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Hannoun-Levi JM, Gimeno Morales M, Gal J, Anchuelo J, Guinot JL, Gaztañaga M, Meszaros N, Polgar C, Strnad V, Schiappa R, Gutierrez C. Very accelerated partial breast irradiation in 1 or 2 days: Late toxicity and early oncological outcome of the GEC-ESTRO VAPBI cohort. Radiother Oncol 2024; 194:110217. [PMID: 38460552 DOI: 10.1016/j.radonc.2024.110217] [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: 01/06/2024] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE To analyze late toxicity after very accelerated partial breast irradiation (VAPBI) for low-risk breast cancer. MATERIALS Methods: In this retrospective, observational, international multicenter study (HDH F20220713143949), patients with low-risk breast cancer underwent lumpectomy + vAPBI (high-dose rate multicatheter interstitial brachytherapy-MIBT). VAPBI was performed with 4(4x6.2 Gy/2d), 3(3x7.45 Gy/2d) or 1 fraction (1x16Gy or 1x18Gy/1d). Primary endpoint was late toxicity. Secondary endpoints were cumulative incidence of breast cancer local relapse (LR) and distant metastatic relapse (DMR) and specific (SS) and overall (OS) survivals. Prognostic factors for late toxicity were analyzed. RESULTS From 01/2012 to 06/2022, 516 pts with early breast cancer were enrolled. Median follow-up was 44 months [95 %CI 39-46]. Median age was 71 years [40-100]. Median tumor size was 12 mm [1-35]. VAPBI delivered 1, 3 and 4 fractions for 205pts (39.7 %), 167pts (32.4 %) and 144pts (28 %) respectively. 221 late toxicity events were observed in 168pts (32.6 %) (Fibrosis, dyschromia, pain and telangiectasia). Grade 2 and 3 late toxicities were observed in 7.2 and 0.6 % respectively (no G4) with no difference between 1 and ≥ 2 treatment days. CTV > 50 cc (p = 0.007) and V150 > 40 % (p = 0.027) were prognostic factors for G ≥ 2 late toxicity. Four-year cumulative incidence rates of LR and DMR were 2 % [95 %CI 0-3] and 1 % [95 %CI 0-2] respectively. CONCLUSIONS VAPBI based on 1 or ≥ 2 days of MIBT represents an attractive de-escalation of irradiation approach for low-risk breast cancer. Late toxicity profile appears acceptable while early oncological outcome shows encouraging local control. Longer follow-up is warranted in order to confirm these preliminary results.
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Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University Côte d'Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France.
| | - Marta Gimeno Morales
- Department of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jocelyn Gal
- Department of Statistics, Antoine Lacassagne Cancer Center - University of Côte d'Azur, Nice, France
| | - Javier Anchuelo
- Department of Radiation Oncology, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Jose-Luis Guinot
- Department of Radiation Oncology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - Miren Gaztañaga
- Department of Radiation Oncology, Hospital Clínico San Carlos, Madrid, Spain
| | - Norbert Meszaros
- Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Csaba Polgar
- National Institute of Oncology and National Tumor Biology Laboratory, Budapest, Hungary; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Cancer Center - University of Côte d'Azur, Nice, France
| | - Cristina Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
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Abdul-Latih M, Gal J, Schiappa R, Rizzi Y, Gautier M, Hannoun-Levi JM. Salvage brachytherapy for second ipsilateral breast tumor event: Relating dosimetric analysis to late side effects. Brachytherapy 2024:S1538-4721(24)00004-7. [PMID: 38383205 DOI: 10.1016/j.brachy.2023.12.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/18/2023] [Accepted: 12/31/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE For second ipsilateral breast tumor event (2ndIBTE), conservative treatment (CT) involving wide local excision plus accelerated partial breast reirradiation (APBrI) is increasingly used as an alternative to mastectomy. This study investigates the impact of APBrI technique and multicatheter interstitial high dose-rate brachytherapy (MIB) dosimetry parameters on toxicity and survival in patients with 2ndIBTE. MATERIALS-METHODS Data from patients with 2ndIBTE treated with CT, were analyzed. Inclusion criteria specified 2ndIBTE occurring at least one year after 1st CT for primary breast cancer. Treatment details and dosimetry parameters were recorded. Primary endpoint was late toxicity. Secondary endpoints were late toxicity prognostic factors analysis and oncological outcome. RESULTS From 07/2005 and 07/2023, 201 patients (pts) received 2nd CT. With a median follow-up of 49.6 months (44.9-59.5), tumor size was less than 2 cm (88.1%), with estrogen receptor positive (92.7%). Patients were low (63.7%) or intermediate (29.8%) GEC-ESTRO APBI risk classification. Late toxicities were observed in 34.8% (G1 52.3%, G2 40.7%). Cutaneous fibrosis was the most common toxicity. Cosmetic outcomes were excellent in 64.1%. Dosimetry analysis revealed positive correlations between complications and absolute volumes of CTV, V100, V150, and V200. Volumes requiring higher needle number and lower DNR resulted in fewer complications. 5-year disease-free and overall survival were 88% and 95% respectively. CONCLUSION Second CT for 2ndIBTE showed favorable oncological outcomes and survival rates. Complications were correlated with specific dosimetric parameters, emphasizing the importance of tailored treatment planning. This study provides valuable insights in risk stratification and MIB optimization for APBrI.
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Affiliation(s)
- Mohamed Abdul-Latih
- Department of Radiotherapy, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Jocelyn Gal
- Biostatistic Unit, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Renaud Schiappa
- Biostatistic Unit, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Yassine Rizzi
- Department of Radiotherapy, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Mathieu Gautier
- Department of Radiotherapy, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiotherapy, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France.
