ObjectiveThe treatment of early-stage cervical cancer (CC) is primarily based on surgery. Adjuvant (chemo)radiotherapy can be necessary in presence of risk factors for relapse (tumor size, deep stromal invasion, lymphovascular space invasion (LVSI), positive margins, parametrial or lymph node involvement), increasing the risk of treatment toxicity. Preoperative brachytherapy can reduce tumor extension before surgery, potentially limiting the need for adjuvant radiotherapy. This study reports long-term clinical outcomes on efficacy and toxicity of preoperative pulse-dose-rate (PDR) brachytherapy in early-stage CC.MethodsAll patients treated at Institut Curie between 2007 and 2022 for early-stage CC by preoperative brachytherapy were included. A PDR technique was used. Patients underwent hysterectomy associated with nodal staging following brachytherapy.Results73 patients were included. The median time from brachytherapy to surgery was 45 days [range: 25-78 days]. With a median follow-up of 51 months [range: 4-185], we reported 3 local (4%), 1 locoregional (1%) and 8 metastatic (11%) relapses. At 10 years, OS was 84.1% [95% CI: 70.0-100], DFS 84.3% [95% CI:74.6-95.3] and LRFS 92.8% [95% CI:84.8-100]. Persistence of a tumor residue, observed in 32 patients (44%), was a significant risk factor for metastatic relapse (p=0.02) and was associated with the largest tumor size before brachytherapy (p=0.04). Five patients (7%) experienced grade 3 toxicity. One patient (1%) developed grade 4 toxicity. Ten patients (14%) received adjuvant radiotherapy, increasing risk of lymphedema (HR 1.31, 95% CI [1.11-1.54]; p=0.002).ConclusionsPDR preoperative brachytherapy for early-stage cervical cancer provides high long-term tumor control rates with low toxicity.

Purpose: The optimal management of locally recurrent prostate cancer after definitive irradiation is still unclear but local salvage treatments are gaining interest. A retrospective, single-institution analysis of clinical outcomes and treatment-related toxicity after salvage I-125 low-dose-rate (LDR) brachytherapy (BT) for locally-recurrent prostate cancer was conducted in a Comprehensive Cancer Center. Patients and methods: A total of 94 patients treated with salvage LDR-BT between 2006 and 2021 were included. The target volume was either the whole-gland +/- a boost on the GTV, the hemigland, or only the GTV. The prescribed dose ranged from 90 to 145 Gy. Toxicity was graded by Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Results: Median follow-up was 34 months. Initial radiotherapy was external beam radiotherapy in 73 patients (78 %) with a median dose of 76 Gy and I-125 BT in 21 patients (22 %) with a prescribed dose of 145 Gy. Median PSA at salvage was 3.75 ng/ml with a median interval between first and salvage irradiation of 9.4 years. Salvage brachytherapy was associated with androgen deprivation therapy for 32 % of the patients. Only 4 % of the patients were castrate-resistant. Failure free survival was 82 % at 2 years and 66 % at 3 years. The only factors associated with failure-free survival on multivariate analysis were hormonosensitivity at relapse and European Association of Urology (EAU) prognostic group. Late grade 3 urinary and rectal toxicities occurred in 12 % and 1 % of the patients respectively. No significant difference in toxicity or efficacy was observed between the three implant volume groups. Conclusion: The efficacy and toxicity results are consistent with those in the LDR group of the MASTER metaanalysis. Salvage BT confirms to be an effective and safe option for locally recurrent prostate cancer. A focal approach could be interesting to reduce late severe toxicities, especially urinary.

