts of all the actors in the field and thus promoting innovation in radiotherapy.

Resume Objectif L’objectif de cette etude est de presenter l’evolution de l’epidemiologie du cancer du rein dans l’Herault a partir des donnees collectees par le registre des tumeurs de l’Herault (RTH) sur une periode de 30 ans. Materiels et methodes A partir de la base de donnees du RTH, nous avons etudie l’evolution du cancer du rein de 1987 a 2016. Nous avons analyse les donnees concernant l’incidence, la mortalite, l’anatomopathologie des tumeurs et leur stade au diagnostic. Nous avons compare ces resultats aux donnees nationales et internationales. Resultats Nous avons recense 3769 nouveaux cas de cancers du rein: 2628 chez l’homme (69,7 %) et 1141 chez la femme (30,3 %). En 2016, le cancer du rein etait le 8e cancer tous sexes confondus, le 7e cancer chez l’homme et le 11e chez la femme. Entre 1987 et 2016 le nombre de nouveaux cas de cancer du rein a ete multiplie par 4,2 chez l’homme et par 3,3 chez la femme. Le nombre de formes localisees a augmente de 9 % en 20 ans. En 2016 la probabilite, d’etre atteint d’un cancer du rein avant 75 ans est de 2,11 % pour un homme et de 0,62 % pour une femme. Conclusion En 30 ans, l’incidence du cancer du rein a fortement augmente dans l’Herault alors que l’on observe une diminution de sa mortalite. Ces donnees analytiques seront ameliorees par le developpement du Registre de l’Herault Specialise en Onco Urologie (RHESOU) Niveau de preuve 3.

Introduction et but de l’etude La radiotherapie externe peut etre a l’origine de nombreuses toxicites selon les parametres dosimetriques, les traitements associes ou la radiosensibilite intrinseque des patients. La revue de morbimortalite est un processus de veille sanitaire visant a detecter, evaluer, rechercher la cause et traiter les toxicites radio-induites. Contrairement a d’autres specialites, la revue de morbimortalite n’est que rarement implementee en radiotherapie. L’objectif du projet « Proust » est de faire un etat des lieux et de promouvoir l’implementation homogene des revues de morbimortalite dans les services en France selon un cahier des charges precis et de creer une base de donnees prospective nationale des donnees de suivi de la toxicite et leur relation potentielle avec une radiosensibilite intrinseque accrue demontree par des tests specifiques. Materiel et methodes Suite a des visites sur sites par notre equipe de revue de morbimortalite, une procedure de « revue de morbimortalite ideale » a ete redigee et validee par cinq centres pilotes. Entre octobre 2016 et mars 2020, huit revues de morbimortalite semestrielles ont eu lieu dans notre service, composees au minimum d’un representant de chaque metier. La declaration des dossiers en revue de morbimortalite se fait apres constatation d’une toxicite de grade superieur ou egal a 2 (selon l’echelle de toxicite CTC NCI 4), anormale et/ou persistante au-dela de 3 mois. Les expertises sont assurees par un binome medecin–physicien, n’ayant pas interfere dans la prise en charge initiale du patient. Une conclusion explicite sur la relation potentielle entre la toxicite et une erreur eventuelle dans le processus de prise en charge est exposee lors de la revue de morbimortalite. Dans le projet Proust, la radiosensibilite intrinseque sera evaluee par l’un des deux tests disponibles developpes en France (culture fibroblastique et apoptose lymphocytaire). Resultats et analyse statistique Entre 2016 et 2020, 74 dossiers ont ete presentes en revue de morbimortalite. Les cas de toxicite rapportes etaient en majorite des rectites (27 %), cystites (25,7 %) et toxicite cutanee (17,6 %). La plupart etaient de grade 2 (45,9 %) et de grade 3 (36,5 %), quatre de grade 4 (soit 5,4 %) et trois (soit 4,1 %) de grade 5 (deces). Soixante dossiers ont ete clos des la premiere revue de morbimortalite (80 %) ; pour la plupart la cause ayant ete identifiee et la toxicite prise en charge. Treize patients sur 74 se sont vus presenter un test de radiosensibilite intrinseque dans la cadre du projet Proust. Conclusion Une methodologie rigoureuse d’organisation des revues de morbimortalite est necessaire afin d’aboutir a une implementation homogene et massive de ces processus en France, comme pour les comites de retour d’experience. Dans notre bilan preliminaire, malgre la « sortie » de leur dossier de la revue de morbimortalite du fait de la regression des symptomes il a ete possible de rassurer les patients sur l’absence de relation entre la toxicite et une erreur potentielle dans leur prise en charge. Comme pour les 13 malades de notre serie, Proust prevoit d’inclure 300 patients qui se verront proposer un test biologique pour evaluer la relation potentielle entre la toxicite inexpliquee par l’expertise du dossier et une radiosensibilite intrinseque elevee.