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Hannoun-Levi JM, Gal J, Polgar C, Strnad V, Loessl K, Polat B, Kauer-Domer D, Schiappa R, Gutierrez C. Second Conservative Treatment for Local Recurrence Breast Cancer: A GEC-ESTRO Oncological Outcome and Prognostic Factor Analysis. Int J Radiat Oncol Biol Phys 2023; 117:1200-1210. [PMID: 37459998 DOI: 10.1016/j.ijrobp.2023.06.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 04/05/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE For second ipsilateral breast tumor event (2nd IBTE), second conservative treatment (2nd CT) combining lumpectomy plus accelerated partial breast reirradiation (APBrI) represents a curative option. The aim of this study was to analyze oncological prognostic factors for patients with a 2nd IBTE treated with 2nd CT. METHODS AND MATERIALS An analysis of clinical practices was conducted across 7 academic hospitals/cancer centers in 6 European countries based on the GEC-ESTRO database. Patients presenting a 2nd IBTE occurring after conservative surgery (lumpectomy + axillary evaluation) and irradiation performed for the primary tumor underwent a 2nd CT with brachytherapy-based APBrI. The main outcome was 5-year cumulative incidence (CI) rate of second local relapse. All analyzed patients were classified according to risk groups for Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) accelerated partial breast irradiation (APBI) and molecular classification and time interval between first and second breast surgery (TIS1S2). Finally, we combined GEC-ESTRO APBI, molecular, and TIS1S2 risk groups, leading to the definition of a new score (named TAM: score based on the combination of time interval [T] between first and second surgery and APBI [A] and molecular [M] classifications) specifically designed for 2nd IBTE oncological outcome analysis. RESULTS From July 1994 to January 2021, a total of 508 patients received a 2nd CT. At the time of 2nd IBTE, median age was 64.6 years (range, 56.2-72.6). With a median follow-up of 60.9 months (56.2-72.6), the 5-year second local relapse CI rate was 4% (95% confidence interval [95% CI], 2%-6%). The 5-year distant metastasis disease CI rate was 7% (95% CI, 4%-10%). Five-year disease-free and overall survival rates were 89% (95% CI, 86%-93%) and 91% (95% CI, 88%-94%), respectively. In multivariate analysis, TAM score was an independent prognostic factor for all the oncological items (P < .001) except disease-specific survival (P = .07) and overall survival (P = .09). The grade ≥3 late toxicity rate was 12.1%. CONCLUSIONS This analysis of 2nd CT combining lumpectomy with APBrI for 2nd IBTE confirmed the excellent oncological results obtained after 2nd CT. Furthermore, the GEC-ESTRO TAM score appears to be an important prognostic factor, assisting patients and physicians in the decision-making process.
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Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France.
| | - Jocelyn Gal
- Department of Epidemiology/Biostatistics, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France
| | - Csaba Polgar
- Department of Oncology, Semmelweis University, Budapest, Hungary; Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
| | - Kristina Loessl
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Bulent Polat
- Department of Radiation Oncology, Wurzburg University, Wurzburg, Germany
| | - Daniela Kauer-Domer
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Renaud Schiappa
- Department of Epidemiology/Biostatistics, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France
| | - Crisitna Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
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Hannoun-Levi JM, Morales MG, Gal J, Anchuelo J, Guinot JL, Boronat MG, Meszaros N, Polgar C, Strnad V, Schiappa R, Gutierrez C. Very APBI in 1 or 2 Days: Late Toxicity and Early Oncological Outcomes of the GEC-ESTRO Cohort. Int J Radiat Oncol Biol Phys 2023; 117:S174-S175. [PMID: 37784433 DOI: 10.1016/j.ijrobp.2023.06.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To analyze late toxicity after very accelerated partial breast irradiation (VAPBI) for low-risk breast cancer. MATERIALS/METHODS In this retrospective observational international multicenter study (HDH F20220713143949) from 7 European centers, patients with low-risk breast cancer underwent lumpectomy + adjuvant VAPBI based on high-dose rate (HDR) multicatheter interstitial brachytherapy (MIB). VAPBI was performed with 4 (4 × 6.2 Gy/2 d), 3 (3 × 7.45 Gy/2 d) or 1 fraction (1 × 16 Gy or 1 × 18 Gy/1 d). Primary endpoint was late toxicity. Secondary endpoints were oncological outcome based on cumulative incidence of breast cancer local relapse (LR) and distant metastasis disease (DMD) and cause-specific (CSS) and overall (OS) survival. Prognostic factors for late toxicity were analyzed. RESULTS From 01/2012 to 06/2022, the GEC-ESTRO VAPBI cohort included 516 pts with an early breast cancer. Median follow-up was 42 months [95% CI = 39 - 44]. Median age was 71 years [40 - 100]. Median tumor size was 12 mm [1 - 46]. Tumor was mainly invasive ductal carcinoma (78%), pN0 (88.5%), with positive hormonal receptors (98.5%) and negative HER2 overexpression (96%). Patients underwent hormonal and chemo-therapy in 93.8% and 2.3% respectively. Catheter placement was performed peri or post-operatively in 50.2% and 49.8% respectively. Median time interval between surgery and VABPI was 10 days [6 - 65]. VAPBI delivered 1, 3 and 4 fractions for 205 pts (39.7%), 167 pts (32.4%) and 144 pts (28%) respectively. Median CTV was 40.7 cc [95% CI = 26.6 - 72], median V100%, V150%, D90% and Dose non-uniformity ratio (DNR) were 90.2% [95% CI = 84.1 - 97.2], 24.2% [95% CI = 18.9 - 31.6], 103.8% [95% CI = 100.1 - 107.4] and 0.28 [95% CI = 0.23 - 0.33] respectively, 211 late toxicity events were observed in 168 pts (32.6%). Fibrosis, dyschromia, pain and telangiectasia were observed in 26.7%, 7.9%, 7.2% and 0.4 respectively. Grade 2 and 3 late toxicities were observed in 7.2 and 0.6% respectively (no G4). Grade ≥2 late toxicity was observed in 8.1%, 16.7% and 3.7% after 1, 3 and 4 fractions, respectively (p = 0.004). CTV > 50 cc (p = 0.007) and V150 > 40% (p = 0.027) were prognostic factors for G≥2 late toxicity. Regarding oncological outcome, 4-year cumulative incidence of LR, RR and DMD were 2% [95% CI = 0 - 3], 1% [95% CI = 0 - 2] and 1% [95% CI = 0 - 2] respectively. CSS and OS were 98% [95% CI = 96 - 100] and 93% [95% CI = 90 - 96] respectively. No significant difference was observed in terms of oncological outcome between the 3-fractionation groups. CONCLUSION VAPBI based on 1 or 2 days of HDR MIB represents an attractive de-escalation irradiation approach for low-risk breast cancer. Late toxicity profile appears acceptable while early oncological outcome shows excellent local control. Brachytherapy technique remains a key component of clinical outcome. Longer follow-up is warranted in order to confirm these encouraging preliminary results.
