Abscopal effect in a patient with malignant pleural mesothelioma treated with palliative radiotherapy and pembrolizumab.

The abscopal effect describes the ability of locally administered radiotherapy to induce systemic antitumor effects. Although mentioned for the first time in the 1950s, records of abscopal effects, considered to be immune-mediated, are scarce with radiotherapy alone. However, with the continued development and use of immunotherapy, reports on the abscopal effect have become increasingly frequent during the last decade. Here, we report a patient with advanced malignant pleural mesothelioma who had progressive disease while on the anti-PDL1 inhibitor pembrolizumab and showed an abscopal response after palliative radiotherapy

Fractionated Stereotactic Radiation Therapy for Pituitary Adenomas: An alternative escalating protocol of hypofractionated stereotactic radiotherapy delivering 35Gy in 5 fractions

PURPOSE: Evaluate efficacy and toxicity of hypofractionated stereotactic radiotherapy (HSRT) for patients treated for pituitary adenoma (PA) with an alternative HSRT escalating protocol delivering 35Gy in 5 fractions. MATERIAL AND METHODS: From June 2007 to March 2017, 29 patients with pituitary adenoma were treated in Antoine Lacassagne Cancer Centre with an alternative HSRT protocol. Prescribed dose was 35Gy in 5 fractions of 7Gy. Radiographic responses were assessed by annual MRI. Hormone blood samples were evaluated each year after HSRT. RESULTS: A total of 29 patients aged between 23 and 86 years (median 54 years) were included. Twelve patients received HSRT for recurrent cases and 12 received postoperative adjuvant HSRT, 5 patients did not have surgery. After a median follow-up period of 47 months local control rate was 96%. One patient presented an out-field tumor regrowth 73 months after HSRT. The majority of PA were endocrine-active (18 patients, 62%). After HSRT, 8 patients (44%) presented complete response on initial secretion, 4 patients (23%) presented partial response on initial secretion. Four patients (14%) presented grade 2 or more acute radiation toxicities. One grade 4 visual disorder was observed for one patient. CONCLUSIONS: HSRT delivering 35Gy in 5 fractions represents a feasible treatment and shows promising results to reduce hormonal overproduction and to improve local control in PA

Re-irradiation of recurrent vertebral metastasis after two previous spinal cord irradiation: A case report

BackgroundManagement of a recurrent vertebral metastasis in a situation of previously irradiated spinal cord is a challenging clinical dilemma.Case presentationWe report a first case of second retreatment of a spinal metastasis initially irradiated with standard radiotherapy and stereotactic body radiation therapy (SBRT), who subsequently progressed with imaging-confirmed local tumor progression at the same level. After a third course of irradiation with SBRT, a complete response was achieved. After 8 months of follow-up, the patients remain free of local recurrence.ConclusionA third course of vertebral irradiation for a recurrent vertebral metastasis failing to two previous irradiations, in this particular case, have shown the feasibility and efficacy of the technique as a salvage treatment option. This approach could be used in a selected group of patient if an adequate dose is delivered to the target while observing critical tissue tolerance limits

Superior outcomes of nodal metastases compared to visceral sites in oligometastatic colorectal cancer treated with stereotactic ablative radiotherapy

Background: Stereotactic ablative radiotherapy (SBRT) is a radical option for oligometastatic colorectal cancer (CRC) patients, but most data relate to visceral metastases. Methods: A prospective, multi-centre database of CRC patients treated with SBRT was interrogated. Inclusion criteria were ECOG PS 0–2, ≤3 sites of disease, a disease free interval of >6 months unless synchronous liver metastases. Primary endpoints were local control (LC), progression free survival (PFS) and overall survival (OS). Results: 163 patients (172 metastases) were analysed. The median FU was 16 months (IQR 12.2–22.85). The LC at 1 year was 83.8% (CI 76.4%−91.9%) with a PFS of 55% (CI 47%−64.7%) respectively. LC at 1 year was 90% (CI 83%−99%) for nodal metastases (NM), 75% (63%−90%) for visceral metastases (VM). NM had improved median PFS (9 vs 19 months) [HR 0.6, CI 0.38–0.94, p = 0.032] and median OS (32 months vs not reached) [HR 0.28, CI 0.18–0.7, p = 0.0062] than VM, regardless of whether the NM were located inside or outside the pelvis. On multivariate analysis, NM and ECOG PS 0 were significant good prognostic factors. An exploratory analysis suggests KRAS WT is also a good prognostic factor. Conclusion: Nodal site is an important prognostic determinant of SBRT that should incorporated into patient selection. We hypothesise this may have an immunoediting basis

Radiosensibilité des oligométastases pulmonaires issues d'un primitif colorectal traitées par irradiation stéréotaxique

Introduction : <br> Les patients atteints de cancers colorectaux métastatiques peuvent présenter des oligométastases pulmonaires pour lesquelles une irradiation par radiothérapie stéréotaxique peut être proposée. L’objectif de l’étude est de rapporter l’efficacité et les facteurs pronostiques de survie dans cette situation.<br> Matériels et méthodes : <br>Il s’agit d’une étude rétrospective qui a inclus des patients présentant des oligométastases pulmonaires de primitif colorectal irradiés par radiothérapie stéréotaxique entre septembre 2007 et Novembre 2014.<br>Résultats : <br>Nous avons identifié 53 patients oligométastatiques qui ont été traitées pour 87 lésions métastatiques pulmonaires. La dose médiane de prescription était de 60 Gy en 3 fractions (médiane de dose biologique efficace de 180 Gy). Le suivi médian était de 33,0 mois. Le contrôle local, le taux de survie sans rechute métastatique et le taux de survie globale à 1 et 2 ans étaient respectivement de 79,8% et 78,2%, 29,2% et 16,2%, et 83,8% et 69,3%. En analyse multivariée, le site primitif rectal (p = 0,001) et un nombre de métastases supérieur à 2 (p = 0,02) étaient significativement associés à un taux de contrôle local diminué. Les lésions rectales étaient associées à une dose d’irradiation plus élevée (169,3 Gy vs 153,3 Gy, p = 0,01) et un taux de mutation KRAS plus élevé (73,3% versus 40,4%, p = 0,002). Le statut mutationnel KRAS n’était pas corrélé au contrôle local, mais corrélé à une diminution de la survie sans métastases à 1 an (0% vs 37,5% ; p = 0,04), comparé aux patients KRAS sauvages. En analyse multivariée, un volume tumoral macroscopique irradié ≥ 3266mm3 (p = 0,03) et un nombre de métastases >2 (p = 0,04) étaient corrélés à une moins bonne survie globale.<br>Conclusion : <br>Dans le CRC, les oligométastases pulmonaires irradiées par radiothérapie stéréotaxique ont présenté de moins bons résultats chez les patients ayant un primitif rectal, > 2 métastases, ou avec un plus important volume tumoral macroscopique irradié. Un traitement plus agressif pourrait être discuté chez cette sous-population