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Varela Cagetti L, Moureau-Zabotto L, Zemmour C, Ferré M, Giovaninni M, Poizat F, Lelong B, De Chaisemartin C, Mitry E, Tyran M, Zioueche-Mottet A, Salem N, Tallet A. The impact of brachytherapy boost for anal canal cancers in the era of de-escalation treatments. Brachytherapy 2023; 22:531-541. [PMID: 37150739 DOI: 10.1016/j.brachy.2023.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To analyze clinical outcomes of high-dose-rate (HDR) interstitial brachytherapy boost (ISBT) after external beam radiation therapy (EBRT) or chemoradiotherapy (CRT) for the treatment of anal canal cancers (ACC). METHODS AND MATERIALS A total of 78 patients with ACC were treated at our institution by ISBT. Local Control (LC), disease-free survival (DFS), overall survival (OS), colostomy-free survival (CFS) and toxicity rates were analyzed. RESULTS With a median followup (FU) of 59.8 months (95% CI [55.8-64.2]), six (7.7%) local recurrences with 2 patients (2.6%) having persistent disease at 3 months were observed. The 5-year rate of LC for the entire population was 92% [83-96%]. The 5-year DFS rate was 86% [76-93%]. The 5-year OS was 96% [88-99%]. In the univariate analysis, chemotherapy was significantly associated with morbidity grade ≥2. Late digestive toxicity grade ≥3 was reported in 8.9% patients, 1 patient underwent colostomy due to toxicity. The 5-year CFS rate was 88% [79-94%]. CONCLUSIONS HDR interstitial brachytherapy boost provide excellent rates of tumor control and colostomy-free survival with a favorable profile of GI toxicity. Continence in anal cancer survivors is a challenge and the boost technique must be discussed in a multidisciplinary approach as part of de-escalation treatments.
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Affiliation(s)
| | - Laurence Moureau-Zabotto
- Department of Radiation Oncology, Centre de Radiothérapie du Pays d'Aix-en-Provence, Aix-en-Provence France
| | - Christophe Zemmour
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - Marjorie Ferré
- Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Marc Giovaninni
- Oncology and Endoscopic Unit, Institut Paoli-Calmettes, Marseille, France
| | - Flora Poizat
- Department of Pathology, Institut Paoli-Calmettes, Marseille, France
| | - Bernard Lelong
- Department of Digestive Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Emmanuel Mitry
- Department on Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Marguerite Tyran
- Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Naji Salem
- Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Agnès Tallet
- Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France
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Abstract
The 2020 recommendations for good brachytherapy procedures ("Recorad") are updated based on the 2016 article. This new brachytherapy article took into account recent data published in the literature as well as international recommendations. The different brachytherapy steps are successively described from the treatment preparation (brachytherapy technique prescription; procedure and material, dedicated images for planification, dose distribution analysis and validation) to the end of the procedure as well as post-treatment surveillance.
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3
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Varela Cagetti L, Gonzague-Casabianca L, Zemmour C, Lambaudie E, Houvenaeghel G, Provansal M, Sabatier R, Sabiani L, Blache G, Jauffret C, Ferré M, Mailleux H, Paciencia M, Tallet A. The impact of modern preoperative high-dose-rate brachytherapy in early-stage cervical cancer. Gynecol Oncol 2021; 161:166-172. [PMID: 33563488 DOI: 10.1016/j.ygyno.2021.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/25/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the clinical outcomes and the safety of preoperative high-dose-rate (HDR) image-guided adaptive brachytherapy (IGABT) followed by minimally invasive surgery (MIS) in the multidisciplinary management of early-stage cervical cancer. METHODS AND MATERIALS Medical records of all consecutive patients with early-stage cervical cancer treated at our institution between 2012 and 2018 with preoperative IGABT in a multidisciplinary approach were reviewed. Treatment schedule was pelvic node dissection, preoperative IGABT followed 6-8 week later by MIS hysterectomy. RESULTS Seventy patients with cervical cancer FIGO stages (IB1 18.6%, IB2 75.7% and IIA1 5.7%) were treated by preoperative HDR brachytherapy. With a median follow-up of 37.4 months [95% confidence interval, 32.1-39.7 months] isolated vaginal vault recurrence was not observed, 3 pelvic relapses were reported (4.3%). None of patients received postoperative radiotherapy (EBRT) or radiochemotherapy. The estimated 3-year local and pelvis relapse free survival for the entire population were respectively 98% [95% confidence interval, 89%-100%] and 90% [80%-96%]. The estimated 3-year disease-free survival (DFS) for the entire population was 88% [77-94%]. The 3-year overall survival (OS) rate was 97% [88%-99%]. Microscopic vaginal resection margin (R1) was observed in one patient ([1].4%). Lymph-vascular space invasion (LVSI) was found found in 6 (8.6%) patients. Forty-eight late complications in 36 patients (51.4%) were observed. Five (7.1%) grade 3 vaginal wound dehiscence toxicities were observed. Urinary and gastrointestinal toxicities were grade 1-2. No grade 4-5 complications were observed. CONCLUSIONS Preoperative image-guided adaptive brachytherapy followed by minimally invasive surgery allows high local control, reduces positive surgical margins and rates of lymph-vascular space invasion avoiding adjuvants treatments. Surgical approaches must be discussed with patients including preoperative brachytherapy as a down-staging treatment.
