PURPOSE:During radiotherapy of non-small-cell lung cancers, changes in radiomics features extracted from cone-beam computed tomography images can serve as unique predictors. For adapting treatment plans or assessing early treatment responses, there is a pressing need to screen cone-beam computed tomography-derived radiomics features for predicting tumour regression volume. PATIENTS AND METHODS:Our study enrolled 58 patients with non-small cell lung cancer undergoing radiotherapy, comprising dataset1, and an additional 32 patients who underwent an adaptive treatment approach, forming dataset2. For dataset1 patients, radiomics features were extracted from both the planning computed tomography and the first treatment cone-beam computed tomography. For dataset2 patients, features were also extracted from the replanning computed tomography and the corresponding cone-beam computed tomography after 20 fractions of radiotherapy. By employing correlation coefficient and intraclass correlation coefficient analyses on planning computed tomography and first treatment cone-beam computed tomography features, we identified robust and reproducible features in dataset1 patients. Reproducible delta radiomics features were further selected to characterize feature changes and screen delta radiomics features for tumour regression in dataset2 patients. Lastly, predictive delta radiomics features were screened using least absolute shrinkage and selection operator regression. RESULTS:Based on dataset1, we selected 34 radiomics features. From these, 16 delta radiomics features were further screened using dataset2. The changes observed in these features were consistent across both computed tomography and cone-beam computed tomography images. Specifically, nine features exhibited significant differences (p<0.05) while seven features remained relatively unchanged (p>0.05). Ultimately, four delta radiomics features were identified to classify tumour regression volume with a 30 % threshold for cone-beam computed tomography images. CONCLUSION:Our study introduces a novel strategy for selecting computed tomography-based cone-beam computed tomography radiomics features, enabling the identification of reliable features for model development. Preliminary findings firstly demonstrate the feasibility of using cone-beam computed tomography-based delta radiomics features to classify tumour regression volume during radiotherapy of non-small-cell lung cancer.
PURPOSE:Radiation-induced sarcomas are a rare but serious long-term complication of radiotherapy. While radiotherapy is an effective treatment for low-grade non-Hodgkin lymphomas, the incidence and characteristics of radiation-induced sarcomas in this setting have not been previously described. The purpose of this study was to analyse the incidence and outcomes of radiation-induced sarcomas following radiotherapy for low-grade non-Hodgkin lymphomas. PATIENTS AND METHODS:We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database (17 registries, 2024 submission) to identify patients diagnosed with follicular or marginal zone lymphoma between 2000 and 2022 who received radiotherapy. Cases of subsequently histologically-confirmed sarcoma were screened and classified as confirmed or possible radiation-induced sarcomas based on anatomical localization and a minimum latency of 3 years. Clinical characteristics, treatments, latency intervals, and survival outcomes were analysed. RESULTS:Among 18,293 patients with low-grade non-Hodgkin lymphomas treated with radiation, 19 developed sarcomas (0.10 %). Ten cases were excluded (eight due to anatomical mismatch, two due to insufficient latency). Of the nine remaining cases, six met criteria for confirmed radiation-induced sarcomas. The median age at lymphoma diagnosis was at least 70years, and the median latency to radiation-induced sarcoma was 12years (range: 3-20years). All sarcomas were localized and treated surgically; three patients also received radiotherapy. After a median follow-up of 78months, the 5-year overall survival rate was estimated at 83.3 % (95 % confidence interval: 43.6 %-97.0 %). One patient died from lymphoma progression. CONCLUSION:Radiation-induced sarcomas following radiotherapy for low-grade non-Hodgkin lymphomas is extremely rare, with favourable outcomes when it occurs. These results provide reassuring data supporting the long-term safety of modern radiotherapy for low-grade non-Hodgkin lymphomas and underscore the importance of continued surveillance and treatment planning in patients with prolonged life expectancy.
