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Adjuvant radiotherapy reduces the risk of biochemical progression in prostate cancer patients after radical prostatectomy. We aimed to compare adjuvant versus early salvage radiotherapy after radical prostatectomy, combined with short-term hormonal therapy, in terms of oncological outcomes and tolerance. GETUG-AFU 17 was a randomised, open-label, multicentre, phase 3 trial done at 46 French hospitals. Men aged at least 18 years who had an Eastern Cooperative Oncology Group performance status of 1 or less, localised adenocarcinoma of the prostate treated with radical prostatectomy, who had pathologically-staged pT3a, pT3b, or pT4a (with bladder neck invasion), pNx (without pelvic lymph nodes dissection), or pN0 (with negative lymph nodes dissection) disease, and who had positive surgical margins were eligible for inclusion in the study. Eligible patients were randomly assigned (1:1) to either immediate adjuvant radiotherapy or delayed salvage radiotherapy at the time of biochemical relapse. Random assignment, by minimisation, was done using web-based software and stratified by Gleason score, pT stage, and centre. All patients received 6 months of triptorelin (intramuscular injection every 3 months). The primary endpoint was event-free survival. Efficacy and safety analyses were done on the intention-to-treat population. The trial is registered with ClinicalTrials.gov, NCT00667069. Between March 7, 2008, and June 23, 2016, 424 patients were enrolled. We planned to enrol 718 patients, with 359 in each study group. However, on May 20, 2016, the independent data monitoring committee recommended early termination of enrolment because of unexpectedly low event rates. At database lock on Dec 19, 2019, the overall median follow-up time from random assignment was 75 months (IQR 50–100), 74 months (47–100) in the adjuvant radiotherapy group and 78 months (52–101) in the salvage radiotherapy group. In the salvage radiotherapy group, 115 (54%) of 212 patients initiated study treatment after biochemical relapse. 205 (97%) of 212 patients started treatment in the adjuvant group. 5-year event-free survival was 92% (95% CI 86–95) in the adjuvant radiotherapy group and 90% (85–94) in the salvage radiotherapy group (HR 0·81, 95% CI 0·48–1·36; log-rank p=0·42). Acute grade 3 or worse toxic effects occurred in six (3%) of 212 patients in the adjuvant radiotherapy group and in four (2%) of 212 patients in the salvage radiotherapy group. Late grade 2 or worse genitourinary toxicities were reported in 125 (59%) of 212 patients in the adjuvant radiotherapy group and 46 (22%) of 212 patients in the salvage radiotherapy group. Late genitourinary adverse events of grade 2 or worse were reported in 58 (27%) of 212 patients in the adjuvant radiotherapy group versus 14 (7%) of 212 patients in the salvage radiotherapy group (p<0·0001). Late erectile dysfunction was grade 2 or worse in 60 (28%) of 212 in the adjuvant radiotherapy group and 17 (8%) of 212 in the salvage radiotherapy group (p<0·0001). Although our analysis lacked statistical power, we found no benefit for event-free survival in patients assigned to adjuvant radiotherapy compared with patients assigned to salvage radiotherapy. Adjuvant radiotherapy increased the risk of genitourinary toxicity and erectile dysfunction. A policy of early salvage radiotherapy could spare men from overtreatment with radiotherapy and the associated adverse events. French Health Ministry and Ipsen.

Background Metastatic breast cancer (MBC) behaviour differs depending on hormone receptors (HR) and human epidermal growth factor receptor (HER2) statuses. Methods The kinetics of central nervous system (CNS) metastases (CNS metastasis-free survival, CNSM-FS) and subsequent patient’s prognosis (overall survival, OS) according to the molecular subtype were retrospectively assessed in 16703 MBC patients of the ESME nationwide multicentre MBC database (Kaplan–Meier method). Results CNS metastases occurred in 4118 patients (24.6%) (7.2% at MBC diagnosis and 17.5% later during follow-up). Tumours were HER2−/HR+ (45.3%), HER2+/HR+ (14.5%), HER2+/HR− (14.9%) and triple negative (25.4%). Median age at CNS metastasis diagnosis was 58.1 years (range: 22.8–92.0). The median CNSM-FS was 10.8 months (95% CI: 16.5–17.9) among patients who developed CNS metastases. Molecular subtype was independently associated with CNSM-FS (HR = 3.45, 95% CI: 3.18–3.75, triple-negative and HER2−/HR+ tumours). After a 30-month follow-up, median OS after CNS metastasis diagnosis was 7.9 months (95% CI: 7.2–8.4). OS was independently associated with subtypes: median OS was 18.9 months (HR = 0.57, 95% CI: 0.50–0.64) for HER2+/HR+ , 13.1 months (HR = 0.72, 95% CI: 0.65–0.81) for HER2+/HR−, 4.4 months (HR = 1.55, 95% CI: 1.42–1.69) for triple-negative and 7.1 months for HER2−/HR+ patients ( p  <0.0001). Conclusions Tumour molecular subtypes strongly impact incidence, kinetics and prognosis of CNS metastases in MBC patients. Clinical trial registration NCT03275311.

