Multicentric development and evaluation of [18F]FDG PET/CT and CT radiomic models to predict regional and/or distant recurrence in early-stage non-small cell lung cancer treated by stereotactic body radiation therapy.

PURPOSE: To develop machine learning models to predict regional and/or distant recurrence in patients with early-stage non-small cell lung cancer (ES-NSCLC) after stereotactic body radiation therapy (SBRT) using [18F]FDG PET/CT and CT radiomics combined with clinical and dosimetric parameters. METHODS: We retrospectively collected 464 patients (60% for training and 40% for testing) from University Hospital of Liège and 63 patients from University Hospital of Brest (external testing set) with ES-NSCLC treated with SBRT between 2010 and 2020 and who had undergone pretreatment [18F]FDG PET/CT and planning CT. Radiomic features were extracted using the PyRadiomics toolbox®. The ComBat harmonization method was applied to reduce the batch effect between centers. Clinical, radiomic, and combined models were trained and tested using a neural network approach to predict regional and/or distant recurrence. RESULTS: In the training (n = 273) and testing sets (n = 191 and n = 63), the clinical model achieved moderate performances to predict regional and/or distant recurrence with C-statistics from 0.53 to 0.59 (95% CI, 0.41, 0.67). The radiomic (original_firstorder_Entropy, original_gldm_LowGrayLevelEmphasis and original_glcm_DifferenceAverage) model achieved higher predictive ability in the training set and kept the same performance in the testing sets, with C-statistics from 0.70 to 0.78 (95% CI, 0.63, 0.88) while the combined model performs moderately well with C-statistics from 0.50 to 0.62 (95% CI, 0.37, 0.69). CONCLUSION: Radiomic features extracted from pre-SBRT analog and digital [18F]FDG PET/CT outperform clinical parameters in the prediction of regional and/or distant recurrence and to discuss an adjuvant systemic treatment in ES-NSCLC. Prospective validation of our models should now be carried out.

[Éditorial. La radiothérapie dix ans après]. / Éditorial. La radiothérapie dix ans après.

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[Network science. Part 2 : in radiotherapy]. / La science des réseaux. Partie 2 : en radiothérapie.

In a former publication, we summarized basic principles of network science in order to understand its potential, especially within the field of oncology. This rather young science offers, for example, the opportunity to identify new systemic treatment options. However, these are not the only therapeutic options within the arsenal devoted to the battle against cancer. The two other main pillars of treatment are surgery and radiotherapy. It is our purpose to highlight some applications - rather limited nowadays - of network science in radiotherapy. Data are not so abundant compared to the field of systemic treatments.

Dans un article précédent, les préceptes de base de la science des réseaux ont été sommairement abordés, afin d'en illustrer l'intérêt en cancérologie, en général. Nous avons pu faire le point - de façon non exhaustive - sur l'utilité de cette science assez jeune, en montrant, par exemple, son apport en matière d'identification de moyens systémiques de traitement. Les traitements systémiques font partie de l'arsenal thérapeutique, tout comme d'ailleurs la chirurgie et la radiothérapie. Nous voulons décrire brièvement certaines applications de la science des réseaux quand il s'agit du domaine particulier des radiations ionisantes, même si leur nombre est somme toute plus limité par rapport à ce qui est publié dans le domaine des traitements systémiques.

[Network science. Part 1 : in oncology in general]. / La science des réseaux. Partie 1 : en cancérologie, en général.

The overwhelming avalanche of data issued from the omics cascade, and particularly the mapping of protein-protein interaction (interactome), allows us to dissect the complexity and overlapping of diseases, as well as their management. With the help of theoretical and scientific bases issued form network science, as well as the rapid evolution of artificial intelligence, in particular machine learning (with its high speed and capacity), we are able today to uncover new driver genes, new biomarkers, new interactions with diagnostic and therapeutic modalities (even for an individual patient). It also opens new perspectives in the fields of prediction of response to treatment as well as prevention. The expectations are particularly high and diverse in health care. We take stock non-exhaustively on some applications in the field of oncology.

