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Lors de la découverte d’un cancer du sein, la qualité du bilan préthérapeutique est essentielle afin d’orienter la décision thérapeutique. L’exploration axillaire est primordiale, car elle évalue l’extension régionale de la maladie, ce qui en fait un des facteurs pronostiques majeurs. Différents examens d’imagerie préopératoires peuvent révéler une atteinte de ces ganglions axillaires. Cependant, l’imagerie de référence reste l’échographie axillaire, qui permet également de guider des prélèvements. Depuis l’étude ACOSOGZ0011, nous sommes face à une désescalade thérapeutique de la chirurgie axillaire. Selon des résultats récents, on constate que la place de l’imagerie axillaire est encore plus importante. Le but de l’échographie est d’éviter un curage en deux temps après un ganglion sentinelle positif lorsque les critères de l’ACOSOG-Z0011 ne sont pas remplis.

Le cancer du sein est le premier cancer féminin en France, et sa détection précoce est indispensable. L’IRM mammaire est un élément de choix dans son diagnostic mais présente des coûts directs et indirects élevés, notamment du fait de sa durée qui ralentit son utilisation plus large. Compte tenu de ses éléments, l’utilisation d’un protocole abrégé se développe pour pallier ces inconvénients. Les premières données de la littérature tendent à penser que cet examen plus rapide permet également une durée d’interprétation plus courte. De plus, la sensibilité et la spécificité de l’examen ne sont pas inférieures à celles du protocole complet. Cet article explique ce nouveau concept et son intérêt, le compare au protocole complet et évoque les perspectives futures et notamment à l’adjonction de séquences à haute résolution temporelle.

Resume Le cancer du sein est le premier cancer chez la femme. La surveillance mammaire en imagerie des patientes traitees est un element incontournable de la prise en charge. Pour ce faire, la connaissance des remaniements post-therapeutiques normaux est primordiale, et ce selon les differentes modalites d’imagerie (IRM, mammographie, echographie). En effet, elle permet de mieux detecter les recidives et/ou les nouveaux cancers qui est le but principal de cette surveillance. Elle permet en outre d’eviter les pieges de cette surveillance afin de detecter au plus tot les eventuelles evolutions tumorales locales chez ces patientes.

Background: CyberKnife ® stereotactic radiotherapy allows for minimally invasive treatment with satisfactory results in patients with inoperable primary or metastatic lung cancer. The objective of this study was to identify factors influencing the probability of local control. Methods: Ninety-five patients (100 lung tumors) treated between January and December 2013 at our department by SBRT (stereotactic body radiation therapy) using CyberKnife ® were included in the study. There were 71 stage T1 or T2 primary tumors and 29 secondary tumors. The tracking methods were as follow: fiducial markers with Synchrony ® in 50 cases (gold seeds in 35, coils in 15 cases), spine with 4D-CT and Xsight ® Spine in 43 cases, and direct viewing by Xsight ® Lung in 7 cases. The methods were allocated according to the characteristics of each target. Results: With a median follow-up of 24 months, the probability of local control at 24 months was 88%. The probability of local control differed according to the size of the target (92% for tumors ≤35 mm and 54% for tumors >35 mm: P=0.013) and according to the distance of the fiducial markers in relation to the target (95% when Conclusions: The best results were obtained with small lesions. With Synchrony ® , the distance of the target relative to the fiducial markers should be less than 50 mm. Gold seeds are recommended, although coils may be used instead of gold seeds. The number of fiducial markers did not have a significant impact on the probability of local control. With an appropriate tracking method, stereotactic radiotherapy is an efficient treatment for stage I lung cancer and lung oligometastases.

