1
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Colson D, Yalvac B, Weterings J, Verrijssen AS, van Haaren P, Bellezzo M, Berbée M, Van Limbergen EJ, Croce O, Verhaegen F, Reniers B. Dosimetry and Monte Carlo modelling of the Papillon+ contact X-ray brachytherapy device. Brachytherapy 2024; 23:535-548. [PMID: 38969605 DOI: 10.1016/j.brachy.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/31/2024] [Accepted: 06/06/2024] [Indexed: 07/07/2024]
Abstract
PURPOSE This study aimed to develop and validate a Monte Carlo (MC) model for the Papillon+ contact x-ray brachytherapy (CXB) device, producing 50 kilovolt (kV) X-rays, specifically focusing on its application with a 25 mm diameter rectal applicator for contact therapy. MATERIAL AND METHODS The validation process involved depth dose and transverse dose profile measurements using EBT3 gafchromic films positioned in a plastic water low energy range phantom. The half-value layer (HVL) was further measured and derived from the simulated X-ray spectra. RESULTS Excellent agreement within ±2% was achieved between the measured and simulated on-axis depth dose curves for the 25 mm rectal applicator. Transverse dose profile measurements showed a high level of agreement between the simulation and measurements, on average 3.1% in contact with the applicator at the surface of the phantom and on average 1.7% at 10 mm depth. A close agreement within 5.5% was noticed concerning the HVL between the measurement and simulation. The simulated gamma spectra and 2D-dose distribution demonstrated a soft X-ray energy spectrum and a uniform dose distribution in contact with the applicator. CONCLUSIONS An MC model was successfully developed for the Papillon+ eBT device with a 25 mm diameter rectal applicator. The validated model, with its demonstrated accuracy in depth dose and transverse dose profile simulations, is a valuable tool for quality assurance and patient safety and, in a later phase, may be used for treatment planning, dose calculations and tissue inhomogeneity corrections.
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Affiliation(s)
- Dries Colson
- Hasselt University, Faculty of Engineering Technology, Nuclear Technological Centre (NuTeC), Hasselt, Belgium
| | - Burak Yalvac
- Hasselt University, Faculty of Engineering Technology, Nuclear Technological Centre (NuTeC), Hasselt, Belgium
| | - Jan Weterings
- Catharina Hospital, Department of Radiation Oncology, Eindhoven, The Netherlands
| | - An-Sofie Verrijssen
- Catharina Hospital, Department of Radiation Oncology, Eindhoven, The Netherlands
| | - Paul van Haaren
- Catharina Hospital, Department of Radiation Oncology, Eindhoven, The Netherlands
| | - Murillo Bellezzo
- Department of Radiation Oncology (MAASTRO), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Center, the Netherlands
| | - Maaike Berbée
- Department of Radiation Oncology (MAASTRO), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Center, the Netherlands
| | - Evert J Van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Center, the Netherlands
| | - Olivier Croce
- Institute for Research on Cancer and Aging of Nice (IRCAN), CNRS, INSERM, Université Côte d'Azur, Nice, France
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Center, the Netherlands
| | - Brigitte Reniers
- Hasselt University, Faculty of Engineering Technology, Nuclear Technological Centre (NuTeC), Hasselt, Belgium.
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Petoukhova A, Snijder R, Vissers T, Ceha H, Struikmans H. In vivodosimetry in cancer patients undergoing intraoperative radiation therapy. Phys Med Biol 2023; 68:18TR01. [PMID: 37607566 DOI: 10.1088/1361-6560/acf2e4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 08/22/2023] [Indexed: 08/24/2023]
Abstract
In vivodosimetry (IVD) is an important tool in external beam radiotherapy (EBRT) to detect major errors by assessing differences between expected and delivered dose and to record the received dose by individual patients. Also, in intraoperative radiation therapy (IORT), IVD is highly relevant to register the delivered dose. This is especially relevant in low-risk breast cancer patients since a high dose of IORT is delivered in a single fraction. In contrast to EBRT, online treatment planning based on intraoperative imaging is only under development for IORT. Up to date, two commercial treatment planning systems proposed intraoperative ultrasound or in-room cone-beam CT for real-time IORT planning. This makes IVD even more important because of the possibility for real-time treatment adaptation. Here, we summarize recent developments and applications of IVD methods for IORT in clinical practice, highlighting important contributions and identifying specific challenges such as a treatment planning system for IORT. HDR brachytherapy as a delivery technique was not considered. We add IVD for ultrahigh dose rate (FLASH) radiotherapy that promises to improve the treatment efficacy, when compared to conventional radiotherapy by limiting the rate of toxicity while maintaining similar tumour control probabilities. To date, FLASH IORT is not yet in clinical use.
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Affiliation(s)
- Anna Petoukhova
- Haaglanden Medical Centre , Department of Medical Physics, Leidschendam, The Netherlands
| | - Roland Snijder
- Haaglanden Medical Centre , Department of Medical Physics, Leidschendam, The Netherlands
| | - Thomas Vissers
- Haaglanden Medical Centre , Medical Library, Leidschendam, The Netherlands
| | - Heleen Ceha
- Haaglanden Medical Centre , Department of Radiation Oncology, Leidschendam, The Netherlands
| | - Henk Struikmans
- Haaglanden Medical Centre , Department of Radiation Oncology, Leidschendam, The Netherlands
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3
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von Wieding E, Dunst J. [Endocavitary contact radiation therapy vs. EBRT as a boost in organ-preserving radiotherapy of T2-T3 rectal cancer: results of the OPERA study]. Strahlenther Onkol 2023; 199:784-786. [PMID: 37358594 PMCID: PMC10361854 DOI: 10.1007/s00066-023-02112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Emilie von Wieding
- Klinik für Strahlentherapie/Radioonkologie, UKSH, Campus Kiel, Kiel, Deutschland
| | - Jürgen Dunst
- Klinik für Strahlentherapie/Radioonkologie, UKSH, Campus Kiel, Kiel, Deutschland.
