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The liver is a large abdominal organ in the right hypondrium. Because of its anatomical situation, it is near many abdominal PTVs as well as some lower thoracic PVTs. The liver could also be at the same time the target (for irradiation of liver metastases or primary liver tumours) and organ at risk (OAR). Radiation-induced liver disease (RILD) is radiobiologically the normal tissue complication probability (NTCP), i.e., the clinical event limiting the total dose that could be delivered. This review describes radiobiological criteria justifying the NTCP data, and recommendations for conformal 3D radiotherapy and stereotactic liver irradiation., (Copyright (c) 2010 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

Purpose: Chemoradiotherapy (CRT) is an alternative to surgery for resectable locally advanced esophageal carcinoma (RLA-EC). We investigated the heterogeneity of the treatment benefits across subgroups of patients, defined according to the radiation scheme., Patients and Methods: Between February 1993 and December 2000, 451 patients were enrolled. The following two schemes were allowed: protracted radiotherapy (P-RT), which scheduled 46 Gy over 4.5 weeks or split-course radiotherapy (SC-RT) with two 1-week courses of 15 Gy. Two courses of cisplatin and fluorouracil were delivered concomitantly. In case of exclusive CRT, a further course of 20 Gy over 2 weeks in the P-RT group and one 1-week course of 15 Gy in the SC-RT group were delivered with three courses of chemotherapy. SC-RT and P-RT were administered to 285 patients (64%) and 161 patients (36%), respectively., Results: For P-RT versus SC-RT, the response rate to induction CRT was 67% v 68%, respectively (P = .09), and 2-year local relapse-free survival rate was 76.7% v 56.8%, respectively (P = .002). Shorter tumor length and P-RT were associated with better local control in multivariate analysis (P = .002 for both). After a median follow-up time of 47.4 months, 2-year overall survival rate was 37.1% for P-RT compared with 30.5% for SC-RT (P = .25). Independent prognostic factors on survival were tumor diameter (P = .02), weight loss of 10% or less (P = .05), and response to induction CRT (P = .002)., Conclusion: Patients with RLA-EC treated with P-RT had better local control than patients treated with SC-RT. Response to induction CRT is a determinant prognostic factor on survival.

A prospective comparative study of the alveolar bone resorption after teeth extraction was achieved in a series of 79 patients in order to analyze macroscopically the possible consequences of radiotherapy and chemotherapy on the toothless edges. After quarterly coronal and sagittal X-rays for two years, this study enhances quite a similar vertical resorption for the radiation and chemotherapy-treated patients as well as for the witness patients. The alveolar bone resorption progression also appears unaltered by anti cancerous treatments. In both cases, a resorption stabilisation can be clearly seen after 6 months according to dental extractions. The vertical alveolar bone resorption is more important in incisor and canine regions. The anti cancerous treatments may not have significant disastrous consequences as far as available bone amount is concerned, on a post prosthetic restoration.

As knowledge continues to develop, regular updates are necessary concerning recommendations for practice. The recommendations for the management of melanoma stages I to III were drawn up in 2005. At the request of the Société Française de Dermatologie, they have now been updated using the methodology for recommendations proposed by the Haute Autorité de Santé in France. In practice, the principal recommendations are as follows: for staging, it is recommended that the 7th edition of AJCC be used. The maximum excision margins have been reduced to 2 cm. Regarding adjuvant therapy, the place of interferon has been reduced and no validated emerging medication has yet been identified. Radiotherapy may be considered for patients in Stage III at high risk of relapse. The sentinel lymph node technique remains an option. Initial examination includes routine ultrasound as of Stage II, with other examinations being optional in stages IIC and III. A shorter strict follow-up period (3 years) is recommended for patients, but with greater emphasis on imaging. [ABSTRACT FROM AUTHOR]

