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Resume Objectifs de l’etude Nous presentons les resultats du PHRC Tridicol, etude prospective francaise de phase II dont l’objectif etait d’augmenter la dose delivree au volume cible lors de la curietherapie des cancers du col de l’uterus localement evolues. Materiel et methodes Huit centres ont inclus 48 patientes, prises en charge par chimioradiotherapie concomitante, puis curietherapie uterovaginale. Resultats Le suivi median etait de 63 mois. La dose mediane de curietherapie delivree en equivalent biologique d’une irradiation delivree par fractions de 2 Gy (EQD2) dans 90% du volume cible anatomoclinique a haut risque (D90 CTV HR) etait de 80 Gy. Le taux de controle local a 5 ans etait de 84 %, proche de l’hypothese de 86,7 %. Le taux de complications severes (de grade 3–4) etait de 23 % a 5 ans. La dose recue par le rectum etait correlee au risque de complications severes. Conclusion La dose dans le CTV HR a ete inferieure a l’objectif (85 Gy) du fait d’une faible utilisation des applicateurs avec aiguilles interstitielles parametriales, les centres participants ne disposant pas toujours d’un applicateur adequat, ou parce qu’ils etaient a l’epoque au debut de leur courbe d’apprentissage. Le taux de controle local a 5 ans etait ameliore par rapport a celui du groupe comparable du STIC PDR (programme de soutien aux techniques innovantes couteuses curietherapie de debit pulse) ([78 %] mais inferieur a la cohorte retroEMBRACE du GEC ESTRO (Groupe Europeen de Curietherapie -European Society for Radiotherapy) (89 %). Le taux de complications etait plus eleve que dans le groupe comparable du STIC PDR mais proche de celui de retroEMBRACE (intErnational study on MRI-guided BRachytherapy in locally Advanced CErvical cancer). La formation des equipes de curietherapie a l’implantation interstitielle ou l’adressage des patientes a des centres de recours doit permettre d’ameliorer l’indice therapeutique des cancers du col de l’uterus.

Purpose To focus on technical aspects of the implementation of interstitial high dose rate brachytherapy, with a step-by-step approach. Materials and methods Patients were selected during multidisciplinary tumor boards, according to inclusion criteria adapted from GEC-ESTRO guidelines. A CT scan was performed a few days before implantation. On pre-implant CT, using surgical scar and clips, surgical and pathological reports, and preoperative images, we delineated the tumor bed to be included in the Clinical Target Volume (CTV), according to GEC ESTRO Recommendations. A 3D virtual implant simulation of the best catheter positions was performed in order to cover the target volume. Implantation was then carried out under local anaesthetic using 3D projections of the catheter inlets and outlets. Dosimetry was performed on post-implantation CT scan. A dose of 34 Gy was delivered in 10 fractions. Acute and late side effects, and local control were evaluated 2 and 8 months after treatment. Results Between July 2017 and January 2020, 20 patients were treated with accelerated partial breast irradiation. Dose constraints regarding target volume coverage, overdose, dose homogeneity, conformation index and organs at risk were met in 94.7%, 100%, 63.2%, 0% and 89.5% of the treatment plans, respectively. Grade 1-2 acute adverse events were observed in 21% of patients, with no grade 3-4 events. Conclusion The first dosimetric results and early clinical tolerance and efficacy achieved by the implementation of breast interstitial multicatheter brachytherapy in routine clinical practice are very encouraging, and confirm the interest of extending this practice.

Background Oligorecurrent pelvic nodal relapse in prostatic cancer is a challenge for regional salvage treatments. Androgen depriving therapies (ADTs) are a mainstay in metastatic prostate cancer, and salvage pelvic radiotherapy may offer long ADT-free intervals for patients harboring regional nodal relapses. Objective To assess the efficacy of the combination of ADT and salvage radiotherapy in men with oligorecurrent pelvic node relapses of prostate cancer. Design, setting, and participants We performed an open-label, phase II trial of combined high-dose intensity-modulated radiotherapy and ADT (6 mo) in oligorecurrent (five or fewer) pelvic node relapses in prostate cancer, detected by fluorocholine positron-emission tomography computed tomography imaging. Outcome measurements and statistical analysis The primary endpoint was 2-yr progression-free survival defined as two consecutive prostate-specific antigen levels above the level at inclusion and/or clinical evidence of progression as per RECIST 1.1 and/or death from any cause. Results and limitations Between August 2014 and July 2016, 67 patients were recruited in 15 centers. Half of the patients had received prior prostatic irradiation. The median age was 67.7 yr. After a median follow-up of 49.4 mo, 2- and 3-yr progression-free survival rates were 81% and 58%, respectively. Median progression-free survival was 45.3 mo. The median biochemical relapse–free survival (BRFS) was 25.9 mo. At 2 and 3 yr, the BRFS rates were 58% and 46%, respectively. Grade 2 + 2-yr genitourinary and gastrointestinal toxicities were 10% and 2%, respectively. Conclusions Combined high-dose salvage pelvic radiotherapy and ADT appeared to prolong tumor control in oligorecurrent pelvic node relapses in prostate cancer with limited toxicity. After 3 yr, nearly half of patients were in complete remission. Our study showed initial evidence of benefit, but a randomized trial is required to confirm this result. Patient summary In this report, we looked at the outcomes of combined high-dose salvage pelvic radiotherapy and 6-mo-long hormone therapy in oligorecurrent pelvic nodal relapse in prostatic cancer. We found that 46% of patients presenting with oligorecurrent pelvic node relapses in prostate cancer were in complete remission after 3 yr following combined treatment at the cost of limited toxicity.

Purpose The aim of this study is to correlate locoregional relapse with radiation therapy volumes in patients with rectal cancer treated with neoadjuvant chemoradiation in the ACCORD 12/0405-PRODIGE 02 trial. Patients and methods We identified patients who had a locoregional relapse included in ACCORD 12's database. We studied their clinical, radiological, and dosimetric data to analyze the dose received by the area of relapse. Results 39 patients (6.5%) presented 54 locoregional relapses. Most of the relapses were in-field (n = 21, 39%) or marginal (n = 13, 24%) with only six out-of-field (11%), 14 could not be evaluated. Most of them happened in the anastomosis, the perirectal space, and the usual lymphatic drainage areas (presacral and posterior lateral lymph nodes). Only patients treated for a lower rectum adenocarcinoma had a relapse outside of the treated volume. 2 patients with T4 tumors extending into anterior pelvic organs had relapses in anterior lateral and external iliac lymph nodes. Conclusions Lowering the upper limit of the treatment field for low rectal tumors increased the risk of out of the field recurrence. For very low tumors, including the inguinal lymph nodes in the treated volume should be considered. Recording locoregional involvement, treated volumes, and relapse areas in future prospective trials would be of paramount interest to refine delineation guidelines.