Objectifs Le registre des tumeurs de l’Herault (RTH) est un registre general qualifie par le comite national des registres depuis 1987. L’objectif de cette etude est de presenter l’evolution de l’epidemiologie du cancer de la vessie dans le departement de l’Herault a partir des donnees collectees par le RTH sur une periode de 30 ans. Methodes A partir de la base de donnees du RTH, nous avons etudie l’incidence, les taux d’incidence standardises sur la population mondiale (TSM), la frequence relative, le sex-ratio, l’âge moyen au diagnostic, les donnees anatomopathologiques et les primo-traitements pour toutes les tumeurs de la vessie ≥ T1 dans la population de l’Herault entre 1987 et 2016. Les donnees de mortalite proviennent du service SC8 de l’INSERM (CepiDC). Nous avons compare ces resultats aux donnees nationales et internationales. Les estimations francaises proviennent des donnees FRANCIM et les donnees mondiales des registres sont regroupees par le Centre international de recherche sur le cancer (CIRC), situe a Lyon. Resultats Les TSM du cancer de la vessie pour 100 000 sont passes de 11,1 en 1987–1988 (21 hommes, 3,1 femmes) a 8,2 en 2015–2016 (15,2 hommes, 2,5 femmes). Sur 30 ans, le RTH a recense 5580 cas et 2718 deces. Le rapport mortalite/incidence etait de 48,7 % (45,9 % chez l’homme, 62,1 % chez la femme) et le sex-ratio etait de 4,7 hommes pour une femme. En 2016, il etait le 7e cancer dans l’Herault (5e chez l’homme). Les carcinomes urotheliaux representaient 91,7 % des cancers. En 2016, l’âge moyen au diagnostic etait de 74,8 ans (74,2 ans chez l’homme, 76,9 ans chez la femme) et la probabilite d’avoir un cancer de la vessie avant l’âge de 75 ans etait de 1,81 % pour un homme (1/55) et 0,26 % pour une femme (1/382) ( Fig. 1 ). Discussion L’incidence des tumeurs de la vessie a faiblement diminue chez l’homme dans l’Herault. Les registres ne recueillent que les tumeurs ≥ T1, ce qui differe des recommandations cliniques. En 2018, le Registre de l’Herault Specialise en Onco-Urologie (RHESOU) a vu le jour, dans le but d’apporter plus de coherence entre les donnees epidemiologiques et la pratique clinique actuelle. Conclusion L’incidence des tumeurs de la vessie a faiblement diminue chez l’homme dans l’Herault. Les registres ne recueillent que les tumeurs ≥ T1, ce qui differe des recommandations cliniques. En 2018, le Registre de l’Herault Specialise en Onco-Urologie (RHESOU) a vu le jour, dans le but d’apporter plus de coherence entre les donnees epidemiologiques et la pratique clinique actuelle.

The objective of this study is to present the history of cancers of the external genital organs of male in Hérault using data from the Hérault tumor register (RTH) over a period of 30 years.Using the RTH database, we studied the development of testicular germ cell tumors (TGCT) and penile cancer (PC) over 30 years, from 1987 to 2016. We analyzed the incidence and mortality data for these tumors. We compared these results to French, European and global data.In 30 years of registration we have recorded 725 cases of TGCT and 175 cases of PC. The age standardized incidence rate (ASR) of TGCT has doubled between 1987 and 2016 (4.2 per 100,000 in 1987 and 9.3 per 100,000 in 2016). It was multiplied by 2.63 in the population of patients aged 30 to 44. There is a decrease of the mortality rate with a ASR of 0.8 deaths per 100,000 in 1987, and 0.4/100 000 in 2016. The PC incidence ASR was stable between 1987 and 2016 (0.4-0.9/100,000). Mortality is stable with a ASR between 0.1 and 0.3 deaths per 100,000 between 1987 and 2016.The incidence of TGCT has increased sharply in the Hérault over the past 30 years, while a decrease in mortality has been observed. The proportion of seminomas is increasing; it has gone from 53 % to 60 % in 30 years in the Hérault. The incidence and mortality of PC shows a stability in the Hérault over the past 30 years.