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Affiliation(s)
| | | | - Christophe Zemmour
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - Eric Lambaudie
- Department of Surgical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, CRCM, 13000 Marseille, France
| | - Gilles Houvenaeghel
- Department of Surgical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, CRCM, 13000 Marseille, France; Aix-Marseille University, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France; Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Magalie Provansal
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Renaud Sabatier
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France; Département of Molecular Oncology, Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Marseille, France
| | - Laura Sabiani
- Departemet of Oncology Surgery 2, Institut Paoli-Calmettes, Marseille, France
| | - Guillaume Blache
- Departemet of Oncology Surgery 2, Institut Paoli-Calmettes, Marseille, France
| | - Camille Jauffret
- Departemet of Oncology Surgery 2, Institut Paoli-Calmettes, Marseille, France
| | - Marjorie Ferré
- Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Hugues Mailleux
- Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Maria Paciencia
- Department of Biopathology, Institut Paoli-Calmettes, Marseille, France
| | - Agnès Tallet
- Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France
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Lino M, Lanore D, Lajoinie M, Jimenez A, Crouzet F, Queiroga FL. Prognostic factors for cats with squamous cell carcinoma of the nasal planum following high-dose rate brachytherapy. J Feline Med Surg 2019; 21:1157-1164. [PMID: 30667286 PMCID: PMC10814269 DOI: 10.1177/1098612x18822409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of the study was to investigate retrospectively the prognostic impact of variables such as sex, neuter status, breed, age, number of lesions, location and size of the tumour, tumour extension beyond the nasal planum, ulceration and lymph node status, among others, in a population of cats treated with high-dose rate brachytherapy. METHODS This study reviews the outcome of 58 cats with cytologically and/or histologically confirmed squamous cell carcinoma of the nasal planum, treated at the Clinic Alliance (Bordeaux, France) with high-dose rate brachytherapy from 2010-2016. The total radiation dose delivered was 30 Gy, administered in two different schedules: five fractions of 6 Gy for a period of 4 days (Tuesday-Friday) or four fractions of 7.5 Gy for a period of 3 days (Tuesday- Thursday). Data were collected from cats' clinical records. RESULTS Complete response was achieved in 72% (n = 36) of the cats, partial response in 24% (n = 13) and 2% (n = 1) did not respond. Median progression-free survival and overall survival times were 316 and 835 days, respectively. CONCLUSIONS AND RELEVANCE Results indicated that sex (P = 0.045), extension of the tumour from the nasal planum to the upper lip (P = 0.015), tumour size (P = 0.015; P = 0.001), the existence of a previous treatment (P = 0.043) and the tumour response to high-dose rate brachytherapy (P = 0.038; P <0.001) are prognostic factors for cats with squamous cell carcinoma of the nasal planum following high-dose rate brachytherapy.
