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

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[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.

Development of a cancer risk model and mobile health application to inform the public about cancer risks and risk factors.

OBJECTIVE: To develop and evaluate a mobile health application, the Cancer Risk Calculator (CRC), aimed at improving public health literacy by providing personalized information on cancer risks and preventive measures. MATERIALS AND METHODS: The CRC was developed through a comprehensive process involving the identification of necessary content, integration of average cancer risks using data from reliable sources, creation of a novel risk model emphasizing modifiable factors, and the application's development for easy access. The application covers 38 cancer types, 18 subtypes, and approximately 790 risk factors, utilizing data from the Surveillance, Epidemiology, and End Results Program and scientific literature. RESULTS: CRC offers users personalized risk assessments across a broad range of cancers, emphasizing modifiable risk factors to encourage preventive behaviors. It distinguishes itself by covering more cancer types and risk factors than existing tools, with preliminary user feedback indicating its utility in promoting health literacy and lifestyle changes. DISCUSSION: The CRC application stands out as an innovative tool in health informatics, significantly enhancing public understanding of cancer risks. Its development underscores the potential of digital health technologies to bolster preventive healthcare strategies through improved health literacy. CONCLUSION: The Cancer Risk Calculator is a pivotal development in mobile health technology, offering comprehensive and personalized insights into cancer risks and prevention. It serves as a valuable resource for public health education, facilitating informed decisions and lifestyle modifications for cancer prevention.

[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.

[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.

[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.

[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.

[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.

Identification of CT radiomic features robust to acquisition and segmentation variations for improved prediction of radiotherapy-treated lung cancer patient recurrence.

The primary objective of the present study was to identify a subset of radiomic features extracted from primary tumor imaged by computed tomography of early-stage non-small cell lung cancer patients, which remain unaffected by variations in segmentation quality and in computed tomography image acquisition protocol. The robustness of these features to segmentation variations was assessed by analyzing the correlation of feature values extracted from lesion volumes delineated by two annotators. The robustness to variations in acquisition protocol was evaluated by examining the correlation of features extracted from high-dose and low-dose computed tomography scans, both of which were acquired for each patient as part of the stereotactic body radiotherapy planning process. Among 106 radiomic features considered, 21 were identified as robust. An analysis including univariate and multivariate assessments was subsequently conducted to estimate the predictive performance of these robust features on the outcome of early-stage non-small cell lung cancer patients treated with stereotactic body radiation therapy. The univariate predictive analysis revealed that robust features demonstrated superior predictive potential compared to non-robust features. The multivariate analysis indicated that linear regression models built with robust features displayed greater generalization capabilities by outperforming other models in predicting the outcomes of an external validation dataset.

[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.

[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.

Predictive clinical and dosimetric parameters for risk of relapse in early-stage non-small cell lung cancer treated by SBRT: A large single institution experience.

Purpose: To evaluate the impact of dosimetric parameters on efficacy of stereotactic body radiation therapy (SBRT) in early-stage non-small cell lung cancer (ES-NSCLC), using Hypofractionated Treatment Effects in the Clinic (HyTEC) reporting standards. Methods: From April 2010 to December 2020, 497 patients who received SBRT for ES-NSCLC at the University Hospital of Liège were retrospectively enrolled. A total dose of 40 to 60 Gy in 3-5 fractions (72-180 Gy biologically effective dose with an α/ß ratio of 10 (BED10)) was prescribed to the 80 % isodose line of the PTV. Potential clinical and dosimetric predictors of recurrence, overall survival (OS) and disease specific survival (DSS) were evaluated using univariate and multivariate analyses. Results: After a median follow-up of 32 months (range 3-143 months), the local control and disease-free survival (DFS) rates at 3 years were 91 % (95 % CI: 90 %-93 %) and 75 % (95 % CI: 73 %-77 %), respectively. The median OS was 41.6 months and the median DSS was not reached. On multivariate analysis, a higher gross tumor volume (GTV) Dmax (BED10) (cut-off 198 Gy) and a larger percent of the GTV receiving ≥110 % of the prescribed dose were predictive of a better local control, only GTV volume was correlated with DSS and no parameter was correlated with OS and regional or distant recurrences. Conclusion: Lung SBRT for ES-NSCLC in 3 to 5 fractions resulted in high local control rates. A higher percent of GTV receiving ≥110 % of the prescribed dose and a higher GTV Dmax (BED10) seem to allow a better local control.

[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.

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.

Comparison between the WHO-CFICPS and the PRISMA classification of safety-related events in a radiation oncology department.

