A Case of RhabdomyoSarcoma Following a Metal Surgical Implant

Patient. We report a 51-year-old male presenting with Grade III rhabdomyosarcoma

Introducing interactive inverse FEM simulation and its application for adaptive radiotherapy

International audienceWe introduce a new methodology for semi-automatic deformable registration of anatomical structures, using interactive inverse simulations. The method relies on non-linear real-time Finite Element Method (FEM) within a constraint-based framework. Given a set of few registered points provided by the user, a real-time optimization adapts the boundary conditions and(/or) some parameters of the FEM in order to obtain the adequate geometrical deformations. To dramatically fasten the process, the method relies on a projection of the model in the space of the optimization variables. In this reduced space, a quadratic programming problem is formulated and solved very quickly. The method is validated with numerical examples for retrieving Young's modulus and some pressures on the boundaries. Then, we apply the approach for the registration of the parotid glands during the radiotherapy of the head and neck cancer. Radiotherapy treatment induces weight loss that modifi es the shape and the positions of these structures and they eventually intersect the target volume. We show how we could adapt the planning to limit the radiation of these glands.Nous introduisons une nouvelle méthode de recalage déformable semi-automatique de structures anatomiques, à l'aide de simulations inverses interactives. La méthode est basée sur la méthode des éléments finis(FEM) et revient à résoudre un système de contraintes. Etant donné un ensemble de quelques points fournies par l'utilisateur, une optimisation en temps réel adapte les conditions aux limites et(/ou) des paramètres de la FEM dans le but d'obtenir les déformations géométriques adéquates. Pour accélérer les calculs de manière conséquente, la méthode repose sur une projection du modèle dans l'espace des variables d'optimisation. Dans cet espace réduit, un problème de programmation quadratique est formulé et résolu très rapidement. La méthode est validée par des exemples numériques (récupérer le module de Young et des pressions à appliquer sur le modèle). Ensuite, nous appliquons l'approche pour le recalage des glandes parotides pendant la radiothérapie de la tête et du cou. Un traitement de radiothérapie induit généralement une perte de poids chez le patient qui modifie la forme et la position de ces structures. Structures qui finissent par entrer dans le volume cible. Nous montrons comment nous pourrions adapter la planification afin de limiter le rayonnement de ces glandes

Stereotactic Re-irradiation for Local Recurrence in the Prostatic Bed After Prostatectomy: Preliminary Results

Objectives: To report the preliminary results of salvage re-irradiation in the prostatic bed after radical prostatectomy and salvage external beam radiation therapy (EBRT) using robotic stereotactic body radiation therapy (SBRT) with Cyberknife® for local recurrence of prostate cancer.Materials and Methods: Retrospective monocentric analysis was performed on patients treated with SBRT for isolated macroscopic recurrence in the prostatic bed. All patients had radical prostatectomy and salvage or adjuvant EBRT. Local recurrence was documented using magnetic resonance imaging (MRI) and positron emission tomography (PET). Biochemical recurrence was defined as 2 rises in prostate-specific antigen (PSA) of ≥ 0.2 ng/mL above nadir. Internal gold fiducials were used for the tracking of tumor motion during SBRT. The prescription dose was 36 Gy in 6 fractions for all patients. Toxicity was scored according to the CTCAE v4.0.Results: Between July 2011 and November 2017, 12 patients were treated with SBRT for prostatic bed recurrence with a median follow-up of 34.2 (range, 3.5–64.4) months. Isolated non-metastatic recurrence in the prostatic bed was seen at MRI and PET imaging. Two patients were treated with 6 months androgen deprivation therapy (ADT) concomitant with re-irradiation. The median planning target volume was 4.5 cm3 (range, 1.2–13.3). A PSA decrease after SBRT was found in 10 (83%) patients. The 1 and 2 years biochemical recurrence-free survival rates were 79 and 56%, respectively. Biochemical recurrence was observed for 6 patients (50%) after a median time of 18 (4-42) months. Toxicity showed: 3 patients (25%) with grade 1 cystitis and 1 patient (8%) with acute grade 2 proctitis at 4 months. One patient (13%) had grade 1 cystitis at 12 months.Conclusion: Re-irradiation for local recurrence in the prostatic bed using Cyberknife® after surgery and salvage or adjuvant EBRT is well-tolerated and associated with 2 years biochemical recurrence-free survival rates of 56%. Longer follow-up and larger series are necessary

IMRT in the treatment of locally advanced or inoperable NSCLC in the pre-durvalumab era: clinical outcomes and pattern of relapses, experience from the Oscar Lambret Center