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Affiliation(s)
- Mafalda Lino
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | | | | | - Ana Jimenez
- Veterinary Clinic Alliance, Bordeaux, France
| | | | - Felisbina L Queiroga
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Center for the Study of Animal Sciences, Institute of Sciences, Technologies and Agro-environment, University of Porto, Porto, Portugal
- Center for Research and Technology of Agro-Environment and Biological Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
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5
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Varela Cagetti L, Zemmour C, Salem N, Minsat M, Ferrè M, Mailleux H, Giovaninni M, Lelong B, De Chaisemartin C, Ries P, Poizat F, Tallet A, Moureau-Zabotto L. High-dose-rate vs. low-dose-rate interstitial brachytherapy boost for anal canal cancers. Brachytherapy 2019; 18:814-822. [PMID: 31515067 DOI: 10.1016/j.brachy.2019.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/23/2019] [Accepted: 08/07/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of this study was to analyze and compare clinical outcomes of low-dose-rate (LDR) and high-dose-rate (HDR) interstitial brachytherapy boost (ISBT) after EBRT or radio chemotherapy for the treatment of anal canal cancers. METHODS AND MATERIALS One hundred patients with anal canal cancers were treated at our institution by ISBT [LDR (n = 50); HDR (n = 50)]. Chronic toxicity rates, local control, disease-free survival, overall survival, and colostomy-free survival of the two different dose-rate brachytherapy modalities were analyzed and compared. RESULTS With a median followup of 42.2 months (95% CI, [34.5-48.8]), 9 (9% [4.8-16.2%]) local recurrences were observed, 4 (8% [3.2-18.8%]) in LDR vs. 5 (10% [4.4-21.4%]) in HDR group (odds ratio [OR] = 1.28 [0.32-5.07], p = 0.73). The 5-year rate of local control for the entire population was 90% [81-95%], 93% [79-98%] vs. 86% [69-94%] for LDR and HDR, respectively (p = 0.38). The 5-year disease-free survival rate for all patients was 82% [71-90%], 88% [73-95%] vs. 72% [44-88%] for LDR and HDR, respectively (p = 0.21). The 5-year overall survival rate for global population was 94% [84-98%], with no significant differences between LDR (97% [79-100%]) and HDR (93% [80-98%]) (p = 0.27). The 5-year colostomy-free survival rate was 92% [83-96%], respectively, 95% [83-99%] vs. 86% [69-94%] for LDR and HDR (p = 0.21). Significant differences were found in terms of chronic toxicity rates, with 28 (56% [42.3-68.8%]) patients concerned in low-dose-rate brachytherapy vs. 17 (34% [22.4-47.9%]) in high-dose-rate brachytherapy (OR = 0.40 [0.18-0.91], p = 0.03). CONCLUSIONS Local recurrence rates were comparable between both groups; HDR brachytherapy seem to have a better toxicity profile. Our data confirmed the finding that HDR can be used to safely administer ISBT without increasing chronic toxicity.
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Affiliation(s)
| | - Christophe Zemmour
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - Naji Salem
- Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Mathieu Minsat
- Department of RadiationOncolgy, Institut Curie, Paris, France
| | - Marjorie Ferrè
- Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Hughes Mailleux
- Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Marc Giovaninni
- Oncology and Endoscopic Unit, Institut Paoli-Calmettes, Marseille, France
| | - Bernard Lelong
- Department of Digestive Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Pauline Ries
- Department on Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Flora Poizat
- Department of Pathology, Institut Paoli-Calmettes, Marseille, France
| | - Agnès Tallet
- Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France
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6
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Jumeau R, Renard-Oldrini S, Courrech F, Buchheit I, Oldrini G, Vogin G, Peiffert D. High dose rate brachytherapy with customized applicators for malignant facial skin lesions. Cancer Radiother 2016; 20:341-6. [PMID: 27321412 DOI: 10.1016/j.canrad.2016.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 03/20/2016] [Accepted: 03/23/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Brachytherapy is a well-known treatment in the management of skin tumors. For facial or scalp lesions, applicators have been developed to deliver non-invasive treatment. We present cases treated with customized applicators with high dose rate system. MATERIAL AND METHODS Patients with poor performance status treated for malignant skin lesions of the scalp or the facial skin between 2011 and 2014 were studied. Afterloading devices were chosen between Freiburg(®) Flap, silicone-mold or wax applicators. The clinical target volume (CTV) was created by adding margins to lesions (10mm to 20mm). The dose schedules were 25Gy in five fractions for postoperative lesions, 30Gy in six fractions for exclusive treatments and a single session of 8Gy could be considered for palliative treatments. RESULTS In 30 months, 11 patients received a treatment for a total of 12 lesions. The median age was 80 years. The median follow-up was 17 months and the 2-year local control rate was 91%. The mean CTV surface was 41.1cm(2) with a mean thickness of 6.1mm. We conceived three wax applicators, used our silicone-mold eight times and the Freiburg(®) Flap one time. We observed only low-grade radiodermitis (grade I: 50%, grade II: 33%), and no high-grade skin toxicity. CONCLUSION High dose rate brachytherapy with customized applicators for facial skin and scalp lesions is efficient and safe. It is a good modality to treat complex lesions in patients unfit for invasive treatment.
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Affiliation(s)
- R Jumeau
- Department of radiotherapy, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France.
| | - S Renard-Oldrini
- Department of radiotherapy, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France
| | - F Courrech
- Department of radiation physics, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France
| | - I Buchheit
- Department of radiation physics, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France
| | - G Oldrini
- Department of radiology, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France
| | - G Vogin
- Department of radiotherapy, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France
| | - D Peiffert
- Department of radiotherapy, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France
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