La radiothérapie par modulation d'intensité de la région para-aortique peut-elle résoudre les problèmes que pose l'épargne des organes à risque ?

peer reviewedBACKGROUND AND PURPOSE: The recent RTOG guidelines for future clinical developments in gynecologic malignancies included the investigation of dose escalation in the paraaortic (PO) region which is, however, very difficult to target due to the presence of critical organs such as kidneys, liver, spinal cord, and digestive structures. The aim of this study was to investigate intensity-modulated radiotherapy's (IMRT) possibilites of either increasing, in a safe way, the dose to 50-60 Gy in case of macroscopic disease or decreasing the dose to organs at risk (OR) when treatment is given in an adjuvant setting. MATERIAL AND METHODS: The dosimetric charts of 14 patients irradiated to the PO region at the Department of Radiation Oncology, University Hospital of Liege, Belgium, in 2000 were analyzed in order to compare six-field conformal external-beam radiotherapy (CEBR) and five-beam IMRT approaches. Both CEBR and IMRT investigations were planned to theoretically deliver 60 Gy to the PO region in the safest way possible. Dose-volume histograms (DVHs) were calculated for clinical target volume (CTV), planning target volume (PTV), and OR. Student's t-test was used to compare the paired DVH data issued from CEBR and IMRT planning. RESULTS: The IMRT approach allowed to cover the PTV at a higher level as compared to CEBR. Using IMRT, the maximal dose to the spinal cord was reduced from 42.5 Gy to 26.2 Gy in comparison with CEBR (p or= 20 Gy in the IMRT approach (p < 0.00001). Irradiation of digestive structures was not different, with < 25% receiving 35 Gy. Doses to the liver remained low regardless of the method used. CONCLUSION: At 60 Gy, IMRT is largely sparing the spinal cord and kidneys as compared to CEBR and represents an interesting approach not only for dose escalation up to 50-60 Gy (probably facilitating the radiochemotherapy approaches) but also in an adjuvant setting at lower doses. The dosimetric data of this study are in the same range as those published recently with a dynamic arc conformal approach

2022-RA-193-ESGO Cost-effectiveness of molecular profiling for endometrial neoplasia: a single institution experience

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Testing of membrane module for ultrafiltration

<div><p>ABSTRACT</p><p><b>Background.</b> To evaluate efficacy and toxicity of radio-chemotherapy (RCT) and MR-guided pulsed-dose-rate (PDR) adaptive brachytherapy (IGABT) for locally advanced cervical cancer (LACC).</p><p><b>Material and methods.</b> Between 2007 and 2014 85 patients with FIGO stage 1B1 N+ or ≥ 1B2 cervical cancer were treated with RCT+ IGABT. The treatment consisted of a pelvic± paraaortic external beam radiotherapy (EBRT) (45–50.4 Gy ± 10 Gy boost to primary tumor and/or to pathologic lymph nodes) with concurrent cisplatin followed by 25–35 Gy of PDR IGABT in 30–50 pulses. The ratio of 3D-CFRT/IMRT was 61/24 patients. Dose-volume parameters of high-risk clinical target volume (HR-CTV), intermediate-risk clinical target volume (IR-CTV) and D2cm³ organs at risk (OARs) were reported. Local control (LC), cancer-specific survival (CCS) and overall survival (OS) were analyzed actuarially and morbidity crude rates were scored using CTCAEv4.0.</p><p><b>Results.</b> Mean follow-up was 36 months (range 6–94). The mean D90 and D98 for HR-CTV was 84.4 ± 9 Gy and 77 ± 8.1 Gy, while for IR-CTV was 69.1 ± 4.3 Gy and 64.8 ± 4.3 Gy, respectively. The mean D2cm³ for OARs was the following: bladder: 77.3 ± 10.5 Gy, rectum: 65 ± 6.8 Gy, sigmoid: 63 ± 7.9 Gy and intestine: 64.0 ± 9.1 Gy. Three year LC, CSS and OS were: 94%, 85% and 81%. The three-year regional- and distant control rates were 95% and 74%. Node negative patients had significantly higher three-year CSS (100 vs. 72%, p = 0.016) and OS (92 vs. 72%, p = 0.001) compared to node positive ones. Three-year actuarial late Grade ≥ 3 morbidity was the following: GI: 8%, GU: 5%, Vaginal: 8%. The frequency of Grade ≥ 3 hematological toxicities including anemia/leukopenia/neutropenia/thrombocytopenia were 8.6%/34.7%/24.3%/24.3%, respectively.</p><p><b>Conclusion.</b> This large mono-institutional experience builds up further evidences that IGABT in conjunction with RCT should be the standard of care for patients suffering LACC.</p></div