Resume Objectif de l’etude La radiotherapie stereotaxique pulmonaire est realisee dans l’equipe du centre Georges-Francois-Leclerc (CGFL) a Dijon depuis 2008 sur un accelerateur Truebeam® (Varian®) avec la technique RPM. Materiels et methodes Cinquante patients atteints d’un cancer bronchique primitif de stade T1–T2 (n = 30) ou une metastase bronchique (n = 20) ont ete inclus dans l’etude. Depuis 2014, trois scanographies quadridimensionnelles successives a j1, j2 et j3, sont realisees afin de s’assurer de la reproductibilite des ITV (Internet Target Volume). Les trois ITV sont delinees (ITV 1,2 et 3) a partir de la MIP (Maximum Intensity Projection) de chacune des trois scanographies. Un ITV global est cree a partir des ITV des trois scanographies (fusion des MIP2 et 3 avec la MIP1). Une CBCT (Cone Beam Computerised Tomography) est realisee au debut de chaque seance d’irradiation pour positionner le patient. L’etude consistait a analyser la pertinence de la realisation de trois scanographies differentes avant la dosimetrie pour definir l’ITV et a comparer les volumes delinees sur les differentes CBCT a l’ITV pour s’assurer que le volume tumoral est bien inclus dans l’ITV au cours des seances. Resultats Il existe une forte correlation entre les differents ITV 1, 2, 3 et global, ainsi qu’entre les volumes obtenus sur les differentes CBCT (p = 0,977). Le coefficient de correlation entre les differents ITV et les volumes delinees sur CBCT etait eleve pour les lesions lobaires superieures. En termes de tolerance, le VEMS (volume maximal expire pendant la premiere seconde) ne semblait pas etre un facteur significatif influant sur la correlation entre les ITV et les volumes delinees sur CBCT. Conclusion La realisation d’une seule scanographie de centrage quadridimensionnelle est suffisante pour envisager une irradiation stereotaxique pulmonaire, quelle que soit la localisation des lesions pulmonaires. Le coefficient de correlation entre les ITV et les CBCT etait eleve pour les lesions lobaires superieures.

Resume Le recours a un ou plusieurs confreres est une pratique medicale habituelle et l’exercice solitaire de la cancerologie est revolu mais il doit encore evoluer pour mieux repondre aux attentes des patients. Le patient et eventuellement ses proches doivent etre associes aux demarches diagnostiques et therapeutiques. L’interet du patient et le secret medical sont toujours a respecter. Le praticien radiotherapeute, doit accepter et aider un patient pour la demande d’un second avis. Les reunions de concertation pluridisciplinaires (RCP) de recours, l’acces aux techniques innovantes, a des protocoles de recherches, a une prise en charge prenant en compte les specificites des patients telle que la population des adolescents et jeunes adultes sont autant d’outils qu’il faut savoir connaitre et manier en respectant les attentes des patients, la pluri-professionnalite et la confraternite. Parfois, lors d’un diagnostic initial, il ressort de tous les avis que l’abstention therapeutique est la meilleure option a proposer. L’information adaptee et une bonne communication sont alors les atouts pour faire comprendre et accepter au patient que la seule surveillance active ne lui fera pas courir de risque carcinologique tout en preservant sa qualite de vie. Dans le cas d’une recidive, une radiotherapie de rattrapage meme realisable doit etre profondement reflechie et toujours discutee si possible au sein de reseaux dit de tumeurs rares. Dans des situations peu frequentes ou complexes savoir passer la main a des centres experts peut aussi etre salutaire. Les modalites de la radiotherapie se sont diversifiees avec les avancees technologiques et ne sont a present plus qu’exceptionnellement disponibles sur un meme site. Parmi ces techniques de recours, on retrouve la protontherapie, la contactherapie, la radiotherapie stereotaxique avec tracking ou la curietherapie. Chaque radiotherapeute doit connaitre les benefices en survie, controle local ou preservation fonctionnelle de ces modalites ainsi que leurs organisations specifiques qui en facilitent l’adressage.

Brachytherapy is part of the treatment of locally advanced cervical cancers, accounting for about half of the total delivered dose. The benefit of dose escalation is the most important in advanced cases or if the tumor has responded poorly. The use of interstitial implantations makes it possible to reach doses of the order of 85 to 90Gy (including external beam radiotherapy contribution) in most patients, through image-guided approaches. Brachytherapy delivery is one of the quality criteria for patient care. To date, no data allow us to consider as an alternative the use of external boost through intensity-modulated or stereotactic body radiotherapy. Indeed, the doses delivered to the tumor and the capacity to spare normal tissues remains lower, as compared to what is permitted by brachytherapy. It is therefore appropriate for centers that do not have access to the technique to establish networks with centers where brachytherapy is performed, to allow each patient to have access to the technique. It is also necessary to promote brachytherapy teaching. The issue of reimbursement will be crucial in the coming years to maintain expertise that is today insufficiently valued in its financial aspects, but has a very high added value for patients.

Radiotherapy is the standard salvage treatment after radical prostatectomy. To date, the role of androgen deprivation therapy has not been formally shown. In this follow-up study, we aimed to update the results of the GETUG-AFU 16 trial, which assessed the efficacy of radiotherapy plus androgen suppression versus radiotherapy alone.GETUG-AFU 16 was an open-label, multicentre, phase 3, randomised, controlled trial that enrolled men (aged ≥18 years) with Eastern Cooperative Oncology Group performance status of 0 or 1, with histologically confirmed adenocarcinoma of the prostate (but no previous androgen suppression or pelvic radiotherapy), stage pT2, T3, or T4a (bladder neck involvement only) and pN0 or pNx according to the tumour, node, metastasis (TNM) staging system, whose prostate-specific antigen (PSA) concentration increased from 0·1 ng/mL to between 0·2 ng/mL and 2·0 ng/mL after radical prostatectomy, without evidence of clinical disease. Patients were assigned through central randomisation (1:1) to short-term androgen suppression (subcutaneous injection of 10·8 mg goserelin on the first day of irradiation and 3 months later) plus radiotherapy (3D conformal radiotherapy or intensity modulated radiotherapy of 66 Gy in 33 fractions, 5 days a week for 7 weeks) or radiotherapy alone. Randomisation was stratified using a permuted block method (block sizes of two and four) according to investigational site, radiotherapy modality, and prognosis. The primary endpoint was progression-free survival in the intention-to-treat population. This post-hoc one-shot data collection done 4 years after last data cutoff included patients who were alive at the time of the primary analysis and updated long-term patient status by including dates for first local progression, metastatic disease diagnosis, or death (if any of these had occurred) or the date of the last tumour evaluation or last PSA measurement. Survival at 120 months was reported. Late serious adverse effects were assessed. This trial is registered on ClinicalTrials.gov, NCT00423475.Between Oct 19, 2006, and March 30, 2010, 743 patients were randomly assigned, 374 to radiotherapy alone and 369 to radiotherapy plus goserelin. At the time of data cutoff (March 12, 2019), the median follow-up was 112 months (IQR 102-123). The 120-month progression-free survival was 64% (95% CI 58-69) for patients treated with radiotherapy plus goserelin and 49% (43-54) for patients treated with radiotherapy alone (hazard ratio 0·54, 0·43-0·68; stratified log-rank test p0·0001). Two cases of secondary cancer occurred since the primary analysis, but were not considered to be treatment related. No treatment-related deaths occurred.The 120-month progression-free survival confirmed the results from the primary analysis. Salvage radiotherapy combined with short-term androgen suppression significantly reduced risk of biochemical or clinical progression and death compared with salvage radiotherapy alone. The results of the GETUG-AFU 16 trial confirm the efficacy of androgen suppression plus radiotherapy as salvage treatment in patients with increasing PSA concentration after radical prostatectomy for prostate cancer.The French Health ministry, AstraZeneca, la Ligue Contre le Cancer, and La Ligue de Haute-Savoie.