We present an application of the industrial Constant-Work-In-Progress (ConWIP) principle to radiotherapy treatments: from Operations Research to application in practice. Radiotherapy involves a chain of preparation steps before treatment. The time periods between patient referral, initial Computed Tomography (CT) scan, and the treatment should always be as short as possible. This is important in order to not allow further tumor growth and to capture the correct patient anatomy for the treatment. Therefore, the high-in-demand limited machine capacity and scheduling of intermediate steps have to be balanced. Conventionally, the treatment machine calendar is consulted for an open spot and the preparation steps are scheduled around that appointment. Conventional radiotherapy treatment scheduling is efficient in a predictable and low variability environment. Yet it is very inefficient for stereotactic radiotherapy treatments, due to the presence of (a) large variability in preparation time, (b) variable In Room Time especially for liver and lung treatments, which becomes known only right before the treatment, and (c) a high rate of cancellations. The end result is a suboptimal capacity use and high stress load for all personnel. We present a different organization method, a hybrid ConWIP system utilizing standardized work: managing work-in-progress instead of scheduling all steps. Discrete Event Simulations were performed before implementation in order to test the hypothesis and obtain the optimal parameters. Treatment type distribution was as follows: lung (29%), liver (21%), intracranial (13%), head and neck (11%), prostate (7%) and 20% other localizations. Implementation of this ConWIP workflow was supported by workflow software (RT-Flow) combining workflow, prioritization and load balancing. This resulted in a 32% (24%–40%) (95% CI) increase in number of treatments for the CyberKnife ® installation with a negligible increase in time from CT to treatment and an improved stress load for personnel. [ABSTRACT FROM AUTHOR]

Background: Concurrent chemoradiotherapy is a valuable treatment option for localised oesophageal cancer (EC), but improvement is still needed. A randomised phase II trial was initiated to assess the feasibility and efficacy in terms of the endoscopic complete response rate (ECRR) of radiotherapy with oxaliplatin, leucovorin and fluorouracil (FOLFOX4) or cisplatin/fluorouracil.Methods: Patients with unresectable EC (any T, any N, M0 or M1a), or medically unfit for surgery, were randomly assigned to receive either six cycles (three concomitant and three post-radiotherapy) of FOLFOX4 (arm A) or four cycles (two concomitant and two post-radiotherapy) of cisplatin/fluorouracil (arm B) along with radiotherapy 50 Gy in both arms. Responses were reviewed by independent experts.Results: A total of 97 patients were randomised (arm A/B, 53/44) and 95 were assessable. The majority had squamous cell carcinoma (82%; arm A/B, 42/38). Chemoradiotherapy was completed in 74 and 66%. The ECRR was 45 and 29% in arms A and B, respectively. Median times to progression were 15.2 and 9.2 months and the median overall survival was 22.7 and 15.1 months in arms A and B, respectively.Conclusion: Chemoradiotherapy with FOLFOX4, a well-tolerated and convenient combination with promising efficacy, is now being tested in a phase III trial. [ABSTRACT FROM AUTHOR]

Abstract: In June 2007, the CyberKnife® has been implemented at Centre Oscar-Lambret in Lille. The program has been developed around specific clinical indications: head and neck reirradiation, liver. Early results are presented. The system includes several way of repositioning fixed targets and tracking moving targets with breathing. With each way, there is a dedicated tool for the quality control. [Copyright &y& Elsevier]