L'avalanche des données issues de la cascade des «omics¼, et en particulier la cartographie des interactions protéine-protéine (l'interactome), permettent aujourd'hui - grâce aux bases théoriques et scientifiques établies dans la science des réseaux, et aux développements rapides en intelligence artificielle, en particulier en «machine learning¼ (avec sa rapidité et sa puissance de calcul) - de disséquer la complexité et la superposition des maladies, ainsi que leur prise en charge. Ceci nous permet également de découvrir de nouveaux gènes clé, de nouveaux biomarqueurs, de nouvelles interactions avec des modalités tant thérapeutiques que diagnostiques (y compris adaptées à l'individu), et nous ouvre de nouvelles perspectives dans les domaines de la prédiction (de la réponse à un traitement) et de la prévention. Les attentes sont donc multiples dans le domaine de la santé. Nous faisons le point - de façon non exhaustive - sur certaines applications dans le domaine particulier de l'oncologie.

[Should we add metaverse to the future medical lexicon ?] / La médecine du futur. Rajouter «Métavers¼ au lexique médical du futur ?

I's too early, nowadays, to assess the potential impact on healthcare of a nascent concept such as the metaverse. The technical tools necessary to construct it are readily available, and for some of them already independently used in selected domains of medical care, with success. The convergence of the construction stones will result in an extended reality. Multisensory feedback (inclusive haptic) will end up in a much more realistic and complex virtual immersion, paving the way to new socio-emotional experiences and new communication models, conducive to education, diagnosis and treatment, all of potential interest in heathcare.

Même s'il est trop tôt pour en estimer l'impact sur le monde des soins de demain, il faut - en tant que professionnel de la santé - dès à présent se familiariser avec le concept «métavers¼. Les éléments techniques clés sont déjà disponibles, et parfois utilisés aujourd'hui séparément, et d'ailleurs avec un certain succès, dans des domaines bien précis de la médecine. La convergence des différentes techniques, créant une réalité étendue, et le retour pluri-sensoriel (y compris haptique), permet de créer une immersion virtuelle beaucoup plus réaliste et complexe, qui ouvre la voie à de nouvelles expériences socio-émotionnelles et de nouveaux moyens de communication, propices à l'éducation, le diagnostic et le traitement, tous potentiellement intéressants pour les soins de santé.

[In matters of health we should all be equal : unfortunately some are more equal than others ]. / Face à la COVID-19. En matière de santé nous devrions tous être égaux : malheureusement certains sont plus égaux que d'autres .

In 1978, at Alma Ata, it was clearly claimed that inequities in health are simply not acceptable. Each individual should be able to achieve the highest possible level of health (in its holistic definition). This should be considered as a fundamental human right. However, this latter is largely undermined by the unequal distribution of power, money and resources. The gap separating advantaged from disadvantaged people has clearly been highlighted, and even accentuated, during the recent health care crisis due to COVID-19. This schism is widely present, both at the international level but also within the boundaries of each country, rich or poor. In the interest of society in general, it will be mandatory to address - rapidly - these social determinants of health (the causes of the causes), because the health inequity is not the illustration of a system failure. It is the result of the organization and operationalization of the system itself.

À Alma Ata en 1978, il est clairement établi que les iniquités ne sont pas acceptables en matière de santé. Le concept que chaque individu doit pouvoir atteindre le plus haut niveau de santé possible (dans sa définition holistique) est considéré comme un droit fondamental humain. Toutefois, ce dernier est largement battu en brèche par la distribution non équitable de la puissance, de l'argent, et des ressources. Le fossé qui sépare les favorisés des défavorisés a clairement été mis en lumière, voire même accentué, à l'occasion de la récente crise sanitaire due à la COVID-19. Ce schisme est largement présent au niveau international, mais également à l'intérieur de chaque pays, riche ou pauvre. Dans l'intérêt sociétal général, il faudra s'attaquer ­ rapidement ­ aux déterminants sociaux de la santé (les causes des causes). En effet, cette iniquité en santé n'est pas l'illustration d'une défaillance d'un système, c'est le résultat de l'organisation et l'opérationnalisation même du système.

[Get used to digital therapeutics (DTx) : they will take the scene in health care !] / La médecine du futur. Habituez-vous aux moyens de traitements digitaux : ils arrivent !

Digital therapeutics are making headways in medical treatment at large. They are used alone or in combination with standard medical treatment in various fields, aiming at essentially behavioral changes. As we are facing a growing imbalance between demand and resources, these digital treatments offer a powerful way for patient empowerment.

