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Abstract: Within the last decades, radiosurgery, also known as stereotactic radiotherapy, has become more and more popular as a non-invasive treatment of small benign tumours, arteriovenous malformations, metastases, and also some functional neurological structures, such as the fifth cranial nerve for trigeminal neuralgesia. It allows precisely delivering very high dose in a small volume under stereotactic conditions with minimal irradiation of tissue around the area. The first equipment devoted to radiosurgery was the Leksell Gamma Knife®. It is now challenged by some linear accelerators providing radiosurgery technology, such as the CyberKnife®, the Novalis Tx® radiosurgery platform, and the True Beam® linear accelerator. [Copyright &y& Elsevier]

Résumé Les gliomes sont les tumeurs cérébrales primitives les plus fréquentes. Leur prise en charge est difficile en raison de la proximité des organes à risque. Le traitement des glioblastomes comprend une chirurgie suivie d’une chimioradiothérapie selon le protocole de Stupp et al. L’ajout du bévacizumab permet un allongement de la survie sans progression de 4 mois mais non de celui la survie globale. Ce traitement reste réservé aux essais thérapeutiques. La radiothérapie avec modulation d’intensité pourrait être utile pour diminuer les effets neurocognitifs tardifs dans les différents types de gliomes. Chez les sujets âgés, une radiothérapie accélérée de 40 Gy en 15 fractions permet une survie similaire à celle observée après une radiothérapie standard. La recherche d’une méthylation de la O(6)-methylguanine-DNA methyltransferase (MGMT) peut aider à choisir entre chimiothérapie et radiothérapie. Il n’y a pas de standard pour la prise en charge des récidives, la ré-irradiation en condition stéréotaxique permet une survie en médiane entre 8 et 12,4 mois. Les gliomes anaplasiques ayant une mutation 1p19q ont une sensibilité plus importante à la chimiothérapie par procarbazine, lomustine et vincristine. La chimioradiothérapie d’emblée chez ces patients est donc devenue le traitement standard. De nombreuses études sont en cours testant des thérapies ciblées, leur place dans la prise en charge thérapeutique et les nouvelles techniques de radiothérapie. Gliomas are the most frequent primary brain tumors. Their care is difficult because of the proximity of organs at risk. The treatment of glioblastoma includes surgery followed by chemoradiation with the protocol of Stupp et al. The addition of bevacizumab allows an increase in progression-free survival by 4 months but it does not improve overall survival. This treatment is reserved for clinical trials. Intensity modulation radiotherapy may be useful to reduce the neurocognitive late effects in different types of gliomas. In elderly patients an accelerated radiotherapy 40 Gy in 15 fractions allows a similar survival to standard radiotherapy. O(6)-methylguanine-DNA methyltransferase (MGMT) status may help to choose between chemotherapy and radiotherapy. There is no standard for the treatment of recurrent gliomas. Re-irradiation in stereotactic conditions allows a median survival of 8 to 12.4 months. Anaplastic gliomas with 1p19q mutation have a greater sensibility to chemotherapy by procarbazine, lomustine and vincristine. Chemoradiotherapy in these patients has become the standard treatment. Many studies are underway testing targeted therapies, their place in the therapeutic management and new radiotherapy techniques. [ABSTRACT FROM AUTHOR]

Abstract: During the last French radiation oncology society annual congress, the therapeutic options for the management of brain metastases were presented. The indications and limits of surgery, stereotactic radiotherapy and whole brain radiotherapy, as well as their benefit in terms of overall survival, local control and improvement of the functional and neurocognitive status were discussed. The prognosis significance of the different phenotypes of breast cancer on the risk for BM as well as their roles in the treatment of brain metastases were also described. Surgery improves overall survival for patients with a single brain metastase and should be considered in the case of symptomatic lesions. The overall survival of patients treated with stereotactic radiotherapy do not differ from that of patients treated with surgery. These treatments should be mainly considered for patients with good performance status, one to three small brain metastases (<3cm) and limited extracranial disease. Whole brain radiotherapy is more and more discussed in adjuvant setting due to potential late neurocognitive toxicity. This toxicity could be improved with the development of techniques sparing the hippocampus. HER2+ and triple-negative breast cancer patients are at increased risk for brain metastases. Prognosis of these patients differs as the overall survival of HER2+ patients has improved with anti-HER2 therapies. The optimal combination of local and systemic therapies remain to be determined. [Copyright &y& Elsevier]

