INTRODUCTION:Pediatric cancers are rare, representing almost 2,500 new cases each year in France meaning 1% of all cancers. Since 2012, a twice-monthly national web-based conference was held in France. Any patient with a pediatric type cancer requiring radiotherapy can be discussed. It aims at answering the physician with specific radiation therapy questions on rare and complex indications, at promoting the use of referential and the inclusion into clinical protocols.RESULTS:From 2012 to 2018, 1,078 cases were discussed for 940 patients in 142 meetings. Mean age was 10 years old (4 months to 45 years). The mean number of attendants was 6 (2 to 32). We review in this paper the main clinical features discussed in the web-conference and the decision of the web-conference. In 85% cases, the first treatment proposed was mostly accepted, but in 15%, other proposals were done (modifications of target volumes, doses or indications).CONCLUSIONS:Between 2012 and 2018, more than 1,000 pediatric irradiation cases were discussed in our web-based conference leading to 15% of change in radiation protocol. The rarity and the complexity of these situations need those meetings. They provide a place to improve the global knowledge and the quality of the treatments provided.

En cas d’échec de la chirurgie transsphénoïdale (TSS) ou de récidive, les traitements en seconde ligne de la maladie de Cushing (MC) comprennent les traitements médicamenteux (TM), la réintervention transsphénoïdale (2 de TSS), la surrénalectomie bilatérale (SB) et la radiothérapie hypophysaire (RH). Nous avons évalué l’apport du traitement médicamenteux. Étude rétrospective monocentrique de 119 patients traités par TSS pour MC en 2001–2020, comprenant 36 candidats à un traitement en seconde ligne dont 19 échecs de TSS (taux de rémission chirurgicale 84 %) et 17 récidives (taux de récidive 17 %). Les 36 patients ont été traités (plusieurs traitements possibles par patient) par TM : 29/36(80 %) ; 2 de TSS : 16/36 (50 %) ; SB : 14/36 (39 %) et RP : 3/36 (8 %). Chez les 29 patients traités par TM, les médicaments utilisés étaient kétoconazole (27/29), métyrapone (15/29), cabergoline (11/29), osilodrostat (8/29), mitotane (3/29), pasiréotide (3/29). À la fin de l’étude, le contrôle de la MC était réalisé par TM chez 11 patients (30 % des 36 patients, 34 % des patients traités par DT) 2 de TSS chez 8 (22 % des 36 patients, 50 % des patients réopérés) et SB chez 14 (39 % des 36 patients, 100 % des patients opérés). Les 11 patients contrôlés par TM utilisaient kétoconazole (6/27 exposés), métyrapone (1/15 exposés) osilodrostat (6/8). Chez 36 patients MC en échec de TSS ou récidive, le TM par inhibiteurs de la steroidogénèse a permis de contrôler à long terme 11/36 (30 %) patients et de retarder la chirurgie chez 13/16 patients traités par TSS et 11/14 patients traités par SB.

Pediatric cancers are rare, representing almost 2,500 new cases each year in France meaning 1% of all cancers. Since 2012, a twice-monthly national web-based conference was held in France. Any patient with a pediatric type cancer requiring radiotherapy can be discussed. It aims at answering the physician with specific radiation therapy questions on rare and complex indications, at promoting the use of referential and the inclusion into clinical protocols.From 2012 to 2018, 1,078 cases were discussed for 940 patients in 142 meetings. Mean age was 10 years old (4 months to 45 years). The mean number of attendants was 6 (2 to 32). We review in this paper the main clinical features discussed in the web-conference and the decision of the web-conference. In 85% cases, the first treatment proposed was mostly accepted, but in 15%, other proposals were done (modifications of target volumes, doses or indications).Between 2012 and 2018, more than 1,000 pediatric irradiation cases were discussed in our web-based conference leading to 15% of change in radiation protocol. The rarity and the complexity of these situations need those meetings. They provide a place to improve the global knowledge and the quality of the treatments provided.

Purpose. - Helical Tomotherapy (HT) appears as a valuable technique for total body irradiation (TBI) to create highly homogeneous and conformal dose distributions with more precise repositioning than conventional TBI techniques. The aim of this work is to describe the technique implementation, including treatment preparation, planning and dosimetric monitoring of TBI delivered in our institution from October 2016 to March 2019. Material and method. - Prior to patient care, irradiation protocol was set up using physical phantoms. Gafchromic films were used to assess dose distribution homogeneity and evaluate imprecise patient positioning impact. Sixteen patients' irradiations with a prescribed dose of 12 Gy were delivered in 6 fractions of 2 Gy over 3 days. Pre-treatment quality assurance (QA) was performed for the verification of dose distributions at selected positions. In addition, in-vivo dosimetry was carried out using optically stimulated luminescence dosimeters (OSLD). Results. - Planning evaluation, as well as results of pre-treatment verifications, are presented. In-vivo dosimetry showed the strong consistency of OSLD measured doses. OSLD mean relative dose differences between measurement and calculation were respectively +0,96% and -2% for armpit and hands locations, suggesting better reliability for armpit OSLD positioning. Repercussion of both longitudinal and transversal positioning inaccuracies on phantoms is depicted up to 2 cm shifts. Conclusion. - The full methodology to set up TBI protocol, as well as dosimetric evaluation and pretreatment QA, were presented. Our investigations reveal strong correspondence between planned and delivered doses shedding light on the dose reliability of OSLD for HT based TBI in-vivo dosimetry. (C) 2020 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