Les traitements numériques font irruption dans l'arsenal thérapeutique. Ils sont utilisés seuls ou en association avec des approches médicamenteuses classiques. Ils visent souvent des changements comportementaux dont on souligne de plus en plus l'importance dans différents domaines de la santé. Vu l'augmentation significative des besoins en soins de santé, dans un contexte tendu de limitations de ressources, ils offrent un moyen d'autonomisation de la prise en charge par les patients.

[Generative artificial intelligence and large language models in healthcare]. / La médecine du futur Intelligence artificielle générative et modèle linguistique large en soins de santé. Du battage médiatique à la réalité.

Generative artificial intelligence (GAI) and large language models (LLM) made their fulgurant irruption in our society at all levels, inclusive in health care. Possible applications and proofs of concept are everywhere. There is without any reasonable doubt an enormous potential, especially nowadays as we are facing an ever-growing imbalance between the flux of data and the availability of human resources. The creativity of GAI will be highlighted in the quest of defining protein structures and search for new medications, as well as for the development and use of digital twins in clinical research. As far as LLM's are concerned, we need to make a distinction between general models and models dedicated specifically to healthcare. Again, making an extensive overview of used cases is becoming impossible today, facing the numerous publications in the field.

Les mots intelligence artificielle générative (GAI) et modèles linguistiques larges (LLM) sont devenus ubiquitaires et incontournables en un temps record. En médecine aussi, le nombre d'applications possibles et preuves de concept foisonnent. Le potentiel est effectivement énorme, en particulier aujourd'hui, dans un monde de soins en déséquilibre, caractérisé par un flux énorme de données et un manque de moyens humains. La force créative de la GAI est illustrée par un exemple issu de la recherche protéomique et le développement de nouveaux médicaments, ainsi que dans le monde de la recherche clinique avec le développement des jumeaux digitaux. Pour le LLM, il faut faire la distinction entre modèles généralistes et spécialisés (adaptés au monde des soins). Là aussi, il devient de plus en plus difficile aujourd'hui d'en faire une revue exhaustive, car la littérature abonde de cas d'usage.

[Sexual health and oncology]. / Santé sexuelle et oncologie.

Over the past 20 years, the number of new cancer diagnoses has risen steadily, partly due to the aging of the population. In 2021, 74,998 new diagnoses were recorded in Belgium. At the same time, improved screening techniques and advances in oncology treatments have increased patient survival. As a result, the prevalence of cancer has risen: 4 out of every 100 Belgians are currently living with cancer. In addition to the symptoms caused by the disease, patients have to cope with the side effects of treatments. Quality of life is becoming essential in the care of these patients, and this requires better communication, quality information, and the implementation of appropriate preventive and therapeutic measures. Sexual health is an integral part of overall health, well-being, and quality of life. It must therefore be assessed and integrated into patient care throughout the entire course of treatment.

Depuis 20 ans, le nombre de nouveaux diagnostics de cancer n'a cessé d'augmenter, en partie en raison du vieillissement de la population. En 2021, 74.998 nouveaux diagnostics ont été enregistrés en Belgique. Parallèlement, l'amélioration des techniques de dépistage et les différentes avancées en matière de traitements oncologiques ont permis d'accroître la survie des patients. La prévalence du cancer a donc augmenté : 4 Belges sur 100 vivent actuellement avec un diagnostic de cancer. En plus des symptômes provoqués par la maladie, les patients doivent faire face aux effets secondaires des traitements. Prendre en compte la qualité de vie devient essentiel dans la prise en charge, et cela passe par une meilleure communication, une information de qualité ainsi que la mise en place de mesures préventives et thérapeutiques adaptées. La santé sexuelle fait partie intégrante de la santé, du bien-être et de la qualité de vie. Elle doit donc être évaluée et intégrée à la prise en charge des patients tout au long de leur parcours de soins.

[Should fire cutters be thrown into the fire ?] / Faut-il jeter au feu les coupeurs de feu ?