Purpose: Use of circulating tumor DNA (ctDNA) for diagnosis is limited regarding the low number of target molecules in early-stage tumors. Human papillomavirus (HPV)–associated carcinomas represent a privileged model using circulating viral DNA (ctHPV DNA) as a tumor marker. However, the plurality of HPV genotypes represents a challenge. The next-generation sequencing (NGS)-based CaptHPV approach is able to characterize any HPV DNA sequence. To assess the ability of this method to establish the diagnosis of HPV-associated cancer via a blood sample, we analyzed ctHPV DNA in HPV-positive or HPV-negative carcinomas. Experimental Design: Patients (135) from France and Senegal with carcinoma developed in the uterine cervix (74), oropharynx (25), oral cavity (19), anus (12), and vulva (5) were prospectively registered. Matched tumor tissue and blood samples (10 mL) were taken before treatment and independently analyzed using the CaptHPV method. Results: HPV prevalence in tumors was 60.0% (81/135; 15 different genotypes). Viral analysis of plasmas compared with tumors was available for 134 patients. In the group of 80 patients with HPV-positive tumors, 77 were also positive in plasma (sensitivity 95.0%); in the group of 54 patients with HPV-negative tumors, one was positive in plasma (specificity 98.1%). In most cases, the complete HPV pattern observed in tumors could be established from the analysis of ctHPV DNA. Conclusions: In patients with carcinoma associated with any HPV genotype, a complete viral genome characterization can be obtained via the analysis of a standard blood sample. This should favor the development of noninvasive diagnostic tests providing the identification of personalized tumor markers. See related commentary by Rostami et al., p. 5158

IntroductionEven if indications for mastectomy have been progressively reduced in loco-regional breast cancer (BC) treatment, the harmful effects of surgery are still numerous and can impact physical and psychological wellbeing of women. The RIPOSTE (Reconstruction, self-Image, Posture, Oncology, “Santé”-Health, Therapy, “Escrime”-Fencing) program aimed to propose adapted fencing to patients with BC. This study aims to investigate the effect and conditions of effectiveness of the RIPOSTE program.Methods and analysisThis is a prospective randomized controlled trial including 24 patients with invasive BC who have just undergone surgery. The study will be proposed to the patient and if interested, the patient will be referred to a sports physician for a medico-sportive evaluation. At the end the evaluation, if the patient meets the inclusion criteria, she will be randomly assigned to one of the 2 groups based on a 1:1 principle: Early RIPOSTE group (receive one fencing session per week for 3 months immediately after their inclusion), Delayed RIPOSTE group (receive one fencing session per week for 3 months but within the 3 months following their inclusion). Patients will be included for 6 months with 3 follow-up times (0, 3, and 6 months) by a sport physician. The primary outcome is the evolution of quality of life score. Secondary outcomes are disability score, fatigue, anxiety-depression, cost-effectiveness and process evaluation.Ethics and disseminationThe study protocol has been approved by a French ethics committee (CPP Sud Méditerranée IV, N°ID-RCB: 2020-A01916-33). Results will be submitted for publication, at scientific conferences and through press releases.Trial RegistrationNCT04627714.

BackgroundIntensity modulated radiation therapy (IMRT) combined with androgen deprivation therapy (ADT) has become the standard treatment for patients with high-risk prostate cancer. Two techniques of rotational IMRT are commonly used in this indication: Volumetric Modulated Arc Therapy (VMAT) and helical tomotherapy (HT). To the best of our knowledge, no study has compared their related costs and clinical effectiveness and/or toxicity in prostate cancer. We aimed to assess differences in costs and toxicity between VMAT and HT in patients with high-risk prostate cancer with pelvic irradiation.Material and MethodsWe used data from the “RCMI pelvis” prospective multicenter study (NCT01325961) including 155 patients. We used a micro-costing methodology to identify cost differences between VMAT and HT. To assess the effects of the two techniques on total actual costs per patient and on toxicity we used stabilized inverse probability of treatment weighting.ResultsThe mean total cost for HT, €2019 3,069 (95% CI, 2,885–3,285) was significantly higher than the mean cost for VMAT €2019 2,544 (95% CI, 2,443–2,651) (p ConclusionUse of VMAT was associated with lower costs for IMRT planning and treatment than HT. Similar stabilized long-term toxicity was reported in both groups after higher acute GI and GU toxicity in VMAT. The estimates provided can benefit future modeling work like cost-effectiveness analysis.

