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Purpose For nonoperable stage I non-small cell lung cancer, stereotactic body radiation therapy (SBRT) has emerged as a standard treatment option. We aimed to compare the clinical outcomes of lung SBRT between patients with versus without pathologic cancer diagnosis. Methods and Materials We included patients treated by SBRT for a single pulmonary lesion between July 2009 and July 2017. Patients in the clinical diagnosis group had a positron emission tomography/computed tomography scan showing hypermetabolism, growth of the mass on sequential computed tomography, and were not eligible for biopsy, refused biopsy, or had an inconclusive biopsy. For each of those patients, a matched pair in the pathologic diagnosis group was identified by matching for patient, treatment, and tumoral characteristics. We performed a power calculation to estimate the sample size required to detect a difference arising from a 5% or 15% rate of benign processes in the group without pathology. Results A total of 924 lung SBRT treatments were performed among 878 patients from 2009 to 2017. Within this population, 131 patients were treated based on clinical findings. They were matched with 131 patients with a pathologic diagnosis who received treatment. At 3 years, no significant differences were observed in overall survival (hazard ratio [HR], 1.2; 95% confidence interval [CI], 0.7-2.1), local control (HR, 0.9; 95% CI, 0.4-2), or regional (HR, 0.5; 95% CI, 0.2-1.4) or distant recurrence (HR, 0.6; 95% CI, 0.3-1.1). Conclusions In our population, we found no clinically significant difference in patterns of recurrence or survival after lung SBRT for patients who had received clinical versus pathological diagnoses. There was, however, a trend toward more distant recurrences in the pathologic diagnosis group. Our power calculation suggests that data from multiple institutions would be required to rule out a difference in outcomes due to 5% to 15% of clinically diagnosed cases being treated for benign processes.

Stereotactic radiotherapy of oligometastases, mono- or hypofractionated, represents a fundamental change in the practice of the specialty as it was developed for a century. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Four main phase II and III trials are underway in France. Future research concerns the association of stereotactic radiotherapy with immunotherapy or different conventional chemotherapy protocols, the identification of the best clinical presentations, and optimization of fractionation and biological dose for poor prognosis localizations.

Résumé De nouveaux concepts de consultations sont actuellement en train de profondément changer la façon d’exercer la médecine. L’utilisation de questionnaires standardisés, des questionnaires patients (PRO, patient-reported outcome, et son application informatique, ePRO) ont déjà fait irruption dans nos consultations. En parallèle, la télémédecine, voire l’utilisation d’agents conversationnels automatiques médicaux, permettent d’assurer une consultation à distance, plus accessible. Ces différents outils ont un intérêt majeur en oncologie, notamment dans le contexte de la chronicisation des maladies et du suivi à long terme que les oncologues radiothérapeutes prennent en charge. Dans cet article, nous détaillons chacun de ces nouveaux concepts.

International audience; De nouveaux concepts de consultations sont actuellement en train de profondément changer la façon d’exercer la médecine. L’utilisation de questionnaires standardisés, des questionnaires patients (PRO, patient-reported outcome, et son application informatique, ePRO) ont déjà fait irruption dans nos consultations. En parallèle, la télémédecine, voire l’utilisation d’agents conversationnels automatiques médicaux, permettent d’assurer une consultation à distance, plus accessible. Ces différents outils ont un intérêt majeur en oncologie, notamment dans le contexte de la chronicisation des maladies et du suivi à long terme que les oncologues radiothérapeutes prennent en charge. Dans cet article, nous détaillons chacun de ces nouveaux concepts

There are various specific therapeutic intervention available to treat hemorrhagic cystitis, once emergency treatment has been carried out. The lack of prospective studies, because of the relative rarity of this condition, makes it difficult to hierarchize the therapeutic sequence. The present review presents and summarizes the literature published on radiation-induced hemorrhagic cystitis from April 2015, date of a precedent exhaustive review, to March 2018.During our period of interest, 13 clinical studies and two new clinical trials protocols were published. Most of the clinical studies were retrospective and presented data about hyperbaric oxygen (HBO) therapy, comforting its place as a well tolerated and effective first-line treatment. Other studies reported the outcomes of treatments with alum, formalin, silver nitrate, fulguration with laser or definitive surgery.Although authors seem to agree that formalin and surgery have their role as effective but potentially morbid last-line treatments, there is no consensus on primary approach to management of radiation-induced hemorrhagic cystitis beyond symptomatic measures. Several treatments have proven excellent response rates and few side effects. The results of on-going prospective studies on mesenchymal stromal cells or tacrolimus instillations are awaited, but the main discriminating factor to choose between treatments remains local availability.