PURPOSE We aimed to compare the diagnostic accuracy and interpretation time of an abbreviated protocol relative to the complete protocol of breast magnetic resonance imaging (MRI) with the use of breast imaging reporting and data system (BI-RADS). Between-reader and between-protocol variability for BI-RADS classification and influence of reader expertise on diagnostic accuracies were also evaluated. METHODS We conducted a retrospective reader study in 90 women who underwent breast MRI: 30 benign examinations (graded as American College of Radiology [ACR] 1 or 2), 30 examinations graded as ACR 3 and 30 examinations requiring a histologic proof (graded as ACR 4 or 5). Two radiologists independently reviewed the protocols. The reference standard was 24 months of imaging follow-up (66.6%, n=60), percutaneous biopsy at the 12th month imaging follow-up (5.5%, n=5), and breast surgery (27.9%, n=25). Analysis was done on a per-breast basis. There were 26 cancers in 168 breasts (15.1%) RESULTS: Interpretation time was higher for the complete protocol (mean difference: 84 s, 95% CI [67;101] for senior and 83 s, 95% CI [70;95] for junior reader; P < 0.001). The reliability of BI-RADS classification between both protocols was very good with intraclass correlation coefficient of 0.89 for junior reader and 0.98 for senior reader; the inter-reader reliability was 0.94 and 0.90 for the complete and abbreviated protocols, respectively. For senior reader, the abbreviated and complete protocols yielded 95.1% and 94.4% specificity and 100% sensitivity. CONCLUSION Our data provide corroborating evidence that abbreviated protocols decrease interpretation time without compromising sensitivity or specificity. There was a high level of concordance between the abbreviated and complete protocols and between the two readers.

Resume Introduction La relecture radiologique systematique en centre expert dans le cancer du sein est un protocole qui se developpe. Les objectifs etaient l’analyse des consequences de la relecture en termes de complement, notamment au niveau axillaire et de l’evolution des delais. Methodes Une etude retrospective descriptive fut realisee concernant les patientes ayant eu comme premier contact un clinicien a l’Institut de cancerologie de Lorraine (ICL) a Nancy entre le 1er janvier 2016 et le 31 decembre 2016. Via leurs dossiers medicaux nous avons analyse : le bilan realise en externe, le plan therapeutique initial, la relecture, le bilan complementaire, les conclusions de la Reunion de Concertation Pluridisciplinaire (RCP) pre-therapeutique, le premier traitement, la RCP post-chirurgicale. Resultats Au total, 251 patientes ont ete incluses. La discordance a la relecture radiologique etait de 72,5 %. Au total, 43,4 % de l’ensemble des patientes ont eu de nouveaux prelevements axillo-mammaires. De nouvelles lesions malignes etaient identifiees chez 19,9 % des patientes. Des changements therapeutiques etaient proposes pour 19,9 % des patientes (incluant patientes avec et sans nouvelle lesion maligne diagnostiquee). Avant la relecture 9,8 % des echographies axillaires aboutissaient a une cytologie positive. Le bilan complementaire identifiait 9,6 % de lesions axillaires supplementaires. Apres un ganglion sentinelle positif, la RCP proposait une reprise par curage pour 27 % des patientes avec echographie axillaire au centre et 70 % des patientes sans echographie axillaire a l’ICL (p = 0,023). Conclusions La relecture systematique en centre expert permet la detection de nouvelles lesions malignes et des changements therapeutiques pertinents. Un controle systematique de l’echographie axillaire en centre expert pourrait etre envisage.

Summary Introduction Suspicious lesions of sarcoma require preoperative biopsies. If surgical biopsies remain the gold standard, radioguided percutaneous microbiopsies are gaining an increasing importance. The purpose of this study was to compare histopathological results of percutaneous biopsies of soft tissues, trunk and retroperitoneal tumors with the histopathological results of operative specimens. Methods This is a retrospective study including 84 patients treated in our institution. The concordance between the results of the microbiopsy and the operative specimen for the benign–malignant differentiation and the histological type was evaluated. The microbiopsy accuracy was calculated. The sensitivity and the specificity of the microbiopsies compared to the operative specimen were also evaluated for the benign–malignant differentiation. Results The concordance was 0.92 [0.79–1] for the benign–malignant differentiation, 0.97 [0.92–1] for the histological type. The accuracy of microbiopsies was therefore 96% (sensibility = 97.0%; specificity = 94.1%) for the benign–malignant detection and 97.8% for the histological type. Conclusion Percutaneous microbiopsies play an important part in the diagnosis of soft tissue tumors of the limbs, trunk and retroperitoneum, in particular as a replacement to more invasive surgical biopsies. This study evidences the increasing importance of the collaboration between radiologist, surgeon and pathologist in the diagnosis of sarcoma.

