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Reynaud T, Hathout L, Carignan D, Barkati M, Martin AG, Foster W, Lacroix F, Delouya G, Taussky D, Morton G, Vigneault E. PSA outcomes and late toxicity of single-fraction HDR brachytherapy and LDR brachytherapy as monotherapy in localized prostate cancer: A phase 2 randomized pilot study. Brachytherapy 2021; 20:1090-1098. [PMID: 34238688 DOI: 10.1016/j.brachy.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/16/2021] [Accepted: 05/19/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the PSA outcomes and the late patient's reported health related quality of life (HRQOL) and toxicity after single-fraction High-Dose-Rate brachytherapy (HDRB) and Low-Dose-Rate brachytherapy (LDRB) for prostate cancer. METHODS Men with low and favorable intermediate-risk prostate cancer across 3 centres were randomized between monotherapy brachytherapy with either Iodine-125 LDRB or 19 Gy single-fraction HDRB. Biochemical outcomes were evaluated using the Phoenix definition, PSA nadir and absolute PSA value <0.4 ng/mL. Toxicities and HRQOL were recorded at 24 and 36 months. RESULTS A total of 31 patients were randomized, 15 in the LDRB arm and 16 patients in the HDRB arm. After a median follow-up of 45(36-53) months, 3 patients in the HDRB arm experienced biochemical failure (p = 0.092). Nineteen Gy single-fraction HDRB was associated with significantly higher PSA nadir compared to LDRB (1.02 ± 0.66vs 0.25 ± 0.39, p < 0.0001). Moreover, a significantly larger proportion of patients in the LDRB group had a PSA <0.4 ng/mL (13/15 vs 2/16, p < 0.0001). For late Genito-Urinary, Gastro-Intestinal, and sexual toxicities at 24 and 36 months, no significant differences were found between the 2 arms. As for HRQOL, the IPSS and EPIC-26 urinary irritative score were significantly better for patients treated with HDRB over the first 36 months post-treatment (p = 0.001 and p = 0.01, respectively), reflecting superior HRQOL. CONCLUSION HDRB resulted in superior HRQOL in the irritative urinary domain compared to LDRB. PSA nadir was significantly lower in the LDRB group and a higher proportion of patients in the LDRB group reached PSA <0.4 ng/mL.
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Affiliation(s)
- Thomas Reynaud
- Department of Radiation Oncology, CHU de Québec-Université Laval, Québec, Canada; Research Centre CHU de Québec-Université Laval, Québec, Canada
| | - Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Damien Carignan
- Research Centre CHU de Québec-Université Laval, Québec, Canada
| | - Maroie Barkati
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - André-Guy Martin
- Department of Radiation Oncology, CHU de Québec-Université Laval, Québec, Canada; Research Centre CHU de Québec-Université Laval, Québec, Canada
| | - William Foster
- Department of Radiation Oncology, CHU de Québec-Université Laval, Québec, Canada
| | - Frédéric Lacroix
- Department of Radiation Oncology, CHU de Québec-Université Laval, Québec, Canada
| | - Guila Delouya
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Eric Vigneault
- Department of Radiation Oncology, CHU de Québec-Université Laval, Québec, Canada; Research Centre CHU de Québec-Université Laval, Québec, Canada.
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Ionizing Radiation Mediates Dose Dependent Effects Affecting the Healing Kinetics of Wounds Created on Acute and Late Irradiated Skin. SURGERIES 2021. [DOI: 10.3390/surgeries2010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Radiotherapy for cancer treatment is often associated with skin damage that can lead to incapacitating hard-to-heal wounds. No permanent curative treatment has been identified for radiodermatitis. This study provides a detailed characterization of the dose-dependent impact of ionizing radiation on skin cells (45, 60, or 80 grays). We evaluated both early and late effects on murine dorsal skin with a focus on the healing process after two types of surgical challenge. The irradiated skin showed moderate to severe damage increasing with the dose. Four weeks after irradiation, the epidermis featured increased proliferation status while the dermis was hypovascular with abundant α-SMA intracellular expression. Excisional wounds created on these tissues exhibited delayed global wound closure. To assess potential long-lasting side effects of irradiation, radiodermatitis features were followed until macroscopic healing was notable (over 8 to 22 weeks depending on the dose), at which time incisional wounds were made. Severity scores and biomechanical analyses of the scar tissues revealed that seemingly healed irradiated skin still displayed altered functionality. Our detailed investigation of both the acute and chronic repercussions of radiotherapy on skin healing provides a relevant new in vivo model that will instruct future studies evaluating the efficacy of new treatments for radiodermatitis.