PURPOSE:Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare but indolent B-cell lymphoma, most often presenting as localized disease. Radiotherapy is a curative option, but its proximity to the heart raises concerns about long-term cardiac toxicity, which remains poorly documented. The purpose of this work was to evaluate the potential risk of cardiac toxicity following radiotherapy in patients with pulmonary MALT lymphoma. PATIENTS AND METHODS:This retrospective, population-based study used Surveillance, Epidemiology, and End Results (SEER) data (17 registries, 2000-2022; November 2024 submission). We identified patients with primary pulmonary MALT lymphoma treated with radiation. Demographic and clinical characteristics, including age, sex, Ann Arbor stage, tumour laterality, lobe involvement, and treatment modality, were collected. Outcomes included overall survival, cancer-specific survival, cardiac-specific survival, and non-cancer/non-cardiac-specific survival. Survival estimates were generated using Kaplan-Meier methods; univariate and multivariate Cox models assessed factors associated with cardiac-specific mortality. RESULTS:Among 248 patients, the median age was 70 years; 54.0 % were women and 81.9 % Caucasian. Most had early-stage disease (90.3 %) and right-sided tumours (57.3 %). Radiotherapy alone was used in 86.7 %. With a median follow-up of 59 months, median overall survival was 120 months. At 20 years, overall survival rate was 28.9 %, cancer-specific survival rate 85.5 %, and cardiac-specific survival rate 85.0 %. In competing risk multivariate analysis, age greater than 70 years (hazard ratio [HR]: 10.51; 95 % confidence interval [CI]: 1.11-99.8; p=0.040) and stage III-IV (HR: 6.52; 95 % CI: 1.17-36.4; p=0.032) were independently associated with cardiac-specific mortality. CONCLUSION:Radiotherapy for pulmonary MALT lymphoma is associated with excellent long-term outcomes and low cardiac-specific mortality. Tumour location within the lung does not influence cardiac risk, supporting the absence of significant radiation-induced cardiotoxicity.
PURPOSE:Primary involvement of the uveal tract by diffuse large B-cell lymphoma is exceedingly rare and poorly characterized. Most reported ocular lymphomas in this location are indolent mucosa-associated lymphoid tissue lymphomas with favourable outcomes. We aimed to evaluate the epidemiologic and clinical features of primary uveal diffuse large B-cell lymphoma using a large population-based dataset. MATERIAL AND METHODS:We performed a retrospective analysis of cases recorded between 2000 and 2022 in the Surveillance, Epidemiology, and End Results (SEER) database. Eligible patients had histologically confirmed diffuse large B-cell lymphoma with primary localization in the choroid (C69.3) or ciliary body/iris (C69.4). Localized primary uveal diffuse large B-cell lymphoma was defined as Ann Arbor stage I disease without systemic involvement. Survival outcomes were analysed using Kaplan-Meier estimates and Cox univariate models. RESULTS:Among 134,366 diffuse large B-cell lymphoma cases, 51 involved the uveal tract (0.038 %), with 42 (82.4 %) classified as localized primary uveal diffuse large B-cell lymphoma. Median age was 65 years. The 5-year overall survival and cancer-specific survival rates were 45.5 % and 58.4 %, respectively. For patients with localized diseases, 5-year cancer-specific survival rate was 59.4 %, with a survival plateau beyond 6 years. No significant associations were found between overall- or cancer-specific survival and clinical or treatment variables, including radiotherapy or chemotherapy. CONCLUSIONS:Primary uveal diffuse large B-cell lymphoma is an ultra-rare and aggressive malignancy, distinct from uveal mucosa-associated lymphoid tissue lymphoma. While outcomes are poorer, a subset of patients with localized disease may achieve long-term remission. Radiotherapy may be a treatment alternative for selected patients, though optimal management remains undefined. Further prospective studies are warranted.