CyberKnifeNinety-five patients (100 lung tumors) treated between January and December 2013 at our department by SBRT (stereotactic body radiation therapy) using CyberKnifeWith a median follow-up of 24 months, the probability of local control at 24 months was 88%. The probability of local control differed according to the size of the target (92% for tumors ≤35 mm and 54% for tumors35 mm: P=0.013) and according to the distance of the fiducial markers in relation to the target (95% when50 mm and 69% when ≥50 mm: P=0.011).The best results were obtained with small lesions. With Synchrony

The systematic second opinion review in cancer centers after breast cancer detection is currently under development. The purposes were the evaluation of review's consequences, in particularly of the axillary staging and the evolution of the delays.A retrospective study was conducted on patients who consulted a clinician at Cancer Center of Lorraine in Nancy from January 1st, 2016 to December 31th, 2016. We analyzed from their medical charts: the outside exams, the initial therapeutic plan, the second opinion review, the additional exams, the multidisciplinary consultation conclusions, the first treatment, the multidisciplinary consultation after surgery.In all, 251 patients were analyzed. Second opinion review discrepancies were seen in 72.5%. As a result, 43.4% of all patients had new breast-axillary biopsies. New malignancies lesions were identified in 19.9% of patients. Modifications in therapeutic plan were recommended in 19.9% of patients (including patients with and without new malignancies lesions diagnosed). Before a second opinion review, 9.8% of axillary ultrasound lead to a positive fine-needle biopsy. The additional exams identified 9.6% additional lesions. After a positive sentinel lymph node excision biopsy, the multidisciplinary consultation recommended a revision surgery of axillary lymph node dissection for 27% of patients with axillary ultrasound performed in our cancer center, and for 70% of patients without ultrasound (P=0.023).The systematic second opinion at cancer center allows the detection of new malignancies lesions and significant modifications in the therapeutic plan. A systematic evaluation of axillary ultrasound in cancer center could be considered.

Resume Objectif de l’etude La radiotherapie conformationnelle avec modulation d’intensite (RCMI) pour les cancers du col uterin a prouve sa superiorite dosimetrique en termes de toxicite digestive, comparativement a la radiotherapie conformationnelle non modulee. L’arctherapie volumetrique modulee a montre son interet dosimetrique comparativement a la RCMI a faisceaux statiques. L’objectif de notre etude etait de comparer arctherapie volumetrique modulee et tomotherapie pour des cancers du col uterin avec irradiation lomboartique. Patientes et methodes Les dosimetries a 45 Gy de dix patientes ont ete comparees entre les deux techniques (arctherapie volumetrique modulee et tomotherapie) ainsi qu’avec la radiotherapie conformationnelle non modulee, avec recueil de la dose recue par les volumes cibles previsionnels, les reins, l’intestin, le rectum, la vessie, la moelle osseuse et la moelle epiniere, ainsi que la dose integrale. Resultats Une difference significative a ete observee en faveur de l’arctherapie volumetrique modulee et de la tomotherapie sur la radiotherapie conformationnelle non modulee pour l’epargne intestinale (volumes recevant respectivement 20, 30 et 45 Gy : V 20 Gy , V 30 Gy et V 45 Gy ), rectale ( V 30 Gy et V 45 Gy ), vesicale ( V 30 Gy et V 45 Gy ) et renale (volume recevant 12 Gy [ V 12 Gy ], dose moyenne, V 20 Gy ). Les volumes recevant 20, 30 et 45 Gy etaient significativement plus grands avec la radiotherapie conformationnelle non modulee qu’avec l’arctherapie volumetrique modulee et la tomotherapie. La difference etait en faveur de la tomotherapie comparativement a l’arctherapie volumetrique modulee pour le V 12 Gy des reins et le V 45 Gy de la vessie. Conclusion Cette etude confirme l’interet des techniques d’arctherapie volumetrique modulee et de tomotherapie pour l’irradiation pelvienne et lomboaortique des cancers du col comparativement a la radiotherapie conformationnelle non modulee. Il y avait peu de difference entre l’arctherapie volumetrique modulee et la tomotherapie, en dehors d’une meilleure epargne renale avec la tomotherapie, ce qui peut etre interessant pour des patientes recevant des chimiotherapies nephrotoxiques.

