Étude AVARTHEC : complications vasculaires de l’irradiation crânienne pour tumeur cérébrale durant l’enfance et l’adolescence

International audienceIn France, as in other developed countries, primary tumors of central nervous system (CNS) represent the second most frequent neoplasm (after leukemia) and the leading cause of cancer-related deaths in childhood. They account for approximately 25% of incident malignancies in children < 15 years of age at diagnosis. For all CNS tumors combined, the 5-year-overall survival is about 65–70%. The goal of neurosurgery is ideally to complete microsurgical removal of the tumor. In pediatric oncology, combined-treatment strategies using surgery, craniospinal radiation, and chemotherapy could be indicated depending on the stage, the grade and the histology of primitive tumor. The potential combined-treatment-associated morbidity must always be taken into consideration. Few studies have investigated the role of radiotherapy and chemotherapy in the long-term risk of cerebrosvascular disease following childhood cancer treatment. The aim of the AVARTHEC study is to describe clinical and imaging characteristics of cerebrosvascular disease in survival patients after radiation treatment of CNS tumor during childhood or adolescence. The short-term goal will be to have information of neurovascular sequelea following new radiation techniques for CNS tumor. The long-term goal will be to identify high-risk patients to develop cerebrosvascular diseases after CNS radiation and to adapt their long-term follow-up at potential primary and secondary prevention. The AVARTHEC study could help French health-care government policies to elaborate recommendations on new radiation therapy techniques considering potential risk factors of cerebrosvascular morbidity.Les tumeurs du système nerveux central (SNC) représentent la principale cause de morbidité et de mortalité par type de cancer chez les personnes âgées de 0 à 18 ans. Dans cette population, environ 500 tumeurs sont diagnostiquées annuellement et la survie à 5 ans est de l’ordre de 65–70 %. La chirurgie est le traitement de référence, mais une chimiothérapie et/ou radiothérapie (RT) peuvent néanmoins être indiquée selon le stade, le grade et la malignité tumorale. La RT est très efficace pour contrôler les tumeurs cérébrales de l’enfant avec près de 90 % de survie sans récidive à cinq ans dans la plupart des études, mais elle est grevée d’un grand nombre de complications tardives. Peu de données existent concernant les complications cérébrovasculaires engendrées par l’irradiation des tumeurs cérébrales chez l’enfant. L’objectif principal de l’étude AVARTHEC est d’estimer la proportion d’anomalies cérébrovasculaires chez les survivants d’une tumeur cérébrale prise en charge durant l’enfance et traitée par radiothérapie et de décrire leurs caractéristiques cliniques et radiologiques. Il s’agira à court terme d’obtenir des informations sur les effets secondaires des techniques de radiothérapie en incluant les nouvelles modalités d’irradiations. À plus long terme, il serait ainsi possible d’identifier des patients à haut risque de développer des complications cérébrovasculaires après une irradiation du SNC et de mettre en place une surveillance accentuée. Enfin, cette étude pourrait orienter les sociétés savantes dans l’élaboration de recommandations sur les modalités d’irradiation en fonction des facteurs de risque. Cet article présente le protocole de l’étude AVARTHEC

Hypofractionated Stereotactic Radiotherapy for Patients with Intracranial Meningiomas: impact of radiotherapy regimen on local control

Abstract We evaluated efficacy and tolerance of hypofractionated stereotactic radiation treatment (hFSRT) in the management of intracranial meningiomas. Between December 2008 and June 2016, 126 patients with 136 intracranial meningiomas were treated with robotic hFSRT. hFSRT was performed as primary irradiation and as a salvage option for the local recurrence after prior radiotherapy. The median prescription dose was 25 Gy (12–40) with a median number of fractions of 5 (3–10). After a median follow-up of 20.3 months (range 1–77 months), the 24-months local control (LC) rate was 81% in the primary hFSRT group and 39% after hFSRT in the re-irradiation group (p=0.002). The clinical control rate of symptoms in the overall population was 95% (95% CI: 89–98%). Progression-free survival (PFS) in the overall population at 24 months was 70% (95% CI: 60%–79%). In the primary hFSRT group, PFS was significantly lower with the most hypofractionated schedules of 21–23 Gy in 3 fractions vs. 25–40 Gy in 5–10 fractions: 62% vs. 92% (p = 0.0006). The incidence of radionecrosis at 24 months was significantly lower in the primary hFSRT group, at 2% vs. 20% in the re-irradiation hFSRT group (p = 0.002)

Management of the vertebrae as an organ at risk in paediatric radiotherapy clinical trials: Initial QUARTET experience.

Irradiation of the vertebrae in prepubertal patients, if non-homogenous, can result in future growth deformities including kyphoscoliosis. Vertebral delineation and dosimetry were assessed for 101 paediatric cases reviewed within QUARTET-affiliated trials. Despite the availability of published consensus guidelines, a high variability in vertebral delineation was observed, with impact on dosimetry

QUARTET: A SIOP Europe project for quality and excellence in radiotherapy and imaging for children and adolescents with cancer.

The European Society for Paediatric Oncology (SIOPE) Radiation Oncology Working Group presents the QUARTET Project: a centralised quality assurance programme designed to standardise care and improve the quality of radiotherapy and imaging for international clinical trials recruiting children and adolescents with cancer throughout Europe. QUARTET combines the paediatric radiation oncology expertise of SIOPE with the infrastructure and experience of the European Organisation for Research and Treatment of Cancer to deliver radiotherapy quality assurance programmes for large, prospective, international clinical trials. QUARTET-affiliated trials include children and adolescents with brain tumours, neuroblastoma, sarcomas including rhabdomyosarcoma, and renal tumours including Wilms' tumour. With nine prospective clinical trials and two retrospective studies within the active portfolio in March 2022, QUARTET will collect one of the largest repositories of paediatric radiotherapy and imaging data, support the clinical assessment of radiotherapy, and evaluate the role and benefit of radiotherapy quality assurance for this cohort of patients within the context of clinical trials