BackgroundIntensity-modulated conformal radiotherapy (IMRT) has become the technique of choice for the treatment of locally advanced or inoperable non-small cell lung cancer (NSCLC). Nevertheless, this technique presents dosimetric uncertainties, particularly in treating moving targets such as pulmonary neoplasms. Moreover, it theoretically increases the risk of isolated nodal failure (INF) due to reduced incidental irradiation.ObjectiveThe objective of this study was to evaluate the efficacy and safety of IMRT in patients with inoperable NSCLC and to describe the pattern of relapses.MethodsPatients with locally advanced NSCLC treated with radiotherapy and chemotherapy between 2015 and 2018 at the Oscar Lambret Center were retrospectively included in the study. Overall and progression-free survival were estimated using the Kaplan–Meier method. The cumulative incidence of the different components of relapse was estimated using the Kalbfleisch and Prentice method. Prognostic factors for relapse/death were investigated using the Cox model. A comparison with literature data was performed using a one-sample log-rank test.ResultsSeventy patients were included, and 65 patients (93%) had stage III disease. All the patients received chemotherapy, most frequently with cisplatin and navelbine. The dose received was 66 Gy administered in 33 fractions. The median follow-up and survival were 49.1 and 39.1 months, respectively. A total of 35 deaths and 43 relapses, including 29 with metastatic components, were reported. The overall survival rates at 1 and 2 years were 80.2% (95% confidence interval 68.3%-88.0%) and 67.2% (95% confidence interval 54.2%-77.3%), respectively. Locoregional relapse was observed in 14 patients, including two INF, one of which was located in the lymph node area adjacent to the clinical target volume. Median relapse-free survival was 15.2 months. No variable was statistically associated with the risk of relapse/death in multivariate analysis. Seven patients (10%) experienced grade 3 or higher toxicity.ConclusionThe use of IMRT for locally advanced or inoperable NSCLC led to favorable long-term clinical outcomes. The rate of locoregional relapse, particularly isolated lymph node failure, was low and comparable with that of the three-dimensional radiotherapy series, as was the rate of early and late toxicities

Robotic image-guided reirradiation of lateral pelvic recurrences: preliminary results

<p>Abstract</p> <p>Background</p> <p>The first-line treatment of a pelvic recurrence in a previously irradiated area is surgery. Unfortunately, few patients are deemed operable, often due to the location of the recurrence, usually too close to the iliac vessels, or the associated surgical morbidity. The objective of this study is to test the viability of robotic image-guided radiotherapy as an alternative treatment in inoperable cases.</p> <p>Methods</p> <p>Sixteen patients previously treated with radiotherapy were reirradiated with CyberKnife^®for lateral pelvic lesions. Recurrences of primary rectal cancer (4 patients), anal canal (6), uterine cervix cancer (4), endometrial cancer (1), and bladder carcinoma (1) were treated. The median dose of the previous treatment was 45 Gy (EqD2 range: 20 to 96 Gy). A total dose of 36 Gy in six fractions was delivered with the CyberKnife over three weeks. The responses were evaluated according to RECIST criteria.</p> <p>Results</p> <p>Median follow-up was 10.6 months (1.9 to 20.5 months). The actuarial local control rate was 51.4% at one year. Median disease-free survival was 8.3 months after CyberKnife treatment. The actuarial one-year survival rate was 46%. Acute tolerance was limited to digestive grade 1 and 2 toxicities.</p> <p>Conclusions</p> <p>Robotic stereotactic radiotherapy can offer a short and well-tolerated treatment for lateral pelvic recurrences in previously irradiated areas in patients otherwise not treatable. Efficacy and toxicity need to be evaluated over the long term, but initial results are encouraging.</p

Proposition d’une approche multidisciplinaire pour la maintenance prédictive des chaussées