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4
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Gerard JP, Barbet N, Schiappa R, Magné N, Martel I, Mineur L, Deberne M, Zilli T, Dhadda A, Myint AS. Neoadjuvant chemoradiotherapy with radiation dose escalation with contact x-ray brachytherapy boost or external beam radiotherapy boost for organ preservation in early cT2-cT3 rectal adenocarcinoma (OPERA): a phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol 2023; 8:356-367. [PMID: 36801007 DOI: 10.1016/s2468-1253(22)00392-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND Organ preservation after reaching clinical complete response on neoadjuvant therapy is gaining interest for rectal cancers, although the role of radiation dose escalation is still not known. We aimed to determine whether a contact x-ray brachytherapy boost, following or preceding neoadjuvant chemoradiotherapy, increases the probability of 3-year organ preservation for patients with early rectal cancers. METHODS OPERA was a multicentre, open-label, phase 3 randomised controlled trial done at 17 cancer centres that included operable patients, aged 18 years or older, with cT2, cT3a, or cT3b adenocarcinoma of low-mid rectum, tumours of less than 5 cm in diameter, and cN0 or cN1 smaller than 8 mm. All patients received neoadjuvant chemoradiotherapy and 45 Gy external beam radiotherapy in 25 fractions over 5 weeks with concurrent oral capecitabine (825 mg/m2 twice a day). Patients were randomly assigned (1:1) to receive a boost of external beam radiotherapy at 9 Gy in five fractions (group A) or a boost with contact x-ray brachytherapy (90 Gy in three fractions; group B). Randomisation was done centrally using an independent web-based system and stratified by trial centre, tumour classification (cT2 vs cT3a or cT3b), tumour distance from rectum (<6 cm from anal verge vs ≥6 cm), and tumour diameter (<3 cm vs ≥3 cm). Treatment in group B was stratified by tumour diameter, with the contact x-ray brachytherapy boost given before neoadjuvant chemoradiotherapy in patients with tumours smaller than 3 cm. The primary outcome was organ preservation at 3 years, analysed in the modified intention-to-treat population. This study was registered with ClinicalTrials.gov, NCT02505750, and is ongoing. FINDINGS Between June 14, 2015, and June 26, 2020, 148 patients were assessed for eligibility and were randomly assigned to group A (n=74) or group B (n=74). Seven patients withdrew their consent (five in group A and two in group B). 141 patients were included in the primary efficacy analysis, including 69 assigned to group A (29 with tumours <3 cm in diameter and 40 with tumours ≥3 cm) and 72 assigned to group B (32 with tumours <3 cm and 40 with tumours ≥3 cm). After a median follow-up of 38·2 months (IQR 34·2-42·5), the 3-year organ preservation rate was 59% (95% CI 48-72) in group A versus 81% (72-91) in group B (hazard ratio [HR] 0·36, 95% CI 0·19-0·70; p=0·0026). For patients with tumours less than 3 cm in diameter, 3-year organ preservation rates were 63% (95% CI 47-84) in group A versus 97% (91-100) in group B (HR 0·07, 95% CI 0·01-0·57; p=0·012). For patients with tumours of 3 cm or larger, 3-year organ preservation rates were 55% (95% CI 41-74) in group A versus 68% (54-85) in group B (HR 0·54, 95% CI 0·26-1·10; p=0·11). 21 (30%) patients in group A and 30 (42%) in group B had an early grade 2-3 adverse event (p=1·0). The most common early grade 2-3 adverse events were proctitis (four [6%] in group A, nine [13%] in group B) and radiation dermatitis (seven [10%] in group A, two [3%] in group B). The main late side-effect was grade 1-2 rectal bleeding due to telangiectasia, which was more frequent in group B (37 [63%] of 59) than in group A (five [12%] of 43; p<0·0001) and subsided after 3 years. INTERPRETATION Neoadjuvant chemoradiotherapy with a contact x-ray brachytherapy boost significantly improved the 3-year organ preservation rate, particularly for patients with tumours smaller than 3 cm who were treated with contact x-ray brachytherapy first, compared with neoadjuvant chemoradiotherapy with a boost via external beam radiotherapy. This approach could be discussed and offered to operable patients with early cT2-cT3 disease who are keen to avoid surgery and seek organ preservation. FUNDING The French Programme Hospitalier de Recherche Cinique.
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Affiliation(s)
| | - Nicolas Barbet
- Centre oncologie radiothérapie Bayard, Villeurbanne, France
| | - Renaud Schiappa
- Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Nicolas Magné
- Institut de Cancérologie de la Loire, Saint Etienne, France
| | - Isabelle Martel
- Le Centre Régional de Lutte Contre le Cancer Léon Bérard, Lyon, France
| | | | | | - Thomas Zilli
- Hôpitaux Universitaires de Genève, Geneva, Switzerland
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Georgi P, Kertzscher G, Nyvang L, Šolc J, Schneider T, Tanderup K, Johansen JG. Towards 3D dose verification of an electronic brachytherapy source with a plastic scintillation detector. Med Phys 2022; 49:3432-3443. [PMID: 35196404 PMCID: PMC9314913 DOI: 10.1002/mp.15568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/19/2022] [Accepted: 02/11/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Electronic brachytherapy (eBT) is considered a safe treatment with good outcome. However, eBT lacks standardised and independent dose verification, which could impede future use. PURPOSE To validate the 3D dose-to-water distribution of an electronic brachytherapy (eBT) source using a small-volume plastic scintillation detector (PSD). METHODS The relative dose distribution of a Papillon 50 (P50) (Ariane Medical Systems, UK) eBT source was measured in water with a PSD, consisting of a cylindrical scintillating BCF-12 fibre (length: 0.5 mm, Ø: 1 mm) coupled to a photodetector via an optical fibre. The measurements were performed with the PSD mounted on a motorised stage in a water phantom (MP3) (PTW, Germany). This allowed the sensitive volume of the PSD to be moved to predetermined positions relative to the P50's applicator which pointed vertically downward while just breaching the water surface. The percentage depth-dose (PDD) was measured from 0 mm to 50 mm source-to-detector distance (SDD) in 1-3 mm steps. Dose profiles were measured along two perpendicular axes at five different SDDs with step sizes down to 0.5 mm. Characterization of the PSD consisted of determining the energy correction through Monte Carlo (MC) simulation and by measuring the stability and dose rate linearity using a well-type ionization chamber as reference. The measured PDD and profiles were validated with corresponding MC simulations. RESULTS The measured and simulated PDD curves agreed within 2% (except at 0 mm and 43 mm depth) after the PSD measurements were corrected for energy-dependency. The absorbed dose decreased by a factor of 2 at 7 mm depth and by a factor of 10 at 26 mm depth. The measured dose profiles showed dose gradients at the profile edges of more than 50%/mm at 5 mm depth and 15%/mm at 50 mm depth. The measured profile widths increased 0.66mm per 1 mm depth, while the simulated profile widths increased 0.74 mm per 1 mm depth. An azimuthal dependency of >10% was observed in the dose at 10 mm distance from the beam centre. The total uncertainty of the measured relative dose is <2.5% with a positional uncertainty of 0.4 mm. The measurements for a full 3D dose characterisation (PDD and profiles) can be carried out within 8 h, the limiting factor being cooling of the P50. CONCLUSION The PSD and MP3 water phantom provided a method to independently verify the relative 3D dose distribution in water of an eBT source. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Peter Georgi
- Department of Clinical Medicine, Aarhus University, Aarhus, 8000, Denmark
| | - Gustavo Kertzscher
- Department of Oncology, Aarhus University Hospital, Aarhus N, 8200, Denmark
| | - Lars Nyvang
- Department of Oncology, Aarhus University Hospital, Aarhus N, 8200, Denmark
