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Chargari C, Renard S, Espenel S, Escande A, Buchheit I, Ducassou A, Peiffert D, Hannoun-Lévi JM. [Can stereotactic body radiotherapy replace brachytherapy for locally advanced cervical cancer? French society for radiation oncology statement]. Cancer Radiother 2020; 24:706-713. [PMID: 32753238 DOI: 10.1016/j.canrad.2020.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/30/2022]
Abstract
Brachytherapy is part of the treatment of locally advanced cervical cancers, accounting for about half of the total delivered dose. The benefit of dose escalation is the most important in advanced cases or if the tumor has responded poorly. The use of interstitial implantations makes it possible to reach doses of the order of 85 to 90Gy (including external beam radiotherapy contribution) in most patients, through image-guided approaches. Brachytherapy delivery is one of the quality criteria for patient care. To date, no data allow us to consider as an alternative the use of external boost through intensity-modulated or stereotactic body radiotherapy. Indeed, the doses delivered to the tumor and the capacity to spare normal tissues remains lower, as compared to what is permitted by brachytherapy. It is therefore appropriate for centers that do not have access to the technique to establish networks with centers where brachytherapy is performed, to allow each patient to have access to the technique. It is also necessary to promote brachytherapy teaching. The issue of reimbursement will be crucial in the coming years to maintain expertise that is today insufficiently valued in its financial aspects, but has a very high added value for patients.
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Affiliation(s)
- C Chargari
- Département d'oncologie radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - S Renard
- Département d'oncologie radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | - S Espenel
- Département d'oncologie radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - A Escande
- Département d'oncologie radiothérapie, centre Oscar-Lambret, 3, rue Fréderic-Combemale, 59020 Lille, France
| | - I Buchheit
- Département d'oncologie radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | - A Ducassou
- Département d'oncologie radiothérapie, institut Claudius-Regaud, 1, avenue Joliot-Curie, 31059 Toulouse, France
| | - D Peiffert
- Département d'oncologie radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | - J-M Hannoun-Lévi
- Département d'oncologie radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06000 Nice, France
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Defourny N, Lievens Y. [Needs and financing of radiotherapy in France and Europe]. Cancer Radiother 2016; 20:427-33. [PMID: 27599682 DOI: 10.1016/j.canrad.2016.07.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/09/2016] [Accepted: 07/11/2016] [Indexed: 11/18/2022]
Abstract
Access to high-quality and safe radiotherapy is a prerequisite to assure optimal oncology care in a multidisciplinary environment. In view of supporting long-term radiotherapy planning, actual and predicted radiotherapy needs should be put in context of the nowadays' available resources. The present article reviews the existing data on radiotherapy resources and needs, along with the prevailing reimbursement systems in the different European countries, with a specific emphasis on France. It describes potential incentives of different financing systems on clinical practice and highlights how knowledge of the cost of radiotherapy treatments, by indication and technique, is essential to support correct reimbursement, hence access to radiotherapy. It is expected that such data will help national professional and scientific radiotherapy societies across Europe in their negotiations with policy makers, with the ultimate aim to make radiotherapy accessible to all cancer patients who need it, now and in the decades to come.
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Affiliation(s)
- N Defourny
- European Society for Radiotherapy and Oncology, 40, rue Martin V, 1200 Bruxelles, Belgique; Ghent University, Sint-Pietersnieuwstraat 25, 9000 Ghent, Belgique
| | - Y Lievens
- Ghent University, Sint-Pietersnieuwstraat 25, 9000 Ghent, Belgique; Radiation Oncology Department - RTP, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgique.
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Mazeron R, Dumas I, Martin V, Martinetti F, Benhabib-Boukhelif W, Gensse MC, Chargari C, Guemnie-Tafo A, Haie-Méder C. [Pulsed-dose rate brachytherapy in cervical cancers: why, how?]. Cancer Radiother 2014; 18:447-51. [PMID: 25155782 DOI: 10.1016/j.canrad.2014.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 06/24/2014] [Accepted: 06/26/2014] [Indexed: 10/24/2022]
Abstract
The end of the production of 192 iridium wires terminates low dose rate brachytherapy and requires to move towards pulsed-dose rate or high-dose rate brachytherapy. In the case of gynecological cancers, technical alternatives exist, and many teams have already taken the step of pulsed-dose rate for scientific reasons. Using a projector source is indeed a prerequisite for 3D brachytherapy, which gradually installs as a standard treatment in the treatment of cervical cancers. For other centers, this change implies beyond investments in equipment and training, organizational consequences to ensure quality.
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Affiliation(s)
- R Mazeron
- Département d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.
| | - I Dumas
- Département de physique médicale, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - V Martin
- Département d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - F Martinetti
- Département de physique médicale, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - W Benhabib-Boukhelif
- Département de physique médicale, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - M-C Gensse
- Département d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - C Chargari
- Département d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - A Guemnie-Tafo
- Département de physique médicale, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - C Haie-Méder
- Département d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
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Hannoun-Lévi JM, Peiffert D. [How to prepare the brachytherapy of the future]. Cancer Radiother 2013; 17:395-9. [PMID: 23993062 DOI: 10.1016/j.canrad.2013.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 05/27/2013] [Accepted: 06/07/2013] [Indexed: 11/26/2022]
Abstract
For more than a century, brachytherapy has been a treatment of choice for delivering a high dose in a small volume. However, over the past 15 years, this irradiation technique has stalled. Even so, brachytherapy allows the delivery of the right dose at the right place by dispensing with target volume motion and repositioning. The evolution of brachytherapy can be based on a road-map including at least the following three points: the acquisition of clinical evidence, teaching and valuation of the procedures. The evolution of brachytherapy will be also impacted by technological considerations (end of the production of low dose rate 192 iridium wires). Regarding the evolution toward a personalized treatment, brachytherapy of the future should take its place as a partner of other modern external beam radiation techniques, be performed by experimented actors (physicians, physicists, technicians, etc.) who received adequate training, and be valued in proportion to the delivered medical service.
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Affiliation(s)
- J-M Hannoun-Lévi
- Pôle de radiothérapie oncologique, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06000 Nice, France; Université Nice-Sophia Antipolis, 06000 Nice, France.
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