Purpose. - We present the results of the PHRC Tridicol, a prospective French phase II study whose objective was to increase the dose delivered to the target volume during brachytherapy for locally advanced cervical cancers. Material and methods. - Eight centers included 48 patients, treated with concomitant radiochemotherapy, then uterovaginal brachytherapy. Results. - The median follow-up was 63 months. The dose of brachytherapy delivered in biological equivalent dose (EQD2) to 90% of the High Risk CTV (D90 CTV HR) was 80 Gy in median dose. The 5 -year local control rate (LC) was 84%, close to the hypothesis of 86.7%. The rate of severe complications (grade 3-4) was 23% at 5 years. The rectal dose was correlated with the risk of severe complications. Conclusion. - HR CTV dose was below the target (85 Gy) due to low use of parametrial interstitial needles, as the centers did not always have an adequate applicator, or were at the time at the beginning of their learning curve. The 5 -year LC rate was improved compared to that of the comparable STIC PDR group (78%) but lower than the retroEMBRACE cohort of GEC ESTRO (89%). The complication rate was higher than in the comparable group of STIC PDR but close to that of retroEMBRACE. Training brachytherapy teams in interstitial implantation or referring patients to referral centers should help improve the therapeutic index of cervical cancer. (c) 2021 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

PURPOSE:The purpose of this study was to evaluate MRI and fluorocholine PET/CT diagnostic performances for the detection of local recurrence following prostate brachytherapy for localised prostate cancer. MATERIAL AND METHODS:In this single-centre study, we retrospectively reviewed data from 21 patients treated by brachytherapy for localised prostate cancer and diagnosed with biochemical recurrence according to Phoenix Criteria, who underwent MRI and fluorocholine PET/CT. We included patients with local relapse suspicion according to imaging exams, with biopsy for the final assessment of local recurrence. Patient analysis data were supplemented by segment analysis using an 8-segment model. RESULTS:The fluorocholine PET/CT was positive for 81% and negative for 19% of patients. The sensitivity and specificity were 92% and 33% with diagnosis accuracy of 67%. The MRI was positive for 57% and negative for 43% of patients. The sensitivity and specificity were 67% and 56% with diagnosis accuracy of 62%. There was no statistically significant difference between fluorocholine PET/CT and MRI accuracy (P=0.63). On a segment-based analysis, the sensitivity and specificity were 44% and 82% for fluorocholine PET/CT with diagnosis accuracy of 78%. For MRI, specificity was 91% diagnosis accuracy was 82%. CONCLUSION:Both MRI and fluorocholine PET/CT permit to highlight local recurrence sites after prostate brachytherapy. Confirmation biopsies are, however, necessary since this accuracy is insufficient.

Une patiente de 66 ans, ayant pour principal antécédent une hystérectomie en 2010 (dans un contexte de dysplasie cervicale récidivante) est prise en charge chirurgicalement en 2014 pour un carcinome épidermoïde du fond vaginal, suivie d’une curiethérapie du fond vaginal réalisée à haut débit de dose. Elle rechute en juillet 2015 au niveau ganglionnaire ainsi que localement au niveau du fond vaginal. Cette récidive hypermétabolique en TEP FDG est traitée en septembre 2015 par pelvectomie totale avec anastomose colorectale protégée et entérocystoplastie avec radiochimiothérapie concomitante. Dans les suites, elle présente une infection urinaire avec dilatation pyélo-calicielle, nécessitant la mise en place d’une sonde double J par voie antégrade changée tous les 6 mois. Une augmentation du SCC en juillet 2018 (5ng/mL pour une norme<2,3) conduit à la réalisation d’une TEP–TDM au 18FDG qui met en évidence des ganglions rétropéritonéaux modérément à intensément hypermétaboliques (rétro-cave 11mm SUVmax 7,8, inter-aortico-cave 8mm SUVmax 4,4 et 9mm SUVmax 5,1) au-dessus du champ de radiothérapie, ainsi qu’un renforcement du métabolisme ostéo-médullaire diffus du squelette non irradié. Compte tenu de la récidive néoplasique probable, une radiothérapie est proposée, mais finalement contre-indiquée après analyse des volumes dosimétriques. Ainsi, il est proposé un traitement par chimiothérapie. La réactualisation du TEP–TDM pré-chimiothérapie réalisée le 11 juillet 2018 met en évidence une disparition spontanée des fixations ganglionnaires rétropéritonéales ainsi qu’une régression de l’activation ostéo-médullaire en lien très probable avec la stérilisation d’un épisode d’infection urinaire, la patiente présentant des infections urinaires à répétition (juin 2018 : tableau septique à point de départ urinaire à Morganella morganii, Klebsiella variicola et Pseudomonas aeruginosa). Un nouveau TEP–TDM de contrôle réalisé en octobre 2018 est toujours négatif, le taux de SCC dosé au même moment retrouve un taux revenu à la normale (0,6ng/mL), écartant définitivement la rechute néoplasique.