PURPOSE:This dosimetric study investigated the feasibility and effectiveness of a hybrid stereotactic radiosurgery technique combining dynamic conformal and volumetric modulated arcs for treating multiple small brain metastases in a single fraction, using two treatment planning systems: Elements and Monaco. MATERIALS AND METHODS:A clinical case involving multiple brain metastases was selected. Four treatment plans were generated: three using the Elements treatment planning system - (i) a volumetric modulated arc therapy plan (Cranial SRS); (ii) a dynamic conformal arc therapy plan (Multiple Brain Mets); and (iii) a hybrid dynamic conformal arc with volumetric modulated arc therapy plan - and a fourth using the Monaco treatment planning system with a volumetric modulated arc technique. Plans were assessed using quality indices, including target coverage, conformity, gradient and homogeneity indices, and doses to organs at risk. Quality assurance evaluation was performed with the stereotactic radiosurgery StereoPHAN™ phantom, MapCHECK® detector, and EBT-XD™ film. The gamma passing rates were analysed using 3 %/1mm criteria. All plans were delivered using a 6 MV flattening filter-free photon beam on a Versa HD™ linear accelerator. RESULTS:The hybrid planning technique demonstrated superior plan quality, with a significant reduction in the volumes of normal brain tissue receiving at least 10Gy and 12Gy, as well as lower doses to organs at risk, in accordance with established stereotactic radiosurgery guidelines. Quality assurance evaluation confirmed the dosimetric accuracy of the hybrid plan, showing excellent agreement between measured and calculated dose distributions, with a gamma passing rate exceeding 98 %. CONCLUSION:For single-isocentre, multitarget stereotactic radiosurgery, the hybrid technique could represent a promising approach, offering improved sparing of surrounding normal tissues and consistent plan quality. However, these results need to be validated in larger clinical cases.
We present the update of the recommendations of the Société française de radiothérapie oncologique (the French society for radiation oncology) on soft tissue sarcomas. Currently, the initial management of sarcomas is very important as it may impact on patients’ quality of life, especially in the case of limb soft tissue sarcomas, and on overall survival in trunk sarcomas. Radiotherapy has to be discussed within a multidisciplinary board meeting with results of biopsy, eventually re-examined by a dedicated sarcoma pathologist. The role of radiotherapy varies according to localization of soft tissue sarcomas; the use of intensity-modulated radiotherapy has become standard of care. It is part of the standard treatment for grade 2 and 3 sarcomas of the extremities and superficial trunk at least 5cm. Preoperative radiotherapy is generally preferred to postoperative irradiation in expert soft tissue sarcomas centres. In the case of incomplete resection, re-excision should be discussed. In such cases, radiation may be delivered preoperatively (50Gy in 25 fractions of 2Gy) or postoperatively. For retroperitoneal sarcomas, preoperative intensity-modulated radiotherapy cannot be proposed systematically following the results of STRASS trial. Concomitant chemoradiotherapy cannot be considered a standard treatment. All other soft tissue sarcomas sites will be addressed as well as as desmoid tumours, and other techniques that may be used such as brachytherapy and proton therapy. Hypofractionated radiotherapy for soft tissue sarcomas has also been adressed.
We present the updated recommendations of the Société française de radiothérapie oncologique (the French society for oncology radiotherapy) on image-guided radiotherapy. The objective of image-guided radiotherapy is to account for anatomical variations of the target volume occurring between or during the irradiation fractions, such as displacements and/or deformations, so that the delivered dose corresponds to the planned dose or could be even improved. This article presents the different image-guided radiotherapy devices, their clinical use, associated quality control procedures, and quantifies the possible additional dose generated by each of them. The practical implementation of image-guided radiotherapy across various tumour sites is summarized, based on the different “RecoRad™” guideline articles. Adaptive radiotherapy strategies are then detailed, due to its complexity and its recent development. The role of radiation technologist in the practice of image-guided radiotherapy is also specified. Finally, a brief update is provided on the issue of the additional dose associated with the in-room ionizing imaging, which must be estimated.
Radiotherapy alone or in association with systemic treatment plays a major role in the treatment of head and neck tumours, either as a primary treatment or as a postoperative modality. The management of these tumours is multidisciplinary, requiring particular care at every treatment step. We present the 2025 update of the recommendations of the Société française de radiothérapie oncologique (the French society for radiation oncology) on the radiotherapy of head and neck tumours from the imaging work-up needed for optimal selection of treatment volume, to optimization of the dose distribution and delivery.
Radiotherapy for hepatic tumours has evolved from palliative care to a potentially curative approach, thanks to advancements like stereotactic body radiotherapy. This technique allows for precise targeting while sparing healthy liver tissue, making it an option for hepatocellular carcinoma and liver metastases when surgery or ablation are contraindicated, achieving high response rates. Additionally, combined approaches such as stereotactic body radiotherapy following transarterial chemoembolization improve tumour response. Emerging modalities like magnetic resonance imaging-guided adaptive radiotherapy and proton beam therapy offer further precision, enhancing outcomes and reducing toxicity. Ongoing studies aim to refine treatment strategies and validate these advances.