La dégradation d’une chaussée a pour origine de multiples facteurs tels que le trafic, les conditions climatiques et ses caractéristiques structurelles. Pour maintenir la qualité des infrastructures routières et prolonger leurs durées de vie tout en réduisant les coûts de maintenance, il devient essentiel de prédire et d'anticiper ces dégradations. Dans cette optique, l’utilisation de la maintenance prédictive, basée sur des moyens de surveillance in-situ, d'analyse statistique et d'intelligence artificielle, est donc nécessaire. Cependant, sa mise en œuvre fait face à de nombreux défis tels que la gestion de grandes quantités de données collectées par diverses sources mais aussi la modélisation dans un environnement incertain. Dans ce contexte, pour améliorer la surveillance des infrastructures routières, cette étude combine trois disciplines scientifiques pour démontrer la faisabilité d’un jumeau numérique d'une section de chaussée. La méthodologie proposée s’appuie sur l'optimisation des moyens d'instrumentation des routes, à l'aide de capteurs sans fil, pour alimenter des modèles mécaniques et issus des données destinés à prédire l'endommagement de la chaussée et ainsi anticiper son état de santé. Cette approche pluridisciplinaire est mise en œuvre sur un cas d'étude : une section d’autoroute instrumentée dans la région de Bordeaux en France.The pavement deterioration can be caused by multiple factors such as traffic, weather conditions and structural characteristics. To maintain the quality of roads and extend their life while reducing maintenance costs, it is essential to predict and anticipate deterioration. The use of predictive maintenance, based on in-situ monitoring, statistical analysis and artificial intelligence, is therefore necessary. Nevertheless, its implementation must deal with several challenges such as managing large amounts of data collected from different sources or modelling in an uncertain environment. In this context, to improve road infrastructure monitoring, this study combines three scientific fields to demonstrate the feasibility of a digital twin of a pavement section. The proposed methodology is based on the optimization of road instrumentation tools, using wireless sensors, to feed mechanical and data-driven models to predict pavement damage and thus anticipate its health. This multidisciplinary approach is implemented on a case study: an instrumented highway section in the Bordeaux region in France

Apprendre en faisant - Présentation d'une démarche pédagogique dans l'enseignement supérieur intégrant un projet pluri-technologique trisannuel

ESTIA, école d'ingénieurs généralistes, a récemment ouvert une formation Bachelor de Technologies. Les modules d'enseignement ont été définis autour d'un Projet Fil Rouge (PFR), projet pluritechnologique trisannuel, s'inscrivant dans la mouvance actuelle de l'apprentissage par projet. Dans ce contexte, le principal défi concerne la démarche pédagogique à mettre en oeuvre pour assurer l'application de connaissances théoriques au travers du PFR. Un sujet de PFR est proposé à chaque promotion entrante. Sur trois années, les étudiants appliquent les connaissances théoriques sur les différentes étapes de conception et de réalisation d'un système pluri-technologique, de la conception préliminaire à la démonstration de fonctionnement. Cette communication détaillera le modus operandi, en s'attachant à illustrer les particularités de la démarche employée. Citons, par exemple, la démonstration finale du système par les étudiants devant un jury composé d'industriels, ou encore l'usage obligatoire des langues étrangères dans le suivi du projet en deuxième année de cycle. Cette démarche a été expérimentée par une première promotion, qui a travaillé sur la conception et la réalisation d'un système de livraison autonome du courrier. Les résultats obtenus, tant sur la réalisation que sur l'intégration des premiers diplômés Bachelor en Cycle Ingénieur sont prometteurs, et les perspectives d'évolution nombreuses

Efficacy and Tolerance of Post-operative Hypo-Fractionated Stereotactic Radiotherapy in a Large Series of Patients With Brain Metastases

Purpose: The aim of this study was to assess, in a large series, the efficacy and tolerance of post-operative adjuvant hypofractionated stereotactic radiation therapy (HFSRT) for brain metastases (BMs).Materials and Methods: Between July 2012 and January 2017, 160 patients from 2 centers were operated for BM and treated by HFSRT. Patients had between 1 and 3 BMs, no brainstem lesions or carcinomatous meningitis. The primary endpoint was local control. Secondary endpoints were distant brain control, overall survival (OS) and tolerance to HFSRT.Results: 73 patients (46%) presented with non-small cell lung cancer (NSCLC), 23 (14%) had melanoma and 21 (13%) breast cancer. Median age was 58 years (range, 22–83 years). BMs were synchronous in 50% of the cases. The most frequent prescription regimens were 24 Gy in 3 fractions (n = 52, 33%) and 30 Gy in 5 fractions (n = 37, 23%). Local control rates at 1 and 2 years were 88% [95%CI, 81–93%] and 81% [95%CI, 70–88%], respectively. Distant control rate at 1 year was 48% [95%CI, 81–93%]. In multivariate analysis, primary NSCLC was associated with a significant reduction in the risk of death compared to other primary sites (HR = 0.57, p = 0.007), the number of extra-cerebral metastatic sites (HR = 1.26, p = 0.003) and planning target volumes (HR = 1.15, p = 0.012) were associated with a lower OS. There was no prognostic factor of time to local progression. Median OS was 15.2 months [95%CI, 12.0–17.9 months] and the OS rate at 1 year was 58% [95% CI, 50–65%]. Salvage radiotherapy was administered to 72 patients (45%), of which 49 received new HFSRT. Ten (7%) patients presented late grade 2 and 4 (3%) patients late grade 3 toxicities. Thirteen (8.9%) patients developed radiation necrosis.Conclusions: This large multicenter retrospective study shows that HFSRT allows for good local control of metastasectomy tumor beds and that this technique is well-tolerated by patients