Abstract: Anticancer treatments-induced central nervous system neurotoxicity has become a major problem in recent years. Real advances in therapeutic results for cancer treatments have improved patients’ survival. Nowadays, central nervous system radiation therapy is widely prescribed, both for palliative and curative treatments in the management of malignant or benign tumors. Recent data on tolerance of normal central nervous system to radiation therapy are reviewed here, early and delayed radiation–induced effects are described and dose recommendations are suggested for clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Merkel cell carcinoma carcinoma (MCC) or primary cutaneous neuroendocrine carcinoma is a rare and aggressive malignancy affecting elderly. Optimal therapeutic strategy has not yet been established in elderly patients. Patients and methods: From March 1996 to March 2007, 29 patients with Merkel cell carcinoma of were treated at the University Hospital of Amiens, France. Adjuvant radiotherapy (RT) was performed for 14 patients (50%) on the tumor bed with margins of 3 to 5cm, an average dose of 46Gy (30–60Gy), by 2Gy per fraction. Ten of them also received RT to the lymph node area at mean dose of 44.3Gy (26–50Gy). Duration of RT was 35 days. A retrospective analysis was conducted to better evaluate survival and prognostic factors. Results: Median overall survival (OS) was 18.9 months (3–122) and the median time to progression (MTP) 5.5 months (1–26). At 5 years, OS for irradiated patients was 47% (IC95: 12–82%) versus 27% (IC95: 5–49%) in cases of surgery alone (p =0.032). The most frequent sites of recurrence were nodal (34.5%), local (24.1%) and metastatic (17.2%). For patients over 70 years, eight (36.5%) were free of disease at last news, 8 (36.5%) had died from cancer and six from other causes (27%). In this subgroup, MTP was 6 months (2–19) and median OS of 19 months (4–87). There was no acute toxicity greater than grade 2. Conclusion: Although limited by a retrospective analysis, this report suggests an advantage of postoperative RT for patients with MCC. It combined low toxicity and improvement of survival. Prospective multicenter trials are needed to clarify and validate the optimal strategy. [Copyright &y& Elsevier]

The purpose of the first two editions of the guidelines for external radiotherapy procedures, published in 2007 and 2016 respectively, was to issue recommendations aimed at optimising, harmonising and standardising practices. The purpose of this third edition, which includes brachytherapy, is identical while also taking into account recent technological improvements (intensity modulation radiation therapy, stereotactic radiotherapy, and three-dimension brachytherapy) along with findings from literature. Part one describes the daily use of general principles (quality, security, image-guided radiation therapy); part two describes each treatment step for the main types of cancer. [ABSTRACT FROM AUTHOR]

Gliomas are the most frequent primary brain tumour. The proximity of organs at risk, the infiltrating nature, and the radioresistance of gliomas have to be taken into account in the choice of prescribed dose and technique of radiotherapy. The management of glioma patients is based on clinical factors (age, KPS) and tumour characteristics (histology, molecular biology, tumour location), and strongly depends on available and associated treatments, such as surgery, radiation therapy, and chemotherapy. The knowledge of molecular biomarkers is currently essential, they are increasingly evolving as additional factors that facilitate diagnostics and therapeutic decision-making. We present the update of the recommendations of the French society for radiation oncology on the indications and the technical procedures for performing radiation therapy in patients with gliomas. [ABSTRACT FROM AUTHOR]

Intracranial radiotherapy has been improved, primarily because of the development of stereotactic approaches. While intracranial stereotactic body radiotherapy is mainly indicated for treatment of benign or malignant tumors, this procedure is also effective in the management of other neurological pathologies; it is delivered using GammaKnife® and linear accelerators. Thus, brain arteriovenous malformations in patients who are likely to experience permanent neurological sequelae can be managed by single session intracranial stereotactic body radiotherapy, or radiosurgery, in specific situations, with an advantageous benefit/risk ratio. Radiosurgery can be recommended for patients with disabling symptoms, which are poorly controlled by medication, such as trigeminal neuralgia, and tremors, whether they are essential or secondary to Parkinson's disease. This literature review aims at defining the place of intracranial stereotactic body radiotherapy in the management of patients suffering from non-tumoral refractory neurological pathologies. It is clear that the multidisciplinary collaboration of experienced teams from Neurosurgery, Neurology, Neuroradiology, Radiation Oncology and Medical Physics is needed for the procedures using high precision radiotherapy techniques, which deliver high doses to locations near functional brain areas. [ABSTRACT FROM AUTHOR]