In 1998, an editorial from the International Journal of Radiation Oncology - Biology - Physics (IJROBP) on the occasion of the publication of Phase I by Zelefsky et al. on 3D radiotherapy dose escalation asked the question: "will more prove better? ". More than 20 years later, several prospective studies have sup-ported the authors' conclusions, making dose escalation a new standard in prostate cancer. The data from prospective randomized studies were ultimately disappointing in that they failed to show an over-all survival benefit from dose escalation. However, there is a clear and consistent benefit in biochemical recurrence-free survival, which must be weighed on an individual patient basis against the potential additional toxicity of dose escalation. Techniques and concepts have become more and more precise, such as intensity modulated irradiation, simultaneous integrated boost, hypofractionated dose-escalation, pelvic irradiation with involved node boost or focal dose-escalation on gross recurrence after prostatectomy. The objective here was to summarize the prospective data on dose escalation in prostate cancer and in particular on recent advances in the field. In 2022, can we finally say that more has proven better? (c) 2022 Societe franc , aise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

La radiothérapie hypofractionnée a montré son équivalence en termes d’efficacité dans plusieurs essais randomisés avec des profils de toxicité différents. Elle n’est pas encore un standard en France. L’objectif de l’étude est d’évaluer la tolérance en cours de radiothérapie et à 4–6 mois sur une série de patients traités pour un adénocarcinome prostatique en radiothérapie modérément hypofractionnée avec escalade de dose. Au total, 212 patients ont été traités consécutivement entre février 2016 et mars 2018. La dose délivrée était de 75 gy en 30 fractions au niveau de la prostate et des vs proximales (eqd2 = 82,5 à 85,7 gy en fractions de 2 gy pour un α/β de 1,5 à 3). Cent quatre-vingt-quinze patients (92 %) ont reçu une irradiation ganglionnaire pelvienne (46 gy en 23 fractions). La technique d’irradiation a été une rcmi rotationnelle (Rapidarc®) guidée par l’image après implantation de 3 grains d’or intraprostatiques. Les toxicités urinaires et digestives ont été recueillies en cours de radiothérapie et à 4–6 mois. Des facteurs prédictifs de toxicité ont été recherchés. Les caractéristiques des patients étaient : âge médian = 71 ans [46–86], psa initial médian = 9,46 ng/mL [1,97–652], stade t1, t2, t3, t4 : 32 %, 23 %, 43 % et 2 %. Stade n1 et m1 : 19 et 1 patients. Score de Gleason 6, 7 (3 + 4), 7 (4 + 3) et ≥ 8 dans 19 %, 44 %, 22 % et 15 % des cas. Les toxicités urinaires et digestives de grade 1 ont été de 50 % et 61 %, celles de grade 2 de 44 % et 2 %. Avec un recul de 4–6 mois après la fin de la radiothérapie, les toxicités urinaires et digestives de grade 1 ont été de 52 % et 23 %, de grade 2 de 15 % et 0 %. Une toxicité urinaire grade 3 (< 1 %) a été observée. Aucune corrélation n’a été retrouvée entre la survenue de ces toxicités et les différents paramètres analysés (Fig. 1, Fig. 2, Fig. 3). La radiothérapie prostatique modérément hypofractionnée avec escalade de dose est bien tolérée. Elle permet de réduire sensiblement le temps de traitement. Ces données encourageantes doivent être confirmées sur le long terme.

Purpose. To evaluate the prognostic value of Ki67 expression, breast cancer molecular subtypes and the impact of postmastectomy radiotherapy in breast cancer patients with pathologic negative lymph nodes (pNO) after modified radical mastectomy.Patients and methods. - Six hundred and ninety-nine breast cancer patients with pN0 status after modified radical mastectomy, treated between 2001 and 2008, were identified from a prospective database in a single institution. Tumours were classified by intrinsic molecular subtype as luminal A or B, HER2+, and triple-negative using estrogen, progesterone, and HER2 receptors. Multivariate Cox analysis was used to determine the risk of locoregional recurrence associated with intrinsic subtypes and Ki67 expression, adjusting for known prognostic factors.Results. - At a median follow-up of 56 months, 17 patients developed locoregional recurrence. Five-year locoregional recurrence-free survival and overall survival in the entire population were 97%, and 94.7%, respectively, with no difference between the postmastectomy radiotherapy (n = 191) and no-postmastectomy radiotherapy (n = 508) subgroups. No constructed subtype was associated with an increased risk of locoregional recurrence. A Ki67 above 20% was the only independent prognostic factor associated with increased locoregional recurrence (hazard ratio, 4.18; 95% CI, 1.11 to 15.77; P < 0.0215). However, postmastectomy radiotherapy was not associated with better locoregional control in patients with proliferative tumours.Conclusion. - Ki67 expression but not molecular subtypes are predictors of locoregional recurrence in breast cancer patients with negative lymph nodes after modified radical mastectomy. The benefit of adjuvant radiotherapy in patients with proliferative tumours should be further investigated in prospective studies. (C) 2013 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