| | - Jaroslav Šolc
- Photon Dosimetry Laboratory, Czech Metrology Institute, Prague, 10200, Czech Republic
| | - Thorsten Schneider
- WG 6.34 "Dosimetry for Brachytherapy and Beta Radiation Protection", Physicalisch-Technische Bundesanstalt (PTB), Braunschweig, 38116, Germany
| | - Kari Tanderup
- Department of Clinical Medicine, Aarhus University, Aarhus, 8000, Denmark.,Department of Oncology, Aarhus University Hospital, Aarhus N, 8200, Denmark
| | - Jacob Graversen Johansen
- Department of Clinical Medicine, Aarhus University, Aarhus, 8000, Denmark.,Department of Oncology, Aarhus University Hospital, Aarhus N, 8200, Denmark
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6
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Kirilovsky A, Sissy CE, Zeitoun G, Marliot F, Haicheur N, Lagorce-Pagès C, Taieb J, Karoui M, Custers P, Dizdarevic E, Iseas S, Hansen TF, Jensen LH, Beets G, Gérard JP, Castillo-Martin M, Figueiredo N, Habr-Gama A, Perez R, Galon J, Pagès F. The "Immunoscore" in rectal cancer: could we search quality beyond quantity of life? Oncotarget 2022; 13:18-31. [PMID: 35018217 PMCID: PMC8734641 DOI: 10.18632/oncotarget.28100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 12/24/2022] Open
Abstract
Because of the function and anatomical environment of the rectum, therapeutic strategies for local advanced rectal cancer (LARC) must deal with two challenging stressors that are a high-risk of local and distal recurrences and a high-risk of poor quality of life (QoL). Over the last three decades, advances in screening tests, therapies, and combined-modality treatment options and strategies have improved the prognosis of patients with LARC. However, owing to the heterogeneous nature of LARC and genetic status, the patient may not respond to a specific therapy and may be at increased risk of side-effects without the life-prolonging benefit. Indeed, each therapy can cause its own side-effects, which may worsen by a combination of treatments resulting in long-term poor QoL. In LARC, QoL has become even more essential with the increasing incidence of rectal cancer in young individuals. Herein, we analyzed the value of the Immunoscore-Biopsy (performed on tumor biopsy at diagnosis) in predicting outcomes, alone or in association with clinical and imaging data, for each therapy used in LARC.
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Affiliation(s)
- Amos Kirilovsky
- Laboratory of Integrative Cancer Immunology, INSERM, Paris, France.,Equipe Labellisée Ligue Contre le Cancer, Paris, France.,Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France.,Immunomonitoring Platform, Laboratory of Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Georges Pompidou European Hospital, Paris, France.,These authors contributed equally to this work
| | - Carine El Sissy
- Laboratory of Integrative Cancer Immunology, INSERM, Paris, France.,Equipe Labellisée Ligue Contre le Cancer, Paris, France.,Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France.,Immunomonitoring Platform, Laboratory of Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Georges Pompidou European Hospital, Paris, France.,These authors contributed equally to this work
| | - Guy Zeitoun
- Immunomonitoring Platform, Laboratory of Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Georges Pompidou European Hospital, Paris, France.,These authors contributed equally to this work
| | - Florence Marliot
- Laboratory of Integrative Cancer Immunology, INSERM, Paris, France.,Equipe Labellisée Ligue Contre le Cancer, Paris, France.,Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France.,Immunomonitoring Platform, Laboratory of Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Georges Pompidou European Hospital, Paris, France
| | - Nacilla Haicheur
- Immunomonitoring Platform, Laboratory of Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Georges Pompidou European Hospital, Paris, France
| | - Christine Lagorce-Pagès
- Laboratory of Integrative Cancer Immunology, INSERM, Paris, France.,Equipe Labellisée Ligue Contre le Cancer, Paris, France.,Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France.,Department of Pathology, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Julien Taieb
- Department of Gastroenterology and Gastrointestinal Oncology, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
| | - Mehdi Karoui
- Department of Digestive Surgery, AP-HP, Georges Pompidou European Hospital, Université de Paris, Paris, France
| | - Petra Custers
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Edina Dizdarevic
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark
| | - Soledad Iseas
- Oncology Unit, Gastroenterology Hospital, Dr. Carlos Bonorino Udaondo, Ciudad Autónoma de Buenos Aires, Argentina
| | - Torben Frøstrup Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark
| | - Lars Henrik Jensen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark
| | - Geerard Beets
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Jean Pierre Gérard
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice Sophia-Antipolis University, Nice, France
| | - Mireia Castillo-Martin
- Service of Pathology, Champalimaud Foundation Biobank (CFB)/Champalimaud Centre for the Unknown/Champalimaud Foundation, Lisbon, Portugal
| | - Nuno Figueiredo
- Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal.,Colorectal Surgery, Lusiadas Hospital Lisboa, Lisbon, Portugal
| | - Angelita Habr-Gama
- Department of Colorectal Surgery, Angelita & Joaquim Gama Institute, São Paulo, Brazil
| | - Rodrigo Perez
- Department of Colorectal Surgery, Angelita & Joaquim Gama Institute, São Paulo, Brazil
| | - Jérôme Galon
- Laboratory of Integrative Cancer Immunology, INSERM, Paris, France.,Equipe Labellisée Ligue Contre le Cancer, Paris, France.,Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France
| | - Franck Pagès
- Laboratory of Integrative Cancer Immunology, INSERM, Paris, France.,Equipe Labellisée Ligue Contre le Cancer, Paris, France.,Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France.,Immunomonitoring Platform, Laboratory of Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Georges Pompidou European Hospital, Paris, France
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Abstract
The purpose of this article is to describe the external irradiation process and updated recommendations of the French society for radiation oncology for patient follow-up.
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Affiliation(s)
- I Barillot
- Hôpital Bretonneau, CHU de Tours, 2, boulevard Tonnellé, 37000 Tours, France; Université François-Rabelais, 10, boulevard Tonnellé, 37000 Tours, France.
| | - D Azria
- Fédération universitaire d'oncologie radiothérapie Forom, Institut régional du cancer Montpellier (ICM), université de Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France; Institut de recherche en cancérologie de Montpellier (IRCM), Inserm U1194, INCa, DGOS_12553, université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - A Lisbona
- Centre René-Gauducheau, Institut de cancérologie de l'ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - M-A Mahé
- Centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
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8
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Contact X-ray brachytherapy for rectal cancer: Past, present, and future. Cancer Radiother 2021; 25:795-800. [PMID: 34052134 DOI: 10.1016/j.canrad.2021.04.006] [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: 03/02/2021] [Revised: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 01/02/2023]
Abstract
The Papillon experience and the Lyon R96-02 trial have shown that contact X-ray brachytherapy of 50kV is efficient and safe to achieve long term local control and organ preservation for cT1 and early cT2-3 rectal cancers. The OPERA trial, using the Papillon 50™ machine, brings further support to this preservation strategy for selected T2T3ab lesions. Future trials using a contact X-ray boost will try to consolidate and enlarge its place in organ preservation for rectal cancers.
