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Penile cancers are uncommon and should be treated in expert center. Radiotherapy indications are mainly limited to exclusive brachytherapy for early stage penile glans cancer. Brachytherapy yields to excellent outcome for disease control and organ and function preservation. Only scarce data are available for external beam radiation therapy. It could be considered as palliative setting for irradiation of the primary tumor. For lymph node irradiation, external beam radiation therapy (with or without chemotherapy) could be discussed either as neoadjuvant approach prior to surgery for massive inguinal lymph node invasion or as adjuvant approach in case of high-risk of relapse. However, these cases should be discussed on an individual basis, as the level of evidence is poor. We present the recommendations of the French Society of Oncological Radiotherapy on the indications and techniques for external beam radiotherapy and brachytherapy for penile glans cancer. [ABSTRACT FROM AUTHOR]

The Papillon experience and the Lyon R96-02 trial have shown that contact X-ray brachytherapy of 50 kV is efficient and safe to achieve long term local control and organ preservation for cT1 and early cT2-3 rectal cancers. The OPERA trial, using the Papillon 50™ machine, brings further support to this preservation strategy for selected T2T3ab lesions. Future trials using a contact X-ray boost will try to consolidate and enlarge its place in organ preservation for rectal cancers. [ABSTRACT FROM AUTHOR]

The purpose of this article is to remind the importance of the inverse square law in radiotherapy and especially in brachytherapy. Indeed, beyond the impact in radiation therapy with high energy beam, there is the use of radionuclides and low energy photons with short FSD where it is still more important. Comparisons between Iridium Brachytherapy and low energy X-rays brachytherapy show equivalent dose distributions in the first few centimeters. If the inverse square law is not the only element influencing the dose distributions calculations, it must not be forgotten. And it is playing a major role in brachytherapy with short FSD (< 6 cm). [ABSTRACT FROM AUTHOR]

En 2019, le bureau de la Société française de radiothérapie oncologique (SFRO) a créé une commission éthique. Sa mission est de proposer à notre communauté professionnelle des éléments de réflexion à propos de questionnements éthiques, et d'en dégager les spécificités au sein des services d'oncologie radiothérapie. À l'occasion du congrès annuel de 2020, la commission s'est penchée sur l'évolution de la relation soigné-soignant, et plus particulièrement sur l'idée forte de partenariat patient. En effet, la rédaction du Livre blanc du cancer a donné la parole aux personnes malades et souligné la nécessité de nouveaux dispositifs, tels que le « temps d'accompagnement soignant ». Les patients ne peuvent plus être considérés comme des objets de soin mais comme des personnes dont la dignité et l'autonomie doivent être impérativement respectées. L'acquisition de connaissances autorise un échange bilatéral, prérequis de la dynamique collaborative. Ils peuvent être partenaires de leurs propres soins, partenaires de la formation et de la recherche (patient expert) mais également partenaires des institutions et politiques de santé. C'est cette notion de partenariat et d'implication de la personne dans son parcours de soin en oncologie radiothérapie que nous allons analyser ici. Il s'agira autant de la définir, en développant la notion d'autonomie, que d'en faire émerger la complexité et l'ambivalence au travers notamment de deux exemples issus de notre pratique clinique : la démarche de décision partagée pour les patients ayant un cancer de la prostate localisé et l'implication du patient dans le bon déroulement de sa radiothérapie. In 2019, the scientific committee of the French society of radiation oncology (SFRO) created an ethics committee. Its mission is to provide our professional community with food for thought on ethical issues, and to identify its specificities within the radiation oncology departments. For the 2020 annual conference, the commission looked into the evolution of the patient-carer relationship, and more particularly to the strong idea of patient partnership. Indeed, the writing of the White Book of Cancer gave voice to sick people and stressed the need for new devices, such as the Caregiving Time. Patients can no longer be considered as objects of care but as people whose dignity and autonomy must be imperatively respected. The acquisition of knowledge allows a bilateral exchange, prerequisite of a dynamic collaboration. Patients can be partners in their own care, partners in training and research (expert patient), but also partners in health institutions and policies. It is this notion of partnership and involvement of the person in their path of care in radiation oncology that we will analyse here. It will be about defining it, by developing the concept of autonomy, and bringing out its complexity and ambivalence through two examples from our clinical practice: the shared decision-making process for patients with localized prostate cancer and the patient's involvement in the success of his radiotherapy. [ABSTRACT FROM AUTHOR]