Purpose The ongoing phase 2/3 PRODIGE 26/CONCORDE trial compares chemoradiation therapy with and without dose escalation in patients with locally advanced or unresectable esophageal cancer. The results of a benchmark case procedure are reported here to evaluate the protocol compliance of participating centers as part of quality assurance for radiation therapy. Methods and Materials Volume delineation, target coverage, and dose constraints to the organs at risk (OARs) were assessed on treatment plans of a common benchmark case performed by each participating center. The centers were classified in 3 categories: per protocol, minor acceptable deviation (MiD), or major unacceptable deviation (MaD). A plan was rejected if ≥4 MiDs or 1 MaD were found. Results Thirty-5 centers submitted 43 plans. Among them, 14 (32.6%) were per protocol, 19 (44.2%) presented at least 1 MiD, 2 (4.6%) presented at least 1 MaD, and 8 (18.6%) presented both MiD and MaD. Overall, 11 (25.6%) plans were rejected. Only 1 plan was rejected because gross tumor volume was not correctly delineated. The OAR delineation was respected in all cases. Dose constraints to the OARs were respected in the majority of cases except for the heart, where one-third of the plans presented a deviation. As for the target volume, 3 plans (5.8%) had a major underdosage and 1 plan (1.9%) had a major overdosage. Overall, 58% of all treatments were planned with intensity modulated radiation therapy, whereas 42% were planned with 3-dimensional chemoradiation therapy. Significantly more plans in the intensity modulated radiation therapy group were accepted compared with the 3-dimensional chemoradiation therapy group (P = .03). Conclusion The high frequency of protocol deviations underlines the importance of a quality assurance program in clinical trials. Further work should assess the impact of quality assurance for radiation therapy on patient outcomes.

NHL-ChirEx is an interprofessional cross-border education project that addresses the potential excess of radiation induced morbidity throughout the radiation planning and treatment process. NHL-ChirEx is supported by ESTRO and the University of the Greater Region and has been recently approved and funded under INTERREG VA Programme.

Introduction et but de l’etude La question ethique est une thematique emergente et peu exploree dans le monde de la radiotherapie. L’objectif de notre travail etait de preciser le questionnement ethique en radiotherapie dans une approche multiprofessionnelle. Materiel et methodes Une etude multicentrique a ete realisee dans 22 departements de radiotherapie francais, a partir d’un questionnaire Google Form (dix questions) soumis aux oncologues radiotherapeutes, manipulateurs d’electroradiologie, physiciens medicaux, assistantes medicales et cadres. Le questionnaire visait a mieux comprendre la frequence et la nature du questionnement ethique dans les departements de radiotherapie, ainsi que le besoin de formation. Resultats et analyse statistique Un total de 200 personnes a repondu aux questionnaires, se repartissant en : oncologues radiotherapeutes (37 %), manipulateurs d’electroradiologie (37 %), physiciens medicaux (12,5 %), assistantes medicales (10 %) et cadres (3,5 %). Le nombre moyen d’annees d’experience en radiotherapie etait de 12 ans (extremes : 6 mois - 40 ans). En termes de frequence dans la pratique de radiotherapie, la question ethique se posait : frequemment (plus d’une fois par mois ; 52,5 %), rarement (entre trois et dix fois par an ; 35,5 %), exceptionnellement (moins de deux fois par an ; 9,5 %) et jamais (2,5 %). En termes de nature, la question ethique concernait : la comprehension et/ou l’acceptation du traitement par les patients (71 %), les objectifs attendus du traitement (65 %), la lourdeur technique et organisationnelle du traitement (62 %) et le cout du traitement (13 %). Une specificite de la question ethique en radiotherapie etait reconnue pour 64 % des personnels. Les questions ethiques etaient effectivement discutees dans les departements de radiotherapie : jamais (18,5 %), parfois (47,5 %), souvent (10,5 %) et ne se prononce pas (18,5 %). Les questions d’ethique etaient considerees comme suffisamment discutees dans ces departements : non (47,5 %), oui (14 %) et ne se prononce pas (38,5 %). Seuls 17 % des personnels ont deja eu une formation en ethique medicale. Le besoin de formation specifique etait ressenti par 83,5 % des personnels n’ayant jamais eu de formation. Conclusion La question ethique se pose effectivement assez frequemment et specifiquement en radiotherapie, avec un sentiment d’insuffisance a la fois de discussion dans les departements et de formation. Les questions principales d’ethique concernent la comprehension du traitement par les patients, ses objectifs et la lourdeur de ceux-ci.

Despite a growing incidence in developed countries and a recent improved understanding of its pathogenesis, anal cancer management has not evolved over the past decades and drug combination used as first-line regimen still largely depends on clinician preferences. Aiming at paving the way for precision medicine, a large cohort of 372 HIV-negative patients diagnosed over a 20-year time period with locally advanced anal carcinoma was collected and carefully characterized at the clinical, demographic, histopathologic, immunologic, and virologic levels. Both the prognostic relevance of each clinicopathological parameter and the efficacy of different concurrent chemoradiation strategies were determined. Overall, the incidence of anal cancer peaked during the sixth decade (mean: 63.4) and females outnumbered males (ratio: 2.51). After completion of treatment, 95 (25.5%) patients experienced progression of persistent disease or local/distant recurrence and 102 (27.4%) died during the follow-up period (median: 53.8 months). Importantly, uni-multivariate analyses indicated that both negative HPV/p16ink4a status and aberrant p53 expression were far better predictors for reduced progression-free survival than traditional risk factors such as tumor size and nodal status. As for overall survival, the significant influences of age at diagnosis, p16ink4a status, cTNM classification as well as both CD3+ and CD4+ T-cell infiltrations within tumor microenvironment were highlighted. Cisplatin-based chemoradiotherapy was superior to both radiotherapy alone and other concurrent chemoradiation therapies in the treatment of HPV-positive tumors. Regarding their HPV-uninfected counterparts, frequent relapses were observed, whatever the treatment regimen administered. Taken together, our findings reveal that current anal cancer management and treatment have reached their limits. A dualistic classification according to HPV/p53 status should be considered with implications for therapy personalization and optimization.

Resume La curietherapie, par son mode d’action, comme par ses resultats cliniques de haut niveau de preuve, represente une technique d’irradiation des cancers specifique dans la prise en charge des cancers comme de certaines rechutes en territoire irradie. Apres la periode faste des annees 1980–1990, la curietherapie a progressivement perdu de son attrait. Afin d’apporter une solution concrete a cette situation deletere, il est important que les tutelles, les organismes payeurs, les associations de patients, les specialistes d’organes et les oncologues radiotherapeutes comprennent les raisons qui ont conduit a une telle situation ainsi que les risques encourus. Un enseignement juge insuffisant, une valorisation inadaptee et une image vieillissante de la curietherapie constituent les trois raisons essentielles de cette degradation et representent les trois enjeux majeurs conditionnant son maintien dans l’arsenal therapeutique anticancereux. Une communication, adaptee au sein de la communaute des oncologues radiotherapeutes, comme avec les autres societes savantes, est primordiale de meme qu’aupres des tutelles et des associations de patients. Il est capital que la curietherapie soit (re)connue afin de lui rendre tout son interet pour les patients qui pourront en beneficier.

