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Chargari C, Peignaux K, Escande A, Renard S, Lafond C, Petit A, Lam Cham Kee D, Durdux C, Haie-Méder C. Radiotherapy of cervical cancer. Cancer Radiother 2021; 26:298-308. [PMID: 34955418 DOI: 10.1016/j.canrad.2021.11.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
External beam radiotherapy and brachytherapy are major treatments in the management of cervical cancer. For early-stage tumours with local risk factors, brachytherapy is a preoperative option. Postoperative radiotherapy is indicated according to histopathological criteria. For advanced local tumours, chemoradiation is the standard treatment, followed by brachytherapy boost, which is not optional. We present the update of the recommendations of the French Society of Oncological Radiotherapy on the indications and techniques for external beam radiotherapy and brachytherapy for cervical cancer.
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Affiliation(s)
- C Chargari
- Département d'oncologie radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - K Peignaux
- Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, avenue Professeur-Marion, 21000 Dijon, France
| | - A Escande
- Département de radiothérapie, centre Oscar-Lambret, avenue Frédéric-Combemale, 59000 Lille, France
| | - S Renard
- Département de radiothérapie, centre Alexis Vautrin, Vandœuvre-lès-Nancy, France
| | - C Lafond
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - A Petit
- Département de radiothérapie, centre régional de lutte contre le cancer institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - D Lam Cham Kee
- Département de radiothérapie, centre Alexandre-Lacassagne, avenue de Valombrose, 06000 Nice, France
| | - C Durdux
- Département d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Haie-Méder
- Département d'oncologie radiothérapie, centre de cancérologie, Charlebourg la Défense, 65, avenue Foch, 92250 La Garenne-Colombes, France
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2
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Kuntz L, Noel G. [Pelvic irradiation and hematopoietic toxicity: A review of the literature]. Cancer Radiother 2020; 25:77-91. [PMID: 33358082 DOI: 10.1016/j.canrad.2020.05.018] [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: 12/14/2019] [Revised: 04/21/2020] [Accepted: 05/03/2020] [Indexed: 02/03/2023]
Abstract
Pelvic bone marrow is the site of nearly 50% of total hematopoiesis. Radiation therapy of pelvic lymph node areas, and cancers located near the bony structures of the pelvis, exposes to hematological toxicity in the range of 30 to 70%. This toxicity depends on many factors, including the presence or absence of concomitant chemotherapy and its type, the volume of irradiated bone, the received doses, or the initial hematopoietic reserve. Intensity modulated radiation therapy allows the optimisation of dose deposit on at risk organs while providing optimal coverage of target volumes. However, this suggests that dose constraints should be known precisely to limit the incidence of radiation side effects. This literature review focuses firstly on pelvic lymph node areas and bony volumes nearby, then on the effects of irradiation on bone marrow and the current dosimetric constraints resulting from it, and finally on hematological toxicities by carcinologic location and progress in reducing these toxicities.
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Affiliation(s)
- L Kuntz
- Département de radiothérapie, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - G Noel
- Département de radiothérapie, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France.
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Neron M, Lambaudie E, Thezenas S, Leaha C, Kerr C, Gonzague L, Provansal M, Colombo PE, Fabbro M. Impact of time to radiation therapy in adjuvant settings in endometrial carcinoma: A multicentric retrospective study. Eur J Obstet Gynecol Reprod Biol 2020; 247:121-126. [PMID: 32088529 DOI: 10.1016/j.ejogrb.2020.02.011] [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: 11/24/2019] [Revised: 02/09/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Time to adjuvant treatment could have an impact on cancer prognosis. It is possible that robotic surgery lengthens the healing time of vaginal cuff after minimally invasive hysterectomy. The objective of this study was to state the impact of time to RT (TTR) on prognosis in endometrial carcinoma (EC) patients and to assess variables associated with TTR. STUDY DESIGN We conducted a multicentric retrospective study in two cancer centers. We included EC patients, between January 1996 and January 2016. We searched variables associated with TTR and impact of TTR on end-points: local recurrence-free survival, metastatic-free survival, event-free survival and overall survival. RESULTS 329 patients were included and 279 were analyzed for TTR impact. Robotic surgery was associated with shorter TTR (8 weeks, 8.9 w for laparotomy, 9.2 w for laparoscopy). Pelvic lymphadenectomy, para-aortic lymphadenectomy, discussion in multidisciplinary meeting and treatment center was independently associated with TTR. No impact of TTR was shown on metastatic-free survival, event-free survival and overall survival but there was a trend of a decreased local recurrence rate in case of prolonged TTR (HRcontinuous variable = 1.08; CI95 %: 0.97-1.2). CONCLUSION Our study did not show any impact of treatment delay on survival end-points although prolonged TTR could moderate the benefit of radiotherapy on local control rate. Surgical route was not associated with TTR, particularly robot-associated laparoscopy did not lengthen treatment delay. TTR seems dependent of health-care organization and could represent a quality criterion of EC care for institutions.