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Affiliation(s)
- J M Hannoun-Levi
- Antoine Lacassagne Cancer Center, Nice, France; University Côte d'Azur, Nice, France
| | - M Gimeno Morales
- epartment of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - J Gal
- Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - J Anchuelo
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - J L Guinot
- Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - N Meszaros
- Semmelweis University, Budapest, Hungary
| | - C Polgar
- Semmelweis University, Budapest, Hungary; National Institute of Oncology, Budapest, Hungary
| | - V Strnad
- Radiation Oncology, University Clinic Erlangen, Erlangen, Germany; Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - R Schiappa
- Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - C Gutierrez
- University of Barcelona, L'Hospitalet-Barcelona, Spain; Department of Radiation Oncology, Instituto Catalan Oncologia (ICO), Barcelona, Spain
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Hannoun-Levi JM, Gautier M, Rizzi Y, Razzouk K. Workflow optimization of brachytherapy-based very accelerated partial breast irradiation. Brachytherapy 2023; 22:491-495. [PMID: 37164824 DOI: 10.1016/j.brachy.2023.04.005] [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: 03/10/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE For low-risk breast cancer, accelerated partial breast irradiation (APBI) is a level 1 evidence procedure. Brachytherapy based very APBI (vAPBI) makes it possible to perform adjuvant irradiation in 4 to 1 fraction. However, vAPBI organization is critical. The aim of this technical note is to report on its optimization. METHODS AND MATERIALS To offer to low-risk breast cancer patient an efficient, simple, rapid adjuvant irradiation with a reduced number of hospital visits, a new organization of vAPBI based on a single fraction was established, merging all the different steps (from first consultation to irradiation) into a 4-5-consecutive-hour period. This therapeutic program was developed in strong collaboration with radiation oncologists, medical physicists, radiation therapists, and the medical secretary. RESULTS After the validation of adjuvant breast irradiation, the patient was offered a telemedicine consultation with the radiation oncologist. Then, the day of vAPBI, the patient arrived at the brachytherapy unit at 08:00 AM for an in-person consultation followed by a preimplant CT scan (defining catheter number and position). After breast local anesthesia, catheter placement was performed followed by a postimplant CT scan for planning purposes. A total dose of 16 Gy in 1 fraction was delivered before removing the catheters. The patient was discharged from the brachytherapy unit around 12:30 PM with an upcoming surveillance consultation date. CONCLUSIONS VAPBI organization optimization makes it possible to propose a short 5-h procedure from medical consultation to treatment with only one round trip. Strict organization among staff is required.
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Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France.
| | - Mathieu Gautier
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France
| | - Yassine Rizzi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France
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Benzaquen J, Bondiau PY, Otto J, Marquette CH, Berthet JP, Naghavi AO, Schiappa R, Hannoun-Levi JM, Padovani B, Doyen J. Comparison of outcome after stereotactic ablative radiotherapy of patients with metachronous lung versus primary lung cancer. Radiat Oncol 2023; 18:97. [PMID: 37287020 DOI: 10.1186/s13014-023-02286-5] [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: 07/31/2022] [Accepted: 05/20/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Early-stage lung cancer, primarily treated with surgery, often occur in poor surgical candidates (impaired respiratory function, prior thoracic surgery, severe comorbidities). Stereotactic ablative radiotherapy (SABR) is a non-invasive alternative that provides comparable local control. This technique is particularly relevant for surgically resectable metachronous lung cancer, in patients unable to undergo surgery.. The objective of this study is to evaluate the clinical outcome of patients treated with SABR for stage I metachronous lung cancer (MLC) versus stage I primary lung cancer (PLC). PATIENTS AND METHODS 137 patients treated with SABR for stage I non-small cell lung cancer were retrospectively reviewed, of which 28 (20.4%) were MLC and 109 (79.6%) were PLC. Cohorts were evaluated for differences in overall survival (OS), progression-free survival (PFS), metastasis-free survival, local control (LC), and toxicity. RESULTS After SABR, patients treated for MLC have comparable median age (76.6 vs 78.6, p = 0.2), 3-year LC (83.6% vs. 72.6%, p = 0.2), PFS (68.7% vs. 50.9%, p = 0.9), and OS (78.6% vs. 52.1%, p = 0.9) as PLC, along with similar rates of total (54.1% vs. 42.9%, p = 0.6) and grade 3 + toxicity (3.7% vs. 3.6%, p = 0.9). Previous treatment of MLC patients was either surgery (21/28, 75%) or SABR (7/28, 25%). The median follow-up was 53 months. CONCLUSION SABR is a safe and effective approach for localized metachronous lung cancer.
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Affiliation(s)
- Jonathan Benzaquen
- Department of Pulmonary Medicine and Thoracic Oncology, Nice University Hospital, Pasteur Hospital, FHU OncoAge, Côte d'Azur University, 30, Voie Romaine, 06000, Nice, France.
