Résultats à long terme de la tomothérapie hélicoïdale chez des patientes atteintes d’un cancer du sein non métastatique : expérience monocentrique

International audienceAbstractPurposeIntensity-modulated radiotherapy with helical Tomotherapy is a novel radiation therapy technique, which may be beneficial in several features compared to traditional methods. Our aim was to evaluate the local control, overall survival, progression free survival and adverse events in breast cancer patients treated with this new technique.Material and methodsThis is retrospective analysis of patients irradiated with intensity-modulated radiotherapy with helical Tomotherapy. Overall survival and progression free survival curves were plotted with Kaplan-Meier method. We also analysed the overall survival and progression-free survival data by molecular subgroups. Long-term toxicity including skin, cardiac and pulmonary complications were also evaluated. Multivariant logistic regression analysis was performed to determine the predictors of the side effects.ResultsBetween 2009–2015, 179 consecutive patients with 194 treated breasts were irradiated with intensity-modulated radiotherapy with helical Tomotherapy. The median follow-up were 65 months. The overall survival rate was 89.2% (95% confidence interval [95CI]: 83.5–95.4%), while disease-free survival rate was 85.4% (95CI: 80.2–91%). The Human epidermal growth factor receptor 2-positive patients had the best 5-year overall survival data of 95% (95CI: 85.9–100%). Long-term skin toxicity was the most common, seen in a total of 20.7% of the patients.ConclusionIntensity-modulated radiotherapy with helical Tomotherapy could be safely used for adjuvant breast cancer irradiation in patients with complex anatomy and provides favourable long-term prognosis with acceptable late toxicity.RésuméObjectif de l’étude La tomothérapie hélicoïdale est une nouvelle technique de radiothérapie avec modulation d’intensité qui peut être bénéfique par rapport aux méthodes traditionnelles. Notre objectif était d’évaluer le contrôle local, la survie globale, la survie sans progression et les événements indésirables chez les patientes atteintes d’un cancer du sein prises en charge par tomothérapie hélicoïdale.Matériel et méthodesIl s’agit d’une analyse rétrospective de patientes prises en charge par tomothérapie hélicoïdale. Les courbes de survie globale et de survie sans maladie ont été tracées avec la méthode de Kaplan-Meier. Nous avons également analysé les données de survie globale et de survie sans maladie par sous-groupes moléculaires. La toxicité à long terme, y compris les complications cutanées, cardiaques et pulmonaires, a également été évaluée. Une analyse de régression logistique multifactorielle a été réalisée pour déterminer les prédicteurs des effets secondaires.RésultatsEntre 2009–2015, 179 patientes consecutives atteintes de 194 cancers du sein ont été prises en charge par tomothérapie hélicoïdale. Le suivi médian était de 65 mois. La probabilité de survie globale était de 89,2 % (intervalle de confiance à 95 % [IC95] : 83,5–95,4 %), celle de survie sans maladie de 85,4 % (IC95 : 80,2–91 %). Les patientes atteintes de cancer Her2 avaient les meilleures données de survie globale à 5 ans de 95 % (IC95 : 85,9–100 %). La toxicité cutanée à long terme était la plus fréquente, observée chez 20,7 % des patientes.ConclusionLa tomothérapie hélicoïdale pourrait être utilisée en toute sécurité pour l’irradiation adjuvante du cancer du sein chez les patientes ayant une anatomie complexe et offre un pronostic favorable à long terme avec une toxicité tardive acceptable

Combined irradiation and targeted therapy or immune checkpoint blockade in brain metastases: toxicities and efficacy

International audienceBackground: Targeted therapies (TT) and immune checkpoint inhibitors (ICI) are currently modifying the landscape of metastatic cancer management and are increasingly used over the course of many cancers treatment. They allow long-term survival with controlled extra-cerebral disease, contributing to the increasing incidence of brain metastases (BMs). Radiation therapy remains the cornerstone of BMs treatment (either whole brain irradiation or stereotactic radiosurgery), and investigating the safety profile of radiation therapy combined with TT or ICI is of high interest. Discontinuing an efficient systemic therapy, when BMs irradiation is considered, might allow systemic disease progression and, on the other hand, the mechanisms of action of these two therapeutic modalities might lead to unexpected toxicities and/or greater efficacy, when combined.Patients and methods: We carried out a systematic literature review focusing on the safety profile and the efficacy of BMs radiation therapy combined with targeted agents or ICI, emphasizing on the role (if any) of the sequence of combination scheme (drug given before, during, and/or after radiation therapy).Results: Whereas no relevant toxicity has been noticed with most of these drugs, the concomitant use of some other drugs with brain irradiation requires caution.Conclusion: Most of available studies appear to advocate for TT or ICI combination with radiation therapy, without altering the clinical safety profiles, allowing the maintenance of systemic treatments when stereotactic radiation therapy is considered. Cognitive functions, health-related quality of life and radiation necrosis risk remain to be assessed. The results of prospective studies are awaited in order to complete and validate the above discussed retrospective data

Early stage primary bone lymphoma - a retrospective, multicenter rare cancer network (rcn) study

Purpose: Primary bone lymphoma (PBL) accounts for less than 1% of all malignant lymphomas, and 4-5% of all extra-nodal lymphomas. In this study, the disease profile, outcome, and prognostic factors were assessed in patients with stage I and II PBL.Patients and Methods: Thirteen Rare Cancer Network (RCN) institutions enrolled 116 consecutive patients with PBL treated between 1987 and 2008 in this study. Inclusion criteria were age > 16 years, stage I and II, minimum 6 months follow-up and a biopsy-proven confirmation of non-Hodgkin's lymphoma (NHL). Eighty-seven patients underwent chemoradiotherapy (CXRT), 15 radiotherapy (RT) without (13) or with (2) surgery, 14 chemotherapy (CXT) without (9) or with (5) surgery. Median RT dose was 40 Gy (range: 4-60). The median number of CXT cycles was 6 (range: 2-8). Median follow-up was 41 months (range: 6-242).Results: The overall response rate at the end of treatment was 91% (CR 74%, PR 17%). Local recurrence or progression was observed in 12 (10%) patients, and systemic recurrence in 17 (15%). Causes of death included disease progression in 21, unrelated in 5, CXT-related toxicity in 1, and second primary cancer in 2 patients. The 5-yr overall survival (OS), lymphoma-specific survival (LSS), and local control (LC) were 76%, 78% and 92%, respectively. In univariate analyses (log-rank test), favorable prognostic factors for OS were age <50 years (P=0.008), international prognostic index (IPI) score ≤1 (P=0.009), high grade histology (P=0.04), CXRT (P=0.05), CXT (P=0,0004), complete response (CR) (P<0.0001), number of CXT cycles ( ≥6 ) (P=0.01), and RT dose > 40 Gy (P=0.005). All above-mentioned parameters were also significant for LSS except for age and number of chemotherapy cycles. For LC, only CR and stage I were favorable factors. In multivariate analysis, IPI score, RT dose, complete response, and chemotherapy were independently influencing the outcome (OS and LSS). Complete response at the end of treatment was the only predicting factor for LC. Six patients developed grade 3 or more toxicities, according to Common Terminology Criteria for Adverse Events (CTCAE) V3.0.Conclusion: This large multicenter study confirms the relatively good prognosis of early stage PBL treated with combined CXRT. Local control was excellent, while systemic failures were rare. An adequate dose of RT (40 Gy or more) and complete CXT regime (≥ 6 cycles) were associated with better outcome