RADIOTHÉRAPIE MAMMAIRE- pret-à-porter ou sur mesure ?

peer reviewedLa radiothérapie mammaire après chirurgie conser - vatrice, pour carcinome canalaire in situ ou pour les formes invasives (carcinome canalaire infiltrant et carcinome lobu - laire infiltrant), semble très bien codifiée et peut être taxée de «prêt-à-porter». Et pourtant, on est en droit de se poser la question s’il est possible de concevoir des indications de traitement «sur mesure». A ce jour, les données de la littéra - ture nous incitent à la prudence. Dans aucun cas de figure, on n’a été capable de démontrer que la radiothérapie pouvait être éliminée de l’approche thérapeutique sans pour autant risquer une augmentation significative du taux de rechute locale. Même si on considère que la radiothérapie adjuvante est une approche standard après une chirurgie conservatrice, il n’en reste pas moins qu’il persiste un certain nombre de questions ouvertes. Ces traitements actiniques pourraient être modulables en fonction des caractéristiques des patientes et des tumeurs. Idéalement, nous aimerions disposer de mar - queurs pronostiques et prédictifs robustes afin de détermi - ner qui il faut soumettre à ce traitement adjuvant. Peut-être que des signatures géniques vont permettre de sélectionner les patientes. Ces signatures géniques ne font pas l’unanimité quant à leur réelle portée cliniqu

Radiotherapy in breast cancer: current standards of treatment, prediction of local recurrence and open questions

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Functional imaging and radiotherapy

peer reviewedLes progrès technologiques réalisés par l’image- rie médicale l’ont placée au centre de la prise en charge des patients oncologiques, tant au niveau du diagnostic, du pro - nostic et du suivi que dans la prise en charge thérapeutique. En effet, l’imagerie représente, à l’heure actuelle, la pierre angulaire des traitements de radiothérapie. Les objectifs du radiothérapeute sont d’irradier le plus précisément possible la tumeur à dose curative, tout en évitant les organes sains. Pour y arriver, le radiothérapeute utilise de façon routinière l’imagerie anatomique (Scanner et IRM). Depuis quelques années, le développement des différentes imageries métabo - liques et fonctionnelles, comme l’imagerie par émission de positons (PET-CT) et la résonnance magnétique fonctionnelle, ouvrent de nouvelles possibilités thérapeutiques grâce aux informations qu’elles apportent sur la biologie des tumeurs. Cet article décrit, de manière non exhaustive, les différentes imageries anatomiques et métaboliques à la disposition du radiothérapeute

Combined FiF+ Tangent-to-tangents VMAT breast SIB technique: Clinical introduction of an optimal class solution

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Clinical outcomes of 130 patients with primary and secondary lung tumors treated with Cyberknife robotic stereotactic body radiotherapy

Background: Authors report clinical outcomes of patients treated with robotic stereotactic body radiotherapy (SBRT) for primary, recurrent and metastatic lung lesions. Patients and methods: 130 patients with 160 lesions were treated with Cyberknife SBRT, including T1-3 primary lung cancers (54%), recurrent tumors (22%) and pulmonary metastases (24%). The mean biologically equivalent dose (BED10Gy) was 151 Gy (72–180 Gy). Median prescribed dose for peripheral and central lesions was 3x20 Gy and 3x15 Gy, respectively. Local control (LC), overall survival (OS), and cause-specific survival (CSS) rates, early and late toxicities are reported. Statistical analysis was performed to identify factors influencing local tumor control. Results: Median follow-up time was 21 months. In univariate analysis, higher dose was associated with better LC and a cut-off value was detected at BED10Gy ≤ 112.5 Gy, resulting in 1-, 2-, and 3-year actuarial LC rates of 93%, vs 73%, 80% vs 61%, and 63% vs 54%, for the high and low dose groups, respectively (p = 0.0061, HR = 0.384). In multivariate analysis, metastatic origin, histological confirmation and larger Planning Target Volume (PTV) were associated with higher risk of local failure. Actuarial OS and CSS rates at 1, 2, and 3 years were 85%, 74% and 62%, and 93%, 89% and 80%, respectively. Acute and late toxicities ≥ Gr 3 were observed in 3 (2%) and 6 patients (5%), respectively. Conclusions: Our favorable LC and survival rates after robotic SBRT, with low rates of severe toxicities, are coherent with the literature data in this mixed, non-selected study population

Clinical outcomes of 130 patients with primary and secondary lung tumors treated with Cyberknife robotic stereotactic body radiotherapy

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The COVID-19 Status of Patients Is an Essential Determinant for Decision-Making by Radiation Oncologists: A European Survey.