Purpose Hepatocellular carcinoma (HCC) remains a global health concern, marked by increasing incidence rates and poor outcomes. This study seeks to develop a robust predictive model by integrating radiomics and deep learning features with clinical data to predict 2-year survival in HCC patients treated with stereotactic body radiation therapy (SBRT). Methods This study analyzed a cohort of 186 HCC patients who underwent SBRT. Radiomics features were extracted from CT scans, complemented by collection of clinical data. Training and validation of machine learning models were conducted using nested cross-validation techniques. Deep learning models, leveraging various convolutional neural networks (CNNs), were employed to effectively integrate both image and clinical data. Post-hoc explainability techniques were applied to elucidate the contribution of imaging data to predictive outcomes. Results Handcrafted radiomics features demonstrated moderate predictive performance, with area under the receiver operating characteristic curve (AUC) values ranging from 0.59 to 0.72. Deep learning models, harnessing the fusion of image and clinical data, exhibited improved predictive accuracy, with AUC values ranging from 0.71 to 0.81. Notably, the ensemble model, amalgamating handcrafted radiomics and deep learning features with clinical data, demonstrated the most robust predictive capability, achieving an AUC of 0.86 (95% CI: 0.80–0.93). Conclusion The ensemble model represents a significant advancement, providing a comprehensive tool for predicting survival outcomes in HCC patients undergoing SBRT. The inclusion of interpretability methods such as Grad-CAM enhances transparency and understanding of these complex predictive models.

The test methods that currently exist for the identification of thyroid hormone system-disrupting chemicals are woefully inadequate. There are currently no internationally validated in vitro assays, and test methods that can capture the consequences of diminished or enhanced thyroid hormone action on the developing brain are missing entirely. These gaps put the public at risk and risk assessors in a difficult position. Decisions about the status of chemicals as thyroid hormone system disruptors currently are based on inadequate toxicity data. The ATHENA project (Assays for the identification of Thyroid Hormone axis-disrupting chemicals: Elaborating Novel Assessment strategies) has been conceived to address these gaps. The project will develop new test methods for the disruption of thyroid hormone transport across biological barriers such as the blood–brain and blood–placenta barriers. It will also devise methods for the disruption of the downstream effects on the brain. ATHENA will deliver a testing strategy based on those elements of the thyroid hormone system that, when disrupted, could have the greatest impact on diminished or enhanced thyroid hormone action and therefore should be targeted through effective testing. To further enhance the impact of the ATHENA test method developments, the project will develop concepts for better international collaboration and development in the area of thyroid hormone system disruptor identification and regulation.

Background Stereotactic radiotherapy (SRT), including stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (hfSRT), plays a key role in the management of brain metastases (BM). As advances in systemic therapies prolong survival, local recurrence of BM has become more frequent, prompting interest in salvage reirradiation strategies. Objective This systematic review aimed to evaluate the efficacy and safety of a second course of stereotactic radiotherapy (SRT2) for in-field recurrent brain metastases. Methods Data on local control, overall survival, and radionecrosis were extracted and pooled using random-effects models. Eleven retrospective studies published between 2020 and 2025 were included, comprising 914 patients and 2,352 brain metastases, with 389 lesions treated with salvage SRS2/SRT2. Patients who had received prior whole-brain radiotherapy were excluded. Results The pooled 1-year local failure rate was 24%, and radionecrosis occurred in approximately 13% of cases. Median overall survival after salvage SRS2 was 14 months. Radionecrosis typically occurred within 4–8 months post-treatment and was associated with larger tumor volume and higher prescribed dose. Moderate heterogeneity was observed across studies, and conclusions regarding the impact of multifraction regimens should be interpreted cautiously. Conclusion Salvage SRS2/SRT2 appears to provide meaningful local control and survival benefit in selected patients with recurrent brain metastases, with an acceptable toxicity profile. These findings support its role as an effective non-surgical salvage option, although prospective studies are needed to better define optimal treatment parameters and patient selection.