Abstract Purpose To evaluate the feasibility of pre-operative radiotherapy (54 Gy) with Helical Tomotherapy (HT) followed by surgery. Methods and materials Ten patients with non-metastatic resectable retroperitoneal liposarcomas were treated by pre-operative tomotherapy (54 Gy) and surgery. Clinical and biological toxicities were evaluated on the CTCAEV3.0 scale. For nine patients, delivered tomotherapy plans were compared with retrospectively-planned dynamic intensity-modulated radiotherapy (IMRT) dosimetric studies. Results No immediate or late Grade>2 toxicities were observed after radiotherapy. Post-operatively, one patient died and three patients experienced Grade 3 toxicity (two digestive and one metabolic). These toxicities disappeared and only two patients presented persistent Grade 1 paresthesia. R0 resection was obtained for four patients, R1 for four, and R2 resection for two. With a median follow-up of 26 months, no local or metastatic relapse was observed. Dosimetric comparisons between HT and retrospectively-planned IMRT demonstrate adequate target volume coverage for both techniques. Gastrointestinal sparing is higher with HT with a D200cc reduced by 5 Gy. Integral dose (ID) was increased in HT. Conclusions High dose pre-operative radiotherapy (54 Gy) for retroperitoneal liposarcoma is feasible and mostly well tolerated. Cumulative toxicity and tolerance depend mainly on patient’s general status. Image-guided radiation therapy (IGRT) is essential, irrespective of the IMRT technique used. Furthermore, HT offers the possibility of sparing selected areas in such complex volumes.

Entendues comme une rupture d'équilibre dans les conditions de pratique des soins selon un fonctionnement conforme à protocoles ou procédures établis, les situations de crise dans les services d'oncologie radiothérapie sont de causes multiples. Leur gravité peut parfois imposer des changements de paradigmes décisionnel, organisationnel ou technique. Une des possibles conséquences peut être la nécessité de procéder à des décisions de priorisation dans l'accès aux soins, lorsque s'installe une inadéquation entre les besoins de soins d'une population et les moyens sanitaires (techniques et humains) disponibles. Les spécificités des parcours de soin et la grande variété des situations cliniques en oncologie radiothérapie rendent ces décisions particulièrement délicates sur le plan éthique. Les réflexions d'anticipation, les procédures décisionnelles collégiales et multi professionnelles ou encore l'intégration des représentants d'usagers dans ces démarches de priorisation sont alors des outils indispensables. Une attention particulière doit être portée à l'information indispensable à fournir aux personnes malades dans un souci de transparence et de respect de la personne humaine. Les situations de priorisation sont d'authentiques mises à l'épreuve de nos services. Elles débordent le seul aspect technique du soin en oncologie radiothérapie. Elles peuvent être source d'une authentique souffrance éthique pour les soignants quand leurs valeurs soignantes se percutent aux limites imposées par les situations de crises. Understood as a disruption of the conditions of care practice according to established protocols or procedures, crisis situations in radiation oncology departments can have multiple causes. Their seriousness can sometimes impose changes in the decision-making, organizational or technical paradigms. A possible consequence may be the need to make prioritization decisions in access to care, when there is a mismatch between the care needs of a population and the available health resources (whether technical or human). The specificities of care pathways and the wide variety of clinical situations in radiation oncology make these ethical decisions particularly difficult. Anticipation, collegial and multi-professional decision-making procedures or the integration of patient representatives in these prioritization processes are essential tools. Particular attention must be paid to the information to be provided to patients in a concern of transparency and respect. Prioritization situations are real tests for our departments. They go beyond the purely technical aspect of radiation oncology. They can lead to real ethical suffering for health professionals when their values come up against the limits imposed by crisis situations. [ABSTRACT FROM AUTHOR]

Abstract: Plexopathies and peripheral neuropathies appear progressively and with several years delay after radiotherapy. These lesions are observed principally after three clinical situations: supraclavicular and axillar irradiations for breast cancer, pelvic irradiations for various pathologies and limb irradiations for soft tissue sarcomas. Peripheral nerves and plexus (brachial and lumbosacral) are described as serial structures and are supposed to receive less than a given maximum dose linked to the occurrence of late injury. Literature data, mostly ancient, define the maximum tolerable dose to a threshold of 60Gy and highlight also a great influence of fractionation and high fraction doses. For peripheral nerves, most frequent late effects are pain with significant differences of occurrence between 50 and 60Gy. At last, associated pathologies (diabetes, vascular pathology, neuropathy…) and associated treatments have probably to be taken into account as additional factors, which may increase the risk of these late radiation complications. [ABSTRACT FROM AUTHOR]