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9
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Benezery K, Montagne L, Evesque L, Schiappa R, Hannoun-Levi JM, Francois E, Thamphya B, Gerard JP. Clinical response assessment after contact X-Ray brachytherapy and chemoradiotherapy for organ preservation in rectal cancer T2-T3 M0: The time/dose factor influence. Clin Transl Radiat Oncol 2020; 24:92-98. [PMID: 32695890 PMCID: PMC7363626 DOI: 10.1016/j.ctro.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 12/27/2022] Open
Abstract
Treatment initiation of T2-T3 rectal cancers with Contact (CXB) provides a fast clinical complete response. In T2N0< 3 cm tumors, CXB first with chemoradiotherapy can achieve local control in more than 85%. The Phase III OPERA trial should bring robust data in favor of CXB as initial treatment of T2N0< 3 cm.
Introduction A neoadjuvant treatment aimed at rectal preservation should achieve a clinical complete response. This study comparing neoadjuvant treatment initiated with Contact X-ray (CXB) or External Beam radiotherapy (EBRT) is evaluating the influence of the time/dose parameter on clinical response during the first six months. Materials and methods This retrospective consecutive series included T2-3 rectal adenocarcinoma staged using digital examination (DRE), endoscopy, magnetic radiation imaging and/or endorectal ultrasound. All patients were treated with organ preservation intent. Treatment protocol combined CXB (80–110 Gy/3–4 fractions) and EBRT ± concurrent capecitabine. In tumor exceeding 3.5 cm treatment was often initiated using EBRT. Clinical response was assessed (DRE, proctoscopy ± imaging) at very close interval between 2 weeks and 6 months after treatment initiation. Results Between 2002 and 2017, 61 patients (T2: 31; T3: 30) M0 (median age: 76 years) were treated. Treatment was initiated in 40 patients (T2: 28, T3: 12) with contact X-ray and in 21 (T2: 4, T3: 17) with EBRT. Using contact X-ray or EBRT first treatment, clinical complete (or near complete) response at week 14(±1) was respectively 88% [95CI:74–96] and 33% [95CI:15–57]. In multivariate analysis the treatment chronology was the most significant factor influencing cCR (OR: 7.53). At 6 months, with contact X-ray first all patients were in clinical complete response and five with EBRT remained in partial response. With 61 months median follow-up time, the local recurrence rate was 10% [95% CI: 6–16] at 5 years. T3 and fungating tumors were at higher risk of local recurrence. Organ preservation with good function was achieved in 95% of cases. Conclusion This non randomized study tends to show that in early T2-3 tumors, a strategy using upfront contact therapy, which is reducing the overall treatment time, is an option allowing a more favorable outcome than EBRT first.
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Affiliation(s)
- Karen Benezery
- Department of Radiotherapy, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Lucile Montagne
- Department of Radiotherapy, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Ludovic Evesque
- Department of Medical Oncology, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Renaud Schiappa
- Department of Statistics, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Brice Thamphya
- Department of Statistics, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Jean-Pierre Gerard
- Department of Radiotherapy, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
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10
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Gérard JP, Dejean C, Montagne L, Benezery K, Doyen J, Hannoun Levi JM. A brief history of contact X-ray brachytherapy 50 kVp. Cancer Radiother 2020; 24:222-225. [PMID: 32171676 DOI: 10.1016/j.canrad.2020.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 11/18/2022]
Abstract
Contact X ray brachytherapy 50 kVp was initiated in the 1930s with the Siemens unit and popularized with the Philips unit in the 1950s. A renaissance was seen in the early 2000s with the Intrabeam™ unit for breast IORT. Presently the Papillon™ systems thanks to its high dose rate (>10Gy/mn) can be used to treat breast (IORT), skin, eyelid and rectal cancers. Future developments are expected to consolidate the place of contact radiotherapy as a safe and efficient treatment for accessible early tumors.
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Affiliation(s)
- J P Gérard
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France.
| | - C Dejean
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - L Montagne
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - K Benezery
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - J Doyen
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - J M Hannoun Levi
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
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11
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Bellezzo M, Fonseca GP, Verrijssen AS, Voncken R, Van den Bosch MR, Yoriyaz H, Reniers B, Berbée M, Van Limbergen EJ, Verhaegen F. A novel rectal applicator for contact radiotherapy with HDR 192Ir sources. Brachytherapy 2018; 17:1037-1044. [PMID: 30122346 DOI: 10.1016/j.brachy.2018.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE Dose escalation to rectal tumors leads to higher complete response rates and may thereby enable omission of surgery. Important advantages of endoluminal boosting techniques include the possibility to apply a more selective/localized boost than using external beam radiotherapy. A novel brachytherapy (BT) rectal applicator with lateral shielding was designed to be used with a rectoscope for eye-guided positioning to deliver a dose distribution similar to the one of contact x-ray radiotherapy devices, using commonly available high-dose-rate 192Ir BT sources. METHODS AND MATERIALS A cylindrical multichannel BT applicator with lateral shielding was designed by Monte Carlo modeling, validated experimentally with film dosimetry and compared with results found in the literature for the Papillon 50 (P50) contact x-ray radiotherapy device regarding rectoscope dimensions, radiation beam shape, dose fall-off, and treatment time. RESULTS The multichannel applicator designed is able to deliver 30 Gy under 13 min with a 20350 U (5 Ci) source. The use of multiple channels and lateral shielding provide a uniform circular treatment surface with 22 mm in diameter. The resulting dose fall-off is slightly steeper (maximum difference of 5%) than the one generated by the P50 device with the 22 mm applicator. CONCLUSIONS A novel multichannel rectal applicator for contact radiotherapy with high-dose-rate 192Ir sources that can be integrated with commercially available treatment planning systems was designed to produce a dose distribution similar to the one obtained by the P50 device.
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Affiliation(s)
- Murillo Bellezzo
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Centro de Engenharia Nuclear, Instituto de Pesquisas Energéticas e Nucleares IPEN-CNEN/SP, São Paulo, Brazil
| | - Gabriel P Fonseca
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - An-Sofie Verrijssen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert Voncken
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michiel R Van den Bosch
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hélio Yoriyaz
- Centro de Engenharia Nuclear, Instituto de Pesquisas Energéticas e Nucleares IPEN-CNEN/SP, São Paulo, Brazil
| | - Brigitte Reniers
- Research group NuTeC, Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Maaike Berbée
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Evert J Van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
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12
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Liang LH, Tomic N, Vuong T, Aldelaijan S, Bekerat H, DeBlois F, Seuntjens J, Devic S. Physics aspects of the Papillon technique-Five decades later. Brachytherapy 2017; 17:234-243. [PMID: 29102741 DOI: 10.1016/j.brachy.2017.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE The Papillon technique using 50-kVp soft X-rays to treat rectal adenocarcinomas was developed and clinically implemented in the 1960s. We describe differences between accurate dosimetry and clinical implementation of this technique that is extending from its very inception to date. METHODS AND MATERIALS A renaissance of the Papillon technique occurred with two recently introduced 50-kVp systems: Papillon+ by Ariane and a custom-made rectal applicator (consisting of a surface applicator inserted into a proctoscope) by iCAD's Xoft Axxent Electronic Brachytherapy (eBT) System (iCad, Inc., Sunnyvale, CA). In contrast to the initial design, we investigated the impact of introducing a plastic lid, which would provide more reproducible and more accurate dose delivery across the rectal adenocarcinoma patient population. We use both parallel-plate chamber and radiochromic film dosimeters to determine differences in basic dosimetry characteristics (beam half-value layers, outputs, percent depth doses, and profiles) between the Xoft Electronic Brachytherapy rectal applicator system with and without the plastic lid in place. RESULTS Compared to the open-cone applicator, the proposed applicator with the plastic lid produces a slightly harder (more penetrating) beam quality (half-value layer of 1.4 vs. 1.3-mm Al), but with reduced output (by 33%), and a slightly broader beam with flatness not worse than 3% and symmetry not worse than 2%. CONCLUSIONS In addition to characterizing beam properties modified by the possible introduction of the plastic cap, we also pointed out and addressed misconceptions in the use of radiochromic films for dose measurements at low-energy photon beams.