The purpose of this prospective dosimetric study was to assess the dose distribution regarding the brain areas implied in cognitive functions using two approaches: volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT). Thirty-seven patients were treated using a dual-arc VMAT approach for supratentorial glioblastoma between 2016 and 2018. The total dose of 60 Gy in 30 daily fractions was administered to the planning target volume (PTV). The brain structures that play an important role in cognitive physiology, such as the hippocampi, corpus callosum, cerebellum, subventricular zones (SVZ), were delineated. For each patient, a new treatment plan in HT was determined by a second medical physicist in a blindly fashion according to the same dose constraints and priorities. Statistical analyses were performed using the Wilcoxon-signed rank test. Conformity indexes remained similar with both techniques. The mean values were 0.96 (0.19–1.00) for VMAT and 0.98 (range, 0.84–1.00) for HT, respectively (P = 0.73). Significant D 50% reductions were observed with VMAT compared to HT: 14.6 Gy (3.8–28.0) versus 17.4 Gy (12.1–25.0) for the normal brain (P = 0.014); 32.5 Gy (10.3–60.0) versus 35.6 Gy (17.1–58.0) for the corpus callosum (P = 0.038); 8.1 Gy (0.4–34.0) versus 12.8 Gy (0.8–27.0) for the cerebellum (P < 0.001), respectively. The VMAT approach seemed to improve the sparing of the key brain areas implied in cognitive functions without jeopardizing PTV coverage. [ABSTRACT FROM AUTHOR]

Objectif de l’étude Évaluer rétrospectivement les résultats de la radiothérapie conformationnelle avec modulation d’intensité (RCMI) chez les patients atteints de paragangliomes craniocervicaux. Matériel et méthode Entre 2011 et 2016, 21 patients, neuf hommes et 12 femmes ont été pris en charge par RCMI pour 24 paragangliomes craniocervicaux, à la dose médiane de 45 Gy [extrêmes : 45–68 Gy] en 25 fractions. Un paragangliome était métastatique. Les moyennes du volume tumoral macroscopique et du volume cible prévisionnel étaient respectivement de 26,33 cm 3 [extrêmes : 5,8–72,7 cm 3 ] et 92,45 cm 3 [extrêmes : 30,6–162,8 cm 3 ]. L’âge médian était de 61 ans [extrêmes : 31–77 ans]. Cinq patients étaient porteurs de mutations génétiques : 2 de succinate dehydrogenase complex subunit D (SDHD), 3 de succinate dehydrogenase complex subunit B (SDHB) ; deux patients n’avaient pas de mutations et 14 n’ont pas eu de test génétique. Quatorze patients ont reçu la RCMI comme traitement primaire, quatre patients après récidive postchirurgicale et trois en complément de la chirurgie. Le suivi médian était de 21,9 mois [extrêmes : 2,76–60,8 mois]. Résultats Le taux de contrôle local était de 100 % (réponse complète : 1 ; réponse partielle : 3 ; stabilité : 20). Au cours du traitement, hormis une alopécie focale de grade 3 et une paralysie faciale de grade 2 réversible sous corticothérapie, aucun effet secondaire de grade 3, 4, 5 n’a été signalé. L’effet secondaire le plus fréquemment signalé était la nausée ( n = 10). Deux patients ont été hospitalisés en cours de traitement pour toux et malaise. Parmi les quatre patients atteints initialement d’une paralysie, deux ont eu une amélioration. Sur les quatre patients atteints d’acouphènes initiaux, deux patients ont eu une réduction des symptômes et les deux autres se sont stabilisés. Aucune aggravation des symptômes initiaux n’a été enregistrée. Conclusion La RCMI est une modalité de traitement bien tolérée pour les paragangliomes craniocervicaux avec un bénéfice fonctionnel documenté. Un suivi long est nécessaire pour évaluer le contrôle local, la survenue d’effets secondaires tardifs et notamment les tumeurs en territoire irradié. [ABSTRACT FROM AUTHOR]