- CNRS, INSERM, Institute of Research On Cancer and Aging, Côte d'Azur University, Nice, France.
| | - Pierre-Yves Bondiau
- Department of Medical Oncology, Centre Antoine-Lacassagne, University of Côte d'Azur, Nice, France
| | - Josiane Otto
- Department of Medical Oncology, Centre Antoine-Lacassagne, University of Côte d'Azur, Nice, France
| | - Charles-Hugo Marquette
- Department of Pulmonary Medicine and Thoracic Oncology, Nice University Hospital, Pasteur Hospital, FHU OncoAge, Côte d'Azur University, 30, Voie Romaine, 06000, Nice, France
- CNRS, INSERM, Institute of Research On Cancer and Aging, Côte d'Azur University, Nice, France
| | - Jean-Philippe Berthet
- Department of Thoracic Surgery, Nice University Hospital, Pasteur Hospital, Nice, France
| | - Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Renaud Schiappa
- Department of Medical Oncology, Centre Antoine-Lacassagne, University of Côte d'Azur, Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Medical Oncology, Centre Antoine-Lacassagne, University of Côte d'Azur, Nice, France
| | - Bernard Padovani
- Department of Radiology, Nice University Hospital, Côte d'Azur University, Nice, France
| | - Jérôme Doyen
- CNRS, INSERM, Institute of Research On Cancer and Aging, Côte d'Azur University, Nice, France
- Department of Medical Oncology, Centre Antoine-Lacassagne, University of Côte d'Azur, Nice, France
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Ka K, Schiappa R, Terlizzi M, Mallet F, Martin E, Chand ME, Demogeot N, Peiffert D, Pommier P, Quivrin M, Kissel M, Pasquier C, Khalifa J, Bossi A, Hannoun-Levi JM, Blanchard P. Outcomes following brachytherapy boost for intermediate- and high-risk prostate cancer: A retrospective bicenter study by the SFRO brachytherapy group. Radiother Oncol 2023; 180:109460. [PMID: 36638842 DOI: 10.1016/j.radonc.2022.109460] [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: 06/27/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Radiotherapy dose escalation improves biochemical control in intermediate- or high-risk prostate cancer. Brachytherapy boost was shown to further improve biochemical control compared to radiotherapy alone in three randomized trials. The SFRO brachytherapy group sought to evaluate the efficacy and toxicity of BT-boost for intermediate and high-risk prostate cancer in real life, and to determine prognostic factors for efficacy and toxicity. MATERIAL AND METHOD A retrospective study was conducted, including all patients with intermediate- or high-risk prostate cancer treated with a combination of external beam radiotherapy (EBRT) and high dose-rate brachytherapy boost (HDR-BB), from 2006 until December 2019 at two centers. Patient characteristics, initial disease, treatment and follow-up were collected. RESULTS 709 patients from two centers were analyzed given a short follow-up in the other centers. Out of those, 277 were intermediate risk (170 favorable and 107 unfavorable) and 432 were high risk. The median EBRT and HDR-BB doses were 46 Gy (35-50) and 14 Gy (10-20). After a median follow-up of 62 months, biochemical control at 5 years was 87.5 % for the overall population, 91 % and 85 % for intermediate- and high-risk cancers, respectively. At 5 years, biochemical and clinical relapse-free survival, metastasis-free survival and local control rates were 83 %, 90 % and 97 % respectively. 5-years overall survival was 94 %. Late grade 2 or higher GU or GI toxicity was found in 36 patients (5 %) and 9 patients (1.3 %). CONCLUSION This bicenter analysis shows the efficacy and tolerability of HDR-BB as a complement to external radiotherapy. Further improvements such as combination with new hormonal agents or new brachytherapy-radiotherapy fractionation regimens are warranted to improve further the outcomes and therapeutic ratio.
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Affiliation(s)
- Kanta Ka
- Gustave Roussy Cancer Center, Villejuif, Paris Saclay University, France
| | | | - Mario Terlizzi
- Gustave Roussy Cancer Center, Villejuif, Paris Saclay University, France
| | | | | | | | | | | | | | | | | | - Corentin Pasquier
- Toulouse University Cancer Institute-Oncopole/Institut Claudius Regaud, Toulouse, France
| | - Jonathan Khalifa
- Toulouse University Cancer Institute-Oncopole/Institut Claudius Regaud, Toulouse, France
| | - Alberto Bossi
- Gustave Roussy Cancer Center, Villejuif, Paris Saclay University, France
| | | | - Pierre Blanchard
- Gustave Roussy Cancer Center, Villejuif, Paris Saclay University, France.
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Anderson B, Arthur D, Hannoun-Levi JM, Kamrava M, Khan A, Kuske R, Scanderbeg D, Shah C, Shaitelman S, Showalter T, Vicini F, Wazer D, Yashar C. Partial breast irradiation: An updated consensus statement from the American brachytherapy society. Brachytherapy 2022; 21:726-747. [PMID: 36117086 DOI: 10.1016/j.brachy.2022.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 03/26/2022] [Revised: 06/15/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE In recent years, results with mature follow-up have been reported for several Phase III trials randomizing women to receive whole breast irradiation (WBI) versus varying modalities of partial breast irradiation (PBI). It is important to recognize that these methods vary in terms of volume of breast tissue treated, dose per fraction, and duration of therapy. As such, clinical and technical guidelines may vary among the various PBI techniques. METHODS Members of the American Brachytherapy Society with expertise in PBI performed an extensive literature review focusing on the highest quality data available for the numerous PBI options offered in the modern era. Data were evaluated for strength of evidence and published outcomes were assessed. RESULTS The majority of women enrolled on randomized trials of WBI versus PBI have been age >45 years with tumor size <3 cm, negative margins, and negative lymph nodes. The panel also concluded that PBI can be offered to selected women with estrogen receptor negative and/or Her2 amplified breast cancer, as well as ductal carcinoma in situ, and should generally be avoided in women with extensive lymphovascular space invasion. CONCLUSIONS This updated guideline summarizes published clinical trials of PBI methods. The panel also highlights the role of PBI for women facing special circumstances, such as history of cosmetic breast augmentation or prior breast irradiation, and discusses promising novel modalities that are currently under study, such as ultrashort and preoperative PBI. Updated consensus guidelines are also provided to inform patient selection for PBI and to characterize the strength of evidence to support varying PBI modalities.