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Affiliation(s)
- Li Heng Liang
- Radiation Oncology Department, Jewish General Hospital, Montreal, Quebec, Canada; Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Nada Tomic
- Radiation Oncology Department, Jewish General Hospital, Montreal, Quebec, Canada; Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Te Vuong
- Radiation Oncology Department, Jewish General Hospital, Montreal, Quebec, Canada; Oncology Department, McGill University, Montreal, Quebec, Canada
| | - Saad Aldelaijan
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada; Biological & Biomedical Engineering Department, Montreal Neurological Institute, Montréal, Québec, Canada; Biomedical Physics Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hamed Bekerat
- Radiation Oncology Department, Jewish General Hospital, Montreal, Quebec, Canada; Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Francois DeBlois
- Radiation Oncology Department, Jewish General Hospital, Montreal, Quebec, Canada; Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Jan Seuntjens
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada; Oncology Department, McGill University, Montreal, Quebec, Canada
| | - Slobodan Devic
- Radiation Oncology Department, Jewish General Hospital, Montreal, Quebec, Canada; Medical Physics Unit, McGill University, Montreal, Quebec, Canada; Segal Cancer Centre, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
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Sun Myint A, Smith FM, Gollins S, Wong H, Rao C, Whitmarsh K, Sripadam R, Rooney P, Hershman M, Pritchard DM. Dose Escalation Using Contact X-ray Brachytherapy After External Beam Radiotherapy as Nonsurgical Treatment Option for Rectal Cancer: Outcomes From a Single-Center Experience. Int J Radiat Oncol Biol Phys 2017; 100:565-573. [PMID: 29229327 DOI: 10.1016/j.ijrobp.2017.10.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To review the outcomes of rectal cancer patients treated with a nonsurgical approach using contact x-ray brachytherapy (CXB) when suspicious residual disease (≤3 cm) was present after external beam chemoradiation therapy/radiation therapy (EBCRT/EBRT). METHODS AND MATERIALS Outcome data for rectal cancer patients referred to our institution from 2003 to 2012 were retrieved from an institutional database. These patients were referred after initial local multidisciplinary team discussion because they were not suitable for, or had refused, surgery. All selected patients received a CXB boost after EBCRT/EBRT. Most patients received a total of 90 Gy of CXB delivered in 3 fractions over 4 weeks. RESULTS The median follow-up period was 2.5 years (range 1.2-8.3). Of 345 consecutive patients with rectal cancer referred to us, 83 with suspicious residual disease (≤3 cm) after EBCRT/EBRT were identified for a CXB boost. Their median age was 72 years (range 36-87), and 58 (69.9%) were men. The initial tumor stages were cT2 (n = 28) and cT3 (n = 55), and 54.2% were node positive. A clinical complete response (cCR) was achieved in 53 patients (63.8%) after the CXB boost that followed EBCRT/EBRT. Of these 53 patients, 7 (13.2%) developed a relapse after achieving a cCR, and the 6 patients (11.6%) with nonmetastatic regrowth underwent salvage surgery (100%). At the end of the study period, 69 of 83 patients (83.1%) were cancer free. CONCLUSIONS Our data suggest that a CXB boost for selected patients with suspicious residual disease (≤3 cm) after EBCRT/EBRT can be offered as an alternative to radical surgery. In our series, patients with a sustained cCR had a low rate of local regrowth, and those with nonmetastatic regrowth could be salvaged successfully. This approach could provide an alternative treatment option for elderly or comorbid patients who are not suitable for surgery and those with rectal cancer who wish to avoid surgery.
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Affiliation(s)
- Arthur Sun Myint
- The Clatterbridge Cancer Centre, Liverpool, United Kingdom; Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
| | - Fraser McLean Smith
- The Royal Liverpool and Broadgreen University Hospital National Health Service Trust, Liverpool, United Kingdom
| | - Simon Gollins
- North Wales Cancer Treatment Centre, Rhyl, United Kingdom
| | - Helen Wong
- The Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | - Christopher Rao
- Department of Surgery, University Hospital Lewisham, London, United Kingdom
| | | | - Raj Sripadam
- The Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | - Paul Rooney
- The Royal Liverpool and Broadgreen University Hospital National Health Service Trust, Liverpool, United Kingdom
| | | | - D Mark Pritchard
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; The Royal Liverpool and Broadgreen University Hospital National Health Service Trust, Liverpool, United Kingdom
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Gollins S, Moran B, Adams R, Cunningham C, Bach S, Myint AS, Renehan A, Karandikar S, Goh V, Prezzi D, Langman G, Ahmedzai S, Geh I. Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Multidisciplinary Management. Colorectal Dis 2017; 19 Suppl 1:37-66. [PMID: 28632307 DOI: 10.1111/codi.13705] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Brendan Moran
- Basingstoke & North Hampshire Hospital, Basingstoke, UK
| | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | | | - Simon Bach
- University of Birmingham and Queen Elizabeth Hospital, Birmingham, UK
| | | | - Andrew Renehan
- University of Manchester and Christie Hospital, Manchester, UK
| | | | - Vicky Goh
- King's College and Guy's & St Thomas' Hospital, London, UK
| | | | | | | | - Ian Geh
- Queen Elizabeth Hospital, Birmingham, UK
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Californium-252 neutron intracavity brachytherapy alone for T1N0 low-lying rectal adenocarcinoma: A definitive anal sphincter-preserving radiotherapy. Sci Rep 2017; 7:40619. [PMID: 28094790 PMCID: PMC5240549 DOI: 10.1038/srep40619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 12/12/2016] [Indexed: 01/27/2023] Open
Abstract
This study evaluated the 4-year results of 32 patients with T1N0 low-lying rectal adenocarcinoma treated solely with californium-252 (Cf-252) neutron intracavity brachytherapy (ICBT). Patients were solicited into the study from January 2008 to June 2011. All the patients had refused surgery or surgery was contraindicated. The patients were treated with Cf-252 neutron ICBT using a novel 3.5-cm diameter off-axis 4-channel intrarectal applicator designed by the authors. The dose reference point was defined on the mucosa surface, with a total dose of 55-62 Gy-eq/4 f (13-16 Gy-eq/f/wk). All the patients completed the radiotherapy in accordance with our protocol. The rectal lesions regressed completely, and the acute rectal toxicity was mild (≤G2). The 4-year local control, overall survival, disease-free survival, and late complication (≥G2) rates were 96.9%, 90.6%, 87.5% and 15.6%, respectively. No severe late complication (≥G3) occurred. The mean follow-up was 56.1 ± 16.0 months. At the end of last follow-up, 29 patients remained alive. The mean survival time was 82.1 ± 2.7 months. Cf-252 neutron ICBT administered as the sole treatment (without surgery) for patients with T1N0 low-lying rectal adenocarcinoma is effective with acceptable late complications. Our study and method offers a definitive anal sphincter-preserving radiotherapy for T1N0 low-lying rectal adenocarcinoma patients.