PURPOSE: The objective of this study was to study survival and tolerance of prostate cancer patients treated with 1251 permanent interstitial brachytherapy by automated vs. manual implantation of seeds. METHODS AND MATERIALS: Between 2002 and 2010, 349 selected patients were treated with 1251 brachytherapy by the same team: from 2002 to April 2005, 65 patients with linked seeds and then 284 patients treated using Nucletron First System automated implantation. We analyzed biochemical recurrence-free survival (bRFS) rates and toxicities (univariate and multivariate analyses). RESULTS: Two hundred seventy-seven (79.4%) and 69 patients (19.8%) with low- and intermediate-risk disease were treated, respectively (median follow-up: 64 months). The 5-year bRFS rate was 93.1% (95% confidence interval 89.3-95.6) for the entire cohort. The 5-year bRFS rates were 93.4% and 91.7% for patients with low- and intermediate-risk disease, respectively (p = 0.42). In univariate and multivariate analyses, there was no statistically significant difference in the 5-year bRFS rate depending on the implantation technique (93.1% vs. 91.8%, respectively, for automated and linked seeds; p = 0.53). In univariate analysis, only D-90 prostate (dose delivered to 90% of the prostate) <140 Gy (p = 0.01), lack of prostate-specific antigen bounce (p = 0.008), and nadir prostate-specific antigen >0.11 (p = 0.01) were predictive factors for bRFS. We observed Grade 3 urethritis in 7 patients (2%), urinary incontinence in 2 patients (0.7%), and Grade 4 proctitis in 2 patients (0.7%). CONCLUSIONS: In this large single-center series, brachytherapy for selected localized prostate cancer achieved excellent rates of biochemical control at 5 years (93.1%) with an acceptable toxicity profile, irrespective of the implantation technique used. (C) 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Objectives. - The management of endometrial carcinoma is constantly evolving. The SFOG and the CNGOF decided to jointly update the previous French recommendations (Institut national du cancer 2011) and to adapt to the French practice the 2015 recommendations elaborated at the time of joint European consensus conference with the participation of the three concerned European societies (ESGO, ESTRO, ESMO). Material and methods. - A strict methodology was used. A steering committee was put together. A systematic review of the literature since 2011 has been carried out. A first draft of the recommendations has been elaborated, with emphasis on high level of evidence. An external review by users representing all the concerned discipines and all kinds of practice was completed. Three hundred and four comments were sent by 54 reviewers. Results. - The management of endometrial carcinoma requires a precise preoperative workup. A provisional estimate of the final stage is provided. This estimation impact the level of surgical staging. Surgery should use a minimal invasive approach. The final pathology is the key of the decision concerning adjuvant therapy, which involves surveillance, radiation therapy, brachytherapy, or chemotherapy. Conclusion. - The management algorithms allow a fast, state of the art based, answer to the clinical questions raised by the management of endometrial cancer. They must be used only in the setting of a multidisciplinary team at all stages of the management. (C) 2017 Elsevier Masson SAS. All rights reserved.