Background Cervical and skull base chordomas may relapse locally, marginally, or in ectopic sites (ie, surgical pathway, lymph nodes, prevertebral space, subdural space, or distant organs). Methods Among 371 patients treated between 1995 and 2010, we matched the initial dosimetry with the 3D imaging of recurrence and selected the patients with isolated ectopic recurrence. Results During our follow-up, we identified 13 patients who developed ectopic relapses (n = 18) in the form of lung metastasis (n = 2), axial dissemination (n = 6), nodal recurrence (n = 2), subcutaneous metastasis (n = 3), and/or seeding along the surgical pathway (n = 5). Despite treatment of these 13 patients with radiation, surgical interventions, and/or chemotherapy, we could only salvage 5 patients with recurrence in surgical pathway, whereas the remaining 8 patients succumbed to a poor prognosis. Conclusion Our study emphasizes an urgent need for prediction and early diagnosis of ectopic relapses in patients with cervical and skull base chordoma to improve accuracy of their aggressive treatments. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

Medical anatomy instruction has been an important issue of debate for many years and imaging anatomy has become an increasingly important component in the field, the role of which has not yet been clearly defined. The aim of the paper was to assess the current deployment of medical imaging in the teaching of anatomy by means of a review of the literature. A systematic search was performed using the electronic database PubMed, ScienceDirect and various publisher databases, with combinations of the relevant MeSH terms. A manual research was added. In most academic curricula, imaging anatomy has been integrated as a part of anatomical education, taught using a very wide variety of strategies. Considerable variation in the time allocation, content and delivery of medical imaging in teaching human anatomy was identified. Given this considerable variation, an objective assessment remains quite difficult. In most publications, students’ perceptions regarding anatomical courses including imaging anatomy were investigated by means of questionnaires and, regardless of the method of teaching, it was globally concluded that imaging anatomy enhanced the quality and efficiency of instruction in human anatomy. More objective evaluation based on an increase in students’ performance on course examinations or on specific tests performed before and after teaching sessions showed positive results in numerous cases, while mixed results were also indicated by other studies. A relative standardization could be useful in improving the teaching of imaging anatomy, to facilitate its assessment and reinforce its effectiveness.

La Presse Medicale - In Press.Proof corrected by the author Available online since mercredi 18 mai 2016

International audience; To evaluate the added value of ULTRAFAST-MR sequence to an abbreviated FAST protocol in comparison with FULL protocol to distinguish benign from malignant lesions in a population of women, regardless of breast MR imaging indication. Materials and methods: From March 10th to September 22th, 2014, we retrospectively included a total of 70 consecutive patients with 106 histologically proven lesions (58 malignant and 48 benign) who underwent breast MR imaging for preoperative breast staging (n = 38), high-risk screening (n = 7), problem solving (n = 18), and nipple discharge (n = 4) with 12 time resolved imaging of contrast kinetics (TRICKS) acquisitions during contrast inflow interleaved in a regular high-resolution dynamic MRI protocol (FULL protocol). Two readers scored MR exams as either positive or negative and described significant lesions according to Bi-RADS lexicon with a TRICKS images (ULTRAFAST), an abbreviated protocol (FAST) and all images (FULL protocol). Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for each protocol and compared with McNemar's test. Results: For all readers, the combined FAST-ULTRAFAST protocol significantly improved the reading with a specificity of 83.3% and 70.8% in comparison with FAST protocol or FULL protocol, respectively, without change in sensitivity. By adding ULTRAFAST protocol to FAST protocol, readers 1 and 2 were able to correctly change the diagnosis in 22.9% (11/48) and 10.4% (5/48) of benign lesions, without missing any malignancy, respectively. Both interpretation and image acquisition times for combined FAST-ULTRAFAST protocol and FAST protocol were shorter compared to FULL protocol (p < 0.001). Conclusion: Compared to FULL protocol, adding ULTRAFAST to FAST protocol improves specificity, mainly in correctly reclassifying benign masses and reducing interpretation and acquisition time, without decreasing sensitivity.

