Radical radiotherapy for paediatric solid tumour metastases:An overview of current European protocols and outcomes of a SIOPE multicenter survey

Purpose/objective: About 20% of children with solid tumours (ST) present with distant metastases (DM). Evidence regarding the use of radical radiotherapy of these DM is sparse and open for personal interpretation. The aim of this survey was to review European protocols and to map current practice regarding the irradiation of DM across SIOPE-affiliated countries. Materials/methods: Radiotherapy guidelines for metastatic sites (bone, brain, distant lymph nodes, lung and liver) in eight European protocols for rhabdomyosarcoma, non-rhabdomyosarcoma soft-tissue sarcoma, Ewing sarcoma, neuroblastoma and renal tumours were reviewed. SIOPE centres irradiating >= 50 children annually were invited to participate in an online survey. Results: Radiotherapy to at least one metastatic site was recommended in all protocols, except for high-risk neuroblastoma. Per protocol, dose prescription varied per site, and information on delineation and treatment planning/delivery was generally missing. Between July and September 2019, 20/27 centres completed the survey. Around 14% of patients were deemed to have DM from ST at diagnosis, of which half were treated with curative intent. A clear cut-off for a maximum number of DM was not used in half of the centres. Regardless of the tumour type and site, conventional radiotherapy regimens were most commonly used to treat DM. When stereotactic radiotherapy was used, a wide range of fractionation regimens were applied. Conclusion: Current radiotherapy guidelines for DM do not allow a consistent approach in a multicentre setting. Prospective (randomised) trials are needed to define the role of radical irradiation of DM from paediatric ST. (C) 2020 The Author(s). Published by Elsevier Ltd

Money for writing: Screenplay development and screenwriters earnings in French cinema

The funds allocated to developing screenplays currently constitute on average 2 to 3% of the overall budget of a film in France. Producers are more than ever dependent on presenting attractive draft screenplays to find their financial partners. As a result, screenwriters undoubtedly are active economic partners of production planning, but they do not seem to receive much professional recognition for this vital role. Moreover, their earnings often fail to reflect the amount of work produced and do not reward adequately the risks taken, including the possibility that production could stop after the screenplay is written. This article investigates the place of screenplay development within the economics of French cinema. Using recently published official reports and interviews, the author identifies different types of screenwriters – freestanding screenwriters, writing teams and screenwriters co-writing with the director – and addresses their working conditions. She surveys some of the contract modalities for the remuneration of professional screenwriters. Finally, she reviews the proposals made by different professional bodies to improve the remuneration of screenwriters and reform the financing of screenwriting

Interaction between the Number of Chemotherapy Cycles and Brachytherapy Dose/Volume Parameters in Locally Advanced Cervical Cancer Patients

Scarce data exist on concurrent chemotherapy in locally advanced cervical cancer (LACC) patients (pts) treated with image-guided adaptive brachytherapy (IGABT). We examined the effect of a number of chemotherapy cycles and their interaction with brachytherapy dose/volume parameters. Clinical records of 209 consecutive pts treated for a LACC were reviewed. Pts received CRT concurrently with cisplatin 40 mg/m² or carboplatin AUC2. An additional cycle could have been delivered during the pulse-dose rate (PDR)-IGABT. The impact of a number of chemotherapy cycles on outcome was examined, as well as the interactions with dose volume parameters. The number of cycles was four in 55 (26.3%) pts, five in 154 (73.7%) including 101 receiving the fifth cycle during IGABT. Median follow-up was 5.5 years. Pts receiving five cycles had a better outcome on all survival endpoints, including three year local control rate (93.9% vs. 77.2%; p < 0.05). In the subgroup, only pts with tumor FIGO (Fédération Internationale de Gynécologie Obstétrique) stage ≤IIB or with CTVHR > 25 cm3 had a better outcome. Pts receiving four cycles with D90CTVHR > 80GyEQD2 had the same locoregional control–(LRC) as those receiving five cycles and achieving D90CTVHR ≤ 80 GyEQD2 (p = 0.75). An optimal propensity score matching the balance for the FIGO stage, CTVHR volume and D90CTVHR confirmed the effect, with the largest life expectancy benefit for locoregional failure-free survival (absolute gain: 1.5 years; p = 0.017). Long-term radiation-induced toxicity was not increased. Increasing the total number of cycles from 4 to 5 improved LFS, suggesting a place for systemic strategies aimed at in-field cooperation. Delivering an additional cycle at the time of brachytherapy did not increase morbidity and there permitted an increase in chemotherapy dose intensity

Le droit du travail peut-il répondre aux défis de l'ubérisation ?

International audience« Ubérisation » : le terme est désormais entré dans la langue courante. Substantivé, le cas particulier des chauffeurs Uber se mue en généralité pour désigner une transformation de l'économie et des formes de mise au travail rendues possibles par l'outil numérique. Face à ces transformations, le droit du travail est sommé de réagir. Il lui faut impérativement repenser ses frontières, adapter ses protections. Les réactions du droit du travail sont déjà en germe. Selon certains, le remède doit être recherché dans la requalification de ces relations en contrat de travail. C'est l'option que suggère notamment l'action en justice de l'URSSAF concernant les chauffeurs Uber. La loi Travail paraît marquer une plus grande défiance à l'égard des solutions du droit du travail par la création (a minima) d'un tiers régime à l'intention des travailleurs des plateformes aux articles. Ces hésitations font surgir une interrogation : le droit du travail peut-il répondre aux défis de l'ubérisation ? S'il est un point d'accord entre Alexandre Fabre, Professeur à l'université d'Artois, et Marie-Cécile Escande-Varniole, Maître de conférences à l'Université Lumière de Lyon, c'est celui de ne pas rabattre la réflexion sur le seul cas des chauffeurs Uber. Pour le premier, une analyse précise des pratiques contractuelles des plateformes fait surgir leur diversité. Toutes ne sont pas réductibles en un seul modèle. Les qualifications du droit du travail ne peuvent toujours faire plier celles des autres branches du droit. Pour la seconde, l'ubérisation présente cette originalité d'être un phénomène global qui met à l'épreuve la plupart des droits nationaux, au-delà de la diversité des histoires nationales de la qualification de travailleur salarié. Aussi une perspective comparée est-elle particulièrement fructueuse pour saisir le dépassement en devenir de la subordination

