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Barry B, Dolivet G, Clatot F, Huguet F, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Coste F, Cupissol D, Cuvelier P, De Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, De Raucourt D. [French national standard for the treatment of squamous cell carcinoma of upper aero-digestive tract - General principles of treatment]. Bull Cancer 2024; 111:393-415. [PMID: 38418334 DOI: 10.1016/j.bulcan.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVES The management of upper aerodigestive tract cancers is a complex specialty. It is essential to provide an update to establish optimal care. At the initiative of the INCa and under the auspices of the SFORL, the scientific committee, led by Professor Béatrix Barry, Dr. Gilles Dolivet, and Dr. Dominique De Raucourt, decided to develop a reference framework aimed at defining, in a scientific and consensus-based manner, the general principles of treatment for upper aerodigestive tract cancers applicable to all sub-locations. METHODOLOGY To develop this framework, a multidisciplinary team of practitioners was formed. A systematic analysis of the literature was conducted to produce recommendations classified by grades, in accordance with the standards of the French National Authority for Health (HAS). RESULTS The grading of recommendations according to HAS standards has allowed the establishment of a reference for patient care based on several criteria. In this framework, patients benefit from differentiated care based on prognostic factors they present (age, comorbidities, TNM status, HPV status, etc.), conditions of implementation, and quality criteria for indicated surgery (operability, resectability, margin quality, mutilation, salvage surgery), as well as quality criteria for radiotherapy (target volume, implementation time, etc.). The role of medical and postoperative treatments was also evaluated based on specific criteria. Finally, supportive care must be organized from the beginning and throughout the patients' care journey. CONCLUSION All collected data have led to the development of a comprehensive framework aimed at harmonizing practices nationally, facilitating decision-making in multidisciplinary consultation meetings, promoting equality in practices, and providing a state-of-the-art and reference practices for assessing the quality of care. This new framework is intended to be updated every 5 years to best reflect the latest advances in the field.
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Affiliation(s)
- Béatrix Barry
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | - Gilles Dolivet
- Institut de cancérologie de Lorraine, ORL et CCF, Nancy (54), France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Olivier Duffas
- Centre hospitalier de Libourne, ORL et CMF, Libourne, France
| | | | | | | | - Diane Evrard
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | | | - Nicolas Fakhry
- Assistance publique-Hôpitaux de Marseille, ORL et CCF, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Didier Salvan
- Centre hospitalier Sud Francilien, ORL et CCF, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
| | - Véronique Block
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
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Dolivet G, Barry B, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Clatot F, Coste F, Cupissol D, Cuvelier P, de Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Huguet F, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, de Raucourt D. [National standard for the treatment of squamous cell carcinoma of upper aerodigestive tract]. Bull Cancer 2024; 111:327-332. [PMID: 38336530 DOI: 10.1016/j.bulcan.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Gilles Dolivet
- ORL et CCF, Institut de cancérologie de Lorraine, Nancy, France.
| | - Béatrix Barry
- ORL et CCF, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | | | | | | | | | | | | | | | | | | | - Philippe Cuvelier
- ORL et CCF libéral à Bayonne et centre hospitalier Oloron, Oloron-Sainte-Marie, France
| | | | | | - Olivier Duffas
- ORL et CMF, centre hospitalier de Libourne, Libourne, France
| | | | | | | | - Diane Evrard
- ORL et CCF, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | | | - Nicolas Fakhry
- ORL et CCF, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sophie Renard
- ORL et CCF, Institut de cancérologie de Lorraine, Nancy, France
| | - Didier Salvan
- ORL et CCF, centre hospitalier sud francilien, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif spécifique régional du cancer Grand Est - NEON, Nancy, France
| | - Véronique Block
- Dispositif spécifique régional du cancer Grand Est - NEON, Nancy, France
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Laune Q, Varnier R, Rousseau A, Larnaudie A, Ghannam Y, Huguet F, Delaye M. [Last year of residency for oncologists: Overview and perspectives]. Bull Cancer 2024; 111:142-152. [PMID: 37845094 DOI: 10.1016/j.bulcan.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/22/2023] [Accepted: 08/11/2023] [Indexed: 10/18/2023]
Abstract
CONTEXT The reform of the third cycle of medical studies in France has introduced of the "Junior Doctor" status during the concluding year of residency. We wish to evaluate its implementation for the first promotion of medical oncology residents during 2021-2022 in correlation with the published guidelines. METHOD AERIO conducted a cross-sectional study among French medical oncology residents. The survey was released via social networks and emails. RESULTS Twenty-eight of 47 residents responded. The typical week involved one to two half-days of consultation, one dedicated to clinical research, one multidisciplinary team meetings, with the rest of time being occupied by day care (mostly) and hospitalization. Teaching and quality management activities were infrequent (monthly or less). The Junior Doctors rated their overall satisfaction at 8/10. A large majority (92.5 %) felt equipped to handle most of the situations they encountered. Almost all residents (92.9 %) had negotiated with their placement supervisor prior to the selection procedure. In one third of the cases (35.7 %), the principle of mismatch between the number of residents and the number of training sites was not respected. Only 42.9 % received training in scientific writing and 82.2 % of the residents agreed on the relevance of the post-internship training modules developed in other specialties. CONCLUSIONS Junior doctors in medical oncology express overall satisfaction with this reform, which aligns with the recommendations. Nevertheless, certain concerns, such as selection procedure and inadequacy, along with areas requiring improvement, such as post-internship training and scientific writing, are clearly established.
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Affiliation(s)
- Quentin Laune
- Association d'enseignement et de recherche des internes en oncologie (AERIO), 149, avenue du Maine, 75014 Paris, France; Hôpital Morvan, centre hospitalier universitaire de Brest, service oncologie, 2, avenue Maréchal-Foch, Brest, Finistère, 29200 Bretagne, France.
| | - Romain Varnier
- Centre Léon-Bérard, association des jeunes oncologues de Rhône-Alpes (AJORA), 28, rue Laennec, 69008 Lyon, France; Inserm U1290, université Claude-Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), Lyon, France
| | - Adrien Rousseau
- Association d'enseignement et de recherche des internes en oncologie (AERIO), 149, avenue du Maine, 75014 Paris, France; Gustave-Roussy Cancer Campus, Departement of Cancer Medecine, Villejuif, France
| | - Audrey Larnaudie
- Centre François-Baclesse, service de radiothérapie, 3, avenue du Général-Harris, Caen, France; Société française des jeunes radiothérapeutes oncologues (SfjRO), 47, rue de la colonie, 75013 Paris, France
| | - Youssef Ghannam
- Société française des jeunes radiothérapeutes oncologues (SfjRO), 47, rue de la colonie, 75013 Paris, France; Institut de cancérologie de l'Ouest, service de radiothérapie, 15, rue André-Boquel, Angers, France
| | - Florence Huguet
- Assistance publique-Hôpitaux de Paris, hôpital Tenon, service d'oncologie-radiothérapie, 75020 Paris, France; Collège national des enseignants en cancérologie (CNEC), Paris, France
| | - Matthieu Delaye
- Association d'enseignement et de recherche des internes en oncologie (AERIO), 149, avenue du Maine, 75014 Paris, France; Université Versailles-Saint-Quentin (UVSQ), institut Curie, département d'oncologie médicale, Saint-Cloud, France
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Huguet F, Tlemsani C, Pierga JY, Curtit E, Deluche E, Domblides C, Guimbaud R, Laprie A, Marchal F, Massard C, Spano JP. [The French National College of Oncology Teachers (CNEC): Missions, organization, and projects]. Bull Cancer 2024; 111:133-141. [PMID: 38185534 DOI: 10.1016/j.bulcan.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/09/2024]
Abstract
The National College of Cancerology Teachers (CNEC) was created in September 1986. Its missions are to develop the teaching of oncology, to promote educational actions in the discipline, to participate in the development of teaching content and the definition of curricula and the control of knowledge for the training of medical students and specialists, to develop and validate educational documents relating to the above teaching, to ensure the representation of oncology teaching to of the National University Council (CNU) and administrative authorities, to ensure and coordinate relations with other university disciplines, scientific societies, national, European, and international professional groups, and to contribute to the development of research in the discipline. The current office was elected in September 2022 for three years.
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Affiliation(s)
- Florence Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Sorbonne université, Paris, France.
| | - Camille Tlemsani
- Service d'oncologie médicale, hôpital Cochin, AP-HP, université Paris cité, Paris, France
| | - Jean-Yves Pierga
- Département d'oncologie médicale, Institut Curie, université Paris cité, Paris, France
| | - Elsa Curtit
- Service d'oncologie médicale, CHU de Besançon, Besançon, France
| | - Elise Deluche
- Service d'oncologie médicale, CHU de Limoges, Limoges, France
| | | | - Rosine Guimbaud
- Service d'oncologie médicale digestive, CHU de Toulouse, Toulouse, France
| | - Anne Laprie
- Département de radiothérapie, IUCT Oncopôle, Toulouse, France
| | - Frédéric Marchal
- Département d'oncologie chirurgicale, Institut de cancérologie de Lorraine, Nancy, France
| | | | - Jean-Philippe Spano
- Service d'oncologie médicale, hôpital Pitié Salpêtrière, AP-HP, Sorbonne université, Paris, France
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Huguet F, Riou O, Pasquier D, Modesto A, Quéro L, Michalet M, Bordron A, Schipman B, Orthuon A, Lisbona A, Vendrely V, Jaksic N. Radiation therapy of the primary tumour and/or metastases of digestive metastatic cancers. Cancer Radiother 2024; 28:66-74. [PMID: 37806823 DOI: 10.1016/j.canrad.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/27/2023] [Accepted: 04/07/2023] [Indexed: 10/10/2023]
Abstract
Metastatic gastrointestinal cancer is not an uncommon situation, especially for pancreatic, gastric, and colorectal cancers. In this setting, few data are available on the impact of the treatment of the primary tumour. Oligometastatic disease is associated with longer survival in comparison with more advanced disease. Metastasis-directed therapy, such as stereotactic body radiotherapy, seems related to better outcomes, but the level of evidence is low. In most tumour locations, prospective data are very scarce and inclusion in ongoing trials is strongly recommended.
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Affiliation(s)
- F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, DMU Orphé, Sorbonne université, Paris, France; Laboratory of Cancer Biology and Therapeutics, centre de recherche Saint-Antoine, U938, Inserm, Paris, France.
| | - O Riou
- Institut de recherche en cancérologie de Montpellier, U1194, Inserm, université de Montpellier, Montpellier, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, ICM, institut régional du cancer de Montpellier, Montpellier, France
| | - D Pasquier
- Service d'oncologie radiothérapie, centre Oscar-Lambret, Lille, France; Université de Lille, CNRS, école centrale de Lille, UMR 9189 - CRIStAL, Lille, France
| | - A Modesto
- Département de radiothérapie, institut universitaire du cancer de Toulouse, Toulouse, France; Centre de recherche du cancer de Toulouse, UMR 1037, Inserm, université Toulouse-III Paul-Sabatier, Toulouse, France
| | - L Quéro
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP Nord, DMU Icare, Paris, France; Université Paris Cité, U1160, Inserm, Paris, France
| | - M Michalet
- Institut de recherche en cancérologie de Montpellier, U1194, Inserm, université de Montpellier, Montpellier, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, ICM, institut régional du cancer de Montpellier, Montpellier, France
| | - A Bordron
- Département de radiothérapie, centre hospitalier universitaire de Brest, Brest, France
| | - B Schipman
- Institut de cancérologie de Bourgogne, Dijon, France
| | - A Orthuon
- Institut de cancérologie de Bourgogne, Dijon, France
| | - A Lisbona
- Institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France
| | - V Vendrely
- Service d'oncologie radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - N Jaksic
- Institut de cancérologie et radiothérapie Brétillien, Saint-Malo, France
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Jaksic N, Modesto A, Meillan N, Bordron A, Michalet M, Riou O, Lisbona A, Huguet F. Stereotactic body radiation therapy for liver metastases in oligometastatic disease. Cancer Radiother 2024; 28:75-82. [PMID: 37865603 DOI: 10.1016/j.canrad.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/07/2023] [Accepted: 04/25/2023] [Indexed: 10/23/2023]
Abstract
Oligometastatic cancers designate cancers in which the number of metastases is less than five, corresponding to a particular biological entity whose prognosis is situated between a localized and metastatic disease. The liver is one of the main sites of metastases. When patients are not suitable for surgery, stereotactic body radiotherapy provides high local control rate, although these data come mainly from retrospective studies, with no phase III study results. The need for a high therapeutic dose (biologically effective dose greater than 100Gy) while respecting the constraints on the organs at risk, and the management of respiratory movements require expertise and sufficient technical prerequisites. The emergence of new techniques such as MRI-guided radiotherapy could further increase the effectiveness of stereotactic radiotherapy of liver metastases, and thus improve the prognosis of these oligometastatic cancers.
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Affiliation(s)
- N Jaksic
- Institut de cancérologie et radiothérapie Brétillien, 35400 Saint-Malo, France.
| | - A Modesto
- Département de radiothérapie, institut régional du cancer, 31100 Toulouse, France
| | - N Meillan
- Département de radiothérapie, centre hospitalier d'Argenteuil, 95107 Argenteuil, France
| | - A Bordron
- Département de radiothérapie, centre hospitalier universitaire de Brest, 29200 Brest, France
| | - M Michalet
- Département de radiothérapie, institut régional du cancer, 34000 Montpellier, France
| | - O Riou
- Département de radiothérapie, institut régional du cancer, 34000 Montpellier, France
| | - A Lisbona
- Département de radiothérapie, institut régional du cancer, 44800 Saint-Herblain, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, Sorbonne université, 75020 Paris, France
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Larnaudie A, Bourbonne V, Michalet M, Laune Q, Delaye M, Huguet F, Azria D, Varnier R, Ghannam Y. [Last year of residency for radiation oncologists in France: Overview and perspectives]. Cancer Radiother 2023; 27:718-724. [PMID: 37891037 DOI: 10.1016/j.canrad.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE The last year of the radiotherapy oncology internship in France has become a phase of empowerment, called "junior doctor", allowing interns to validate acts previously reserved only for senior doctors. This study focused on the responsibilities given to the first promotion of junior doctors in France and their feelings on this new status. MATERIAL AND METHODS A cross-sectional survey was carried out by the French associations of interns and young doctors in oncology, Aerio and SFjRO. A questionnaire was sent to the class referents of each city for transmission to the junior doctors of the year 2021-2022 from September 1st to November 30th, 2022. The questions concerned training, the modalities of this year and the feelings. Responses were analyzed anonymously using R. 4.3.1 software. RESULTS For radiation oncology, 33 responses were obtained from 21 cities. For most junior doctors, three to four localizations (51%) were performed with an average of five new patients per week. The contours were reviewed either systematically (51%) or only at the beginning (32%). Dosimetry was reported as never countersigned in 19%; 80% of junior doctors described having been the only radiation oncologist during multidisciplinary staff meetings. The two main areas of improvement were theoretical training (45%) and legal frameworks/contracts (42%). CONCLUSION These results relating to the first class of junior doctors showed an overall agreement with the recommendations of the Cnec. Feedback from interns was positive. The supervision of brachytherapy and dosimetry activities, the presence alone in multidisciplinary panel remained points of vigilance.