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[Low-dose irradiation of non-malignant diseases: Did we throw the baby out with the bathwater?]. Cancer Radiother 2021; 25:279-282. [PMID: 33451911 DOI: 10.1016/j.canrad.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/25/2022]
Abstract
The irradiation of non-malignant diseases, essentially for anti-inflammatory purpose, have been largely proposed and performed worldwide until the 1970-80s. At that time, the better assessment of the radio-induced malignancies, essentially in children and young patients, as well as the efficacy of the new anti-inflammatory drugs (steroids and non-steroids), led to the almost disappearance of those techniques, at least in France. In contrast, our German colleagues are still going on treating about 50,000 patients per year for non-malignant (more or less severe) diseases. After a short historical overview, the present article suggests that we were possibly going too far in the rejection of those low-dose irradiations for benign lesions. The recent emergence of new preclinical data, the better understanding of the risk of radio-induced secondary tumours (almost nil in the elderly), and the severity of some situations, such as the cytokine storm of the COVID-19, should probably lead us to reconsider those low - and sometimes very low (less than 1Gy) - irradiations for well-selected indications in the elderly.
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Bertho A, Dos Santos M, François A, Milliat F. Histoire de la prise en charge des cancers bronchopulmonaires non à petites cellules de stade précoce : de la chirurgie à la radiothérapie stéréotaxique. RADIOPROTECTION 2020; 55:165-172. [DOI: 10.1051/radiopro/2020050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Avant le début du XXe siècle, le cancer bronchopulmonaire était une maladie rare. Aujourd’hui, c’est le quatrième cancer le plus fréquent en France et concerne, chaque année, près de 50 000 patients. Si à travers l’histoire, la pierre angulaire de la prise en charge thérapeutique du cancer bronchopulmonaire reste la chirurgie, la radiothérapie en est un des piliers, notamment chez les patients à haut risque chirurgical. La radiothérapie est apparue quelques mois après la découverte des rayons X en 1896 et, rapidement, des protocoles standardisés ont été mis au point par les premiers radiobiologistes. Ces protocoles sont ceux que nous connaissons encore aujourd’hui : 2 Gy par fraction et 5 fractions par semaine sur une durée totale de 5 à 8 semaines. Si les protocoles ont peu changé en un siècle, la technique et la balistique ont connu de grandes avancées. Ces améliorations ont mené à un bouleversement profond des protocoles. Les améliorations techniques de délivrance de dose, par l’optimisation de l’imagerie, de la précision du positionnement des patients et dans la modulation de la géométrie des faisceaux ont conduit au développement de la radiothérapie en conditions stéréotaxiques ou radiothérapie stéréotaxique. Aujourd’hui, la radiothérapie stéréotaxique est utilisée pour la prise en charge des tumeurs bronchopulmonaires de stade précoce comme alternative à la chirurgie.