In the era of intensity-modulated radiation therapy, image-guided radiotherapy (IGRT) appears crucial to control dose delivery and to promote dose escalation while allowing healthy tissue sparing. The place of IGRT following radical prostatectomy is poorly described in the literature. This review aims to highlight some key points on the different IGRT techniques applicable to prostatic bed radiotherapy. Furthermore, methods used to evaluate target motion and to reduce planning target volume margins will also be explored.

The management of endometrial carcinoma is constantly evolving. The SFOG and the CNGOF decided to jointly update the previous French recommendations (Institut national du cancer 2011) and to adapt to the French practice the 2015 recommendations elaborated at the time of joint European consensus conference with the participation of the three concerned European societies (ESGO, ESTRO, ESMO).A strict methodology was used. A steering committee was put together. A systematic review of the literature since 2011 has been carried out. A first draft of the recommendations has been elaborated, with emphasis on high level of evidence. An external review by users representing all the concerned discipines and all kinds of practice was completed. Three hundred and four comments were sent by 54 reviewers.The management of endometrial carcinoma requires a precise preoperative workup. A provisional estimate of the final stage is provided. This estimation impact the level of surgical staging. Surgery should use a minimal invasive approach. The final pathology is the key of the decision concerning adjuvant therapy, which involves surveillance, radiation therapy, brachytherapy, or chemotherapy.The management algorithms allow a fast, state of the art based, answer to the clinical questions raised by the management of endometrial cancer. They must be used only in the setting of a multidisciplinary team at all stages of the management.

Après curiethérapie de prostate (CTP), la ré-ascencion du PSA peut être liée à un phénomène inflammatoire de rebond dans 30 à 40 % des cas. Notre objectif est de décrire la sémiologie des fixations prostatiques de la 18F-Choline TEP/TDM (TEP) après CTP et d’évaluer ses performances diagnostiques quand une rechute biologique est suspectée. Analyse rétrospective des patients traités par CTP par implants permanents de grains d’iode 125, adressés à notre centre pour TEP, dans un contexte d’augmentation du PSA. Un protocole TEP, 30 min après la perfusion de Lasilix, comprenant l’acquisition pelvienne dynamique immédiatement après 3 MBq/kg de 18F-Choline et une acquisition plus tardive (>10 minutes) a été analysé. Les caractéristiques d’analyse visuelle prostatique enregistrées sont : fixation diffuse versus focal et périphérique versus centrale. Les SUVmax précoces et tardifs des fixations prostatiques ont également été enregistrés. Le Gold Standard (GS) positif a été défini par biopsie et/ou prostatectomie. Le GS négatif a été défini par une biopsie négative et/ou chute spontanée du PSA. Les patients ont été exclus si aucun GS pour le statut prostatique n’était disponible. Le SUVmax des foyers hyperfixants a été analysé selon le test de régression logistique. Le seuil de rehaussement a été analysé selon le test exact de Fischer. De 12/2012 à 12/2016, parmi 395 patients explorés par TEP pour rechute biologique de cancer de prostate, 21 avec GS/31 traités par CTP ont été inclus. Le PSA moyen lors de la TEP était de 3,82 ng/mL chez les 12 patients Vrais Positifs (VP) et de 3,57 ng/mL chez les 8 Faux Positifs (FP) (p = 0,77). Une fixation intra-prostatique centrale, diffuse modérée était constante autant chez les VP (SUVmax = 2,82) que les FP (SUVmax = 2,58) (p = 0,54). Une fixation intra-prostatique focale et périphérique (FFP) était retrouvée dans 92 % des VP (11/12 patients). Le SUVmax de la FFP ne différait pas entre les VP (SUVmax = 3) et les FP (SUVmax = 3,1). Un rehaussement du SUVmax > 0,7 était suspect de récidive avec une différence significative entre les VP et les FP (p = 0,0095). La sensibilité était de 1, la spécificité de 0,11, la VPP de 0,6 (IC95 % : 0,39–0,78), la VPN de 1 (IC95 % : 0,21–1) et la précision diagnostique de 0,62. La rechute locale après CTP est détectable en TEP. La FFP même avec un faible SUV est suspecte. Une fixation centrale est fréquente, probablement inflammatoire.