In 2006, three sites were selected by the French Institut national du cancer to evaluate the CyberKnife robotic radiotherapy system. This device, able to track mobile tumours in real time, offers new possibilities in the field of extracranial stereotactic radiotherapy. The device’s functionalities, as well as medical and economical issues, will be evaluated for two years on the three sites. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess if multicriteria optimization could limit interoperator variability in radiation therapy planning and assess if this method could contribute to target volume coverage and sparing of organ at risk for intensity-modulated curative radiation therapy of head and neck cancers. We performed a retrospective analysis on 20 patients treated for an oropharyngeal or oral cavity squamous cell carcinoma. We carried out a comparative dosimetric study of manual plans produced with Precision® software, compared with the plans proposed using the multicriteria optimization method (RayStation®). We assessed interoperator reproducibility on the first six patients, and dosimetric contribution in sparing organs at risk using the multicriteria optimization method. Median age was 69 years, most lesions were oropharyngeal carcinoma (65%), and 35% lesions were stage T3. First, we obtained a high degree of similarity between the four operator measurements for each patient at the level of each organ. Intraclass correlation coefficients were greater than 0.85. Second, we observed a significant dosimetric benefit for contralateral parotid gland, homolateral and contralateral masseter muscles, homolateral and contralateral pterygoid muscles and for the larynx (P < 0.05). For the contralateral parotid gland, the mean dose difference between the multicriteria optimization and manual plans was −2.0 Gy (P = 0.01). Regarding the larynx, the mean dose difference between the two plans was −4.6 Gy (P < 0.001). Multicriteria optimization is a reproducible technique and faster than manual optimization. It allows dosimetric advantages on organs at risk, especially for those not usually taken into consideration in manual dosimetry. This may lead to improved quality of life. [ABSTRACT FROM AUTHOR]

Les tumeurs cérébrales peuvent être associées à une inaptitude légale à la conduite. Nous avons cherché à évaluer la connaissance des patients irradiés concernant la législation relative à la conduite automobile. Il s'agissait d'une étude descriptive prospective réalisée au Centre Oscar Lambret à Lille, auprès de détenteurs du permis de conduire traités pour une (ou plusieurs) tumeur(s) cérébrale(s) primitive(s) ou secondaire(s). L'enquête a été réalisée par questionnaire hétéro-administré. Le critère de jugement principal était la fréquence de patients informés sur la législation relative à la conduite automobile lors de la consultation initiale de radiothérapie, donnée avec un intervalle de confiance à 95 % par la méthode binomiale exacte de Clopper-Pearson. Du 1er février au 31 mars 2022, 33 patients atteints d'une tumeur cérébrale ont été inclus. Trois patients ont été exclus de l'analyse, car non-détenteurs du permis de conduire. Parmi les 30 patients restants, 12 (40 % ; intervalle de confiance à 95 % : 22,7–59,4) avaient été informés de l'existence d'une possible contre-indication à la conduite avant la consultation en radiothérapie. Au sein de ces 30 patients, 21 (70 %) avaient une contre-indication à la conduite. Parmi les huit patients (26,6 %) qui conduisaient, quatre (13,3 %) ne devraient pas conduire. La majeure partie des patients présentait une contre-indication à la conduite automobile, mais seuls 40 % des patients interrogés déclaraient avoir été informés de l'existence d'une éventuelle contre-indication avant la consultation en radiothérapie. Brain tumors can be associated with various neurological symptoms impairing driving ability. We sought to assess patients' knowledge on the French driving legislation. This is a prospective descriptive epidemiological study carried out at the Oscar Lambret center in Lille, among driving license holders treated by radiotherapy for one or more primary cerebral tumor or brain metastasis. The survey was carried out by hetero-administered questioners. The primary endpoint was the frequency of patients informed on the French driving legislation at the initial radiotherapy consultation, given with a 95% confidence interval by the Clopper-Pearson exact binomial method. From the 1st February to March 31st, 2022, 33 patients with brain tumors were evaluated. Three of them were excluded because they did not have a driving license. Among the 30 patients analyzed, 12 patients (40% IC95 [22.7; 59.4]) had been informed of the existence of a possible contraindication to drive before the radiotherapy consultation. Among the 30 patients, 21 (70%) had a contraindication to drive. Of the eight patients (26.6%) who drove, four (13.3%) should not. Most patients have a contraindication to drive, but only 40% of the patients questioned stated that they had been informed of the existence of a possible contraindication before the radiotherapy consultation. [ABSTRACT FROM AUTHOR]