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Bertho A, Dos Santos M, Buard V, Paget V, Guipaud O, Tarlet G, Milliat F, François A. Preclinical Model of Stereotactic Ablative Lung Irradiation Using Arc Delivery in the Mouse: Effect of Beam Size Changes and Dose Effect at Constant Collimation. Int J Radiat Oncol Biol Phys 2020; 107:548-562. [PMID: 32278852 DOI: 10.1016/j.ijrobp.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Stereotactic body radiation therapy is a therapeutic option offered to high surgical risk patients with lung cancer. Focal lung irradiation in mice is a new preclinical model to help understand the development of lung damage in this context. Here we developed a mouse model of lung stereotactic therapy using arc delivery and monitored the development of lung damage while varying the beam size and dose delivered. METHODS AND MATERIALS C57BL/6JRj mice were exposed to 90 Gy focal irradiation on the left lung using 1-mm diameter, 3 × 3 mm2, 7 × 7 mm2, or 10 × 10 mm2 beam collimation for beam size effect and using 3 × 3 mm2 beam collimation delivering 20 to 120 Gy for dose effect. Long-term lung damage was monitored with micro-computed tomography imaging with anatomopathologic and gene expression measurements in the injured patch and the ipsilateral and contralateral lungs. RESULTS Both 1-mm diameter and 3 × 3 mm2 beam collimation allow long-term studies, but only 3-mm beam collimation generates lung fibrosis when delivering 90 Gy. Dose-effect studies with constant 3-mm beam collimation revealed a dose of 60 Gy as the minimum to obtain lung fibrosis 6 months postexposure. Lung fibrosis development was associated with club cell depletion and increased type II pneumocyte numbers. Lung injury developed with ipsilateral and contralateral consequences such as parenchymal thickening and gene expression modifications. CONCLUSIONS Arc therapy allows long-term studies and dose escalation without lethality. In our dose-delivery conditions, dose-effect studies revealed that 3 × 3 mm2 beam collimation to a minimum single dose of 60 Gy enables preclinical models for the assessment of lung injury within a 6-month period. This model of lung tissue fibrosis in a time length compatible with mouse life span may offer good prospects for future mechanistic studies.
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Affiliation(s)
- Annaïg Bertho
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France
| | - Morgane Dos Santos
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Accidentelles, Fontenay-aux-Roses, France
| | - Valérie Buard
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France
| | - Vincent Paget
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France
| | - Olivier Guipaud
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France
| | - Georges Tarlet
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France
| | - Fabien Milliat
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France
| | - Agnès François
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France.
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Effets biologiques des hautes doses par fraction. Cancer Radiother 2020; 24:153-158. [DOI: 10.1016/j.canrad.2019.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/29/2023]
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7
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Quel rapport alpha/bêta pour le cancer prostatique en 2019 ? Cancer Radiother 2019; 23:342-345. [DOI: 10.1016/j.canrad.2019.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/29/2018] [Accepted: 01/06/2019] [Indexed: 12/13/2022]
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Fekrmandi F, Panzarella T, Dinniwell RE, Helou J, Levin W. Predictive factors for persistent and late radiation complications in breast cancer survivors. Clin Transl Oncol 2019; 22:360-369. [PMID: 31123988 DOI: 10.1007/s12094-019-02133-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE With improved diagnostic techniques and treatments of breast cancer, overall survival times are longer, giving more opportunity for normal tissue complications of treatment to manifest. Radiation late effects (RLEs) could have profound long-term impacts on the quality of life of the survivors. The aim of this study was to identify predictive factors influencing timing and types of complications in patients referred to the Adult Radiation Late Effects Clinic (ARLEC). METHODS In a period of 16 years, 296 breast cancer patients were referred to the ARLEC. The clinical records were retrospectively studied to collect epidemiologic, medical and treatment data. Associations were sought between candidate predictive factors and time to the first complication after radiation treatment (RT) completion (primary outcome), and pain or swelling (secondary outcomes) using univariable and multivariable linear and logistic regression analyses. All analyses were performed in SAS, version 9.4. RESULTS All patients were female with a mean age of 56.3 years. The first treatment-related complication occurred after a median of 3 months. Patients were followed at ARLEC for a median of 18 months. Older age and delay from surgery to RT (S-RT delay) were associated with earlier onset of complications (both p < 0.001). The most common complications were breast pain (62.1%) and swelling (45.9%). Histology and RT boost were associated with pain (p = 0.035 and 0.013). RT boost and S-RT delay on the other hand were associated with swelling (p = 0.013 and 0.005). CONCLUSIONS Clinical factors identified could help recognize the patients at high risk for developing RLEs and alert physicians to initiate earlier diagnostic and therapeutic measures.
