BACKGROUND:The availability of mechanical thrombectomy (MT) is limited. Thus, there are two paradigms for patients living closer to a primary stroke center (PSC) than a comprehensive stroke center (CSC) capable of MT: "Mothership" (direct referral to a CSC) and "Drip-and-Ship" (referral to a PSC for imaging and thrombolysis and transfer to a CSC for thrombectomy or monitoring). We aimed to compare the prognosis of patients at three months between the two paradigms in a rural area. MATERIALS:From September 2019 to March 2021, we prospectively included patients living closer to a PSC than the one CSC, regardless of the type of stroke or reperfusion treatment. The proportion of patients with a good functional outcome (Rankin≤2) at three months was compared between the two initial orientations for all patients and for subgroups: patients with ischemic stroke and patients treated by MT. RESULTS:Among the 206 patients included, 103 were admitted directly to the CSC (82.5% had an ischemic stroke and 24.3% a MT) and 103 initially admitted to a PSC and then transferred to the CSC (100% had an ischemic stroke and 52.4% a MT). The proportion of patients with a good outcome was comparable between the two groups (54.5% vs. 43.7%, P=0.22). Among the 79 patients who underwent MT, the prognosis at three months was better in the Mothership group (49.3% vs. 15.3%, P=0.01). CONCLUSION:The functional prognosis is comparable between Mothership and Drip-and-Ship paradigms in our setting, despite a trend towards a better prognosis for the Mothership. As has been shown in urban settings, the mothership paradigm also leads to a better prognosis for patients treated with MT in a rural setting.

Purpose. - Brain necrosis after radiotherapy is a challenging diagnosis, since it has similar radiological appearance on standard MRI to tumor progression. Consequences on treatment decisions can be impor-tant. We compare recent imaging techniques in order to adopt a reliable diagnostic protocol in doubtful situations.Patients and method. - This is a retrospective study comparing the performance of three imaging tech-niques after radiotherapy of brain metastasis: Perfusion-MRI, TRAMs technique and F-dopa PET-CT. The evolution of the treated metastasis volume was also analyzed by contouring all patients MRIs. All included patients were suspected of relapse and had the three exams once the volume of treated metastasis increased.Results. - The majority of our patients were treated by stereotactic radiotherapy. Suspicion of relapse was on average around 17 months after treatment. Four cases of radionecrosis were diagnosed and six cases of real tumor progression. Neurological symptoms were less present in radionecrosis cases. All of our radionecrosis cases had relative cerebral blood volume below 1. F-dopa PET-CT succeeded to set the good diagnosis in eight cases, although we found one false positive and one false negative exam. The TRAMs technique failed in one case of false negative exam.Conclusions. - Perfusion-MRI showed high performance in the diagnosis of radionecrosis, especially when calculating relative cerebral blood volume rate. The TRAMs technique showed interesting results and deserves application in daily routine combined with the perfusion-MRI. F-dopa CT might induce false results because of different metabolic uptake according to tumor type, medication and brain blood barrier leak.& COPY; 2023 Socie & PRIME;te & PRIME; franc,aise de radiothe & PRIME;rapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

PURPOSE:To compare the evaluation of collaterals on multiphase computed tomography (CT) angiography using the score proposed by the reference study by Menon et al. and the Alberta Stroke Program Early CT (ASPECT) score for the prediction of favorable clinical outcome in patients with anterior ischemic stroke (IS). MATERIALS AND METHODS:Retrospective single center study including 199 patients with anterior ischemic stroke and evaluated using multiphase CT angiography. Collaterals were assessed using the reference score and ASPECT score. The early clinical outcome [National Institute of Health Stroke Score (NIHSS) over day 1] and later clinical outcome [90-day modified Rankin Scale (mRS)] were collected. The primary analysis related to the association between collateral scores and clinical outcome. RESULTS:Collaterals are an independent predictive factor of favorable clinical outcome with the two scores, ranging from an odds ratio (OR) [95% confidence interval (CI)] = 1.84 [1.23; 2.76], P = 0.003 for the reference score to an OR [95% CI] = 2.63 [1.21; 5.73], p = 0.015 for the phase 3 ASPECT score. The phase 3 ASPECT score offers better sensitivity (Se) for the prediction of a favorable clinical outcome [Se = 95%, specificity (Sp) = 37% for a threshold of 7/7] than the reference score (Se = 83%, Sp = 47% for a threshold of 4/5). CONCLUSION:This study demonstrates the value of the ASPECT score in analyzing collaterals using multiphase CT angiography for the prediction of clinical outcome.