IMPORTANCE: Many women dread undergoing mammography, and some may not attend or reattend breast cancer screening because of the discomfort or pain induced by breast compression. OBJECTIVE: To evaluate the noninferiority of the self-compression mammography technique for reducing breast thickness compared with standard compression. DESIGN, SETTING, AND PARTICIPANTS: This prospective, parallel-group, noninferiority randomized clinical trial was conducted from May 7, 2013, to October 26, 2015, at 6 cancer care centers in France. Participants were women aged 50 to 75 years, without a history of recent breast surgical procedure or treatment, and who could perform self-compression. Analyses were performed on intention-to-treat basis from January 27, 2017, to March 30, 2018. INTERVENTIONS: Patients were randomized 1:1 to the self-compression group or the standard compression group. MAIN OUTCOMES AND MEASURES: Primary end point was breast thickness expressed as the mean of 4 views: right and left craniocaudal and right and left mediolateral oblique. The predefined noninferiority margin was a difference of 3 mm, with a 1-sided 95% CI. Secondary end points included compression force, image quality, requirement for additional views, pain, and patient satisfaction and radiographer assessment questionnaires. RESULTS: Among the 549 women randomized, 548 (97.3%) completed the trial. Of these, 275 (48.8%) (mean [SD] age, 61.35 [6.34] years) were randomized to the self-compression arm and 273 (48.5%) (mean [SD] age, 60.84 [6.41] years) to the standard compression arm. The difference in the mean thickness between the 2 arms was lower than the noninferiority margin, with an upper 1-sided 95% CI less than 3 mm (–0.17; 95% CI,−∞ to 1.89 mm; P

La Presse Medicale - In Press.Proof corrected by the author Available online since jeudi 27 aout 2015

Purpose Brachytherapy is a well-known treatment in the management of skin tumors. For facial or scalp lesions, applicators have been developed to deliver non-invasive treatment. We present cases treated with customized applicators with high dose rate system. Material and methods Patients with poor performance status treated for malignant skin lesions of the scalp or the facial skin between 2011 and 2014 were studied. Afterloading devices were chosen between Freiburg® Flap, silicone-mold or wax applicators. The clinical target volume (CTV) was created by adding margins to lesions (10 mm to 20 mm). The dose schedules were 25 Gy in five fractions for postoperative lesions, 30 Gy in six fractions for exclusive treatments and a single session of 8 Gy could be considered for palliative treatments. Results In 30 months, 11 patients received a treatment for a total of 12 lesions. The median age was 80 years. The median follow-up was 17 months and the 2-year local control rate was 91%. The mean CTV surface was 41.1 cm2 with a mean thickness of 6.1 mm. We conceived three wax applicators, used our silicone-mold eight times and the Freiburg® Flap one time. We observed only low-grade radiodermitis (grade I: 50%, grade II: 33%), and no high-grade skin toxicity. Conclusion High dose rate brachytherapy with customized applicators for facial skin and scalp lesions is efficient and safe. It is a good modality to treat complex lesions in patients unfit for invasive treatment.