Purpose. - Neoadjuvant chemotherapy generally induces significant changes in the pathological extent of disease and challenges the standard indications of adjuvant postmastectomy radiation therapy. We retrospectively evaluated the impact of postmastectomy radiation therapy in breast cancer patients with negative lymph nodes (pNO) after neoadjuvant chemotherapy.Patients and materials. - Among 1054 breast cancer patients treated with neoadjuvant chemotherapy in our institution between 1990 and 2004, 134 patients had pN0 status after neoadjuvant chemotherapy and mastectomy. Demographic data, tumor characteristics, metastatic sites, and treatments were prospectively recorded. The impact of postmastectomy radiation therapy on locoregional recurrence-free survival and overall survival was evaluated by multivariate analysis including known prognostic factors.Results. - Among 134 eligible patients, 78 patients (58.2%) received postmastectomy radiation therapy, and 56 patients (41.8%) did not. With a median follow-up time of 91.4 months, the 10-year locoregional recurrence-free survival and overall survival rates were 96.2% and 77.2% with postmastectomy radiation therapy and 86.8% and 87.7% without radiation therapy, respectively (no significant difference). In multivariate analysis, there was a trend towards poorer overall survival among patients who did not have a pathologically complete primary tumour response after neoadjuvant chemotherapy (hazard ratio [HA], 6.65; 95% CI, 0.82-54.12; P=0.076). Postmastectomy radiation therapy had no effect on either locoregional recurrence-free survival (HR, 0.37; 95% Cl, 0.09-1.61; P=0.18) or overall survival (HR, 2.06; 95% Cl, 0.71-6; P=0.18). There was a trend towards poorer overall survival among patients who did not have pathologically complete in-breast tumour response after neoadjuvant chemotherapy (HR, 6.65; 95% Cl, 0.82-54.12; P=0.076).Conclusions. - This retrospective study showed no increase in the risk of distant metastasis, locoregional recurrence or death when postmastectomy radiation therapy was omitted in breast cancer patients with pN0 status after neoadjuvant chemotherapy and mastectomy. Whether the omission of postmastectomy radiation therapy is acceptable for these patients should be addressed prospectively. (C) 2011 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

581 Background: To evaluate the influence of loco-regional radiotherapy and adjuvant chemotherapy on the outcome of breast cancer patients with axillary lymph node micrometastases (MMTS) or isolated tumor cells (ITC). Methods: Between 1995 and 2005, 10,296 breast cancer patients were treated in our institution, 177 of them for unilateral breast cancer with MMTS (147) or ITC (30) by breast-conserving surgery or total mastectomy. The impact of chemotherapy and irradiation on overall survival (OS), disease-free survival (DFS) and metastases-free survival (MFS) were studied. Results: Median follow-up time was 77 months (mean 83.2 months), OS at 5 years 94.1 (89.2- 96.9), DFS 90.1 (84.4–93.9). No improvement in OS, DFS nor MFS were found in patients treated by supraclavicular irradiation (127/177), internal mammary lymph nodes (IMLN) irradiation (103/177) or axillary region irradiation (52/177). The OS, DFS and MFS were similar in patients with (93) or without (84) chemotherapy. Conclusions: Neither loco-regional radiotherapy nor adjuvant chemotherapy influenced the outcome of breast patients with MMTS or ITC. No significant financial relationships to disclose.