La radiothérapie hypofractionnée du carcinome épidermoïde du larynx glottique, de stade précoce, est une option de traitement prometteuse. Celle-ci peut être divisée en radiothérapie avec hypofractionnement modérée (jusque 2,5 Gy par fraction), hypofractionnement plus intense (entre 2,5 et 4,5 Gy par fraction) et radiothérapie stéréotaxique (au-delà de 4,5 Gy par fraction). La plupart des études évaluant l'hypofractionnement modéré montrent un taux de contrôle local entre 85 et 95 %. La toxicité aiguë laryngée est plus sévère que celle du traitement classique, mais uniquement pour les cancers de grades 1 et 2, sans différence significative rapportée pour la toxicité sévère. La radiothérapie stéréotaxique est également une entité émergente, mais certains auteurs ont rapporté une toxicité non négligeable. Il n'existe pas aujourd'hui, de directives standardisées pour le traitement et le schéma de prise en charge. Nous avons réalisé une revue systématique de la littérature des essais prospectifs et rétrospectifs publiés, afin d'évaluer l'efficacité, la toxicité, et de discuter des orientations futures. Hypofractionated radiotherapy of early-stage squamous cell carcinoma of the glottic larynx is a promising treatment option. This can be divided into radiotherapy with moderate hypofractionation (up to 2.5 Gy per fraction), more intense hypofractionation (between 2.5 and 4.5 Gy per fraction) and stereotactic radiotherapy (above 4.5 Gy per fraction). Most studies evaluating moderate hypofractionation show a local control rate between 85 and 95%. Acute laryngeal toxicity is superior to conventional treatment, but only for grades 1 and 2, with no significant difference reported for severe toxicity. Stereotactic radiotherapy in this pathology is also an emerging entity, but some authors have reported significant toxicity. There are currently no standardized guidelines for treatment and management regimen. We conducted a systemic review of published prospective and retrospective trials to evaluate efficacy, toxicity, and discuss future directions. [ABSTRACT FROM AUTHOR]