Purpose Dynamic conformal radiotherapy with helical TomoTherapy ® (HT) offers a more quantitative paradigm for total body irradiation. Treatment planning, delivery, dose verification of the first French experiences of total body irradiation using helical TomoTherapy ® are presented. Materials and methods Patients planned for total body irradiation at our institution from February 2012 to May 2013 were reported. Total body irradiation consisted in a single fraction of 2 Gy. Planning target volume was divided in two due to the limited translation length of the table. Delivery quality assurance was performed with cylindrical phantom, ionization chamber and films. Thermoluminescent dosimeters and radiochromic films were used for in vivo dosimetry and junction region heterogeneity assessment. Results Six patients were included. One finally did not receive the treatment but dosimetric data were analyzed. Planned V 95% was covered by D 95% and V 2% did not exceed D 107% for five of the six patients. The mean relative difference between measured and calculated absolute dose of the Delivery quality assurance was always less than 2.5% (mean value ± SD : 1% ± 0.67%). Gamma index (3%; 3 mm) was less than 1 for at least 93% of the points (value ± SD : 97.4 ± 1.6% and 96.6 ± 2.5% for upper and lower part of treatment respectively). Difference between in vivo measured and calculated dose was above 5% for only two out of 15 points (maximum: 10.2%, mean: 0.73 ± 4.6%). Junction region heterogeneity was in average 5.8 ± 1%. The total treatment session of total body irradiation lasted 120 min, with a mean beam on time of 17.2 ± 0.6 and 11.2 ± 1.6 min for upper and lower part of the body respectively. Conclusion Total body irradiation using helical TomoTherapy ® guaranteed high dose homogeneity throughout the body and dose verification was achievable, showing small difference between planned and delivered doses. [ABSTRACT FROM AUTHOR]

Résumé En raison de leur différence de pronostic, les objectifs et les modalités de la surveillance des gliomes de haut et de bas grades traités par irradiation diffèrent sensiblement. Les patients atteints de gliomes de bas grade ont une survie de longue durée. La surveillance de la toxicité du traitement dans ce cas est un objectif majeur. Les infections opportunistes et le syndrome dépressif sont des effets secondaires de la corticothérapie, largement sous-estimés. La recherche d’une radionécrose et sa différentiation avec une récidive est réalisée par l’IRM. La séquence de perfusion et la spectroscopie photonique montrant un rapport choline/créatine augmenté orientent vers une récidive. Le statut cognitif et la qualité de vie doivent être évalués lors de la surveillance. Ils doivent l’être par des échelles adaptées. La réhabilitation cognitive précoce améliore de manière intéressante le statut cognitif après le traitement. Le taux de pseudoprogression pour les gliomes de haut grade est de près de 20 %. L’IRM est l’examen de référence pour son diagnostic. La séquence de diffusion et la spectroscopie sont actuellement les techniques les plus intéressantes. Linked to the difference of prognosis, the terms and conditions of the follow-up of low-grade and high-grade gliomas treated by irradiation differ highly. Patients treated for a low-grade glioma have prolonged survival. In this case, monitoring of toxicities linked to the treatment is a major objective. Opportunistic infections and depression are corticosteroids side effects widely underestimated. Radionecrosis search and differentiation with recurrent disease are done by MRI. Perfusion and spectroscopy showing a choline/creatine ratio increase are in favour of disease recurrence. Cognitive status and quality of life must be evaluated during the follow-up. They have to be evaluated by adapted scales. Cognitive rehabilitation improves interestingly the post-treatment cognitive status. Pseudoprogression rates for high-grade gliomas are near 20%. MRI is the benchmark imaging for its diagnosis. Diffusion weight imaging and spectroscopy are actually the most interesting techniques. [ABSTRACT FROM AUTHOR]

Résumé L’irradiation de l’encéphale en totalité est la pierre angulaire de la radiothérapie des métastases cérébrales. Elle permet parfois d’être curative sur les localisations en place et prophylactique sur le reste de l’encéphale. Cependant, ces deux avantages peuvent être discutés et à la lumière des même données conduire à des conclusions diamétralement opposées. Whole brain radiation therapy is the angular stone of the brain metastasis radiation therapy. This treatment allows reaching two goals, potentially curative for in place metastasis and prophylactic in the rest of brain tissue. However, these two advantages can be disputed and in light of the same data opposite conclusions could be drawn. [ABSTRACT FROM AUTHOR]

Résumé: Le neurocytome central est une tumeur rare et de pronostic favorable du système nerveux central touchant l’adulte jeune. Des formes typiques et atypiques ont été décrites selon des critères histopathologiques et immunohistochimiques. Le neurocytome central se développe dans les régions périventriculaires et est classiquement révélé par des signes d’hypertension intracrânienne. La tumeur présente des caractéristiques typiques en scanographie et IRM, avec un pic caractéristique de glycine en spectro-IRM. Le traitement de référence est l’exérèse macroscopiquement complète, possible dans la moitié des cas. La radiothérapie externe améliore le taux de contrôle local des neurocytomes centraux atypiques et/ou incomplètement réséqués. La place de la radiothérapie en conditions stéréotaxiques peut être discutée : comme un traitement exclusif, en cas de résidu postopératoire, ou en cas de récidive. La chimiothérapie reste un traitement de dernière ligne dans les formes récidivantes après chirurgie et/ou radiothérapie et dans les formes disséminées neuroméningées et/ou extracrâniennes et les récidives. [Copyright &y& Elsevier]