cancelled

Purpose. The improvement of the management of childhood cancer has led to a strong increase of the overall survival rate about 80%. Radiation therapy, element still required for the management in some cancers, is associated with long-term side effects. The aim of this study was to analyze late effects of childhood cancer survivors whose treatment included radiation therapy.Methods. SALTO's study, based on childhood cancer registers of Rhone-Alpes-Auvergne, concerned children with solid cancer or lymphoma before the age of 15 years, diagnosed between 1987 and 1992. These patients, at least 18 years old, attended to a clinic consultation with a pediatric oncologist and adult internist between 2011 and 2014. Adults treated during childhood cancer with radiation therapy, associated or not with chemotherapy or surgery, have been included and compared with those treated only with chemotherapy and/or surgery. Late effects have been classified as moderate or severe according to the CTCAE.Results. Fifty-nine patients with radiation therapy attended these consultations and 91 without radiation therapy. Fifty-eight patients with radiation therapy (98.3%) had at least one sequela. The main late effects all ranks were orthopedic (37%), endocrine (32%), thyroid (31%) dysfunction and obesity (31%). The main late effects of grade 3-4 were endocrine, renal, obesity and secondary cancers. The proportion of endocrine, thyroid, orthopedic, skin late effects, hearing loss and secondary cancers were significantly higher in irradiated patients compared to non-irradiated patients.Conclusion. These results are important for the current implementation of long term follow up of childhood cancer survivors, focused on these late effects to greater prevention or early treatment. (C) 2016 Elsevier Masson SAS. All rights reserved.

Les métastases cérébrales sont les tumeurs les plus fréquentes du système nerveux central. Le bilan IRM doit comporter des séquences pondérées en T1 sans et avec injection, en T2/FLAIR. Elles apparaissent le plus souvent comme des lésions multiples prenant le contraste de façon annulaire ou nodulaire et sont entourées d’œdème. Elles sont hypervascularisées, ne présentent pas de restriction du coefficient de diffusion dans leur zone nécrotique, contiennent des lipides en spectroscopie 1H. L’absence d’infiltration péritumorale par des cellules malignes permet de différencier métastases et tumeurs primitives. La radiothérapie stéréotaxique peut induire une augmentation du volume tumoral transitoire sans valeur péjorative d’un point de vue carcinologique. Plus rares, les atteintes médullaires peuvent être asymptomatiques et sont à rechercher par IRM.

Radiotherapy and chemotherapy may induce neurological toxicities with different appearances on CT and MRI scans. While optimized radiotherapy techniques have reduced some complications, new unwanted effects have occurred on account of therapeutic protocols involving the simultaneous use of radiotherapy and chemotherapy. Advances in radio-surgery, innovative anti-angiogenic therapies, as well as prolonged patient survival have led to the emergence of new deleterious side effects. In this report, we describe the early, semi-delayed, and late encephalic complications, while specifying how to identify the morphological lesions depending on the therapeutic protocol.

Cerebral metastases are the commonest central nervous system tumors. The MR assessment should include T1-weighted images with and without enhancement and T2/FLAIR images. They usually appear as multiple lesions with nodular or annular enhancement and are surrounded by edema. They are hypervascularized and have no restriction of their diffusion coefficient in their necrotic area and contain lipids on 1H spectroscopy. Metastases can be distinguished from primary tumors by the lack of malignant cell infiltration around the tumor. Stereotactic radiotherapy may temporarily increase tumor volume, although this is not of adverse oncological value. Less commonly, spinal disease may be asymptomatic and should be examined by MR.

Les carcinomes des voies aérodigestives supérieures (VADS) sont fréquents en France chez les hommes. Ils regroupent les cancers de la cavité buccale, du pharynx et du larynx. Il s'agit essentiellement de carcinomes épidermoïdes. Les facteurs de risque majeurs sont l'alcool et le tabac, dont les effets se multiplient. Chez les hommes, la baisse de la consommation d'alcool en France et la baisse de la consommation de cigarettes a entraîné une diminution de l'incidence de ces cancers. La meilleure prévention des carcinomes épidermoïdes des voies aérodigestives supérieures est une réduction de la consommation d'alcool et de tabac.Head and neck carcinomas, i.e. oral cavity, pharynx and larynx cancers, are frequent among men in France. They are mostly squamous-cell carcinomas. The main risk factors are alcohol and tobacco, and their effects are multiplicative. In France, alcohol and tobacco consumptions are decreasing in the male population leading to decrease in head and neck carcinoma incidence and mortality. The best way to prevent head and neck carcinoma is the reduction of alcohol and tobacco consumption.