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Affiliation(s)
- A Larnaudie
- Service de radiothérapie, centre François-Baclesse, avenue du Général-Harris, 14000 Caen, France; Société française des jeunes radiothérapeutes oncologues (SFJRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France.
| | - V Bourbonne
- Société française des jeunes radiothérapeutes oncologues (SFJRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Service de radiothérapie, centre hospitalier universitaire de Brest, 2, avenue Foch, 29200 Brest, France
| | - M Michalet
- Service de radiothérapie, institut de cancérologie, Montpellier, parc Euromédecine, 208, avenue des Apothicaires, 34090 Montpellier, France
| | - Q Laune
- Service de radiothérapie, centre hospitalier universitaire de Brest, 2, avenue Foch, 29200 Brest, France; Association d'enseignement et de recherche des internes en oncologie (Aerio), 149, avenue du Maine, 75014 Paris, France
| | - M Delaye
- Association d'enseignement et de recherche des internes en oncologie (Aerio), 149, avenue du Maine, 75014 Paris, France; Service d'oncologie médicale, institut Curie, 35, rue Daily, 92210 Saint-Cloud, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, 75020 Paris, France; Collège national des enseignants en cancérologie (Cnec), Paris, France
| | - D Azria
- Service de radiothérapie, institut de cancérologie, Montpellier, parc Euromédecine, 208, avenue des Apothicaires, 34090 Montpellier, France; Société française de radiothérapie oncologique (SFRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France
| | - R Varnier
- Research on Healthcare Performance (Reshape), Inserm, U1290, université Claude-Bernard, Lyon, France; Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Y Ghannam
- Société française des jeunes radiothérapeutes oncologues (SFJRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Service de radiothérapie, institut de cancérologie de l'Ouest, 15, rue André-Boquel, 49100 Angers, France
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8
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Boustani J, Huguet F, Vendrely V. Practice-changing clinical trials in radiation oncology for gastrointestinal malignancies in 2021-2023. Cancer Radiother 2023; 27:768-777. [PMID: 38415359 DOI: 10.1016/j.canrad.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 02/29/2024]
Abstract
Gastrointestinal cancers are one of the most frequent cancers and a leading cause of cancer deaths worldwide. We provide an overview of the most important practice-changing trials that were either published or presented at the international scientific meetings in 2021-2023. Highlights included reports on three phase III trials (CONCORDE/PRODIGE 26, ARTDECO, and a study by Xu et al.) that evaluated dose escalation in the definitive setting for locally advanced oesophageal cancers, as well as two phase III trials that evaluated the role of chemotherapy (neo-AEGIS) and targeted therapy (NRG/RTOG 1010) in the neoadjuvant setting for adenocarcinoma oesophageal cancers or gastroesophageal junction cancer. CheckMate 577 evaluated nivolumab in patients who had residual pathological disease after neoadjuvant chemoradiation followed by complete resection. The use of radiation therapy for borderline and locally advanced pancreatic cancer is also discussed (SMART and CONKO-007 trials). Stereotactic body radiation therapy followed by sorafenib was compared to sorafenib alone in patients with hepatocellular carcinoma in the NRG/RTOG 1112 study. New options in the management of rectal cancer are emerging such as total neoadjuvant treatment (PRODIGE 23, RAPIDO, PROSPECT), organ preservation (OPRA, OPERA), and the role of immunotherapy in patients with DNA mismatch-repair deficient/microsatellite instability. Finally, preliminary results of the ACT 4 trial that evaluated de-escalation in anal cancer are presented.
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Affiliation(s)
- J Boustani
- Department of Radiation Oncology, centre hospitalier universitaire de Besançon, Besançon, France; Inserm, EFS BFC, UMR 1098, RIGHT, Greffon-hôte-tumeur interactions/Ingénierie cellulaire et génique, université de Franche-Comté, Besançon, France.
| | - F Huguet
- Department of Radiation Oncology, hôpital Tenon, AP-HP, Sorbonne université, Paris, France
| | - V Vendrely
- Department of Radiation Oncology, centre hospitalier universitaire de Bordeaux, Bordeaux, France; BoRdeaux Institute of onCology (BRIC), UMR1312, Inserm, université de Bordeaux, 33000, Bordeaux, France
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Modesto A, Tougeron D, Tremolières P, Ronchin P, Jouve AD, Leignel DA, Vendrely V, Riou O, Martin-Babau J, Le Sourd S, Mirabel X, Leroy T, Huguet F, Montaigne L, Baumgaertner I, Deslandres M, Moyal E, Seva C, Selves J, Otal P, Pezzella V, Guimbaud R, Filleron T, Quéro L. Association of Radiochemotherapy to Immunotherapy in unresectable locally advanced Oesophageal carciNoma-randomized phase 2 trial ARION UCGI 33/PRODIGE 67: the study protocol. BMC Cancer 2023; 23:966. [PMID: 37828434 PMCID: PMC10568784 DOI: 10.1186/s12885-023-11227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 07/25/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND In case of locally advanced and/or non-metastatic unresectable esophageal cancer, definitive chemoradiotherapy (CRT) delivering 50 Gy in 25 daily fractions in combination with platinum-based regimen remains the standard of care resulting in a 2-year disease-free survival of 25% which deserves to be associated with new systemic strategies. In recent years, several immune checkpoint inhibitors (anti-PD1/anti-PD-L1, anti-Program-Death 1/anti-Program-Death ligand 1) have been approved for the treatment of various solid malignancies including metastatic esophageal cancer. As such, we hypothesized that the addition of an anti-PD-L1 to CRT would provide clinical benefit for patients with locally advanced oesophageal cancer. To assess the efficacy of the anti-PD-L1 durvalumab in combination with CRT and then as maintenance therapy we designed the randomized phase II ARION (Association of Radiochemotherapy with Immunotherapy in unresectable Oesophageal carciNoma- UCGI 33/PRODIGE 67). METHODS ARION is a multicenter, open-label, randomized, comparative phase II trial. Patients are randomly assigned in a 1:1 ratio in each arm with a stratification according to tumor stage, histology and centre. Experimental arm relies on CRT with 50 Gy in 25 daily fractions in combination with FOLFOX regimen administrated during and after radiotherapy every two weeks for a total of 6 cycles and durvalumab starting with CRT for a total of 12 infusions. Standard arm is CRT alone. Use of Intensity Modulated radiotherapy is mandatory. The primary endpoint is to increase progression-free survival at 12 months from 50 to 68% (HR = 0.55) (power 90%; one-sided alpha-risk, 10%). Progression will be defined with central external review of imaging. ANCILLARY STUDIES ARE PLANNED PD-L1 Combined Positivity Score on carcinoma cells and stromal immune cells of diagnostic biopsy specimen will be correlated to disease free survival. The study of gut microbiota will aim to determine if baseline intestinal bacteria correlates with tumor response. Proteomic analysis on blood samples will compare long-term responder after CRT with durvalumab to non-responder to identify biomarkers. CONCLUSION Results of the present study will be of great importance to evaluate the impact of immunotherapy in combination with CRT and decipher immune response in this unmet need clinical situation. TRIAL REGISTRATION ClinicalTrials.gov, NCT: 03777813.Trial registration date: 5th December 2018.
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Affiliation(s)
- Anouchka Modesto
- Radiation Oncology Department Institut Claudius Regaud at Institut, Universitaire du Cancer de Toulouse-Oncopole, 1 Rue Irene Joliot Curie, 31059, Toulouse, France.
- Inserm Team 11 RadOpt CRCT 1, Avenue Hubert Curien, 31059, Toulouse, France.
| | - David Tougeron
- Service d'hépato-Gastro-Entérologie, Centre Hospitalier Universitaire de Poitiers, 86000, Poitiers, France
| | - Pierre Tremolières
- Institut de Cancérologie de L'Ouest: Angers Et Saint Herblain, Saint-herblain, France
| | - Philippe Ronchin
- Hôpital Privé Arnault Tzanck- Centre Azuréen de Cancérologie, Mougins, France
| | | | | | | | | | | | | | | | - Thomas Leroy
- Nouvelle Clinique Des Dentellières, Valenciennes, France
| | - Florence Huguet
- Radiation Oncology Department, Tenon Hospital, AP-HP,, Sorbonne University, Paris, France
| | | | | | - Marion Deslandres
- GI Oncology Department Centre Hospitalo, Universitaire Rangueil, Toulouse, France
| | - Elizabeth Moyal
- Radiation Oncology Department Institut Claudius Regaud at Institut, Universitaire du Cancer de Toulouse-Oncopole, 1 Rue Irene Joliot Curie, 31059, Toulouse, France
- Inserm Team 11 RadOpt CRCT 1, Avenue Hubert Curien, 31059, Toulouse, France
| | - Catherine Seva
- Inserm Team 11 RadOpt CRCT 1, Avenue Hubert Curien, 31059, Toulouse, France
| | - Janick Selves
- Pathology department, Centre Hospitalo Universitaire IUCT-Oncopole, Toulouse, France
| | - Philippe Otal
- Imaging Department Centre Hospitalo, Universitaire Rangueil, Toulouse, France
| | | | - Rosine Guimbaud
- GI Oncology Department Centre Hospitalo, Universitaire Rangueil, Toulouse, France
| | - Thomas Filleron
- Biostatistics Departement Institut Claudius Regaud Institut, Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Laurent Quéro
- Radiation Oncology Department, Saint Louis Hospital, AP-HP, Paris, France
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Haaser T, Lahmi L, Osman D, Gesbert C, Cheval V, Constantinides Y, de Crevoisier R, Dejean C, Escande A, Ghannam Y, Lorchel F, Thureau S, Lagrange JL, Durdux C, Huguet F. [Ethical stakes of information in radiation oncology: Thinking the risk and building the therapeutic alliance]. Cancer Radiother 2023; 27:480-486. [PMID: 37573195 DOI: 10.1016/j.canrad.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 08/14/2023]
Abstract
Informing patients before receiving radiation therapy is a fundamental ethical imperative. As a condition of the possibility of autonomy, information allows people to make health decisions concerning themselves, which is required by French law. This information includes in particular the potential risks due to radiation therapy. It is therefore necessary to think about what risk is, and how to define and assess it, in order to finally communicate it. The practice of informing people involves many ethical issues relating to the very content of the information, the form in which it is transmitted or even the intention that leads the health professional to say (or not to say) the risk. The transmission of information also questions the way to build a relationship of trust with the patients and how to integrate their own representations about these treatments. Between the risks of paternalism or even defensive medicine, this practice is at the heart of our professional practice.
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Affiliation(s)
- T Haaser
- Service d'oncologie radiothérapie, hôpital Haut Lévêque, centre hospitalier universitaire de Bordeaux, avenue Magellan, 33600 Pessac, France; Centre éthique et recherche en santé de Bordeaux, centre hospitalier universitaire de Bordeaux, Bordeaux, France; EA 4574 sciences, philosophie, humanités, universités de Bordeaux et Bordeaux Montaigne, Pessac, France.
| | - L Lahmi
- Service d'oncologie radiothérapie, institut Curie, Paris, France
| | - D Osman
- Service de médecine intensive-réanimation, hôpital de Bicêtre, AP-HP, DMU Correve, université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France
| | - C Gesbert
- Direction de la qualité, des services aux patients et des parcours, centre hospitalier de Versailles, Versailles, France
| | - V Cheval
- Service universitaire d'oncologie radiothérapie, centre Oscar-Lambret, faculté de médecine Henri-Warembourg, laboratoire CRIStAL, UMR9189, université de Lille, Lille, France
| | - Y Constantinides
- Espace éthique Île-de-France, Paris université Sorbonne Nouvelle, Paris, France
| | - R de Crevoisier
- Service d'oncologie radiothérapie, centre Eugène-Marquis, Rennes, France
| | - C Dejean
- Service d'oncologie radiothérapie, unité de physique médicale, centre Antoine-Lacassagne, Nice, France
| | - A Escande
- Service universitaire d'oncologie radiothérapie, centre Oscar-Lambret, faculté de médecine Henri-Warembourg, laboratoire CRIStAL, UMR9189, université de Lille, Lille, France
| | - Y Ghannam
- Service d'oncologie radiothérapie, hôpital Tenon, centre de recherche Saint-Antoine UMR_S 938, institut universitaire de cancérologie, AP-HP, Sorbonne université, Paris, France
| | - F Lorchel
- Service d'oncologie radiothérapie, centre hospitalier universitaire Lyon-Sud, Lyon, France; Centre d'oncologie radiothérapie et oncologie de Mâcon (Orlam), Mâcon, France
| | - S Thureau
- Service d'oncologie radiothérapie, Quantis Litis EA 4108, centre Henri-Becquerel, Rouen, France
| | - J L Lagrange
- Université Paris-Est Créteil Val-de-Marne, Paris, France
| | - C Durdux
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Paris, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, centre de recherche Saint-Antoine UMR_S 938, institut universitaire de cancérologie, AP-HP, Sorbonne université, Paris, France
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11
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Vienne A, Collet L, Chevalier T, Borel C, Tardy M, Huguet F, Richard S, Salas S, Saada-Bouzid E, Fayette J, Daste A. Efficacy of second-line chemotherapy or immune checkpoint inhibitors for patients with a prolonged objective response (≥ 6 months) after first-line therapy for recurrent or metastatic head and neck squamous cell carcinoma: a retrospective study. BMC Cancer 2023; 23:663. [PMID: 37452287 PMCID: PMC10347750 DOI: 10.1186/s12885-023-11133-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M-HNSCC) have a poor prognosis and limited therapeutic options. Immune checkpoint inhibitors (ICIs) are effective in patients with tumor progression < 6 months following first-line, platinum-based chemotherapy (PBC), but data are missing for patients with progression ≥ 6 months after the last platinum dose. METHODS Retrospective analysis (six French centers, 2008-2019) of all consecutive R/M-HNSCC patients. treated first-line with PBC and tumor progression ≥ 6 months after the last platinum dose. PRIMARY ENDPOINT progression-free survival after second-line therapy (PFS2). Additional endpoints: overall survival from Day 1 of first-line (OS1) and second-line (OS2) therapy. RESULTS R/M-HNSCC patients (n = 144) received cisplatinum (n = 67, 47%) or carboplatinum (n = 77, 53%) first-line. Response after first-line: complete response (CR; n = 16, 11%); partial response (PR; n = 77, 53%); stable disease (n = 22, 15%). Second-line therapy: PBC (n = 95, 66%); platinum-free regimen (PFR) (n = 25, 17%); ICI (n = 24, 17%). Median [95% confidence interval] PFS (months): PBC 5.0 [3.8-6.2]; PFR 4.0 [1-7.0]; ICI 2.0 [0.4-3.6] (p = 0.16). For PBC, PFR, and ICI, respectively: OS1 30, 23, and 29 months (p = 1.02); OS2 14, 10, and 16 months (p = 0.25); PR, 26%, 16%, and 21% patients; CR, 0%, 8%, and 4% patients. For subsequent lines, ICIs were administered for PBC (n = 11, 12%) and PFR (n = 2, 8%). No predictive factor for efficacy (PFS, OS) was identified. CONCLUSIONS Our retrospective study suggests similar efficacy regarding OS2 for second-line chemotherapy or ICI in R/M-HNSCC patients with progression ≥ 6 months after the last first-line platinum dose.