Abstract: Radiation tolerance for bone tissue has been mostly evaluated with regard to bone fracture. Main circumstances are mandibula osteoradionecrosis, hip and costal fracture, and patent or radiologic fractures in the treated volume. After radiation therapy of bone metastasis, the analysis of related radiation fracture is difficult to individualize from a pathologic fracture. Frequency of clinical fracture is less than 5% in the large series or cohorts and is probably underevaluated for the asymptomatic lesions. Women older than 50years and with osteoporosis are probably the main population at risk. Dose–effect relations are difficult to qualify in older series. Recent models evaluating radiations toxicity on diaphysa suggest an important risk after 60Gy, for high dose–fraction and for a large volume. [ABSTRACT FROM AUTHOR]

The quality of radiotherapy partly depends on the level of technicity, notably for 3D-conformal radiotherapy and intensity modulated radiotherapy. Use of these techniques, in trying to achieve a perfect dose distribution, involves a great precision in the definition of the anatomical volumes and in the dose administrations. Research into this precision is presented by showing the different steps of treatment for a case of prostate cancer, from its preparation to its realisation. Particular attention is given to the uncertainties and their impact on the treatment as well as the quality controls specific to these techniques. [ABSTRACT FROM AUTHOR]

En 2021, la Commission d'Éthique de la Société française de Radiothérapie Oncologique (SFRO) s'est saisie de la thématique délicate de la pratique des soins à visée palliative en oncologie radiothérapique. L'oncologie radiothérapie joue un rôle central dans la prise en charge des patients atteints de cancer en phase palliative. Mais derrière la dénomination large de radiothérapie palliative, on retrouve en réalité un grand nombre de situations relevant d'enjeux éthiques très divers. Le rôle de l'oncologue radiothérapeute sera de prendre en compte de multiples facteurs mobilisés à l'occasion d'un processus décisionnel complexe. Si la question de l'indication thérapeutique, et du choix technique permettant de la mettre en œuvre reste centrale, la réflexion ne saurait se limiter à ces seuls aspects décisionnel et technique. Il est aussi question de pouvoir créer les conditions d'un soin attentif à la singularité des personnes et de construire au-delà de la technicité, une authentique relation de soin. C'est au travers de ce travail éthique quotidien, en lien étroit avec les personnes malades, et dans des conditions indispensables de pluri disciplinarité et de pluri professionnalité, que se déploie pleinement notre rôle fondamental de soignant. In 2021, the Ethics Commission of the SFRO has chosen the issue of the practice of palliative care in radiotherapy oncology. Radiation oncology plays a central role in the care of patients with cancer in palliative phase. But behind the broad name of palliative radiotherapy, we actually find a large variety of situations involving diverse ethical issues. Radiation oncologists have the delicate task to take into account multiple factors throughout a complex decision-making process. While the question of the therapeutic indication and the technical choice allowing it to be implemented remains central, reflection cannot be limited to these decision-making and technical aspects alone. It is also a question of being able to create the conditions for a singularity focused care and to build an authentic care relationship, beyond technicity. It is through this daily ethical work, in close collaboration with patients, and under essential conditions of multidisciplinarity and multiprofessionalism, that our fundamental role as caregiver can be deployed. [ABSTRACT FROM AUTHOR]

The reaction of tin tetrachloride with a series of variously substituted α-hydroxyphosphonates (L) in anhydrous dichloromethane produces new octahedral tin complexes of the type [SnCl 4 L 2 ]. These adducts were characterized by multinuclear ( 1 H, 13 C, 31 P and 119 Sn) NMR, IR spectroscopy, and elemental analysis. The NMR data show that these complexes exist in solution as mixtures of cis and trans isomers. Moreover, the solution behavior of these complexes in the presence of excess ligand was investigated with variable temperature NMR using the coalescence temperature method. The resulting metal-ligand exchange activation energies were determined, showing values in the range 50–52 kJ/mol. The remote substituent effect on the metal-ligand interaction was also studied and compared with closely related phosphoryl-tin complexes. [ABSTRACT FROM AUTHOR]

