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Despite recent advances, the prognosis of pancreatic adenocarcinomas remains poor, even for patients with resectable tumors. For these latter, new approaches based on neoadjuvant treatment have been developed. Two components are used: chemotherapy and radiation therapy (RT). Indeed, pre-operative RT has many advantages in terms of efficacy and tolerance. It increases notably the chances of subsequent complete tumor resection. Several prospective trials are currently ongoing to clarify its place in the therapeutic arsenal. Another crucial question is to know which is the best RT technique: conventional normofractionated chemoradiotherapy or hypofrationated stereotactic body RT?

We present the update of the recommendations of the French society of oncological radiotherapy on radiotherapy of pancreatic tumors. Currently, the use of radiation therapy for patients with pancreatic cancer is subject to discussion. In the adjuvant setting, the standard treatment is six months of chemotherapy with 5-fluorouracile, irinotecan and oxaliplatin. Chemoradiation may improve the survival of patients with incompletely resected tumours (R1). This remains to be confirmed by a prospective trial. Neoadjuvant chemoradiation is a promising treatment especially for patients with borderline resectable tumours. For patients with locally advanced tumours, there is no standard. An induction chemotherapy followed by chemoradiation for non progressive patients reduces the rate of local relapse. Whereas in the first trials of chemoradiation large fields were used, the treated volumes have been reduced to improve tolerance. Tumour movements induced by breathing should be taken in account. Intensity modulated radiation therapy allows a reduction of doses to the organs at risk. Whereas widely used, this technique has poor evidence-based recommendation. Stereotactic body radiation therapy is also being studied, as a neoadjuvant or exclusive treatment.

For many years, adjuvant chemoradiotherapy remained essential in the therapeutic management of gastric and pancreatic adenocarcinomas. For these tumours, surgical excision, the only hope of offering the patient prolonged survival, is only possible in 20% of cases. The median survival of operated patients is only 12 to 20 months due to the frequency of locoregional and/or metastatic recurrences. For stomach cancers, adjuvant chemoradiotherapy is justified by the results of the phase III trial Intergroup 0116 published by MacDonald et al. The gain in survival was at the cost of significant toxicity. This treatment was supplanted in the early 2000s by perioperative chemotherapy. Currently, neoadjuvant chemoradiotherapy clinical studies are ongoing with the aim of improving treatments observance and tolerance. For pancreatic cancers, the role of adjuvant chemoradiotherapy has long been discussed because of trials with contradictory results. Neoadjuvant radiotherapy has many advantages in terms of efficacy and tolerance. It increases the chances of subsequent complete tumour resection. Several prospective trials are currently ongoing to clarify its place in the therapeutic arsenal.

We present the update of the recommendations of the French society for radiation oncology on external radiotherapy and brachytherapy of anal canal carcinoma. The following guidelines are presented: indications, treatment procedure, as well as dose and dose-constraints objectives, immediate postoperative management, post-treatment evaluation, and long-term follow-up.

We present the updated recommendations of the French society of oncological radiotherapy for rectal cancer radiotherapy. The standard treatment for locally advanced rectal cancer consists in chemoradiotherapy followed by radical surgery with total mesorectal resection and adjuvant chemotherapy according to nodal status. Although this strategy efficiently reduced local recurrences rates below 5% in expert centres, functional sequelae could not be avoided resulting in 20 to 30% morbidity rates. The early introduction of neoadjuvant chemotherapy has proven beneficial in recent trials, in terms of recurrence free and metastasis free survivals. Complete pathological responses were obtained in 15% of tumours treated by chemoradiation, even reaching up to 30% of tumours when neoadjuvant chemotherapy is associated to chemoradiotherapy. These good results question the relevance of systematic radical surgery in good responders. Personalized therapeutic strategies are now possible by improved imaging modalities with circumferential margin assessed by magnetic resonance imaging, by intensity modulated radiotherapy and by refining surgical techniques, and contribute to morbidity reduction. Keeping the same objectives, ongoing trials are now evaluating therapeutic de-escalation strategies, in particular rectal preservation for good responders after neoadjuvant treatment, or radiotherapy omission in selected cases (Greccar 12, Opera, Norad).

The aim is to assess the outcome of patients treated for vaginal carcinoma with radiation therapy in terms of long-term tolerance and survival. This single-center retrospective study included patients with squamous cell carcinoma of the vagina treated with pelvic external beam radiation therapy (EBRT) with or without vaginal brachytherapy (VB) between 1990 and 2013. Thirty-seven patients were included with stage I (24%), II (60%), III (8%), or IV (8%) vaginal tumors. Median age was 66 years (range 27–86 years). Median tumor size was 4 cm (range 0.7–12 cm). Seven patients underwent first intention surgery. The 37 patients received pelvic EBRT (45 Gy) with inguinal irradiation in 57% of cases. Fifteen (41%) received concurrent chemotherapy. Low-dose supplemental VB was performed in 31 patients (84%) (median dose: 20 Gy). Median follow-up was 59 months (range 7–322 months). Four patients (11%) had late grade 3–4 complications. Relapse occurred in 11 patients (30%), five of them locally. The 5-year relapse-free and cancer-specific survival rates were 68% and 76%, respectively. Surgery and concurrent chemotherapy did not seem to have an impact on the course of the disease. In our experience, pelvic EBRT leads to prolonged survival with acceptable long-term toxicity in patients with squamous cell carcinoma of the vagina.