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Affiliation(s)
- Agathe Vienne
- Department of Medical Oncology, Hôpital Saint-André, CHU Bordeaux-University of Bordeaux, 1 Rue Jean Burguet, Bordeaux, 33000, France
| | - Laetitia Collet
- Department of Medical Oncology, Léon Bérard Center, University of Lyon, Lyon, France
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Bruxelles, Belgium
| | - Thomas Chevalier
- Department of Medical Oncology, CHU la Timone, AP-HM, Marseille, France
| | - Christian Borel
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Magalie Tardy
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Florence Huguet
- Department of Radiation Oncology, AP-HP, Tenon Hospital, Sorbonne University, Paris, France
| | - Sandrine Richard
- Department of Medical Oncology, Tenon Hospital, AP-HP Sorbonne University, Paris, France
| | - Sebastien Salas
- Department of Medical Oncology, CHU la Timone, AP-HM, Marseille, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Jerome Fayette
- Department of Medical Oncology, Léon Bérard Center, University of Lyon, Lyon, France
| | - Amaury Daste
- Department of Medical Oncology, Hôpital Saint-André, CHU Bordeaux-University of Bordeaux, 1 Rue Jean Burguet, Bordeaux, 33000, France.
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Beddok A, Loi M, Rivin Del Campo E, Dumas JL, Orthuon A, Créhange G, Huguet F. [Limits of dose constraint definition for organs at risk specific to stereotactic radiotherapy]. Cancer Radiother 2023:S1278-3218(23)00067-7. [PMID: 37208260 DOI: 10.1016/j.canrad.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 05/21/2023]
Abstract
Stereotactic radiotherapy is a very hypofractionated radiotherapy (>7.5Gy per fraction), and therefore is more likely to induce late toxicities than conventional normofractionated irradiations. The present study examines four frequent and potentially serious late toxicities: brain radionecrosis, radiation pneumonitis, radiation myelitis, and radiation-induced pelvic toxicities. The critical review focuses on the toxicity scales, the definition of the dose constrained volume, the dosimetric parameters, and the non-dosimetric risk factors. The most commonly used toxicity scales remain: RTOG/EORTC or common terminology criteria for adverse events (CTCAE). The definition of organ-at-risk volume requiring protection is often controversial, which limits the comparability of studies and the possibility of accurate dose constraints. Nevertheless, for the brain, whatever the indication (arteriovenous malformation, benign tumor, metastasis of solid tumors...), the association between the volume of brain receiving 12Gy (V12Gy) and the risk of cerebral radionecrosis is well established for both single and multi-fraction stereotactic irradiation. For the lung, the average dose received by both lungs and the V20 seem to correlate well with the risk of radiation-induced pneumonitis. For the spinal cord, the maximum dose is the most consensual parameter. Clinical trial protocols are useful for nonconsensual dose constraints. Non-dosimetric risk factors should be considered when validating the treatment plan.
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Affiliation(s)
- A Beddok
- Institut Curie, université PSL, université Paris Saclay, Inserm, Lito U1288, 75005 Orsay, France; Service de radiothérapie oncologique, institut Curie, université PSL, Paris, France.
| | - M Loi
- Radiotherapy Department, University of Florence, Florence, Italie
| | - E Rivin Del Campo
- Service de radiothérapie oncologique, hôpital Tenon, AP-HP, Sorbonne Université, 75020 Paris, France; Faculté de médecine, Sorbonne Université, 75013 Paris, France
| | - J-L Dumas
- Service de radiothérapie oncologique, institut Curie, université PSL, Paris, France
| | - A Orthuon
- Service de radiothérapie oncologique, hôpital Tenon, AP-HP, Sorbonne Université, 75020 Paris, France
| | - G Créhange
- Institut Curie, université PSL, université Paris Saclay, Inserm, Lito U1288, 75005 Orsay, France; Service de radiothérapie oncologique, institut Curie, université PSL, Paris, France
| | - F Huguet
- Service de radiothérapie oncologique, hôpital Tenon, AP-HP, Sorbonne Université, 75020 Paris, France; Faculté de médecine, Sorbonne Université, 75013 Paris, France
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Sarrade T, Gautier M, Schernberg A, Jenny C, Orthuon A, Maingon P, Huguet F. Educative Impact of Automatic Delineation Applied to Head and Neck Cancer Patients on Radiation Oncology Residents. J Cancer Educ 2023; 38:578-589. [PMID: 35359258 DOI: 10.1007/s13187-022-02157-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2022] [Indexed: 05/20/2023]
Abstract
To evaluate the educational impact on radiation oncology residents in training when introducing an automatic segmentation software in head and neck cancer patients regarding organs at risk (OARs) and prophylactic cervical lymph node level (LNL) volumes. Two cases treated by exclusive intensity-modulated radiotherapy were delineated by an expert radiation oncologist and were considered as reference. Then, these cases were delineated by residents divided into two groups: group 1 (control group), experienced residents delineating manually, group 2 (experimental group), young residents on their first rotation trained with automatic delineation, delineating manually first (M -) and then after using the automatic system (M +). The delineation accuracy was assessed using the Overlap Volume (OV). Regarding the OARs, mean OV was 0.62 (SD = 0.05) for group 1, 0.56 (SD = 0.04) for group 2 M - , and 0.61 (SD = 0.03) for group 2 M + . Mean OV was higher in group 1 compared to group 2 M - (p = 0.01). There was no OV difference between group 1 and group 2 M + (p = 0.67). Mean OV was higher in the group 2 M + compared to group 2 M - (p < 0.003). Regarding LNL, mean OV was 0.53 (SD = 0.06) in group 1, 0.54 (SD = 0.03) in group 2 M - , and 0.58 (SD = 0.04) in group 2 M + . Mean OV was higher in group 2 M + for 11 of the 12 analysed structures compared to group 2 M - (p = 0.016). Prior use of the automatic delineation software reduced the average contouring time per case by 34 to 40%. Prior use of atlas-based automatic segmentation reduces the delineation duration, and provides reliable OARs and LNL delineations.
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Affiliation(s)
- Thomas Sarrade
- Department of Radiation Oncology, Tenon Hospital, AP-HP.Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
| | - Michael Gautier
- Department of Medical Physics, AP-HP.Sorbonne Université, Paris, France
| | - Antoine Schernberg
- Department of Radiation Oncology, Tenon Hospital, AP-HP.Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
| | - Catherine Jenny
- Department of Medical Physics, AP-HP.Sorbonne Université, Paris, France
| | - Alexandre Orthuon
- Department of Medical Physics, AP-HP.Sorbonne Université, Paris, France
| | - Philippe Maingon
- Department of Radiation Oncology, Pitié-Salpêtrière Hospital, AP-HP.Sorbonne Université, Paris, France
- Institut Universitaire de Cancérologie, Sorbonne Université, Paris, France
| | - Florence Huguet
- Department of Radiation Oncology, Tenon Hospital, AP-HP.Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.
- Institut Universitaire de Cancérologie, Sorbonne Université, Paris, France.
- Centre de Recherche Saint-Antoine, Inserm UMR_S 938, Saint-Antoine Hospital, Paris, France.
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Savanović M, Štrbac B, Jaroš D, Loi M, Huguet F, Foulquier JN. Quantification of Lung Tumor Motion and Optimization of Treatment. J Biomed Phys Eng 2023; 13:65-76. [PMID: 36818005 PMCID: PMC9923245 DOI: 10.31661/jbpe.v0i0.2102-1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/18/2021] [Indexed: 02/02/2023]
Abstract
Background Mobility of lung tumors is induced by respiration and causes inadequate dose coverage. Objective This study quantified lung tumor motion, velocity, and stability for small (≤5 cm) and large (>5 cm) tumors to adapt radiation therapy techniques for lung cancer patients. Material and Methods In this retrospective study, 70 patients with lung cancer were included that 50 and 20 patients had a small and large gross tumor volume (GTV). To quantify the tumor motion and velocity in the upper lobe (UL) and lower lobe (LL) for the central region (CR) and a peripheral region (PR), the GTV was contoured in all ten respiratory phases, using 4D-CT. Results The amplitude of tumor motion was greater in the LL, with motion in the superior-inferior (SI) direction compared to the UL, with an elliptical motion for small and large tumors. Tumor motion was greater in the CR, rather than in the PR, by 63% and 49% in the UL compared to 50% and 38% in the LL, for the left and right lung. The maximum tumor velocity for a small GTV was 44.1 mm/s in the LL (CR), decreased to 4 mm/s for both ULs (PR), and a large GTV ranged from 0.4 to 9.4 mm/s. Conclusion The tumor motion and velocity depend on the tumor localization and the greater motion was in the CR for both lobes due to heart contribution. The tumor velocity and stability can help select the best technique for motion management during radiation therapy.
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Affiliation(s)
- Milovan Savanović
- Faculty of Medicine, University of Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
- Department of Radiation Oncology, Tenon Hospital, APHP, Sorbonne University, 75020 Paris, France
| | - Bojan Štrbac
- MATER Private Hospital, Department of Physics, Eccles Street, Dublin 7, Ireland
| | - Dražan Jaroš
- Center for Radiotherapy, International Medical Centers, Affidea, 78000 Banja Luka, Bosnia, and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia, and Herzegovina
| | - Mauro Loi
- Department of Radiation Oncology, Tenon Hospital, APHP, Sorbonne University, 75020 Paris, France
| | - Florence Huguet
- Department of Radiation Oncology, Tenon Hospital, APHP, Sorbonne University, 75020 Paris, France
| | - Jean-Noël Foulquier
- Department of Radiation Oncology, Tenon Hospital, APHP, Sorbonne University, 75020 Paris, France
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de Crevoisier R, Leseur J, Bouvet C, Huguet F, Lagrange JL, Haaser T, Pasquier D, Créhange G, Supiot S, Pommier P, Roy A, Berna A, Blanchard P, Marcucci L. Compréhension/acceptation de la radiothérapie : un dilemme éthique résolu par une éthique de la considération et de la sollicitude. Cancer Radiother 2023; 27:115-125. [PMID: 37011968 DOI: 10.1016/j.canrad.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 03/02/2023]
Abstract
PURPOSE Ethical questions are poorly investigated specifically in radiation oncology. The objective of the study was to identify and understand the main ethical issue in radiation oncology. MATERIALS AND METHODS A quantitative analysis was based on the answers to a questionnaire of 200 professionals from 22 radiation oncology departments. The questionnaire mainly aimed to characterize the main ethical issue. A monocentric qualitative analysis was based on semi-structured interviews focused on the main identified ethical issue, carried out with eight technologists, and 20 patients undergoing radiotherapy. RESULTS The main ethical issue was the understanding and/or acceptance of the treatment by the patients (71 %), which frequently arises (more than once a month) (52 %), and corresponds to an ethical tension between the principles of respect for autonomy and beneficence (the good as viewed by the patient) as defined by Beauchamp and Childress. The technologists, wish the patient to be fully involved in his treatment, with the even possibility of refusing it. However, excluding paternalism and autonomic relentlessness, the technologists have the feeling of acting for the good of the patients by treating them with radiation, even if the patients are not always aware of it, because they are within a situation of vulnerability. If the hierarchy of principles is a compromise alternative, this problem is finally well resolved by the effective implementation of an ethic of consideration and solicitude, restoring the patient capabilities, i.e. the maximum development of his potentialities in his situation of vulnerability. Beyond the legal dimension, patient information is crucial and must consider the specific temporality of the patient. CONCLUSION The main ethical issue in radiation oncology is the understanding and/or acceptance of the treatment involving the development of an ethic of consideration and solicitude.
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Huguet F, Gilly O, Dufour H, Figarella-Branger D, Guedj A. Gangliocytome hypophysaire et maladie de Cushing : à propos d’un cas. Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Le Roy C, Vernerey D, Evin C, Richard S, Crespel C, Samaille T, Le Tourneau C, Huguet F. Efficacy and Tolerance of Carboplatin plus Cetuximab (Simplified EXTREME Regimen) in Patients with Recurrent and/or Metastatic Head and Neck Squamous Cell Carcinoma. Clin Oncol (R Coll Radiol) 2022; 34:e473-e481. [PMID: 36207237 DOI: 10.1016/j.clon.2022.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/13/2022] [Accepted: 09/14/2022] [Indexed: 01/31/2023]
Abstract
AIMS The EXTREME regimen is the standard for recurrent and/or metastatic head and neck squamous cell carcinoma (HNSCC). However, many patients have a poor performance status and/or comorbidities, making them unfit for this regimen. We have treated them with carboplatin and cetuximab (simplified EXTREME regimen) since 2007. Our aim was to assess the efficacy and tolerance of this regimen in this frail population. MATERIALS AND METHODS A retrospective chart review of all patients treated with the simplified EXTREME regimen for recurrent and/or metastatic HNSCC in three academic hospitals between 2007 and 2017 was carried out. The primary end point was overall survival. Secondary end points were progression-free survival (PFS), overall response rate (ORR) and toxicity. RESULTS One hundred and three patients were included. The median age was 63 years, 40% had performance status 2-3. The median follow-up was 30.2 months. The median overall survival and PFS were 7.2 and 3.7 months, respectively. The median overall survival was 10.1 months in patients with performance status 0-1 versus 4.6 months in patients with performance status 2-3 (P = 0.01). ORR was 39%. Acute grade 3-4 haematological and non-haematological toxicity rates were 25.2% and 27.2%, respectively. Patients with grade 1 or more skin toxicity had a higher ORR (hazard ratio = 3.44; P = 0.03), a prolonged overall survival (hazard ratio = 0.37; P < 0.0001) and PFS (hazard ratio = 0.29; P < 0.0001). During treatment, 29% of patients had pain reduction, 13.5% had weight gain and 17.2% had an improvement in performance status. CONCLUSIONS This is the largest cohort of patients treated with simplified EXTREME for HNSCC. It was well tolerated, with a high ORR. Interestingly, skin toxicity correlated with treatment efficacy.
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Affiliation(s)
- C Le Roy
- Department of Radiation Oncology, Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - D Vernerey
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, INSERM UMR 1098, Besançon, France
| | - C Evin
- Department of Radiation Oncology, Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Department of Medical Oncology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université de Paris, Paris, France
| | - S Richard
- Department of Medical Oncology, Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - C Crespel
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université de Paris, Paris, France
| | - T Samaille
- Department of Radiation Oncology, Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Institut Curie, Department of Drug Development and Innovation (D3i), Paris & Saint-Cloud, France
| | - C Le Tourneau
- Institut Curie, INSERM U900 Research Unit, Saint-Cloud, France; Paris-Saclay University, Paris, France
| | - F Huguet
- Department of Radiation Oncology, Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Centre de Recherche Saint-Antoine, INSERM UMR_S 938, Saint-Antoine Hospital, Paris, France; Institut Universitaire de Cancérologie, Sorbonne Université, Paris, France.