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Affiliation(s)
- Mathias Neron
- Department of Surgical Oncology, Institut du Cancer de Montpellier, Univ Montpellier, 34000 Montpellier, France.
| | - Eric Lambaudie
- Department of Surgical Oncology, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, 13000 Marseille, France
| | - Simon Thezenas
- Department of Biostatistics, Institut du Cancer de Montpellier, 34000 Montpellier, France
| | - Cristina Leaha
- Department of Pathology, Institut du Cancer de Montpellier, 34000 Montpellier, France
| | - Christine Kerr
- Department of Radiation Oncology, Institut du Cancer de Montpellier, 34000 Montpellier, France
| | - Laurence Gonzague
- Department of Radiation Oncology, Aix-Marseille Univ, Institut Paoli-Calmettes, 13000 Marseille, France
| | - Magali Provansal
- Department of Medical Oncology, Aix-Marseille Univ, Institut Paoli-Calmettes, 13000 Marseille, France
| | - Pierre-Emmanuel Colombo
- Department of Surgical Oncology, Institut du Cancer de Montpellier, Univ Montpellier, 34000 Montpellier, France
| | - Michel Fabbro
- Department of Medical Oncology, Institut du Cancer de Montpellier, 34000 Montpellier, France
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Reboux PA, Azaïs H, Canova CH, Bendifallah S, Ouldamer L, Raimond E, Hudry D, Coutant C, Graesslin O, Touboul C, Collinet P, Bricou A, Huchon C, Daraï E, Ballester M, Lévêque J, Lavoué V, Koskas M, Uzan C, Canlorbe G. Impact of vaginal brachytherapy in intermediate and high-intermediate risk endometrial cancer: a multicenter study from the FRANCOGYN group. J Gynecol Oncol 2019; 30:e53. [PMID: 31074238 PMCID: PMC6543117 DOI: 10.3802/jgo.2019.30.e53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/26/2018] [Accepted: 01/09/2019] [Indexed: 11/30/2022] Open
Abstract
Objective According to recent European Society of Medical Oncology, European Society of Gynaecological Oncology and European Society of Radiotherapy and Oncology guidelines, adjuvant vaginal brachytherapy (VB) is optional in patients with intermediate risk (IR) and high-intermediate risk (HIR) endometrial cancer (EC). The aim of this French retrospective, multicenter study was to assess the impact of VB in these groups on local recurrence rate, local recurrence-free survival (RFS) and overall survival (OS). Methods Data of 191 patients with IR and HIR EC who underwent primary surgery with or without VB and no other adjuvant treatment between 2000 and 2016 were extracted from the FRANCOGYN database. Rate of local recurrence, OS and local RFS in these two groups were compared using the Kaplan-Meier method. Results The number of patients with IR and HIR EC were 118 and 73 respectively. VB was used in 92 patients in IR group and 43 in HIR group. Median follow-up was 22 months. In the HIR group, the local recurrence rate was significantly higher in the no adjuvant therapy group in comparison with the VB group (16.7% and 0% respectively, p=0.02). There was also a significant improvement in local RFS (p=0.01) in VB group. In IR EC, there is no significant difference on local recurrence rate (4.2% and 3.2%, respectively, p=1.00) or local RFS (p=0.54) between the two groups. Conclusions VB is an efficient adjuvant treatment for patients with HIR EC. VB is not associated with an improvement of RFS or OS in IR EC patient.
