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Background: A clinical decision support system (CDSS) has been designed to predict the outcome (overall survival) by extracting and analyzing information from routine clinical activity as a complement to clinical guidelines in lung cancer patients. Materials and methods: Prospective multicenter data from 543 consecutive (2013–2017) lung cancer patients with 1167 variables were used for development of the CDSS. Data Mining analyses were based on the XGBoost and Generalized Linear Models algorithms. The predictions from guidelines and the CDSS proposed were compared. Results: Overall, the highest (> 0.90) areas under the receiver-operating characteristics curve AUCs for predicting survival were obtained for small cell lung cancer patients. The AUCs for predicting survival using basic items included in the guidelines were mostly below 0.70 while those obtained using the CDSS were mostly above 0.70. The vast majority of comparisons between the guideline and CDSS AUCs were statistically significant (p < 0.05). For instance, using the guidelines, the AUC for predicting survival was 0.60 while the predictive power of the CDSS enhanced the AUC up to 0.84 (p = 0.0009). In terms of histology, there was only a statistically significant difference when comparing the AUCs of small cell lung cancer patients (0.96) and all lung cancer patients with longer (≥ 18 months) follow up (0.80; p < 0.001). Conclusions: The CDSS successfully showed potential for enhancing prediction of survival. The CDSS could assist physicians in formulating evidence-based management advice in patients with lung cancer, guiding an individualized discussion according to prognosis. Instituto de Salud Carlos III PI16/02104 Junta de Andalucía PIN-0476-2017 Ministerio de Economía y Competitividad FPAP13-1E-2429

International audience; Introduction: Adjuvant whole-pelvic radiation therapy (WPRT) improves locoregional control for high-intermediate stages I-III endometrial cancer patients. Intensity modulated radiation therapy (IMRT) tends to replace the standard 3D conformal radiation therapy (3DCRT) technique used in trials.Material and methods: Consecutive patients with stages I-IIIc endometrial cancer treated between 2008 and 2014 in our department with post-operative 3DCRT or IMRT WPRT were studied retrospectively. Patients with cervical involvement underwent additional low-dose rate vaginal brachytherapy. The impact of the WPRT technique on local control, tolerance, disease-free survival (DFS) and overall survival (OS) was assessed. Clinicians evaluated routinely acute radiation toxicity each week during radiation therapy and late toxicity during standard follow-up consultations.Results: Median follow-up was 50 months (range: 6-158). Among the 83 patients included, 47 were treated with 3DCRT and 36 with IMRT. There was no difference in patient characteristics between groups. The 5-year locoregional control and DFS rates were 94.5% and 68%, respectively. No significant difference was found between the 3DCRT and IMRT groups in terms of survival, with 5-year OS rates of 74.6% and 78%, respectively. In multivariate analysis, age over 68, stage > T1 and grade 3 were independently associated with shorter DFS and OS. Seven patients (8.4%) had grades 3-4 acute gastrointestinal (GI) toxicity with five patients (10.6%) and two (5.4%) in the 3DCRT and IMRT groups, respectively (p = .69). One case (1.2%) of late grade 3 GI toxicity was observed treated in 3DCRT.Conclusions: IMRT seems to be a safe technique for the treatment of endometrial cancer with a trend towards decreased acute GI toxicities. Results of the phase 3 RTOG 1203 trial are needed to confirm these results.

Introducción - Las herramientas educativas en línea permiten una formación médica interactiva para estudiantes dispersos geográficamente. Pocos estudios tienen como objetivo primario su validación objetiva. Por sus ventajas logísticas, se utilizó un taller de delineación en línea (TDE) para homogeneizar el contorneo como control de calidad de radioterapia en el ensayo prospectivo multicéntrico europeo RAIDs (Rational molecular Assessments and Innovative Drug Selection) en cáncer de cérvix localmente avanzado (CCLA). Se realizaron dos TDE idénticos para evaluar sobre un paciente de simulacro las delineaciones de los centros RAIDs. Objetivos .- Principales: 1. Realizar una validación interobservadora de los TDE en CCLA mediante una evaluaci ón cualitativa y cuantitativa de la mejoría de delineaciones entre participantes (variabilidad interobservadora). 2. Efectuar una validación intraobservadora del TDE en CCLA mediante una evaluaci ón cualitativa y cuantitativa de la mejoría de delineaciones de cada participante (variabilidad intraobservadora). .- Secundarios: 1. Evaluar la metodología de enseñanza del TDE mediante cuestionarios de satisfacci ón. 2. Análizar las delineaciones de los participantes de los centros europeos que utilizan la resonancia magnética para planificar braquiterapia (BQT) con respecto a los que no la usan. Metodología - Se realizaron dos TDE incluyendo 46 especialistas de 14 centros de RAIDs. Se estableció una colaboración técnica con la Sociedad Europea de Oncología Radioter ápica (ESTRO). La formación se realizó por una experta en la materia, CHM. Mediante 3 presentaciones en directo en línea se presentaron la plataforma de contorneo Fellowship in Anatomical deLineation and CONtouring (FALCON) EduCaseTM, las guías de delineaci ón y los contornos de los participantes. Los participantes completaron contornos basales (C1), guía (C2) y finales (C3) para radioterapia externa (RTE) y braquiterapia (BQT) en CCLA. La variabilidad interobservadora e intraobservadora se evaluó cuantitativamente (Índice DICE) y se analizaron mediante un modelo lineal mixto. La variabilidad intraobservadora fue evaluada cualitativamente mediante el test de McNemar. Resultados - Nueve participantes enviaron contornos para RTE y BQT (C1-C3). Treinta y dos envió algún contorno. La comparación interobservadora cuantitativa de RTE mostró una mejoría significativa entre C2 y C1 para intestino, CTV ganglionar, CTV-p y GTVganglio con un detrimento significativo para GTV-ganglio (entre C3 y C1; C2), CTV-p (entre C3 y C2) e intestino (entre C3 y C2), es decir, una mejoría en general entre C2 y C1, con un detrimento significativo entre C3 y C2 en dos volúmenes blanco y un órgano de riesgo. Para BQT hubo una mejoría significativa entre C2 y C1 para vejiga, GTV, HRCTV e IR-CTV con un detrimento significativo para vejiga (entre C3 y C2), en resumen, una mejoría general entre C2 y C1, con sólo un detrimento entre C3 y C2 para la vejiga. Las comparaciones intraobservadoras cuantitativas mostraron una mejoría signi cativa de delineaciones de regiones de interés entre C2 y C1, C3 y C1 y C3 y C2 para RTE y entre C2 y C1 para BQT. Las comparaciones cualitativas intraobservadoras destacables en BQT fueron una mejoría significativa en las direcciones derecha y posterolateral derecha para los volúmenes blanco entre C2 y C1, que pasaron a ser signi cativamente peores para estas direcciones entre C3 y C1; C2. El resultado de las preguntas acerca de la organización y el contenido del TDE del cuestionario de satisfacción (escala del 1 al 5, 1=poco satisfecho, 5=muy satisfecho) para los 20 participantes que respondieron fue de media 4.36 (rango: 3.95-4.60). Los centros que empleaban resonancia magnética para la delineación en BQT tuvieron una mejoría significativa para HR-CTV con respecto a los que usaban otras técnicas (entre C2 y C1: p-value < 0.005; entre C3 y C1: p-value = 0.02). Conclusiones - Los TDE permiten formar, armonizar inicialmente la delineación y evaluar la experiencia de los centros antes de la inclusión de pacientes de una forma cómoda y eficaz en el seno de un estudio multicéntrico. Introduction - E-learning programmes allow e ective medical training for geographically dispersed participants. Few studies aim primarily to validate these programmes objectively. Considering its logistical aptitudes, an ODW using FALCON was used to homogenise delineation practice in cervical cancer as quality control among European centres participating in a multicentre prospective trial on locally advanced cervical cancer (LACC). Two identical ODW were performed, to evaluate the delineations of RAIDs centres on a ctitious patient. Aims Primary endpoints: 1. Interobserver validation of the ODW in LACC by using qualitative and quantitative assessments of the improvement of clinician contours between clinicians (interobserver variability). 2. Intraobserver validation of the ODW in LACC by assessing qualitatively and quantitatively the improvement of the clinician contours for each clinician (intraobserver variability). Secondary endpoints: 1. Evaluation of the teaching methodology of the ODW as re ected by the participant satisfaction questionnaires. 2. Analysis of clinician contouring on magnetic resonance imaging (MRI) for European centres which use MRI for brachytherapy planning versus those which do not. Methods - Two ODW included 46 clinicians from 14 RAIDs centres. A technical collaboration was established with European Society for Radiotherapy & Oncology (ESTRO). Training was performed by an expert in the eld, CHM. Through 3 live online presentations, the contouring platform FALCON EduCaseTM, the delineation guidelines and the participant contours were presented. Participants were asked to complete baseline contouring (C1), guideline contouring (C2) and nal contouring (C3) for external beam radiotherapy (EBRT) and brachytherapy (BT) for LACC. Interobserver and intraobserver variability was quantitatively evaluated (DICE index) and analysed by a linear mixed model. Intraobserver variability was qualitatively evaluated by the McNemar test. Results - Nine participants contoured for EBRT and BT for C1 - C3. Thirty-two clinicians submitted any contour. Concerning interobserver quantitative comparisons for EBRT, signi cant improvement was observed for C2 vs. C1 for bowel, nodal elective volume (CTV-node), GTV-p, uterus and vagina, at least 20 mm below GTV-p (CTV-p) and radiologically pathological lymph nodes to boost (GTV-node), versus a signi cant detriment for GTV-node (C3 vs. C1; C2), CTV-p (C3 vs. C2) and bowel (C3 vs. C2), showing overall an improvement in C2 vs. C1, versus a detriment in C3 vs. C2 for two target volumes and one organ at risk. In the BT treatment there was signi cant improvement for C2 vs. C1 for bladder, gross tumor volume (GTV), high risk CTV (HR-CTV) and intermediate risk CTV (IR-CTV), versus a signi cant detriment for bladder (C3 vs. C2), thus a general improvement in C2 vs. C1, with only a detriment in C3 vs. C2 for bladder. As for intraobserver quantitative comparisons, a signi cant improvement was observed for contouring a region of interest between C2 vs. C1, C3 vs. C1 and C3 vs. C2 for EBRT and between C2 vs. C1 for BT. Notable intraobserver qualitative comparisons were found for BT, a signi cant improvement towards the right and posterolateral right directions for target volumes in C2 vs. C1, which became signi cantly worse in these directions in C3 vs. C1 and C2. The average result of the Organisation and Content items in the satisfaction questionnaire for the 20 ODW participants who responded (scale 1-5, 1=poor, 5=excellent) was 4.36 (range 3.95-4.60). With regard to the imaging technique used for BT planning, centres using magnetic resonance imaging (MRI) did significantly better in the BT case for HR-CTV than centres using other techniques (C2 vs. C1: p-value < 0.005; C3 vs. C1: p-value = 0.02). Conclusions - ODW allow to train, initially harmonise contouring and assess the experience of centres before patient inclusion conveniently and eficiently in the context of a multicentre trial.