The present report is of two patients who, immediately after internal carotid endarterectomy, presented with unexplained hemiplegia, despite normal findings on repeated MRI scans, which secondarily evolved into homolateral subacute corticobasal syndrome (CBS), with asymmetrical hemispheric hypometabolism and evidence of dopaminergic denervation. This prompted us to propose an hypothesis of transient cerebral hypoxia arising during the surgical clamping period that might have provoked a prolonged or permanent functional lesion of the left hemisphere and basal ganglia, with no visible infarction on MRI but only synaptic rearrangement of the neural networks, thereby revealing or exacerbating a potentially preexisting silent impairment.

We assessed the impact of internal mammary chain radiotherapy (IMC RT) to the radiation dose received by the heart in terms of heart dose-volume histogram (DVH). Thirty-six consecutive breast cancer patients presenting with indications for IMC RT were enrolled in a prospective study. The IMC was treated by a standard conformal RT technique (50 Gy). For each patient, a cardiac DVH was generated by taking into account the sole contribution of IMC RT. Cardiac HDV were compared according to breast cancer laterality and the type of previous surgical procedure, simple mastectomy or breast conservative therapy (BCT). The contribution of IMC RT to the heart dose was significantly greater for patients with left-sided versus right-sided tumors (13.8% and 12.8% for left-sided tumors versus 3.9% and 4.2% for right-sided tumors in the BCT group and the mastectomy group, respectively; p < 0.0001). There was no statistically significant difference in IMC contribution depending on the initial surgical procedure. IMC RT contributes to cardiac dose for both left-sided and right-sided breast cancers, although the relative contribution is greater in patients with left-sided tumors.

Background The Belgian Federal College of Radiotherapy carried out an external audit of breast cancer patient documentation in the 26 Belgian radiotherapy centres. The objective was to assess compliance with the recommendations regarding minimal requirements for documentation of radiotherapy prescription and administration. All centres volunteered to take part in this audit. Methods Two experienced radiation oncologists site-visited the departments over a 6 month period (Sept. 2003–Feb. 2004), with a list of items to be verified, including details on the surgery, the pathological report, details on systemic treatments, details on the radiotherapy prescription (and consistency with therapeutic guidelines) and delay surgery/radiotherapy. Findings Three hundred and eighty-nine patients files were reviewed, for a total of 399 breast cancers (10 patients with bilateral cancer). Mean age was 57.8 y (range 29–96). Breast conservative surgery (BCS) was used in 71%; radical mastectomy in 29%. A complete pathological report was present in all files but 2 (99.5% conformity). 5.2% were treated for DCIS, 61.6% for pT1, 28.2% for pT2 and 5% for pT3-4. Data regarding resection margins were specified to be free in 76.2%, tangential in 12% (within 2 mm) and positive for DCIS in 3.8% or invasive cancer in 1.5% (no information, on margins in 6.5%). The pT stage was always specified, and consistent with the macroscopic and microscopic findings. Hormonal receptors were routinely assessed (94.7%), as well as Her2neu (87.4%). Axillary surgery was carried out in 92%, either by sentinel node biopsy or by complete clearance, in which case the median number of nodes analysed was 12 for all centres together (7–17). All radiotherapy prescriptions were in line with evidence-based standards of therapy (i.e., irradiation of breast after BCS or after mamectomy (in case of pN+), but one. The mean delay between surgery and radiotherapy was 5.5 weeks (SD 11days). Conclusion There was a high degree of conformity of the various centres with the minimal requirements for documentation of radiotherapy prescription and administration of the Federal College of Radiotherapy. In addition, the quality of surgery (assessed by margin clearance) and of pathological reports was excellent, whatever the institution of origin (teaching vs. non-teaching, private vs. public). Belgian patients referred for radiotherapy are treated with great care. Prescriptions are based on pathological evidence, gathered through appropriate surgery. All indications were evidence-based; there was no overuse of radiotherapy in early breast cancer treatment.