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Serre R, Deutsch E, Huguet F, Pointreau Y. [Immuno-radiotherapy: A review of the rationale, recent clinical developments and future prospects]. Cancer Radiother 2022; 26:955-961. [PMID: 36030189 DOI: 10.1016/j.canrad.2022.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022]
Abstract
Thanks to the success of checkpoint inhibitors, immunotherapy now plays a major role in the management of a large number of solid tumors, while the number of indications continues to grow and new combinations could, in the near future, further modify treatment standards. However, the response rates of immunotherapies as monotherapy are modest and their use is increasingly considered in combination with other cancer treatments (chemotherapy, surgery, radiotherapy or certain targeted therapies). Combinations with radiotherapy seem particularly attractive because there is a strong experimental rationale linking part of the efficacy of ionizing radiation to an induced stimulation of both of the innate and adaptive response. Many early phases and a number of large randomized combination trials have published efficacy and safety results, while important trials are still ongoing and will provide answers in the near future. This short review recalls the experimental biological rationale for immuno-radiotherapy and highlights some of the fundamental directions being explored, then presents the clinical efficacy and safety results available to date, those expected in the near future, and finally outlines the outlook in this rapidly evolving field.
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Affiliation(s)
- R Serre
- Department of Radiation Oncology, Centre Hospitalier Universitaire Dupuytren, Limoges, France, Inria-Inserm team COMPO, Marseille, France.
| | - E Deutsch
- Gustave Roussy Cancer Campus, Villejuif, France, Université Paris-Saclay, Ile-de-France, France; Department of Radiation Oncology, Gustave Roussy, Villejuif, France; Inserm U1030, Radiothérapie Moléculaire et Innovation Thérapeutique, Villejuif, France
| | - F Huguet
- Department of Radiation Oncology, Hôpital Tenon, AP-HP, Paris, France, Sorbonne Université, Paris, France; Inserm U938 Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Paris, France
| | - Y Pointreau
- Department of Radiation Oncology, ILC-Centre Jean Bernard, Le Mans, France
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19
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Larrouy A, Giraud N, Huguet F, Vendrely V. [Organ preservation for rectal cancer: What are the arguments in favor of radiotherapy?]. Cancer Radiother 2022; 26:766-770. [PMID: 35995720 DOI: 10.1016/j.canrad.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
Abstract
Standard care for rectal cancers relies on both tumor (location relative to the sphincter, T and N stage, sphincter involvement) and patients characteristics. Radical surgery (total mesorectal excision) following short-course radiotherapy (RT) or standard chemo-radiotherapy, associated with induction or consolidation chemotherapy (total neoadjuvant treatment), remains the cornerstone of locally advanced rectal cancer (T3cd, T4 and/or N+) treatment. Nevertheless, for early stages, this radical resection could be avoided in favor of conservative approaches combining RT (external, contact, brachytherapy) with or without chemotherapy (concurrent, induction or consolidative), or even be limited, for good responders, to a local excision with view of organ-preservation strategies. This conservative approach could also be offered selectively to patients with complete clinical response after the induction sequence, irrespective of initial tumor characteristics. The Watch and Wait strategy relies on clinical, endoscopic and radiological evaluations, as well as sustained surveillance. Ongoing studies aim to improve response rates, either with chemotherapy intensification, or RT boost dose escalation with brachytherapy or contact-therapy.
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Affiliation(s)
- A Larrouy
- Institut cancérologie Paris Nord, service d'oncologie radiothérapie, avenue Charles-Péguy, 95200 Sarcelles, France.
| | - N Giraud
- Service d'oncologie radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, Bordeaux, France
| | - F Huguet
- Assistance publique-Hôpitaux de Paris, service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Sorbonne université, Paris, France
| | - V Vendrely
- Service d'oncologie radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, Bordeaux, France; U1312-BRIC, eq BioGO, Inserm, université de Bordeaux, 33000 Bordeaux, France
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20
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Huguet F, Cerbai C, Ta MH, Sarrade T, Evin C, Aziez S, Rivin Del Campo E, Durand B, Loi M. Neoadjuvant treatment of pancreatic adenocarcinoma: Chemoradiation or stereotactic body radiation therapy? Cancer Radiother 2022; 26:858-864. [PMID: 35987811 DOI: 10.1016/j.canrad.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 10/15/2022]
Abstract
Despite recent advances, the prognosis of pancreatic adenocarcinomas remains poor, even for patients with resectable tumors. For these latter, new approaches based on neoadjuvant treatment have been developed. Two components are used: chemotherapy and radiation therapy (RT). Indeed, pre-operative RT has many advantages in terms of efficacy and tolerance. It increases notably the chances of subsequent complete tumor resection. Several prospective trials are currently ongoing to clarify its place in the therapeutic arsenal. Another crucial question is to know which is the best RT technique: conventional normofractionated chemoradiotherapy or hypofrationated stereotactic body RT?
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Affiliation(s)
- F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Sorbonne université, institut universitaire de cancérologie, 4, rue de la Chine, Paris, France; Inserm U938 Cancer Biology and Therapeutics, centre de recherche Saint-Antoine, 75012 Paris, France.
| | - C Cerbai
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Sorbonne université, institut universitaire de cancérologie, 4, rue de la Chine, Paris, France; Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - M H Ta
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Sorbonne université, institut universitaire de cancérologie, 4, rue de la Chine, Paris, France
| | - T Sarrade
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Sorbonne université, institut universitaire de cancérologie, 4, rue de la Chine, Paris, France
| | - C Evin
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Sorbonne université, institut universitaire de cancérologie, 4, rue de la Chine, Paris, France
| | - S Aziez
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Sorbonne université, institut universitaire de cancérologie, 4, rue de la Chine, Paris, France
| | - E Rivin Del Campo
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Sorbonne université, institut universitaire de cancérologie, 4, rue de la Chine, Paris, France
| | - B Durand
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Sorbonne université, institut universitaire de cancérologie, 4, rue de la Chine, Paris, France
| | - M Loi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Dabout V, de la Fouchardière C, Voron T, André T, Huguet F, Cohen R. Traitements péri-opératoires des adénocarcinomes œsogastriques localisés. Bull Cancer 2022; 110:521-532. [PMID: 35965103 DOI: 10.1016/j.bulcan.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 12/24/2022]
Abstract
Gastric cancer is the 6th most common cancer in the world. Gastric adenocarcinomas can be divided into two groups: gastroesophageal junction adenocarcinomas and distal gastric adenocarcinomas, with different risk factors and potentially different therapeutic strategies. Therapeutic strategy for esogastric adenocarcinoma is multimodal. Gastric adenocarcinomas are managed with surgery and peri-operative chemotherapy. Gastroesophageal junction adenocarcinomas can either be treated surgically after neoadjuvant chemoradiotherapy or in the same way than gastric adenocarcinomas. There is currently no evidence of superiority of either treatment strategy. Recently, nivolumab has been validated as an adjuvant therapy for patients with esophageal cancer who received preoperative chemoradiotherapy and had residual tumor on the surgical specimen. In the absence of preoperative treatment, adjuvant chemoradiotherapy or chemotherapy should be discussed on a patient-by-patient basis. Currently, there is not indication for targeted therapies, nor for adapting postoperative treatment according to the response to preoperative treatment. The only validated indication for immunotherapy is as adjuvant treatment of esophageal cancer, but many studies are ongoing and may change practices in the future. The objective of this review is to synthesize the literature concerning the management of localized esogastric adenocarcinoma.
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22
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Savanović M, Loi M, Rivin Del Campo E, Huguet F, Foulquier JN. Assessment of Organ Dose Reduction Using Dynamic Conformal Arc and Static Field with FFF Beams for SBRT in Lung Cancer. Cancer Invest 2022; 40:868-878. [DOI: 10.1080/07357907.2022.2103705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Milovan Savanović
- Faculty of Medicine, University of Paris-Saclay, Le Kremlin-Bicetre, France
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Mauro Loi
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Eleonor Rivin Del Campo
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
- Faculty of Medicine, Sorbonne University Medical Faculty, Paris, France
| | - Florence Huguet
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
- Faculty of Medicine, Sorbonne University Medical Faculty, Paris, France
| | - Jean-Noël Foulquier
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
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Atallah S, Marc M, Schernberg A, Huguet F, Wagner I, Mäkitie A, Baujat B. Beyond Surgical Treatment in Adenoid Cystic Carcinoma of the Head and Neck: A Literature Review. Cancer Manag Res 2022; 14:1879-1890. [PMID: 35693117 PMCID: PMC9176735 DOI: 10.2147/cmar.s355663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/24/2022] [Indexed: 12/16/2022] Open
Abstract
Introduction Adenoid cystic carcinoma (AdCC) is a rare tumour as it accounts for about 10% of all salivary gland neoplasms. It occurs in all age groups with a predominance of women, but no risk factors have been identified to date. Although AdCC behaves as a slow-growing tumour, it is characterized by multiple and late recurrences. Therefore, we aim to update the knowledge of the treatment options in advanced and recurrent cases. Materials and Methods We performed a systematic literature review to provide a synthesis of the practical knowledge required for AdCC non-surgical management. Altogether, 99 out of the 1208 available publications were selected for analysis. Results AdCC is described as a basaloid tumour consisting of epithelial and myoepithelial cells. Immunohistochemistry is useful for diagnosis (PS100, Vimentin, CD117, CKit, muscle actin, p63) and for prognosis (Ki67). Identified mutations could lead to therapeutic opportunities (MYB-NFIB, Notch 1). The work-up is mainly based on neck and chest CT scan and MRI, and PET-CT with 18-FDG or PSMA can be considered. Surgical treatment remains the gold standard in resectable cases. Post-operative intensity modulated radiotherapy is the standard of care, but hadron therapy may be used in specific situations. Based on the available literature, no standard chemotherapy regimen can be recommended. Conclusion There is currently no consensus on the use of chemotherapy in AdCC, either concomitantly to RT in a postoperative setting or at a metastatic stage. Further, the available targeted therapies do not yet provide significant tumour response.
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Affiliation(s)
- Sarah Atallah
- Department of Otorhinolaryngology–Head and Neck Surgery, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
- Doctoral School of Public Health, University of Paris Sud, CESP, INSERM U1018, University of Paris-Saclay, UVSQ, Villejuif, France
- Correspondence: Sarah Atallah, Hôpital Tenon, AP-HP, 4 rue de la Chine, Paris, 75020, France, Tel +33 156016417, Email
| | - Morgane Marc
- Department of Otorhinolaryngology–Head and Neck Surgery, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Antoine Schernberg
- Department of Radiotherapy, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Florence Huguet
- Department of Radiotherapy, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Isabelle Wagner
- Department of Otorhinolaryngology–Head and Neck Surgery, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Bertrand Baujat
- Department of Otorhinolaryngology–Head and Neck Surgery, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
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Evin C, Quéro L, Le Malicot K, Blanchet-Deverly S, François E, Buchalet C, Lemanski C, Baba Hamed N, Rivin del Campo E, Bauwens L, Pommier P, Lièvre A, Tougeron D, Macé V, Sergent G, Diaz O, Zucman D, Mornex F, Locher C, De la Rochefordière A, Vendrely V, Huguet F. MO-0226 Clinical outcomes of HIV-positive patients with anal cancer in the ANABASE multicentric cohort. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02328-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Bisson E, André M, Durand B, Huguet F, Ta MH. [Place of radiotherapy in the treatment of rectal cancer in the elderly]. Soins Gerontol 2022; 27:23-27. [PMID: 35393032 DOI: 10.1016/j.sger.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Rectal cancer is a common disease of the elderly. Current treatment recommendations are established for young subjects in good general health condition, without taking into account the frailty, comorbidities and polymedications inherent in patients over 75 years old. For locally advanced lower and middle rectal cancers (T3, T4 or N+), these are based on variations of regimens including neoadjuvant chemoradiotherapy, surgery of the rectum with total removal of the mesorectum, and a possibility of adjuvant chemotherapy. This restrictive treatment presents a problem of compliance and is not without adverse effects. Treatment by short exclusive radiotherapy or chemoradiotherapy with close monitoring according to the Watch and Wait strategy can be proposed to fragile patients not eligible for surgery, even if there is a non-negligible risk of recurrence.
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Affiliation(s)
- Eva Bisson
- Service d'oncologie-radiothérapie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - Magali André
- Service d'oncologie-radiothérapie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - Bénédicte Durand
- Service d'oncologie-radiothérapie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - Florence Huguet
- Service d'oncologie-radiothérapie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - Minh-Hanh Ta
- Service d'oncologie-radiothérapie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 75020 Paris, France.
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26
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Cren PY, Chartier J, Penel N, Huguet F, Spano JP, Ollivier L, Delaye M, Turpin A. La phase socle en oncologie : retour d’expérience sur les trois premières années d’application de la réforme du troisième cycle. Bull Cancer 2022; 109:130-138. [DOI: 10.1016/j.bulcan.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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Abstract
We present the updated recommendations of the French society for radiation oncology on radiotherapy of oesophageal cancer. Oesophageal cancer still remains a malignant tumour with a poor prognosis. Surgery remains the standard treatment for localized cancers, regardless of histology. For locally advanced stages, surgery remains a standard for adenocarcinomas after neoadjuvant treatment with chemotherapy or chemoradiotherapy. However, it is a therapeutic option after initial chemoradiotherapy for stage III squamous cell carcinomas, given the increased morbidity and mortality with a multimodal treatment, which results in an equivalent overall survival with or without surgery. Preoperative or exclusive chemoradiotherapy should be delivered according to validated regimens with an effective total dose (50Gy), if surgery is not planned or if the tumour is deemed resectable before chemoradiotherapy. Intensity-modulated radiotherapy significantly reduces irradiation of the lungs and heart and may reduce the morbidity of this treatment, especially in combination with surgery. In case of exclusive chemoradiotherapy, dose escalation beyond 50Gy is not currently recommended. Some technical considerations still remain questionable, such as the place of prophylactic lymph node irradiation, adaptive radiotherapy, evaluation of response during and after chemoradiotherapy and the value of proton therapy.
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Affiliation(s)
- G Créhange
- Service d'oncologie radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| | - A Modesto
- Service d'oncologie radiothérapie, institut Claudius-Regaud, université de Toulouse, 31000 Toulouse, France
| | - V Vendrely
- Service d'oncologie radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33600 Pessac, France
| | - L Quéro
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75010 Paris, France
| | - X Mirabel
- Département de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - P Rétif
- Département of physique médicale, CHRU de Metz, 1, allée du Château, 57085 Metz, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, Hôpitaux universitaires Est Parisien, Sorbonne université, 75020 Paris, France
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Peiffert D, Huguet F, Vendrely V, Moureau-Zabotto L, Rivin Del Campo E, Créhange G, Dietmann AS, Moignier A. Radiotherapy of anal canal cancer. Cancer Radiother 2021; 26:279-285. [PMID: 34955416 DOI: 10.1016/j.canrad.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We present the update of the recommendations of the French society for radiation oncology on external radiotherapy and brachytherapy of anal canal carcinoma. The following guidelines are presented: indications, treatment procedure, as well as dose and dose-constraints objectives, immediate postoperative management, post-treatment evaluation, and long-term follow-up.