Purpose. - Neoadjuvant chemotherapy generally induces significant changes in the pathological extent of disease. This potential down-staging challenges the standard indications of adjuvant radiation therapy. We assessed the utility of lymph node irradiation in breast cancer patients with pathological N0 status (pN0) after neoadjuvant chemotherapy and breast-conserving surgery.Patients and materials. - Among 1054 breast cancer patients treated with neoadjuvant chemotherapy in our institution between 1990 and 2004, 248 patients with clinical N0 or N1-N2 lymph node status at diagnosis had pN0 status after neoadjuvant chemotherapy and breast-conserving surgery. Cox regression analysis was used to identify factors influencing locoregional recurrence-free survival, disease-free survival and overall survival.Results. - All 248 patients received breast irradiation, and 158 patients (63.7%) also received lymph node irradiation. With a median follow-up of 88 months, the 5-year locoregional recurrence-free survival and overall survival rates were respectively 89.4% and 88.7% with lymph node irradiation and 86.2% and 92% without lymph node irradiation (no significant difference). Survival was poorer among patients who did not have a pathological complete primary tumor response (pCR) (hazards ratio [HR] = 3.05; 95% Cl, 1.17 to 7.99) and in patients with N1-N2 clinical status at diagnosis ([HR] = 2.24; 95% Cl, 1.15 to 4.36). Lymph node irradiation did not significantly affect survival.Conclusions. - Relative to combined breast and local lymph node irradiation, isolated breast irradiation does not appear to be associated with a higher risk of locoregional relapse or death among breast cancer patients with pN0 status after neoadjuvant chemotherapy. These results need to be confirmed in a prospective study. (C) 2010 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

To propose a specific prognostic score for patients with brain metastases (BM) from breast cancer (BC), including molecular subtypes and treatment parameters. We analyzed the outcome of 130 BM from BC patients treated with whole brain radiotherapy (WBRT) between January 1998 and April 2006 and evaluated the hierarchical risk groups for the estimated survival using the recursive partitioning analysis (RPA). Seven prognostic factors including performance status, age, trastuzumab-based therapy for HER-2 overexpressing tumor, triple-negative phenotype, Scarff-Bloom-Richardson grade, serum LDH level and lymphocyte count at BM diagnosis were incorporated into the RPA. The final nodes of RPA were grouped according to their survival times. According to the RPA tree, the best survival (median: 19.5 months) was observed in patients with HER2-overexpressing tumors who were treated with trastuzumab-based therapy. The worst survival (median: 3.5months) was observed in patients with HER2-overexpressing not treated with trastuzumab and with lymphopenia at BM diagnosis or with a KPS <70 and older than 50 years or in patients with KPS ≥ 70 with triple negative tumors. The other patients had a median survival of 12.49 months. Survival analysis using the Kaplan-Meier and log-rank test confirmed the significant differences among groups (p < 0.001). This 3-classes specific prognostic score successfully predict the outcome of this heterogeneous group of patients with BM from BC. This information may be useful to tailor the therapy for subgroups of patients and to define homogeneous cohorts for retrospective comparison and prospective randomized trials.