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Affiliation(s)
- Bethany Anderson
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Douglas Arthur
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA
| | | | | | - Atif Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Kuske
- Arizona Breast Cancer Specialists, Scottsdale, AZ
| | - Daniel Scanderbeg
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH
| | - Simona Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Timothy Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | | | - David Wazer
- Department of Radiation Oncology, Tufts Medical Center, Boston, MA
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
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9
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Marcié S, Gerard JP, Dejean C, Feuillade J, Gautier M, Montagné L, Fuentes C, Hannoun-Levi JM. The inverse square law: A basic principle in brachytherapy. Cancer Radiother 2022; 26:1075-1077. [PMID: 35843781 DOI: 10.1016/j.canrad.2022.04.002] [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] [Accepted: 04/02/2022] [Indexed: 11/28/2022]
Abstract
The purpose of this article is to remind the importance of the inverse square law in radiotherapy and especially in brachytherapy. Indeed, beyond the impact in radiation therapy with high energy beam, there is the use of radionuclides and low energy photons with short FSD where it is still more important. Comparisons between Iridium Brachytherapy and low energy X-rays brachytherapy show equivalent dose distributions in the first few centimeters. If the inverse square law is not the only element influencing the dose distributions calculations, it must not be forgotten. And it is playing a major role in brachytherapy with short FSD (<6cm).
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Affiliation(s)
- S Marcié
- Radiotherapy Department, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice cedex2, France
| | - J P Gerard
- Radiotherapy Department, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice cedex2, France.
| | - C Dejean
- Radiotherapy Department, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice cedex2, France
| | - J Feuillade
- Radiotherapy Department, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice cedex2, France
| | - M Gautier
- Radiotherapy Department, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice cedex2, France
| | - L Montagné
- Radiotherapy Department, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice cedex2, France
| | - C Fuentes
- Hospital Nuestra Senora-de-Candelaria, Tenerife, Spain
| | - J M Hannoun-Levi
- Radiotherapy Department, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice cedex2, France
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Hannoun-Levi JM, Gutierrez C, Polgar C, Strnad V. Risk-adapted modulation through de-intensification of cancer treatments: An ESMO classification. Ann Oncol 2022; 33:1088. [PMID: 35803547 DOI: 10.1016/j.annonc.2022.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University Côte d'Azur, Nice, France.
| | - Cristina Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
| | - Csaba Polgar
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
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11
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Marotte D, Chand-Fouche ME, Boulahssass R, Hannoun-Levi JM. Irradiation of localized prostate cancer in the elderly: A systematic literature review. Clin Transl Radiat Oncol 2022; 35:1-8. [PMID: 35492872 PMCID: PMC9046879 DOI: 10.1016/j.ctro.2022.04.006] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/17/2022] Open
Abstract
Oncological benefit for elderly patients with optimal treatment. Elderly patients often received inadequate treatment. Elderly comorbidities can influence oncological outcomes and treatment tolerance. Optimal curative treatment after oncogeriatric assessment.
Purpose To analyze the literature that addresses radiation therapy for intermediate and high-risk prostate cancer (PC) in the elderly. Patients and methods A PubMed literature search was conducted including articles from 01/01/2000 to 30/06/21, with the following keywords: PC, radiotherapy/brachytherapy and elderly. The analysis mainly focused on the issue of under-treatment in the elderly and the benefit/risk balance of irradiation. Results Of the 176 references analyzed, 24 matched the selection criteria. The definition of “elderly patient” varied from 70 to 80 years. The analysis was impacted by the inhomogeneous primary end points used in each cohort. Age was often an obstacle to radical treatment, with a subsequent risk of under-treatment, particularly in patients with a poorer prognosis. However, comparable elderly oncological outcomes were compared to younger patients, both with external beam radiotherapy alone or combined with brachytherapy boost. Late toxicity rates are low and most often comparable to younger populations. However, a urinary over- toxicity was observed in the super-elderly (>80 years) after brachytherapy boost. The use of ADT should be considered in light of comorbidities, and may even be deleterious in some patients. Conclusion Due to the increase in life expectancy, the management of PC in the elderly is a challenge for patients, clinicians and health insurance payers. Except for unfit men, elderly patients remain candidates for optimal curative treatment (i.e. regardless of age) after oncogeriatric assessment. More solid data from prospective trials conducted specially in this population will provide better guidance in our daily clinical practice.
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Affiliation(s)
- Delphine Marotte
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d’Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
| | - Marie-Eve Chand-Fouche
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d’Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
| | - Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est, CHU de NICE, University of Cote d’Azur, Oncoage Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d’Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
- Corresponding author at: Department of Radiation Oncology, Antoine Lacassagne Cancer Center – University Cote d’Azur, 33 Avenue Valombrose, 06107 Nice CEDEX, France.
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12
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Hannoun-Levi JM, Guinot JL, Gutierrez C, Polgar C, Strnad V. In Regard to Rahimi et al. Int J Radiat Oncol Biol Phys 2022; 113:474-475. [PMID: 35569484 DOI: 10.1016/j.ijrobp.2022.02.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University of Côte d'Azur, Nice, France
| | - José-Luis Guinot
- Department of Radiation Oncology, Valencia Institute of Oncology, Valencia, Spain
| | - Cristina Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
| | - Csaba Polgar
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary;; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
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Marotte D, Gal J, Schiappa R, Gautier M, Boulahssass R, Chand-Fouche ME, Hannoun-Levi JM. High-Dose-Rate brachytherapy boost for elderly patients with intermediate to high-risk prostate cancer: 5-year clinical outcome of the PROSTAGE cohort. Clin Transl Radiat Oncol 2022; 35:104-109. [PMID: 35692263 PMCID: PMC9184865 DOI: 10.1016/j.ctro.2022.05.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/01/2022] [Accepted: 05/12/2022] [Indexed: 12/02/2022] Open
Abstract
Intermediate/high risk elderly prostate cancer benefits less from received standards of care. Age is an independent factor for disease control and tolerance. Brachytherapy boost remains efficient and feasible in the elderly. Careful discussion for super elderly patients (>80 y) is warranted. Oncogeriatric assessment is necessary to identify best candidates.