New approaches are needed for frail or elderly patients with locally advanced head and neck squamous cell carcinoma (LA HNSCC) who are unfit to receive cisplatin with concurrent radiotherapy (RT). NBTXR3 is a first-in-class radioenhancer, composed of functionalized hafnium oxide nanoparticles, administered by a single intratumoral injection and activated by RT. NBTXR3 locally amplifies the anti-tumoral response of RT without adding toxicity to surrounding healthy tissue as shown in a randomized trial in soft tissue sarcoma. This two-part study: dose-escalation followed by the dose-expansion part reported here, evaluated the safety and preliminary efficacy for NBTXR3 activated by RT in elderly or frail patients ineligible to cisplatin. Patients with previously untreated AJCC 8th Stage III-IVA or T3,T4 SCC of the oral cavity or oropharynx (OPC) ineligible to cisplatin were enrolled. Eligible patients received a single IT injection of NBTXR3 at the recommended dose (22% of the baseline tumor volume) followed by RT (IMRT 70 Gy in 35 fractions). The primary objectives of the dose expansion part were to test the recommended dose, to confirm its safety, and obtain preliminary evidence of efficacy. The secondary objectives included the evaluation of progression-free survival (PFS) and overall survival (OS). 56 patients in the dose expansion part were treated from April 2019-January 2022; 44 patients were evaluable for objective tumor response. In the all treated (AT) population, median age was 72 years. 67% had age-adjusted Charlson Comorbidity Index scores ≥4, 55.4% had OPC (45.2% HPV+) and 80% had T3-4. Median injected volume of NBTXR3 was 13.6 [0.6-57.1] mL. Grade ≥ 3 treatment emergent adverse events (TEAE) reported as potentially related to NBTXR3 or to injection procedure were 1.3% all TEAEs reported, respectively. In the evaluable (EV) population, ORR of the NBTXR3 injected lesion was 81.8%; complete response rate was 63.6%. ORR of injected and non-injected lesions was 79.5%. Median PFS by independent central review was 11.4 mos (AT) and 16.9 mos (EV). Median OS was 18.1 mos (AT) and 23.1 mos (EV). PFS of injected lesion (LPFS) was 16.9 mos (AT) and not reached (EV). Exploratory analyses of additional endpoints will be presented. NBTXR3 IT injection followed by activation with RT was confirmed to be feasible and well tolerated in elderly or frail patients with LA HNSSC and significant comorbidities. The high ORR suggests that NBTXR3+RT is effective in this elderly population ineligible to cisplatin with a high unmet medical need. These results reinforced by exploratory analyses support our ongoing phase III study comparing NBTXR3/RT±cetuximab vs. RT±cetuximab in platinum-based chemotherapy ineligible elderly patients with LA-HNSCC: NANORAY 312 (NCIT04892173). [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe the adjuvant management of high grade uterine sarcoma and highlight prognostic factors for overall survival and progression-free survival. Between 01/2000 and 01/2015, 91 patients undergoing surgery were presented at the multidisciplinary team meeting of our institution. The type of surgery, the anatomopathological features, adjuvant treatments, dates and sites of recurrence were collected. The prognostic value of the various factors was evaluated with the multivariate Cox model. A total of 50 women with uterine sarcoma were identified and lesions included 43 leiomyosarcomas (86%) and seven high grade sarcomas (14%). Eighteen patients received adjuvant pelvic radiotherapy (36%) and six adjuvant systemic therapy (12%). The median follow-up time was 63 months. Thirty-nine patients (78%) had a recurrence: 22 had only metastatic recurrence (58%), two had isolated pelvic recurrence (5%) and 15 had pelvic and metastatic recurrence (38%). Adjuvant radiotherapy was associated with survival without pelvic recurrence in univariate analysis (P = 0.005, hazard ratio [HR] = 0.15); age greater than 55 years and adjuvant radiotherapy were associated with metastatic free survival in multivariate analysis (P = 0.015, HR = 2.37, and P = 0.013, HR = 0.41 respectively) According to the results of our series, there is a benefit of radiotherapy after surgery in terms of local control of uterine sarcoma. It is necessary to identify the subgroup of patients who will benefit from an adjuvant radiotherapy in order to provide them with more optimal care. [ABSTRACT FROM AUTHOR]

New approaches are needed for frail or elderly patients with locally advanced head and neck squamous cell carcinoma (LA HNSCC) who are unfit to receive cisplatin with concurrent radiotherapy (RT). NBTXR3 is a first-in-class radioenhancer, composed of functionalized hafnium oxide nanoparticles, administered by a single intratumoral (IT) injection and activated by RT. NBTXR3 locally amplifies the anti-tumoral response of RT without adding toxicity to surrounding healthy tissue as shown in a randomized trial in soft tissue sarcoma. This two-part study: dose-escalation followed by the dose-expansion part reported here, evaluated the safety and preliminary efficacy for NBTXR3 activated by RT in elderly or frail patients ineligible to cisplatin. This trial enrolled patients who had previously untreated AJCC 8th Stage III-IVA or T3, T4 SCC of the oral cavity or oropharynx (OPC) ineligible to cisplatin. Eligible patients received a single IT injection of NBTXR3 at the recommended dose (22% of the baseline tumor volume) followed by RT (IMRT 70 Gy in 35 fractions). The primary objectives of the dose expansion part were to test the recommended dose, to confirm its safety, and obtain preliminary evidence of efficacy. The secondary objectives included the evaluation of progression-free survival (PFS) and overall survival (OS). Fifty-sixpatients in the dose expansion part were treated from April 2019-January 2022; 44 patients were evaluable for objective tumor response. In the all-treated population, median age was 71.9 years. 64.3% had age-adjusted Charlson Comorbidity Index scores ≥4, 55.4% had OPC (45.2% HPV+) and 80% had T3-4. Median injected volume of NBTXR3 was 13.6 [0.5-57.1] mL. Grade ≥ 3 adverse events reported as potentially related to NBTXR3 or to injection procedure were 1.2% and 0.4% of all AEs reported, respectively. In the evaluable population, the best objective response rate of the NBTXR3 injected lesion was 81.8% with a complete response rate of 63.6%. The best overall response rate (injected and non-injected lesions) was 79.5%. Final analyses on PFS and OS with long-term follow-up will be presented. NBTXR3 IT injection followed by activation with RT was confirmed to be feasible and well tolerated in elderly or frail patients with LA HNSSC and significant comorbidities. The high rate of best overall response suggests that NBTXR3+RT is effective in this elderly population ineligible to cisplatin with a high unmet medical need. These results support our ongoing phase III study comparing NBTXR3/RT ± cetuximab vs. RT ± cetuximab in platinum-based chemotherapy ineligible elderly patients with LA-HNSCC: NANORAY 312 (NCIT04892173). [ABSTRACT FROM AUTHOR]