INDICATIONS D’UN TRAITEMENT DE RADIOTHERAPIE LOCALE APRES PROSTATECTOMIE RADICALE

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LA CURIETHÉRAPIE PROSTATIQUE PAR IMPLANTS PERMANENTS D'IODE 125- résultats après 10 ans d'expérience au CHU de Liège

peer reviewedLa curiethérapie prostatique, par implantation per - manente de grains radioactifs d’iode 125, offre aux patients atteints d’un cancer localisé de la prostate une alternative attractive au traitement chirurgical. La survie globale et la survie sans récidive biochimique y sont superposables, mais le profil de toxicité est différent. La plus grande opportunité de préservation de la fonction érectile, la diminution du risque d’incontinence et l’hospitalisation de jour peuvent être inté - ressantes pour le patient optant pour la curiethérapie. Par contre, la présence d’un syndrome obstructif urinaire de départ devrait orienter préférentiellement vers un traitement chirurgical. Un patient doit pouvoir faire un choix éclairé entre ces différentes possibilités thérapeutiques moyennant une information transparente et complète. Dans cet exposé, nous relatons notre expérience en curiethérapie par implants permanents d’iode 125. La survie globale, la survie libre sans récidive biochimique à long terme et la toxicité enregistrée sont similaires à celles décrites dans la littérature

Radiotherapy and urogenital Paget disease

peer reviewedUne maladie de Paget urogénitale est habituellement traitée par chirurgie. Cependant, dans certains cas, que ce soit dans le contexte d’une récidive ou à l’évocation d’une chirurgie mutilante, la radiothérapie peut être une alternative. Nous relatons le cas d’une patiente traitée avec succès par radiothérapie

Management of metastatic hormone-naive prostate cancer at diagnosis

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Which alpha/beta ratio and half-time of repair are useful for predicting outcomes in prostate cancer?

To calculate the ?/? of prostate adenocarcinoma.From January 1997 to December 2005, 328 patients were treated consecutively with external beam radiotherapy and brachytherapy boost. The patients with at least one of the following adverse prognostic factors were included: PSA&gt;10 ng/ml, Gleason score ?7, T?2B. A total EQD2 of 80 Gy was delivered uniformly within the same timeframe. Prior to August 2002, the patients were treated to low-dose-rate brachytherapy using (192)Ir (n=201), and those treated thereafter received a high-dose-rate brachytherapy boost (n=127). The equivalency of dose was established using the incomplete repair model, with generally accepted ?/? ratio of 3 Gy, and half-time for repair of sublethal damage (HTR) of 1.5h.In a Cox proportional hazards model, the two groups displayed no difference (HR: 0.99, 95% CI: 0.87-1.1, p=0.98) in biochemical control. Analyzing using the linear quadratic model, the data fit well an ?/? ratio of 3.41 Gy (95% CI: 2.56-4.26) and the recently published HTR of 1.9 h (95% CI: 1.4-2.4), but also an ?/? of 5.87 Gy (95% CI: 4.67-7.07) and the more widely established HTR of 1.5 h.Unlike the previously published data, calculation of the ?/? ratio from consecutive patients and using a uniform treatment duration points to higher values than 2.5 Gy

Optimal treatment in locally advanced cervical cancer.

INTRODUCTION: Locally advanced cervical cancer (LACC) (International Federation of Gynecology and Obstetrics (FIGO) 2009/2018 - stages IB2-IVA/IB3-IVA, respectively) is treated using a multimodal approach that includes chemoradiotherapy followed by brachytherapy. AREAS COVERED: This review provides an overview of the progress made over the past decade in the treatment of LACC. Prognostic factors, FIGO classification and the role of imaging staging will be discussed. Efficacy of external-beam radiotherapy, brachytherapy and chemotherapy will be detailed. Indications for paraaortic staging lymphadenectomy and adjuvant hysterectomy, as well as follow-up and special population, will be covered. EXPERT OPINION: The initial workup is one of the most crucial steps in the optimal care of patients, which should be realized by a multi-disciplinary expert team. With the implementation of modern conformal radiotherapy techniques, the local control rate has been optimized. Nevertheless, 40% of patients experience recurrence with distant metastasis and a dismal prognosis. Currently, a clear benefit of neo- and adjuvant chemotherapy has not been established. The future likely involves (1) improved selection of patients for whom treatment intensification is justified, (2) a combination of new drugs with chemoradiation that are currently being tested in trials, and (3) the development of tailored treatment based on molecular characteristics