Purpose To analyze the oncological outcome in elderly (>70 years) prostate cancer after high-dose rate brachytherapy (HDB) boost. Materials/methods In this retrospective study, patients with intermediate (IR) and high-risk (HR) prostate cancer underwent external beam radiation therapy (EBRT) followed by HDB boost with/without androgen deprivation therapy (ADT). The impact of age (≤70y vs. > 70y) was investigated. Oncological outcome focused on biochemical relapse-free survival (bRFS), cause-specific (CSS) and overall survival (OS). Late genito-urinary (GU) and gastro-intestinal (GI) toxicities were investigated. Results From 07/08 to 01/22, 518 pts received a HDB boost, and 380 were analyzed (≤70y:177pts [46.6%] vs. > 70y:203pts [53.4%]). Regarding NCCN classification, 98 pts (≤70y: 53pts; >70y: 45pts; p = 0.107) and 282 pts (≤70y: 124pts; >70y: 158pts; p = NS) were IR and HR pts respectively. Median EBRT dose was 46 Gy [37.5–46] in 23 fractions [14–25]. HDB boost delivered a single fraction of 14/15 Gy (79%). ADT was used in 302 pts (≤70y: 130pts; >70y: 172pts; p = 0.01). With MFU of 72.6 months [67–83] for the whole cohort, 5-y bRFS, 5-y CSS and 5-y OS were 88% [85–92], 99% [97–100] and 94% [92–97] respectively; there was no statistical difference between the two age groups except for 5-y CSS (p = 0.05). Late GU and GI toxicity rates were 32.4% (G ≥ 3 7.3%) and 10.1% (no G3) respectively. Conclusions For IR and HR prostate cancers, HDB boost leads to high rates of disease control with few late G ≥ 3 GU/GI toxicities. For elderly pts, HDB boost remains warranted mainly in HR pts, while competing comorbidity factors influence OS.
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14
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Gerard JP, Montagne L, Thamphya B, Doyen J, Schiappa R, Benezery K, Gourgou S, Dejean C, Hannoun-Levi JM. Propensity score analysis of radical proctectomy versus organ preservation using contact X-ray brachytherapy for rectal cancer. Clin Transl Radiat Oncol 2022; 33:70-76. [PMID: 35118202 PMCID: PMC8791854 DOI: 10.1016/j.ctro.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/25/2022] Open
Abstract
Key objective: the goal provides data to evaluate the oncological risk of performing a planned- conservative strategy in selected patients presenting early T2-T3 rectal adenocarcinoma. Knowledge generated: This propensity score analysis on 72 patients, comparing neoadjuvant chemoradiotherapy followed by radical surgery with planned organ preservation using combined chemoradiotherapy and contact X-ray brachytherapy boost, showed no detrimental oncological safety results after 5 year follow-up. Relevance: This study supplies additional arguments in favor of organ preservation for selected early rectal T2-T3.
Introduction Radical proctectomy (RP-TME) with neo adjuvant chemoradiotherapy (nCRT) remains the standard treatment for T2-T3 rectal cancer. Organ preservation (OP) using CRT and a “watch and wait” strategy (W&W) is a field of research. Planned organ preservation can be proposed for early T1-T3 using contact X-ray brachytherapy (CXB). We compared the oncological outcomes of both approaches using a propensity score matched-cohort analysis. Material and methods For comparative analyses between patients with nCRT + RP-TME and patients with CXB + CRT, propensity scores were calculated with logistic regression and multiple imputations for missing data. The variables included in the propensity score model were PS status, T-N stage and rectal circumference extension. Patients were matched 1:1 using the nearest neighbor method with a 0.1 caliper restriction. The 5-year Cancer Specific survival was the primary end point. Results The Accord 12 phase III trial included 584 patients who treated with nCRT + RP-TME. The CXB cohort included 71 patients with a planned OP. To select OP patient candidate, T4, tumor with extension >66% circumference were eliminated and only patients treated with CXB + CRT were analyzed in the CXB cohort resulting in a total of 374 patients. A one to one paired cohort with 36 patients in each group was derived. These two cohorts were well matched for all confounding factors except for age. The 5-year cancer specific rate showed no significant difference between the two groups (89% in Accord 12 vs 82% in CXB; p = 0.84). At 5 years, rate of metastasis (15% vs 22%, p = 0.54) showed no significant difference. In the CXB group 33/36 patients preserved their rectum. Conclusion The organ preservation strategy using CXB boost yielded a 5-year cancer specific survival rate similar to patients treated with RP-TME. In selected early T2-3 rectal adenocarcinoma an organ preservation strategy could be offered as a reasonable option.
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Hannoun-Levi JM, Peiffert D. Obituary for Monique Pernot M.D. (1928-2021). Brachytherapy 2022; 21:139-140. [PMID: 35115263 DOI: 10.1016/j.brachy.2022.01.002] [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)
- J M Hannoun-Levi
- Université Côte d'Azur, Radiation Oncology, Antoine Lacassagne Cancer Centre, 33 Avenue de Valombrose, NICE CEDEX 06189.
| | - Didier Peiffert
- Université Côte d'Azur, Radiation Oncology, Antoine Lacassagne Cancer Centre, 33 Avenue de Valombrose, NICE CEDEX 06189; Radiotherapy Department, Institut de cancérologie de Lorraine, 6, avenue de Bourgogne, CS 30519, 54500 Vandoeuvre-lès-Nancy, France
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16
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Gauci PA, Kee DLC, Thamphya B, Schiappa R, Delotte J, Chand-Fouche ME, Hannoun-Levi JM. Preoperative high-dose-rate brachytherapy for high-risk early-stage cervical cancer: Long-term clinical outcome analysis. Brachytherapy 2022; 21:273-282. [PMID: 35094933 DOI: 10.1016/j.brachy.2021.11.007] [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: 09/09/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report long-term oncological and toxicity outcomes after high-dose-rate brachytherapy (HDB) followed by oncologic surgery for patients with early-stage cervical cancer. METHODS AND MATERIALS From 2005 to 2019, all patients treated with preoperative HDB at Antoine Lacassagne Cancer Center for early-stage (IB1-IB2-IIA - FIGO 2018) cervical cancer with local relapse risk factors were included. HDB was performed followed by hysterectomy. Oncological and toxicity outcomes were evaluated prospectively. RESULTS We identified 61 patients, with a median follow-up of 84 months. Posthysterectomy complete pathological response was observed in 46 patients (75.4%). Six patients (9.8%) experienced recurrence, including 4 local relapses (6.6%), and 2 deaths (3.3%) due to cervical cancer. Five-year local, nodal and metastatic relapse-free survivals were 94% (95% CI 87-100%), 96% (95% CI 90-100%) and 93% (95% CI 86-100%) respectively. Five-year overall survival was 98% (95% CI 95-100%). No grade ≥ 3 acute toxicity was observed, and 3 patients (4.9%) experienced grade 2 acute toxicity. One patient presented grade 4 late digestive toxicity, and 6 patients had grade 2 late toxicity. Only 1 patient still had grade 2 toxicity, after 9 years follow-up. CONCLUSIONS To our knowledge, we are reporting the longest follow-up of a preoperative HDB cohort. With similar oncological outcomes and less morbidity compared to primary surgery treatment followed more or less by adjuvant radiotherapy, HDB followed by hysterectomy could be a promising therapeutic option for early-stage cervical cancers with poor prognostic factors.
