Search

Purpose: Intensity-modulated radiation therapy or volumetric-modulated arctherapy is nowadays the recommended radiation technique for the treatment of head and neck cancers. However, by providing a significant dose gradient between target volumes and organs at risk, there is a risk of target missing and thus recurrence in case of inadequate delineation. It is therefore necessary to determine the origin of these recurrences to improve clinical practice. Over the past years, different methods have been described for the analysis of recurrences. Using the patterns of failure of patients with oral cavity and oropharynx carcinoma, treated with postoperative volumetric-modulated arctherapy in our institution, the purpose of this work was to analyse the sites of local recurrences and to evaluate the disparity in the classification of recurrences when different methods were used., Material and Methods: Between 2011 and 2019, 167 patients who underwent postoperative volumetric-modulated arctherapy for oral cavity or oropharyngeal cancers were included (60 and 40 % respectively). Two or three dose levels were prescribed (54Gy, 59.4/60Gy±66Gy). Local recurrence occurred in 17 patients (10.2 %). We assessed the patterns of local recurrences according to four methods: 1/ volume-based method using the volume overlap between the recurrence volume and initial target volumes; 2/ volume-based method of overlap between the recurrence volume and the 95 % treatment isodose; 3/ point-based method using the position of the barycentre of the recurrence volume; 4/ combined centroid method classifying recurrences according to both the initial target volumes and dose distribution. Each case was reviewed to make a clinical judgment on these classifications and assessed them as "appropriate", "possible", or "inappropriate"., Results: For the volume-based method using overlap between the recurrence volume and the initial clinical target volume, this classification was clinically judged as inappropriate in 11 out of 17 cases (65 %). For the volume-based method using overlap between the recurrence volume and the 95 % prescribed isodose, this classification was clinically judged as appropriate in 15 out of 17 cases (88 %). For the point-based method, this classification was clinically judged as appropriate in 14 out of 17 cases (82 %). Thirteen out of 17 local recurrences had the same classification between this point-based method and the volume-based method of overlap between the recurrence volume and the 95 % prescribed isodose. For the combined centroid method, among 17 local recurrences nine were classified as type A, two as type B, two as type C, three as type D and one as type E. This classification was clinically judged as appropriate in 15 out of 17 cases (88 %). Only five out of 17 of the local recurrences were classified the same way according to the four different methods (29 %)., Conclusion: Recurrences that are "marginal" or "outfield" represent a major challenge for intensity-modulated radiation therapy/volumetric-modulated arctherapy quality assurance and improvement of delineation recommendations. To date, there are no published methods that give complete satisfaction., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: Presently, there are few published reports on postoperative radiation therapy for oropharyngeal and oral cavity cancers treated with IMRT/VMAT technique. This study aimed to assess the oncological outcomes of this population treated with postoperative VMAT in our institution, with a focus on loco-regional patterns of failure., Material and Methods: Between 2011 and 2019, 167 patients were included (40% of oropharyngeal cancers, and 60% of oral cavity cancers). The median age was 60 years. There was 64.2% of stage IV cancers. All patients had both T and N surgery. 34% had a R1 margin, 42% had perineural invasion. 72% had a positive neck dissection and 42% extranodal extension (ENE). All patients were treated with VMAT with simultaneous integrated boost with three dose levels: 66Gy in case of R1 margin and/or ENE, 59.4-60Gy on the tumor bed, and 54Gy on the prophylactic areas. Concomittant cisplatin was administrated concomitantly when feasible in case of R1 and/or ENE., Results: The 1- and 2-year loco-regional control rates were 88.6% and 85.6% respectively. Higher tumor stage (T3/T4), the presence of PNI, and time from surgery >45 days were significant predictive factors of worse loco-regional control in multivariate analysis (p=0.02, p=0.04, and p=0.02). There were 17 local recurrences: 11 (64%) were considered as infield, 4 (24%) as marginal, and 2 (12%) as outfield. There were 9 regional recurrences only, 8 (89%) were considered as infield, and 1 (11%) as outfield. The 1- and 2-year disease-free survival (DFS) rates were 78.9% and 71.8% respectively. The 1- and 2-year overall survival (OS) rates were 88.6% and 80% respectively. Higher tumor stage (T3/T4) and the presence of ENE were the two prognostic factors significantly associated with worse DFS and OS in multivariate analysis., Conclusion: Our outcomes for postoperative VMAT for oral cavity and oropharyngeal cancers are encouraging, with high rates of loco-regional control. However, the management of ENE still seems challenging., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Mione, Casile, Moreau, Miroir, Molnar, Chautard, Bernadach, Kossai, Saroul, Martin, Pham-Dang, Lapeyre and Biau.)