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Affiliation(s)
- F Fekrmandi
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, 700 University Avenue, Toronto, ON, M5G 1Z5, Canada
| | - T Panzarella
- Biostatistics Department, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - R E Dinniwell
- Department of Radiation Oncology, London Regional Cancer Program, Western University, London, Canada
| | - J Helou
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, 700 University Avenue, Toronto, ON, M5G 1Z5, Canada
| | - W Levin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, 700 University Avenue, Toronto, ON, M5G 1Z5, Canada.
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Lyu J, Liu T, Li T, Li F, Wang Q, Wang J, Han Y, Wang J, Zhang J, Peng L, Lang J. Comparison of efficacy, safety, and costs between neoadjuvant hypofractionated radiotherapy and conventionally fractionated radiotherapy for esophageal carcinoma. Cancer Med 2019; 8:3710-3718. [PMID: 31119872 PMCID: PMC6639169 DOI: 10.1002/cam4.2250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/17/2022] Open
Abstract
Background We compared the efficacy, safety, and costs of hypofractionated radiotherapy (HFRT) and conventional fractionated radiotherapy (CFRT) for the neoadjuvant treatment of esophageal cancer. Materials and Methods Overall, 110 patients with esophageal cancer treated with neoadjuvant chemoradiotherapy from October 2002 to July 2017 were retrospectively included and divided into a HFRT group (42 patients received 30 Gray [Gy]/10 fractions for 2 weeks) and a CFRT group [68 patients received 40 Gy/20 fractions for 4 weeks]. Concurrent chemotherapy comprised cisplatin combined with either 5‐FU or taxane. Surgery was performed 3‐8 weeks after radiotherapy. We compared the outcomes, adverse events, and costs between the two groups. Results Pathological downstaging was achieved in 78.6% of the HFRT group and 83.8% of the CFRT group (P = 0.612). Compared with the CFRT group, the HFRT group had similar pathological complete response (pCR) (33.3% vs 35.3%; P = 0.834), median overall survival (OS) (40.8 months vs 44.9 months; P = 0.772) and progression free survival (32.7 months vs 35.4 months; P = 0.785). The perioperative complication rates were also similar between the groups, but the treatment time and costs were significantly reduced in the HFRT group (P < 0.05). Finally, multivariate analysis identified cN0 stage, pathological downstaging and pCR as independent predictors of better OS. Conclusion Preoperative HFRT is effective and safe for esophageal cancer. Moreover, it is similar to CFRT in terms of overall survival and toxicity and is cost effective and less time consuming.
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Affiliation(s)
- Jiahua Lyu
- Sichuan Cancer Hospital and Institute, Chengdu, China.,School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Tao Liu
- Ya'an people's hospital, Ya'an, China
| | - Tao Li
- Sichuan Cancer Hospital and Institute, Chengdu, China.,School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Fang Li
- Sichuan Cancer Hospital and Institute, Chengdu, China.,School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qifeng Wang
- Sichuan Cancer Hospital and Institute, Chengdu, China.,School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Wang
- Sichuan Cancer Hospital and Institute, Chengdu, China.,School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yongtao Han
- Sichuan Cancer Hospital and Institute, Chengdu, China.,School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Junchao Wang
- Sichuan Cancer Hospital and Institute, Chengdu, China.,School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jun Zhang
- Sichuan Cancer Hospital and Institute, Chengdu, China.,School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lin Peng
- Sichuan Cancer Hospital and Institute, Chengdu, China.,School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jinyi Lang
- Sichuan Cancer Hospital and Institute, Chengdu, China.,School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Modesto A, Chira C, Sol JC, Lubrano V, Boulinguez S, Pagès C, Sibaud V, Gomez-Roca C, Moyal É, Meyer N. Prise en charge des patients atteints de métastases cérébrales de mélanome. Cancer Radiother 2019; 23:147-150. [DOI: 10.1016/j.canrad.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 11/29/2022]
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11