To assess patterns of uptake of (18) F-Choline-PET/CT (FCH PET/CT) and its diagnostic performances in case of biochemical relapse after I125 brachytherapy for localized prostate cancer. To evaluate how FCH PET/CT can guide the decision of implementation of prostatic biopsies and the salvage treatment. Between December 2012 and December 2016, 32 patients - previously treated by I125 brachytherapy according to NCCN recommendations - had a biochemical relapse based on ASTRO criteria and the Phoenix definition (nadir+2 ng/ml) and were referred to our center for FCH PET/CT. All imaging indications were validated in a multidisciplinary team meeting. The gold standard was defined by histology on prostatic biopsies. Patients were excluded if no gold standard was available. FCH PET/CT used a two-time protocol - 30 minutes after furosemide infusion - including dynamic pelvic acquisition immediately after 3 MBq/kg FCH and a later acquisition (> 10 minutes). Two experienced nuclear medicine physicians retrospectively recorded the following FCH PET/CT imaging prostatic characteristics: diffuse vs focal and peripheral vs central uptake, SUVmax from dynamic and late step and delta SUV absolute value (ΔSUV) - defined by the difference between late and dynamic SUVmax values. Statistical analysis used Student’s t test for SUVmax values and Fisher's exact test to compare ΔSUV results of true positive (TP) and false positive (FP) patients. Twenty-one patients reached histological gold standard. Mean time between I125 brachytherapy and FCH PET/CT was 64 months [23-120], mean PSA on the time of FCH PET/CT was 6.04 ng/mL [4.34-12.5] and mean PSA doubling time was 22.3 months [2.7-84.0]. Mean PSA value on the time of FCH PET/CT was respectively 3.9 ng/mL [1.07-8.00] and 4.3 ng/mL [2.1-9.2] for TP and FP patients (p=0.84). PSA doubling time was 21.6 months [5.2-84] for TP and 22.5 months [7.7-27.2] for FP (p=0,91). A central and diffuse uptake was constant - mean SUVmax=2.71 [1.9-5.8] - without any statistically significant differences between TP (mean SUVmax=2,82) and FP (mean SUVmax=2,58) (p=0.31). A peripheral uptake was found on 11 of 12 TP patients (mean SUVmax = 2.9 [2.3-3.9]). The ΔSUV>0.7 was correlated with histologically proven recurrence (p=0,01). Estimated sensitivity, specificity, predictive positive value, negative predictive value and accuracy were 1, 0.11, 0.6 [95% CI: 0.39-0.78], 1 [95% CI: 0.21-1] and 0.62 respectively. FCH PET/CT guided implementation of prostatic biopsies in 18 patients of 21 (85.7%) and salvage treatment in 47.6% of cases (4 prostatectomies, 4 HIFU and one multimodal treatment). A focal and peripheral prostatic uptake with ΔSUV>0.7 was correlated with recurrence after I125 brachytherapy. FCH PET/CT can guide the decision of implementation of prostatic biopsies and salvage treatment in case of histologically confirmed local recurrence.

Purpose. - To evaluate the feasibility of robotic salvage prostatectomy for local recurrence after permanent brachytherapy implants for prostate cancer.Patients and methods. - Seven patients were operated by robotic salvage prostatectomy with or without pelvic lymph node dissection between October 2007 and March 2012, for a local recurrence after iodine 125 permanent brachytherapy implants. Local recurrence was proved by prostate biopsies, once biochemical relapse was diagnosed and imaging assessment performed.Results. - The average age of a patient at the time of diagnosis was 66 years (62-71 years). The median nadir prostate specific antigen (PSA) serum concentration after brachytherapy was 1.29 ng/mL (0.6-2.1 ng/mL), obtained after a median of 12 months (7-21 months). The average [PSA] before robotic salvage prostatectomy was 6.60 ng/mL (4.17-13.80 ng/mL). [PSA] at 1 and 3 months after prostatectomy was less than 0.05 ng/mL in five patients. [PSA] remained below 0.05 ng/mL for six patients at 12 and 24 months. One month after robotic salvage prostatectomy, all patients had at least partial urinary incontinence. At 12 and 24 months after robotic salvage prostatectomy four patients have regained full urinary continence. In terms of erectile function at 24 months, three patients retained erectile function with possible sexual intercourse.Conclusion. Robotic salvage prostatectomy appears to be a reliable treatment in terms of oncological outcome with convincing results both for urinary continence and erectile function for selected patients with local recurrence after permanent brachytherapy implants. (C) 2017 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