La Presse Medicale - In Press.Proof corrected by the author Available online since mardi 19 decembre 2017

The aim of this paper was to present an overview of the most important recent advances in medical imaging and their potential clinical and anatomical applications. Dramatic changes have been particularly observed in the field of computed tomography (CT) and magnetic resonance imaging (MRI). Computed tomography (CT) has been completely overturned by the successive development of helical acquisition, multidetector and large area-detector acquisition. Visualising brain function has become a new challenge for MRI, which is called functional MRI, currently based principally on blood oxygenation level-dependent sequences, which could be completed or replaced by other techniques such as diffusion MRI (DWI). Based on molecular diffusion due to the thermal energy of free water, DWI offers a spectrum of anatomical and clinical applications, ranging from brain ischemia to visualisation of large fibrous structures of the human body such as the anatomical bundles of white matter with diffusion tensor imaging and tractography. In the field of X-ray projection imaging, a new low-dose device called EOS has been developed through new highly sensitive detectors of X-rays, allowing for acquiring frontal and lateral images simultaneously. Other improvements have been briefly mentioned. Technical principles have been considered in order to understand what is most useful in clinical practice as well as in the field of anatomical applications. Nuclear medicine has not been included.

Objectif de l’etude Decrire les resultats de la radiotherapie stereotaxique utilisee seule ou en association avec une radiotherapie conformationnelle de fractionnement standard dans le traitement des oligometastases osseuses. Materiel et methode Cette etude de cohorte retrospective a inclus des patients traites par irradiation stereotaxique entre janvier 2007 et decembre 2015 a l’Institut de cancerologie de Lorraine. Les adultes avec un indice de performance selon l’Eastern Cooperative Oncology Group score (ECOG) d’au plus 2, atteints d’une a trois metastases osseuses issues d’une tumeur primitive solide histologiquement prouvee et controlee ont ete inclus. Le controle local, la survie globale, la survie sans progression, l’incidence de la progression osseuse, la survie sans evenement osseux, la toxicite et la reponse antalgique ont ete evalues. Resultats Quarante-six patients et 52 metastases osseuses ont ete traites. Vingt-trois metastases (44,2 %) ont recu un traitement par irradiation stereotaxique exclusive et 29 (55,8 %) une association d’irradiation stereotaxique et de radiotherapie conformationnelle de fractionnement standard. Le suivi median etait de 22 mois. Cinq recidives locales (9,6 %) ont ete observees et le taux de controle local etait de 95,6 % a 1 an et 92,0 % a 2 ans. Les probabilites de survie globale a 1 et 2 ans etaient respectivement de 90,8 % et 87,4 %. La presence de metastases viscerales (hazard ratio [HR] : 3,40 [1,10–10,50]) et un delai entre le diagnostic initial de la maladie et la radiotherapie sterotaxique des metastases osseuses de plus de 30 mois (HR : 0,22 [0,06–0,82]) etaient des facteurs pronostiques independants pour la survie globale. Les probabilites de survie sans progression a 1 et 2 ans etaient respectivement de 66,8 % et 30,9 %, avec un temps median de progression de 18 mois. Les incidences de la progression osseuse a 1 et 2 ans etaient respectivement de 72,3 % et 44,7 %. En analyse multifactorielle, une histologie defavorable etait associee a une incidence de la progression osseuse plus basse (HR 3,19 : 1,32–7,76). Les probabilites de survie sans evenement osseux etaient respectivement de 93,3 % et 78,5 % a 1 et 2 ans. Le taux de reponse antalgique etait de 75 % chez les patients evaluables (neuf sur 12). Aucune toxicite de grade ≥ 3 ni aucune myelopathie radio-induites n’ont ete observees. Conclusion La radiotherapie stereotaxique seule ou associee a une radiotherapie conformationnelle de fractionnement standard est un traitement efficace et bien tolere qui permet l’obtention d’un taux de controle local eleve des oligometastases osseuses.

International audience; Age estimation is commonly of interest in a judicial context. In adults, it is less documented than in children. The aim of this study was to evaluate age estimation in adults using CT images of the sternal plastron with volume rendering technique (VRT). The evaluation criteria are derived from known methods used for age estimation and are applicable in living or dead subjects. The VRT images of 456 patients were analyzed. Two radiologists performed age estimation independently from an anterior view of the plastron. Interobserver agreement and correlation coefficients between each reader's classification and real age were calculated. The interobserver agreement was 0.86, and the correlation coefficients between readers classifications and real age classes were 0.60 and 0.65. Spearman correlation coefficients were, respectively, 0.89, 0.67, and 0.71. Analysis of the plastron using VRT allows age estimation in vivo quickly and with results similar than methods such as Iscan, Suchey-Brooks, and radiographs used to estimate the age of death.