Résumé: Les lymphomes NK/T sont rares en Europe et aux États-Unis mais relativement fréquents en Asie et en Amérique du Sud. Ils se présentent cliniquement comme des lésions destructrices des voies aérodigestives supérieures, préférentiellement localisées au niveau des fosses nasales, avec une atteinte possible des structures avoisinantes. Le diagnostic positif repose sur une analyse histologique, immunophénotypique et la mise en évidence du virus d’Eptein-Barr. Les modalités de traitement de ces lymphomes restent encore discutées de part le peu d’études dont nous disposons et la rareté de cette pathologie. La radiothérapie permet d’obtenir un contrôle rapide de la maladie et se place comme un traitement majeur des lymphomes NK/T localisés des fosses nasales. Elle délivre une dose 50Gy dans de larges volumes en association à une chimiothérapie à base de l-asparaginase. Nous présentons donc la place de la radiothérapie dans les formes localisées de lymphome NK/T des fosses nasales. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To assess effectiveness and toxicity levels of stereotactic radiation therapy without whole brain radiation therapy in patients with solitary brain metastases larger than 3cm. Patients and methods: Between June 2007 and March 2009, 12 patients received fractionated stereotactic radiation therapy and 24 patients underwent stereotactic radiosurgery. For the fractionated stereotactic radiation therapy group, 3×7.7Gy were delivered to the planning target volume (PTV); median volume and diameter were 29.4 cm3 and 4.4cm, respectively. For the stereotactic radiosurgery group, 14Gy were delivered to the PTV; median volume and diameter were 15.6 cm3 and 3.7cm, respectively. Results: Median follow-up was 218 days. For the fractionated stereotactic radiation therapy group, local control rates were 100% at 360 days and 64% at 720 days; for the stereotactic radiosurgery group, rates were 58% at 360 days and 48% at 720 days (P =0.06). Median survival time was 504 days for the fractionated stereotactic radiation therapy group and 164 days for the stereotactic radiosurgery group (P =0.049). Two cases of grade 2 toxicity were observed in the fractionated stereotactic radiation therapy group, and 6 cases of grade 1–2 toxicity, in the stereotactic radiosurgery group. Conclusions: This study provides data to support that fractionated stereotactic radiation therapy without whole brain radiation therapy with a margin dose of 3 fractions of 7.7Gy for treatment of solitary large brain metastases is efficient and well-tolerated. Because of the significant improvement in overall survival, this schedule should be assessed in a randomized trial. [Copyright &y& Elsevier]

Abstract: The morphological similarity of organs is studied with feature vectors based on geometric and Zernike 3D moments. It is particularly investigated if outliers and average models can be identified. For this purpose, the relative proximity to the mean feature vector is defined, principal coordinate and clustering analyses are also performed. To study the consistency and usefulness of this approach, 17 livers and 76 hearts voxel models from several sources are considered. In the liver case, models with similar morphological feature are identified. For the limited amount of studied cases, the liver of the ICRP male voxel model is identified as a better surrogate than the female one. For hearts, the clustering analysis shows that three heart shapes represent about 80% of the morphological variations. The relative proximity and clustering analysis rather consistently identify outliers and average models. For the two cases, identification of outliers and surrogate of average models is rather robust. However, deeper classification of morphological feature is subject to caution and can only be performed after cross analysis of at least two kinds of feature vectors. Finally, the Zernike moments contain all the information needed to re-construct the studied objects and thus appear as a promising tool to derive statistical organ shapes. [Copyright &y& Elsevier]

Abstract: Glial tumors represent 2000 to 3000 new cases per year in France and 75% of them are of high grade. Recent understanding of the molecular biology of these tumors revealed the importance of 1p19q codeletion and mgMT promotor methylation. Radiotherapy also recently evolved with the progress in medical imaging which allows a better definition of the target volumes. Even modest, therapeutic progress is based on chemoradiotherapy with temozolomide and on the development of non-coplanar conformational radiotherapy. Knowledge and precise evaluation of potential late effects of our treatments is necessary due to actual improvement of survival with chemoradiotherapy in glioblastoma. [ABSTRACT FROM AUTHOR]