The standard medical care of glioblastoma (GBM) patients with good performance status is based on focal brain radiotherapy (40–60 Gy) with concurrent temozolomide (TMZ) followed by adjuvant TMZ. Newly diagnosed multifocal and/or multicentric GBM (M/M GBM) cases are usually treated with TMZ alone: whole brain chemoradiotherapy (CRT) is avoided for safety reasons. To our knowledge, no study has investigated the safety and efficacy of whole-brain radiotherapy (WBRT) with concurrent TMZ in M/M GBM patients. This retrospective study sought to assess the role of WBRT associated with concurrent TMZ followed by TMZ alone in this population. Eleven patients with pathologically proven M/M GBM (≥3 lobes) were treated with WBRT between April 2009 and September 2017. The median age was 50 years [34–74]. The median dose of radiotherapy was 45 Gy at 1.8 Gy per fraction over 37 days [29–41], with concurrent daily TMZ at the dose of 75 mg/m2. This treatment was followed by adjuvant monthly TMZ (150 mg/m2-D1-D5). All pathology slides and radiology images were reviewed. The median overall and progression-free survival times for all patients were 10 months [4–25] and 5 months [3–21], respectively. There was no grade 3–4 toxicity due to radiotherapy. One patient stopped the TMZ during the radiochemotherapy period and 9 patients received adjuvant TMZ with a median number of 5 cycles [2–8]. Our study supports the safety and the efficacy of WBRT with TMZ in newly diagnosed M/M GBM. Larger prospective studies are needed to support our results.

[Purpose] Chronic inflammation contributes to cancer development via multiple mechanisms. We hypothesized that cardiovascular diseases (CVD) are also an independent risk factor for survival in non-small cell lung cancer (NSCLC)., [Materials and methods] Prospective multicenter data from 345 consecutive NSCLC patients treated from January 2013 to January 2017 were assessed. Median follow-up for all patients was 13 months (range 3–60 months). There were 109 patients with baseline heart disease (HD 32%), 149 with arterial hypertension (43%), 85 with diabetes mellitus (25%), 129 with hyperlipidemia (37%) and 45 with venous thromboembolism events (VTE 13%). A total of 289 patients (84%) were treated with platinum-based chemotherapy (CT), 300 patients (87%) received thoracic radiation therapy (RT; median radiation dose: 60 Gy [range 12–70]); and 50 (15%) patients underwent surgery., [Results] Our cohort consisted of 305 men (88%) and 40 (12%) women, with a median age of 67 years (range 31–88 years). Seventy percent had a Karnofsky performance status (KPS) ≥ 80. Multivariate analyses showed a lower OS and higher risk of distant metastasis in patients with advanced stages (p = 0.05 and p, [Conclusions] HD and VTE are associated with a higher risk of mortality and distant metastasis in NSCLC patients. Chronic inflammation associated with CVDs could be an additional pathophysiologic factor in the development of distant metastasis., This work was supported by grants from ISCIII (Fis: PI13/01155, PI16/02104) and Consejeria de Salud of the Junta de Andalucia (PI-0096-2012).

Introduction et but de l’etude Comparer les objectifs cliniques et la tolerance de la (chimio)radiotherapie chez des patients avec un carcinome epidermoide du canal anal selon l’infection par le virus de l’immunodeficience humaine (VIH). Materiel et methodes Il s’agissait d’une analyse en sous-groupe de la cohorte multicentrique, prospective et retrospective, Anabase, menee par la Federation francaise de cancerologie digestive (FFCD). Les objectifs cliniques incluaient la survie globale, la survie specifique, la survie sans recidive, le controle locoregional, la survie sans colostomie, le taux de reponse a 4–6 mois et la toxicite aigue et tardive severe (de grade 3 ou plus). Les facteurs pronostiques des principaux objectifs cliniques ont ete recherches. Resultats et analyse statistique Entre fevrier 2016 et avril 2020, 1097 patients atteints d’un carcinome epidermoide localise traite par irradiation ont ete inclus dans Anabase. Seuls les 488 patients avec un statut VIH connu ont ete inclus dans cette analyse (86 patients positifs et 402 patients negatifs issus de 50 centres). Le suivi median etait de 35,8 mois. Les caracteristiques tumorales initiales etaient comparables dans les deux groupes (stades T, X2 = 0,32 et N, X2 = 0,54). Les patients VIH-positifs etaient plus jeunes (p Tableau 1 et montrent que les taux de survie globale, controle locoregional et de survie sans colostomie etaient significativement diminues chez les patients infectes par le VIH. Il n’existait pas de difference significative pour la reponse a 4-6 mois, les taux de survie sans recidive et de survie specifique. La tolerance du traitement etait similaire dans les deux groupes (47,7 % de toxicite aigue de grade 3 ou plus chez les patients infectes par le VIH contre 45 % chez les patients non infectes, p = 0,65). Le sexe masculin, le statut OMS ≥ 1 et l’absence de reponse complete a 4–6 mois etaient associes a une survie globale diminuee en analyse uni- et multivariee. Conclusion Les patients infectes par le VIH recevant une (chimio)radiotherapie pour un carcinome epidermoide du canal anal avaient des taux de survie globale et sans colostomie inferieure a ceux des patients non infectes, ainsi qu’un controle locoregional moindre. La toxicite de ce traitement avec les techniques modernes d’irradiation conformationnelle avec modulation d’intensite n’etait pas majoree chez ces patients.