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Affiliation(s)
- Pierre Alain Reboux
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Henri Azaïs
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Charles Henry Canova
- Department of Radiation Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics", Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France
| | - Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069, Université François-Rabelas, Tours, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Delphine Hudry
- Center de Lutte Contre le Cancer Georges François Leclerc, Dijon, France
| | - Charles Coutant
- Center de Lutte Contre le Cancer Georges François Leclerc, Dijon, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Pierre Collinet
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - Alexandre Bricou
- Department of Gynaecology and Obstetrics, Jean Verdier University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris 13, Bondy, France
| | - Cyrille Huchon
- Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal, Poissy, France
| | - Emile Daraï
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Marcos Ballester
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Jean Lévêque
- CHU de Rennes, Service de Gynécologie, Hopital Sud, Université de Rennes 1, Rennes, France
| | - Vincent Lavoué
- CHU de Rennes, Service de Gynécologie, Hopital Sud, Université de Rennes 1, Rennes, France.,INSERM 1242, Oncogenesis, Stress and Signaling, CRLC Eugène Marquis, Rennes, France
| | - Martin Koskas
- Division of Gynecologic Oncology, Bichat University Hospital, Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics", Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics", Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France.
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Espenel S, Garcia MA, Vallard A, Langrand-Escure J, Guy JB, Trone JC, Ben Mrad M, Chauleur C, de Laroche G, Moreno-Acosta P, Rancoule C, Magné N. Outcomes and treatments of IB1 cervical cancers with high recurrence risk: A 13 years’ experience. Cancer Radiother 2018; 22:790-796. [DOI: 10.1016/j.canrad.2018.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 02/19/2018] [Accepted: 03/05/2018] [Indexed: 10/28/2022]
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Chargari C, Gouy S, Pautier P, Haie-Meder C. Cancers du col utérin : nouveautés dans la prise en charge en oncologie radiothérapie. Cancer Radiother 2018; 22:502-508. [DOI: 10.1016/j.canrad.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 06/26/2018] [Indexed: 11/30/2022]
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7
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Radiothérapie guidée par l’image des cancers gynécologiques. Cancer Radiother 2018; 22:608-616. [DOI: 10.1016/j.canrad.2018.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/26/2018] [Indexed: 11/24/2022]
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8
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Quéro L, Gobert A, Spano JP. [Radiotherapy for HIV-infected patients]. Cancer Radiother 2018; 22:496-501. [PMID: 30087055 DOI: 10.1016/j.canrad.2018.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 11/28/2022]
Abstract
Since the advent of highly active antiretroviral therapy, cancer incidence is still 2 to 3-fold higher in patients infected by human immunodeficiency virus (HIV) than in the general population, with an increased incidence of malignancies not associated with acquired immunodeficiency syndrome (AIDS). HIV-infected patients cancer treatment does not differ from that in the general population. However, the management of those patients have some particularities due to preexisting comorbid conditions, including metabolic, cardiovascular, renal or hepatic complications and the risk for potential drug - drug interactions in HIV-infected patients. In this review, we described efficacy and tolerance of radiotherapy with or without chemotherapy in this frail population treated for cancer. Utilization of modern radiotherapy techniques such as intensity-modulated radiotherapy may improve the treatment tolerance.
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Affiliation(s)
- L Quéro
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - A Gobert
- Groupe hospitalier Pitié-Salpêtrière-Charles-Foix, 75013 Paris, France; Sorbonne Université, 75006 Paris, France
| | - J-P Spano
- Groupe hospitalier Pitié-Salpêtrière-Charles-Foix, 75013 Paris, France; Sorbonne Université, 75006 Paris, France
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Duvergé L, Castelli J, Lizée T, de Crevoisier R, Azria D. [Doses to organs at risk for conformational and stereotactic radiotherapy: Bladder]. Cancer Radiother 2017; 21:597-603. [PMID: 28882511 DOI: 10.1016/j.canrad.2017.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/13/2017] [Indexed: 11/16/2022]
Abstract
Bladder dose constraints in case of conformational radiotherapy/intensity-modulated radiotherapy and stereotactic radiotherapy are reported from the literature, in particular from the French radiotherapy society RECORAD recommendations, according to the treated pelvic tumor sites. The dose-volume effect on urinary toxicity is not clearly demonstrated, making difficult to establish absolute dose constraints for the bladder. In case of high-dose prostate cancer radiotherapy, the bladder dose constraints are: V60Gy<50% and maximum dose<80Gy for standard fractionation and V60Gy<5%, V48Gy<25% and V41Gy<50% for moderate hypofractionation (20 fractions of 3Gy). In case of prostate stereotactic radiotherapy (five fractions of 7.25Gy), the most frequent dose constraints in the literature are V37Gy<10cm3 and V18Gy<40%. In case of conformational radiotherapy of cervix cancer, postoperative endometrium, anal canal and rectum, the recommendations are V40Gy<40% and D2% lower than the prescribed dose.
