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Le standard thérapeutique des cancers du canal anal localisés est une radiothérapie externe pelvienne, pouvant être suivi d'un complément par curiethérapie. Il persiste des inconnues concernant la sélection et les facteurs prédictifs de ces patients, ainsi que la préservation de leur fonction sphinctérienne. Entre 2005 et 2017, 179 patients consécutifs atteints d'un cancer du canal anal ont reçu un complément par curiethérapie dans notre institution après radiothérapie externe, 159 étaient disponibles pour l'analyse. Les facteurs pronostiques retenus concernaient notamment l'atteinte initiale de la tumeur (stade cT, circonférence, atteinte de la marge anale ou muqueuse rectale). La fonction sphinctérienne était autoévaluée par le questionnaire de Wexner. Avec un suivi moyen de 44,5 mois, les taux de contrôle local et de survie sans progression étaient respectivement de 89 % et 82 % à 5 ans. Seize patients ont subi une amputation pour une récidive (n = 14) ou une toxicité sévère (n = 2), 14,5 % des patients ont souffert d'une toxicité tardive muqueuse de grade 2 ou plus. En analyse multifactorielle, la réponse clinique au moment de la curiethérapie (hazard ratio [HR] = 4,46 en cas de réponse partielle) et la modalité de radiothérapie externe (HR = 3,25 pour radiothérapie conformationnelle tridimensionnelle contre la radiothérapie conformationnelle avec modulation d'intensité) étaient significativement associés à la survie sans progression. L'intervalle de temps entre la radiothérapie externe et la curiethérapie était significativement plus long chez les patients traités par irradiation conformationnelle tridimensionnelle (30,3 contre 17,6 jours, p = 0,002). L'extension tumorale initiale n'influencait pas significativement la survie sans progression en analyse multifactorielle. Le score moyen de Wexner était de 4,1/20. Dix-neuf pour cent des patients avaient une incontinence significative. Seulement 2,5 % des patients déclaraient des symptômes graves et 45,6 % une urgence fécale. Aucun facteur n'a été identifié comme étant associé à la survenue d'une incontinence anale. La curiethérapie de débit pulsé est une modalité efficace après radiothérapie externe pour ces patients, notamment avec une atteinte limitée de la muqueuse anale (maximum deux sur trois). Nous retrouvons une faible incidence de l'incontinence, mais l'urgence fécale reste importante. [ABSTRACT FROM AUTHOR]

Introduction As part of a phase 2 randomized clinical trial that compares Internal Target Volume (ITV) and Mid-Position (Mid-P) conformational planning strategies in locally advanced non-small cell lung cancer treatment, we investigated the impact of the type of CT image, i.e. Maximum Intensity Projection (MIP) image and Mid-P image on the inter-observer delineation variability. Methods We considered 12 patients among the 40 patients included in the clinical trial. For each patient, dataset for the delineation consisted in MIP image and Mid-P image, computed from four-dimensional CT scan (Big Bore, Philips). Primary tumor (IGTVT for MIP image and GTVT for Mid-P image) and pathological lymph nodes for 8 of the 12 patients (IGTVN for MIP image and GTVN for Mid-P image) were delineated on both images by an expert in lung radiation oncology and 2 or 3 radiation oncologists. The expert contours were considered as a reference and were compared to the others using paired Dice coefficient to estimate the overlap, Bidirectional Local Distance (BLD) to evaluate a Hausdorff distance-based between contours and the reference and Root-Mean-Square Deviation (RMSD) to measure volume variations with respect to the reference. Results The Mid-P delineated volumes were smaller than the MIP ones in average: 2.96 ± 2.75 cc and 16.7 ± 20.7 cc for nodes and primary tumors respectively. For the whole cohort, the DICE means and standard deviations were 0.685 ± 0.102, 0.706 ± 0.124, 0.777 ± 0.0926 and 0.784 ± 0.0756 for the GTVN, IGTVN, GTVT and IGTVT respectively. The absolute means BLD between the expert contours and the others were, in the same order, 2.08 ± 0.819 mm, 2.22 ± 1.36 mm, 2.60 ± 1.34 mm and 2.92 ± 1.35 mm. The RMSD were 3.05 ± 1.92 cc, 4.15 ± 4.66 cc, 13.4 ± 13.1 cc and 17.9 ± 18.3 cc respectively. Conclusions For one patient, we excluded an observer because of a non-complete contour. Regarding GTVN and IGTVN, we