Purpose To determine the 3 years late toxicity among patients with non-metastatic breast cancer who received concurrent bevacizumab and locoregional radiotherapy. Material and methods This is a single-arm, multicentre, prospective study, of the toxicity of adjuvant concomitant association of bevacizumab and radiotherapy in patients with breast cancer. Toxicity was assessed by the Common Terminology Criteria for Adverse Events version 3.0 during the radiotherapy and follow-up clinics at 12 and 36 months after its completion. The study was designed to evaluate the toxicity at one year, 3 years and 5 years. Results Sixty-four patients were included from October 2007 to August 2010. All of them received concurrent adjuvant radiotherapy and bevacizumab (in 24 cases after primary systemic treatment). All patients received non-fractionated radiotherapy to breast or chest wall with or without irradiation of regional lymph nodes. Early toxicity has been previously reported. Median follow-up was 46.4 months (range: 18–77 months). Median age was 53 years old (range: 23–68 years). The 3-years overall survival was 93% (range: 87–100%). Evaluation of the toxicity at 3 years was available for 67% of the patients. There was a low rate of toxicity: 14% grade 1 pain, 9% grade 1 fibrosis, 2% grade 1 telangiectasia, 2% grade 1 paresis, 7% grade 1 lymphedema and 2% grade 3 lymphedema. No grade 4 toxicity was observed. No patient had a left ventricular ejection fraction below 50% at 3 years. Conclusions Concurrent bevacizumab with locoregional radiotherapy is associated with acceptable 3-years toxicity in patients with breast cancer.

Purpose/Objectives The purpose of this study was to determine early and late toxicities among patients with non-metastatic breast cancer (BC) receiving concurrent bevacizumab (BV) and radiation therapy (RT). Materials/Methods Multicentre, prospective study, of the toxicity of adjuvant concomitant association of BV and RT in patients with non-metastatic BC enrolled in Phase 3 BEATRICE, BEVERLY and BETH trial. Early and late toxicities were assessed by the Common Terminology Criteria for Adverse Events v. 3.0 during RT, 12 months and 36 months after its completion. Results Sixty-four patients were included from october 2007 to august 2010. They all received adjuvant RT and BV concomitant treatment, plus neo-adjuvant BV for 24 patients. RT was adjuvant and normo-fractionated. Twelve months toxicity was available for 60 patients and 36 months toxicity was available for 43 patients. Median follow-up was 46 months (18-77). Median age was 51 years old (23-68). Among 63 evaluated patients during RT, acute radiation dermatitis was observed in 48 (76%) patients : Grade 1 for 27 (43%), grade 2 for 17 (27%), grade 3 for 4 patients (6%). Grade 2 acute oesophagitis was observed in 1 patient. At 3 years, few toxicities were observed : 6 patients (14%) had grade 1 pain, 4 (9%) had grade 1 fibrosis, one (2%) had grade 1 telangiectasis, one (2%) had grade 1 paresis, 3 (7%) had grade 1 lymphoedema and one grade 3 lymphoedema. No grade 4 toxicity was observed. At 12 months, only one evaluated patient had a LVEF Conclusions Concurrent bevacizumab with locoregional RT is associated with acceptable early and late 3-years toxicities in patients with BC. Determination of late toxicity at 60 months is currently underway. Citation Format: Dautruche A, Belin L, Cottu P, Bontemps P, Lemanski C, De La Lande B, Baumann P, Missohou F, Levy C, Peignaux K, Reynaud-Bougnoux A, Denis F, Gobillion A, Ady Vago N, Fourquet A, Kirova Y. Radiotherapy associated with concurrent bevacizumab in patients with non-metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-10-17.