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Affiliation(s)
- D Peiffert
- Département de radiothérapie, Institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France.
| | - F Huguet
- Service de radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - V Vendrely
- Service d'oncologie-radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33600 Pessac, France; Inserm U1035, université de Bordeaux, 33000 Bordeaux, France
| | - L Moureau-Zabotto
- Service de radiothérapie, institut Paoli-Calmettes, 13000 Marseille, France
| | - E Rivin Del Campo
- Service de radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - G Créhange
- Département d'oncologie radiothérapie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
| | - A-S Dietmann
- Département de radiothérapie, Institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | - A Moignier
- Service de physique médicale, Institut de cancérologie de l'Ouest centre René-Gauducheau, 44805 Saint-Herblain, France
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Vendrely V, Rivin Del Campo E, Modesto A, Jolnerowski M, Meillan N, Chiavassa S, Serre AA, Gérard JP, Créhanges G, Huguet F, Lemanski C, Peiffert D. Rectal cancer radiotherapy. Cancer Radiother 2021; 26:272-278. [PMID: 34953708 DOI: 10.1016/j.canrad.2021.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We present the updated recommendations of the French society of oncological radiotherapy for rectal cancer radiotherapy. The standard treatment for locally advanced rectal cancer consists in chemoradiotherapy followed by radical surgery with total mesorectal resection and adjuvant chemotherapy according to nodal status. Although this strategy efficiently reduced local recurrences rates below 5% in expert centres, functional sequelae could not be avoided resulting in 20 to 30% morbidity rates. The early introduction of neoadjuvant chemotherapy has proven beneficial in recent trials, in terms of recurrence free and metastasis free survivals. Complete pathological responses were obtained in 15% of tumours treated by chemoradiation, even reaching up to 30% of tumours when neoadjuvant chemotherapy is associated to chemoradiotherapy. These good results question the relevance of systematic radical surgery in good responders. Personalized therapeutic strategies are now possible by improved imaging modalities with circumferential margin assessed by magnetic resonance imaging, by intensity modulated radiotherapy and by refining surgical techniques, and contribute to morbidity reduction. Keeping the same objectives, ongoing trials are now evaluating therapeutic de-escalation strategies, in particular rectal preservation for good responders after neoadjuvant treatment, or radiotherapy omission in selected cases (Greccar 12, Opera, Norad).
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Affiliation(s)
- V Vendrely
- Service d'oncologie radiothérapie, Hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33600 Pessac, France; Inserm U1035, université de Bordeaux, 33000 Bordeaux, France.
| | - E Rivin Del Campo
- Service d'oncologie radiothérapie, hôpital Tenon, Hôpitaux universitaires Est Parisien, Sorbonne université, 75020 Paris, France
| | - A Modesto
- Service d'oncologie radiothérapie, institut Claudius-Regaud, université de Toulouse, 31000 Toulouse, France
| | - M Jolnerowski
- Service universitaire de radiothérapie, Institut de cancérologie de Lorraine centre Alexis-Vautrin, 54000 Nancy, France
| | - N Meillan
- Service d'oncologie radiothérapie, hôpital Pitié Salpêtrière, APHP, Sorbonne université, 75013 Paris, France
| | - S Chiavassa
- Service de physique médicale, Institut de cancérologie de l'Ouest (ICO) centre René-Gauducheau, 44805 Saint-Herblain, France
| | - A-A Serre
- Service d'oncologie radiothérapie, centre Léon-Bérard, 69000 Lyon, France
| | - J-P Gérard
- Service d'oncologie radiothérapie, centre Antoine-Lacassagne, université Côte d'Azur, 06000 Nice, France
| | - G Créhanges
- Service d'oncologie radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, Hôpitaux universitaires Est Parisien, Sorbonne université, 75020 Paris, France
| | - C Lemanski
- Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, Institut du cancer de Montpellier, université de Montpellier, 34000 Montpellier, France
| | - D Peiffert
- Service universitaire de radiothérapie, Institut de cancérologie de Lorraine centre Alexis-Vautrin, 54000 Nancy, France
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30
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Huguet F, Rivin Del Campo E, Orthuon A, Mornex F, Bessières I, Guimas V, Vendrely V. Radiation therapy of pancreatic cancers. Cancer Radiother 2021; 26:259-265. [PMID: 34953706 DOI: 10.1016/j.canrad.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present the update of the recommendations of the French society of oncological radiotherapy on radiotherapy of pancreatic tumors. Currently, the use of radiation therapy for patients with pancreatic cancer is subject to discussion. In the adjuvant setting, the standard treatment is six months of chemotherapy with 5-fluorouracile, irinotecan and oxaliplatin. Chemoradiation may improve the survival of patients with incompletely resected tumours (R1). This remains to be confirmed by a prospective trial. Neoadjuvant chemoradiation is a promising treatment especially for patients with borderline resectable tumours. For patients with locally advanced tumours, there is no standard. An induction chemotherapy followed by chemoradiation for non progressive patients reduces the rate of local relapse. Whereas in the first trials of chemoradiation large fields were used, the treated volumes have been reduced to improve tolerance. Tumour movements induced by breathing should be taken in account. Intensity modulated radiation therapy allows a reduction of doses to the organs at risk. Whereas widely used, this technique has poor evidence-based recommendation. Stereotactic body radiation therapy is also being studied, as a neoadjuvant or exclusive treatment.
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Affiliation(s)
- F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, Sorbonne Université, 4, rue de la Chine, 75020 Paris, France.
| | - E Rivin Del Campo
- Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - A Orthuon
- Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - F Mornex
- Service de radiothérapie, centre hospitalier Lyon-Sud, hospices civils, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - I Bessières
- Département de physique médicale, centre Georges-François-Leclerc, 1, rue Professeur-Marion, 21000 Dijon, France
| | - V Guimas
- Service d'oncologie radiothérapie, institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - V Vendrely
- Service de radiothérapie, CHU de Bordeaux, 33604 Pessac cedex, France
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Abstract
Nasopharyngeal cancers are a rarity in France. Radiotherapy is the cornerstone of treatment, frequently combined with chemotherapy. The technical modality of radiotherapy is complex in this disease, which is located in the vicinity of numerous organs at risk. In this article, we will present the updated guidelines of the French society for radiation oncology (Société française de radiothérapie oncologique, SFRO) on the indications, and technical details of radiotherapy in nasopharyngeal cancers.
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Affiliation(s)
- P Blanchard
- Département de radiothérapie oncologique, Gustave-Roussy, université Paris Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Sorbonne Université, IUC, Paris, France
| | - S Racadot
- Centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex 08, France; Creatis, CNRS UMR5220, Inserm U1044, Insa-Lyon, université Lyon 1, 69621 Villeurbanne cedex, France
| | - C Berthold
- Département de radiothérapie oncologique, Gustave-Roussy, université Paris Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - S Wong-Hee-Kam
- Service d'oncologie radiothérapie, Assistance publique-hôpitaux de Marseille, 13000 Marseille, France
| | - M-C Biston
- Centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex 08, France; Creatis, CNRS UMR5220, Inserm U1044, Insa-Lyon, université Lyon 1, 69621 Villeurbanne cedex, France
| | - P Maingon
- Service d'oncologie radiothérapie, CHU Pitié-Salpêtrière, 75013 Paris, France
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Huguet F, Durand B, Atallah S, Prébet C, Richard S, Baujat B. Combination of radiation therapy-immunotherapy for head and neck cancers: Promises kept? Cancer Radiother 2021; 25:811-815. [PMID: 34711485 DOI: 10.1016/j.canrad.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 12/24/2022]
Abstract
Chemoradiotherapy with concurrent cisplatin has been the standard treatment for locally advanced head and neck squamous cell carcinoma (HNSCC) for over 20 years. Recently, immunotherapy, a new therapeutic class, has emerged for patients with recurrent or metastatic HNSCC and has significantly extended their survival. Will it bring the same benefit to patients with localized tumors? There is a strong rationale for combining radiation therapy and checkpoint inhibitors for HNSCC. Indeed, radiation therapy can have both immunostimulatory and immunomodulatory effects. This is what explains the famous abscopal effect. The aim of this review is to present the data available on the combination of radiation therapy and immunotherapy for HNSCC.
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Affiliation(s)
- F Huguet
- Service d'Oncologie Radiothérapie, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
| | - B Durand
- Service d'Oncologie Radiothérapie, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - S Atallah
- Service d'Oto-Rhino-Laryngologie Chirurgie cervico-faciale, France
| | - C Prébet
- Service d'Oncologie Médicale, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - S Richard
- Service d'Oncologie Médicale, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - B Baujat
- Service d'Oto-Rhino-Laryngologie Chirurgie cervico-faciale, France
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Roge M, Salleron J, Kirova Y, Guigo M, Huguet F, Nebbache R, Rivera S, Nunez Baez M, Lazarescu I, Servagi Vernat S, Cailleteau A, Supiot S, Thariat J, Thureau S. Étude Raibeca : radiotherapy for inflammatory breast cancer. Cancer Radiother 2021. [DOI: 10.1016/j.canrad.2021.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Evin C, Quéro L, Le Malicot K, Blanchet-Deverly S, François E, Buchalet C, Lemanski C, Baba Hamed N, Rivin Del Campo E, Bauwens L, Pommier P, Lièvre A, Tougeron D, Mace V, Sergent G, Diaz O, Zucman D, Mornex F, Locher C, de La Rochefordiere A, Vendrely V, Huguet F. Efficacité et toxicité de la (chimio)radiothérapie chez les patients séropositifs pour le VIH atteints d’un carcinome épidermoïde du canal anal, analyse en sous-groupe de la cohorte multicentrique Anabase. Cancer Radiother 2021. [DOI: 10.1016/j.canrad.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Leseur J, Créhange G, Pasquier D, Supiot S, Pommier P, Latorzeff I, Blanchard P, Mahé M, Sargos P, Colliaux J, Huguet F, Haaser T, Clavère P, Peiffert D, Lartigau É, Giraud P, Noël G, Simon JM, Hasbini A, Chauveinc L, Hennequin C, Lagrange J, de Crevoisier R. Évaluation du questionnement éthique en radiothérapie. Cancer Radiother 2021. [DOI: 10.1016/j.canrad.2021.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khalladi N, Dejean C, Bosset M, Pointreau Y, Kinj R, Racadot S, Castelli J, Huguet F, Renard S, Guihard S, Tao Y, Rouvier JM, Johnson A, Bourhis J, Xu Shan S, Thariat J. A priori quality assurance using a benchmark case of the randomized phase 2 GORTEC 2014-14 in oligometastatic head and neck cancer patients. Cancer Radiother 2021; 25:755-762. [PMID: 34565664 DOI: 10.1016/j.canrad.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE A Benchmark Case (BC) was performed as part of the quality assurance process of the randomized phase 2 GORTEC 2014-14 OMET study, testing the possibility of multisite stereotactic radiation therapy (SBRT) alone in oligometastatic head and neck squamous cell carcinoma (HNSCC) as an alternative to systemic treatment and SBRT. MATERIAL AND METHODS Compliance of the investigating centers with the prescription, delineation, planning and evaluation recommendations available in the research protocol was assessed. In addition, classical dosimetric analysis was supplemented by quantitative geometric analysis using conformation indices. RESULTS Twenty centers participated in the BC analysis. Among them, four major deviations (MaD) were reported in two centers. Two (10%) centers in MaD had omitted the satellite tumor nodule and secondarily validated after revision. Their respective DICE indexes were 0.37 and 0 and use of extracranial SBRT devices suboptimal There were significant residual heterogeneities between participating centers, including those with a similar SBRT equipment, with impact of plan quality using standard indicators and geometric indices. CONCLUSION A priori QA using a BC conditioning the participation of the clinical investigation centers showed deviations from good SBRT practice and led to the exclusion of one out of the twenty participating centers. The majority of centers have demonstrated rigorous compliance with the research protocol. The use of quality indexes adds a complementary approach to improve assessment of plan quality.
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Affiliation(s)
- N Khalladi
- Centre François Baclesse, 3, avenue General Harris, 14076 Caen, France
| | - C Dejean
- Centre Antoine Lacassagne, Nice, France
| | - M Bosset
- Centre Marie Curie, Valence, France
| | | | - R Kinj
- Centre Antoine Lacassagne, Nice, France
| | | | | | - F Huguet
- Centre hospitalier et universitaire Tenon, Paris, France
| | - S Renard
- Institut de Cancérologie de Lorraine, Nancy, France
| | - S Guihard
- Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Y Tao
- Institut Gustave Roussy, Villejuif, France
| | - J M Rouvier
- Centre hospitalier régional et universitaire, Besançon-Montbéliard, France
| | - A Johnson
- Centre François Baclesse, 3, avenue General Harris, 14076 Caen, France
| | - J Bourhis
- Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - S Xu Shan
- Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - J Thariat
- Centre François Baclesse, 3, avenue General Harris, 14076 Caen, France; Corpuscular Physics Laboratory-Normandy University, Caen, France.
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Abstract
At diagnosis, about 15% of patients with pancreatic cancer present with a resectable tumour, 50% have a metastatic tumour, and 35% a locally advanced tumour, non-metastatic but unresectable due to vascular invasion, or borderline resectable. Despite the technical progress made in the field of radiation therapy and the improvement of the efficacy of chemotherapy, the prognosis of these patients remains very poor. Recently, the role of radiation therapy in the management of pancreatic cancer has been much debated. This review aims to evaluate the role of radiation therapy for patients with locally advanced tumours.
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Affiliation(s)
- Florence Huguet
- Service d'Oncologie Radiothérapie, Hôpital Tenon, APHP.Sorbonne Université, Paris, France.,Institut Universitaire de Cancérologie, Sorbonne Université, Paris, France
| | - Victoire Dabout
- Service d'Oncologie Radiothérapie, Hôpital Tenon, APHP.Sorbonne Université, Paris, France
| | | | - Sébastien Gaujoux
- Institut Universitaire de Cancérologie, Sorbonne Université, Paris, France.,Service de Chirurgie digestive et hépato-bilio-pancréatique, Hôpital Pitié Salpêtrière, APHP.Sorbonne Université, Paris, France
| | - Jean Baptiste Bachet
- Institut Universitaire de Cancérologie, Sorbonne Université, Paris, France.,Service de Chirurgie digestive et hépato-bilio-pancréatique, Hôpital Pitié Salpêtrière, APHP.Sorbonne Université, Paris, France.,Service d'Hépato - Gastro - Entérologie, Hôpital Pitié Salpêtrière, APHP.Sorbonne Université, Paris, France
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Camprodon G, Huguet F. Unrecognized digestive toxicities of radiation therapy. Cancer Radiother 2021; 25:723-728. [PMID: 34391649 DOI: 10.1016/j.canrad.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 12/16/2022]
Abstract
The aim of this article is to review unrecognized toxicities resulting from radiation therapy of digestive neoplasms. Due to their precocious occurrence, acute toxicities are well-known by radiation oncologist, and their treatment well-established. Thus, acute toxicities will not be described in this review. We will focus on incidence, diagnosis, and management of late and uncommon toxicities occurring in the digestive tract and digestive organs. Prevention, by respecting healthy tissues constraints, is the main tool to reduce incidence of those rare complications. Nonetheless, once installed, late toxicities remain a major burden in terms of quality of life and can even be life threatening. Hence, information and education about their diagnosis and management is important.
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Affiliation(s)
- G Camprodon
- Service d'Oncologie Médicale, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif, France.
| | - F Huguet
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
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Haaser T, Constantinides Y, Huguet F, De Crevoisier R, Dejean C, Escande A, Ghannam Y, Lahmi L, Le Tallec P, Lecouillard I, Lorchel F, Thureau S, Lagrange JL. [Ethical stakes in palliative care in radiation oncology]. Cancer Radiother 2021; 25:699-706. [PMID: 34400087 DOI: 10.1016/j.canrad.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
In 2021, the Ethics Commission of the SFRO has chosen the issue of the practice of palliative care in radiotherapy oncology. Radiation oncology plays a central role in the care of patients with cancer in palliative phase. But behind the broad name of palliative radiotherapy, we actually find a large variety of situations involving diverse ethical issues. Radiation oncologists have the delicate task to take into account multiple factors throughout a complex decision-making process. While the question of the therapeutic indication and the technical choice allowing it to be implemented remains central, reflection cannot be limited to these decision-making and technical aspects alone. It is also a question of being able to create the conditions for a singularity focused care and to build an authentic care relationship, beyond technicity. It is through this daily ethical work, in close collaboration with patients, and under essential conditions of multidisciplinarity and multiprofessionalism, that our fundamental role as caregiver can be deployed.