observed differences in terms of node selections and also delineation interpretations (nodes vs. lymph node areas). To ensure robust data, we only kept nodes selected by the expert. The presence of atelectasis and fibrosis led to large variations of primary tumor delineation (GTVT and IGTVT). The volumes and its variations decreased between MIP and Mid-P contours. Dice coefficients were lower with MIP compared to Mid-P. However, this metric is volume-dependent and tends to be lower for smaller volume. It may not be adapted here. The BLD was not statistically different. Finally, the volume variations were reduced but our results depended on delineation difficulties and did not demonstrate the statistical superiority of the Mid-P strategy in terms of inter-observer delineation variability. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether SBRT of spinal metastasis using a dedicated treatment planning system (TPS) and delivered with a gantry-based LINAC could provide plans of similar quality to the Cyberknife technology. Additional comparison was also done with other commercial TPS used for volumetric modulated arc therapy (VMAT) planning., Materials and Methods: Thirty Spine SBRT patients, previously treated in our institution with CyberKnife (Accuray, Sunnyvale) using Multiplan TPS, were replanned in VMAT with an dedicated TPS (Elements Spine SRS, Brainlab, Munich) and our clinical TPS (Monaco, Elekta LTD, Stockholm), using exactly the same arc geometry. The comparison was done by assessing differences in dose delivered to PTV, CTV and spinal cord, calculating modulation complexity scores (MCS) and performing quality control (QA) of the plans., Results: Regardless of the vertebra level, in general, no statistical difference was found in PTV coverage between all TPS. Conversely, PTV and CTV D 50% were found significantly higher for the dedicated TPS compared to others. In addition, the dedicated TPS also resulted in better gradient index (GI) than clinical VMAT TPS, whatever the vertebral level, and better GI than Cyberknife TPS for the thoracic level only. The D 2% to the spinal cord was generally significantly lower with the dedicated TPS compared with others. No significant difference was found in the MCS between both VMAT TPS. All QA were clinically acceptable., Conclusion: The Elements Spine SRS TPS offers very effective and user-friendly semi-automated planning tools and is secure and promising for gantry-based LINAC spinal SBRT., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This work was performed in the framework of a research cooperation agreement with Brainlab society., (Copyright © 2023 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights reserved.)

Introduction: Indications of adjuvant radiotherapy (RT) for high-risk cutaneous squamous cell carcinoma (cSCC) are not clearly defined. We aimed to identify factors predicting relapse in cSCC patients treated with surgery or RT alone and to assess in which clinical setting adjuvant RT was beneficial in term of progression free survival (PFS)., Methods: This retrospective analysis included patients with resectable primary cSCC treated with surgery and/or RT in curative intent, managed at Centre Léon Bérard (Lyon, France) from April 2010 to September 2020., Results: A total of 303 patients with 529 cSCC were included. 31 (5.9%) cSCC were treated with surgery and adjuvant RT. With a median follow-up of 54 (0.2-126) months, 103 (19.5%) cSCC relapsed. In multivariate analysis, the highest predictive factor of relapse in cSCC was the number of risk factors (HR = 15.110 [95% CI: 3.91-58.40] for ≥3 risk factors p < 0.001), followed by poor differentiation (HR = 4.930 [95% CI: 2.47-9.86], p < 0.001) and perineural invasion (HR = 2.442 [95% CI: 1.11-5.38], p = 0.027). For cSCC with ≥3 risk factors, PFS was significantly higher in cSCC treated with surgery and adjuvant RT compared to those treated with surgery or RT alone (the 36-month PFS was 74% [95% CI: 43-90%] and 31% [95% CI: 10-54%] respectively, p = 0.008)., Conclusion: An increased number of risk factors was identified as being the highest predictive factor of relapse in cSCC. Adjuvant RT improved PFS for high-risk cSCC with ≥3 risk factors., Competing Interests: Conflict of interest All authors declare that there is no conflict of interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)