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Mione C, Casile M, Moreau J, Miroir J, Molnar I, Chautard E, Bernadach M, Kossai M, Saroul N, Martin F, Pham-Dang N, Lapeyre M, Biau J. Outcomes among oropharyngeal and oral cavity cancer patients treated with postoperative volumetric modulated arctherapy. Front Oncol 2023; 13:1272856. [PMID: 38023128 PMCID: PMC10644788 DOI: 10.3389/fonc.2023.1272856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background Presently, there are few published reports on postoperative radiation therapy for oropharyngeal and oral cavity cancers treated with IMRT/VMAT technique. This study aimed to assess the oncological outcomes of this population treated with postoperative VMAT in our institution, with a focus on loco-regional patterns of failure. Material and methods Between 2011 and 2019, 167 patients were included (40% of oropharyngeal cancers, and 60% of oral cavity cancers). The median age was 60 years. There was 64.2% of stage IV cancers. All patients had both T and N surgery. 34% had a R1 margin, 42% had perineural invasion. 72% had a positive neck dissection and 42% extranodal extension (ENE). All patients were treated with VMAT with simultaneous integrated boost with three dose levels: 66Gy in case of R1 margin and/or ENE, 59.4-60Gy on the tumor bed, and 54Gy on the prophylactic areas. Concomittant cisplatin was administrated concomitantly when feasible in case of R1 and/or ENE. Results The 1- and 2-year loco-regional control rates were 88.6% and 85.6% respectively. Higher tumor stage (T3/T4), the presence of PNI, and time from surgery >45 days were significant predictive factors of worse loco-regional control in multivariate analysis (p=0.02, p=0.04, and p=0.02). There were 17 local recurrences: 11 (64%) were considered as infield, 4 (24%) as marginal, and 2 (12%) as outfield. There were 9 regional recurrences only, 8 (89%) were considered as infield, and 1 (11%) as outfield. The 1- and 2-year disease-free survival (DFS) rates were 78.9% and 71.8% respectively. The 1- and 2-year overall survival (OS) rates were 88.6% and 80% respectively. Higher tumor stage (T3/T4) and the presence of ENE were the two prognostic factors significantly associated with worse DFS and OS in multivariate analysis. Conclusion Our outcomes for postoperative VMAT for oral cavity and oropharyngeal cancers are encouraging, with high rates of loco-regional control. However, the management of ENE still seems challenging.
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Affiliation(s)
- Cécile Mione
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Mélanie Casile
- INSERM U1240 IMoST, University of Clermont Auvergne, Clermont-Ferrand, France
- UMR 501, Clinical Investigation Centre, Clermont-Ferrand, France
- Department of Clinical Research, Clinical Search and Innovation, Centre Jean Perrin, Clermont-Ferrand, France
| | - Juliette Moreau
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Jessica Miroir
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Ioana Molnar
- INSERM U1240 IMoST, University of Clermont Auvergne, Clermont-Ferrand, France
- UMR 501, Clinical Investigation Centre, Clermont-Ferrand, France
- Department of Clinical Research, Clinical Search and Innovation, Centre Jean Perrin, Clermont-Ferrand, France
| | - Emmanuel Chautard
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
- INSERM U1240 IMoST, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Maureen Bernadach
- UMR 501, Clinical Investigation Centre, Clermont-Ferrand, France
- Department of Clinical Research, Clinical Search and Innovation, Centre Jean Perrin, Clermont-Ferrand, France
- Medical Oncology Department, Jean Perrin Center, Clermont-Ferrand, France
| | - Myriam Kossai
- INSERM U1240 IMoST, University of Clermont Auvergne, Clermont-Ferrand, France
- Department of Pathology and Molecular Pathology, Centre Jean Perrin, Clermont-Ferrand, France
| | - Nicolas Saroul
- Department of Otolaryngology-Head and Neck Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - F. Martin
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Nathalie Pham-Dang
- Department of Maxillo-Facial Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Michel Lapeyre
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Julian Biau
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
- INSERM U1240 IMoST, University of Clermont Auvergne, Clermont-Ferrand, France
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Grégoire V, Boisbouvier S, Giraud P, Maingon P, Pointreau Y, Vieillevigne L. Management and work-up procedures of patients with head and neck malignancies treated by radiation. Cancer Radiother 2021; 26:147-155. [PMID: 34953696 DOI: 10.1016/j.canrad.2021.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Radiotherapy alone or in association with systemic treatment plays a major role in the treatment of head and neck tumours, either as a primary treatment or as a postoperative modality. The management of these tumours is multidisciplinary, requiring particular care at every treatment step. We present the update of the recommendations of the French Society of Radiation Oncology on the radiotherapy of head and neck tumours from the imaging work-up needed for optimal selection of treatment volume, to optimization of the dose distribution and delivery.