Abstract: Many clinical studies have showed the key role of radiotherapy in anticancer treatment strategy. Radiations are delivered alone or in combination with systemic therapies. In recent years, the main goal of all clinical developments has focused on improving clinical benefit, with an increased tumour control and a higher normal tissue protection. This research was designed to reduce local recurrences, to increase recurrence-free or overall survival and to decrease acute and late effects. Technological and biological evolutions (or revolutions) accompanied clinicians to improve clinical benefit, namely with strong progress in radiology and better understanding of radiobiology, particularly at the molecular level. Differences in tumour and normal tissues radiosensitivity are nowadays integrated in daily clinical practice of radiation oncologists. The current report details the last 5-year developments of clinical and translational research in radiation oncology, especially the role of French teams in the development of personalized treatment. [Copyright &y& Elsevier]

Abstract: The aim of this paper is to describe the difficulties encountered when implementing stereotactic radiotherapy of non-small cell lung cancer (T1-T2, N0, M0) using a voluntary breath-hold technique. From 25/03/2010 to 22/02/2011, eight patients with a non-small cell lung cancer were selected for treatment. CT images were obtained with the patient maintaining breath-hold using a spirometer. Treatment was delivered when the patient maintains this level of breath-hold. Treatment was performed with a 4MV and 10MV photon beams from a linear accelerator Varian 2100CS, equipped with a 120 leaves collimator. 60Gy or 48Gy were delivered, in four sessions, to the 80% isodose. The planning target volume (PTV) was defined by adding a 5mm margin to the internal target volume (ITV), the ITV corresponding to the gross tumour volume (GTV) plus a 3mm margin. CTV is considered equal to GTV. The non-understanding of the gating technique, the great number of beams and the limited breath-hold times led to the failure of some treatments. It can be explained by some patients insufficient respiratory abilities and the low dose rate of one of the beams used for treatment, thus forcing some radiation fields to be delivered in two or three times. Implementing such a technique can be limited by the patients’ physical abilities and the materials used. Some solutions were found: a training phase more intense with a coaching of the breath-hold technique more precise, or the use of an abdominal compression device. [Copyright &y& Elsevier]

Abstract: Purpose: To assess the potential benefit of a boost in patients treated with whole brain irradiation by a conventional linear accelerator for lung cancer solitary brain metastasis. Patients and methods: From 2002 to 2006, a retrospective analysis was carried out from 64 unselected consecutive patients with secondary brain metastasis from lung cancer, treated with whole brain irradiation without surgical resection. Thirty patients (47%) received a boost in their brain metastases. Three potential prognostic factors were studied: sex, RPA score and improvement of neurological symptoms after radiotherapy. An analysis was conducted to determine whether an additional dose may improve survival in the absence of surgical resection. Results: The mean follow-up was 4.9 months. The median overall survival was 8.5 months (6.4 to 10.7 months). The total dose of radiotherapy was the only significant prognostic factor for overall survival. The median overall survival was 6.2 months for patients without additional radiation versus 11.2 months for patients receiving a boost dose (p =0.011). Sex, RPA score and improvement of neurological symptoms after radiotherapy were not found as prognostic factors for overall survival. Conclusions: Boost delivered after whole brain radiation therapy by a conventional particle accelerator may provide a benefit in selected patients, especially for centres that do not have radiotherapy techniques in stereotactic conditions. This warrants further prospective assessment. [Copyright &y& Elsevier]

Abstract: For the second year, the French Radiotherapy Database presents information from French radiation oncology centers. Among 179 centers, 159 have participated (90 %). The number of accelerators increased from 371 to 384 between 2006 and 2007, 11 % of these machines are more than 15 years old. On average, centers are open 50hours per week for treatment and 9.5 % more for maintenance. The lack of dedicated CT remains a difficulty: 158 from 159 centers have an access to a CT, but only 50 % have a dedicated scanner. There is no progress compared to 2006. The proportion of centers having a MU double calculation system has increased from 51 to 58 %. Two thirds of centers do not implement in vivo dosimetry. The activity is stable around 190 000 treatments per year. Three-dimension conformal radiotherapy is used for more than half of treatments in 77.2 % of private centers and 50 % of public hospitals. Intensity modulated radiotherapy remains rarely used. The number of radiation oncologists and technologists remains stable. The number of radiophysicists has increased from 7.6 %. Despite some progress, the difficulties of this speciality persist in France and are equally distributed across all regions, and between private and public centers. In 2009, the French Society for Radiation Oncology and the associated partners will continue this survey, which interest is recognized by both professionals and health administrations. [Copyright &y& Elsevier]