This critical review examines constructional apraxia from a cognitive neuropsychological perspective. To our knowledge, van Sommers (1989) is the only researcher to present a global cognitive model of drawing abilities. He organizes it into two hierarchical systems: Marr's model of visual perception and a graphic production system. The latter comprises four hierarchically organized components: depiction decisions, production strategy, contingent planning, and articulatory and economic constraints. Van Sommers' model will be discussed in light of other models and on the basis of empirical neuropsychological studies (Farah, 1984; Kosslyn & Koenig, 1992; Roncato, Sartori, Masterson, & Rumiati, 1987; van Sommers, 1989). We find that: (1) the Kosslyn and Koenig visual perception model describes more accurately the perceptual components underlying copying than the visual perception system of van Sommers' drawing model, (2) Van Sommers' arguments in favor of a depiction processing as opposed to visual imagery are not convincing, (3) Van Sommers' assumption that a production strategy is a component is unclear, and (4) articulatory and economic constraints are not cognitive components, but constraints imposed during action programming. This literature review leads to a discussion of future research topics and the specificity of constructional apraxia.

Les métastases cérébrales sont une cause importante de mortalité et de morbidité. La survie dépasse rarement un an. À partir cette revue, il apparaît que l'irradiation encéphalique en totalité reste le traitement de référence. Son rôle prédominant est toutefois discuté devant les résultats de la radiothérapie en conditions stéréotaxiques et de ceux des nouveaux médicaments de chimiothérapie. Cependant, le statut neurocognitif des patients après l'irradiation reste insuffisamment connu.Brain metastases are an important cause of mortality and morbidity. The prognosis is poor with a median survival of less than one year in the majority of cases. From this review, whole-brain irradiation clearly appears as the standard treatment. However, its role could be discussed according to newer treatment modalities, radiosurgery or new chemotherapies. Post irradiation neurocognitive status remains insufficiently known.

Radiotherapy is a complex medical speciality involving technology research, biology research and clinical research. All these basic researches are performed in order to optimise the management of cancer treatment patients. The aim of the present review is to present radiotherapy as a moving speciality whatever the concerned section. It will be particularly described the new approaches in terms of technology but also clinical developments.

It is known that primary lesions of lobular invasive carcinoma (Ici) concentrate the glucose analogue FDG-F18 lesser than the primary ductal invasive (dci) ones. To our knowledge, at present, there is no evidenee that the SUV's of secondary lesions in lobular invasive carcinoma are lower than those in ductal invasive carcinoma. 66 investigations (for 58 patients) realized between July 2001 and March 2002 were retrospectively reviewed. 4 patients were examined for initial staging and 54 patients for recurrence suspicion (clinical suspicion, radiological suspicion or elevated serum markers). 42 patients (72%) had a ductal carcinoma histology, 11 patients (19%) had a lobular one, 4 (7%) had a mixed one and one had another histology. 136 lesions were described on the FDG-F18 PETscan. 67/136 (49%) were also described by conventional imaging or by biopsy and 37/136 (27%) are still on follow-up. 32/136 (24%) were never investigated (in 69% of these cases, the prove of their nature would not have changed the therapeutic strategy). 95 of the 136 lesions were quantified (SUVbwmax measurements). 74/95 (77%) of these lesions were secondary ductal ones, 11/95 (11%) were secondary lobular ones and 9/95(9%) were secondary mixed ones.