Introduction: Bone metastases (BM) in renal cell carcinoma (RCC) are associated with a poor prognosis based on retrospective studies evaluating antiangiogenic agents. Few data are available regarding immune checkpoint inhibitors (ICI) in patients with bone metastatic RCC. NIVOREN is a multicentre prospective study in which patients were treated with nivolumab after the failure of antiangiogenic agents. We aim to assess the impact of BM on prognosis, and the efficacy and safety of nivolumab in patients enrolled in the NIVOREN trial., Materials and Methods: All patients with BM at inclusion were included in our study. The primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS), objective response rate (ORR), safety, and skeletal-related events (SRE)., Results: Among 720 patients treated with nivolumab, 194 presented BM at inclusion. The median follow-up was 23.9 months. Median OS was 17.9 months in patients with BM versus 26.1 months in patients without BM (p = 0.0023). The difference was not statistically significant after adjustment (p = 0.0707). The median PFS was shorter in patients with BM even after adjustment (2.8 versus 4.6 months, p = 0.0045), as well as the ORR (14.8% versus 23.3%). SRE occurred for 36% of patients with BM. A post-hoc analysis evaluating the impact of bone-targeting agents (BTA) on SRE incidence showed a significant benefit of BTA on the incidence of SRE (OR = 0.367, CI95% [0.151-0.895])., Conclusion: Nivolumab is associated with shorter PFS, and lower ORR in RCC patients with BM. Our study suggests that BTA in association with immunotherapy decreases the incidence of SRE., Competing Interests: Conflict of interest statement The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MaudVELEV, Cecile Dalban, Florence Joly, Mathieu Laramas, Berangère Narciso, Jean-François BERDAH, Victoria FERRARI, Quentin Dominique THOMAS, Cecile Mione, Florence Tantot and Sylvie Chabaud have nothing to disclose. Christine Chevreau: consulting or advisory role – BMS; Ipsen; Novartis; Pfizer. Travel, accommodations, and expenses – AstraZeneca, BMS, Pfysez-Ipsen. Gwenaelle Gravis: AstraZeneca (Inst); Bayer (Inst); BMS (Inst); IPSEN (Inst); Janssen (Inst); MSD Oncology (Inst); Pfizer (Inst); Sanofi/Aventis (Inst). Speaker's: Amgen (Inst); Astellas Pharma (Inst); BMS (Inst); Ipsen (Inst); Janssen Oncology (Inst); MSD Oncology (Inst); Sanofi/Aventis (Inst), Research Funding: BMS. Sylvie Negrier: Honoraria: Bristol-Myers Squibb; Ipsen; MSD Oncology; Novartis; Pfizer. Consulting or advisory role – Bristol-Myers Squibb; Ipsen; MSD Oncology; Novartis; Pfizer. Research Funding: IPSEN (Inst); Pfizer (Inst). Travel, accommodations, and expenses – Bristol-Myers Squibb; IPSEN; Novartis; Pfizer. Brigitte Laguerre: Honoraria: Astellas Pharma; AstraZeneca; Ipsen; Ipsen; Ipsen; Janssen-Cilag; MSD Oncology. Travel, accommodations, and expenses – Astellas Pharma; Janssen; Janssen Oncology; Novartis; Pfizer. Marine Gross-Goupil: consulting or advisory role – Amgen; Astellas Medivation; AstraZeneca; Bayer/Onyx; Bristol-Myers Squibb; Ipsen; Janssen-Cilag; MSD Oncology; Pfizer; Roche; Sanofi. Research Funding – AstraZeneca (Inst); AstraZeneca (Inst); BMS (Inst); Ipsen (Inst); Janssen-Cilag (Inst); Merck (Inst); MSD Oncology (Inst); Pfizer (Inst); Roche (Inst). Sylvain Ladoire: Expert testimony – Astellas Pharma; Bristol-Myers Squibb; Ipsen; Janssen Oncology; Lilly; Novartis; Pfizer; Roche; Sanofi. Travel, accommodations, and expenses – Astellas Pharma; AstraZeneca; Bristol-Myers Squibb; Ipsen; Janssen Oncology; Novartis; Pfizer; Sanofi. Delphine Borchiellini has received consulting and advisory fees from Astellas Pharma, AstraZeneca, Bristol-Myers Squibb, Ipsen, Janssen-Cilag, MSD Oncology, Novartis, Pfizer, and Sanofi; research funding from Astellas Pharma, AstraZeneca, Bristol-Myers Squibb, Exelixis, Infinity Pharmaceuticals, Janssen, MSD, and Roche; and travel and accommodations expenses from Bristol-Myers Squibb, Janssen, Pfizer, and Roche. Lionnel Geoffrois: Honoraria: BMS; Ipsen; Merck serono; Pfizer. Consulting or advisory role – Ipsen. Frank Priou: consulting or advisory role – AstraZeneca. Philippe Barthélémy: Honoraria Astellas Pharma; BMS; IPSEN; Janssen-Cilag; Merck KGaA; MSD; Novartis; Pfizer. Consulting or advisory role – Amgen; AstraZeneca; BMS; Eisai; Ipsen; Janssen-Cilag; Merck KGaA; MSD Oncology; Pfizer. Travel, accommodations, and expenses – Astellas