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International audience; Multiple myeloma is characterized by bone lesions linked to increased osteoclast and decreased osteoblast activities. In particular, the osteoblast differentiation of bone marrow-derived stem cells (MSC) is impaired. Among the potential therapeutic tools for counteracting bone lesions, adipose-derived stem cells (ASC) could represent an appealing source for regenerative medicine due to their similar characteristics with MSC. Our study is among the first giving detailed insights into the osteoblastogenic capacities of ASC isolated by fat aspiration from myeloma patients (MM-ASC) compared to healthy subjects (HD-ASC). We showed that MM-ASC and HD-ASC exhibited comparable morphology, proliferative capacity, and immunophenotype. Unexpectedly, although normal in adipocyte differentiation, MM-ASC present a defective osteoblast differentiation, as indicated by less calcium deposition, decreased alkaline phosphatase activity, and downregulation of RUNX2 and osteocalcin. Furthermore, these ASC-derived osteoblasts displayed enhanced senescence, as shown by an increased β-galactosidase activity and cell cycle inhibitors expression (p16 INK4A , p21 WAF1/CIP1 .), associated with a markedly increased expression of DKK1, a major inhibitor of osteoblastogenesis in multiple myeloma. Interestingly, inhibition of DKK1 attenuated senescence and rescued osteoblast differentiation, highlighting its key role. Our findings show, for the first time, Cells 2019, 8, 441 2 of 16 that multiple myeloma is a systemic disease and suggest that ASC from patients would be unsuitable for tissue engineering designed to treat myeloma-associated bone disease.; Le myélome multiple est caractérisé par des lésions osseuses liées à une augmentation de l'activité ostéoclastique et à une diminution de l'activité ostéoblastique. En particulier, la différenciation ostéoblastique des cellules souches issues de la moelle osseuse (CSM) est altérée. Parmi les outils thérapeutiques potentiels pour contrer les lésions osseuses, les cellules souches dérivées de l'adipeux (CSA) pourraient représenter une source intéressante pour la médecine régénérative en raison de leurs caractéristiques similaires à celles des cellules MSC. Notre étude est l'une des premières à donner un aperçu détaillé des capacités ostéoblastogènes de l'ASC isolée par aspiration graisseuse chez les patients atteints de myélome (MM-ASC) par rapport aux sujets sains (HD-ASC). Nous avons montré que le MM-ASC et le HD-ASC présentaient une morphologie, une capacité proliférative et un immunophénotype comparables. De façon inattendue, bien que normal dans la différenciation adipocytaire, le MM-ASC présente une différenciation ostéoblastique défectueuse, comme l'indiquent la diminution des dépôts de calcium, la diminution de l'activité des phosphatases alcalines et la régulation négative de RUNX2 et de l'ostéocalcine. De plus, ces ostéoblastes dérivés de l'ASC présentaient une sénescence accrue, comme en témoigne l'augmentation de l'activité de la β-galactosidase et de l'expression des inhibiteurs du cycle cellulaire (p16 INK4A, p21 WAF1/CIP1 .), associée à une expression nettement accrue du DKK1, un inhibiteur majeur de l'ostéoblastogenèse dans les myélomes multiples. Il est intéressant de noter que l'inhibition du DKK1 a atténué la sénescence et sauvé la différenciation des ostéoblastes, soulignant son rôle clé. Nos résultats montrent, pour la première fois, que le myélome multiple est une maladie systémique et suggèrent que les cellules 2019, 8, 441 2 sur 16 ne conviennent pas au génie tissulaire conçu pour traiter les maladies osseuses associées au myélome.

Aims: The treatment of prostate cancer has evolved markedly over the last 40 years, including radiotherapy, notably with escalated dose and targeting. However, the optimal treatment for localised disease has not been established in comparative randomised trials. The aim of this article is to describe the history ofprostate radiotherapy trials, including their quality assurance processes, and to compare these with the ProtecT trial.Materials and methods: The UK ProtecT randomised trial compares external beam conformal radiotherapy, surgery and active monitoring for clinically localized prostate cancer and will report on the primary outcome (disease-specific mortality) in 2016 following recruitment between 1999 and 2009. The embedded quality assurance programme consists of on-site machine dosimetry at the nine trial centres, a retrospective review of outlining and adherence to dose constraints based on the trial protocol in 54 participants (randomly selected, around 10% of the total randomised to radiotherapy, n ¼ 545). These quality assurance processes and results were compared with prostate radiotherapy trials of a comparable era.Results: There has been an increasingly sophisticated quality assurance programme in UK prostate radiotherapy trials over the last 15 years, reflecting dose escalation and treatment complexity. In ProtecT, machine dosimetry results were comparable between trial centres and with the UK RT01 trial. The outliningreview showed that most deviations were clinically acceptable, although three (1.4%) may have been of clinical significance and were related to outlining of theprostate. Seminal vesicle outlining varied, possibly due to several prostate trials running concurrently with different protocols. Adherence to dose constraints inProtecT was considered acceptable, with 80% of randomised participants having two or less deviations and planning target volume coverage was excellent.Conclusion: The ProtecT trial quality assurance results were satisfactory and comparable with trials of its era. Future trials should aim to standardise treatment protocols and quality assurance programmes where possible to reduce complexities for centres involved in multiple trials. 2016 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

Atlas-based auto segmentation with OnQ rts® has been shown to deliver time-savings for the delineation of organs at risk in head and neck patients being treated with intensity-modulated radiotherapy. However, as the initial time to set up atlases can be high in busy departments the optimal number of atlas cases needed for auto-contouring was investigated. Using conformity index and mean distance to conformity to compare automatically generated with gold standard clinical contours, it was found that the majority of contours were unaffected by reducing the number of atlas cases from 30 to 10. The optimum number of atlas cases, however, was considered to be 20 due to the reduction in accuracy of the mandible, larynx and brain, below this level.