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Frin AC, Evesque L, Gal J, Benezery K, François E, Gugenheim J, Benizri E, Château Y, Marcié S, Doyen J, Gérard JP. Organ or sphincter preservation for rectal cancer. The role of contact X-ray brachytherapy in a monocentric series of 112 patients. Eur J Cancer 2016; 72:124-136. [PMID: 28027515 DOI: 10.1016/j.ejca.2016.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/31/2016] [Accepted: 11/16/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contact X-ray brachytherapy (CXB) has been used at Centre Antoine Lacassagne since 2002 to increase the chance of conservative treatment (organ or sphincter preservation) in rectal cancer. A consecutive series of 112 patients (pts) is reported. METHODS Three protocols were used in selected rectal adenocarcinomas. Group 1: T1 N0 treated with local excision (LE) followed by adjuvant CXB. Group 2: T2 or 'early' T3 N0 treated with CXB combined with chemoradiotherapy (CRT) followed by surveillance or LE. Group 3: distal 'locally advanced' T3 N0-2 treated with CXB and CRT before total proctectomy. RESULTS Group 1: 27 pt (pTis: 3; pT1: 21; pT2: 3). After LE with CXB alone (20 pt) or CXB + CRT (7 pt) one local recurrence occurred. Organ preservation was achieved in 26 pt (96%). Group 2: 45 pt (T1: 2; T2: 23; T3: 20) treated with CXB alone (4 pt) or CXB + CRT or external beam radiotherapy (EBRT) (41 pt). A clinical complete response (cCR) was observed in 43/45 (96%) and 3 pt developed a local recurrence (11% at 5 years). The specific survival was 76% at 5 years and the rate of organ preservation was 89% (40/45 pt) with good bowel function in 36 pt. Group 3: 40 pt, anterior resection (with sphincter preservation) was possible in 35 pt (86%) with a 3-year local recurrence of 6%. CONCLUSION CXB usually combined as a boost with CRT or EBRT may safely increase the chance of a conservative treatment (organ or sphincter preservation) for selected rectal cancers.
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Affiliation(s)
- Anne Claire Frin
- CHU Nice, Department of Gastroenterology, Nice Sophia-Antipolis University, France
| | - Ludovic Evesque
- Centre Antoine Lacassagne, Department of Medical Oncology, Nice Sophia-Antipolis University, France
| | - Jocelyn Gal
- Centre Antoine Lacassagne, Department of Research and Methodology, Nice Sophia-Antipolis University, France
| | - Karène Benezery
- Centre Antoine Lacassagne, Department of Radiation Oncology, Nice Sophia-Antipolis University, France
| | - Eric François
- CHU Nice, Department of Gastroenterology, Nice Sophia-Antipolis University, France
| | - Jean Gugenheim
- CHU Nice, Department of Surgery, Nice Sophia-Antipolis University, France
| | - Emmanuel Benizri
- CHU Nice, Department of Surgery, Nice Sophia-Antipolis University, France
| | - Yan Château
- Centre Antoine Lacassagne, Department of Research and Methodology, Nice Sophia-Antipolis University, France
| | - Serge Marcié
- Centre Antoine Lacassagne, Department of Radiation Oncology, Nice Sophia-Antipolis University, France
| | - Jérome Doyen
- Centre Antoine Lacassagne, Department of Radiation Oncology, Nice Sophia-Antipolis University, France
| | - Jean-Pierre Gérard
- Centre Antoine Lacassagne, Department of Radiation Oncology, Nice Sophia-Antipolis University, France.
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Shi M, Paquette B, Thippayamontri T, Gendron L, Guérin B, Sanche L. Increased radiosensitivity of colorectal tumors with intra-tumoral injection of low dose of gold nanoparticles. Int J Nanomedicine 2016; 11:5323-5333. [PMID: 27789945 PMCID: PMC5068480 DOI: 10.2147/ijn.s97541] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The potential of gold nanoparticles (GNPs) as radiosensitizers for the treatment of malignant tumors has been limited by the large quantities of GNPs that must be administered and the requirement for low-energy X-ray irradiation to optimize radiosensitization. In this study, we enhance the radiosensitivity of HCT116 human colorectal cells with tiopronin-coated GNPs (Tio-GNPs) combined with a low-energy X-ray (26 keV effective energy) source, similar to the Papillon 50 clinical irradiator used for topical irradiation of rectal tumors. Sensitizer enhancement ratios of 1.48 and 1.69 were measured in vitro, when the HCT116 cells were incubated with 0.1 mg/mL and 0.25 mg/mL of Tio-GNPs, respectively. In nude mice bearing the HCT116 tumor, intra-tumoral (IT) injection of Tio-GNPs allowed a 94 times higher quantity of Tio-GNPs to accumulate than was possible by intravenous injection and facilitated a significant tumor response. The time following irradiation, for tumors growing to four times their initial tumor volume (4Td) was 54 days for the IT injection of 366.3 μg of Tio-GNPs plus 10 Gy, compared to 37 days with radiation alone (P=0.0018). Conversely, no significant improvement was obtained when GNPs were injected intravenously before tumor irradiation (P=0.6547). In conclusion, IT injection of Tio-GNPs combined with low-energy X-rays can significantly reduce the growth of colorectal tumors.
