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Abstract: The authors describe the recent organization of the pediatric radiation oncology in France. Since 2008, some criteria have been published by the National Cancer Institute and are mandatory to obtain a pediatric radiation therapy agreement. These criteria include clinical activity, on site involvement of the physician in the pediatric staff. Twice a month, a Web conferencing allows a clinical data discussion among the French pediatric RT community. A regular update of criteria is asked in order to adapt them to the new challenge. [Copyright &y& Elsevier]

To evaluate efficacy and feasibility of high-dose intensity-modulated radiotherapy (RT) with pre-operative helical tomotherapy, delivering 54 Gy/30 fractions in patients with retroperitoneal liposarcomas (RPLS). Patients with operable, biopsy-proven, RPLS were included in this phase II multicenter study. Surgery was planned 4 to 8 weeks following RT. The primary objectives were to analyze cumulative incidence of loco-regional relapse (LRR), overall survival (OS) and toxicities, graded according to CTCAE V3.0. From April 2009 to September 2013, 48 patients were included. Median age was 63 years (range, 36-82 years). Performance status was ≤ 2 except for one patient. Histological types were: 20 well differentiated (WDLS) and 28 dedifferentiated liposarcomas. Median clinical target volume (CTV) was 2570 cc (range, 0-8734 cc). The radio-surgical schedule was completed as planned in all patients apart from one. A monobloc wide excision was achieved for all patients. Surgical margins were R0 (16; 34%), R1 (28; 60%), R2 (2; 4%) or missing (1; 2%). With a median follow-up of 5.5 years, cumulative incidence of LRR at 3 years and 5 years was 16.9% [95%CI, 7.9-28.8] and 25.6% [95%CI, 14.2-38.6], respectively. The 3- and 5-year OS was 80.6% [95%CI, 66.0-89.4] and 73.9% [95%CI, 58.7-84.3], respectively. During RT, the most common grade 3-4 adverse events were hematological (N=20; 41.6%) and general (N=3; 6.3%). After surgery and during follow-up, 17 patients (35.4%) presented a grade 3-4 toxicity. Two patients (4.1%) died due to a duodenal toxicity. Nine second cancers were observed. This phase II trial confirms the feasibility of preoperative high-dose RT in RPLS patients. Although efficacy of this approach is supported by adequate local control and OS data, toxicity within the first 6 months was non-negligible. Furthermore, due to low number of events, the relevance of a pre-operative RT for WDLS remains questionable. [ABSTRACT FROM AUTHOR]

In this phase I trial, combining bevacizumab with standard fractionation whole-brain radiotherapy (WBRT) as treatment of unresectable brain metastases from solid tumours was tolerable. No dose-limiting toxicities were observed and encouraging efficacy was noted. The proposed regimen for phase II is 3 cycles of bevacizumab 15 mg/kg every 2 weeks with WBRT from day 15 (30 Gy/10 fractions/2 weeks).Background Brain metastases (BMs) are associated with a poor prognosis. Standard treatment comprises whole-brain radiation therapy (WBRT). As neo-angiogenesis is crucial in BM growth, combining angiogenesis inhibitors such as bevacizumab with radiotherapy is of interest. We aimed to identify the optimal regimen of bevacizumab combined with WBRT for BM for phase II evaluation and provide preliminary efficacy data. Patients and methods In this multicentre single-arm phase I study with a 3 + 3 dose-escalation design, patients with unresectable BM from solid tumours received three cycles of bevacizumab at escalating doses [5, 10 and 15 mg/kg every 2 weeks at dose levels (DL) 0, 1 and 2, respectively] and WBRT (30 Gy/15 fractions/3 weeks) administered from day 15. DL3 consisted of bevacizumab 15 mg/kg with WBRT from day 15 in 30 Gy/10 fractions/2 weeks. Safety was evaluated using NCI-CTCAE version 3. BM response (RECIST 1.1) was assessed by magnetic resonance imaging at 6 weeks and 3 months after WBRT. Results Nineteen patients were treated, of whom 13 had breast cancer. There were no DLTs. Grade 1–2 in-field and out-field toxicities occurred for five and nine patients across all DLs, respectively, including three and six patients (including one patient with both, so eight patients overall) of nine patients in DL3. One patient experienced BM progression during treatment (DL0). At the 3-month post-treatment assessment, 10 patients showed a BM response: one of three treated at DL0, one of three at DL1, two of three at DL2 and six of seven at DL3, including one complete response. BM progression occurred in five patients, resulting in two deaths. The remaining patient died from extracranial disease progression. Conclusion Bevacizumab combined with WBRT appears to be a tolerable treatment of BM. DL3 warrants further efficacy evaluation based on the favourable safety/efficacy balance. Clinical trials.gov Identifier NCT01332929. [ABSTRACT FROM AUTHOR]

Abstract: Purpose. – To analyse outcomes after interstitial brachytherapy of facial periorificial skin carcinomas. Patients and methods. – We performed a retrospective analysis of 97 skin carcinomas (88 basal cell carcinomas (BCCs), 9 squamous cell carcinomas (SCCs)) of the nose, periorbital areas and ears from 40 previously untreated patients (group 1) and 57 patients who had undergone surgery (group 2). The average dose was 55 Gy [50–65] in group 1 and 52 Gy [50–60] in group 2 (mean implantation times: 79 and 74 hours respectively). We calculated survival rates and assessed functional and cosmetic results de visu. Results. – Median age was 71 years [17–97]. There were 29 T1, 8 T2, 1 T3 and 2 Tx tumors in group 1. Tumors were<2 cm in group 2. Local control was 92.5% in group 1 and 88% in group 2 (median follow-up: 55 months [6–132]). Five-year disease-free survival was better in group 1 (91% [75–97]) than in group 2 (80% [62–90]), P =0.23. Of the 34 patients whose results were re-assessed, eight presented pruritus or epiphora. One group 2 patient had an impaired eyelid aperture. Cosmetic results were better in group 1 than in group 2, with respectively 72% (8/11) vs 52% (12/23) of good results and 28 (3/11) vs. 43% (10/23) of fair results. Conclusion. – Brachytherapy provided a high level of local control and good cosmetic results for facial periorificial skin carcinomas that pose problems of surgical reconstruction. Results were better for untreated tumors than for incompletely excised tumors or tumors recurring after surgery. [Copyright &y& Elsevier]