The objective of the study was to determine the specificities of renal cell carcinoma (RCC) in the department of Herault using the Herault Tumor Registry over 30 years.Data of this study were obtained from the Herault cancer database. We analysed the evolution of RCC from 1987 to 2016, including the incidence, mortality, cancer pathology and staging at the moment of diagnosis. We compared our results with national and international data.We identified 3769 newly diagnosed RCC: 2628 in men (69,7%) and 1141 in women (30,3%). In 2016, RCC was the 8th most frequent cancer, both genders combined, the 7th most frequent cancer in men and the 11th in women. New cases of RCC increased by 4.2 in men and 3.3 in women over the study period. The number of localised forms increased by 9% over 20 years. In 2016, the probability of having a RCC before the age of 75 was of 2.11% for a man and of 0.62% for a woman.Over 30 years, the incidence rate of RCC increased in the department of Herault; however, mortality decreased over the same period. This analytical data should be improved by the development of the Registry of Herault Specialised in Onco-Urology (RHESOU).3.

To evaluate our long-term experience on one-day breast intraoperative radiotherapy (IORT) given as sole radiation treatment to selected patients with breast cancer.Inclusion criteria of INTRAOBS study (prospective observational study) were: ER+ T1N0 unifocal ductal carcinoma; absence of lymphovascular invasion or of extensive intraductal component (Scarff-Bloom-Richardson grade III and HER2+++ excluded). Two different linacs were used (20Gy/1 fraction): one dedicated electron linac (October 2011), and afterwards a mobile linac (50kV photons). The primary endpoint was the local recurrence rate (=ipsilateral breast cancer recurrences number). Secondary endpoints were recurrence-free survival (RFS), overall and specific survival, cosmetic results, and patient satisfaction.Of the present pre-planned analysis for the first 200 patients (median age: 68 years; range, 59-87 years) who received IORT between January 2010 and October 2014 (median follow-up of 53.4 months). A total of 193 patients were still alive. The local recurrence rate was 2.5% (n=5). The 1- and 5-year local RFS rates were 100% and 95.2%, respectively. At 12 months post-surgery, satisfaction about IORT was excellent for 86.9% of patients. Cosmetic results were considered by patients and physicians as good or very good in 89.4% and 97.3% of cases, respectively.IORT for selected patients with breast cancer shows low recurrence rates, good cosmetic outcomes and excellent satisfaction.

Overall treatment time is an important factor of local recurrence and indirectly of distant evolution, namely in case of protracted treatments. The current pandemic impacts on the duration of radiotherapy if patients under treatments and synchronously suffering from COVID-19. The models used to compensate the total dose in case of temporary treatment interruption are well known but it is of importance in that pandemic context to update and homogenize clinical practice in order to improve local control without increasing normal tissue complications.

Purpose/Objective(s) Magnetic resonance imaging guided radiotherapy (MRgRT) offers the ability of daily treatment adaptation: a game changer for various cancers. Contouring of organs at risk (OAR) during adaptation is time-consuming and lacks reproducibility across physicians, hampering the accuracy of high precision MRgRT and diminishing its adoption potential. Artificial intelligence (AI) can accelerate and homogenize OAR delineation. This study aims at (i) assessing the reproducibility of clinicians OAR delineation, (ii) comparing the precision between clinical experts (CEs) and AI based contours (AC) and (iii) evaluating the clinical benefit of AI tools for treatment standardization. Materials/Methods For the case of low field abdominal MR-based daily treatment adaptation, transfer learning was applied on a CE/FDA-cleared deep learning solution. Models were re-trained using 270 retrospectively selected annotated fractions samples treated with a MR-LINAC at two European cancer care excellence centers. Validation was performed using 2 cohorts of (i) 15 double-blindly annotated patients and (ii) a random 50/50 mix of 30 CEs and AI based annotations. Contours of 8 OARs (right/left kidneys, stomach, liver, duodenum, inferior vena cava, bowel and, abdominal aorta) were scored by 3 CEs as A/ acceptable, B/ acceptable after minor corrections, and C/not acceptable. Results The average interobserver variability among the 8 OARs in terms of DICE score coefficient (DSC) was 84.38% with the highest and lowest scores being observed for stomach (95%) and bowel (68%), respectively. The average DSC between CEs and AI annotations was 85.88% with the left/right kidneys (94%) and the duodenum/vena cava (76%) depicting the highest and lowest values, respectively. CE and AI produced annotations scored as A for 89.36% and 71.89% and were considered acceptable (A+B) for 100% and 92.49% of the cases, respectively. AI solutions seem to suffer in organs whit significant discrepancies across CEs for top and the bottom slices. Conclusion The results show that AI-driven contours are clinically useable in most cases. Disagreement between experts reflect the subjectivity of scoring. Objective metrics should be used in complement.