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Affiliation(s)
- T Haaser
- Service d'Oncologie Radiothérapie, Hôpital Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, avenue Magellan, 33600 Pessac, France.
| | - Y Constantinides
- Espace Éthique Ile de France, Paris Université Sorbonne Nouvelle, Paris, France
| | - F Huguet
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Centre de Recherche Saint-Antoine UMR_S 938, Institut Universitaire de Cancérologie, AP-HP, Sorbonne Université, Paris, France
| | - R De Crevoisier
- Service d'Oncologie Radiothérapie, Centre Eugène Marquis, Rennes, France
| | - C Dejean
- Service d'Oncologie Radiothérapie, Unité de Physique Médicale, Centre Antoine Lacassagne, Nice, France
| | - A Escande
- Service universitaire d'Oncologie Radiothérapie, Centre Oscar Lambret, Faculté de médecine Henri Warembourg, Laboratoire CRIStAL, UMR9189, Université de Lille, Lille, France
| | - Y Ghannam
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Centre de Recherche Saint-Antoine UMR_S 938, Institut Universitaire de Cancérologie, AP-HP, Sorbonne Université, Paris, France
| | - L Lahmi
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Centre de Recherche Saint-Antoine UMR_S 938, Institut Universitaire de Cancérologie, AP-HP, Sorbonne Université, Paris, France
| | - P Le Tallec
- Service d'Oncologie Radiothérapie, Quantis Litis EA 4108, Centre Henri Becquerel, Rouen, France
| | - I Lecouillard
- Service d'Oncologie Radiothérapie, Centre Eugène Marquis, Rennes, France
| | - F Lorchel
- Service d'Oncologie Radiothérapie, Centre Hospitalier Universitaire Lyon-Sud, Lyon, France; Centre d'Oncologie Radiothérapie et Oncologie de Mâcon - ORLAM, Mâcon, France
| | - S Thureau
- Service d'Oncologie Radiothérapie, Quantis Litis EA 4108, Centre Henri Becquerel, Rouen, France
| | - J L Lagrange
- Université Paris-Est Créteil Val de Marne, Paris, France
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Briens A, Neuzillet C, Huguet F, Rivin Del Campo E, Guimas V, Fallet E, Garcia Molina S, François E, Montagne L, Schick U, Lesueur P, Siphroudis L, Edeline J, Castelli J, de Crevoisier R, Lièvre A, Gnep K. PO-1263 Exclusive radiotherapy in early stage anal cancer - outcomes, patterns and predictors of relapse. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07714-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Giraud P, Racadot S, Vernerey D, Goldstein D, Glimelius B, Van Houtte P, Gubanski M, Spry N, Van Laethem JL, Hammel P, Huguet F. Investigation of Relation of Radiation Therapy Quality With Toxicity and Survival in LAP07 Phase 3 Trial for Locally Advanced Pancreatic Carcinoma. Int J Radiat Oncol Biol Phys 2021; 110:993-1002. [PMID: 33561507 DOI: 10.1016/j.ijrobp.2021.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/22/2021] [Accepted: 01/30/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE The LAP07 multicenter randomized study assessed whether chemoradiation therapy increases overall survival versus continuation chemotherapy in patients whose locally advanced pancreatic cancer was controlled after 4 months of induction chemotherapy. This analysis investigated whether failure to adhere to radiation therapy (RT) guidelines influenced survival and toxicity. METHODS AND MATERIALS This is a planned analysis of secondary objectives in the framework of a randomized international phase 3 trial. The protocol included detailed written RT guidelines. All participating institutions undertook an initial benchmark case to check adherence to protocol guidelines. Centers with major deviation were not allowed to include patients until they achieved a significant improvement and rigorously followed the guidelines. On-trial RT quality assurance consisted of a central review of treatment plan with dose-volume histograms for each patient. Adherence to guidelines was graded as per protocol (PP), minor deviation (MiD), or major deviation (MaD). RESULTS Fifty-seven benchmark cases were evaluated, 26% were classified as PP, 60% were MiD, and 14% were MaD. Among the 442 included patients, 133 patients were randomized in the chemoradiation therapy arm, and 117 patients were assessable for RT quality analysis. RT quality was graded as PP in 38.5% of patients, MiD in 43.6% of patients, and MaD in 17.9% of patients. The most frequent protocol violations were dose distribution heterogeneities. Median overall survival was 17 months with PP and MiD versus 13.4 months with MaD (hazard ratio [HR], 1.63; 95% confidence interval [CI], 0.99-2.71; P = .055). There was no difference in terms of progression-free survival (HR, 1.09; 95% CI, 0.66-1.8; P = .72). Patients with MaD had more nausea than patients treated PP or with MiD (P = .0045). CONCLUSIONS MaD was associated with a trend for worst survival. There was no difference in terms of progression-free survival. Because of the low rate of major deviations, their effects on the LAP07 trial results may be negligeable.
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Affiliation(s)
- Paul Giraud
- Department of Radiation Oncology, Tenon Hospital, Institut Universitaire du Cancer, AP-HP, Sorbonne Université, Paris, France
| | - Séverine Racadot
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Dewi Vernerey
- Methodology and Quality of Life in Oncology Unit (EA 3181) and Quality of Life and Cancer Clinical Research Platform, CHU de Besançon, Besançon, France
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Paul Van Houtte
- Department of Radiation Oncology, Institut Jules-Bordet, Brussels, Belgium
| | - Michael Gubanski
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Nigel Spry
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Jean Luc Van Laethem
- Department of Gastroenterology and Gastrointestinal cancer Unit, Erasme Hospital, Université Libre Bruxelles, Brussels, Belgium
| | - Pascal Hammel
- Service de Gastroentérologie-Pancréatologie, Beaujon Hospital, AP-HP, Clichy, France
| | - Florence Huguet
- Department of Radiation Oncology, Tenon Hospital, Institut Universitaire du Cancer, AP-HP, Sorbonne Université, Paris, France.
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Schernberg A, Vernerey D, Goldstein D, Van Laethem JL, Glimelius B, van Houtte P, Bonnetain F, Louvet C, Hammel P, Huguet F. Predictive Value of Neutrophils Count for Local Tumor Control After Chemoradiotherapy in Patients With Locally Advanced Pancreatic Carcinoma. Int J Radiat Oncol Biol Phys 2021; 110:1022-1031. [PMID: 33548338 DOI: 10.1016/j.ijrobp.2021.01.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Baseline neutrophil count may predict overall survival (OS) in patients with locally advanced pancreatic cancer (LAPC). METHODS AND MATERIALS The international multicenter randomized LAP07 phase 3 trial has enrolled 442 patients with LAPC. We analyzed the prognostic value of both baseline neutrophilia (neutrophil count >7 g/L) and elevated or increasing neutrophil count as (1) neutrophilia or (2) increased absolute neutrophil count after induction chemotherapy versus baseline for OS, progression-free survival, and local control (LC). A Cox proportional hazard model was used to assess elevated or increasing neutrophil count status by randomly assigned treatment interactions for each endpoint. RESULTS Among the 442 patients, 47 patients (11%) with baseline neutrophilia had worse OS (median 8.9 vs 13.3 months; P = .01). After induction chemotherapy, among the 235 patients whose blood counts were available, 90 patients (38%) had elevated or increasing neutrophil count associated with poorer OS in univariate (median 14.4 vs 17.9 months; P = .001) and multivariate analysis (P = .004). Elevated or increasing neutrophil count was also predictive of a decreased benefit of chemoradiation therapy on LC. In 126 patients without elevated or increasing neutrophil count, 1-year LC was 80% in the chemoradiation arm versus 54% in the chemotherapy arm (P < .001; interaction test P = .015). CONCLUSIONS In this study, baseline neutrophilia and increased absolute neutrophil count were associated with worse OS in this large series of patients with LAPC. In addition, the counts were an independent prognosis factor and a strong predictive LC biomarker for chemoradiation therapy benefit. An assessment of neutrophils counts can help to improve the selection of patients who might benefit from chemoradiation therapy after induction chemotherapy.
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Affiliation(s)
| | - Dewi Vernerey
- Methodological and Quality of Life in Oncology Unit, INSERM UMR 1098, University Hospital of Besancon, France
| | - David Goldstein
- Kinghorn Cancer Centre and Garvan Institute of Medical Research, Darlinghurst, Sydney, Australia
| | | | - Bengt Glimelius
- Department of Oncology, University of Uppsala, Akademiska Sjukhuset, Sweden
| | | | - Franck Bonnetain
- Methodological and Quality of Life in Oncology Unit, INSERM UMR 1098, University Hospital of Besancon, France; Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France
| | - Christophe Louvet
- Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France; Département d'Oncologie Médicale, Institut Mutualiste Montsouris, Paris, France
| | - Pascal Hammel
- Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France; Service d'Oncologie Digestive, Hôpital Beaujon, Clichy, France
| | - Florence Huguet
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Paris, France; Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France
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Leleu T, Bastit V, Doré M, Kammerer E, Florescu C, Alfonsi M, Troussier I, Bensadoun RJ, Biau J, Blais E, Coutte A, Deberne M, Wiazzane N, Dupin C, Faivre JC, Giraud P, Graff P, Guihard S, Huguet F, Janoray G, Liem X, Pointreau Y, Racadot S, Schick U, Servagi-Vernat S, Sun XS, Thureau S, Villa J, Vulquin N, Wong S, Patron V, Thariat J. Histosurgical mapping of endoscopic endonasal surgery of sinonasal tumours to improve radiotherapy guidance. Cancer Radiother 2021; 26:440-444. [PMID: 34175228 DOI: 10.1016/j.canrad.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/21/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Endoscopic endonasal surgery (EES) is becoming a standard for most malignant sinonasal tumours. Margin analysis after piecemeal resection is complex and optimally relies on accurate histosurgical mapping. Postoperative radiotherapy may be adapted based on margin assessment mapping to reduce the dose to some sinonasal subvolumes. We assessed the use of histosurgical mapping by radiation oncologists (RO). MATERIAL AND METHODS A French practice survey was performed across 29 ENT expert RO (2 did not answer) regarding integration of information on EES, as well as quality of operative and pathology reportsto refine radiotherapy planning after EES. This was assessed through an electronic questionnaire. RESULTS EES was ubiquitously performed in France. Operative and pathology reports yielded accurate description of EES samples according to 66.7% of interviewed RO. Accuracy of margin assessment was however insufficient according to more than 40.0% of RO. Additional margins/biopsies of the operative bed were available in 55.2% (16/29) of the centres. In the absence of additional margins, quality of resection after EES was considered as microscopically incomplete in 48.3% or dubious in 48.3% of RO. As performed, histosurgical mapping allowed radiotherapy dose and volumes adaptation according to 26.3% of RO only. CONCLUSIONS Standardized histosurgical mapping with margin and additional margin analysis could be more systematic. Advantages of accurate EES reporting could be dose painting radiotherapy to further decrease morbidity in sinonasal tumours.
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Affiliation(s)
- T Leleu
- Department of radiation oncology, centre François-Baclesse, Caen, France
| | - V Bastit
- Department of surgery, centre François-Baclesse, Caen, France
| | | | - E Kammerer
- Department of radiation oncology, centre François-Baclesse, Caen, France
| | - C Florescu
- Department of radiation oncology, centre François-Baclesse, Caen, France
| | | | | | | | - J Biau
- CJP, Clermont-Ferrand, France
| | - E Blais
- AP-HP, Pitié-Salpêtrière, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - X S Sun
- CHU, Besançon Montbéliard, France
| | | | | | | | | | - V Patron
- Department of ENT surgery, CHU Caen, Caen, France
| | - J Thariat
- Department of radiation oncology, centre François-Baclesse, Caen, France; Unicaen, Normandie Université, Caen, France; GORTEC, France.
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Meillan N, Orthuon A, Chauchat P, Atlani D, Bouche O, Chaulin B, David C, Deberne M, Debrigode C, Kao W, Keller A, Laharie H, Lamezec B, Lemanski C, Magné N, Mahé MA, Mere P, Moureau-Zabotto L, Peiffert D, Pointreau Y, Quéro L, Racadot S, Roca S, Sargos P, Servagi S, Tang E, Vendrely V, Doyen J, Huguet F. Locoregional relapses in the ACCORD 12/0405-PRODIGE 02 study: Dosimetric study and risk factors. Radiother Oncol 2021; 161:198-204. [PMID: 34144078 DOI: 10.1016/j.radonc.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/21/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study is to correlate locoregional relapse with radiation therapy volumes in patients with rectal cancer treated with neoadjuvant chemoradiation in the ACCORD 12/0405-PRODIGE 02 trial. PATIENTS AND METHODS We identified patients who had a locoregional relapse included in ACCORD 12's database. We studied their clinical, radiological, and dosimetric data to analyze the dose received by the area of relapse. RESULTS 39 patients (6.5%) presented 54 locoregional relapses. Most of the relapses were in-field (n = 21, 39%) or marginal (n = 13, 24%) with only six out-of-field (11%), 14 could not be evaluated. Most of them happened in the anastomosis, the perirectal space, and the usual lymphatic drainage areas (presacral and posterior lateral lymph nodes). Only patients treated for a lower rectum adenocarcinoma had a relapse outside of the treated volume. 2 patients with T4 tumors extending into anterior pelvic organs had relapses in anterior lateral and external iliac lymph nodes. CONCLUSIONS Lowering the upper limit of the treatment field for low rectal tumors increased the risk of out of the field recurrence. For very low tumors, including the inguinal lymph nodes in the treated volume should be considered. Recording locoregional involvement, treated volumes, and relapse areas in future prospective trials would be of paramount interest to refine delineation guidelines.
