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Purpose Bowel is often the dose-limiting organ in curative pelvic irradiation because of radiation enteritis when dose exceeds 40 to 45 Gy. To limit radiation enteritis, a silicone tissue-expander prothesis (STEP) connected to a subcutaneous self-sealing valve was prospectively used in children undergoing pelvic or abdominal radiation therapy. This study reports the 15-year long-term outcomes of this prospective series. Methods and materials Between 1987 and 2008, 29 children from 3 Paris institutions received pelvic radiation therapy after surgical placement of a STEP in the pelvis. The median prescribed dose was 50.4 Gy (44.1-55 Gy) using 5 daily fractions of 1.8 Gy per week, except for 1 patient receiving 4 fractions of 2.5 Gy per week. The median treatment duration was 40 days (29-49 days). After 2000, computed tomography (CT) conformal 3-dimensional radiation therapy was used, and 12 patients had CT simulation. Four had CT before and after insertion of the STEP, enabling us to compare pre- and postprosthesis insertion bowel dose-volume histograms. Acute and late toxicities were captured using the Radiation Therapy Oncology Group or the National Cancer Institute Common Terminology Criteria for Adverse Events 4.0 scale. Results No patient experienced significant perioperative complications. Pre- and post-STEP insertion small bowel dose-volume histograms show significant reductions in small bowel: 51%, 45%, and 64%, respectively, in V10, V15, and V40 (Vx = irradiated volume by x Gy). Twenty-five patients (86%) completed their radiation therapy with no or minimal small bowel toxicity. One patient also treated with neutrons developed delayed grade 4 toxicities. The 15-year complication-free survival for those surviving was 70.3%. Conclusions We report the long-term follow-up of STEP prosthesis insertion in children to reduce the small bowel volume in the radiation field. The acute and long-term tolerances were excellent. The STEP reduced the bowel dose over 40 Gy by 64%.

Breast cancer is the most common malignancy diagnosed in women (http://seer.cancer.gov/statfacts/html/breast.html). Today, with the widespread generalization of mammography, it is most frequently diagnosed at an early stage (Nystrom et al. 2002). The outcomes of those early-stage cancers are excellent, with local control above 98% and a risk of dying of cancer at 5 years below 2% (http://seer.cancer.gov/statfacts/html/breast.html; Strnad et al. 2016). Clinical researches since the 1980s have aimed at optimizing the cosmetic outcome, minimizing the long-term side effects, and reducing the treatment burden. Several randomized clinical trials and meta-analyses have shown that breast-conserving surgery followed by adjuvant radiotherapy (XRT) to the whole breast achieves local control rate and survival equivalent to mastectomy, with the advantage of allowing breast conservation and hence improved quality of life (Fisher et al. 2002; Veronesi et al. 2002; Clark et al. 1996; EBCTCG et al. 2011).

Rarely since the introduction of breast-conserving therapy in the 1980s has the breast radiation oncology community been so passionately divided and arguing for the introduction of a new concept as for accelerated partial breast irradiation (APBI). The idea looks a priori counterintuitive—limiting the concept of clinical target volume (CTV) and hence the irradiated volume within anatomical breast boundaries. The passion in published opinions possibly comes from a strange mix of financial interest, competition between techniques, and the extensive use of patient’s advertisements and press releases instead of clinical evidence and data (Smith et al. JAMA 307:1827–1837, 2012; Khan et al. JAMA 308:567, 2012). It is striking that in 2016 two articles reviewing the best available evidence, one by Vicini et al. and the other from the Cochrane Library (Vicini et al. Brachytherapy 15:607–615, 2016; Hickey et al. Cochrane Database System Review 7:CD007077, 2016), had exactly opposite conclusions. The former concluded that “Four contemporary trials with over 2000 patients comparing APBI and whole breast irradiation (WBI) have been published and demonstrate no differences in the rates of local/regional recurrence or survival though long-term follow-up is limited to one study. In addition, reductions in the rates of acute and chronic toxicity and improvements in cosmetic outcome were noted in two of these trials.” The latter concluded that “It appeared that local recurrence and 'elsewhere primaries’ (new primaries in the ipsilateral breast) are increased with PBI/APBI (the difference was small), but we found no evidence of detriment to other oncological outcomes. It appeared that cosmetic outcomes and some late effects were worse with PBI/APBI but its use was associated with less acute skin toxicity.” There is one thing most experts would agree on: that almost 25 years after the first mention of partial breast irradiation by Bethune in the Journal of the National Medical Association (Bethune Journal of the National Medical Association 83:768, 800–808, 1991), evidence is now emerging that the APBI paradigm is safe for highly selected patients. This chapter reviews a selection of the available evidence.

The purpose of this multicenter prospective and descriptive study was to determine late toxicities and outcomes among patients with non-metastatic breast cancer receiving concurrent bevacizumab (BV) and radiation therapy (RT) in the clinical trials. Early and late toxicities were assessed and evaluation was available for 63 patients (pts) at 12 months. Acute radiation dermatitis was observed in 48 (76%): grade 1 for 27, grade 2 for 17 and grade 3 for 4 pts. Grade 2 acute oesophagitis was observed in one patient (2%). Little toxicity was described 1 year after the completion of RT: 7 pts (12%): grade 1–2 pain, 3 (5%) presented grade 1 fibrosis, and 2 pts (4%) – telangiectasia. One patient (2%) experienced grade 1 dyspnoea. Five grade 1–2 lymphoedema occurred. Only one patient experienced a LEVF value less than 50% one year after the end of RT. In conclusion , the concurrent BV with locoregional RT provides acceptable toxicities.

International audience; Purpose of this study was to determine the effect of waiting time for radiotherapy on overall survival of patients with glioblastoma treated in the EORTC-NCIC trial at 18 centers in France. A total of 400 adult patients with glioblastoma who were treated between January 1, 2006 and December 31, 2006 were included. There were 282 patients with "minimum criteria" according to the EORTC-NCIC trial: (i) concurrent chemotherapy with temozolomide; and (ii) age between 18 and 70 years old. Among these patients, 229 were treated with adjuvant temozolomide and were classified as "maximal criteria". One-hundred and eighteen patients were in the "without minimal criteria" group. Waiting time from the first symptom (FS-RT), pathology diagnosis (P-RT), multidisciplinary meeting (MM-RT), surgery (S-RT), and CT scan for delineation (CT-RT) until the start of radiotherapy were recorded. Median follow-up for all patients was 327 days. Overall, median FS-RT, P-RT, MM-RT, CT-RT, and S-RT times were 77, 36, 32, 12, and 41 days, respectively. Median, and 12 and 24-month overall survival were 409 days, and 56.3 ± 2.1 % and 27.6 ± 2.6 %, respectively. Univariate analysis failed to reveal a difference in survival, irrespective of the delay. In multivariate analysis, independent favorable prognostic factors for overall survival were age (p ≤ 0.0001) and type of surgery (p = 0.0006). In this large series treated during the EORTC-NCIC protocol period, waiting time until radiotherapy did not seem to affect patient outcome.