Desmoplastic small round cell tumor (DSRCT) is a rare peritoneal tumor affecting predominantly children and young adult white males with a high rate of local failure after surgery. We performed a multicentric retrospective study to identify the prognostic impact of adjuvant abdominal radiation therapy. All patients treated for primary abdominal DSRCT in 8 French centers from 1991 to 2014 were included. Patients were retrospectively staged into 3 groups: group A treated with adjuvant radiation therapy (RT) after cytoreductive surgery, group B without RT after cytoreductive surgery, and group C by exclusive chemotherapy. Peritoneal progression-free survival (PPFS), progression-free survival (PFS), and overall survival (OS) were evaluated. We also performed a direct comparison between groups A and B to evaluate RT after cytoreductive surgery. RT was also evaluated according to completeness of surgery: complete cytoreductive surgery (CCS) or incomplete cytoreductive surgery (ICS). We also compared results according to RT modalities: whole abdominopelvic RT (WAP-RT) or focalized RT (F-RT), WAP-RT dose or boost modalities. Thirty-seven (35.9%), 36 (34.9%), and 30 (28.0%) patients were included in groups A, B and C, respectively. Three-year OS was 61.2% (41.0-76.0), 37.6% (22.0-53.1), and 17.3% (6.3-32.8) for groups A, B and C, respectively. OS, PPFS, and PFS differed significantly between the 3 groups (P<0.001; P<0.001; and P<0.001, respectively). OS and PPFS were higher in group A (RT group) compared to group B (no RT group) (P=0.045 and P=0.006, respectively). Three-year PPFS was 23.8% (10.3-40.4) for group A and 12.51% (4.0-26.2) for group B. After CCS, RT improved PPFS (P=0.024) but differences in OS and PFS were not significant (P=0.40 and P=0.30, respectively). Median PFS for patients undergoing WAP-RT was 22.4 (14.4-42.3) months and 8.6 (8.6-29.1) months for patients undergoing F-RT (P=0.0376) after CCS (P=0.031). On the 26 patients treated by WAP-RT, PPFS differed significantly for patients treated by a dose ≥30 Gy (P=0.031). A trend of OS increase was observed (47.0 vs 28.0 months) but was not statistically significant (P=0.116). Boost radiation was not associated with better survival. After ICS, RT improved OS (P=0.044). A trend of PPFS and PFS increase was observed but the difference was not statistically significant (P=0.073 and P=0.076). Analysis according to RT modalities for patients with ICS was not performed because of the very limited number of patients. In this large series for DSCRT, adjuvant RT as part of multimodal treatment seems to confer oncological benefits for patients treated for abdominal DSRCT after cytoreductive surgery and perioperative chemotherapy.