Cervical and skull base chordomas may relapse locally, marginally, or in ectopic sites (ie, surgical pathway, lymph nodes, prevertebral space, subdural space, or distant organs).Among 371 patients treated between 1995 and 2010, we matched the initial dosimetry with the 3D imaging of recurrence and selected the patients with isolated ectopic recurrence.During our follow-up, we identified 13 patients who developed ectopic relapses (n = 18) in the form of lung metastasis (n = 2), axial dissemination (n = 6), nodal recurrence (n = 2), subcutaneous metastasis (n = 3), and/or seeding along the surgical pathway (n = 5). Despite treatment of these 13 patients with radiation, surgical interventions, and/or chemotherapy, we could only salvage 5 patients with recurrence in surgical pathway, whereas the remaining 8 patients succumbed to a poor prognosis.Our study emphasizes an urgent need for prediction and early diagnosis of ectopic relapses in patients with cervical and skull base chordoma to improve accuracy of their aggressive treatments. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1238-E1246, 2016.

International audience; PURPOSE:To describe efficacy and safety of stereotactic body radiation therapy (SBRT) for the treatment of inoperable hepatocellular carcinoma.METHODS:The records of 77 consecutive patients treated with SBRT for 97 liver-confined HCC were reviewed. A total dose of 45Gy in 3 fractions was prescribed to the 80% isodose line. Local control (LC), overall survival (OS), progression-free survival (PFS) and toxicity were studied.RESULTS:The median follow-up was 12months. The median tumor diameter was 2.4cm. The LC rate was 99% at 1 and 2years. The 1 and 2-year OS were 81.8% and 56.6% respectively. The median time to progression was 9months (0-38). The rate of hepatic toxicity was 7.7% [1.6-13.7], 14.9% [5.7-23.2] and 23.1% [9.9-34.3] at 6months, 1year and 2years respectively. In multivariate analysis, female gender (HR 7.87 [3.14-19.69]), a BCLC B-C stage (HR 3.71 [1.41-9.76]), a sum of all lesion diameters ⩾2cm (HR 7.48 [2.09-26.83]) and a previous treatment (HR 0.10 [0.01-0.79]) were independent prognostic factors of overall survival.CONCLUSION:SBRT allows high local control for inoperable hepatocellular carcinomas. It should be considered when an ablative treatment is indicated in Child A patients.

Background To evaluate the MRI features of a tumor response, local control, and predictive factors of local control after stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC). Methods Thirty-five consecutive patients with 48 HCCs who were treated by SBRT were included in this retrospective study. All patients provided written informed consent to be treated by SBRT, and prior to inclusion they authorized use of the treatment data for further studies. The assessment was made using MRI, with determination of local and hepatic responses according to Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST) criteria during a two-year follow-up. Results The local response rate according to mRECIST was higher than with RECIST. A tumor diameter less than 20 mm at baseline was an independent predictive factor for RECIST and mRECIST responses, as was diffusion-weighted signal for RECIST. During follow-up, a tumor diameter of

Resume Depuis plusieurs annees et la mise en route de traitement par analogue de la LH-RH dans les cancers du sein, les modifications mammographiques induites par ces traitements commencent a etre bien connues. En effet, ces modifications concernent essentiellement la diminution de la densite mammaire. Les modifications secondaires a l’arret de ces traitements sont moins bien connues des radiologues et consistent en une augmentation de la densite mammaire. Une augmentation de la densite mammaire peut faire suspecter chez ces femmes a risque une lesion infiltrante de type carcinome lobulaire. Dans des cas difficiles et en l’absence de cible on peut avoir recours a l’IRM mammaire pour eliminer ou rechercher un carcinome lobulaire infiltrant.