INTRODUCTION: Describing Safety-Related Events (SREs) in a radiotherapy (RT) department and comparing WHO-CFICPS (World Health Organization's Conceptual Framework For The International Classification For Patient Safety) and PRISMA (Prevention and Recovery Information System for Monitoring and Analysis) methods for classifying SREs. METHODS: From February 2017 to October 2020, two Quality Managers (QMs) randomly classified 1173 SREs using 13 incident types of WHO-CFICPS. The same two QMs, reclassified the same SREs according to 20 PRISMA incident codes. Statistical analysis was performed to assess the association between the 13 incident types of WHO-CFICPS and the 20 PRISMA codes. The chi-squared and post-hoc tests using adjusted standardized residuals were applied to detect the association between the two systems. RESULTS: There was a significant association between WHO-CFICPS incident types and PRISMA codes (P < 0.001). Ninety-two percent of all SREs were categorized using 4 of 13 WHO-CFICPS incident types including Clinical Process/Procedure (n = 448, 38.2%), Clinical Administration (n = 248, 21.1%), Documentation (n = 226, 19.2%) and Resources/Organizational Management (n = 15,613.3%). According to PRISMA classification, 14 of the 20 codes were used to describe the same SREs. PRISMA captured 41 Humans Skill Slips from 226 not better defined WHO-CFICPS Documentation Incidents, 38 Human Rule-based behaviour Qualification from not better defined 447 Clinical Process/Procedure and 40 Organization Management priority events from 156 not better defined WHO-CFICPS Resources/Organizational Management events (P < 0.001). CONCLUSION: Although there was a significant association between WHO-CFICPS and PRISMA, The PRISMA method provides a more detailed insight into SREs compared to WHO-CFICPS in a RT department.

Intracoronary Brachytherapy for Restenosis: 20 Years of Follow-Up.

BACKGROUND/PURPOSE: Intracoronary brachytherapy (ICB) has mainly been used to treat in-stent restenosis following percutaneous coronary intervention and was virtually abandoned about 20 years ago. However, patients treated with this strategy are still alive and some teams continue to perform this therapy. We aimed to investigate the very long-term clinical outcome of patients treated with ICB. METHODS/MATERIALS: A total of 173 consecutive patients who had been treated with ICB at a large tertiary referral centre between 1998 and 2003 were included. The primary endpoint of the study was all-cause mortality. The secondary endpoints were as follows: occurrence of major adverse cardiac events (MACE, defined as all-cause death, non-fatal myocardial infarction, or target vessel revascularization), cardiac death, and presence of angina at the end of follow-up. RESULTS: Patients' mean age at the time of ICB was 64 ± 10 years and 77 % were male. Restenosis (bare metal stent vs. balloon angioplasty) was the only indication for ICB. Unstable angina was present in 34 % of the patients. Follow-up was available for 166 patients. After a mean follow-up of 20 ± 1.3 years, 66 % of the patients had died (including 74 patients (67 %) with cardiac death). Cumulative MACE rate at 20 years was 96 %. CONCLUSIONS: Very long-term follow-up of patients with in-stent restenosis treated with ICB confirmed a high all-cause mortality rate mainly due to cardiac causes and MACEs.

Interval From Simulation Imaging to Treatment Delivery in SABR of Lung Lesions: How Long is Too Long for the Lung?

Purpose: The purpose of this study was to evaluate the effect of delay between planning computed tomography (CT) used as a basis for treatment planning and the start of treatment (delay planning treatment [DPT]), on local control (LC) for lung lesions treated by SABR. Methods and Materials: We pooled 2 databases from 2 monocentric retrospective analysis previously published and added planning CT and positron emission tomography (PET)-CT dates. We analyzed LC outcomes based on DPT and reviewed all available cofounding factors among demographic data and treatment parameters. Results: A total of 210 patients with 257 lung lesions treated with SABR were evaluated. The median DPT was 14 days. Initial analysis revealed a discrepancy in LC as a function of DPT and a cutoff delay of 24 days (21 days for PET-CT almost systematically done 3 days after planning CT) was determined according to the Youden method. Cox model was applied to several predictors of local recurrence-free survival (LRFS). Univariate analysis showed LRFS decreasing significantly related to DPT ≥24 days (P = .0063), gross tumor volume, and clinical target volume (P = .0001 and P = .0022), but also with the presence of >1 lesion treated with the same planning CT (P = .024). LRFS increased significantly with higher biological effective dose (P < .0001). On multivariate analysis, LRFS remained significantly lower for lesions with DPT ≥24 days (hazard ratio, 2.113; 95% confidence interval, 1.097-4.795; P = .027). Conclusions: DPT to SABR treatment delivery for lung lesions appears to reduce local control. Timing from imaging acquisition to treatment delivery should be systematically reported and tested in future studies. Our experience suggests that the time from planning imaging to treatment should be <21 days.

[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.