For many years, adjuvant chemoradiotherapy remained essential in the therapeutic management of gastric and pancreatic adenocarcinomas. For these tumours, surgical excision, the only hope of offering the patient prolonged survival, is only possible in 20% of cases. The median survival of operated patients is only 12 to 20 months due to the frequency of locoregional and/or metastatic recurrences. For stomach cancers, adjuvant chemoradiotherapy is justified by the results of the phase III trial Intergroup 0116 published by MacDonald et al. The gain in survival was at the cost of significant toxicity. This treatment was supplanted in the early 2000s by perioperative chemotherapy. Currently, neoadjuvant chemoradiotherapy clinical studies are ongoing with the aim of improving treatments observance and tolerance. For pancreatic cancers, the role of adjuvant chemoradiotherapy has long been discussed because of trials with contradictory results. Neoadjuvant radiotherapy has many advantages in terms of efficacy and tolerance. It increases the chances of subsequent complete tumour resection. Several prospective trials are currently ongoing to clarify its place in the therapeutic arsenal.

[Purpose]: Lung cancer (LC) has a significant impact on patients’ health-related quality of life (HRQoL). We investigate the correlations between pre-radiation therapy HRQoL and survival. [Materials and methods]: A prospective, intention-to-treat, multicentre study of 437 patients with LC recruited at the radiation oncology departments of three different institutions was conducted between 2012 and 2016. QoL was assessed using the EORTC-QLQ-C30 (v3.0) and EORTC-QLQ-LC13 questionnaires. Global health status (GHS), physical (PF), role functioning (RF), emotional (EF), cognitive (CF), and social functioning (SF) as well as symptoms scores were evaluated in univariate and multivariate analyses. [Results]: The cohort consisted of 376 men (86%) and 61 women, with a median age of 66 years (range 31–88). Histology was: 72% (n = 315) non-small cell lung cancer and 28% small cell lung cancer. The most common stage was III (80%) and the median follow-up for alive patients was 30 months (range 7–76). Multivariate analysis showed that RF was associated with a lower risk of mortality (HR: 0.693; p = 0.008) and recurrence (HR: 0.737; p = 0.040). Additionally, lower scores on EF and PF were associated with higher mortality (HR: 0.696; p = 0.003 and HR: 0.765; p = 0.044, respectively). Appetite loss, constipation, and dysphagia were associated with a higher risk of mortality (HR: 1.985; p

The present work aims at evaluating intensity-modulated radiation therapy with simultaneous integrated boost (IMRT-SIB) in squamous cell carcinomas (SCC) of the larynx and hypopharynx. We performed a single institutional retrospective analysis on 116 pharyngo (29%)-laryngeal (71%) SCC patients (93% male) treated with IMRT-SIB to 66–69.96 Gy in 33 fractions between 2008 and 2016. Those who underwent surgery (54%) received adjuvant radiation of 66 Gy at 2 Gy/fraction to the surgical bed. 16 patients (14%) were treated for a local recurrence after prior surgery. High-risk lymph node regions received 59.4 Gy at 1.8 Gy/fraction and low risk regions 54.12 Gy at 1.64 Gy/fraction. The median age was 60 years and 95% of patients had an ECOG performance status 0–2. Most had advanced stage disease (III 22%, IV 74%). Chemotherapy was delivered in 74% of cases. Median follow-up was 32 months. Two and three-year overall survival for all patients was 87% and 82%, respectively. There were 28 (24%) locoregional recurrences and 19 (16%) distant failures. Grade 3 mucositis, dermatitis, and xerostomy were observed in 12%, 10%, and 3%, respectively. A longer IMRT-SIB overall treatment time was associated with a higher risk of mortality (HR 1.09, CI 1.01–1.17, P = 0.02). Postoperative IMRT-SIB associated with a significantly lower risk of any recurrence (HR 0.34, CI 0.18–0.64, P = 0.001) and higher local control (HR 0.06, CI 0.01–0.24, P

Adjuvant radiotherapy is the pillar of breast conserving surgery. Its omission is related with a higher risk of local recurrence and of breast cancer related or non-related mortality. It is of paramount importance to guarantee this treatment is fully administered to all patients after breast conserving surgery, including the elderly. In the last three decades several hypofractionated treatment schemes have shown their non-inferiority, allowing for treatment time reduction facilitating adhesion to treatment and reducing radiotherapy burden. This review focuses on the schemes and indications which have been validated by large phase 3 trials and those which are still under evaluation.