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Affiliation(s)
- Nicolas Meillan
- APHP, Pitié-Salpêtrière Hospital, Department of Radiation Oncology, Paris, France; Sorbonne Université, AP-HP, Pitié Salpêtrière Hospital, Department of Radiation Oncology, Paris, France.
| | | | - Paul Chauchat
- APHP, Pitié Salpêtrière Hospital, Department of Medical Physics, Paris, France
| | - David Atlani
- Department of Radiation Oncology, Civil Colmar Hospital, Colmar, France
| | - Olivier Bouche
- Department of Gastroenterology, Reims University Hospital, France
| | - Bertrand Chaulin
- Department of Radiation Oncology, Bordeaux Nord Aquitaine Polyclinic, France
| | - Céline David
- Department of Medical Physics, Mulhouse and South Alsace Hospital, France
| | - Mélanie Deberne
- Department of Radiation Oncology, South Lyon Hospital, France
| | | | - William Kao
- Department of Radiation Oncology, François Baclesse Cancer Center, Caen, France
| | - Audrey Keller
- Department of Radiation Oncology, ICANS, Strasbourg, France
| | - Hortense Laharie
- Department of Radiation Oncology, Tivoli Ducos Clinic, Bordeaux, France
| | - Bruno Lamezec
- Department of Radiation Oncology, Armorican Radiation Therapy, Radiology and Oncology Center, Plérin, France
| | - Claire Lemanski
- Department of Radiation Oncology, Montpellier-Val d'Aurelles Cancer Institute, France
| | - Nicolas Magné
- Department of Radiation Oncology, Loire Cancer Institute Saint-Priest-en-Jarez France
| | - Marc-André Mahé
- Department of Radiation Oncology, Western Cancer Institute, Nantes, France
| | - Pascale Mere
- Department of Radiation Oncology, Jean Mermoz Private Hospital, Lyon, France
| | | | - Didier Peiffert
- Department of Radiation Oncology, Lorraine Cancer Institute, Nancy, France
| | - Yoann Pointreau
- Department of Radiation Oncology, Inter-régionaL Cancer Institute (ILC) - Jean Bernard Center-Victor Hugo Clinic, Le Mans, France
| | - Laurent Quéro
- Department of Radiation Oncology, Saint-Louis Hospital, APHP, Paris, France
| | - Séverine Racadot
- Department of Radiation Oncology, Léon Bérard Center, Lyon, France
| | - Sophie Roca
- Department of Medical Oncology, Sainte-Anne Clinic, Langon, France
| | - Paul Sargos
- Department of Radiation Oncology, Bergonié Institute, Bordeaux, France
| | - Stéphanie Servagi
- Department of Radiation Oncology, Jean Godinot Institute, Reims, France
| | - Eliane Tang
- Hôpitaux Universitaires Henri Mondor, APHP, Henri Mondor Hospital, Department of Radiation Oncology, Paris, France
| | - Véronique Vendrely
- Department of Radiation Oncology, Bordeaux University Hospital, France; INSERM 1035, University of Bordeaux, France
| | - Jérôme Doyen
- Department of Radiation Oncology, Antoine Lacassagne Center, Nice, France
| | - Florence Huguet
- Sorbonne Université, AP-HP, Pitié Salpêtrière Hospital, Department of Radiation Oncology, Paris, France; UMR_S 938, Centre de Recherche de Saint Antoine, Paris, France; APHP, Tenon Hospital, Department of Radiation Oncology, Paris, France
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Tougeron D, Hentzien M, Seitz-Polski B, Bani-Sadr F, Bourhis J, Ducreux M, Gaujoux S, Gorphe P, Guiu B, Hoang-Xuan K, Huguet F, Lecomte T, Lièvre A, Louvet C, Maggiori L, Mansi L, Mariani P, Michel P, Servettaz A, Thariat J, Westeel V, Aparicio T, Blay JY, Bouché O. Severe acute respiratory syndrome coronavirus 2 vaccination for patients with solid cancer: Review and point of view of a French oncology intergroup (GCO, TNCD, UNICANCER). Eur J Cancer 2021; 150:232-239. [PMID: 33934060 PMCID: PMC8015403 DOI: 10.1016/j.ejca.2021.03.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/14/2021] [Indexed: 02/07/2023]
Abstract
The impacts of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on cancer care are multiple, entailing a high risk of death from coronavirus disease 2019 (COVID-19) in patients with cancer treated by chemotherapy. SARS-CoV-2 vaccines represent an opportunity to decrease the rate of severe COVID-19 cases in patients with cancer and also to restore normal cancer care. Patients with cancer to be targeted for vaccination are difficult to define owing to the limited contribution of these patients in the phase III trials testing the different vaccines. It seems appropriate to vaccinate not only patients with cancer with ongoing treatment or with a treatment having been completed less than 3 years ago but also household and close contacts. High-risk patients with cancer who are candidates for priority access to vaccination are those treated by chemotherapy. The very high-priority population includes patients with curative treatment and palliative first- or second-line chemotherapy, as well as patients requiring surgery or radiotherapy involving a large volume of lung, lymph node and/or haematopoietic tissue. When possible, vaccination should be carried out before cancer treatment begins. SARS-CoV-2 vaccination can be performed during chemotherapy while avoiding periods of neutropenia and lymphopenia. For organisational reasons, vaccination should be performed in cancer care centres with messenger RNA vaccines (or non-replicating adenoviral vaccines in non-immunocompromised patients). Considering the current state of knowledge, the benefit-risk ratio strongly favours SARS-CoV-2 vaccination of all patients with cancer. To obtain more data concerning the safety and effectiveness of vaccines, it is necessary to implement cohorts of vaccinated patients with cancer.
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Affiliation(s)
- David Tougeron
- Hepatology and Gastroenterology Department, Poitiers University Hospital and University of Poitiers, FFCD, Poitiers, France.
| | - Maxime Hentzien
- Internal Medicine and Infectious Diseases Department, Reims University Hospital, Reims, France
| | | | - Firouze Bani-Sadr
- Internal Medicine and Infectious Diseases Department, Reims University Hospital, Reims, France
| | - Jean Bourhis
- Radiotherapy Department, Vaud University Hospital, GORTEC/Intergroupe ORL, Lausanne, Switzerland
| | - Michel Ducreux
- Digestive Oncology Department, Gustave Roussy Institute, Paris-Saclay University, UNICANCER, Villejuif, France
| | - Sébastien Gaujoux
- Digestive Surgery Department, Pitié-Salpêtrière Hospital, AP-HP, ACHBT, Paris, France
| | - Philippe Gorphe
- Cervico-Facial Department, Gustave Roussy Institute, Paris-Saclay University, Intergroupe ORL, Villejuif, France
| | - Boris Guiu
- Radiology Department, Montpellier University Hospital, SFR, Montpellier, France
| | - Khê Hoang-Xuan
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris-Sorbonne Université, IGCNO-ANOCEF, Paris, France
| | - Florence Huguet
- Radiotherapy Department, Tenon Hospital, Sorbonne Université, APHP, Institut Universitaire de Cancérologie, SFRO, Paris, France
| | - Thierry Lecomte
- Hepatology, Gastroenterology and Digestive Oncology Department, Tours University Hospital and UMR INSERM 1069 N2C, Tours University, SFED, Tours, France
| | - Astrid Lièvre
- Gastroenterology Department, Pontchaillou University Hospital, INSERM UMR 1242, COSS "Chemistry, Oncogenesis, Stress Signaling", Rennes, SNFGE, France
| | - Christophe Louvet
- Medical Oncology Department, Institut Mutualiste Montsouris, GERCOR, Paris, France
| | - Léon Maggiori
- Digestive Surgery Department, Saint Louis Hospital, APHP, SNFCP, Paris, France
| | - Laura Mansi
- INSERM, EFS BFC, UMR1098, RIGHT, University of Bourgogne Franche-Comté, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Department of Medical Oncology, University Hospital of Besançon, GINECO, Besançon, France
| | - Pascale Mariani
- Oncology Digestive Surgery Department, Curie Institute, SFCD, Paris, France
| | - Pierre Michel
- Hepatology and Gastroenterology Department, Rouen University Hospital, Normandie University, UNIROUEN, Inserm U1245, IRON Group, FFCD, Rouen, France
| | - Amélie Servettaz
- Internal Medicine and Infectious Diseases Department, Reims University Hospital, Reims, France
| | - Juliette Thariat
- Radiotherapy Department, François Baclesse Center, Normandie Université, GORTEC/Intergroupe ORL, Caen, France
| | - Virgine Westeel
- Pneumology Department, Jean Minjoz Hospital, CHU Besançon, INSERM UMR 1098, Franche-Comté University, IFCT, Besançon, France
| | - Thomas Aparicio
- Gastroenterology and Digestive Oncology Department, Saint Louis Hospital, APHP, Université de Paris, GCO, Paris, France
| | - Jean-Yves Blay
- Medical Oncology Department, Léon Bérard Center, UNICANCER, Lyon, France
| | - Olivier Bouché
- Digestive Oncology Department, CHU Reims University Hospital, TNCD, Reims, France
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Chevalier T, Daste A, Saada‐Bouzid E, Loundou A, Peyraud F, Lambert T, Le Tourneau C, Peyrade F, Dupuis C, Alfonsi M, Fayette J, Reure J, Huguet F, Fakhry N, Toullec C, Salas S. Cetuximab combined with paclitaxel or paclitaxel alone for patients with recurrent or metastatic head and neck squamous cell carcinoma progressing after EXTREME. Cancer Med 2021; 10:3952-3963. [PMID: 34080776 PMCID: PMC8209557 DOI: 10.1002/cam4.3953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 03/22/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Prognosis of recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) remains poor. The addition of cetuximab, to platinum and fluorouracil chemotherapy (EXTREME regimen) has been shown to improve patients' outcomes in first-line settings. METHODS We conducted a retrospective, multicenter study, including HNSCC that progressed after a first line of platinum-based chemotherapy and cetuximab, treated either by paclitaxel + cetuximab (PC) or paclitaxel alone (P), between January 2010 and April 2018. The end points were overall survival (OS), progression-free survival (PFS), and overall response rates (ORR). Patients were matched according to their propensity scores, estimated with a logistic regression model. The secondary objectives were to study the safety profile and to look for prognostic and predictive factors of effectiveness. RESULTS Of the 340 identified patients, 262 were included in the analysis, 165 received PC, and 97 received P. In unmatched population, ORR was 16.4% with PC and 6.2% for P. Median PFS was 2.9 months [95% Confidence Interval 2.7-3.0] for PC versus 2.5 months [2.2-2.7] for P, hazard ratio (HR) = 0.770 [0.596-0.996]. Median OS was 5.5 months [4.4-6.9] for PC versus 4.2 months [3.4-4.8] for P, HR = 0.774 [0.590-1.015]. In multivariate analysis, PC was associated with better PFS and OS. These results were consistent in matched-paired population. Previous cetuximab maintenance for more than 3 months was predictive of better OS with PC. CONCLUSION Although the continuation of cetuximab in combination with paclitaxel after EXTREME provides moderate benefit, it could be an interesting option for selected patients.
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Affiliation(s)
| | - Amaury Daste
- Department of Medical OncologyHôpital Saint‐AndréBordeaux University Hospital‐CHUBordeauxFrance
| | | | - Anderson Loundou
- EA3279Self‐Perceived Health Assessment Research UnitAix‐Marseille UniversityMarseilleFrance
| | - Florent Peyraud
- Department of Medical OncologyHôpital Saint‐AndréBordeaux University Hospital‐CHUBordeauxFrance
| | - Tiphaine Lambert
- Department of Drug Development and Innovation (D3i)Paris‐Saclay UniversityInstitut CurieParis & Saint‐CloudFrance
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i)Paris‐Saclay UniversityInstitut CurieParis & Saint‐CloudFrance
| | - Frédéric Peyrade
- Department of Medical OncologyCentre Antoine LacassagneNiceFrance
| | | | - Marc Alfonsi
- Department of Radiation OncologyClinique Sainte CatherineAvignonFrance
| | - Jérôme Fayette
- Department of Medical OncologyLéon Bérard CenterUniversity of LyonLyonFrance
| | - Juliette Reure
- Department of Medical OncologyLéon Bérard CenterUniversity of LyonLyonFrance
| | - Florence Huguet
- Department of Radiation OncologyTenon HospitalParis Sorbonne Université, Assistance Publique‐Hôpitaux de ParisParisFrance
| | - Nicolas Fakhry
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryAP‐HMAix‐Marseille UniversityFrance
| | - Clémence Toullec
- Department of Medical OncologyClinique Sainte CatherineAvignonFrance
| | - Sébastien Salas
- Department of Medical OncologyCHU la TimoneAP‐HMMarseilleFrance
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Carsuzaa F, Lapeyre M, Gregoire V, Maingon P, Beddok A, Marcy PY, Salleron J, Coutte A, Racadot S, Pointreau Y, Graff P, Beadle B, Benezery K, Biau J, Calugaru V, Castelli J, Chua M, Di Rito A, Dore M, Ghadjar P, Huguet F, Jardel P, Johansen J, Kimple R, Krengli M, Laskar S, Mcdowell L, Nichols A, Tribius S, Valduvieco I, Hu C, Liem X, Moya-Plana A, D'onofrio I, Parvathaneni U, Takiar V, Orlandi E, Psyrri A, Shenouda G, Sher D, Steuer C, Shan Sun X, Tao Y, Thomson D, Tsai MH, Vulquin N, Gorphe P, Mehanna H, Yom SS, Bourhis J, Thariat J. Recommendations for postoperative radiotherapy in head & neck squamous cell carcinoma in the presence of flaps: A GORTEC internationally-reviewed HNCIG-endorsed consensus. Radiother Oncol 2021; 160:140-147. [PMID: 33984351 DOI: 10.1016/j.radonc.2021.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Head and neck reconstructive surgery using a flap is increasingly common. Best practices and outcomes for postoperative radiotherapy (poRT) with flaps have not been specified. We aimed to provide consensus recommendations to assist clinical decision-making highlighting areas of uncertainty in the presence of flaps. MATERIAL AND METHODS Radiation, medical, and surgical oncologists were assembled from GORTEC and internationally with the Head and Neck Cancer International Group (HNCIG). The consensus-building approach covered 59 topics across four domains: (1) identification of postoperative tissue changes on imaging for flap delineation, (2) understanding of tumor relapse risks and target volume definitions, (3) functional radiation-induced deterioration, (4) feasibility of flap avoidance. RESULTS Across the 4 domains, international consensus (median score ≥ 7/9) was achieved only for functional deterioration (73.3%); other consensus rates were 55.6% for poRT avoidance of flap structures, 41.2% for flap definition and 11.1% for tumor spread patterns. Radiation-induced flap fibrosis or atrophy and their functional impact was well recognized while flap necrosis was not, suggesting dose-volume adaptation for the former. Flap avoidance was recommended to minimize bone flap osteoradionecrosis but not soft-tissue toxicity. The need for identification (CT planning, fiducials, accurate operative report) and targeting of the junction area at risk between native tissues and flap was well recognized. Experts variably considered flaps as prone to tumor dissemination or not. Discrepancies in rating of 11 items among international reviewing participants are shown. CONCLUSION International GORTEC and HNCIG-endorsed recommendations were generated for the management of flaps in head and neck radiotherapy. Considerable knowledge gaps hinder further consensus, in particular with respect to tumor spread patterns.