Purpose: Desmoplastic small round cell tumor (DSRCT ) is a rare peritoneal tumor affecting predominantly children and young adult Caucasian ma les with a high rate of local failure after surgery. We performed a multicentric retrospective study to identify the prognostic impact of adjuvant abdominal radiotherapy. Methods and Materials: All patients treated for pri mary abdominal DSRCT in 8 French centers from 1991 to 2014 were included. Patients w ere retrospectively staged into 3 groups: group A treated with adjuvant radiotherapy (RT) aft er cytoreductive surgery, group B without RT after cytoreductive surgery and group C by exclu sive chemotherapy. Peritoneal progression-free survival (PPFS), progression-free survival (PFS) and overall survival (OS) were evaluated. We also performed a direct comparis on between group A and B to evaluate RT after cytoreductive surgery. RT was also evaluat ed according to completeness of surgery: complete cytoreductive surgery (CCS) or incomplete cytoreductive surgery (ICS). Results: Thirty-seven (35.9%), thirty-six (34.9%) a nd thirty (28.0%) patients were included in group A, B and C, respectively. Three-year OS was 6 1.2% (41.0-76.0), 37.6% (22.0-53.1), and 17.3% (6.3-32.8) for group A, B and C, respecti v ly. OS, PPFS and PFS differed significantly between the 3 groups (p<0.001; p<0.00 1 and p<0.001, respectively). OS and PPFS were higher in group A (RT group) compared to group B (no RT group) (p=0.045 and p=0.006, respectively). Three-year PPFS was 23.8% ( 10.3-40.4) for group A and 12.51% (4.0-26.2) for group B. After CCS, RT improved PPFS (p=0.024) but differences in OS and PFS were not significant (p=0.40 and p=0.30, respec tively). After ICS, RT improved OS (p=0.044). A trend of PPFS and PFS increase was obs erved but the difference was not statistically significant (p=0.073 and p=0.076). M AN US CR IP T AC CE PT ED ACCEPTED MANUSCRIPT 3 Conclusions: Adjuvant radiotherapy as part of multi modal treatment seems to confer oncological benefits for patients treated for abdom inal DSRCT after cytoreductive surgery and perioperative chemotherapy.

Purpose: To identify the prognostic role of adjuvant abdominal radiation therapy (RT) on oncologic outcomes as a part of multimodal treatment in the management of desmoplastic small round cell tumor (DSRCT) and to determine its impact according to the quality of surgical resection.Methods and Materials: All patients treated for primary abdominal DSRCT in 8 French centers from 1991 to 2014 were included. Patients were retrospectively staged into 3 groups: group A treated with adjuvant RT after cytoreductive surgery, group B without RT after cytoreductive surgery, and group C by exclusive chemotherapy. Peritoneal progression-free survival (PPFS), progression-free survival (PFS), and overall survival (OS) were evaluated. We also performed a direct comparison between groups A and B to evaluate RT after cytoreductive surgery. Radiation therapy was also evaluated according to completeness of surgery: complete cytoreductive surgery (CCS) or incomplete cytoreductive surgery (ICS).Results: Thirty-seven (35.9%), thirty-six (34.9%), and thirty (28.0%) patients were included in groups A, B, and C, respectively. Three-year OS was 61.2% (range, 41.0%-76.0%), 37.6% (22.0%-53.1%), and 17.3% (6.3%-32.8%) for groups A, B, and C, respectively. Overall survival, PPFS, and PFS differed significantly among the 3 groups (P<.001, P<.001, and P<.001, respectively). Overall survival and PPFS were higher in group A (RT group) compared with group B (no RT group) (P = . 045 and P =. 006, respectively). Three-year PPFS was 23.8% (10.3%-40.4%) for group A and 12.51% (4.0%-26.2%) for group B. After CCS, RT improved PPFS (P =. 024), but differences in OS and PFS were not significant (PZ. 40 and PZ. 30, respectively). After ICS, RT improved OS (P = .044). A trend of PPFS and PFS increase was observed, but the difference was not statistically significant (PZ. 073 and P = .076).Conclusions: Adjuvant RT as part of multimodal treatment seems to confer oncologic benefits for patients treated for abdominal DSRCT after cytoreductive surgery and perioperative chemotherapy. (C) 2016 Published by Elsevier Inc.

External irradiation and brachytherapy still have a major place in the treatment of cervix and endometrial carcinoma. This review presents the French guidelines in terms of preparation and choice of irradiation techniques of these gynecological malignancies.