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Affiliation(s)
- L Duvergé
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France.
| | - J Castelli
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - T Lizée
- Département de radiothérapie, institut de cancérologie de l'Ouest, site Paul-Papin, 2, rue Moll, 49100 Angers, France
| | - R de Crevoisier
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - D Azria
- Département de cancérologie radiothérapie, CRLC Val-d'Aurelle-Paul-Lamarque, 208, rue des Apothicaires, 34000 Montpellier, France
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Gamelon-Bénichou C, Oldrini S, Charra-Brunaud C, Vogin G, Salleron J, Peiffert D. [Comparison of survival and chronic gastrointestinal toxicities in patients with locally advanced cervical cancer, treated by conventional or intensity-modulated radiation technique]. Cancer Radiother 2017; 21:171-179. [PMID: 28457817 DOI: 10.1016/j.canrad.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 10/28/2016] [Accepted: 11/23/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate prospectively chronic gastrointestinal toxicity in patients with cervical cancer treated with conventional irradiation or with intensity-modulated irradiation (IMRT). PATIENTS AND METHODS Between June 2005 and September 2013, 109 patients underwent external radiotherapy followed by brachytherapy for cervical cancer at the "Institut de Cancérologie de Lorraine". Each patient receiving IMRT was paired with a patient receiving conventional radiotherapy on the following criteria: concomitant chemotherapy, additional nodal dose, treatment of para-aortic lymph node area, age. The toxicity collection was prospective using the RTOG scale. The main objective was to compare the incidence of gastrointestinal toxicity chronic between the two groups. In a second time, the influence of dosimetric parameters on chronic GI toxicity was investigated. Comparisons of acute toxicity, chronic genitourinary toxicities, overall survival, disease-free survival were secondary objectives. RESULTS Sixty-six patients were able to be matched. Overall survival at 36 months was 71% in the conventional radiotherapy group against 73% in the IMRT group (P=0.54). There was no significant difference between the two groups in terms of digestive chronic toxicity (P=0.17), nor in terms acute gastrointestinal toxicities (P=0.6445) and genitourinary (P=0.5724). IMRT spared significantly small bowel (P=0.0006) and rectum (P=0.0046) from 30Gy dose, and bladder from 45Gy (P<0.001). The incidence of genitourinary toxicity was significantly different between the two groups (P=0.03) in favor of conventional radiotherapy. CONCLUSION Our study does not seem to show significant difference in the occurrence of chronic gastrointestinal toxicities between the two groups. Clinical efficacy seems comparable. Larger studies with longer follow-up period should be conducted.
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Affiliation(s)
- C Gamelon-Bénichou
- Département universitaire de radiothérapie, institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, CS 30 519, 54511 Vandœuvre-lès-Nancy cedex, France.
| | - S Oldrini
- Département universitaire de radiothérapie, institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, CS 30 519, 54511 Vandœuvre-lès-Nancy cedex, France
| | - C Charra-Brunaud
- Département universitaire de radiothérapie, institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, CS 30 519, 54511 Vandœuvre-lès-Nancy cedex, France
| | - G Vogin
- Département universitaire de radiothérapie, institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, CS 30 519, 54511 Vandœuvre-lès-Nancy cedex, France
| | - J Salleron
- Cellule data biostatistique, institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, CS 30 519, 54511 Vandœuvre-lès-Nancy cedex, France
| | - D Peiffert
- Département universitaire de radiothérapie, institut de cancérologie de Lorraine-Alexis-Vautrin, 6, avenue de Bourgogne, CS 30 519, 54511 Vandœuvre-lès-Nancy cedex, France
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