Spirituality (in addition to laughter) is inherent to humans. When their health deteriorates, especially in the field of oncology, people often seek help through it. Prayer is the most commonly used tool and is sometimes entrusted to a particular person believed to possess certain powers referred to as a «fire cutter¼. It is then used in a targeted manner against specific symptoms such as burns. No biophysical effects are known. This intercession brings secondary benefits (positive effects on anxiety, stress, placebo effect) that can improve the patients' health. It is not the healthcare provider's mission to prescribe these spiritual practices, but they should be able to recognize them and openly discuss with patient who choose to use them, knowing that a benefit is likely to be reached.

La spiritualité (en plus du rire) est le propre de l'homme. Quand son état de santé se dégrade, en particulier en cancérologie, il y cherche souvent une aide. La prière est l'outil le plus souvent utilisé. Elle est parfois confiée à une personne particulière dotée de certains pouvoirs appelée «coupeur de feu¼. La prière est alors utilisée de manière ciblée contre une symptomatologie spécifique type brûlure. Aucun effet biophysique n'est connu. Cette intercession amène des bénéfices secondaires (effet sur l'anxiété, le stress, effet placebo) à même d'améliorer l'état de santé des patients. Le soignant n'a pas pour mission de prescrire ces accompagnements qui relèvent du spirituel, mais doit savoir les reconnaître et en discuter de manière ouverte avec le patient y ayant recours, sachant qu'un bénéfice sera vraisemblablement au rendez-vous.

[The place of radiation therapy following radical prostatectomy in 2024]. / La place de la radiothérapie après une prostatectomie dans les cancers de la prostate en 2024.

Radiation therapy after prostatectomy for a prostate cancer is a recommended treatment in case of biochemical relapse (rising PSA) following surgery. Controversies regarding its optimal use, delivery, and toxicities are often discussed, not only within scientific congresses but also during multidisciplinary oncological boards. This article aims at making an assessment of up-to-date knowledge and recommendations to guide decision making regarding the treatments of patients with prostate cancer.

La radiothérapie après prostatectomie pour un cancer de prostate est un traitement recommandé en cas de «récidive biochimique¼ (ré-élévation du PSA) après l'opération. Des controverses quant à son utilisation optimale, sa réalisation, et ses toxicités font régulièrement l'objet de discussio, que ce soit au sein des sociétés scientifiques ou lors des concertations oncologiques multidisciplinaires. Cet article a pour but de faire l'état des lieux des connaissances actuelles et des recommandations existantes afin de guider nos réflexions et prises de décision concernant les traitements des patients présentant un cancer de la prostate.

[Diversity, equity and inclusion in radiation oncology : where do we stand ?] / Diversité, équité et inclusion en radiothérapie-oncologie : où en sommes-nous ?

INTRODUCTION: The promotion of diversity, equity and inclusion (DEI) is increasingly sought after in healthcare, which is why we wanted to draw up a picture of DEI in radiation oncology and give some ideas on how to contribute to its dissemination. METHOD: This article proposes a non-exhaustive review of the international literature on DEI in radiation oncology, both among health professionals and patients. In addition, this review identifies some implicit cognitive biases and proposes strategies to address them. RESULTS: Most of the proposed publications identify a lack of DEI among radiation oncology staff and document inequities in access to high-quality radiotherapy affecting patients belonging to minority groups. CONCLUSION: Significant disparities exist between genders and ethnic groups within the radiotherapy teams, and in the radiotherapy treatment of patients. Nevertheless, DEI is gaining importance, and a range of initiatives and instruments are being developed to address these disparities.

INTRODUCTION: La promotion de l'équité, de la diversité et de l'inclusion (EDI) est de plus en plus recherchée dans les soins de santé, raison pour laquelle nous avons voulu dresser un tableau de l'EDI en radiothérapie et donner des pistes pour contribuer à sa diffusion. Méthode : Cet article propose une revue non exhaustive de la littérature internationale sur l'EDI en radiothérapie, tant chez les professionnels de la santé que chez les patients. En outre, cette revue relève des biais cognitifs implicites et propose des stratégies pour y remédier. Résultats : La majorité des publications proposées identifient un manque d'EDI parmi les professionnels en radiothérapie, et documentent également des iniquités dans l'accès à une radiothérapie de haute qualité touchant les patients issus de groupes minoritaires. CONCLUSION: D'importantes disparités existent entre genres et groupes ethniques au sein des équipes de radiothérapie ainsi que dans le traitement des patients par radiothérapie. Néanmoins, l'EDI gagne en importance et toute une série d'initiatives et d'instruments pour remédier à ces disparités se développent.