Abstract Purpose: EGFR is frequently overexpressed in cervical cancer, suggesting EGFR blockade as a promising treatment approach. Cetuximab, an anti EGFR antibody, used conjointly with radiochemotherapy, was feasible in first-line treatment of cervix carcinoma limited to the pelvis. Experimental Design: This randomized phase II trial enrolled 78 FIGO stage IB2–IIIB cervical cancer patients to either cisplatin-based radiochemotherapy alone (arm B, n = 38) or conjointly with a 6-week course of weekly cetuximab (arm A, n = 40). Brachytherapy was given to the pelvic mass. Primary endpoint was disease-free survival (DFS) at 2 years. EGFR expression and targeted sequencing were performed in 54 of 78 patients. Results: Cetuximab over a 6-week period did not improve DFS at 24 months. At 31 months median follow-up, DFS was not significantly different (P = 0.18). Complete response at 4 to 6 months was strongly predictive for excellent DFS (log-rank test; P < 0.001). PIK3CA, KRAS, and STK11 mutations were observed in 22%, 4%, and 2% of patients, respectively. No tumor with a PI3K pathway mutation showed complete response (0/8 in arm A and 0/6 in arm B), whereas 14 of 52 (27%) tumors without mutations did (P = 0.021). PI3K pathway-mutated tumors showed a trend toward poorer DFS (P = 0.06) following cetuximab (8/22) as compared with those following standard treatment only (6/18). Conclusions: Similar to patients with head and neck cancer, patients with cervical cancer showed no gain in DFS at 2 years following a combined treatment of cetuximab with radiochemotherapy. Although treatment tolerance and compliance were satisfactory, it remains to be demonstrated whether maintenance therapy with cetuximab could be beneficial in selected patient groups. Clin Cancer Res; 21(11); 2530–7. ©2015 AACR.

BACKGROUND:Steady progress in outcomes has been observed after standard treatment by surgery and chemotherapy in patients with advanced ovarian cancer (AOC), but little is known about outcomes after alternative neoadjuvant chemotherapy (NAC) proposed to primary inoperable patients. We assessed whether NAC offers comparable survival to standard treatment, whether survival rates have progressed over time, and what the optimal extent of surgery at late interval debulking surgery (IDS) should be.METHODS:This was a retrospective data analysis of prospectively recorded patients with poor prognosis AOC treated by platinum/taxane NAC and late IDS (after six cycles). Independent prognostic factors for surgical morbidity and overall survival (OS) are determined and survival outcomes are compared to survival rates for a similar group of patients treated with platinum protocols.RESULTS:A total of 118 patients with stages IIIC-IV AOC (median age: 64 years, stage IV: 31%) received IDS (46% standard surgery and 54% radical, with 68% obtaining complete resection). Major morbidity was 18%. OS was 42 months across all patients (95% confidence interval 35.3-49.1) and 80 months in stage IIIC. This is higher by 15 months than after platinum-based treatment. Higher morbidity was associated with bowel resection. Longer OS was associated with ASA class I, stage IIIC, no bowel surgery, and no residual disease.CONCLUSIONS:The neoadjuvant approach with late IDS offers survival similar to that reported by standard treatment, with progress in outcomes compared with rates after platinum treatment. The goal of IDS surgery is complete resection, while sparing surrounding organs.