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Affiliation(s)
| | - Michel Lapeyre
- Department of Radiation Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | - Vincent Gregoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Philippe Maingon
- Department of Radiation Oncology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Arnaud Beddok
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Pierre-Yves Marcy
- Department of Radiology, Clinique du Cap d'Or, La Seyne-sur-mer, France
| | - Julia Salleron
- Department of Biostatistics, Institut de cancérologie de Lorraine, France
| | - Alexandre Coutte
- Department of Radiation Oncology, Amiens Picardie University Medical Center, Amiens, France
| | - Severine Racadot
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Yoann Pointreau
- Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France
| | - Pierre Graff
- Department or Radiation Oncology, Institut C. Regaud, Toulouse, France
| | - Beth Beadle
- Department of Radiation Oncology, Stanford University Medical Center, Stanford University Medical Center, USA
| | - Karen Benezery
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France
| | - Julian Biau
- Department of Radiation Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | | | - Joel Castelli
- Department of Radiation Oncology, Centre Eugène Marquis, Rennes, France
| | - Melvin Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore
| | - Alessia Di Rito
- Department of Radiation Oncology, OC Radioterapia Ospedale "Mons. A.R. Dimiccoli" di Barletta, Rome, Italy
| | - Melanie Dore
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest, St Herblain, France
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité, Berlin, Germany
| | - Florence Huguet
- Department of Radiation Oncology, Hospital de Tenon, Paris, France
| | - Pauline Jardel
- Department of Radiation Oncology, CHU de la Milétrie, Poitiers, France
| | - Jorgen Johansen
- Department of Radiation Oncology, Odense University Hospital, Denmark
| | - Randall Kimple
- Department of Medical Oncology, University of Wisconsin-Madison, WI, USA
| | - Marco Krengli
- Department of Translational Medicine University of Piemonte Orientale, Novara, Italy
| | | | - Lachlan Mcdowell
- Department of Radiation Oncology, Peter McCallum Cancer Center, Melbourne, Australia
| | - Anthony Nichols
- Department of Head and Neck surgery, London Health Sciences Center, Ontario, Canada
| | - Silke Tribius
- Department of Radiation Oncology, Hermann-Holthusen-Institute for Radiation Oncology, Asklepios Hospital St. Georg, Hamburg, Germany
| | | | - Chaosu Hu
- Department of Radiation Oncology, Fundan University, Shanghai, China
| | - Xavier Liem
- Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | | | - Ida D'onofrio
- Department of Radiation Oncology, Hospital Naples, Italy
| | | | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinaty, USA
| | - Ester Orlandi
- Department of Radiation Oncology, CNAO, Milan, Italy
| | - Amanda Psyrri
- Department of Medical Oncology, Attikon University Hospital, Athens, Greece
| | - George Shenouda
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Canada
| | - David Sher
- Department of Radiation Oncology, UT Southwestern, Dallas, USA
| | - Conor Steuer
- Department of Head and Neck Surgery, Winship Cancer Institute, Atlanta, USA
| | - Xu Shan Sun
- Department of Radiation Oncology, University hospital CHBM, Montbéliard, France
| | - Yungan Tao
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - David Thomson
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mu-Hung Tsai
- Department of Radiation Oncology, National Cheng Kung University Hospital, Tïnan, Taiwan
| | - Noemie Vulquin
- Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France
| | - Philippe Gorphe
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - Hisham Mehanna
- Department of Radiation Oncology, Institute for Global Innovation, Birmingham, UK
| | - Sue S Yom
- Department of Radiation Oncology, NRG Oncology Cancer Research Group, USA
| | - Jean Bourhis
- Department of Radiation Oncology, UNIL-CHUV, Lausanne, Switzerland
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François-Baclesse, Laboratoire de physique corpusculaire IN2P3/ENSICAEN - UMR6534. Normandie University, Caen, and GORTEC, France.
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48
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Tougeron D, Seitz-Polski B, Hentzien M, Bani-Sadr F, Bourhis J, Ducreux M, Gaujoux S, Gorphe P, Guiu B, Hardy-Bessard AC, Hoang Xuan K, Huguet F, Lecomte T, Lièvre A, Louvet C, Maggiori L, Mariani P, Michel P, Servettaz A, Thariat J, Westeel V, Aparicio T, Blay JY, Bouché O. [Vaccination against COVID-19 in patients with solid cancer: Review and point of view from a French oncology inter-group (CGO, TNCD, UNICANCER)]. Bull Cancer 2021; 108:614-626. [PMID: 33902918 PMCID: PMC8041180 DOI: 10.1016/j.bulcan.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/20/2022]
Abstract
The COVID-19 pandemic has a major impact at all stages of cancer treatment. Risk of death from COVID-19 in patients treated for a cancer is high. COVID-19 vaccines represent a major issue to decrease the rate of severe forms of the COVID-19 cases and to maintain a normal cancer care. It is difficult to define the target population for vaccination due to the limited data available and the lack of vaccine doses available. It appears theoretically important to vaccinate patients with active cancer treatment or treated since less than three years, as well as their family circle. In France, patients actually defined at "high risk" for priority access to vaccination are those with a cancer treated by chemotherapy. A panel of experts recently defined another "very high-priority" population, which includes patients with curative or palliative first or second-line chemotherapy, as well as patients requiring surgery or radiotherapy involving a large lung volume, lymph nodes and/or of hematopoietic tissue. Ideally, it is best to vaccinate before cancer treatment. Despite the lack of published data, COVID-19 vaccines can also be performed during chemotherapy by avoiding periods of bone marrow aplasia and if possible, to do it in cancer care centers. It is necessary to implement cohorts with immunological and clinical monitoring of vaccinated cancer patients. To conclude, considering the current state of knowledge, the benefit-risk ratio strongly favours COVID-19 vaccination of all cancer patients.
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Affiliation(s)
- David Tougeron
- CHU de Poitiers, université de Poitiers, Service d'Hépato-gastro-entérologie, FFCD, 2, rue de la Milétrie, 86021 Poitiers, France.
| | | | - Maxime Hentzien
- CHU de Reims, service de médecine interne, maladies infectieuses et immunologie clinique, rue du Général-Koenig, 51100 Reims, France
| | - Firouze Bani-Sadr
- CHU de Reims, service de médecine interne, maladies infectieuses et immunologie clinique, rue du Général-Koenig, 51100 Reims, France
| | - Jean Bourhis
- CHU Vaud, Lausanne, service de radiothérapie, GORTEC/Intergroupe ORL, rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Michel Ducreux
- Université Paris-Saclay, service d'oncologie digestive, Gustave-Roussy, Villejuif, UNICANCER, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Sébastien Gaujoux
- AP-HP, hôpital Pitié-Salpêtrière, service de chirurgie digestive, Paris, ACHBT, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Philippe Gorphe
- Université Paris-Saclay, service de cancérologie cervico-faciale, Gustave Roussy, Villejuif, Intergroupe ORL, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Boris Guiu
- CHU de Montpellier, Montpellier, service de radiologie, SFR, 191, avenue du Doyen-Giraud, 34295 Montpellier cedex 5, France
| | - Anne Claire Hardy-Bessard
- Centre armoricain d'oncologie, CARIO-HPCA, Plérin, ARCAGY-GINECO, 10, rue François-Jacob, 22190 Plérin, France
| | - Khê Hoang Xuan
- AP-HP, hôpital Pitié-Salpêtrière, Paris, département de neurologie, IGCNO-ANOCEF, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Florence Huguet
- AP-HP, institut universitaire de cancérologie, Paris, hôpital Tenon, Sorbonne université, service d'oncologie radiothérapie, SFRO, 4, rue de la Chine, 75020 Paris, France
| | - Thierry Lecomte
- CHU de Tours et UMR Inserm 1069 N2C, université de Tours, Tours, service d'hépato-gastro-entérologie et cancérologie digestive, SFED, 2, boulevard Tonnellé, 37000 Tours, France
| | - Astrid Lièvre
- CHU Pontchaillou, service des maladies de l'appareil digestif, Inserm UMR 1242, COSS « Chemistry, Oncogenesis, Stress Signaling », Rennes, SNFGE, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - Christophe Louvet
- Institut mutualiste Montsouris, Paris, département d'oncologie médicale, GERCOR, 42, boulevard Jourdan, 75014 Paris, France
| | - Léon Maggiori
- AP-HP, Paris, hôpital Saint-Louis, service de chirurgie digestive, SNFCP, 1, Avenue Claude-Vellefaux, 75010 Paris, France
| | - Pascale Mariani
- Institut Curie, Paris, service de chirurgie digestive oncologique, SFCD, 26, rue d'Ulm, 75005 Paris, France
| | - Pierre Michel
- CHU de Rouen, Normandie université, UNIROUEN, service d'hépato-gastro-entérologie, Inserm U1245, IRON group, Rouen, FFCD, 37, boulevard Gambetta, 76000 Rouen, France
| | - Amélie Servettaz
- CHU de Reims, service de médecine interne, maladies infectieuses et immunologie clinique, rue du Général-Koenig, 51100 Reims, France
| | - Juliette Thariat
- Normandie université, Caen, GORTEC/Intergroupe ORL, centre François-Baclesse, service de radiothérapie, 3, avenue du Général-Harris, 14000 Caen, France
| | - Virginie Westeel
- CHU de Besançon, hôpital Jean-Minjoz, université de Franche-Comté, Besançon, IFCTservice de pneumologie, Inserm UMR 1098, , 3, Boulevard Alexandre Fleming, 25000 Besançon, France
| | - Thomas Aparicio
- AP-HP, hôpital Saint-Louis, université de Paris, Paris, GCO, service de gastro-entérologie et cancérologie digestive, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Jean Yves Blay
- Centre Léon-Bérard, Lyon, service d'oncologie médicale, UNICANCER, 28, Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Olivier Bouché
- CHU de Reims, Reims, service d'oncologie digestive, TNCD, Rue du Général Koenig, 51100 Reims, France
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Tougeron D, Michel P, Lièvre A, Ducreux M, Gaujoux S, Guiu B, Huguet F, Lecomte T, Lepage C, Louvet C, Maggiori L, Mariani P, Aparicio T, Bouché O. Management of digestive cancers during the COVID-19 second wave: A French intergroup point of view (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFR). Dig Liver Dis 2021; 53:306-308. [PMID: 33341421 PMCID: PMC7836265 DOI: 10.1016/j.dld.2020.11.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has major impact of healthcare systems, including cancer care pathways. The aim of this work is to discuss in a multidisciplinary approach the therapeutic and/or strategies adaptations for patients treated for a digestive cancer during the European second wave of COVID-19 pandemic. METHODS A collaborative work was performed by several French societies to answer how to preserve digestive cancer care with no loss of chance during the second wave of COVID-19. In this context, all recommendations are graded as expert's agreement according to level evidence found in literature until October 2020 and the experience of the first wave of the COVID-19 pandemic. RESULTS As far as possible, no therapeutic modification should be carried out. If necessary, therapeutic adjustments may be considered if they do not constitute a loss of chance for patients. Considering the level of evidence all therapeutic modifications need to be discussed in multidisciplinary tumor board meeting and with patient consent. By contrast to first wave cancer prevention, cancer screening, supportive care and clinical trials should be continued. CONCLUSION Recommendations proposed could limit cancer excess mortality due to the COVID-19 pandemic but should be adapted according to the situation in each hospital.
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Affiliation(s)
- David Tougeron
- Gastroenterology and Hepatology Department, Poitiers University Hospital, University of Poitiers, Poitiers, France,Corresponding author
| | - Pierre Michel
- Normandie University, UNIROUEN, Inserm U1245, IRON Group, Rouen University Hospital, Gastroenterology and Hepatology Department, Rouen, France
| | - Astrid Lièvre
- Rennes 1 University, Rennes, France, Gastroenterology Department, Pontchaillou University Hospital, Rennes, France, INSERM UMR 1242, COSS "Chemistry, Oncogenesis, Stress Signaling", Rennes, France, Centre Régional de Coordination des Dépistage des Cancers, antenne d'Ille-et-Vilaine (Adeci 35), France
| | - Michel Ducreux
- Digestive Oncology Department, Gustave Roussy Institut, Villejuif, Paris-Saclay University, France
| | - Sébastien Gaujoux
- Digestive Surgical Department, Pitié-Salpêtrière University Hospital, Paris, France
| | - Boris Guiu
- Radiology Department, Montpellier University Hospital, Montpellier, France
| | - Florence Huguet
- Radiotherapy Department, Tenon University Hospital, Institut Universitaire de Canécrologie, APHP, Sorbonne University, Paris, France
| | - Thierry Lecomte
- Gastroenterology, Digestive Oncology and Hepatology Department, Tours University Hospital, UMR INSERM 1069 N2C, Tours University, Tours, France
| | - Côme Lepage
- Gastroenterology and Hepatology Department, Le Bocage University Hospital, EPICAD INSERM LNC-UMR 1231, Bourgogne and Franche Comté University, Dijon, France
| | - Christophe Louvet
- Medical Oncology Department, Mutualiste Montsouris Institut, Paris, France
| | - Léon Maggiori
- Digestive Surgery Department, St Louis University Hospital, Paris, France
| | - Pascale Mariani
- Oncologic Digestive Surgery Department, Curie Institut, Paris, France
| | - Thomas Aparicio
- Gastroenterology and Digestive Oncology Department, Saint Louis Hospital, APHP, Nord, Université de Paris, Paris
| | - Olivier Bouché
- Digestive Oncology Department, Reims University Hospital, Reims, France
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50
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Even C, Sagaon Teyssier L, Pointreau Y, Temam S, Huguet F, Geoffrois L, Schwarzinger M. Factors associated with under-reporting of head and neck squamous cell carcinoma in cause-of-death records: A comparative study of two national databases in France from 2008 to 2012. PLoS One 2021; 16:e0246252. [PMID: 33534860 PMCID: PMC7857613 DOI: 10.1371/journal.pone.0246252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/18/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To date, no study has evaluated the detection rate of head and neck squamous cell carcinoma (HNSCC) in cause-of-death records in Europe. Our objectives were to compare the number of deaths attributable to HNSCC from two national databases in France and to identify factors associated with under-reporting of HNSCC in cause-of-death records. METHODS The national hospital discharge database and the national underlying cause-of-death records were compared for all HNSCC-attributable deaths in adult patients from 2008 to 2012 in France. Factors associated with under-reporting of HNSCC in cause-of-death records were assessed using multivariate Poisson regression. RESULTS A total of 41,503 in-hospital deaths were attributable to HNSCC as compared to 25,647 deaths reported in national UCoD records (a detection rate of 62%). Demographics at death were similar in both databases with respect to gender (83% men), age (54% premature deaths at 25-64 years), and geographic distribution. In multivariate Poisson regression, under-reporting of HNSCC in cause-of-death records significantly increased in 2012 compared to 2010 (+7%) and was independently associated with a primary HNSCC site other than the larynx, a former primary or second synchronous cancer other than HNSCC, distant metastasis, palliative care, and death in hospitals other than comprehensive cancer care centers. The main study results were robust in a sensitivity analysis which also took into account deaths outside hospital (overall, 51,129 HNSCC-attributable deaths; a detection rate of 50%). For the year 2012, the age-standardized mortality rate for HNSCC derived from underlying cause-of-death records was less than half that derived from hospital discharge summaries (14.7 compared to 34.1 per 100,000 for men and 2.7 compared to 6.2 per 100,000 for women). CONCLUSION HNSCC is largely under-reported in cause-of-death records. This study documents the value of national hospital discharge databases as a complement to death certificates for ascertaining cancer deaths.
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Affiliation(s)
- Caroline Even
- Department of Surgical & Medical Head & Neck Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Luis Sagaon Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
- Translational Health Economics Network (THEN), Paris, France
| | - Yoann Pointreau
- Department of Radiation Oncology, ILC- Institut inter-régionaL de Cancérologie, Centre Jean Bernard-Clinique Victor Hugo, Le Mans, France
| | - Stéphane Temam
- Department of Surgical & Medical Head & Neck Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Florence Huguet
- Department of Radiation Oncology, Hôpital Tenon, AP-HP, Paris, France
| | - Lionnel Geoffrois
- Department of Medical Oncology, Institut de cancérologie de Lorraine – Alexis Vautrin, Vandoeuvre Les Nancy, France
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