At diagnosis, about 15% of patients with pancreatic cancer present with a resectable tumour, 50% have a metastatic tumour, and 25% a locally advanced tumor (non-metastatic but unresectable due to vascular invasion) or borderline resectable. Despite the technical progress made in the field of radiation therapy and the improvement of the efficacy of chemotherapy, the prognosis of these patients remains very poor. Recently, the role of radiation therapy in the management of pancreatic cancer has been much debated. This review aims to evaluate the role of radiation therapy for these patients.

Background Chronic lymphocytic leukaemia is a common disease affecting the hematopoietic organs. The disease remains classically indolent for years preceding a blast crisis. However, the disease can affect all parts of the body. We report here an unusual localization. Case presentation A 72-year-old man was followed for 2 years for an indolent chronic lymphocytic leukaemia while he presented a rapidly progressive dysuria. Prostate biopsies were performed concluding to a prostate involvement by the chronic lymphocytic leukaemia. In the absence of progression according to RAI staging system and Binet's classification, he was treated with local low-dose radiotherapy, twice 2 Gy, allowing for a rapid resolution of the symptoms. No systemic treatment was introduced, and 1 year after the completion of his treatment, he is still under watchful waiting strategy for his chronic lymphocytic leukaemia. Conclusion Low-dose radiotherapy is an underused effective strategy in indolent lymphoma. In this case, urinary symptoms from a prostate involvement were relieved non-invasively at low cost.

Introduction L’immunotherapie est recemment devenue un standard therapeutique des CBNPC localement avances et metastatiques. Des etudes recentes suggerent que la RT pourrait stimuler la reponse immunitaire antitumorale. L’objectif de cette etude etait d’evaluer l’impact d’une RT prealable ou concomitante a une immunotherapie dans les CBNPC metastatiques. Methodes Cette etude retrospective monocentrique concerne 194 CBNPC metastatiques diagnostiques dans un CHU entre 01/2015 et 08/2018 et traites par un anti-PD1. Le critere de jugement principal etait la survie sans progression (SSP) a partir du debut de l’immunotherapie. Les criteres secondaires etaient la survie globale a partir du debut de l’immunotherapie (SG) et la tolerance. Resultats Au total, 65 patients (pts) avaient recu une RT prealable ou concomitante a l’immunotherapie (RT + ) et 129 n’en avaient pas recu (RT − ). Les patients RT+ presentaient davantage de sites metastatiques (p = 0,015), de metastases osseuses (p Conclusion La RT prealable ou concomitante a l’immunotherapie semble etre un facteur de bon pronostic sur la SSP et la SG chez les pts traites par immunotherapie dans les CBNPC metastatiques. Des etudes prospectives sont en cours pour confirmer cet impact.

Adjuvant radiotherapy is the pillar of breast conserving surgery. Its omission is related with a higher risk of local recurrence and of breast cancer related or non-related mortality. It is of paramount importance to guarantee this treatment is fully administered to all patients after breast conserving surgery, including the elderly. In the last three decades several hypofractionated treatment schemes have shown their non-inferiority, allowing for treatment time reduction facilitating adhesion to treatment and reducing radiotherapy burden. This review focuses on the schemes and indications which have been validated by large phase 3 trials and those which are still under evaluation.

At diagnosis, about 15% of patients with pancreatic cancer present with a resectable tumour, 50% have a metastatic tumour, and 25% a locally advanced tumor (non-metastatic but unresectable due to vascular invasion) or borderline resectable. Despite the technical progress made in the field of radiation therapy and the improvement of the efficacy of chemotherapy, the prognosis of these patients remains very poor. Recently, the role of radiation therapy in the management of pancreatic cancer has been much debated. This review aims to evaluate the role of radiation therapy for these patients.

An estimated 990,000 new cases of gastric cancer are diagnosed worldwide each year. Surgical excision, the only chance for prolonged survival, is feasible in about 20% of cases. Even after surgery, the median survival is limited to 12 to 20 months due to the frequency of locoregional and/or metastatic recurrences. This led to clinical trials associating surgery with neoadjuvant or adjuvant treatments to improve tumor control and patient survival. The most studied modalities are perioperative chemotherapy and adjuvant chemoradiotherapy. To date, evidence has shown a survival benefit for postoperative chemoradiotherapy and for perioperative chemotherapy. Phase III trials are ongoing to compare these two modalities. The aim of this review is to synthesize current knowledge about adjuvant chemoradiotherapy in the management of gastric adenocarcinoma, and to consider its prospects by integrating modern radiotherapy techniques. Keywords: Gastric cancer, Adjuvant therapy, Chemoradiotherapy, IMRT, Adenocarcinoma