Abstract: In glioblastoma multiform-patients, advanced age has been associated with poor prognosis and decreased tolerance to treatments. The optimal management, especially with irradiation, was not definitively determined in the eighth and ninth decades. The Association of French-speaking neuro-oncologists (Anocef) has recently conducted a randomized clinical trial comparing radiotherapy plus supportive care versus supportive care alone in such patients. Patients aged 70-years and older with newly diagnosed glioblastoma and a Karnofsky performance score of 70 or above were randomly assigned to receive focal irradiation in daily fraction of 1.8Gy given five days per week for a total dose of 50Gy plus supportive care or supportive care only. Radiotherapy resulted in a modest but significant improvement in overall survival without reducing quality of life or cognition. However, the optimal regimen of radiotherapy in this fragile population remains uncertain. Abbreviated course of radiotherapy (40Gy in 15 fractions over 19 days) has been proposed. Analysis of preliminary results showed that efficacy and safety of this hypofractionated accelerated regimen compared favourably with those of classically fractionated treatments. Finally, the potential contribution of surgery and chemotherapy should be evaluated in prospective clinical trials. [Copyright &y& Elsevier]

Abstract: Purpose: The optimal schedule of irradiation in elderly patients suffering from glioblastoma multiforme (GBM) is unsettled. Materials and methods: This study reviewed the charts of 28 consecutive GBM patients aged 70 years or more with a Karnofsky Performance Status (KPS) greater than or equal to 70 who received a short course of radiotherapy (40grays in 15 fractions over three weeks). Results: The median age at surgery was 74.6 years (range, 70.1–85.7). No patient received prior or concomitant chemotherapy. The median progression-free survival and overall survival were 21.6 weeks (95% CI, 17.0–39.9) and 50.6 weeks (95% CI, 26.3–62.0), respectively. Even within a narrow range (<90 or ≥90), KPS remained a prognostic factor (p =0.03). Tolerance appeared acceptable in terms of KPS changes and corticosteroid use during radiation therapy. Conclusion: These results support the efficacy of short schedule radiotherapy for GBM in elderly patients with a good KPS. [Copyright &y& Elsevier]

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: Purpose: Retrospective analysis of ten cases of germinoma of the central nervous system treated in Pitié-Salpêtrière Hospital, Paris. Patients and methods: Ten male patients were treated from 1997 to 2005 for histologically verified primary seminoma of the central nervous system. The median age was 27 years (range 18–40 years). Our option for the treatment was the association of 3–4 cycles of neoadjuvant chemotherapy (cisplatin and etoposide) to radiotherapy. Five patients received a craniospinal radiotherapy of 30 Gy (for one patient 36 Gy) followed by a tumoral boost from 20 to 24 Gy. For five patients, irradiated volume was limited to the tumour, total dose from 24 to 54 Gy (for three patients the total dose was from 24 to 30 Gy). Surgery was used for five patients, but only in one case was macroscopic complete. Results: Six patients were in situation of complete remission after neoadjuvant chemotherapy. All the patients were in situation of complete remission after the irradiation. All the patients were alive free of disease with a median follow-up 46 months (range 13–90 months). Conclusion: In spite of the fact that the intracranial germinal tumours are not the subject of a consensual treatment strategy, this retrospective analysis pleads in favour of chemotherapy followed by limited dose and volume irradiation. [Copyright &y& Elsevier]

Abstract: The prognosis of glioblastoma remains extremely poor. Clinical research has been very active for thirty years, and has explored all the concepts developed in the laboratories of radiobiology. Radiosensitisation of hypoxic tumours, hyperfractioned radiotherapy, external beam radiotherapy plus stereotactic radiosurgery or brachytherapy boost, and intensity modulated radiation therapy failed to improve the results of the treatment of these patients. Concomitant chemoradiotherapy has just obtained a new success in the treatment of glioblastoma. The addition of temozolomide to radiotherapy resulted in a statistically significant survival benefit with minimal acute additional toxicity. The challenge remains to improve clinical outcomes further, and some new research pathways are open. [Copyright &y& Elsevier]