Pharma; BMS; IPSEN; Janssen-Cilag; MSD; Pfizer. Antoine Thiery-Vuillemin has received honoraria from Astellas Pharma, AstraZeneca, Bristol-Myers Squibb, Ipsen, Janssen, MSD, Novartis, Pfizer, Roche/Genentech, and Sanofi; consulting and advisory fees from Astellas Pharma, AstraZeneca, Bristol-Myers Squibb, Ipsen, Janssen, MSD, Novartis, Pfizer, Roche, and Sanofi; research funding from Pfizer; and travel and accommodations expenses from AstraZeneca, Bristol-Myers Squibb, Janssen, MSD, Pfizer, and Roche. Hubert Curcio: Honoraria or consultation fees: Bristol Myers Squibb. Stephane Oudard has received honoraria from Astellas Pharma, Bayer, Bristol-Myers Squibb, Eisai, Ipsen, Janssen, Merck, MSD, Novartis, Pfizer, Roche/Genentech, and Sanofi; consulting and advisory fees from Astellas Pharma, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eisai, Ipsen, Janssen, Merck, MSD Oncology, Novartis, Pfizer, Roche, Roche, and Sanofi; research funding from Ipsen and Sanofi; and travel and accommodation expenses from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eisai, Merck, MSD Oncology, Novartis, Pfizer, and Roche. Bernard Escudier: Honoraria Bristol-Myers Squibb; Ipsen; Oncorena; Pfizer. Consulting or Advisory Role – AVEO; Bristol-Myers Squibb; Ipsen; Oncorena; Pfizer. Research Funding - BMS France (Inst). Travel, accommodations, and expenses - Bristol-Myers Squibb; Ipsen; MSD. Laurence Albiges: consulting or advisory role – Amgen (Inst); Astellas Pharma (Inst); AstraZeneca (Inst); Bristol-Myers Squibb (Inst); Corvus Pharmaceuticals (Inst); Exelixis (Inst); Ipsen (Inst); Janssen (Inst); Merck (Inst); MSD (Inst); Novartis (Inst); Peloton therapeutics (Inst); Pfizer (Inst); Roche (Inst). Research Funding – Bristol-Myers Squibb (Inst). Travel, accommodations, and expenses – Bristol-Myers Squibb; MSD. Constance Thibault: consulting or advisory role – Astellas/Agensys; AstraZeneca; Bristol-Myers Squibb; Ipsen; Janssen; Merck; MSD; Pfizer; Sanofi. Travel, accommodations, and expenses - Astellas/Agensys; Janssen; Sanofi., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: The advent of immune checkpoint inhibitors (ICIs) such as nivolumab has enabled outcomes for metastatic renal cell carcinoma (mRCC) to be improved. However, only around 25% of patients respond to these therapies without being able to formally identify them. Data on relevant predictive markers are still lacking. The obesity paradox has been shown as a relevant prognostic marker in mRCC with better outcomes for obese patients. Nevertheless, the impact of weight variation and the presence of sarcopenia during ICI treatment is not known for now., Methods: In a retrospective study, weight and its variations were collected at first day of ICI and at 6 weeks of treatment. Scanographic imagery was used to define the skeletal muscle index (SMI) as a reflect of sarcopenia. The impact of these parameters as predictive and prognostic factors for mRCC with nivolumab was evaluated., Results: A higher body mass index (BMI) at baseline was significantly associated with response at the first scan (p = 0.036). Longer overall survival (OS) was observed for patients with a weight gain compared to the group with weight loss (p = 0.00028). Median OS for sarcopenic patients was 17.2 months and 31.6 months for the non-sarcopenic group of patients, but there was no statistical difference., Conclusion: This trial showed that a higher BMI and weight gain during nivolumab treatment were good predictive markers for outcomes in mRCC with nivolumab. Sarcopenia and variations in SMI could thus be of interest, but further studies are required., (© 2021 S. Karger AG, Basel.)

Serum osmolality is one of the end-points in the management of neurologic intensive care patient. Its leading role in the concept of cerebrovascular homeostasis is underlined. Normal plasma osmolality is generally 285 mOsm kg-1, a value determined almost entirely by small molecules and ions (Na+, K+, urea and lactate). The plasma osmolality value is determined by measuring the changes in freezing point related to the zero value of a sample of distilled water. The measurement of plasma osmolality is very easy and inexpensive; its widely use could be very useful in the neurologic intensive care units to improve the treatment of neurological critical patient. According to the authors the monitoring of plasma osmolality should be mandatory to evaluate the effectiveness of treatment of brain edema.