Five-fraction HDR brachytherapy in locally advanced cervical cancer: A monocentric experience.

PURPOSE: The 5-fraction scheme (5×5-5.5Gy) is a common High-Dose Rate (HDR) intracavitary brachytherapy regimen for locally advanced cervical cancer (LACC). Yet, its equivalence with Pulse-Dose rate (PDR) schemes remains unproved. The present study aimed at reporting on the outcome of LACC patients treated with 5-fraction HDR brachytherapy. MATERIALS AND METHODS: The medical records of all consecutive patients treated with curative-intent HDR brachytherapy for a LACC in a French Cancer Center were retrospectively reviewed. RESULTS: Thirty-eight LACC patients underwent a 5-fraction intracavitary HDR brachytherapy between 2015 and 2019 (median dose=25Gy/5 fractions, following external-beam radiotherapy). Median age at diagnosis was 60 (range: 29-87). Thirty-one patients (81.5%) underwent concurrent chemotherapy. Tumor stages ranged from 3 IB2 (7.8%), 4 IB3 (10.5%), 4 IIA2 (10.5%), 12 IIB (31.7%), 1 IIIA (2.6%), 2 IIIB (5.3%), 7 IIIC1 (18.5%), 4 IIIC2 (10.5%), 1 IVA (2.6%) (2018 FIGO). Median D90% to CTVHR reached 79.5Gy (EQD2). Median D90% to CTVIR reached 59.5Gy (EQD2). Median Bladder D2cc was 69.8Gy (EQD2). Median Rectum D2cc was 58.3Gy (EQD2). Acute/late grade 3 toxicity was reported in one patient (2.6%). No grade 4-5 toxicity occurred. At a median 38 months follow-up, 10 patients (26.3%) had local (n=7, 18.4%), nodal (n=6, 15.7%) and/or distant (n=7, 18.4%) relapse. Three-year overall survival rate was of 81.6%. CONCLUSION: The 5-fraction HDR scheme was well tolerated even in frail patients. Three-year local control was lower than expected. Treatment (absence of parametrial interstitial implants and use of cervical EBRT boost) and patients' characteristics (age, comorbidities) may explain such results.

[Telemedicine for prostate cancer during long-term radiotherapy follow-up: An opportunity for digital innovation in oncology]. / La téléconsultation pour le suivi après radiothérapie du cancer de la prostate : une place à l'innovation numérique en cancérologie.

PURPOSE: The annual follow-up in radiotherapy for prostate cancer consists of an oral interview with a radiation oncologist. The present study aimed at surveying the target population on their knowledge and perceptions of telemedicine. MATERIALS AND METHODS: A prospective study was conducted at the Lucien Neuwirth Cancer Institute (France) that included patients with prostate cancer undergoing treatment or in follow-up, during spring 2019 (n=158). A specific questionnaire was designed for the study. Patient's self-evaluation of satisfaction and enthusiasm was assessed through visual analog scale (VAS) (0/10 to 10/10). RESULTS: One hundred and fifty-eight patients completed the survey. The vast majority of the population commonly used phone for communication and 56% of patients owned internet connexion. Around 56% of patients declared telemedicine knowledge without having ever experienced telemedicine. If 60.8% of patients would not be against telemedicine with a median enthusiasm VAS of 6/10, patients' opinions were divergent: 48.7% of patients would like to keep a classical follow-up and 48.7% of patients would envision to alternate classical consultation with telemedicine. CONCLUSION: This feasibility study with an aged cohort showed that telemedicine is a valuable option for long-term radiotherapy follow-up, even if therapeutic education and information will be necessary to supervise this novel approach.

Use of 4D-CT for radiotherapy planning and reality in France: Data from a national survey.

PURPOSE: Lung and some digestive tumours move during a respiratory cycle. Four-dimensional scanography (4D-CT) is commonly used in treatment planning to account for respiratory motion. Although many French radiotherapy centres are now equipped, there are no guidelines on this subject to date. We wanted to draw up a description of the use of the 4D-CT for the treatment planning in France. METHODS AND MATERIAL: We conducted a survey in all French radiotherapy centres between March and April 2017. RESULTS: One hundred and seventy-two were contacted. The participation rate was 88.37%. The use of the 4D-CT seems to be common and concerned planning for 15.28% of kidney and adrenal cancers, 19.72% of pancreatic cancers, 27.78% of oesophageal cancers and 73.24% of lung cancers in case of normofractionated treatments. The use of the 4D-CT was also widespread in the case of stereotactic body radiation therapy: with 61.11% in the case of pulmonary irradiation and 34.72% in the case of hepatic irradiation. Many centres declared they carried out several 4D-CT for treatment planning (29, 55% in case of stereotactic body radiation therapy for lung tumours and 20% for liver tumours). Private centres tend to repeat 4D-CT more. CONCLUSION: Although the use of the 4D-CT appears to be developing, it remains very heterogeneous. To date, the repetition of the 4D-CT has been very poorly studied and could be the subject of clinical studies, allowing to define in which indications and for which populations there is a real benefit.