Stereotactic radiotherapy represents a fundamental change in the practice of radiotherapy of lung cancers. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Stereotactic radiotherapy can be realized either by a dedicated accelerator (CyberKnife®) or by a conventional accelerator associated with specific systems. The two modalities deliver a very precise irradiation whose very good results published to date are similar. Some technical characteristics specific to each type of linear accelerator could guide the choice according to the target volume treated.

Stereotactic radiotherapy represents a fundamental change in the practice of radiotherapy of lung cancers. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Stereotactic radiotherapy can be realized either by a dedicated accelerator (CyberKnife

Stereotactic radiotherapy of oligometastases, mono- or hypofractionated, represents a fundamental change in the practice of the specialty as it was developed for a century. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Four main phase II and III trials are underway in France. Future research concerns the association of stereotactic radiotherapy with immunotherapy or different conventional chemotherapy protocols, the identification of the best clinical presentations, and optimization of fractionation and biological dose for poor prognosis localizations.

Purpose We report the patient outcomes of a treatment combining proton therapy and Tomotherapy in sinonasal adenoid cystic carcinoma involving skull base. Materials and methods We included patients treated at Curie Institute, Paris, France, between March 2010 and February 2014 for an advanced adenoid cystic carcinoma involving skull base. Patients received Tomotherapy, proton therapy or both. We evaluated treatment toxicity (according to CTCAE V4), local control, distant metastasis-free survival and overall survival. Results Thirteen patients were included, with a median follow-up of 34 months. Radiation therapy followed surgery for 77% of the patients and margins were positive in all those cases. Median dose was 73.8 Gy. Local control, distant metastasis-free survival and overall survival at 3 years were respectively 60%, 48% and 60%. One-sided grade 3 hearing impairment occurred in 46% of the patients. Conclusion Combining high-dose proton therapy and Tomotherapy is effective and has moderate toxicity in the treatment of T4 sinonasal adenoid cystic carcinoma involving skull base.

Le Rara de Léogâne, une pratique rituelle des collectivités haïtiennes, a fait l’objet de plusieurs réaménagements au fil des évolutions sociétales. Les événements composés de musiques, de danses et de processus ritualisés sont organisés en bande et dirigés par des chefs. Ce sont eux qui, les premiers, ont changé l’image de cette pratique hautement culturelle à l’occasion du premier festival de Rara, qui a eu lieu en 1992. L’étude de leurs communications avec les médias lors de ce premier événement centralisateur démontre une médiation culturelle auprès du public qui a été appuyée par l’ensemble des acteurs de la gouvernance sociale, la mairie, la députation et le ministère de la Culture. L’auteur, dans cet article, se questionne sur les processus qui ont fait du Rara un patrimoine identitaire territorial et met en lumière l’importance de la potentialité touristique de l’événement, qui s’impose en tant que ressource de développement dans une zone ravagée par des confrontations humaines et des catastrophes naturelles répétées., The Rara of Léogâne, a ritual practice in Haitian communities, has been the subject of several reworkings in the course of social evolution. The events made up of music, dance and ritual procedures are organized as a group and orchestrated by leaders. It is they who first changed the image of this unique cultural practice at the first Rara Festival in 1992. The study of their communications with the media at the time of this first consolidating event, shows a cultural mediation in connection with the public, which found support on the part of all the players in social governance, the mayor’s office, members of parliament and the Ministry of Culture. In his article, the author muses about the processes which have conveyed on Rara a territorial heritage of identity, and he brings to light the importance of the tourist potential latent in this event as a developmental resource in an area torn apart by repeated human confrontations and natural disasters.