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Affiliation(s)
- V Grégoire
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon, France.
| | - S Boisbouvier
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon, France
| | - P Giraud
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - P Maingon
- Département de radiothérapie, Sorbonne Université, groupe hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France
| | - Y Pointreau
- Institut interrégional de cancérologie (ILC), centre Jean-Bernard, 9, rue Beauverger, 72000 Le Mans, France
| | - L Vieillevigne
- Unité de physique médicale, institut Claudius-Regaud, Institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
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Racadot S, Vérillaud B, Serre AA, Le Guevelou J, Guzene L, Laude C, Grégoire V, Deneuve S, Larnaudie A, Lasne-Cardon A, Thariat J. [Impact of reconstructive or minimal invasive surgery on the assessment of current definitions of postoperative clinical target volume for head and neck cancers]. Cancer Radiother 2020; 24:649-657. [PMID: 32782167 DOI: 10.1016/j.canrad.2020.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/20/2020] [Accepted: 05/30/2020] [Indexed: 10/23/2022]
Abstract
Advances in the reconstructive surgery and minimally invasive endonasal endoscopic surgery of head and neck is poorly evaluated in terms of their impact on radiotherapy planning and outcomes. These surgical advances have resulted in reduced morbidity with equivalent or better tumor control. In the absence of a recommendation on how to delineate target volumes in patients with flaps or to consider margins after endoscopic endonasal surgery, radiotherapy practices are inevitably heterogeneous. Efforts are needed to increase the therapeutic index of postoperative radiotherapy in these situations. We analysed the rare existing literature and outlined a preliminary basis for a recommendation. Strengthening of multidisciplinarity to accurately define target volumes in these complex and relatively new situations, and "delineation concertation meetings" between radiologists, surgeons and radiation oncologists could probably contribute to improved outcomes.
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Affiliation(s)
- S Racadot
- Radiation Oncology Department, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - B Vérillaud
- Department of Otolaryngology-Head and Neck Surgery/Skull Base Surgery, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; Université Paris-Diderot, 5, rue Thomas-Mann, 75013 Paris, France
| | - A-A Serre
- Radiation Oncology Department, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - J Le Guevelou
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France
| | - L Guzene
- Radiation Oncology Department, CHU d'Amiens, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - C Laude
- Radiation Oncology Department, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - V Grégoire
- Radiation Oncology Department, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - S Deneuve
- Oncologic Surgery Department, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - A Larnaudie
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France
| | - A Lasne-Cardon
- Oncologic Surgery Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France
| | - J Thariat
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue General-Harris, 14000 Caen, France.
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Bondue C, Racadot S, Coutte A, Dupuis P, Biston MC, Grégoire V. Volumetric and dosimetric comparison of two delineation guidelines for the radiation treatment of laryngeal squamous cell carcinoma. Clin Transl Radiat Oncol 2019; 19:1-11. [PMID: 31334365 PMCID: PMC6614748 DOI: 10.1016/j.ctro.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/31/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022] Open
Abstract
The delineation of target volumes for Head and Neck IMRT is complex. There have been several approaches for the delineation of the primary tumor clinical target volume: the anatomical guidelines, the geometric guidelines and more recently the international guidelines.
Purpose Three methods have been recently proposed for the delineation of the primary tumor clinical target volume (CTV-P) in Head and Neck Cancers: the anatomic method popularized in the French literature by Lapeyre et al. the geometric methods proposed by the DAHANCA group, and more recently the international guidelines promoted by Grégoire et al. integrating the latter two. The aim of this study was to perform a volumetric and dosimetric comparison of the French and the International consensus methods in laryngeal SCC. Patients and methods Two radiation oncologists independently delineated the high dose and low dose primary tumor CTV in four patients with T2 or T3 N0-M0 laryngeal SCC following either the so-called French guidelines or the International guidelines. For the 4 cases, the GTV was delineated by a single radiation oncologist. Nodal CTVs were delineated by one radiation oncologist for the 4 cases using International guidelines. Dose optimization was then performed with VMAT (MONACO version 5.11) using 6 MeV photons. Differences in target volumes and dose distributions in OARs and PTVs were then evaluated with various metrics such as the DICE Similarity Coefficient and the homogeneity index. Results Major differences were observed in the CTV delineation between the 2 delineation methods for the low dose volumes and to a lower extend for the high dose volumes. These differences translated into variations in dose distribution favoring the International guidelines for decreasing dose to various OARs. Such differences toned down when dose distribution on the primary tumors PTVs and nodal PTVs were combined. Conclusion This study demonstrated large differences in CTV delineation between the 2 delineation guidelines. Such differences translated into differences in dose distribution.