Purpose To investigate clinical outcome and predicting factors of local failures in patients with colorectal cancer treated for unresectable liver metastases with stereotactic body radiation therapy (SBRT). Methods and materials We restrospectively reviewed the medical records of 67 patients treated with the Cyberknife SBRT system for 99 hepatic metastases between January 2007 and December 2015 in our center. In total, 37.5 to 54.0 Gy in 3 to 5 fractions were prescribed to the 80% isodose line. Local control (LC), intrahepatic progression incidence, Progression-Free Survival (PFS), Overall Survival (OS) and toxicity were evaluated. Results The median follow-up was 47 months (IQR, 28–59 months). The median OS was 53 months, the 2-year OS and PFS rates were 81.4% and 54.0%. The 1- and 2-year LC rates were 86.6% and 72.4%. In the multivariate analysis, the degree of differentiation was the only prognostic factor for LC (HR 0.31, 95% CI, 0.10–0.98, P = 0.046). Margin expansion > 5 mm was not associated with a better LC (HR 0.72, 95% CI, 0.38–1.37, P = 0.317). Performans Status ≥ 2 (HR 3.27, 95% CI, 1.07–9.98, P = 0.038), chemotherapy for metastases before SBRT (HR 0.36, 95% CI, 0.18–0.75, P = 0.006) and regional lymph node at diagnosis (HR 2.19, 95% CI, 1.09–4.43, P = 0.029) were independent prognostic factors for OS. We report 2 cases of grade ≥ 3 toxicity (3.0%) – one grade 3 acute nausea and one grade 3 late gastric ulcer. Conclusion Stereotactic body radiation therapy is an effective and well-tolerated treatment that allow high LC for liver metastases from colorectal cancer during the first two years. A prescription dose of 45 Gy in 3 fractions to the 80% isodose line with a risk adapted schedule to respect Organ At Risk constraints allows a low rate of toxicity.

Purpose In France, the reference technique for skin cancer was low-dose-rate brachytherapy (BT) delivered via iridium wire. At the end of their commercialization in 2015 we have replaced them by high-dose-rate (HDR) BT via interstitial catheters. We assessed efficacy and tolerance as soon as this technique was implemented. Methods and materials Patients received 7 Gy on the first day, followed by 8 × 4 Gy over the next 4 days for exclusive BT and 9 × 4 Gy over 5 days for post-operative BT. Results Sixty-six patients of median age 81 years received a total of 58 primary BT and 13 post-operative BT for non-melanoma facial skin cancers. Implantation was without difficulty. Median follow up was 15.3 months. Two patients died of intercurrent diseases before first follow up. For the others, 98.5% showed complete response and 3% local recurrence after a median of 20.5 months. Four patients had grade 3 acute dermatitis and three patients had grade 3 mucositis. All the Grade 3 toxicities were resolved within 3 months. A late significant hypopigmentation occurred in 4 patients. Conclusions HDR BT is efficient and well-tolerated with good cosmetic results. HDR catheters are similar with iridium wires in terms of technical difficulty.

Purpose Liver transplantation is the standard definitive treatment for nonmetastatic hepatocellular carcinoma (HCC). However, less than 5% of patients are ultimately candidates as a result of frequent comorbidities and graft shortage. The aim of this study was to evaluate stereotactic body radiation therapy (SBRT) as an ablative treatment for inoperable HCC. Methods and Materials A prospective phase 2 trial included newly diagnosed single HCC lesions that were without extrahepatic extension and that were deemed unsuitable for standard locoregional therapies, with a tumor size ranging from 1 to 6 cm. The SBRT dose was 45 Gy in 3 fractions. Primary endpoint was the local control of irradiated HCC at 18 months, defined by Response Evaluation Criteria in Solid Tumors. Results Forty-three patients were treated and evaluable. Median follow-up was 4.0 years (range, 1.2-4.6 years). All 43 patients had cirrhosis; 37 (88%) were Child–Pugh grade A and 5 (12%) grade B (1 missing data). No patients had received prior local treatment. Thirteen patients (31%) presented grade ≥3 acute adverse events, including 8 patients with an abnormality of the liver function tests (19%). Three patients (10%) experienced a decline in Child–Pugh at 3 months post-SBRT. The 18-month local control rate was 98% (95% confidence interval, 85%-99%). The 18-month overall survival rate was 72% (range, 56%-83%). Median overall survival was 3.5 years. Conclusions Local control and overall survival after SBRT for untreated solitary HCC were excellent despite candidates being unfit for transplantation, resection, ablation, or embolization treatments. SBRT should be considered as a bridge to transplant or as definitive therapy for those ineligible for transplant.

Purpose The aim of this analysis was to assess the 5-year tolerance and survival in patients undergoing hypofractionated stereotactic boost after external beam radiation therapy (EBRT) for intermediate-risk prostate cancer. Methods and Materials Between August 2010 and April 2013, 76 patients with intermediate-risk prostate carcinoma were included in the study. A first course delivered 46 Gy using conventional fractionation. The second course delivered a boost of 18 Gy (3 × 6 Gy) within 10 days using stereotactic body radiation therapy (SBRT). Gastrointestinal and genitourinary toxicities were assessed according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events v4.0. Secondary outcome measures were overall, biochemical relapse–free, and relapse-free survival; prostate-specific antigen kinetics; and patient functional status (urinary and sexual) according to the International Index of Erectile Function and International Prostate Symptom Score questionnaires. Results Sixty patients (79%) were treated by CyberKnife and 16 (21%) by linear accelerator. Median follow-up was 62 months (range, 29-69). The cumulative incidence of genitourinary and gastrointestinal grade ≥2 toxicities at month 60 after the end of radiation therapy was 1.4% (95% confidence interval [CI], 0.1%-6.6%) and 9.3% (95% CI, 4.1%-17.1%), respectively. Biochemical relapse–free and relapse-free survival rates at 5 years were 87.4% (95% CI, 77.1%-93.2%) and 86.2% (95% CI, 75.8-92.3), respectively. The mean (standard deviation) prostate-specific antigen variation within 3 months and 5 years post–radiation therapy was –1.20 ng/mL/mo (0.79) and –1.30 ng/mL/y (1.05), respectively. There was no significant difference between the International Prostate Symptom quality of life score between inclusion and month 60. For the International Index of Erectile Function, there was a significant difference between inclusion and month 60 (P = .005), with a higher proportion of severe/noninterpretable disorders at 60 months. Conclusions The results of the trial demonstrate that the EBRT and SBRT combination is well tolerated and yields good efficacy results. These data provide a good basis for comparing EBRT and brachytherapy boost to EBRT and SBRT boost in future prospective studies.