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Tao Z, Gao J, Qian L, Huang Y, Zhou Y, Yang L, He J, Yang J, Wang R, Zhang Y. Factors associated with acute oral mucosal reaction induced by radiotherapy in head and neck squamous cell carcinoma: A retrospective single-center experience. Medicine (Baltimore) 2017; 96:e8446. [PMID: 29390253 PMCID: PMC5815665 DOI: 10.1097/md.0000000000008446] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate risk factors for acute oral mucosal reaction during head and neck squamous cell carcinoma radiotherapy.A retrospective study of patients with head and neck squamous cell carcinoma who underwent radiotherapy from November 2013 to May 2016 in Anhui Provincial Cancer Hospital was conducted. Data on the occurrence and severity of acute oral mucositis were extracted from clinical records. Based on the Radiation Therapy Oncology Group (RTOG) grading of acute radiation mucosal injury, the patients were assigned into acute reaction (grades 2-4) and minimum reaction (grades 0-1) groups. Preradiotherapy characteristics and treatment factors were compared between the 2 groups. Multivariate logistic regression analysis was used to detect the independent factors associated with acute oral mucosal reactions.Eighty patients completed radiotherapy during the study period. Oral mucosal reactions were recorded as 25, 31, and 24 cases of grades 1, 2, and 3 injuries, respectively. Significant differences between acute reaction and minimum reaction groups were detected in cancer lymph node (N) staging, smoking and diabetes history, pretreatment platelet count and T-Helper/T-Suppressor lymphocyte (Th/Ts) ratio, concurrent chemotherapy, and total and single irradiation doses.Multivariate analysis showed that N stage, smoking history, single dose parapharyngeal irradiation, and pretreatment platelet count were independent risk factors for acute radiation induced oral mucosal reaction. Smoking history, higher grading of N stage, higher single dose irradiation, and lower preirradiation platelet count may increase the risk and severity of acute radiation oral mucosal reaction in radiotherapy of head and neck cancer patients.
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Affiliation(s)
- Zhenchao Tao
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Jin Gao
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Liting Qian
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yifan Huang
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yan Zhou
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Liping Yang
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Jian He
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Jing Yang
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Ru Wang
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yangyang Zhang
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
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12
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Cosset JM. [Hypofractionated irradiation of prostate cancer: What is the radiobiological understanding in 2017?]. Cancer Radiother 2017; 21:447-453. [PMID: 28847464 DOI: 10.1016/j.canrad.2017.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/16/2017] [Indexed: 01/10/2023]
Abstract
For prostate cancer, hypofractionation has been based since 1999 on radiobiological data, which calculated a very low alpha/beta ratio (1.2 to 1.5Gy). This suggested that a better local control could be obtained, without any toxicity increase. Consequently, two types of hypofractionated schemes were proposed: "moderate" hypofractionation, with fractions of 2.5 to 4Gy, and "extreme" hypofractionation, utilizing stereotactic techniques, with fractions of 7 to 10Gy. For moderate hypofractionation, the linear-quadratic (LQ) model has been used to calculate the equivalent doses of the new protocols. The available trials have often shown a "non-inferiority", but no advantage, while the equivalent doses calculated for the hypofractionated arms were sometimes very superior to the doses of the conventional arms. This finding could suggest either an alpha/beta ratio lower than previously calculated, or a negative impact of other radiobiological parameters, which had not been taken into account. For "extreme" hypofractionation, the use of the LQ model is discussed for high dose fractions. Moreover, a number of radiobiological questions are still pending. The reduced overall irradiation time could be either a positive point (better local control) or a negative one (reduced reoxygenation). The prolonged duration of the fractions could lead to a decrease of efficacy (because allowing for reparation of sublethal lesions). Finally, the impact of the large fractions on the microenvironment and/or immunity remains discussed. The reported series appear to show encouraging short to mid-term results, but the results of randomized trials are still awaited. Today, it seems reasonable to only propose those extreme hypofractionated schemes to well-selected patients, treating small volumes with high-level stereotactic techniques.