Introduction et but de l’etude Les effets secondaires lies a la radiotherapie sont habituellement rapportes par les medecins a la place des patients. Les patient-reported outcomes (PROs) s’utilisent de plus en plus en clinique et dans des essais. Dans le cadre de developpement d’une application pour evaluer des PROs electroniques (ePROs), le young Radiation Oncology Group (yROG) de l’European Organization for the Research and Treatment of Cancer (EORTC) a mene une enquete pour evaluer l’utilisation, l’acceptation et les benefices ressentis des PROs et quantifier ses caracteristiques souhaitables. Materiel et methodes L’enquete a ete adressee a des medecins, des manipulateurs en electroradiologie et des infirmiers de 26 pays qui traitent des patients par irradiation. Cette enquete d’acces publique en ligne incluait 40 questions qui cotaient les caracteristiques des ePROs sur une une echelle Likert bipolaire a 5 points, allant de 1 (peu important) a 5 (tres important). Les sous-groupes ont ete compares par le test de Mann-Whitney-Wilcoxon. L’enquete etait promue par les newsletters du reseau l’EORTC et les societes savantes nationales de radiotherapie. Resultats et analyse statistique Entre juillet et decembre 2018, 367 reponses ont ete recues, dont 354 eligibles comportant 4,5 % reponses francaises, le sixieme pays le plus participatif apres l’Allemagne (24,3 %), l’Italie (13,3 %), la Chine (12,2 %), le Danemark (11,6 %), et Israel (9,9 %). En France les PROs etaient utilises dans un quart des reponses (contre 42,4 % des reponses des autres pays ; p Conclusion L’utilisation des PROs en France est significativement moins importante qu’internationalement. Tous les repondeurs francais utiliseraient un ePRO en routine s’ils y avaient acces.

Resume La radiotherapie, apres chirurgie conservatrice ou mastectomie pour cancer du sein, ameliore la probabilite de survie globale en diminuant le risque de recidive. Toutefois, l’irradiation prophylactique postoperatoire des aires ganglionnaires de drainage du sein et en particulier de la region axillaire reste un sujet de controverse, car la part de benefice et de risque attribuable a l’irradiation de l’aire axillaire reste mal definie. Il faut tout d’abord noter qu’a l’heure de la radiotherapie conformationnelle, la definition des volumes est un element crucial dans l’analyse de la balance benefice/risque de toute irradiation. La definition et la delineation des aires axillaire sont donc abordees en premier lieu dans ce manuscrit a la lumiere des recommandations de la societe europeenne de radiotherapie oncologie (ESTRO). Les recidives axillaires sont rares et la tendance actuelle est a la desescalade chirurgicale dans le traitement de l’aisselle. Dans cette revue de la litterature, nous exposons les elements qui nous conduisent a ne pas proposer de radiotherapie axillaire complementaire chez les patientes atteintes de cancer de stades pN0, pN0i+ et pN1mi, y compris en l’absence de curage, ainsi que les situations pouvant justifier cette irradiation. Enfin, nous proposons ici une mise au point sur la toxicite eventuelle de l’irradiation axillaire complementaire, indispensable pour guider nos choix therapeutiques actuels et l’evolution de nos techniques et indications d’irradiation axillaire.

Since accelerated partial breast irradiation has demonstrated non-inferiority to whole breast irradiation regarding recurrence rate in patients with early stage breast cancer, our objective was to compare its impact on short-term adverse events, patient satisfaction and costs.Patients with early stage breast cancer treated by breast-conserving surgery between 2007 and 2012 were included: 48 women who received three-dimensional conformal accelerated partial breast irradiation in a multicentre phase-II trial were paired with 48 patients prospectively treated with whole breast irradiation. Adverse events, and patients' opinions concerning cosmesis, satisfaction and pain, were gathered 1 month after treatment. Direct and indirect costs were collected from the French National Health Insurance System perspective until the end of radiotherapy.When comparing its impact, skin reactions occurred in 37% of patients receiving three-dimensional conformal accelerated partial breast radiotherapy and 60% of patients receiving whole breast irradiation (P=0.07); 98% were very satisfied in the group three-dimensional conformal accelerated partial breast radiotherapy versus 46% in the group treated with whole breast irradiation (P0.001); direct costs were significantly lower in the group treated with partial breast irradiation (mean cost: 2510€ versus 5479€/patient), due to less radiation sessions.In patients with early-stage breast cancer, partial irradiation offered a good alternative to whole breast irradiation, as it was less expensive and satisfactory. These, and the clinical safety and tolerance results, need to be confirmed by long-term accelerated partial breast irradiation results in on-going phase III trials.

[Purpose] The aim of this study was to assess the feasibility and treatment outcome of intensity modulated radiation therapy with simultaneous integrated boost (SIB-IMRT) in locally advanced non-small cell lung cancer (NSCLC) patients., [Materials and methods] A total of 64 NSCLC patients with stage IIB (3%), IIIA (36%), and IIIB (61%) were treated with concomitant (N = 47; 73%) or sequential (N = 9; 14%) chemotherapy between February 2009 and January 2014. Eight patients (13%) received RT alone. All patients received the same irradiation scheme using IMRT: prophylactic dose for mediastinum was 56 Gy at 1.65 Gy/fraction and SIB to macroscopic disease up to 68 Gy at 2 Gy/fraction., [Results] The median follow-up was 16 months (range, 1–70 months). The overall survival rate for all patients was 79% after 1 year and 46% after 2 years. Disease-free survival (DFS) was 81 and 45% after 1 and 2 years, respectively, resulting in a median DFS of 16 months. Multivariate analysis showed a statistically significant association between stage IIIB patients and a higher risk of mortality (HR 2.11; P = 0.019). In addition, T4 stage associated with higher risk of recurrence (HR 2.23; P = 0.024) while concomitant chemoradiation was associated with lower risk of any recurrence (HR 0.34; P = 0.004) No patient experienced grade ≥3 esophagitis and only 6 cases (9%) had grade 3 pneumonitis. Only having a higher lung volume was associated with higher risk of pneumonitis in the multivariate analysis (HR 16.21; P = 0.022)., [Conclusion] This study in advanced NSCLC patients shows that SIB-IMRT is an effective technique with acceptable toxicity, also when combined with chemotherapy.