PURPOSE:Cancer impacts populations in low- and middle-income countries disproportionately, where resources are limited, and cancer often diagnosed at more advanced stages. Radiotherapy plays a crucial role in treatment of cancer. However, language barriers often hinder partnerships and training with certain low- and middle-income countries, as most scientific societies primarily operate in English. This project aimed to evaluate the current, projected needs and gaps in radiotherapy specific to French-speaking low- and middle-income countries. MATERIALS AND METHODS:An infrastructure database of 89 French-speaking countries was compiled, including countries associated with the Organisation internationale de la francophonie. Cross-referencing with World Bank income groups identified French-speaking low- and middle-income countries. Available radiotherapy infrastructures were obtained from the International Atomic Energy Agency. Projections for cancer cases and radiation therapy needs were made for 2030 and 2040. RESULTS:Thirty-five countries were identified as French-speaking low- and middle-income countries. Projected cancer burden is expected to increase by 44.7 % between 2020 and 2040. Assuming a conservative 50 % of patients benefit from radiotherapy, demand for treatment units will increase of 34.8 % between 2020 and 2040. The average number of radiotherapy units per 1000 cases remained low at 1.0 among countries with radiotherapy; significantly below the targeted two units per 1000 cases. Fourteen French-speaking low- and middle-income countries had no radiation capacity. CONCLUSION:French-speaking low- and middle-income countries have a significant shortage of radiotherapy infrastructure for the increasing cancer demand. Limited language diversity in educational resources poses a barrier to radiotherapy access in these settings. This linguistic barrier may exacerbate workforce shortages in radiotherapy. Global initiatives should prioritize language considerations when strategizing efforts and allocating resources. High-income French-speaking nations are strategically well placed to cultivate collaborative networks essential for the advancement of these initiatives.
The aim of this article is to present the specifics of clinical research in radiotherapy in France, in order to facilitate the drafting of research protocols. The objectives of research are similar to those of any oncological research: to improve the therapeutic index and, if possible, the results in terms of survival. Phase III trials are still essential, but phase II trials provide interesting information on both the efficacy and tolerability of treatments. The particularities of radiotherapy trials are discussed in terms of inclusion criteria, judgment criteria and therapeutic modalities. The importance of quality control is emphasized. Finally, the difficulties of funding, which is usually academic, are discussed.
Intensity-modulated conformal radiotherapy and brachytherapy are among the standard techniques for radiation treatments of oral cavity cancers. In this paper, each technique is detailed in terms of indications, treatment planning, volume delineation and selection, dosimetry, and position verification. This document represents an update of the Société française de radiothérapie oncologique (the French society for radiation oncology) guidelines (RecoRad™) for this anatomical site within the upper aerodigestive tract.
Herein are presented the update of the recommendations from the Société française de radiothérapie oncologique (the French society for radiation oncology) regarding the indications and methods of lung cancer radiotherapy. The recommendations for delineation of the target volumes and organs at risk are detailed.
This article reports on the updated recommendations of the Société française de radiothérapie oncologique on external radiotherapy for prostate cancer. External radiotherapy is aimed for all localized prostate cancers, and more recently at oligometastatic prostate cancers. Irradiation techniques are detailed according to different risk levels. Prostate image-guided intensity-modulated radiotherapy is the recommended technique for these cancers. A total dose of 74 to 80Gy is recommended for standard fractionation (delivered in 2Gy fractions). Moderate hypofractionation (delivering a total dose of 60Gy at a rate of 3Gy per fraction over 4weeks) in the prostate has become a therapeutic standard. Extreme hypofractionation (delivering 35 to 40Gy in five fractions) to treat the prostate without pelvis, using a technique under stereotactic conditions, can be considered a recent standard in favourable and intermediate risk disease. The postoperative irradiation technique, mainly indicated in cases of biochemical recurrence and lymph node involvement, is described in detail. Recommendations concerning contouring and dosimetry are also provided.
The process of reirradiation in oncology presents a distinctive set of challenges, wherein clinical decision-making is predicated on a delicate balancing act between the efficacy of the treatment and the risk of severe toxicity. Despite the paucity of randomised and prospective data, there is an increasing number of data encouraging its consideration for patients with local or metastatic recurrence. While awaiting dedicated guidance from international scientific societies, this publication is based on multicentre reflections of the "Recommendations Commission" of the Société française de radiothérapie oncologique (the French society for radiation oncology). It addresses key questions related to reirradiation, with a particular focus on lung, breast and bone tumours.