Le down-staging tumoral après chimiothérapie néoadjuvante pourrait modifier les indications d’irradiation adjuvante des aires ganglionnaires. L’objectif était d’évaluer l’intérêt de l’irradiation des aires ganglionnaires chez les patientes atteintes d’un cancer du sein sans envahissement ganglionnaire (pN0) après chimiothérapie néoadjuvante et chirurgie mammaire conservatrice. Parmi 1054 patientes prises en charge entre 1990 et 2004 par chimiothérapie néoadjuvante pour un cancer du sein, 248 (23,5 %) étaient indemnes d’envahissement ganglionnaire après chimiothérapie néoadjuvante et chirurgie mammaire conservatrice. Les survies sans récidive locorégionale, sans maladie et globale ont été analysées en fonction de l’irradiation ou non des aires ganglionnaires. Toutes les patientes (248) ont reçu une irradiation mammaire, associée pour 158 (63,7 %) d’entre elles à une irradiation adjuvante des aires ganglionnaires. Après un suivi médian de 88 mois, les taux de survie sans récidive locorégionale et de survie globale à cinq ans étaient respectivement de 89,4 % et 88,7 % avec irradiation adjuvante des aires ganglionnaires et 86,2 % et 92 % sans irradiation adjuvante des aires ganglionnaires (NS). En analyse multifactorielle, l’absence de réponse histologique complète de la tumeur (hazard ratio [HR] = 3,05 ; intervalle de confiance à 95 % [IC 95 %], 1,17 à 7,99 ; p = 0,023) et le statut cN1-N2 lors du diagnostic (HR = 2,24 ; IC 95 %, 1,15 à 4,36 ; p = 0,017) étaient associés à une diminution de la survie globale. L’absence d’irradiation adjuvante des aires ganglionnaires n’avait d’effet délétère ni sur la survie sans maladie ni sur la survie globale. Nos résultats suggèrent que l’irradiation mammaire seule ne serait pas associée à un risque plus élevé de récidive locorégionale ou de décès chez les patientes atteintes d’un cancer du sein classé pN0 après chimiothérapie néoadjuvante. Neoadjuvant chemotherapy generally induces significant changes in the pathological extent of disease. This potential down-staging challenges the standard indications of adjuvant radiation therapy. We assessed the utility of lymph node irradiation in breast cancer patients with pathological N0 status (pN0) after neoadjuvant chemotherapy and breast-conserving surgery. Among 1054 breast cancer patients treated with neoadjuvant chemotherapy in our institution between 1990 and 2004, 248 patients with clinical N0 or N1-N2 lymph node status at diagnosis had pN0 status after neoadjuvant chemotherapy and breast-conserving surgery. Cox regression analysis was used to identify factors influencing locoregional recurrence-free survival, disease-free survival and overall survival. All 248 patients received breast irradiation, and 158 patients (63.7%) also received lymph node irradiation. With a median follow-up of 88 months, the 5-year locoregional recurrence-free survival and overall survival rates were respectively 89.4% and 88.7% with lymph node irradiation and 86.2% and 92% without lymph node irradiation (no significant difference). Survival was poorer among patients who did not have a pathological complete primary tumor response (pCR) (hazards ratio [HR] = 3.05; 95% CI, 1.17 to 7.99) and in patients with N1-N2 clinical status at diagnosis ([HR] = 2.24; 95% CI, 1.15 to 4.36). Lymph node irradiation did not significantly affect survival. Relative to combined breast and local lymph node irradiation, isolated breast irradiation does not appear to be associated with a higher risk of locoregional relapse or death among breast cancer patients with pN0 status after neoadjuvant chemotherapy. These results need to be confirmed in a prospective study.

e11539 Background: The increased use of neoadjuvant chemotherapy (CT) in breast cancer (BC) management has raised new questions regarding the optimal locoregional treatment. The aim of this retrospective study was to compare the outcomes of BC patients (pts) with pathological N0 status (pN0) following primary CT and conservative surgery who received breast radiotherapy with or without lymph node irradiation. Methods: Between 1990 and 2004, 1054 patients received preoperative CT for locally advanced BC. Data from 248 pts (23.5%) with clinical N0 (164 pts) or N1-N2 (84 pts) lymph node status at diagnosis and pN0 status after primary CT were studied. Among them, 93 pts (37.5%) received breast irradiation alone and 155 pts (62.5%) underwent locoregional irradiation. Outcome was assessed in relation to lymph node recurrence, disease-free survival (DFS) and overall survival (OS). Results: Both groups were comparable in terms of baseline characteristics. With a median follow-up of 88 months, 3 pts experienced nodal recurrence in the breast irradiation alone group compared with 2 pts in the locoregional irradiation group (p>.05). Among the 164 N0 pN0 pts, the 5-year DFS and OS rates were respectively 84% and 89% vs 84% and 95%, according to whether they received (n=87) or not (n=77) lymph node irradiation(p>.05). Among the 84 N1-N2 pN0 pts, same outcome values did not show any significant difference according to group of treatment: 72% and 88% in 68 pts treated with locoregional irradiation vs 81% and 81% in 16 pts treated with breast irradiation alone (p>.05). Conclusions: Our results suggest that breast irradiation alone is not associated with a higher risk of regional recurrence in locally advanced BC pts with pN0 status after neoadjuvant chemotherapy. Whether this allows the omission of lymph node irradiation for such strategy should be addressed prospectively. No significant financial relationships to disclose.