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Affiliation(s)
- Pierre-Alexis Gauci
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice Cedex 2, Nice, France; Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine, CHU de Nice, University of Côte d'Azur, Nice, France
| | - Daniel Lam Cham Kee
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice Cedex 2, Nice, France
| | - Brice Thamphya
- Department of Statistics, Antoine Lacassagne Cancer Center - University of Côte d'Azur, Nice, France
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Cancer Center - University of Côte d'Azur, Nice, France
| | - Jerome Delotte
- Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine, CHU de Nice, University of Côte d'Azur, Nice, France
| | - Marie-Eve Chand-Fouche
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice Cedex 2, Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice Cedex 2, Nice, France.
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le Guyader M, Lam Cham Kee D, Thamphya B, Schiappa R, Gautier M, Chand-Fouche ME, Hannoun-Levi JM. High-dose-rate brachytherapy boost for locally advanced cervical cancer: Oncological outcome and toxicity analysis of 4 fractionation schemes. Clin Transl Radiat Oncol 2021; 32:15-23. [PMID: 34816022 PMCID: PMC8592834 DOI: 10.1016/j.ctro.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/31/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 12/04/2022] Open
Abstract
Brachytherapy boost is a standard of care for locally advanced cervical cancer. High-dose-rate brachytherapy (HDR-BT) boost procedure is not standardized. The number of implants, fractions, doses and imaging differ in literature. Bi-fractionated HDR-BT in 1 implant is feasible with good oncological outcome. Bi-fractionated HDR-BT dose escalation slightly increases acute toxicity.
Purpose Brachytherapy (BT) boost after radio-chemotherapy (RCT) is a standard of care in the management of locally advanced cervical cancer (LACC). As there is no consensus on high-dose-rate (HDR) BT fractionation schemes, our aim was to report the oncological outcome and toxicity profile of four different schemes using twice-a-day (BID) HDR-BT. Patients and methods This was an observational, retrospective, single institution study for patients with LACC receiving a HDR-BT boost. The latter was performed with a single implant and single imaging done on day 1. The different fractionation schemes were: 7 Gy + 4x3.5 Gy (group 1); 7 Gy + 4x4.5 Gy (group 2); 3x7Gy (group 3) and 3x8Gy (group 4). Local (LFS), nodal (NFS) and metastatic (MFS) recurrence-free survival as well as progression-free survival (PFS) and overall survival (OS) were analyzed. Acute (≤6 months) and late toxicities (>6 months) were reported. Results From 2007 to 2018, 191 patients were included. Median follow-up was 57 months [45–132] and median EQD210D90CTVHR was 84, 82 and 90 Gy for groups 2, 3 and 4 respectively (dosimetric data missing for group 1). The 5-year LFS, NFS, MFS, PFS and OS were 85% [81–90], 83% [79–86], 70% [67–73], 61% [57–64] and 75% [69–78] respectively, with no significant difference between the groups. EQD210D90CTVHR < 85 Gy was a prognostic factor for local recurrence in univariate analysis (p = 0.045). The rates of acute/late grade ≥ 2 urinary, digestive and gynecological toxicities were 9%/15%, 3%/15% and 9%/25% respectively. Conclusion Bi-fractionated HDR-BT boost seems feasible with good oncological outcome and slightly more toxicity after dose escalation.
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Key Words
- BED, biologically effective dose
- BID, twice-a-day
- BMI, body-mass index
- BT, brachytherapy
- Brachytherapy
- CT, computerized tomography
- CTCAE, common terminology criteria for adverse events
- CTV, clinical target volume
- Cervical cancer
- EBRT, external beam radiotherapy
- EMBRACE, image guided intensity modulated External beam radiochemotherapy and MRI based Adaptative BRAchytherapy in locally advanced CErvical cancer
- EQD2Gy, equivalent dose at 2 Gy
- ESTRO, European Society for Radiotherapy and Oncology
- FIGO, International Federation of Gynecology and Obstetrics
- Fractionation scheme
- GEC, groupe européen de curiethérapie
- GTV, gross tumor volume
- HDR, high-dose-rate
- HIV, human immunodeficiency virus
- HR, high-risk
- High-dose-rate
- ICRU, International Commission on Radiation Units and measurements
- IGABT, image-guided adaptative brachytherapy
- IMRT, intensity modulated radiotherapy
- IR, intermediate-risk
- LACC, locally advanced cervical cancer
- LDR, low-dose-rate
- LFS, local recurrence-free survival
- LQ, linear quadratic
- MFS, metastatic recurrence-free survival
- MFU, median follow up
- MRI, magnetic resonance imaging
- NA, not available
- NCI, national cancer institute
- NFS, nodal recurrence-free survival
- OAR, organs at risk
- OS, overall survival
- OTT, overall treatment time
- PDR, pulsed-dose-rate
- PET, positron emission tomography
- PFS, progression-free survival
- PTV, planning target volume
- RCT, radio-chemotherapy
- SCC, squamous cell cancer
- SEER, surveillance, epidemiology and end results
- pt, patient
- pts, patients
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Affiliation(s)
- Maud le Guyader
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
| | - Daniel Lam Cham Kee
- Department of Radiation Oncology, Pôle Santé République, Clermont-Ferrand, France
| | - Brice Thamphya
- Department of Statistics, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice, France
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice, France
| | - Mathieu Gautier
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
| | - Marie-Eve Chand-Fouche
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
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Hannoun-Levi JM, Gutierrez C, Polgar C, Strnad V. Letter comments on: The impact of isolated local recurrence on long-term outcome in early-breast cancer patients after breast-conserving therapy. Eur J Cancer 2021; 159:224-226. [PMID: 34781170 DOI: 10.1016/j.ejca.2021.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University of Côte D'Azur, Nice, France.