Abstract: Objective. – To define prognostic factors for local control and survival in 100 consecutive patients treated by fractionated photon and proton radiation for chordoma of the skull base and upper cervical spine. Patients and methods. – Between December 1995 and August 2002, 100 patients (median age: 53 years, range: 8–85, M/F sex-ratio: 3/2), were treated by a combination of high-energy photons and protons. The proton component was delivered by the 201 MeV proton beam of the Centre de Protonthérapie d''Orsay (CPO). The median total dose delivered to the gross tumour volume was 67 Cobalt Gray Equivalent (CGE) (range: 60–71). A complete surgery, incomplete surgery or a biopsy was performed before the radiotherapy in 16, 75 and 9 cases, respectively. Results. – With a median follow-up of 31 months (range: 1–87), 25 tumours failed locally. The 2 and 4-year local control rates were 86.3% (±3.9%) and 53.8% (±7.5%), respectively. According to multivariate analysis, less than 95% of the tumour volume encompassed by the 95% isodose line (P =0.048; RR: 3.4 IC95% [1.01–11.8]) and a minimal dose less than 56 CGE (p =0.042; RR: 2.3 IC95% [1.03–5.2]) were independent prognostic factors of local control. Ten patients died. The 2 and 5-year overall survival rates were 94.3% (±2.5%) and 80.5% (±7.2%). According to multivariate analysis, a controlled tumour (P =0.005; RR: 21 IC95% [2.2–200]) was the lonely independent favourable prognostic factor for overall survival. Conclusion. – In chordomas of the skull base and upper cervical spine treated by surgical resection followed by high-dose photon and proton irradiation, local control is mainly dependent on the quality of radiation, especially dose-uniformity within the gross tumour volume. Special attention must be paid to minimise underdosed areas due to the close proximity of critical structures and possibly escalate dose-constraints to tumour targets in future studies, in view of the low toxicity observed to date. [Copyright &y& Elsevier]

Goal of radiotherapy is to treat patient with the best therapeutic ratio, i.e. the highest local control and the lowest toxicity rates. The conformal approach, three-dimensional conformal radiotherapy or intensity-modulated radiotherapy, is based on imageries, up-dated 3-D treatment planning systems, immobilization systems, restricted quality assurance and treatment verification. The aim is to ensure a high dose distribution tailored to the limits of the target volume, while reducing exposure of normal tissues. The evaluation tools used for optimizing treatment are the visual inspection of the dose distribution in various planes, and the dose-volume histograms, but they do not fully quantify the conformity of dose distributions. The conformal index is a tool for scoring a given plan or for evaluating different treatment plans for the same patient. This paper describes the onset and evolution of conformal index and his potential application field. [Copyright &y& Elsevier]

Protons have physical characteristics, which differ from those of photons used in conventional radiotherapy. Better shielding of critical organs is obtained by using their particular ballistic (Bragg peak and lateral narrow penumbra). Some indications as ocular melanoma, chordoma and chondrosarcoma of the base of skull are now strongly accepted by the radiation oncologist community. Others are still in evaluation: meningioma, locally advanced nasopharynx tumor and paediatric tumors. The aim of this review is to present the clinical results of a technic which seems “confidential” because of the rarety and the cost of equipments. [Copyright &y& Elsevier]

Neutrons have radiobiological characteristics, which differ from those of conventional radiotherapy beams (photons) and which offer a theoretical advantage over photons to fight radioresistance by the differential relative biological effect of them between normal and tumour tissues. Neutron therapy beneficed of great interest between 1975 and 1985. Many of phase III trials were conducted and indications have been definitively deducted of them. After briefly describing the properties of neutron beams, this review discusses the indication of neutron therapy on the basis of the clinical results. Salivary, prostate tumours and sarcomas are the main indications of neutron therapy. In concern to the prostate cancers, other alternative treatments reduce the neutron therapy field. For sarcomas, the lack of randomised trials limits the impact of the interest of neutrons. For other tumours, the ratio benefice/risk of neutron therapy is inferior to these obtained with photons and they could not be considered like classical indications. [Copyright &y& Elsevier]

Despite the high incidence of prostate carcinoma, metastases of the uvea are very rare and the iris localization is even more. Only a few cases worldwide have been described so far. We report here the case of a 66-year-old man diagnosed with a metastatic prostate carcinoma. Nine months later, he developed brain and skin metastases. A couple of weeks later, the metastatic lesion appeared on his left iris. He has received whole brain radiation therapy including the iris lesion in the radiation fields. Through this case report and a literature review, we discuss the incidence, the different clinical presentations and the impact on the survival prognosis of this uncommon metastatic site. [ABSTRACT FROM AUTHOR]

Résumé: L’indication d’une radiothérapie externe est parfois posée chez des patients porteurs d’un dispositif médical implantable comme les pompes diffuseurs. La tolérance à l’irradiation de ce type de dispositif est peu, voire pas étudiée. Nous rapportons ici le cas d’une patiente que nous avons traitée par irradiation pelvienne pour un cancer du col utérin et qui avait un dispositif médical implantable dans la fosse iliaque. Nous avons aussi fait des tests sur cinq pompes paramétrées, qui ont montré que ces dispositifs ont une bonne tolérance à l’irradiation. [ABSTRACT FROM AUTHOR]