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Affiliation(s)
- C Bondue
- Department of Radiation Oncology, University Hospital, Amiens, France
| | - S Racadot
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - A Coutte
- Department of Radiation Oncology, University Hospital, Amiens, France
| | - P Dupuis
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - M C Biston
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - V Grégoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
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Grégoire V, Grau C, Lapeyre M, Maingon P. Target volume selection and delineation (T and N) for primary radiation treatment of oral cavity, oropharyngeal, hypopharyngeal and laryngeal squamous cell carcinoma. Oral Oncol 2018; 87:131-137. [DOI: 10.1016/j.oraloncology.2018.10.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/26/2018] [Indexed: 11/30/2022]
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The keys to conservative treatment of early-stage squamous cell carcinoma of the tonsillar region. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:259-264. [DOI: 10.1016/j.anorl.2017.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lapeyre M, Biau J, Racadot S, Moreira J, Berger L, Peiffert D. Radiothérapie des cancers de la cavité buccale. Cancer Radiother 2016; 20 Suppl:S116-25. [DOI: 10.1016/j.canrad.2016.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Yossi S, El Alouani C, Pointreau Y, Laccourreye L, Capitain O, Gustin P, Peyraga G, Septans AL, Jadaud É, Vinchon-Petit S, Cellier P, Autret D, Tuchais C. [Recurrence sites following definitive intensity-modulated conformational radiotherapy of squamous-cell carcinomas of the upper aerodigestive tract]. Cancer Radiother 2015; 19:73-81. [PMID: 25623256 DOI: 10.1016/j.canrad.2014.10.006] [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: 05/16/2014] [Revised: 10/10/2014] [Accepted: 10/15/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The implementation of intensity-modulated radiotherapy (IMRT) in a centre requires regular critical review of medical practices and feedback to optimize the subsequent management of patients. PATIENTS AND METHODS We reviewed and determined through a retrospective single-centre study recurrence sites of 167 consecutive patients treated for head and neck squamous cell carcinoma excluding skin or sinuses. Patients had mostly stage III or IV locally advanced cancer (n=123). RESULTS Locoregional control rates at 1 and 2 years were respectively 87.9% (95% confidence interval [95%CI]: 81.6%-92.1%) and 77.6% (95%CI: 70.1%-83.5). Among 55 relapses, 20 patients (36.4%) had treatment failures. Patients treated with 70 Gy relapsed mainly in high risk volume (78%). Those treated with 66 Gy recurred regionally outside the irradiated volume (n=4) or in the irradiated high risk volume (n=3) or had isolated metastatic failure (n=3). Those irradiated with 50 Gy had regional relapse outside the irradiated volume (n=2) or isolated metastatic relapse (n=2). We noticed respectively 5.4%, 10.2% and 4.2% isolated metastatic, local, cervical lymph node relapse. CONCLUSION Our results are consistent with data from the literature. Corrective actions were performed to enhance our practices.
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Affiliation(s)
- S Yossi
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France.
| | - C El Alouani
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France; Département de radiothérapie, centre hospitalier universitaire de Marrakech, Marrakech, Maroc
| | - Y Pointreau
- Centre Jean-Bernard-clinique Victor-Hugo, 9, rue Beauverger, 72000 Le Mans, France
| | - L Laccourreye
- Service d'ORL et de chirurgie maxillofaciale, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49100 Angers, France
| | - O Capitain
- Département d'oncologie médicale, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - P Gustin
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - G Peyraga
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - A-L Septans
- Délégation à la recherche clinique et à l'innovation, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - É Jadaud
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - S Vinchon-Petit
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - P Cellier
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - D Autret
- Département de physique médicale, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - C Tuchais
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
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Approche anatomopathologique de l’extension microscopique des carcinomes épidermoïdes ORL : implications pour la définition du volume cible anatomoclinique. Cancer Radiother 2014; 18:666-71. [DOI: 10.1016/j.canrad.2014.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 04/11/2014] [Accepted: 04/18/2014] [Indexed: 11/23/2022]
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Lapeyre M, Miroir J, Biau J. Délinéation des adénopathies et aires ganglionnaires pour les cancers de la sphère ORL. Cancer Radiother 2014; 18:572-6. [DOI: 10.1016/j.canrad.2014.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/07/2014] [Indexed: 10/24/2022]
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