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Affiliation(s)
- J-M Cosset
- GIE Charlebourg, groupe Amethyst, 65, avenue Foch, 92250 La Garenne-Colombes, France.
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13
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Viau M, Perez AF, Bodgi L, Devic C, Granzotto A, Ferlazzo ML, Bourguignon M, Puisieux A, Lacornerie T, Lartigau É, Lagrange JL, Foray N. [Repeated radiation dose effect and DNA repair: Importance of the individual factor and the time interval between the doses]. Cancer Radiother 2016; 20:217-25. [PMID: 27020715 DOI: 10.1016/j.canrad.2015.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/09/2015] [Accepted: 05/12/2015] [Indexed: 11/19/2022]
Abstract
The dose fractionation effect is a recurrent question of radiation biology research that remains unsolved since no model predicts the clinical effect only with the cumulated dose and the radiobiology of irradiated tissues. Such an important question is differentially answered in radioprotection, radiotherapy, radiology or epidemiology. A better understanding of the molecular response to radiation makes possible today a novel approach to identify the parameters that condition the fractionation effect. Particularly, the time between doses appears to be a key factor since it will permit, or not, the repair of certain radiation-induced DNA damages whose repair rates are of the order of seconds, minutes or hours: the fractionation effect will therefore vary according to the functionality of the different repair pathways, whatever for tumor or normal tissues.
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Affiliation(s)
- M Viau
- Inserm, UMR1052, centre de recherches en cancérologie de Lyon, 28, rue Laennec, 69008 Lyon, France
| | - A-F Perez
- Inserm, UMR1052, centre de recherches en cancérologie de Lyon, 28, rue Laennec, 69008 Lyon, France
| | - L Bodgi
- Inserm, UMR1052, centre de recherches en cancérologie de Lyon, 28, rue Laennec, 69008 Lyon, France
| | - C Devic
- Inserm, UMR1052, centre de recherches en cancérologie de Lyon, 28, rue Laennec, 69008 Lyon, France
| | - A Granzotto
- Inserm, UMR1052, centre de recherches en cancérologie de Lyon, 28, rue Laennec, 69008 Lyon, France
| | - M L Ferlazzo
- Inserm, UMR1052, centre de recherches en cancérologie de Lyon, 28, rue Laennec, 69008 Lyon, France
| | - M Bourguignon
- Institut de radioprotection et sûreté nucléaire, BP 17, 92260 Fontenay-aux-Roses, France
| | - A Puisieux
- Inserm, UMR1052, centre de recherches en cancérologie de Lyon, 28, rue Laennec, 69008 Lyon, France
| | - T Lacornerie
- Département de radiothérapie, centre Oscar-Lambret, ONCOLille, université de Lille, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - É Lartigau
- Département de radiothérapie, centre Oscar-Lambret, ONCOLille, université de Lille, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - J-L Lagrange
- Département de radiothérapie, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - N Foray
- Inserm, UMR1052, centre de recherches en cancérologie de Lyon, 28, rue Laennec, 69008 Lyon, France.
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14
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[Small animal image-guided radiotherapy: A new era for preclinical studies]. Cancer Radiother 2016; 20:43-53. [PMID: 26856635 DOI: 10.1016/j.canrad.2015.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 12/11/2022]
Abstract
Preclinical external beam radiotherapy irradiations used to be delivered with a static broad beam. To promote the transfer from animal to man, the preclinical treatment techniques dedicated to the animal have been optimized to be similar to those delivered to patients in clinical practice. In this context, preclinical irradiators have been developed. Due to the small sizes of the animals, and the irradiation beams, the scaling to the small animal dimensions involves specific problems. Reducing the size and energy of the irradiation beams require very high technical performance, especially for the mechanical stability of the irradiator and the spatial resolution of the imaging system. In addition, the determination of the reference absorbed dose rate must be conducted with a specific methodology and suitable detectors. To date, three systems are used for preclinical studies in France. The aim of this article is to present these new irradiators dedicated to small animals from a physicist point of view, including the commissioning and the quality control.