Objective. - The purpose of this study was to evaluate retrospectively whether cerebral blood volume measurement based on pretreatment perfusion MRI is a prognostic biomarker for survival in patients with oligodendroglioma or mixed oligoastrocytoma.Patients and methods. - Between 1998 and 2004, 54 patients (23 females and 31 males), aged 21-73 years, with oligodendroglioma (or mixed tumour) were examined prior to beginning treatment with dynamic susceptibility-weighted contrast (DSC) perfusion MRI during gadolinium first-pass. The relative cerebral blood volume (rCBV) was calculated by dividing the measurement within the tumour by the measurement of the normal-appearing contralateral region. Patients were classified in two groups, grade A and grade B, according to the Saint-Anne Hospital classification and followed-up clinically and by means of MRI until their death or for a minimum of 5 years. Patients were also classified in grade II and grade according to the World Health Organisation (WHO) classification, and were analysed with the same methods. Age, sex, treatment, tumour grade, contrast agent uptake, and rCBV were tested using survival curves with Kaplan-Meier's method, and their differences were analysed using the log-rank test.Results. - In this population, median survival was 3 years. A rCBV threshold value of 2.2 was validated as a prognostic factor, for survival in these patients with oligodendrogliomas. Age, sex, contrast uptake, and maximum rCBV were found to be prognostic factors in univariate analysis. Multivariate analysis revealed that tumour grade (grade A/grade B), rCBV, age, and sex were prognostic factors independent of the other factors. The tumour grade according to the WHO classification (II versus III-IV) was also detected as an independent prognostic factor.Conclusion. - Pretreatment rCBV measured by DSC perfusion MRI was found to be a prognostic factor for survival in patients with oligodendroglioma or mixed tumour, by using the Saint-Anne Hospital classification, which separate the IIB from the IIA. (C) 2010 Elsevier Masson SAS. All rights reserved.

To characterize peritumoral BOLD contrast disorders, 25 patients referred for resection of primary frontal or parietal neoplasms (low-grade glioma (LGG) (n=8); high-grade glioma (HGG) (n=7); meningioma (n=10)) without macroscopic tumoral infiltration of the primary sensorimotor cortex (SM1) were examined preoperatively using BOLD fMRI during simple motor tasks. Overall cerebral BOLD signal was estimated using vasoreactivity to carbogen inhalation. Using bolus of gadolinium, cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) were estimated. In a 1cm3 region-of-interest centered on maximal T-value in SM1 contralateral to movements, interhemispheric asymmetry was evaluated using interhemispheric ratios for BOLD and perfusion parameters. During motor tasks contralateral to the tumor, ipsitumoral sensorimotor activations were decreased in HGG and meningiomas, correlated to the distance between the tumor and SM1. Whereas CBV was decreased in ipsitumoral SM1 for HGG, it remained normal in meningiomas. Changes in basal perfusion could not explain motor activation impairment in SM1. Decreased interhemispheric ratio of the BOLD response to carbogen was the best predictor to model the asymmetry of motor activation (R=0.51). Moreover, 94.9±4.9% of all motor activations overlapped significant BOLD response to carbogen inhalation.

PURPOSE:To present the imaging and perfusion data obtained in nine patients with pilocytic astrocytomas (PA) and to discuss the original functional issues of this technique.METHOD:Nine patients with pathologically proven PA underwent conventional and perfusion MR imaging. Various areas of relative cerebral blood volume (rCBV) within the tumors were obtained. The maximum rCBV ratios were identified and considered as representative of the tumor. The results were compared with the pathological findings.RESULTS:In all patients, rCBV was <1.5 (mean 1) and the signal intensity curve overshot the baseline.CONCLUSION:PA tend to have low rCBV values and a first-pass curve that crosses the baseline. These characteristics may be explained by the histological profile of the tumoral vascularity and are of relevance in the identification of these rare tumors.

In a few years, magnetic resonance imaging (MRI) has evolved from a morphology-based examination to one that encompasses metabolism and function.MRI is a well-established tool for the initial evaluation of brain tumors, but conventional MR sequences have some limitations. Conventional MRI is unable to distinguish high-grade glioma from metastasis and abscess, to define precisely the histopathological grade of gliomas, to determine exactly the limits of tumor extension, to characterize meningeal tumors. Differentiation of tumor recurrence from treatment-related changes may be difficult with standard MR imaging because the interpretation is essentially based on volume analysis.1H Spectroscopy, diffusion and perfusion imaging become possible with the development of MR imagers and can be routinely performed in clinical settings. They give complementary information about tumor metabolism and vascularity and allow a better analysis of post-treatment modifications. Functional and metabolic explorations should be used to characterize brain tumors.