Introduction et but de l’etude La radiotherapie externe avec chimiotherapie concomitante (5-fluoro-uracile–mitomycine C) est le traitement de reference du cancer de canal anal. Une analyse des donnees de sept essais a ete faite pour quantifier l’effet des parametres relie avec la radiotherapie externe sur les resultats therapeutiques. Materiel et methodes Apres fusion des jeux de donnees l’impact des parametres de radiotherapie (etalement, duree de l’intervalle de temps, dose totale) sur les resultats therapeutiques (recidive locoregionale, taux de survie sans progression a 5 ans et toxicite) ont ete evalues. Les donnees ont ete recues de dix essais publies sur 13, realises entre 1987 et 2008 (n = 3031). Une regression de Cox a ete utilisee. Resultats et analyse statistique Seuls les dossiers de 1343 patients des sept essais plus recents et homogenes ont ete analyses (duree mediane de suivi :4,1 ans). Un taux superieur de recidive locoregionale a 5 ans avait une correlation significative avec un etalement plus long (22,8 %, intervalle de confiance a 95 % [IC 95 %] : 22,3–27,3 %, p = 0,030), une taille tumorale superieure (p 79,3 % ; p Conclusion Pour des patients pris en charge par chimioradiotherapie concomitante par deux agents et une radiotherapie externe, un etalement plus long semble desavantageux. De futurs essais avec des techniques modernes pourraient mieux definir l’etalement optimal et le role de l’escalade de dose.

Objectif de l’etude Dans notre institution, les cancers du pancreas localement evolues inoperables, en reponse ou stables apres une premiere ligne de chimiotherapie, beneficient d’une radiotherapie en conditions stereotaxiques en cloture. Nous avons entrepris d’evaluer retrospectivement la tolerance et les taux de controle local a 6 et 12 mois pour les patients traites par irradiation stereotaxique pour un cancer du pancreas localement evolue. Materiel et methode Le traitement a ete realise en blocage inspiratoire profond sur un appareil Novalis TX® (Varian, Palo Alto) ou sur un appareil Cyberknife® (Accuray, Sunnyvale) avec un tracking de la lesion en temps reel apres implantation de reperes fiduciels sous echo-endoscopie. Nous avons rapporte la toxicite aigue (survenant avant 3 mois) et tardive (apres 3 mois) cotee selon la Common Terminology Criteria for Adverse Events v 4.0. Les probabilites de controle local a 6 mois et un an, de survie globale et de survie sans progression ont ete evalues a compter de la premiere seance de radiotherapie. Resultats D’aout 2015 a octobre 2017, 16 patients ont beneficie d’une radiotherapie en conditions stereotaxiques pour un cancer du pancreas localement evolue. Le suivi median etait de 12 mois. La dose delivree etait de 32,5 Gy en cinq fractions de 6,5 Gy pour 11 patients et 30 Gy en cinq fractions pour cinq patients. Trois patients (18 %) ont souffert d’une toxicite aigue de grade 2, aucune toxicite aigue ou tardive de grade 3 ou plus n’a ete rapportee. Les probabilites de controle local a 6 mois etait de 78 % et il etait a un an de 56 %. Les probabilites de survie globale et sans progression a un an etaient respectivement de 88 % et 18 %. Dans quatre cas (25 %) la radiotherapie a permis d’obtenir un effet antalgique. Conclusion Ces resultats sont en accord avec les donnees de la litterature. La radiotherapie stereotaxique pancreatique presente l’avantage d’un traitement court et bien tolere avec un fractionnement prudent de 30 a 32,5 Gy en cinq fractions. La probabilite de controle local a un an etait de 55 % et les recidives se font plus frequemment et precocement sur le mode metastatique. Le faible taux de toxicite tardive doit etre interprete avec prudence etant donne le faible recul disponible.

Adjuvant radiotherapy, after breast conserving surgery or mastectomy for breast cancer, improves overall survival while decreasing the risk of recurrence. However, prophylactic postoperative radiotherapy of locoregional lymph nodes for breast cancer, particularly of the axillary region, is still controversial since the benefits and the risks due to axillary irradiation have not been well defined. To begin with, when performing conformal radiotherapy, volume definition is crucial for the analysis of the risk-benefit balance of any radiation treatment. Definition and contouring of the axillary lymph node region is discussed in this work, as per the recommendations of the European Society for Radiotherapy and Oncology (ESTRO). Axillary recurrences are rare, and the recent trend leads toward less aggressive surgery with regard to the axilla. In this literature review we present the data that lead us to avoid adjuvant axillary radiotherapy in pN0, pN0i+ and pN1mi patients even without axillary clearance and to perform it in some other situations. Finally, we propose an update about the potential toxicity of adjuvant axillary irradiation, which is essential for therapeutic decision-making based on current evidence, and to guide us in the evolution of our techniques and indications of axillary radiotherapy.

