3D radiation therapy boost improves the outcome of whole brain radiation therapy treated RPA II patients with one or two brain metastases

PURPOSE: to evaluate the role of whole brain radiotherapy (WBRT) and radiation boost (RB) for 208 patients recursive partitioning analysis (RPA) II with 1 or 2 brain metastases (BM) at a single institution. METHODS AND MATERIALS: the dose of WBRT was 30 Gy (10 fractions of 3 Gy). One hundred thirty-two patients (63.5%) benefited from RB of 9 Gy in 3 fractions of 3 Gy at the metastatic site. Patients had 1 or 2 BM in 122 (58.7%) and 86 cases (41.3%), respectively. RESULTS: patients with one or two metastases had similar survival (4.6 and 5.1 months, respectively) (p = 0.4). Median overall survival (OS) for patients treated with WBRT and RB, and with WBRT alone was 5.9 and 3.7 months, respectively (p = 0.03). The 6-, 12- and 24-month OS rates after WBRT and RB were 48.5%, 25% and 10.6%, respectively, while WBRT alone resulted in OS rates of 34%, 22.4% and 3.2%, respectively (p = 0.03). After WBRT and RB, the 6-, 12- and 24-month local control rates were 92%, 82% and 67%, respectively, while they were 81.2%, 75% and 37.5%, respectively, after WBRT alone (p = 0.03). The 6-, 12- and 24-month brain control rates after WBRT and RB were 88.7%, 75.8% and 62%, respectively, and after WBRT alone they were 78.5%, 59% and 37.7%, respectively (p = 0.03). CONCLUSION: additional boost delivered with 3D conformal radiotherapy improves local and brain control rates significantly as well as overall survival for RPA II patients with 1 or 2 unresectable BM

Brain metastasis and renal cell carcinoma : prognostic scores assessment in the era of targeted therapies

Aim: This study aimed at exploring several brain metastatic prognostic scores in patients with renal cell carcinoma. Patients and Methods: We retrospectively analyzed data of 93 metastatic renal cell carcinoma patients who were diagnosed with brain metastases between October 2005 and July 2016 who received targeted therapy. Potential prognostic factors (RTOG RPA, BS-BM, and a newly developed score CERENAL) were analyzed. Results: A total of 75 patients received targeted therapy. All scores showed prognostic value in progression-free survival after first-line treatment with CERENAL being the sole independent prognostic factor associated with improved duration of first-line treatment. Both RTOG RPA and CERENAL were potential prognosticators for overall survival, whereas only the CERENAL score was associated with prolonged disease-specific survival. Conclusion: Several prognostic scores can be useful to predict survival of patients with brain metastases from renal cancer, especially the newly developed CERENAL score

Outcomes in newly diagnosed elderly glioblastoma patients after concomitant temozolomide administration and hypofractionated radiotherapy

This study aimed to analyze the treatment and outcomes of older glioblastoma patients. Forty-four patients older than 70 years of age were referred to the Paul Strauss Center for chemotherapy and radiotherapy. The median age was 75.5 years old (range: 70-84), and the patients included 18 females and 26 males. The median Karnofsky index (KI) was 70%. The Charlson indices varied from 4 to 6. All of the patients underwent surgery. O6-methylguanine-DNA methyltransferase (MGMT) methylation status was determined in 25 patients. All of the patients received radiation therapy. Thirty-eight patients adhered to a hypofractionated radiation therapy schedule and six patients to a normofractionated schedule. Neoadjuvant, concomitant and adjuvant chemotherapy regimens were administered to 12, 35 and 20 patients, respectively. At the time of this analysis, 41 patients had died. The median time to relapse was 6.7 months. Twenty-nine patients relapsed, and 10 patients received chemotherapy upon relapse. The median overall survival (OS) was 7.2 months and the one- and two-year OS rates were 32% and 12%, respectively. In a multivariate analysis, only the Karnofsky index was a prognostic factor. Hypofractionated radiotherapy and chemotherapy with temozolomide are feasible and acceptably tolerated in older patients. However, relevant prognostic factors are needed to optimize treatment proposals

Radiochimiothérapie exclusive du cancer de l'oesophage (une étude rétrospective multicentrique portant sur 143 patients)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Design-oriented simulation tools in french SFR projects

International audienceDuring the last decade, France has carried out new emerging Sodium Fast Reactor Projects among which the advanced ASTRID project. Within this context, a significant work on Sodium Fast Reactor design has been achieved. The CEA's methodology considers the safety requirements regarding severe accidents at the earliest stage of the undergoing reactor design process. At this point, the use of mechanistic tools (like SAS4A, SIMMER codes) encompassing the whole knowledge of the severe accident phenomenology (making them capable of simulating any accidental sequence) requires an advanced knowledge of the reactor design. Also, the associated calculation costs are too high to provide rapid feedbacks that the early design process demands. This motivated the development of fast-running design-oriented physical tools, devoted to unprotected accidental sequence from various initiators, and mostly based on low-dimensional modeling (mostly 0D and 1D). Allowing a large number of simulations in a reasonable computational time, they enable uncertainty propagation studies and sensitivity analyses.This approach is highly consistent with the current trend to take into account uncertainties (on input data or models) in safety studies, especially in the domain of severe accidents where many uncertainty sources remain. Various design options may be tested and their influence on the margins from the safety requirements may be rapidly characterized. Sensitivity analyses lead to highlight cliff edge effects which feature some major accident transient bifurcations which are of interest for safety. These design-oriented fast-running simulation tools are the object of this paper. Their specificities, since each of them is dedicated to a particular accidental sequence, and main associated models are described. Their development is part of a quality process involving verification and validation steps to ensure the consistency of their results with the reality. Their validation studies on separated and integral tests versus experimental results or numerical results from mechanistic codes are summarized. Finally, illustrations of studies performed with these tools to challenge and to improve the design of the reactor cores in other versions from ASTRID are presented

“CinNapht” Dyes as New Cinnoline/Naphthalimide Fused Hybrids Fluorophores: Synthesis, Photo-Physical Study and Use for Bio-Imaging

Six-membered diaza ring of Cinnoline have been fused on Naphthalimide dye to give donor–acceptor system called CinNapht. These red shifted fluorophore, that can be synthetised in gram scale, exhibits a large Stoke Shift and quantum yield up to 0.33. It is also caracterized by strong solvatochromic effect for green to red emission as well and can be used for bio-imagin

Biocompatible and Photostable Photoacoustic Contrast Agents as Nanoparticles Based on Bodipy Scaffold and Polylactide Polymers: Synthesis, Formulation, and In Vivo Evaluation

International audienceWe have designed a new Bodipy scaffold for efficient in vivo photoacoustic (PA) imaging of nanoparticles commonly used as drug nanovectors. The new dye has an optimized absorption band in the near-infrared window in biological tissue and a low fluorescence quantum yield that leads to a good photoacoustic generation efficiency. After Bodipy-initiated ring opening polymerization of lactide, the polylactide-Bodipy was formulated into PEGylated nanoparticles (NPs) by mixing with PLA-PEG at different concentrations. Formulated NPs around 100 nm exhibit excellent PA properties: absorption band at 760 nm and molar absorption coefficient in between molecular PA absorbers and gold NPs. Highly improved photostability-compared to cyanine-labelled PLA NPs as well as innocuity in cultured macrophages were demonstrated. After intravenous injection in healthy animals, NPs were easily detected using a commercial PA imaging system and spectral unmixing, opening the way to their use as theranostic agents