Purpose The only prognostic factor of prostate-specific antigen (PSA) bounce in prostate cancer found in several studies is young age but has never been specifically studied in this subset of patients for long-term results. Bounce characteristics, histological, clinical, and dosimetric data in young patients were analyzed, as well as their impact on toxicity and survival. Material and Methods This retrospective study included patients aged ≤60 years treated with exclusive iodine 125 brachytherapy with low or intermediary prostate adenocarcinoma during 1999–2014. Exclusion criteria were a follow-up of ≤24 months. PSA bounce was defined as a ≥0.2-ng/mL increase above the interval PSA nadir, followed by a decrease to nadir or below. Results This study analyzed 179 patients. Median age was 56 years (46–59 years). The median follow-up was 79 months (54; 123). The bounce incidence was 56.8% (49.6%; 64.2%) at 5 years, inversely proportional to positive/total biopsies ratio (HR 0.98, 95% CI [0.97, 0.99]). Incidence of biochemical failure was 1.2%, 95% CI (0.3%; 4.7%), at 5 years with no difference between the bounce and no-bounce group (HR 0.96, 95% CI [0.25; 3.58]). Bounce is an unfavorable prognostic factor for grade two and three urinary toxicities 6.67 (4.14; 10.76) (p Conclusions PSA bounce is common in young people after brachytherapy. It should be monitored without starting an inadequate and sometimes invasive relapse checkup or a relapse treatment.

Resume La radiotherapie conformationnelle avec modulation d’intensite des cancers du canal anal permet d’optimiser l’irradiation et d’epargner les tissus sains. La toxicite reste importante avec l’adjonction de la chimiotherapie concomitante. La precision du bilan par IRM et tomographie par emission de positons-scanographie permet de mieux preciser les volumes recevant une dose elevee mais necessite le respect des regles de delineation. L’irradiation est uniforme a ce jour pour tous les stades, mais pourrait etre individualisee selon le stade clinique et la reponse tumorale initiale. De nouveaux paradigmes apparaissent concernant la biologie, le bilan d’extension, les volumes, les doses, le fractionnement et les traitements associes.

Background: CyberKnife ® stereotactic radiotherapy allows for minimally invasive treatment with satisfactory results in patients with inoperable primary or metastatic lung cancer. The objective of this study was to identify factors influencing the probability of local control. Methods: Ninety-five patients (100 lung tumors) treated between January and December 2013 at our department by SBRT (stereotactic body radiation therapy) using CyberKnife ® were included in the study. There were 71 stage T1 or T2 primary tumors and 29 secondary tumors. The tracking methods were as follow: fiducial markers with Synchrony ® in 50 cases (gold seeds in 35, coils in 15 cases), spine with 4D-CT and Xsight ® Spine in 43 cases, and direct viewing by Xsight ® Lung in 7 cases. The methods were allocated according to the characteristics of each target. Results: With a median follow-up of 24 months, the probability of local control at 24 months was 88%. The probability of local control differed according to the size of the target (92% for tumors ≤35 mm and 54% for tumors >35 mm: P=0.013) and according to the distance of the fiducial markers in relation to the target (95% when Conclusions: The best results were obtained with small lesions. With Synchrony ® , the distance of the target relative to the fiducial markers should be less than 50 mm. Gold seeds are recommended, although coils may be used instead of gold seeds. The number of fiducial markers did not have a significant impact on the probability of local control. With an appropriate tracking method, stereotactic radiotherapy is an efficient treatment for stage I lung cancer and lung oligometastases.

Background Approximately 900 children/adolescents are treated with radiotherapy (RT) every year in France. However, among the 80% of survivors, the cumulative incidence of long-term morbidity – including second malignancies - reach 73.4% thirty years after the cancer diagnosis. Identifying a priori the subjects at risk for RT sequelae is a major challenge of paediatric oncology. Individual radiosensitivity (IRS) of children/adolescents is unknown at this time, probably with large variability depending on the age when considering the changes in metabolic functions throughout growth. We previously retrospectively showed that unrepaired DNA double strand breaks (DSB) as well a delay in the nucleoshuttling of the pATM protein were common features to patients with RT toxicity. We aim to validate a high performance functional assay for IRS prospectively. Methods/design ARPEGE is a prospective open-label, non-randomized multicentre cohort study. We will prospectively recruit 222 children/adolescents who require RT as part of their routine care and follow them during 15 years. Prior RT we will collect blood and skin samples to raise a primary dermal fibroblast line to carry out in blind the IRS assay. As a primary objective, we will determine its discriminating ability to predict the occurrence of unusual early skin, mucous or hematological toxicity. The primary endpoint is the measurement of residual double-strand breaks 24 h after ex vivo radiation assessed with indirect immunofluorescence (γH2AX marker). Secondary endpoints include the determination of pATM foci at 10 min and 1 h (pATM marker) and micronuclei at 24 h. In parallel toxicity including second malignancies will be reported according to NCI-CTCAE v4.0 reference scale three months of the completion of RT then periodically during 15 years. Confusion factors such as irradiated volume, skin phototype, previous chemotherapy regimen, smoking, comorbities (diabetes, immunodeficiency, chronic inflammatory disease...) will be reported. Discussion ARPEGE would be the first study to document the distribution of IRS in the pediatric subpopulation. Screening hypersensitive patients would be a major step forward in the management of cancers, opening a way to personalized pediatric oncology. Trial registration ID-RCB number: 2015-A00975–44, ClinicalTrials.gov Identifier: NCT02827552 Registered 7/6/2016.

Resume Les principales indications de curietherapie des cancers de la tete et du cou localisees sont les tumeurs des levres et la pyramide nasale, de la cavite buccale et de l’oropharynx. Les tumeurs du cavum sont aujourd’hui plus accessibles a la radiotherapie conformationnelle avec modulation d’intensite. La curietherapie peut etre realisee seule ou apres une radiotherapie externe ou une chirurgie. Elle fait partie des traitements de recours pour les secondes localisations en territoire irradie et les situations perioperatoires a risque. La curietherapie de debit pulse permet de reproduire les connaissances acquises de bas debit de dose et l’optimisation de la distribution de la dose. Les resultats de series de patients traites avec le haut debit font leur apparition dans plusieurs localisations. Cet article fait etat des donnees issues des recommandations du Groupe europeen de curietherapie–European Society for Radiotherapy and Oncology (Gec-ESTRO) publiees en 2017, tenant compte des connaissances issues des series en bas debit de dose, et actualisees pour les techniques de debit pulse et de haut debit de dose.