[Anal canal cancer : epidemiology, work-up, treatment and perspective]. / Le cancer du canal anal : épidémiologie, bilan, traitement et futur.

Although rare, around 2 % of digestive tumours, anal canal tumours remain a pathology that should not be neglected. These are frequently underdiagnosed due to the affected region and the symptoms that can be confused with more common and benign pathologies such as haemorrhoids or anal fissures. The treatment of these tumours is mainly based on radio-chemotherapy to avoid heavy surgical treatment which remains the salvage option. This article aims to review the epidemiology, diagnosis, management, monitoring and future developments for these cancers.

Bien que rares (environ 2 % des tumeurs digestives), les tumeurs du canal anal restent une pathologie à ne pas négliger. Elles sont souvent sous-diagnostiquées en raison de la région touchée et de la symptomatologie non spécifique, et confondues avec des pathologies plus fréquentes et bénignes comme des hémorroïdes ou des fissures anales. Le traitement de ces tumeurs repose principalement sur la radio-chimiothérapie, afin d'éviter une prise en charge chirurgicale lourde qui reste l'option de sauvetage. Cet article a pour but de passer en revue l'épidémiologie, le diagnostic, la prise en charge, le suivi et les futurs développements pour ces cancers.

Outcome analysis of HDR compared to PDR IGABT in locally advanced cervical cancer: a single-center cohort analysis.

PURPOSE: This monocentric study aimed to assess the impact of technical advancement in brachytherapy (BT) on local control (LC) and cancer-specific survival (CSS) in locally advanced cervical cancer (LACC). METHODS: Since 2010, 211 patients with LACC have been treated with 45/50.4 Gy or 60 Gy radiochemotherapy (RTCT) followed by image-guided adaptive brachytherapy (IGABT) at the authors' institution. In 2013, combined intracavitary and interstitial brachytherapy (BT IC/IS) was implemented and in 2018, pulsed-dose-rate BT (PDR-BT) was replaced by high-dose-rate BT (HDR-BT). LC, CSS, and morbidity according to the RTOG/EORTC scoring system were analyzed. Dose-volume parameters for the high-risk clinical target volume (HRCTV) and organs at risk (OAR) were reported. RESULTS: While 27 (12.8%) patients died of LACC, complete local remission was achieved in 199 (94.3%). Local relapse decreases with a high D95 in the HRCTV (hazard ratio, HR = 0.85, p = 0.0024). D95 in the HRCTV is lower after 60 Gy even if interstitial BT is used. Mean D95 in the HRCTV is 78.2 Gy, 83.3 Gy, and 83.4 Gy with PDR-BT IC, PDR-BT IC/IS, and HDR-BT IC/IS, respectively, after 45/50.4 Gy. D2 cc of OARs is significantly reduced by using interstitial BT. The mean rectum and sigmoid D2 cc are about 61.5 Gy with PDR-BT IC/IS and significantly decreased with HDR-BT IC/IS. This translates into a low fistula incidence. A very low rate of severe gastrointestinal (3.4%) and genitourinary (2.3%) toxicity was observed with HDR-BT IC/IS. CONCLUSION: This large monocentric study provides further evidence that implementation of BT IC/IS has an impact on D95 in the HRCTV, LC, and CSS. There are no differences between HDR and PDR in terms of efficacy, D95 in the HRCTV, and toxicity grade ≥ 3.

[Syndemics and non infectious diseases]. / Application du concept de syndémie en dehors des maladies infectieuses.

The concept of "syndemics" is getting more and more popularity in scientific journals, especially since the end of the first decade of the current century. It relates to the dynamic interaction of synchronous or sequential diseases (whether communicable or not, also including mental diseases), with social and environmental factors, resulting at the end in a worse global outcome. A first article in the same Journal (1) was devoted to infectious diseases, especially COVID-19 and HIV infections. In this second article, we highlight the fact that the concept is also applicable on diseases which are not transmitted by infectious pathogens. The importance of considering action within the field of social determinants of care will be illustrated by a limited selection of examples.