Background: Numerous studies have shown important impact of tumor-infiltrating lymphocytes (TILs) on natural or therapeutically-modified evolution of invasive breast cancer (IBC), however knowledge about TIL role in breast ductal carcinoma in situ (DCIS) is still limited. Because of the lack of reliable prognostic parameters, DCIS treatment is much less personalized than IBC therapy. BONBIS is a phase 3 French multicenter randomized trial designed to compare 2 schemes of adjuvant radiotherapy (adjRT) for DCIS (Azria et al, ASCO meeting 2011, TPS 131). It is accompanied by a translational study of DCIS pathobiology, aimed to discover predictive or prognostic biomarkers. Here we present results of TIL density (TIL-d) assessment, its correlation with pathobiology of the lesions and preliminary clues for further biomarker search in this DCIS cohort. Methods: Formalin-fixed, paraffin-embedded DCIS surgical specimens, obtained before adjRT, were prospectively collected and centrally reviewed for histology (architectural pattern, nuclear grade, proliferation, presence of necrosis), receptor status (ER, PR, HER2) and TIL-d. TIL-d was assessed on H&E-stained DCIS sections and reported as percentage of the DCIS specialized stroma area occupied by lymphocytes, lympho-plasmocytes and plasmocytes. Tumors were classified using the St Gallen 2011 criteria for IBC (PMID 21709140). For purpose of this study, the HER2+ category included all cases with HER2 protein expression scored 2+ and 3+, irrespective of the ERBB2 amplification status. Results: TIL-d was assessed in 495 cases, with distribution as follows: 0-4% TILs (D1): 85.5% (n=423); 5-9% TILs (D2): 9.3% (n=46); ≥10% TILs (D3): 5.2% (n=26). Molecular subclasses of those cases were: luminal A (LumA): 39% (n=192); luminal B (LumB): 25.5% (n=126), HER2+: 28.5% (n=141) and triple-negative (TN): 7% (n=33). TIL-d significantly correlated with molecular subclass: ≥5% TILs (D2) were found in 39.4% (13/33) TN, 22.7% (32/141) HER2+, 18.2% (23/126) LumB and only in 1% (2/192) LumA cases (p Citation Format: Bayol B, Tixier-Deves L, Dauplat M, Kwiatkowski F, Cayre A, Abrial C, Azria D, Penault-Llorca F, Radosevic-Robin N. Tumor-infiltrating lymphocytes in breast ductal carcinoma in situ: Correlations with tumor pathobiology in a French cohort of 495 cases (BONBIS) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-15-03.

Introduction Les carcinomes epidermoides cutanes avances (acSCC), des tumeurs dont la prise en charge curative par chirurgie ou radiotherapie n’est plus possible, touchent le plus frequemment des sujets âges, fragiles et polypathologiques peu representes dans les essais cliniques. L’immunotherapie a recemment ete recommandee dans cette indication. Materiel et methodes Objectif - Evaluer l’efficacite et la tolerance des anti-PD-1 dans la prise en charge des acSCC de la personne âgee et etudier cette population d’un point de vue oncogeriatrique. Methodes - Une etude retrospective multicentrique francaise incluant des patients de > 70 ans traites par cemiplimab, nivolumab ou pembrolizumab pour un acSCC avec possibilite de radiotherapie concomitante. Le critere de jugement principal etait le taux de reponse (ORR). Les criteres de jugements secondaires incluaient la duree avant reponse, la duree de la reponse, la survie globale (OS), la survie sans progression (PFS) et la tolerance. Resultats A la date de point (15/05/2020), 63 patients etaient inclus. L’ORR etait de 57,1% (IC95 % : 44,0–69,5), le temps median avant reponse de 3 mois et la duree moyenne de reponse de 5,5 mois. L’OS median n’etait pas atteint (IC95 % : 12,5 mois-non atteint), la PFS mediane etait de 8 mois (IC95 % : 5-non atteint) ; 87,3 % des patients presentaient des effets secondaires tous grades confondus et 47,6 % de grade 3–5 avec 5 deces possiblement imputables au traitement. Figure - effet du cemiplimab associe a une radiotherapie concomitante chez un patient de 73 ans presentant un carcinome epidermoide cutane du cuir chevelu metastatique : photo a baseline apres un traitement par carboplatine + 5-FU + cetuximab (gauche) ; apres 14 seances de radiotherapie pour un total de 30 Gy et 1 mois de cemiplimab (milieu) ; apres 3 mois de cemiplimab (droite). Discussion Conclusion–Les anti-PD-1 representent un traitement prometteur des acSCC mais sont greves d’une tolerance variable chez les patients âges. Un suivi oncogeriatrique specialise semble opportun, de meme que discuter de l’adjonction d’une radiotherapie concomitante.