International audience; Purpose: To study overall survival, risk of neurological death, local recurrence and development of new brain metastasis in patients treated for brain oligometastases with hypofractionated stereotactic radiotherapy with CyberKnife®, according to the association or not with an additional whole brain irradiation.Patients and methods: Institutional retrospective study of 102 patients treated for one to three brain metastasis: 76 with exclusive hypofractionated stereotactic radiotherapy and 26 with hypofractionated stereotactic radiotherapy and whole brain irradiation. Objectives were assessed and compared between these two groups according to the Kaplan–Meier method and Cox model.Results: Median follow-up was 18.8 months. There were no difference between exclusive hypofractionated stereotactic radiotherapy and hypofractionated stereotactic radiotherapy with whole brain irradiation for overall survival (respective median 21.5 and 20.1 months), risk of neurological death (respectively 9.2% and 15.4% at one year). At one year: the risk of cerebral progressive disease was greater in the group receiving exclusive hypofractionated stereotactic radiotherapy (respectively 43.4% vs. 26.2%, P = 0.043), the risk of local recurrence was 25% versus 17.6% (P = 0.28) and the development of new brain metastasis was 23.7% versus 11.5% (P = 0.27). After salvage treatments, crude local control was similar in the two groups, respectively 78.6% and 73.5%. Whole brain irradiation has been avoided for 72.4% of patients in the group receving exclusive hypofractionated stereotactic radiotherapy.Conclusion: Whole brain irradiation improves local control of brain metastatic disease in addition to hypofractionated stereotactic radiotherapy. Sparing whole brain irradiation for salvage treatments only does not affect overall survival or risk of neurological death in selected patients with favourable prognosis.; Objectifs: Étude de la survie globale, du risque de décès neurologique, de la progression locale et de l’apparition de nouvelles métastases cérébrales chez des patients pris en charge pour des oligométastases cérébrales par irradiation stéréotaxique hypofractionnée par CyberKnife®, selon l’association ou non à une irradiation encéphalique totale complémentaire.Patients et méthodes: Étude rétrospective institutionnelle sur 102 patients pris en charge pour une à trois métastases cérébrales : 76 par irradiation stéréotaxique hypofractionnée exclusive et 26 par irradiation stéréotaxique hypofractionnée et irradiation encéphalique totale. Les objectifs ont été évalués et comparés entre ces deux groupes selon la méthode de Kaplan–Meier et le modèle de Cox.Résultats: Le suivi médian était de 18,8 mois. Il n’y avait pas de différence entre les groupes traités par irradiation stéréotaxique hypofractionnée exclusive et ceux traités par irradiation stéréotaxique hypofractionnée et irradiation encéphalique totale en termes de survie globale (médianes respectives de 21,5 mois et 20,1 mois), ni de risque de décès neurologique (9,2 % et 15,4 % à un an). Le risque de progression cérébrale à un an était plus important dans le groupe traité par irradiation stéréotaxique hypofractionnée exclusive (43,4 % contre 26,2 %, p = 0,043), avec un risque de progression locale de 25 % contre 17,6 % (p = 0,28) et d’apparition de nouvelles métastases cérébrales de 23,7 % contre 11,5 % (p = 0,28). Après traitements de rattrapage, le taux de contrôle local brut était identique entre les deux groupes, respectivement 78,6 % et 73,5 %. La radiothérapie encéphalique totale a pu être évitée pour 72,4 % des patients du groupe traité par irradiation stéréotaxique hypofractionnée exclusive.Conclusion: L’irradiation encéphalique totale améliore le taux de contrôle local de la maladie métastatique cérébrale en complément de l’irradiation stéréotaxique hypofractionnée. Ne pas la réaliser d’emblée pour la réserver aux seuls traitements de rattrapage n’altère ni la survie globale ni le risque de décès neurologique chez les patients sélectionnés, atteints de cancer de pronostic favorable.

Purpose/Objective(s) Increasing dose of chemoradiotherapy in locally advanced esophageal cancer unsuitable for surgery has been a matter of debate in the last 2 decades. Advances in tumor staging and radiation targeting with modern imaging and IMRT should allow further testing exclusive radiation dose escalation in esophageal cancer. Materials/Methods We performed a multicenter, randomized, open-label, parallel-group, phase 2/3 trial of patients aged 18 years or older enrolled from 28 centers in France between 07/06/2011 and 11/10/2019. Eligible participants had confirmed stage I-III biopsy proven esophageal carcinoma, ECOG 0-2 and sufficient caloric intake. Patients were randomly assigned (1:1) to receive 50Gy in 25 fractions over 5 weeks (standard arm) or 66Gy in 33 fractions over 6.5 weeks (experimental arm). Elective nodal irradiation (40Gy) was delivered in both groups. Concomitant chemotherapy was FOLFOX-4 for 3 courses followed by 3 adjuvant courses. Random allocation to treatment groups was done by a central computerized randomization procedure by minimization, stratified by center, histology, weight loss, and technique of radiotherapy. The primary endpoint was 2-year locoregional progression-free survival (LRPFS). Results 109 participants were randomly allocated to the 50Gy arm and 108 to the 66Gy group (intention-to-treat population). 177 men (81.6%) and 40 women (18.4%) were included with a mean age of 62.6 years (± 7.8). 191 patients (88.4%) had squamous cell cancer and 25 (11.6%) has adenocarcinoma. Most of the patients had stage III tumors (74% vs 26% for stage I-II). IMRT was delivered in 169 patients (80.1%) and 3D conformal in 42 patients (19.9%). 59 patients (54.1%) have died in the 50Gy group and 65 patients (60.2%) in the 66Gy group with a median follow up 35.3 months (range: 2.0-65.7) and 35.5 months (range: 1.3-60.7), respectively. Median overall survival was 25.2 months (95% CI 17.8-NR) in the 50Gy group and 23.5 months (14.5-32.2) in the 66Gy group (HR 1.14, 95% CI 0.82-1.59; P = 0.44). Median LRPFS was 16.2 months (95% CI 10.9-26.0) in the 50Gy group and 18.4 months (12.2-25.7) in the 66Gy group (HR 1.03, 95% CI 0.75-1.40; P = 0.88). The 2-year LRPFS rates were 42.7% (95% CI 33.2%-51.8%) and 43.8% (95% CI 34.1%-54.1%). No significant differences were recorded in the rates of late adverse events between the treatment groups (P = 0.14). The rates of grade 3/4 toxicities in the 50Gy group were 29.5%/0% and 24.0%/5.3% in the 66Gy group. 5 toxic deaths (4.6%) occurred in the 50Gy group and 7 (6.7%) in the 66Gy group. One and 2 toxic deaths out of the 5 in the 50Gy were related to radiotherapy or chemotherapy, respectively. Two and 3 out of the 7 toxic deaths in the 66Gy were related to radiotherapy or chemotherapy, respectively. Conclusion Dose escalated chemoradiotherapy delivering 66Gy is not more toxic than 50Gy but did not improve locoregional progression-free survival. Chemoradiotherapy delivering 50Gy should be definitely admitted as a standard dose.