Abstract: The relatively recent introduction of CyberKnife® in the field of radiotherapy has prompted the question of accessibility and usefulness of this technique for seniors. From June 2007 to June 2009, we treated 345 patients of all ages with CyberKnife as part of a single-center study. Median age was 61 years (range, 8–86 years). Ninety-eight patients were over 70 and 17 were older than 80. The treatment could not be completed with 2% (2/98) patients over 70 vs. 3.6% (9/247) among the younger (ns). Physiologic or psychologic problems in maintaining position for a long time were not more frequent among those over 70. The same was true with those over 80. Patients over 70 years old are able to tolerate CyberKnife treatment as efficiently as their younger counterparts. Elderly patients should not be restricted from access to CyberKnife radiosurgery with curative intent. [Copyright &y& Elsevier]

Abstract: The liver is a large abdominal organ in the right hypondrium. Because of its anatomical situation, it is near many abdominal PTVs as well as some lower thoracic PVTs. The liver could also be at the same time the target (for irradiation of liver metastases or primary liver tumours) and organ at risk (OAR). Radiation-induced liver disease (RILD) is radiobiologically the normal tissue complication probability (NTCP), i.e., the clinical event limiting the total dose that could be delivered. This review describes radiobiological criteria justifying the NTCP data, and recommendations for conformal 3D radiotherapy and stereotactic liver irradiation. [ABSTRACT FROM AUTHOR]

Abstract: In 2006, 3 sites have been selected by the Institut national of cancer (Lille, Nancy et Nice) to evaluate a radiotherapy robot, the CyberKnife®. This machine, able to track mobile tumours in real time, gives new possibilities in the field of extra cranial stereotactic radiotherapy. Functionalities and medico economical issues of the machine will be evaluated during 2 years on the 3 sites. [Copyright &y& Elsevier]

Poster: Physics track: Intra-fraction motion management PO-1639: Surface Image Guided Radiotherapy for breast treatments on Halcyon F. Crop, P. Comte, J. Laffarguette, R. Cayez, D. Pasquier, X. Mirabel, T. Lacornerie. [Extracted from the article]

Poster: Clinical track: Breast PO-0974: Helical intensity-modulated radiation therapy for locally advanced breast cancer:a prospective study B. Bataille, F. Le Tinier, R. Bennadji, L. Basson, A. Escande, E. Tresch, F. Crop, F. Darloy, D. Carlier, X. Mirabel, E. Lartigau, D. Pasquier. [Extracted from the article]

Abstract: Esophageal cancers are highly malignant tumours with often a poor pronostic, except for minimal lesions treated with surgery. Radiation therapy, or combined radiation and chemotherapy is the most used therapeutic modality, alone or before oesophagectomy. The delineation of target volumes is now more accurate owing the possibility to use routinely the new imaging techniques (mainly PET). The aim of this work is to precise the radio-anatomical particularities, the pattern of spread of esophageal cancer and the principles of 3D conformal radiotherapy illustrated with a clinical case. [ABSTRACT FROM AUTHOR]