Bladder dose constraints in case of conformational radiotherapy/intensity-modulated radiotherapy and stereotactic radiotherapy are reported from the literature, in particular from the French radiotherapy society RECORAD recommendations, according to the treated pelvic tumor sites. The dose-volume effect on urinary toxicity is not clearly demonstrated, making difficult to establish absolute dose constraints for the bladder. In case of high-dose prostate cancer radiotherapy, the bladder dose constraints are: V60Gy

International audience; ObjectifsLe registre des tumeurs de l’Hérault est un registre général qualifié par le comité national des registres depuis 1987. L’objectif de cette étude est de présenter l’évolution de l’épidémiologie des cancers testiculaires dans le département de l’Hérault à partir des données collectées par le registre des tumeurs de l’Hérault (RTH) sur une période de 30 ans.MéthodesÀ partir de la base de données du RTH, nous avons étudié l’évolution des tumeurs de la vessie de 1987 à 2016. Nous avons analysé les données concernant l’incidence, la mortalité, l’anatomopathologie des tumeurs et leur stade au diagnostic. Nous avons comparé ces résultats aux données nationales et internationales.RésultatsNous avons recensé 729 nouveaux cas de tumeur du testicule. Le taux standardisé sur la population mondiale (TSM) de l’incidence est passé de 4,6 en 1987 à 9 en 2016 pour 100 000, la mortalité de 0,6 à 0,2 pour 100 000 pour la même période. Le pic d’incidence se situe entre 30 et 35 ans.ConclusionEn 30 ans, l’incidence des tumeurs testiculaire à fortement augmenter dans l’Hérault, on observe une faible diminution de sa mortalité sur cette même période. Ces données analytiques seront améliorées par le développement du Registre de l’Hérault Spécialisé en onco-urologie (RHESOU).

Objectifs La radiotherapie adjuvante (aRT) reduit le risque de rechute biochimique chez les patients atteints d’un cancer de la prostate traites par une prostatectomie radicale (RP). L’etude GETUG-AFU 17 a compare l’efficacite et la toxicite de l’aRT par rapport a la radiotherapie de rattrapage precoce (sRT), associee a un traitement hormonal. Methodes Cette etude multicentrique, de phase III, randomisee et controlee, a ete realisee dans 46 centres francais. Les patients devaient etre âges de plus de 18 ans, avec un statut Eastern Cooperative Oncology Group ≤ 1, une maladie classee pT3-4 et marges positives, pNx ou pN0, avec PSA postoperatoire ≤ 0,1 ng/mL. Les patients ont ete randomises (par minimisation ; 1 : 1) apres RP, entre aRT ou observation avec sRT, combine avec 6 mois de triptoreline. Le critere principal etait la survie sans evenement (EFS). Les criteres d’evaluation secondaires etaient la survie globale (SG), la survie sans metastase (MFS), l’incidence des toxicites aigues et tardives (CTCAE v3.0) et la qualite de vie (QoL) (echelles QLQ-C30 et PR-25). Cet essai est enregistre sous le numero ClinicalTrials.gov NCT00667069 . Resultats Entre le 7 mars 2008 et le 23 juin 2016, 424 patients ont ete inclus. Nous avions prevu d’inclure 718 patients. Les inclusions ont ete interrompues prematurement en raison de taux d’evenements etonnamment bas. Les caracteristiques initiales des patients et de leur tumeur etaient bien equilibrees entre les bras. Le suivi median etait de 75, 3 mois (IQR : 50–100). Lors de l’analyse, 115/212 patients (54 %) du bras sRT avaient commence le traitement. Avec 58 evenements, l’EFS a 5 ans etait de 92 % (IC95 % : 86–95) dans le bras aRT et de 90 % (IC95 % : 85–94) dans le bras sRT (HR = 0,81 [IC95 % : 0,48–1,36] ; test du log-rank p = 0,42). Le taux de SG a 5 ans etait de 96 % (IC95 % : 92–98) dans le bras aRT et de 99 % (IC95 % : 96–100) dans le bras sRT (HR = 1,60 [IC95 % : 0,71–3,60] ; p = 0,25). Les toxicites genito-urinaires de grade ≥ 2 etaient plus importantes dans le bras aRT (27 % vs 7 % ; p Conclusion L’etude GETUG-AFU 17 n’a montre aucun benefice en EFS pour l’aRT par rapport a la sRT. L’aRT a augmente le risque de toxicite genito-urinaire et de dysfonction erectile. Une strategie de sRT precoce pourrait epargner aux hommes la RT et la toxicite associee.