The purpose of this article is to describe the external irradiation process and updated recommendations of the Société française de radiothérapie oncologique for patient follow-up.
The process of reirradiation in oncology presents a distinctive set of challenges, wherein clinical decision-making is predicated on a delicate balancing act between the efficacy of the treatment and the risk of severe toxicity. Despite the paucity of randomized and prospective data, an increasing number of clinical guidelines encourage its consideration for patients with local or metastatic recurrence. While awaiting dedicated guidance from international scientific societies, the following publication is based on the guidelines and multicentre reflections of the Recommendations Commission of the Société française de radiothérapie oncologique (SFRO, the French society for radiation oncology). It addresses key questions related to reirradiation, with a particular focus on prostate, gynaecological and pelvic tumours.
The RadioTransNet program, led by the Société française de radiothérapie oncologique (SFRO, the French society for radiation oncology) in association with the Société française de physique médicale (SFPM, the French society of medical physics), certified by the Institut du cancer (INCa, the French national cancer institute), was created at the end of 2018. The aim is to create a coherent, national, and multidisciplinary structure for preclinical and translational research in oncological radiotherapy by identifying research priorities. Its activities are coordinated by a scientific council, composed of radiation oncologists-therapists, medical physicists and academic radiobiologists researchers, and organized around four major axes which are: the definition of target volumes, the interaction of ionizing radiation with tissues, combined treatments and modern approaches to dose calculation. These four major axes are associated with different objectives concerning basic radiobiology, the studies of implementation of new drugs in preclinical settings, the contribution of imaging and new tracers, research in medical physics, by integrating a cross-cutting dimension of medical oncology and cost/effectiveness considerations. The selected themes form the basis for the projects studied and developed, taking into account the complementary skills of all the partner platforms involved in the network. Orientation proposals based on the priorities selected by the scientific council are submitted to INCa for the opening of dedicated calls to finance the human and technical resources necessary to conduct, under the best conditions, preclinical and translational research in radiotherapy.
We present the updated recommendations from the Société française de radiothérapie oncologique (SFRO, the French society for radiation oncology) regarding the use of external beam radiotherapy and brachytherapy in the management of anal cancer. Anal cancer is a rare malignancy with an increasing incidence, largely due to the high prevalence of Human papillomavirus infection. It primarily affects females over 65years of age. The most common histological type is squamous cell carcinoma. The standard treatment involves a combination of intensity-modulated radiotherapy and concurrent chemotherapy with 5-fluorouracil (or capecitabine) and mitomycin. A localized boost dose to the tumour can be delivered either by external beam radiotherapy or brachytherapy. Recent studies have demonstrated that intensity-modulated radiotherapy helps avoid treatment interruptions, which are considered detrimental to efficacy. However, while radiotherapy achieves good outcomes for T1-T2 tumours without nodal involvement, T3-T4 stages or tumours with nodal involvement are associated with a poorer prognosis. Therefore, concomitant chemotherapy (5-fluorouracil or capecitabine with mitomycin) is recommended for tumours greater than 3cm or those with nodal invasion. This approach remains a topic of debate for early-stage tumours. Target volumes, organs at risk delineation, doses, and fractionation regimens are discussed with respect to the balance between treatment efficacy and toxicity. Follow-up recommendations are provided to ensure early detection of cancer recurrence and late treatment-related side effects.
Gliomas are the most frequent malignant primary brain tumours in adults. The proximity of organs at risk, the infiltrating nature, and the radioresistance of gliomas have to be taken into account in the choice of prescribed dose and technique of radiotherapy. The management of glioma patients is based on clinical factors (age, Karnofsky performance status) and tumour characteristics (histology, molecular biology, tumour location), and strongly depends on available and associated treatments, such as surgery, radiotherapy, and chemotherapy. The knowledge of molecular biomarkers is currently essential; they are increasingly evolving as additional factors that facilitate diagnostics and therapeutic decision-making. We present the update of the recommendations of the Société française de radiothérapie oncologique (the French Society for Radiation Oncology) on the indications and the technical procedures for performing radiotherapy in patients with gliomas.