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15
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Antoni D, Noël G. Quelles contraintes pour quels organes à risque pour les radiothérapies chez l’adulte ? Cancer Radiother 2015; 19:479-83. [DOI: 10.1016/j.canrad.2015.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 11/28/2022]
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16
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Supiot S, Clément-Colmou K, Paris F, Corre I, Chiavassa S, Delpon G. [Which rules apply to hypofractionated radiotherapy?]. Cancer Radiother 2015; 19:421-5. [PMID: 26321647 DOI: 10.1016/j.canrad.2015.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 12/22/2022]
Abstract
Hypofractionated radiotherapy is now more widely prescribed due to improved targeting techniques (intensity modulated radiotherapy, image-guided radiotherapy and stereotactic radiotherapy). Low dose hypofractionated radiotherapy is routinely administered mostly for palliative purposes. High or very high dose hypofractionated irradiation must be delivered according to very strict procedures since every minor deviation can lead to major changes in dose delivery to the tumor volume and organs at risk. Thus, each stage of the processing must be carefully monitored starting from the limitations and the choice of the hypofractionation technique, tumour contouring and dose constraints prescription, planning and finally dose calculation and patient positioning verification.
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Affiliation(s)
- S Supiot
- Département de radiothérapie, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France; Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France.
| | - K Clément-Colmou
- Département de radiothérapie, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France; Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France
| | - F Paris
- Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France
| | - I Corre
- Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France
| | - S Chiavassa
- Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France; Département de radiophysique, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - G Delpon
- Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France; Département de radiophysique, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France
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17
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De Bari B, Daidone A, Alongi F. Is high dose rate brachytherapy reliable and effective treatment for prostate cancer patients? A review of the literature. Crit Rev Oncol Hematol 2015; 94:360-70. [DOI: 10.1016/j.critrevonc.2015.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 12/16/2014] [Accepted: 02/03/2015] [Indexed: 10/24/2022] Open
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18
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Cancers de prostate : quelles techniques de radiothérapie pour quelles tumeurs ? Enjeux éthiques et méthodologiques. Cancer Radiother 2014; 18:369-78. [DOI: 10.1016/j.canrad.2014.07.154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/21/2014] [Accepted: 07/24/2014] [Indexed: 11/22/2022]
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19
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Radiobiologie des doses ablatives en radiothérapie stéréotaxique : mise au point des données récentes. Cancer Radiother 2014; 18:264-9. [DOI: 10.1016/j.canrad.2014.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/15/2014] [Indexed: 11/24/2022]
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20
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Quero L, Hennequin C. [Stereotactic radiotherapy for prostate cancer]. Cancer Radiother 2014; 18:332-6. [PMID: 24958683 DOI: 10.1016/j.canrad.2014.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 05/18/2014] [Indexed: 01/10/2023]
Abstract
Stereotactic radiotherapy is a new option in the treatment of prostate cancer. However, only retrospective series and a few prospective phase II trials are available at this moment, including a few thousands of patients with a short follow-up. Most of the protocols delivered 33 to 38 Gy in four or five fractions. Acute toxicity seems to be similar to the one observed after conventional radiotherapy. Late toxicity is less evaluable because of the short follow-up: the rate of radiation-induced proctitis seems low in the published series. Urinary toxicities are not properly evaluated: some series reported a high incidence of urinary complications grade or higher. Most of the patients belong to the D'Amico's favourable group: biochemical controls are equivalent to those observed after conventional irradiation, but the follow-up is often shorter than 5 years and no definitive conclusion could be made about the efficiency of the technique. Data for the intermediate and high risk groups are not mature. In conclusion, stereotactic radiotherapy could strongly modified the management of prostate cancer: some phase III trials have started to confirm the good results reported in preliminary series.
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Affiliation(s)
- L Quero
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75475 Paris, France; Université Paris-Diderot Paris VII, 1, avenue Claude-Vellefeaux, 75475 Paris, France.
| | - C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75475 Paris, France; Université Paris-Diderot Paris VII, 1, avenue Claude-Vellefeaux, 75475 Paris, France.
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