Biomass‐derived 5‐hydroxymethyl furfural (5‐HMF) is a promising starting substrate for producing two high value‐added products 2,5‐diformylfuran (DFF) and 2,5‐furandicarboxylic acid (FDCA). DFF, which is produced by selectively oxidizing the hydroxymethyl group of 5‐HMF to an aldehyde group, has many applications in pharmaceuticals, macrocyclic ligands and fluorescent materials. Oxidizing both aldehyde and hydroxymethyl groups of 5‐HMF leads to FDCA, which is an important monomer in the production of a bioplastic polyethylene furanoate polymer. Electrochemical conversion of 5‐HMF is a potential route for sustainable chemical production of DFF and FDCA. In fact, using 2,2,6,6‐tetramethyl‐ piperidine‐1‐oxyl (TEMPO) as a redox mediator leads to a highly efficient and selective electro‐oxidation of 5‐HMF into FDCA in a basic buffer solution. In this report, the direct and TEMPO‐mediated electro‐oxidation of 5‐HMF was investigated in various organic and hydro‐organic media at room temperature. Direct electro‐oxidation leads to a low selective conversion of 5‐HMF to DFF (10 % of yield) and the formation of unwanted products such as formic acid and protoanemonin (90 % and 37 % of yield respectively) in acetonitrile. Electrocatalytic 5‐HMF conversion in the presence of TEMPO as a redox mediator achieved a near‐quantitative yield of DFF in acetonitrile and γ‐valerolactone. Importantly, we demonstrate the role of water in the conversion of aldehydes to carboxylic acids. Electrooxidation of biomass‐derived 5‐Hydroxymethyl furfural (5‐HMF) to produce 2,5‐diformylfuran (DFF), either direct and 2,2,6,6‐tetramethyl‐ piperidine‐1‐oxyl (TEMPO)‐mediated, is investigated in various organic and hydro‐organic media at room temperature. The direct electrooxidation mainly yields unwanted products such as formic acid and protoanemonin, near‐quantitative yields of DFF are obtained in acetonitrile and γ‐valerolactone.

Treatment of metastatic non-small cell lung cancer (mNSCLC) has been modified due to the development of immunotherapy. We assessed survival outcomes (overall [OS] and progression-free [rwPFS] survivals, time-to-next-treatment [TNT]) in mNSCLC patients after first-line immunotherapy and chemotherapy in real-life settings. Association between rwPFS and TNT, two candidate surrogate endpoints (SE), with OS was assessed. This retrospective multi-center study uses data from patients included in the Epidemio-Strategy Medico-Economic program with mNSCLC over 2015–2019. The impact of treatment on rwPFS/OS was evaluated with Cox models. Individual-level associations between SE and OS were estimated with an iterative multiple imputation approach and joint survival models. The population included 5294 patients (63 years median age). Median OS in immunotherapy group was 16.4 months (95%CI [14.1–NR]) and was higher than in chemotherapy group (11.6 months; 95%CI [11.0–12.2]). Improved OS was observed for the immunotherapy group after 3 months for subjects with performance status 0–1 (HR = 0.59; 95%CI [0.42–0.83], p < 0.01). The associations between rwPFS and TNT with OS were close ( τ =0.57). Results emphasized a survival improvement with immunotherapy for patients in good health condition. There was moderate evidence of individual-level association between candidate SE and OS.