Background The objective of the study was to assess the prognostic role of skeletal muscle index (SMI) in metastatic renal cell carcinoma (mRCC) patients treated with everolimus, and its effect of on everolimus-induced toxicity. Patients and Methods Consecutive mRCC patients treated with everolimus between February 2007 and November 2014 underwent computed tomography scans at a single center performed by the same radiologist. SMI was assessed before everolimus treatment using the L3 cross-sectional area. Overall survival (OS) was analyzed according to SMI value. Results were adjusted using the International Metastatic Database Consortium (IMDC) prognostic group, body mass index (BMI), and/or number of previous tyrosine kinase inhibitor lines (NPL). Results One hundred twenty-four mRCC patients (mean age, 60.21 years) were treated with everolimus as second- or third-line (82.3%) or > third-line (17.7%) therapy. Most patients (87.9%) had clear cell carcinoma. IMDC prognostic group was “favorable” (32.3%), “intermediate” (50%), or “poor” (17.7%). Median SMI was 40.75. OS was longer in patients from the highest versus lowest SMI tercile: 21.9 versus 10 months ( P = .002). Continuous SMI at baseline was not significantly associated with OS after adjustment for IMDC prognostic group, BMI, or NPL but the highest versus lowest SMI tercile was an independent prognostic factor in multivariate analysis ( P = .025). There was no difference in everolimus toxicity between SMI tercile groups. Conclusion SMI was an independent prognostic factor for mRCC patients treated with everolimus. Whether this provides additional prognostic value to IMDC criteria needs to be confirmed in a larger cohort. SMI does not seem to be predictive of everolimus-induced toxicity.

Background A single‐incision laparoscopic cholecystectomy (SILC) was developed to improve outcomes as compared with the four‐port classic laparoscopic cholecystectomy (CLC). Any potential benefits associated with a SILC have been suggested by previous studies reporting few patients with different surgical techniques. The aim of this study was to describe the experience with a standardized SILC as compared with CLC. Methods From June 2010 to January 2012, 40 patients underwent a SILC [median age: 47.5 years (25–92)] and operative and peri‐operative data were prospectively collected. Over the same period, 37 patients underwent a CLC. A 10‐point visual analogue scale (VAS) was used for qualitative data. The costs of SILC and CLC were also compared. Results For those patients undergoing a SILC the median operating time was 70 min (24–110). There were no conversions. An additional trocar was necessary in 16 patients. Four patients developed post‐operative complications. The median immediate post‐operative pain score was 5 (0–10). The median quality of life and cosmetic satisfaction at the initial post‐operative visit were 10 (6–10) and 10 (5–10), respectively (VAS). Although the surgical results of both groups were similar, post‐operative complications were exclusively reported in the SILC group (two incisional hernias). Conclusion Standardization of SILC is possible but associated with an important rate of additional trocar placement and a disturbing rate of incisional hernias.

Objectif Cette etude a evalue le controle local et a distance, la survie et la tolerance suite a une irradiation hautement conformationnelle chez des patients atteints d’un carcinome adenoide kystique sinonasal localement evolue envahissant la base du crâne. Patients et methodes Entre 2010 et 2014, 13 patients atteints d’un carcinome adenoide kystique sinonasal ont ete pris en charge dans notre centre. Le suivi median etait de 12 mois (1 - 47). Le sinus sphenoide etait la localisation la plus courante, puis le sinus maxillaire. La base du crâne etait atteinte chez tous les patients. Dix patients (77 %) ont beneficie d’une chirurgie R1 ou R2 prealable et trois (23 %) etaient atteints d’une tumeur non resecable. Il s’agissait d’une re-irradiation chez deux patients (15 %). La radiotherapie etait pour cinq patients (38 %) une tomotherapie exclusive, pour trois (23 %) une protontherapie exclusive et pour cinq (38 %) une association de tomotherapie et de protontherapie. Les doses delivrees etaient de 70 a 73,8 Gy. Trois patients (23 %) ont recu une chimiotherapie concomitante par cisplatine a la dose de 100 mg/m2. Resultats A 12 mois, le taux de controle local etait de 83 %, celui de survie sans metastase de 75 % et celui de survie globale de 80 %. La tolerance immediate a ete tres bonne, un patient seulement a ete atteint d’une radiodermite de grade III. Comme toxicite tardive a un an, on notait une hypoacousie de grade III pour cinq patients (38 %), homolaterale a la lesion, ainsi qu’une rhinite de grade III chez un patient. Conclusion Notre etude suggere que l’irradiation a doses elevees, a l’aide de technique de radiotherapie hautement conformationnelles (protontherapie et tomotherapie), serait un moyen efficace et sur de traiter les patients atteints de carcinome adenoide kystique sino-nasal localement evolue.