Strategies are needed to compensate for volume losses at the extremes of motion for both 4DCT MIP and CBCT images for larger and varied amplitudes, and for patterns with rest periods following expiration. Lesions moving greater than 2 cm would warrant larger treatment margins added to the 4DCT MIP ITV to account for the volume being under-represented at the extremes of motion. Lesions moving with a rest period following expiration would be better aligned using an edge-to-edge alignment technique. Sinusoidal patterns represented the ideal clinical scenario, reinforcing the importance of investigating clinically relevant motions and their effects on 4DCT MIP and CBCT volumes. Since most patients do not breathe sinusoidally this may lead to misinterpretation of previous studies using only sinusoidal motion.

MDT meetings significantly impact on the management plans for lung oncology patients. The majority of MDT recommendations (72%) were implemented into patient care. These findings provide further evidence to support the role of MDT meetings as an essential part of the decision-making process for the optimal multidisciplinary management of patients with cancer.

Secondary endpoints were overall survival, metastasis-free survival, incidence of acute and late toxicities, and quality of life (QOL). Stratification factors were Gleason score, pT stage, and center. We present the acute and late toxicity (CTCAE V3.0) and QOL (EORTC QLQ-C30 and PR-25 scales) results. Results: Between 2008 and 2016, 424 patients were randomized (n Z 212 aRT; n Z 212 sRT) in 46 centers, in France. The Independent Data Monitoring Board recommended that enrolment be stopped early due to insufficient accrual and low event rate. Median age was 63.8 years, with 77.3% of patients pT3a and 80.4% with Gleason 7. The baseline characteristics were similar in the arms. In the sRT arm, 113 patients (53.3%) had their biochemical relapse triggering sRT. The median delay between randomization and sRT was 23 months. Median follow-up was 6.3 years. Grade >2 acute toxicity was observed in 1.9% of patients in the sRT arm compared to 2.9% in the aRT arm (p Z 0.75). Late grade >2 toxicities, essentially incontinence, pollakiuria, sexual dysfunction, and hot flushes, were observed in 17/212 patients (8%) in the sRT arm, and in 42/212 (19.8%) in the aRT arm (p<0.001). The global health status measured by QLQC30 was not significantly different in the arms (p Z 0.114). Conclusion: Initial results from GETUG-AFU 17 show that aRT significantly increased the risk of late toxicity. No difference was seen in the QOL between arms. Further follow-up is needed to analyze long-term efficacy endpoints.

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