Purpose. - To evaluate toxicity and early disease outcome among patients treated for cervical cancer with extended-field helical tomotherapy to the para-aortic nodes.Patients and methods. - Thirty-eight patients (International Federation of Gynecology and Obstetrics [FIGO] stage IB2-IVA) from four institutions received extended-field helical tomotherapy and were retrospectively evaluated. All had nodal disease. Para-aortic lymph nodes were involved in 31 patients. Patients were assessed for toxicity using version 4 of the National Cancer Institute's common terminology criteria for adverse events. Survival curves were plotted using Kaplan-Meier estimates.Results. - All patients underwent radiation to the tumor region (median dose: 45 Gy; range: 44-66 Gy), pelvic lymph nodes and para-aortic lymph nodes (median dose: 45 Gy; range: 44-60 Gy). The median dose to positive lymph nodes was 55 Gy (range: 45-65 Gy). All received platinum-based chemotherapy (31 concurrently). The median follow-up was 15 months. Acute toxicity events observed included one patient with grade 5 febrile neutropenia, 11 patients (29%) with grade 3 hematologic complications. Grades 3-4 gastrointestinal and genitourinary toxicities occurred in six (16%) and four (11%) patients, respectively. Three patients had grade 3 pelvic pain (8%). The 6-and 18-month overall survival rates were 94.7 and 63.9%, respectively. The 18-month locoregional control, disease-free survival, and late grade 3 toxicity rates were 60.2, 43.3 and 7.3%, respectively.Conclusion. - Extended-field helical tomotherapy was associated with low rates of acute gastrointestinal and genitourinary toxicities with early survival and locoregional control similar to other published series. (C) 2016 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

Caractériser le taux de complications aiguës et tardives de la tomothérapie hélicoïdale avec irradiation lomboaortique pour un cancer du col de l’utérus. Les dossiers de 38 patientes issues de quatre institutions et atteintes de cancer du col utérin selon la classification internationale des gynécologues-accoucheurs (Figo) de stade IB2-IVB, dont 31 avec une atteinte lombo-aortique, ont été analysés rétrospectivement. La toxicité a été évaluée selon l’échelle CTCAE (Common Terminology Criteria for Adverse Events), version 4, chaque semaine pendant l’irradiation et 2–3 mois après la fin du traitement pour la toxicité aiguë, à plus de 6 mois pour la toxicité tardive. Les courbes de survie ont été déterminées selon Kaplan-Meyer. L’ensemble des patientes a reçu une irradiation externe dans la région tumorale primitive (dose médiane : 45 Gy ; extrêmes : 44–66), les ganglions pelviens (dose médiane : 45 Gy ; extrêmes : 44–60) et lomboaortiques (dose médiane : 45 Gy ; extrêmes : 44–60) associée à une chimiothérapie à base de platine (31 de manière concomitante). La dose médiane dans les ganglions envahis (pelviens ou lomboaortiques) était de 55 Gy (extrêmes : 45–60). Vingt-trois patientes ont bénéficié d’une curiethérapie et sept d’une hystérectomie radicale après la chimioradiothérapie. En ce qui concerne la toxicité aiguë, on notait un cas de toxicité de grade 5 (neutropénie fébrile), une toxicité de grade 3-4 hématologique chez 11 patientes (29 %), gastro-intestinale chez six (16 %), génito-urinaire chez quatre (11 %), et une douleur pelvienne chez trois (8 %). Le suivi médian était de 15 mois (extrêmes : 1–65). En ce qui concerne la toxicité tardive, on notait une toxicité grade 4 gastro-intestinale et urinaire développée simultanément, et une dyspareunie de grade 3. Deux patientes ont été atteintes d’une une fracture pelvienne asymptomatique. La probabilité de survie globale à 6 et 18 mois était respectivement de 94,7 % et 63,9 %, celles de contrôle locorégional et de survie sans récidive à 18 mois respectivement de 60,2 % et 43,3 %. Cette étude montre la faisabilité d’une tomothérapie lomboaortique avec un faible taux de complications aiguës gastro-intestinales et génito-urinaires.

Deep modifications have occurred these last years in the brachytherapy use in patients with cervix cancer. Imaging allowed a more precise definition of the volumes of interest linked to the tumour and its extension as well as a better visualization of organs at risk. Recommendations on delineation modalities were published in 2005, leading to definition homogeneity, even if large variations are still observed among centres, in terms of techniques and doses. These new definitions also served as basis for new applicators development, allowing a combination of interstitial and endocavitary techniques. Results from centres using image-guided brachytherapy (MRI in particular) evidenced local control improvement, without increase in complications. Retrospective and prospective studies are currently under evaluation. These studies will likely be able to determine dose required to sterilize tumours, as a function of stage and size, as well as dose limits for organs at risk.