Le concept de «syndémie¼ - l'interaction entre maladies co-existantes ou séquentielles (transmissibles, non transmissibles, et maladies mentales), avec des phénomènes sociaux et environnementaux qui amplifient les effets négatifs de cette interaction - fait de plus en plus l'objet de publications dans des journaux internationaux, particulièrement ces dernières années. Un premier article dans cette même Revue (1) avait ciblé plus particulièrement les maladies infectieuses, en particulier les infections COVID-19 et HIV. Dans ce deuxième article, nous soulignons que le concept est aussi d'application pour des maladies non infectieuses. L'importance de la prise en charge des déterminants sociaux de la santé est illustré par quelques exemples choisis.

Crossover of the patient satisfaction surveys, adverse events and patient complaints for continuous improvement in radiotherapy department.

OBJECTIVE: The patient's needs and expectations can be assessed through satisfaction surveys, adverse event declarations and records of complaints. By cross-referencing individual complaints, satisfaction surveys and the adverse events received, we could get valuable information. The objective is to identify common elements of work between these different sources to improve care. METHODS: A retrospective analysis of patients' complaints, surveys and adverse events was carried out in order to highlight common improvement items between these three sources of information. RESULTS: A satisfaction survey was given to the patients at the end of their treatment, who filled it out and left it in the 'ad hoc' letterbox. At the end of December 2019, 4695 questionnaires had been collected (response rate 37%). In addition, since 2014, 1369 patients (∼20 patients per month) have been interviewed 'face to face' by the research nurse who assesses their satisfaction using open questions. At the same time, a collection of complaints and adverse events was carried out. All these data have been analysed and cross-checked in order to highlight areas for improvement and strengthen the safety and quality of care in our department. CONCLUSIONS: Collect and analyse satisfaction surveys, unexpected events and complaints constitute in our opinion, an effective tool to achieve patient empowerment. We aim for the patients to become a real player in their safety and involve in the overall effort to improve the quality of their radiotherapy treatment by reporting what does not meet their expectations.

Training of radiotherapy professionals: status, content, satisfaction and improvement suggestions in the Greater Region.

BACKGROUND: The initial training of Radiation Oncology professionals can vary widely across Europe. The aim of this study was to assess the status and content of the initial training programs currently implemented in the Greater Region: Lorraine (Nancy, France), Saarland (Homburg, Germany), Luxembourg, and Liège (Wallonia, Belgium). METHODS: A survey was developed to investigate (1) the overall satisfaction, learning objectives, and teaching methods used during initial training programs and (2) the perceptions of the importance of key professional competencies as described by the CanMEDS (a framework that identifies and describes the abilities physicians require to effectively meet the health care needs of the people they serve). In addition, open-ended questions were used to elicit opinions on room for improvement. Participants (N = 38) were physicians (radiation oncologists (RO) seniors and residents) and radiation therapists (RTTs). RESULTS: Only 21.1% of the respondents declared having acquired all the competencies required for their professional practice during their initial training. Heterogeneity in teaching methods was noted within professional programs but there is no difference between those from RO and RTT in the teaching of technical and relational skills. Relational skills were not addressed in a range of 39.5-57.9% of respondent's curricula. More practical lessons were deemed necessary to improve radiotherapy (RT) training programs. CONCLUSIONS: Radiation oncology professionals expressed the need for more practical teaching, especially in the training of non-technical skills. Regarding the perceived importance of professional aptitudes, radiation oncology professionals highlighted medical and relational skills as the most important competencies.

Group interventions to reduce emotional distress and fatigue in breast cancer patients: a 9-month follow-up pragmatic trial.

BACKGROUND: Long-term effects of psychosocial interventions to reduce emotional distress, sleep difficulties, and fatigue of breast cancer patients are rarely examined. We aim to assess the effectiveness of three group interventions, based on cognitive behavioural therapy (CBT), yoga, and self-hypnosis, in comparison to a control group at a 9-month follow-up. METHODS: A total of 123 patients chose to participate in one of the interventions. A control group was set up for those who agreed not to participate. Emotional distress, fatigue, and sleep quality were assessed before (T0) and after interventions (T1), and at 3-month (T2) and 9-month follow-ups (T3). RESULTS: Nine months after interventions, there was a decrease of anxiety (P=0.000), depression (P=0.000), and fatigue (P=0.002) in the hypnosis group, and a decrease of anxiety (P=0.024) in the yoga group. There were no significant improvements for all the investigated variables in the CBT and control groups. CONCLUSIONS: Our results showed that mind-body interventions seem to be an interesting psychological approach to improve the well-being of breast cancer patients. Further research is needed to improve the understanding of the mechanisms of action of such interventions and their long-term effects on quality of life.