Neutrophilia as a biomarker for overall survival in newly diagnosed high-grade glioma patients undergoing chemoradiation

Objective: To study the prognostic value of neutrophil disorders in a retrospective cohort of high-grade glioma patients receiving definitive concurrent temozolomide and radiation. Materials and methods: Clinical records of consecutive patients treated in our Institution between January 2005 and December 2010 with concurrent temozolomide (75 mg/m2 daily) and radiation were collected. The prognostic value of pretreatment neutrophilia on survival, defined as a neutrophil count exceeding 7 G/L, was examined. Results: We identified 164 patients, all treated with concurrent temozolomide-based chemoradiotherapy. Initial surgery was achieved in most (75%), with resection > 90% in 55 patients (34%). Total 151 patients (92%) had glioblastoma, and 13 patients (8%) had WHO grade III glioma. Eighty-two patients (50%) displayed pretreatment neutrophilia. Neutrophilia was not associated with concurrent or adjuvant temodal discontinuation (p > 0.3). The 2-year actuarial overall survival was 45%. Steroid consumption, i.e. 60 mg or more of daily prednisolone, increased pretreatment neutrophil count (p = 0.005). In univariate analysis, neutrophilia was associated with worse overall survival (p = 0.019), as well as age ≥ 65 years (p = 0.009), surgical resection < 90% (p = 0.003) and prednisolone consumption ≥ 60 mg/day (p = 0.016). In multivariate analysis, neutrophilia (p = 0.013), age ≥ 65 (p = 0.001), and surgical tumor resection < 90% (p = 0.010) independently decreased overall survival, while, steroid consumption was not (p = 0.088). Conclusion: In high-grade gliomas treated with concurrent temozolomide and radiation, pretreatment neutrophilia may be a significant prognosis factor for overall survival. In addition with previously available markers, this independent cost-effective biomarker could help identifying patients with worsened prognosis. Keywords: High grade gliomas, Glioblastoma, Concurrent chemoradiation, Prognostic factor, Biomarkers, Neutrophili

Impact de l’âge et radiothérapie: points clés chez les AJA

International audienceWhen using radiation therapy for adolescents and young adults (AYA), paediatricians, adults’ oncologists and radiation oncologists need to keep in mind several particularities through the whole therapeutic process. They embrace the indication, target volumes, prescribed dose, treatment techniques and follow-up. Indeed, the young age and the cancer features that characterised this population influence the modalities of irradiation. This article highlights the key points of AYA care with radiation therapy

Diffusion weighted MRI as an early predictor of tumor response to hypofractionated stereotactic boost for prostate cancer

International audienc

Effectiveness of AOPs processes for the removal of emerging contaminants from wastewater: the mepanipyrim case.

International audienc

Total Reference Air Kerma is Associated with Late Bowel Morbidity in Locally Advanced Cervical Cancer Patients Treated with Image-Guided Adaptive Brachytherapy

No dose volume parameter has been identified to predict late bowel toxicities in locally advanced cervical cancer (LACC) patients treated with image-guided adaptive brachytherapy. We examined the incidence of bowel toxicities according to the total reference air kerma (TRAK) in 260 LACC patients. In both univariate and multivariate analysis, late morbidity positively correlated with a TRAK &#8805;2 cGy (centigray) at 1 meter, emphasizing the importance of this parameter in term of late bowel morbidity. Objective: There is no validated dose volume parameter to predict late bowel toxicities in cervical cancer patients treated with image-guided adaptive brachytherapy (IGABT). We examined the incidence of bowel toxicities according to the TRAK, which is proportional to the integral dose to the patients. Material/Methods: Clinical data of 260 LACC patients treated with curative intent from 2004 to 2016 were examined. Patients received chemoradiation plus a pulse-dose rate IGABT boost. The relationship between TRAK and morbidity was assessed by Kaplan-Meier method, log-rank tests, and Cox proportional-hazards model on event-free periods. Results: Median follow-up was 5.2 years (SE (Standard Error): 0.21). Probability of survival without late bowel toxicity Grade &#8805; 2 rate for patients without recurrence (n = 227) at 5 years was 66.4% (SE 3.7). In univariate analysis, bowel and/or sigmoid dose/volume parameters were not significant. Late morbidity positively correlated with active smoking, CTVHR volume &gt;25 cm3, and a TRAK &#8805;2 cGy at 1 meter. In multivariate analysis, the following factors were significant: Active smoking (p &lt; 0.001; HR: 2.6; 95%CI: 1.4&#8315;5.0), and the TRAK (p = 0.02; HR: 2.4; 95%CI: 1.2&#8315;5.0). Conclusion: TRAK was associated with late bowel toxicities probability, suggesting that the integral dose should be considered, even in the era of IGABT