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Affiliation(s)
- Minghan Shi
- Department of Nuclear Medicine and Radiobiology, Center for Research in Radiotherapy
| | - Benoit Paquette
- Department of Nuclear Medicine and Radiobiology, Center for Research in Radiotherapy
| | | | - Louis Gendron
- Department of Pharmacology-Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Brigitte Guérin
- Department of Nuclear Medicine and Radiobiology, Center for Research in Radiotherapy
| | - Léon Sanche
- Department of Nuclear Medicine and Radiobiology, Center for Research in Radiotherapy
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Modelling the radiobiological effect of intraoperative X-ray brachytherapy for breast cancer using an air-filled spherical applicator. J Contemp Brachytherapy 2016; 8:313-8. [PMID: 27648085 PMCID: PMC5018525 DOI: 10.5114/jcb.2016.61758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/20/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose We present a framework, in which we compare a conventional standard dose of 50 Gy in 25 fractions with accelerated partial breast irradiation (APBI) using electronic brachytherapy (eBT). We discuss how radiobiological modelling enables us to establish a framework, within which we can compare external beam radiotherapy (EBRT). This leads to a determination of the shell of isoeffect in breast tissue, at which very low kV eBT can be considered to be clinically equivalent to standard EBRT. Material and methods To estimate relative biological effectiveness (RBE) values as a function of dose and irradiation time, we used a modified linear quadratic (LQ) approach, taking into account the ability of this new device, to deliver 20 Gy at the surface of a 40 mm diameter rigid, hollow spherical applicator in less than 2 minutes. In this study, we considered the radiobiological effectiveness of the Papillon +™ X-ray brachytherapy device operating at 30 kV, 0.3 mA producing dose rates in excess of 14 Gy/min. Results Calculated clinical RBEs ranged from 1.154 at the surface of a 40 mm diameter applicator to 1.100 at 35 mm from the applicator surface for the Papillon+ device. The absolute physical dose D (abs) 30 kV ranged from 20.00 Gy at the applicator surface to 1.20 at 35 mm distant. The product of the isoeffective single dose of 60Co reference radiation – (RBE)60Co, and the RBE corrected standard 2 Gy equivalent dose fractions (EQD2) doses, EQD2(30 kV) * (RBE)60Co ranged from 98.62 Gy at the applicator surface to 1.13 at 35 mm. The ‘shell of isoeffect’, the value on the X-axis where the EQD2(30 kV) * (RBE)60Co line crosses the 50 Gy mark on the Y-axis, was found to be approximately 3.5 mm beyond the applicator surface. Conclusions The ‘shell of isoeffect’ can serve as a useful metric with which to compare the radiobiological effectiveness of low kV eBT with various regimes of conventional EBRT.
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Barillot I, Chauvet B, Hannoun Lévi J, Lisbona A, Leroy T, Mahé M. Processus du traitement par irradiation. Cancer Radiother 2016; 20 Suppl:S8-S19. [DOI: 10.1016/j.canrad.2016.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Stoll A, van Oepen A, Friebe M. Intraoperative delivery of cell-killing boost radiation – a review of current and future methods. MINIM INVASIV THER 2016; 25:176-87. [DOI: 10.3109/13645706.2016.1173563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Intraoperative radiotherapy with low energy photons in recurrent colorectal cancer: a single centre retrospective study. Contemp Oncol (Pozn) 2016; 20:52-7. [PMID: 27095940 PMCID: PMC4829748 DOI: 10.5114/wo.2016.58500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY Intraoperative radiotherapy (IORT) may improve outcome of surgical treatment of recurrent colorectal cancer (CRC). The aim of this study is to determine the feasibility, safety and long-term results of surgical treatment of recurrent CRC with orthovolt IORT. MATERIAL AND METHODS Fifty-nine consecutive CRC patients with local recurrence (LR), undergoing surgery, were included in the retrospective analysis of prospectively collected data. The modified Wanebo classification was used to stage LR (Tr). Twenty-five (43%) patients received IORT using INTRABEAM(®) PRS 500. The complications were classified according to the Clavien-Dindo classification. RESULTS There were 32 males and 27 females, with a median age of 63 years. Multi-visceral resections were performed in 37 (63%) patients. Median hospitalization time after surgery with IORT was 7 days. One (1.7%) in-hospital postoperative death was reported. Grade 3/4 postoperative complications were found in 11 (19%) patients. Intraoperative radiotherapy had no effect on the postoperative hospitalization time, morbidity and mortality. Median survival after R0 resection was 32 months. Complete resection (R0), no synchronous liver metastases (M0), and no lateral and posterior pelvic wall involvement, were significant predictors of improved survival. Stage of LR was found to be an independent prognostic factor in the multivariate analysis (p = 0.03); Cox regression model). In patients with LR stage < Tr5, a 3-year overall survival (OS) rate was 52%. CONCLUSIONS Combination of surgical resection and orthovolt IORT is a safe and feasible procedure that does not increase the risk of postoperative complications or prolongs the hospital stay. Despite aggressive surgery supported by IORT, the advanced stage of LR is a limiting factor of long-term survival.
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Gérard JP, Doyen J, Barbet N. New Neoadjuvant Treatment Strategies for Non-Metastatic Rectal Cancer (M0). CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-015-0287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Foray N. [Léon Bouchacourt (1865-1949): How an obstetrician pointed out individual radiosensitivity]. Cancer Radiother 2015; 19:752-61. [PMID: 26585802 DOI: 10.1016/j.canrad.2015.09.007] [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: 07/21/2015] [Revised: 09/03/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022]
Abstract
Léon Bouchacourt (1865-1949) was a misknown pioneer of radiology and radiotherapy from Lyon, France. While he was resident in obstetrics in Hôpitaux de Paris from 1892 to 1898, he met Charcot, the future polar explorer, and wrote the first thesis dissertation about X-rays. He invented a new radiology technique for cavitary organs such as vagina, rectum and mouth, the endodiascopy, which permitted him to perform the first pelvimetry and dental radiographies in France. While he undertook the first trials of contact-radiotherapy, he was confronted with radiation-induced reactions. In 1911, he wrote the first paper about individual radiosensitivity. During the First World War, he commanded one of the radiology vehicles, he met Irène Curie and developed his « radiological helmet », which will hold his name and became essential for interventional radiology. After the war, with Béclère and ten others, Léon Bouchacourt funded the French Radiology Society. He ended his career by thinking about public health and the different aspects of the duties of radiologists.
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Affiliation(s)
- N Foray
- Groupe de radiobiologie, centre de recherche en cancérologie de Lyon, UMR1052, institut national de la santé et de la recherche médicale, rue Laennec, 69008 Lyon, France.
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Eaton DJ. Electronic brachytherapy--current status and future directions. Br J Radiol 2015; 88:20150002. [PMID: 25748070 PMCID: PMC4628482 DOI: 10.1259/bjr.20150002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/28/2015] [Accepted: 03/05/2015] [Indexed: 12/17/2022] Open
Abstract
In the past decade, electronic brachytherapy (EB) has emerged as an attractive modality for the treatment of skin lesions and intraoperative partial breast irradiation, as well as finding wider applications in intracavitary and interstitial sites. These miniature X-ray sources, which operate at low kilovoltage energies (<100 kV), have reduced shielding requirements and inherent portability, therefore can be used outside the traditional realms of the radiotherapy department. However, steep dose gradients and increased sensitivity to inhomogeneities challenge accurate dosimetry. Secondly, ease of use does not mitigate the need for close involvement by medical physics experts and consultant oncologists. Finally, further studies are needed to relate the more heterogeneous dose distributions to clinical outcomes. With these provisos, the practical convenience of EB strongly suggests that it will become an established option for selected patients, not only in radiotherapy departments but also in a range of operating theatres and clinics around the world.