peer reviewed[en] AIM: To assess the tendencies of radiation oncologists (ROs) in adjusting radiotherapy treatments (RTH) according to the coronavirus disease 2019 (COVID-19) status of patients during the early severe acute respiratory syndrome coronavirus 2 (SARS-COV2) pandemic in Europe. MATERIAL AND METHODS: An electronic survey was sent to 79 academic RTH departments across Europe. Only one respondent per institution was included. Respondents were asked how they would adjust RTH treatments based on COVID-19 status for more common cancers during the first wave of the pandemic. Respondents were also asked to report the number of external beam radiotherapy (EBRT) units and the number of new cases referred to their department. Descriptive statistical analysis was conducted focusing on different cancers. RESULTS: The overall response rate to the survey was 30.38% (24 institutions from 13 European countries). There was a wide range of different institutions regarding the number of patients, radiation oncologists, and facilities. A large proportion of respondents supported adjustment of RTH treatment (delay or switch to a shorter fractionation) for COVID-19-negative patients during the first wave of the pandemic only for early breast cancer (20% delay, 42.3% shorter), prostate cancer (53.6% delay, 21.4% shorter), and benign brain tumours (32% delay, 12% shorter). For COVID-19-negative patients with other cancers, most respondents recommended the standard RTH treatment. For COVID-19-positive patients, most respondents favoured a delay in RTH treatment or a shorter fractionation, regardless of cancer type and stage. CONCLUSION: The patient's COVID status significantly influenced the decision to undergo RTH treatment, regardless of the type and aggressiveness of cancer

Az individuális sugárérzékenység szerepe és jelentősége a sugárterápiában = Role and significance of individual radiosensitivity in radiation oncology

Betegek 1. Bőr-biopsiás mintákból nyert fibroblast (Fb)-kultúrákban a survival fraction at 2 Gy (SF2)-értékek meghatározása 93 betegben. A radiogén második tumor relatív kockázatának (RR) becslése 6, 0-IA stádiumú, méhnyakrákos betegben. 2. A génexpresszió vizsgálata 7 normális, illetve 3 fokozottan sugárérzékeny sejtvonalban. 3. Multisegmentális (MS) besugárzás tanulmányozása 436 emlőrákbetegnél. Eredmények 1. Az akut dermatitis/mucositis 8/14 (57%), a reirradiáció 1/6, a késői idegrendszeri károsodás 4/11 (36%), a késői kötőszöveti/bőr toxicitás 9/50 (18%) beteg esetében járt együtt fokozott Fb-sugárérzékenységgel. A sugárkezelt, korai méhnyakrákos betegek RR-je rectumtumorra 9, anusrákra 23. 2. A normális sugárérzékenységű Fb-kből származó RNS-ekben a besugárzás hatására 109 gén expressziója növekedett, és 115 gén működése csökkent; fokozott sugárérzékenység esetén a hasonló adatok 142, illetve 56. 3. MS tervezéssel a tervezési céltérfogat (TCT) 90,9%-a esett a kívánatos dózisértékek közé (hagyományos tervezéssel: 82,8%), s a normális szervek dózisterhelése nem növekedett. Konklúziók 1. Nagyobb gyakorisággal alakulnak ki radiogén sérülések olyan betegekben, akik Fb-jének fokozott a sugárérzékenysége. 2. A sugárérzékenység sugárterápia előtti meghatározása elősegíthetné az egyénre szabott terápiás protokollok kialakítását. 3. Az MS sugárkezelés a normális szövetek dózis-terhelésének növekedése nélkül javítja a TCT dózisellátottságát. | Patients 1. Survival fractions at 2 Gy (SF2s) were determined using skin biopsy-based fibroblast (Fb) cultures in 93 pts. The relative risks (RRs) of radiogenic, secondary cancer were determined for 6, stage 0-IA, radiotherapy?treated cervix cancer pts. 2. Gene expressions were analyzed for 7 normal and 3 radiosensitive Fb cell lines. 3. Multisegmental (MS) radiotherapy was investigated in 436 breast cancer pts. Results 1. Inreased radiosensitivity was detected in 8/14 (57%) pts with acute dermatitis/mucositis, in 1/6 pts before reirradiation, in 4/11 (36%) pts with late neurological sequelae, and 9/50 (18%) pts with late subcutaneus/cutaneous toxicity. For radiotherapy-treated, early cervical cancer pts, the RRs are 9 and 23 to develope rectal and anal cancer, respectively. 2. Expressions of 109 genes were increased and 115 of them were decreased following irradiation of normal Fbs, while the comparative results for radiation-sensitive Fbs were 142 and 56, respectively. 3. Using MS radiotherapy, 90,9% of the planning target volme (PTV) was covered by the prescribed dose without an increase of radiation burden on normal tissues. Conclusions 1. The probability of radiation sequelae is higher among pts with radiosensitive Fbs. 2. Identification of radiosensitivity would help to determine individualized therapy protocols. 3. Introduction of MS radiotherapy would improve the PTV coverage without increasing the radiation burden on normal tissues