We assessed therapeutic outcomes of reirradiation with helical tomotherapy (HT) for locoregional recurrent nasopharyngeal carcinoma (LRNPC) patients. Treatment outcomes were evaluated retrospectively in 17 consecutive LRNPC patients receiving HT between 2006 and 2012. Median age was 57 years and most patients (n = 13) were male. Simultaneous systemic therapy was applied in 5 patients. Initial treatment covered the gross tumor volume with a median dose of 70 Gy (60–81.6 Gy). Reirradiation was confined to the local relapse region with a median dose of 63 Gy (50–70.2 Gy), resulting in a median cumulative dose of 134 Gy (122–148.2 Gy). The median time interval between initial and subsequent treatment was 42 months (11–126). The median follow-up for the entire cohort was 23 and 35 months for survivors. Three patients (18 %) developed both local and distant recurrences and only one patient (6 %) suffered from isolated local recurrence. Two-year actuarial DFS and LC rates were 74 and 82 %, respectively. Two-year OS rate was 79 %. Acute and late grade 2 toxicities were observed in 8 patients (47 %). No patient experienced late grade ≥3 toxicity. Late toxicity included fibrosis of skin, hypoacusia, dysphagia, and xerostomia. Patients with higher Karnofsky performance status scores associated with a lower risk of mortality (HR 0.85, p = 0.015). Reirradiation with HT in patients with LRNPC is feasible and yields encouraging results in terms of local control and overall survival with acceptable toxicity.

Purpose Concomitant chemoradiation followed by brachytherapy is the standard treatment for locally advanced cervical cancers. The place of adjuvant hysterectomy remains unclear but tends to be limited to incomplete responses to radiotherapy or local relapse. The aim was to analyse the benefit from immediate salvage surgery following radiation therapy in incomplete responders. Methods Among the patients with locally advanced cervical cancer treated with concomitant chemoradiation followed by 3D image-guided adaptive brachytherapy and hysterectomy, cases with genuine macroscopic remnant, defined as at least 1 cm in width, were identified. Their clinical data and outcomes were retrospectively reviewed and compared to the patients treated with the same modalities. Results Fifty-eight patients were included, with a median follow-up of 4.2 years. After hysterectomy, 9 patients had macroscopic residual disease, 10 microscopic and the remaining 39 patients were considered in complete histological response. The 4-year overall survival and disease-free survival rates were significantly decreased in patients with macroscopic residual disease: 50 and 51% versus 92% and 93%, respectively. Intestinal grades 3–4 toxicities were reported in 10.4% and urinary grades 3–4 in 8.6% in the whole population without distinctive histological features. Planning aims were reached in only one patient with macroscopic residuum (11.1%). In univariate analysis, overall treatment time (> 55 days) and histological subtype (adenocarcinomas or adenosquamous carcinomas) appeared to be significant predictive factors for macroscopic remnant after treatment completion (P = 0.021 and P = 0.017, respectively). In multivariate analysis, treatment time was the only independent factor (P = 0.046, odds ratio = 7.0). Conclusions Although immediate salvage hysterectomy in incomplete responders provided a 4-year disease-free survival of 51%, its impact on late morbidity is significant. Efforts should focus on respect of treatment time and dose escalation. Adenocarcinoma might require higher high-risk clinical target volume planning aims.

Purpose To report the application of the global risk analysis (GRA) in the pulsed-dose rate (PDR) brachytherapy workflow. Material and Methods Analyses were led by a multidisciplinary working group established within the unit with the guidance of a quality engineer. First, a mapping of hazardous situations was developed as a result of interactions between the patient workflow for a treatment using PDR brachytherapy split into 51 sub-phases with a comprehensive list of the hazards that he/she faces (44). Interactions, when relevant, were sorted by level of priority: to be treated immediately, secondarily (the group is not entitled to treat the situation), or later (safe situation). Secondly, for each high priority dangerous situation, scenarios were developed to anticipate their potential consequences. Criticality was assessed, using likelihood and severity scales and a matrix, which allocated risks into categories: acceptable (C1), tolerable under control (C2) and unacceptable (C3). Then, corrective actions were proposed and planned when relevant, after assessment of their feasibility with a scale of effort. Finally, the criticality of the scenarios was reevaluated, taking into account the implementation of these actions, leading to a residual risk mapping, which could trigger additional proposals of actions. Results Two thousand one hundred and eighty-four potential interactions between the list of hazards and the workflow were analyzed. Mapping of dangerous situations identified 213 relevant interactions, from which 61 were considered with high priority. One hundred and twenty-six scenarios were generated: 68 with a low criticality (74.3%), 58 with an intermediate score (25.7%). No scenario with the highest criticality was individualized. Twenty-one corrective actions were planned. Mapping of residual risk resulted in the disappearance of most C2 risks, leaving 5 C2 scenarios (4%), for which four monitoring indicators were implemented in addition to the corrected actions decided on. Conclusion The implementation of the GRA appeared feasible, and led to implement 21 corrective actions, based on scenarios and not on incidents.