Organ-at-risk (OAR) delineation is an essential step for radiotherapy treatment (RT) planning. Standard practice during the last decade referred to manual delineation of OARs from medical experts. Manual delineation is the current standard of practice and can be a tedious, time-consuming process, prone to errors due to intra and inter-observer variations. This is the case for lung stereotactic body radiation therapy (SBRT) due to the variety of structures to be contoured. The latest advances of artificial intelligence methods offer new perspectives towards a fully automatic delineation. This study aims at evaluating an AI-based auto-contouring solution (AC) and compare its clinical acceptability against contours delineated by experts (EC). In this study, a CE/FDA cleared anatomically preserving ensemble deep-learning architecture contouring solution was used. The AI-solution was trained using more than 300+ fully annotated multi-centric SBRT cases according to the ESTRO guidelines (male and female) cases. A fully external cohort of 30 additional patients was considered to assess performance quantitatively and qualitatively. In terms of quantitative metrics, the Dice coefficient was used while qualitative assessment was done through a scoring mechanism: A/acceptable, B/ acceptable after minor corrections, and C/ not acceptable for clinical use. In terms of reference/comparisons with clinical experts, two independent annotations were used while treatment experts' contours were blended blindly with the AI-solution at 50/50 ratio. Random blending at the patient level was performed guaranteeing that, among contours being evaluated per patient and OAR, the 50/50 split was satisfied. The mean Dice coefficient between expert and AI was 88 % which dropped to 87% among experts. Overall clinical acceptability after aggregating blinded evaluations for the combined categories (A+B) was 95% for the AC which dropped to 81% for EC. When looking at the overall acceptability of contours that do not require any modifications (A), the AC (67%) outperformed the EC (48%) by significant margin. AC outperformed the EC on 14 structures. This work reports clinical evaluation of AC solution on CT scans for Thorax-SBRT. Our results suggest that the deep learning model could be a viable clinical alternative to the human expert offering treatment standardization and potentially better outcomes. [ABSTRACT FROM AUTHOR]

The Advanced GAmma Tracking Array (AGATA) has been installed at the GANIL facility, Caen-France. This set-up exploits the stable and radioactive heavy-ions beams delivered by the cyclotron accelerator complex of GANIL. Additionally, it benefits from a large palette of ancillary detectors and spectrometers to address in-beam γ-ray spectroscopy of exotic nuclei. The set-up has been designed to couple AGATA with a magnetic spectrometer, charged-particle and neutron detectors, scintillators for the detection of high-energy γ rays and other devices such as a plunger to measure nuclear lifetimes. In this paper, the design and the mechanical characteristics of the set-up are described. Based on simulations, expected performances of the AGATA 1π array are presented. [ABSTRACT FROM AUTHOR]