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Affiliation(s)
- D J Eaton
- NCRI Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, London, UK
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26
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Gerard JP, Frin AC, Doyen J, Zhou FX, Gal J, Romestaing P, Barbet N, Coquard R, Chapet O, François E, Marcié S, Benezery K. Organ preservation in rectal adenocarcinoma (T1) T2-T3 Nx M0. Historical overview of the Lyon Sud - nice experience using contact x-ray brachytherapy and external beam radiotherapy for 120 patients. Acta Oncol 2015; 54:545-51. [PMID: 25389568 DOI: 10.3109/0284186x.2014.975840] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hill R, Healy B, Holloway L, Kuncic Z, Thwaites D, Baldock C. Advances in kilovoltage x-ray beam dosimetry. Phys Med Biol 2014; 59:R183-231. [DOI: 10.1088/0031-9155/59/6/r183] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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28
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Monte Carlo dosimetry for the Papillon P50 contact radiotherapy and IORT device. Radiother Oncol 2013; 109:367-9. [DOI: 10.1016/j.radonc.2013.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 10/14/2013] [Accepted: 10/22/2013] [Indexed: 11/18/2022]
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Myint AS. Contact radiotherapy for elderly patients with early low rectal cancers. Br J Hosp Med (Lond) 2013; 74:391-6. [DOI: 10.12968/hmed.2013.74.7.391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A Sun Myint
- Clatterbridge Papillon Clinic, Clatterbridge Cancer Centre, Bebington, Wirral, Merseyside CH63 4JY, and Honorary Professor in the Department of Gastroenterology, University of Liverpool, Liverpool
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30
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Doyen J, Parks SK, Marcié S, Pouysségur J, Chiche J. Knock-down of hypoxia-induced carbonic anhydrases IX and XII radiosensitizes tumor cells by increasing intracellular acidosis. Front Oncol 2013; 2:199. [PMID: 23316475 PMCID: PMC3539669 DOI: 10.3389/fonc.2012.00199] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 12/07/2012] [Indexed: 12/31/2022] Open
Abstract
The relationship between acidosis within the tumor microenvironment and radioresistance of hypoxic tumor cells remains unclear. Previously we reported that hypoxia-induced carbonic anhydrases (CA) IX and CAXII constitute a robust intracellular pH (pHi)-regulating system that confers a survival advantage on hypoxic human colon carcinoma LS174Tr cells in acidic microenvironments. Here we investigate the role of acidosis, CAIX and CAXII knock-down in combination with ionizing radiation. Fibroblasts cells (-/+ CAIX) and LS174Tr cells (inducible knock-down for ca9/ca12) were analyzed for cell cycle phase distribution and survival after irradiation in extracellular pHo manipulations and hypoxia (1% O2) exposure. Radiotherapy was used to target ca9/ca12-silenced LS174Tr tumors grown in nude mice. We found that diminishing the pHi-regulating capacity of fibroblasts through inhibition of Na+/H+ exchanger 1 sensitize cells to radiation-induced cell death. Secondly, the pHi-regulating function of CAIX plays a key protective role in irradiated fibroblasts in an acidic environment as accompanied by a reduced number of cells in the radiosensitive phases of the cell cycle. Thirdly, we demonstrate that irradiation of LS174Tr spheroids, silenced for either ca9 or both ca9/ca12, showed a respective 50 and 75% increase in cell death as a result of a decrease in cell number in the radioresistant S phase and a disruption of CA-mediated pHi regulation. Finally, LS174Tr tumor progression was strongly decreased when ca9/ca12 silencing was combined with irradiation in vivo. These findings highlight the combinatory use of radiotherapy with targeting of the pHi-regulating CAs as an anti-cancer strategy.
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Affiliation(s)
- Jérome Doyen
- Institute for Research on Cancer and Aging of Nice, CNRS UMR 7284, University of Nice Sophia-Antipolis, Nice, France ; Department of Radiation Oncology, Centre Antoine-Lacassagne , Nice, France
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31
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Thariat J, Hannoun-Levi JM, Sun Myint A, Vuong T, Gérard JP. Past, present, and future of radiotherapy for the benefit of patients. Nat Rev Clin Oncol 2012. [PMID: 23183635 DOI: 10.1038/nrclinonc.2012.203] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiotherapy has been driven by constant technological advances since the discovery of X-rays in 1895. Radiotherapy aims to sculpt the optimal isodose on the tumour volume while sparing normal tissues. The benefits are threefold: patient cure, organ preservation and cost-efficiency. The efficacy and tolerance of radiotherapy were demonstrated by randomized trials in many different types of cancer (including breast, prostate and rectum) with a high level of scientific evidence. Such achievements, of major importance for the quality of life of patients, have been fostered during the past decade by linear accelerators with computer-assisted technology. More recently, these developments were augmented by proton and particle beam radiotherapy, usually combined with surgery and medical treatment in a multidisciplinary and personalized strategy against cancer. This article reviews the timeline of 100 years of radiotherapy with a focus on breakthroughs in the physics of radiotherapy and technology during the past two decades, and the associated clinical benefits.
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Affiliation(s)
- Juliette Thariat
- Department of Radiation Oncology, Centre Antoine Lacassagne--University Nice Sophia Antipolis, 33 Avenue Valombrose, 06189 Nice, France
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Ceelen WP. Progress in rectal cancer treatment. ISRN GASTROENTEROLOGY 2012; 2012:648183. [PMID: 22970381 PMCID: PMC3437282 DOI: 10.5402/2012/648183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 08/08/2012] [Indexed: 12/17/2022]
Abstract
The dramatic improvement in local control of rectal cancer observed during the last decades is to be attributed to attention to surgical technique and to the introduction of neoadjuvant therapy regimens. Nevertheless, systemic relapse remains frequent and is currently insufficiently addressed. Intensification of neoadjuvant therapy by incorporating chemotherapy with or without targeted agents before the start of (chemo)radiation or during the waiting period to surgery may present an opportunity to improve overall survival. An increasing number of patients can nowadays undergo sphincter preserving surgery. In selected patients, local excision or even a "wait and see" approach may be feasible following active neoadjuvant therapy. Molecular and genetic biomarkers as well as innovative imaging techniques may in the future allow better selection of patients for this treatment option. Controversy persists concerning the selection of patients for adjuvant chemotherapy and/or targeted therapy after neoadjuvant regimens. The currently available evidence suggests that in complete pathological responders long-term outcome is excellent and adjuvant therapy may be omitted. The results of ongoing trials will help to establish the ideal tailored approach in resectable rectal cancer.
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Affiliation(s)
- Wim P Ceelen
- Department of Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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Développement de l’appareil Papillon50™ et de ses applicateurs pour la radiothérapie 50kV des cancers du rectum et de la peau. Ing Rech Biomed 2012. [DOI: 10.1016/j.irbm.2012.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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