Connaître le large éventail des pathologies relatives aux traumatismes fermés du thorax TTF. Connaître la sémiologie radiologique afin d’obtenir un diagnostic précis et rapide voire de participer à la prise en charge thérapeutique. Connaître les atteintes isthmiques aortiques et du rachis cervico-thoracique. Savoir les différentes techniques d’imagerie disponibles dans la prise en charge des TTF. Montrer à travers cette approche didactique l’importance du scanner aux urgences dans la prise en charge des TTF. Il s’agit de différentes atteintes compartimentales (paroi, plèvre, parenchyme, bronches, diaphragme, médiastin et cœur…). Nous insistons sur la démarche diagnostique concernant les atteintes isthmiques aortiques et du rachis cervico-thoracique.

Savoir faire une orientation diagnostique devant une opacité pulmonaire excavée OPE. Connaître les OPE suspectes de malignité et orienter la prise en charge. Connaître les OPE bénignes et éviter des explorations ou des procédures thérapeutiques lourdes et inutiles. Situation fréquente : découverte fortuite, symptomatologie respiratoire ou altération de l’état général. L’orientation étiologique dépend de la taille, de l’épaisseur de la paroi et du contenu de la cavité. La majorité des lésions bénignes ont une paroi fine régulière inférieur à 4 mm et un contenu liquide réalisant parfois un niveau hydroaérique. Les lésions malignes ont une paroi irrégulière supérieure à 15 mm et un contenu tissulaire souvent nodulaire.

The value of lymph node irradiation (LNI) for breast cancer (BC) patients with pathologic N0 status (pN0) after neoadjuvant chemotherapy (NAC) and breast-conservative surgery (BCS) is unknown. We compared the outcomes of pN0 patients following NAC and BCS who received breast radiotherapy (BRT) with or without LNI. Among 1,054 BC patients treated with NAC between 1990 and 2004, 248 patients (23.5%) had pN0 status after NAC and BCS. We limited our study to the patients who were treated with BCS as all patients who were selected for postmastectomy irradiation had LNI. Demographic data, tumor characteristics, and treatments were prospectively recorded. Outcome was assessed in relation to locoregional recurrence-free survival (LRR-FS), disease-free survival (DFS), and overall survival (OS). Among 248 patients (T1–T2: 193 patients, T3: 41 patients, T4: 14 patients, cN0: 164 patients, cN1–N2: 84 patients), 158 (63.7%) received BRT and LNI and 90 (36.3%) received BRT alone. Younger age (p = 0.005), N1–N2 clinical lymph node status at diagnosis (p = 0.0001) and internal or central localizations (p < 0.00001) were associated with LNI. With a median follow-up of 88 months (15–218), 2 patients experienced nodal recurrence in the BRT and LNI group compared with 3 patients in the BRT group. The 5-year LRR-FS rates were 89.4% in the BRT and LNI group compared with 86.2% in the BRT group (p > 0.5). Among 164 cN0 pN0 patients, the 5-year DFS and OS rates were 83% and 89.3% vs. 85% and 94.5%, respectively, according to whether they received LNI (n = 89) or not (n = 75; p > 0.05). Among 84 cN1–N2 pN0 patients, the 5-year DFS and OS rates were 72% and 87.9% vs. 79.4% and 80%, respectively, according to whether they received LNI (n = 69) or not(n = 15; p > 0.05). In a multivariate analysis, absence of pathologic complete response of the tumor (hazard ratio [HR] = 3.05; 95% CI, 1.17–7.99; p = 0.023) and N1–N2 clinical status at diagnosis (HR, 2.24; 95% CI, 1.15–4.36; p = 0.017) were associated with worse survival. Omission of LNI had no effect on either DFS (HR, 1.18; 95% CI, 0.64–2.15) or OS (HR, 1.19; 95% CI, 0.48–2.94). Our results suggest that BRT alone is not associated with a higher risk of LRR or death in BC patients with pN0 status after NAC. Whether this allows the omission of LNI for such strategy should be addressed prospectively.