Résumé Le traitement de référence des carcinomes épidermoïdes du canal anal localement évolués (stades II et III) est la chimioradiothérapie exclusive. Celle-ci délivre une dose de 45 Gy à raison de cinq fractions de 1,8 Gy par semaine dans un volume pelvien, puis un complément de dose de 14 à 20 Gy dans la tumeur. La chimiothérapie concomitante la plus souvent utilisée comprend une association de 5-fluoro-uracile et de mitomycine-C délivrée lors de la première et cinquième semaine d’irradiation. Une couverture optimale des volumes cibles est parfois difficile à obtenir avec une irradiation conformationnelle (jonctions des faisceaux, combinaison d’électrons et photons parfois complexes dans les aires ganglionnaires). La toxicité cutanéomuqueuse et digestive induite par le traitement peut nécessiter un intervalle libre avant la réalisation du complément d’irradiation. Celui-ci peut avoir un effet délétère sur les résultats s’il est prolongé (plus de 38 jours). Les différentes techniques de radiothérapie conformationnelle avec modulation d’intensité (statique segmentée, dynamique, arcthérapie volumique modulée et tomothérapie hélicoïdale) ont leur intérêt dans cette localisation. Elles permettent d’obtenir une stérilisation tumorale et ganglionnaire avec une baisse des doses intermédiaires et élevées aux organes à risque (intestin grêle, périnée/organes génitaux, vessie, moelle osseuse) entraînant une réduction de la toxicité aiguë de grade 3 ou plus ainsi qu’une meilleure conservation fonctionnelle du sphincter anorectal. Une description de la réalisation de l’arcthérapie volumique modulée est présentée dans cet article. Les avantages et inconvénients de cette technique par rapport aux autres y sont discutés. The standard treatment of locally advanced (stage II and III) squamous cell carcinoma of the anal canal consists of concurrent chemoradiotherapy (two cycles of 5-fluoro-uracil, mitomycin C, on a 28-day cycle), with a dose of 45 Gy in 1.8 Gy per fraction in the prophylactic planning target volume and additional 14 to 20 Gy in the boost planning target volume (5 days per week) with a possibility of 15 days gap period between the two sequences. While conformal irradiation may only yield suboptimal tumor coverage using complex photon/electron field junctions (especially on nodal areas), intensity modulated radiation therapy techniques (segmented static, dynamic, volumetric modulated arc therapy and helical tomotherapy) allow better tumour coverage while sparing organs at risk from intermediate/high doses (small intestine, perineum/genitalia, bladder, pelvic bone, etc.). Such dosimetric advantages result in fewer severe acute toxicities and better potential to avoid a prolonged treatment break that increases risk of local failure. These techniques also allow a reduction in late gastrointestinal and skin toxicities of grade 3 or above, as well as better functional conservation of anorectal sphincter. The technical achievements (simulation, contouring, prescription dose, treatment planning, control quality) of volumetric modulated arctherapy are discussed. [ABSTRACT FROM AUTHOR]

Résumé: La curiethérapie consiste à placer des sources radioactives scellées à l’intérieur ou au contact de la zone à traiter. Le type de source, ses caractéristiques et son utilisation seront adaptés en fonction du type de traitement recherché. Les techniques modernes de curiethérapie emploient des appareils de chargement à distance permettant d’améliorer la qualité et la sécurité des traitements. Ce développement de technologie s’accompagne d’une nécessité accrue de contrôle de qualité des équipements, y compris des sources radioactives et des procédures. [ABSTRACT FROM AUTHOR]

Résumé: Le calcul de la distribution de dose en curiethérapie a évolué en passant de l’utilisation simple d’abaques à celle du formalisme TG-43. Il dépend des caractéristiques physiques et géométriques de chaque source, de la position de la source par rapport au point de calcul et de la composition du milieu. Le principe et les limitations de celui-ci sont présentés ainsi que les différents systèmes dosimétriques associés aux règles d’implantation et à la définition de la dose prescrite. Les nouvelles générations d’algorithmes et leurs apports sont discutés. [ABSTRACT FROM AUTHOR]

Abstract: Radiotherapy of glial tumors is rapidly evolving with the recent technical and therapeutic progress. About technical aspects, progress in technical imaging and development of non-coplanar conformal and IMRT techniques provide new possibilities for sparing healthy tissue while increasing dose in tumoral volume. Furthermore, functional and molecular imaging are helpful for delineation and for prediction of relapse. Even modest, the actual improvement of survival with radiochemotherapy leads now to new and important developments for clinical research according to clincal data (age, general status), biological data (MGMT promotor methylation and cytogenetic modifications) and technical data (quality of surgery and radiotherapy). Understanding of molecular mechanisms allows for rational targeting or specific pathways of repair, signaling angiogenesis associated with surgery and radiotherapy in a multidisciplinary approach. [Copyright &y& Elsevier]

Abstract: After a request for proposal initiated by National Institute against cancer (INCa) in 2005, three French centers in France started tomotherapy in the first semester of 2007. A national policy of evaluation was performed to study the feasibility of this innovative technique and to compare the interest of helicoidal tomotherapy with other modalities of conformal therapy. Common protocols have been designed to facilitate this evaluation. Description of dose, IMRT levels and constraints are achieved according to each selected indication as: sarcoma, head and neck tumors, lung cancer, mesothelioma, bone metastases, anal carcinoma and craniospinal irradiation. [Copyright &y& Elsevier]

