Le cancer de prostate est considéré comme une tumeur « hormonodépendante ». L’inhibition de l’action pro-tumorale de la testostérone a rapidement trouvé sa place dans la prise en charge des cancers de prostate métastatiques, puis s’est imposée aussi dans les cancers localisés. Pour tirer profit de l’action locale de la radiothérapie et de l’action systémique de l’hormonothérapie, de nombreuses études ont montré un bénéfice clinique majeur, démontrant même une action synergique à l’association des deux traitements. La radiothérapie associée à de l’hormonothérapie par analogues de la LH-RH représente à présent un traitement de référence dans les cancers de prostate localisés de risque intermédiaire et de haut risque, en tirant profit de l’action directe de l’hormonothérapie contre les cellules tumorales, mais également de son action radiosensibilisante. Cet article fait le point sur les bénéfices cliniques de l’association radiohormonale et les mécanismes de cette action synergique, et développe les perspectives que vont offrir prochainement les nouvelles molécules d’hormonothérapie.

L’immunothérapie occupe une place grandissante en cancérologie urologique, principalement pour les cancers du rein et de la vessie. Sur la base de travaux précliniques encourageants, la combinaison de l’immunothérapie avec la radiothérapie ambitionne de majorer la réponse tumorale, y compris des tumeurs métastatiques ce qui suscite de nombreux espoirs dont cet article fait le bilan.

Immunotherapy occupies a growing place in urologic oncology, mainly for kidney and bladder cancers. On the basis of encouraging preclinical work, the combination of immunotherapy with radiotherapyaims to increase the tumor response, including in metastatic tumors, which raises many hopes, whichthis article reviews. (c) 2021 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. Allrights reserved.

Purpose or ObjectiveModern pre-clinical radiotherapy allows to mimic 3D image-guided clinical radiotherapy but has to be adapted to small animal and target size constraints: beam size, targeting accuracy and image resolution are scaled-down; and beam energy is reduced from MV to kV.In our institution, the XRAD225Cx µ-irradiator is used for preclinical studies and a Monte Carlo (MC) model (GATEv7) was previously created and validated for dose calculation in small animals.However, typical MC environments do not provide the same tools that are available in a clinical treatment planning system (TPS) to manage patient workflow and irradiation.Moreover, these tools are not adapted for pre-clinical requirements.The goal of this

Stereotactic body radiation therapy (SBRT) dedicated to spinal metastases (SM) allows high doses delivered to tumors while sparing the spinal cord. Clinical target volumes (CTV) are delineated on MRI images based on the International Spine Radiosurgery Consensus (ISRC). Magnetic resonance imaging reconstructed axial images from sagittal acquisitions are difficult to use for lesion delineation. This study aimed to test a new delineation approach based on functional imaging PET-CT and phenotypic pre-targeted immuno-PET-CT (anti-CEA x anti-HSG humanized trivalent TF2 BsMAb and 68Ga-IMP288 HSG peptide) in metastatic breast (BC) or medullary thyroid (MTC) cancer CEA positive patients compared to reference imaging (MRI). All patients underwent PET-CT (FDG for BC or F-DOPA for MTC) and iPET images that were compared to MRI. Lesion segmentation was performed by absolute threshold (SUV = 2, 5) in PET images. For each modality, vertebrae locations and vertebral segments of lesions were collected according to the schema of the ISRC. The impact on CTV delineation was evaluated. The results were compared in pairs. Seven patients (4BC, 3MTC) with spinal metastases were included. One hundred sixteen SM were evaluated, and 35 lesions were eligible for SBRT. Sixty-three vertebrae segments were detected in MRI, 25 with PET and 48 with iPET; iPET was able to detect as many lesions as MRI for vertebral bodies (31 vs 31), laminas and transverse processes (9 vs 9), but less for pedicles (8 vs 21), and spinous processes (0 vs 2). These differences modified the CTV in 88% (31/35) for MRI/iPET comparison, 60% (21/35) and 86% (30/35), respectively for MRI/(FDG or FDOPA)-PET and PET/iPET; iPET determination of segments was easier due to higher contrast. Due to its volume acquisition and its phenotypic uptake, iPet segmental mapping is achieved easier and more accurately than MRI, and a change in 88% of cases of the CTV of lesions to be treated by SBRT.