Background Intramedullary metastasis (IMM) is a rare disease with poor prognosis. The incidence of IMMs has increased, which has been linked to improved systemic treatment in many cancers. Surgery and/or radiotherapy are the most commonly used treatments; only small-sample retrospective studies and case reports on stereotactic body radiotherapy (SBRT) have reported acceptable results in terms of local control and clinical improvement, with no reported toxicity. Thus, we performed this monocentric retrospective study on five cases treated with SBRT for IMMs, which we supplemented with a systematic review of the literature. Methods We included all patients treated for IMM with SBRT. The target tumor volume, progression-free survival, prescription patterns in SBRT, survival without neurological deficit, neurological functional improvement after treatment, and overall survival were determined. Results: Five patients treated with a median dose of 30 Gy in a median number of fractions of 5 (prescribed at a median isodose of 86%) included. The median follow-up duration was 23 months. Two patients showed clinical improvement. Three patients remained stable. Radiologically, 25% of patients had complete response and 50% had stable disease. No significant treatment-related toxicity was observed. Conclusion: SBRT appears to be a safe, effective, and rapid treatment option for palliative patients.

Background Large-scale trials have shown that hypofractionated adjuvant breast radiotherapy was as effective in terms of survival and local control as conventional fractionated radiotherapy, and acute toxicity was reduced with hypofractionated radiotherapy. However, there is a lack of data about the toxicity of breast with regional nodal irradiation (RNI). The aim of this study was to assess the effect of fractionation on radiation-related acute skin toxicity in patients receiving RNI in addition to whole-breast or chest wall irradiation, using real-life data. Methods We conducted a prospective, multicenter cohort study with systematic computerized data collection integrated into Mosaiq®. Three comprehensive cancer centers used a standardized form to prospectively collect patient characteristics, treatment characteristics and toxicity. Results Between November 2016 and January 2022, 1727 patients were assessed; 1419 (82.2%) and 308 (17.8%) patients respectively received conventional fractionated and hypofractionated radiation therapy. Overall, the incidence of acute grade 2 or higher dermatitis was 28.4% (490 patients). Incidence was lower with hypofractionated than with conventional fractioned radiation therapy (odds ratio (OR) 0.34 [0.29;0.41]). Two prognostic factors were found to increase the risk of acute dermatitis, namely 3D (vs IMRT) and breast irradiation (vs chest wall). Conclusion Using real-life data from unselected patients with regional nodal irradiation, our findings confirm the decreased risk of dermatitis previously reported with hypofractionated radiation therapy in clinical trials. Expansion of systematic data collection systems to include additional centers as well as dosimetric data is warranted to further evaluate the short- and long-term effects of fractionation in real life.

Background and purpose Between 5% and 20% of patients with breast cancer (BC) experience locoregional recurrence (LRR). Managing LRR in previously irradiated areas is particularly challenging. We evaluated the toxicity and efficacy of stereotactic body re-irradiation in this context. Materials and methods This was a single-center retrospective study conducted between January 2009 and December 2022. It included patients who underwent stereotactic re-irradiation for LRR of BC. We assessed toxicity, local control (LC), progression-free survival (PFS), and overall survival (OS). Results Eighteen patients were included. The median dose of the initial radiotherapy (RT) was 60 Gy (range: 50–68 Gy). Recurrences occurred in level I-II nodes ( n  = 10), internal mammary nodes (IMN; n  = 4), level III ( n  = 2), and level IV ( n  = 2). The median interval between the two irradiations was 11 years (range: 1–24 years). The most commonly used stereotactic re-irradiation regimens were 6 × 6 Gy and 3 × 9 Gy. Median D50% to the GTV and PTV was 36.9 Gy (32–41.8 Gy) and 35.7 (30.2–40.6 Gy), respectively. The D0.035 cc to the brachial plexus was 11.2 Gy (range, 4–33.6 Gy). With a median follow-up of 4.5 years from the start of SRT (IQR: 2.0‒7.5), no radiation-induced brachial plexopathy was observed. The cumulative incidence of locoregional recurrence was 56.4% (95%CI: 30.8–75.6) at 2 years. The 5-year overall survival (OS) rate was 75.5% (95CI: 39.7–91.8), with most deaths attributed to distant metastases. Conclusion Stereotactic re-irradiation is a well-tolerated treatment option for LRR in breast cancer. Particular care should be taken to minimize the dose to the brachial plexus. While local control is acceptable, the risk of further regional recurrence remains high.