Dye-based fluorescent organic nanoparticles are a specific class of nanoparticles obtained by nanoprecipitation in water of pure dyes only. While the photophysical and colloidal properties of the nanoparticles strongly depend on the nature of the aggregated dyes, their excellent brightness in the visible and in the near infrared make these nanoparticles a unique and versatile platform for in vivo application. This article examines the promising utilization of these nanoparticles for in vivo optogenetics applications. Their photophysical properties as well as their biocompatibility and their capacity to activate Chrimson opsin in vivo through the fluorescence reabsorption process are demonstrated. Additionally, an illustrative example of employing these nanoparticles in fear reduction in mice through closed-loop stimulation is presented. Through an optogenetic methodology, the nanoparticles demonstrate an ability to selectively manipulate neurons implicated in the fear response and diminish the latter. Dye-based fluorescent organic nanoparticles represent a promising and innovative strategy for optogenetic applications, holding substantial potential in the domain of translational neuroscience. This work paves the way for novel therapeutic modalities for neurological and neuropsychiatric disorders., (© 2024 The Author(s). Advanced Healthcare Materials published by Wiley‐VCH GmbH.)

The term "event" covers a wide range of concrete situations in radiation oncology, from particularly intense radiation-related side effects to the possibility of technical or human error. Although quality procedures are an integral part of radiotherapy oncology department operations ensuring the analysis and prevention of such events, their occurrence during radiation treatment still has a significant impact on patients and their experience of the treatment process, as well as on health professionals. These practical, emotional and symbolic impacts are all the greater when the event occurs in the aftermath of an error. The ethical approach therefore comprises three essential stages: recognizing the event as such, informing those involved of the event and, finally, creating conditions for the continuation of care. Each of these stages is marked by specific issues and questions, requiring a complex ethical approach that constantly involves reconciling the possible divergent perceptions of patients and health professionals. The occurrence of an event can also lead to a genuine crisis of confidence with multiple dimensions, which health professionals will also have to face and to support. Finally, the occurrence of an event calls into question not only our responsibility towards patients, but also our ideal of control. We need to criticize our culture of performance, rethink our approach to events and errors, and see them also as opportunities for positive change., (Copyright © 2024 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

The irrigation of urban vegetation in planters aims to keep the vegetation healthy and control the cooling effect from evapotranspiration during overheatingdays. The choice of sensors that characterise the water status of the plant, the soil and/or relevant criteria for triggering irrigation are crucial and far from obvious. This descriptive and analytical paper targets the identification of effective system properties, on which irrigation strategies should rely from a properly thought trial-and-error procedure relying on observational evidence. The study takes advantage of a real-scale pilot in Mediterranean climate (Montpellier, France), which simulates an east-west street canyon with three planters with shrubs on the north side and three planters with climbing plants on the south side, and a dense mesh of sensors in the substrate monitoring the condition of the planters. The provided guidelines explain how to comprehend and qualify any given context (plant species, planter dimensions, type and location of the sensors), before establishing ad hoc irrigation decision rules. This study demonstrates the developed methodology, by testing different irrigation doses, frequencies and criteria based on soil water content and tension information, which proves efficient for understanding and managing irrigation, even with limited information on plant stress tolerance and soil characteristics. Moreover, it allows for periodic reassessment of optimization criteria, which is crucial in addressing current challenges posed by sustainable cities without compromising water resources., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The EFOMP working group on the Role of Medical Physics Experts (MPEs) in Clinical Trials was established in 2010, with experts from across Europe and different areas of medical physics. Their main aims were: (1) To develop a consensus guidance document for the work MPEs do in clinical trials across Europe. (2) Complement the work by American colleagues in AAPM TG 113 and guidance from National Member Organisations. (3) To cover external beam radiotherapy, brachytherapy, nuclear medicine, molecular radiotherapy, and imaging. This document outlines the main output from this working group. Giving guidance to MPEs, and indeed all Medical Physicists (MP) and MP trainees wishing to work in clinical trials. It also gives guidance to the wider multidisciplinary team, advising where MPEs must legally be involved, as well as highlighting areas where MPEs skills and expertise can really add value to clinical trials., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: Since 2017, in France, medical physicists (MP) are finally defined by law as health professionals and as such, the roles and responsibilities of an MP lean on those medical professional ethics but MPs lack initial or continuing training in this subject. In order to find out how our colleagues feel about this subject, the following survey was conducted., Methods: French Society of Medical Physics (SFPM) designed a web survey addressed to its members and non-members concerning ethics based on the 2013 AAPM work; experience and training were highlighted as particularly important within the survey structure., Results: 249 answers were collected and showed a pronounced concern at the lack of initial and continuous training in this subject. Professional experience of non-ethical behaviour was attributed to the lack of training, resources or competences and hostile work environments., Conclusion: To address the shortcomings highlighted in the survey, SFPM has created a dedicated voluntary working group aimed at producing a professional code of ethics for MP and training modules to be applied at entry level or as continuing professional development for education., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights reserved.)