Clinical Outcomes of 130 Patients with Primary and Secondary Lung Tumors treated with Cyberknife Robotic Stereotactic Body Radiotherapy.

BACKGROUND: Authors report clinical outcomes of patients treated with robotic stereotactic body radiotherapy (SBRT) for primary, recurrent and metastatic lung lesions. PATIENTS AND METHODS: 130 patients with 160 lesions were treated with Cyberknife SBRT, including T1-3 primary lung cancers (54%), recurrent tumors (22%) and pulmonary metastases (24%). The mean biologically equivalent dose (BED10Gy) was 151 Gy (72-180 Gy). Median prescribed dose for peripheral and central lesions was 3×20 Gy and 3×15 Gy, respectively. Local control (LC), overall survival (OS), and cause-specific survival (CSS) rates, early and late toxicities are reported. Statistical analysis was performed to identify factors influencing local tumor control. RESULTS: Median follow-up time was 21 months. In univariate analysis, higher dose was associated with better LC and a cut-off value was detected at BED10Gy ≤ 112.5 Gy, resulting in 1-, 2-, and 3-year actuarial LC rates of 93%, vs 73%, 80% vs 61%, and 63% vs 54%, for the high and low dose groups, respectively (p = 0.0061, HR = 0.384). In multivariate analysis, metastatic origin, histological confirmation and larger Planning Target Volume (PTV) were associated with higher risk of local failure. Actuarial OS and CSS rates at 1, 2, and 3 years were 85%, 74% and 62%, and 93%, 89% and 80%, respectively. Acute and late toxicities ≥ Gr 3 were observed in 3 (2%) and 6 patients (5%), respectively. CONCLUSIONS: Our favorable LC and survival rates after robotic SBRT, with low rates of severe toxicities, are coherent with the literature data in this mixed, non-selected study population.

FDG PET/CT texture analysis for predicting the outcome of lung cancer treated by stereotactic body radiation therapy.

INTRODUCTION: With (18)F-FDG PET/CT, tumor uptake intensity and heterogeneity have been associated with outcome in several cancers. This study aimed at investigating whether (18)F-FDG uptake intensity, volume or heterogeneity could predict the outcome in patients with non-small cell lung cancers (NSCLC) treated by stereotactic body radiation therapy (SBRT). METHODS: Sixty-three patients with NSCLC treated by SBRT underwent a (18)F-FDG PET/CT before treatment. Maximum and mean standard uptake value (SUVmax and SUVmean), metabolic tumoral volume (MTV), total lesion glycolysis (TLG), as well as 13 global, local and regional textural features were analysed. The predictive value of these parameters, along with clinical features, was assessed using univariate and multivariate analysis for overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS). Cutoff values were obtained using logistic regression analysis, and survivals were compared using Kaplan-Meier analysis. RESULTS: The median follow-up period was 27.1 months for the entire cohort and 32.1 months for the surviving patients. At the end of the study, 25 patients had local and/or distant recurrence including 12 who died because of the cancer progression. None of the clinical variables was predictive of the outcome, except age, which was associated with DFS (HR 1.1, P = 0.002). None of the (18)F-FDG PET/CT or clinical parameters, except gender, were associated with OS. The univariate analysis showed that only dissimilarity (D) was associated with DSS (HR = 0.822, P = 0.037), and that several metabolic measurements were associated with DFS. In multivariate analysis, only dissimilarity was significantly associated with DSS (HR = 0.822, P = 0.037) and with DFS (HR = 0.834, P < 0.01). CONCLUSION: The textural feature dissimilarity measured on the baseline (18)F-FDG PET/CT appears to be a strong independent predictor of the outcome in patients with NSCLC treated by SBRT. This may help selecting patients who may benefit from closer monitoring and therapeutic optimization.