Introduction et but de l’etude L’escalade de dose de radiotherapie dans les cancers de prostate de risque intermediaire ou haut risque ameliore le controle biochimique. Le complement en curietherapie qui permet de delivrer une dose elevee, a montre dans trois essais randomises un benefice superieur par rapport a la radiotherapie seule. Le groupe curietherapie de la Societe francaise de radiotherapie oncologique (SFRO) a conduit une etude retrospective multicentrique pour rapporter des donnees d’efficacite et de tolerance du complement en curietherapie en vie reelle. Materiel et methodes une etude retrospective multicentrique a ete conduite, incluant la totalite des patients consecutifs atteints de cancer de prostate de risque intermediaire ou haut risque pris en charge par association de radiotherapie externe et de boost par curietherapie, qu’elle soit par haut debit de dose ou par implants permanents de grains d’iode 125, de 2006 jusqu’en decembre 2019. Les caracteristiques des patients, de la maladie initiale, des traitements et du suivi ont ete recueillies. Resultats et analyse statistique Mille treize patients ont ete inclus (dont 960 pris en charge apres 2010) ; 914 patients ont ete suivis et leurs resultats analyses, dont 864 ayant recu une curietherapie de haut debit de dose (dose mediane 14 Gy en une fraction) et 50 par implants permanents de grains d’iode 125 (dose mediane 110 Gy). Quatre-cent-vingt-quatre cancers etaient de risque intermediaire et 490 de haut risque. La dose mediane de radiotherapie externe etait de 46 Gy. Apres un suivi median de 63 mois, le controle biochimique a 5 ans etait de 90 % pour la population globale, 94 % et 86 % pour les cancers de risque intermediaire ou haut risque, respectivement. A 5 ans, les taux de survie sans rechute biochimique ni clinique, survie sans metastase et controle local etaient respectivement de 67 %, 92 % et 97 %. Une toxicite tardive de grade 2 ou plus etait retrouvee chez 70 patients (soit 7,7 %) et 18 patients (soit 2 %) sur les plans urinaire et digestif. Conclusion Cette etude multicentrique montre l’efficacite de l’association de la curietherapie en complement de la radiotherapie externe et sa bonne tolerance. Cette base de donnees, en cours d’enrichissement, montre le dynamisme du groupe curietherapie de la SFRO et permettra de mieux etudier les facteurs influencant le controle du cancer de prostate et de contribuer a la diffusion de cette technique sur le territoire national.

Cerebral arteriovenous malformations (AVMs) are rare vascular lesions potentially responsible for substantial neurological morbidity and mortality. Over the past four decades, radiosurgery has become a valid therapeutic option for many patients with small intracranial AVMs, but reports describing the use of robotic stereotactic radiosurgery (SRS) are rare. The purposes of this study are to describe the efficacy and toxicity of robotic SRS for AVMs and to review the literature. The reports of 48 consecutive patients treated with SRS were reviewed. A total dose of 18 Gy in a single fraction was prescribed to the 70% isodose line. Efficacy (i.e., total obliteration of the AVM) and toxicity were analyzed. Literature search was performed on Embase and PubMed for the terms “Radiosurgery and AVMs”, “Cyberknife and AVMs” and “Radiation therapy and AVMs.” The median follow-up was 41 months. The median AVM volume was 2.62 cm3. The incidence of obliteration was 59% at 3 years. Regarding toxicity, 92% of patients remained symptom-free, 66% developed radiogenic edema on MRI, and none developed radionecrosis. Forty-one patients (85%) had embolization prior to SRS. Our study was incorporated in an exhaustive review of 25 trials categorized by SRS technique. In this review, the median follow-up was 60 months. The median nidus volume was 2 cm3. The median overall obliteration rate for SRS was 68% (range 36 to 92). The median embolization rate prior to SRS was 31% (range 8.23 to 90). Compared to other studies, tolerability was excellent and the obliteration rate was acceptable but probably affected by the high embolization rate prior to radiosurgery. Our study suggests that a higher dose is feasible. A larger cohort with a longer follow-up period will be needed to confirm the safety and effectiveness, and subsequently validate different prognosis and predictive scores with this treatment modality to maximize the benefits of this technology for selected patients in the long term.

// Guillaume Conroy 1 , Julia Salleron 2 , Arthur Belle 1 , Mouni Bensenane 1 , Abdelbasset Nani 1 , Ahmet Ayav 3 , Didier Peiffert 4 , Anthony Lopez 1 , Cedric Baumann 5 , Helene Barraud 1 and Jean-Pierre Bronowicki 1 1 INSERM U954, Department of Hepato-gastroenterology, Lorraine University, Nancy University Hospital, Vandœuvre-les-Nancy, France 2 Department of Biostatistics, Lorraine Comprehensive Cancer Center, Vandœuvre-les-Nancy, France 3 Department of Digestive, Hepatobiliary and Endocrine Surgery, Lorraine University, Nancy University Hospital, Nancy, France 4 Department of Radiotherapy, Lorraine University, Lorraine Comprehensive Cancer Center, Vandœuvre-les-Nancy, France 5 ESPRI-BioBase Unit, Platform of PARC, Nancy University Hospital, Vandœuvre-les-Nancy, France Correspondence to: Jean-Pierre Bronowicki, email: Jp.bronowicki@chru-nancy.fr Keywords: HCC; inflammation-based scores; sorafenib; prognostic factor Received: June 20, 2017 Accepted: July 25, 2017 Published: September 30, 2017 ABSTRACT Background and Aims: The multikinase inhibitor sorafenib is the only currently approved drug for the indication of advanced hepatocellular carcinoma (HCC). It provides a limited gain in survival time but is frequently associated with adverse events. We currently lack simple prognostic factors in sorafenib-treated HCC patients. Various inflammation-based scores (IBSs) have been evaluated as predictors of tumor recurrence and survival in various malignancies (including HCC). The objective of the present study was to determine the prognostic value of IBSs for overall survival (OS) in advanced HCC patients prior to the initiation of sorafenib therapy. Methods: Patients with Barcelona Clinic Liver Cancer stage C HCC were enrolled retrospectively between October 2007 and September 2015. To identify prognostic factors for OS, bivariate and multivariate analysis were performed using a Cox proportional hazards regression model. Results: 161 patients (87.0% males; median age: 67; median OS: 9.1 months) were enrolled. A multivariate analysis identified a body mass index 38 U/L (HR=2.65, p