The dynamic suppression of threat-related behavior as a function of environmental constraint is critical for survival in mammals, yet the neurobiological underpinnings remain largely unknown. In this issue of Neuron, Wang et al. 1 identified prefrontal dynorphin-expressing neurons as key elements for tracking threat-related behavioral states and regulating fear suppression., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The management of head and neck cancers is multidisciplinary, often relying on the use of combined treatments to maximize the chances of cure. Combined treatments are however also responsible for cumulative side effects. The aim of reconstructive surgery with a flap is to restore a function lost with the loss of substance from the tumor resection. However, changes in reconstructive surgery have impact of postoperative radiotherapy planning. The optimization of imaging protocols for radiotherapy planning should make it possible to identify postoperative changes and to distinguish flaps from surrounding native tissues to delineate the flaps and document the spontaneous evolution of these flaps or dose-effect relationships in case of radiotherapy. Such changes include atrophy, fibrosis of soft tissue flaps and osteoradionecrosis of bone flaps. Radiotherapy optimization also involves standardization of the definition of target volumes in situations where a flap is present, a situation that is increasingly common in routine care. This evolution of practice, beyond the essential multidisciplinary consultation meetings defining treatment indications, requires a close radio surgical collaboration with respect to technical aspects of the two disciplines. Doing so, anticipation of relapse and toxicity profiles could possibly lead to propose strategies for personalized de-escalation of multimodal treatments through interdisciplinary trials., (Copyright © 2024 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Background: Major advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging. We aimed to provide an interdisciplinary view of the challenges encountered by radiation oncologists in planning head and neck postoperative radiotherapy., Methods: A systematic and critical review was conducted to address areas of optimization in surgery and radiology that may be relevant to poRT., Results: Despite extensive surgical literature on flap techniques and salvage surgery, 13 retrospective series were identified, where flap outcomes were indirectly compared between surgery alone or poRT. These low-evidence studies suggest that radiotherapy accelerates flap atrophy, fibrosis, and osteoradionecrosis and deteriorates functional outcomes. Preliminary evidence suggests that tumor spread occurs at the flap-tissue junction rather than in the flaps. One prospective 15-patient study showed 31.3% vs. 39.2% flap volume reduction without or with poRT. In an international consensus, experts recognized the needs for optimized flap-sparing poRT against flap-related functional deterioration and bone damage. CT, MRI, and PET-CT modalities show potential for the delineation of the junction area between native tissues and flap for flap segmentation and to characterize flap-specific changes quantitatively and correlate them with patterns of relapse or complications., Conclusion: Flap management in poRT is insufficiently documented, but poRT seems to damage flaps. Current gaps in knowledge underscore the need for prospective flap assessment and interdisciplinary trials investigating flap morbidity minimization by flap-sparing poRT planning., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Thariat, Carsuzaa, Beddok, Deneuve, Marcy, Merlotti, Dejean and Devauchelle.)

The consolidation of recent memories depends on memory replays, also called ripples, generated within the hippocampus during slow-wave sleep, and whose inactivation leads to memory impairment. For now, the mobilisation, localisation and importance of synaptic plasticity events associated to ripples are largely unknown. To tackle this question, we used cell surface AMPAR immobilisation to block post-synaptic LTP within the hippocampal region of male mice during a spatial memory task, and show that: 1- hippocampal synaptic plasticity is engaged during consolidation, but is dispensable during encoding or retrieval. 2- Plasticity blockade during sleep results in apparent forgetting of the encoded rule. 3- In vivo ripple recordings show a strong effect of AMPAR immobilisation when a rule has been recently encoded. 4- In situ investigation suggests that plasticity at CA3-CA3 recurrent synapses supports ripple generation. We thus propose that post-synaptic AMPAR mobility at CA3 recurrent synapses is necessary for ripple-dependent rule consolidation., (© 2023. The Author(s).)