Purpose The implementation of image-guided brachytherapy in cervical cancer raises the problem of adapting the experience acquired with 2D brachytherapy to this technique. The GEC-ESTRO (Groupe europeen de curietherapie – European Society for Radiotherapy and Oncology) has recommended reporting the dose delivered to the rectum in the maximally exposed 2 cm 3 volume, but so far, the recommended dose constraints still rely on 2D data. The aim of this study was to evaluate the relationship between the doses evaluated at the ICRU rectal point and modern dosimetric parameters. Material and methods For each patient, dosimetric parameters were generated prospectively at the time of dosimetry and were reported. For analysis, they were converted in 2 Gy equivalent doses using an α/β ratio of 3 with a half-time of repair of 1.5 hours. Results The dosimetric data from 229 consecutive patients treated for locally advanced cervical cancer was analyzed. The mean dose calculated at ICRU point (DICRU) was 55.75 Gy ± 4.15, while it was 59.27 Gy ± 6.16 in the maximally exposed 2 cm 3 of the rectum ( P = 0.0003). The D2 cm 3 was higher than the DICRU in 78% of the cases. The mean difference between D2 cm 3 and DICRU was 3.53 Gy ± 4.91. This difference represented 5.41% ± 7.40 of the total dose delivered to the rectum (EBRT and BT), and 15.49% ± 24.30 of the dose delivered when considering brachytherapy alone. The two parameters were significantly correlated ( P = 0.000001), and related by the equation: D2 cm 3 = 0.902 × DICRU + 0.984. The r 2 coefficient was 0.369. Conclusion In this large cohort of patients, the DICRU significantly underestimates the D2 cm 3 . This difference probably results from the optimization process itself, which consists in increasing dwell times above the ICRU point in the cervix. Considering these findings, caution must be taken while implementing image-guided brachytherapy and dose escalation.

Objectif de l’etude Evaluer l’impact de l’hysterectomie de cloture apres chimioradiotherapie et curietherapie adaptative guidee par l’image dans les cancers du col uterin localement evolues. Etablir des relations dose-effets pour le rectum et la vessie en fonction de la realisation ou non d’une hysterectomie. Materiel et methode Deux cohortes de patientes prises en charge par chimioradiotherapie pelvienne suivie d’une curietherapie adaptative guidee par l’image ont ete identifiees, differant par la realisation d’une hysterectomie. Les inclusions etaient limitees aux tumeurs de stade, selon la classification de la Federation internationale de gynecologie obstetrique (Figo) I–II. Des tests du Log-rank ont ete utilises pour comparer les survies et des analyses probit pour etudier les relations dose-effet. Resultats Les deux cohortes comprenaient respectivement 54 patientes dans le groupe ayant eu une hysterectomie et 157 patients dans le groupe exclusivement irradie. Elles etaient bien equilibrees, sauf pour le suivi, plus long dans la cohorte ayant eu une hysterectomie et le recours a la TEP-scanographie dans le bilan initial, plus frequent dans la cohorte exclusivement irradiee. Bien que les rechutes locales aient ete moins frequentes dans le groupe exclusivement irradie, les taux de survie sans maladie et globale a 5 ans ne differaient pas. Le taux d’incidence cumulee de morbidite severe tardive a 5 ans etait significativement superieur dans la cohorte ayant eu une hysterectomie : 22,5 % contre 6,5 % (p = 0,016). Des effets dose-volume ont ete observes pour la vessie, avec une difference de 24 Gy entre les seuils correspondant a une probabilite de morbidite severe de 10 %. L’objectif de planification de 85 Gy correspondait a un taux de controle local de 93,3 % dans la cohorte exclusivement irradiee et a une probabilite de 77,3 % d’obtenir une bonne reponse histologique dans le groupe ayant eu une hysterectomie. Conclusion L’hysterectomie de cloture a ete responsable d’une augmentation de la morbidite tardive severe sans benefice en termes de taux de survie globale ni sans recidive. Sa realisation desequilibre la relation dose-effet etablie de la vessie.

Studies assessing the relationship between dose to the penile bulb (PB) and risk of ED in men treated for prostate cancer with external beam radiation therapy (EBRT) have been critically scored. A review of published literature examining dose received by the PB and clinical erectile function outcomes for patients receiving EBRT was performed. Of 146 retrieved articles, 8 evaluated EBRT-induced ED in relation to PB dose. Half of these articles showed a relationship between dose to PB and ED, and the other half did not. A reliability score (RS) was constructed to more uniformly evaluate strengths and weaknesses of these eight articles. Subsequently, they were scored by two independent reviewers. An average of both scores was calculated. A close consensus was found (identical RS for six of the eight studies; kappa statistic: P=0.97). The studies with highest RS consistently support a relationship between ED and PB doses, whereas those with low scores did not. The RS-based analysis supports the recommended dose–volume limits specified in the Quantitative Analysis of Normal Tissue Effects in the Clinic review, maintaining the mean dose to 95% of the PB