| | - Cristina Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
| | - Csaba Polgar
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
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Le Roy T, Baron D, Vandendorpe B, Bataille B, Hannoun-Levi JM, Blanchard P, Lartigau E, Latorzeff I, Pasquier D. [The role of radiotherapy to the primary tumor and metastases in patients with oligometastatic prostate cancer]. Cancer Radiother 2021; 25:526-532. [PMID: 34400086 DOI: 10.1016/j.canrad.2021.07.001] [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: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 11/18/2022]
Abstract
Oligometastatic prostate cancer is among the most studied oligometastatic cancers in the literature. However few prospective studies have assessed stereotactic body radiotherapy (SBRT) for prostate cancer oligometastases. Two randomised phase II trials show a progression-free survival benefit compared with observation. Prospective registry data show very good local control and low toxicity too. Inclusion in ongoing trials should be strongly encouraged to define the role of SBRT in addition to systemic therapy. Radiation therapy to the primary tumour has been studied in randomised trials and provides an overall survival benefit in patients with low metastatic burden. The benefit is inversely correlated with the number of bone lesions using conventional imaging, up to three metastases. Radiotherapy to the primary tumour is recommended by the learned societies for patients with low metastatic burden. Its role in combination with second generation anti androgen therapy needs to be clarified.
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Affiliation(s)
- T Le Roy
- Département universitaire de radiothérapie, centre O. Lambret, 3, rue F. Combemale, 59020 Lille, France
| | - D Baron
- Département d'oncologie radiothérapie, centre Antoine-Lacassagne, université Côte d'Azur, 33, avenue de Valombrose, 06000 Nice, France
| | - B Vandendorpe
- Département universitaire de radiothérapie, centre O. Lambret, 3, rue F. Combemale, 59020 Lille, France
| | - B Bataille
- Département universitaire de radiothérapie, centre O. Lambret, 3, rue F. Combemale, 59020 Lille, France
| | - J M Hannoun-Levi
- Département d'oncologie radiothérapie, centre Antoine-Lacassagne, université Côte d'Azur, 33, avenue de Valombrose, 06000 Nice, France
| | - P Blanchard
- Département de radiothérapie-oncologie, Gustave-Roussy cancer campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - E Lartigau
- Département universitaire de radiothérapie, centre O. Lambret, 3, rue F. Combemale, 59020 Lille, France; Centre de recherche en informatique, signal et automatique de Lille UMR CNRS 9189, université de Lille, Lille, France
| | - I Latorzeff
- Département de radiothérapie-oncologie, Bât Atrium, clinique Pasteur, 1, rue de la petite vitesse, 31300 Toulouse, France
| | - D Pasquier
- Département universitaire de radiothérapie, centre O. Lambret, 3, rue F. Combemale, 59020 Lille, France; Centre de recherche en informatique, signal et automatique de Lille UMR CNRS 9189, université de Lille, Lille, France.
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Hannoun-Levi JM, Polgar C, Strnad V. In regard to Van den Bruele AB et al. Management of ipsilateral breast tumor recurrence following breast conservation surgery: a comparative study of re-conservation vs mastectomy. Breast Cancer Res Treat. 2021 May;187(1):105-112. doi:10.1007/s10549-020-06080-9. Epub 2021 Jan 12. PMID: 33433775; PMCID: PMC8068641. Breast Cancer Res Treat 2021; 190:3-4. [PMID: 34357492 DOI: 10.1007/s10549-021-06348-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Jean-Michel Hannoun-Levi
- Radiation Oncology Department, Antoine Lacassagne Cancer Centre, University of Côte d'Azur, 33 Avenue Valombrose, 06107 CEDEX, Nice, France.
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Jereczek-Fossa BA, Marvaso G, Zaffaroni M, Gugliandolo SG, Zerini D, Corso F, Gandini S, Alongi F, Bossi A, Cornford P, De Bari B, Fonteyne V, Hoskin P, Pieters BR, Tree AC, Arcangeli S, Fuller DB, Franzese C, Hannoun-Levi JM, Janoray G, Kerkmeijer L, Kwok Y, Livi L, Loi M, Miralbell R, Pasquier D, Pinkawa M, Scher N, Scorsetti M, Shelan M, Toledano A, van As N, Vavassori A, Zilli T, Pepa M, Ost P. Salvage stereotactic body radiotherapy (SBRT) for intraprostatic relapse after prostate cancer radiotherapy: An ESTRO ACROP Delphi consensus. Cancer Treat Rev 2021; 98:102206. [PMID: 33965893 DOI: 10.1016/j.ctrv.2021.102206] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 02/26/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Between 30% and 47% of patients treated with definitive radiotherapy (RT) for prostate cancer are at risk of intraprostatic recurrence during follow-up. Re-irradiation with stereotactic body RT (SBRT) is emerging as a feasible and safe therapeutic option. However, no consensus or guidelines exist on this topic. The purpose of this ESTRO ACROP project is to investigate expert opinion on salvage SBRT for intraprostatic relapse after RT. MATERIALS AND METHODS A 40-item questionnaire on salvage SBRT was prepared by an internal committee and reviewed by a panel of leading radiation oncologists plus a urologist expert in prostate cancer. Following the procedure of a Delphi consensus, 3 rounds of questionnaires were sent to selected experts on prostate re-irradiation. RESULTS Among the 33 contacted experts, 18 (54.5%) agreed to participate. At the end of the final round, participants were able to find consensus on 14 out of 40 questions (35% overall) and major agreement on 13 questions (32.5% overall). Specifically, the consensus was reached regarding some selection criteria (no age limit, ECOG 0-1, satisfactory urinary flow), diagnostic procedures (exclusion of metastatic disease, SBRT target defined on the MRI) and therapeutic approach (no need for concomitant ADT, consideration of the first RT dose, validity of Phoenix criteria for salvage SBRT failure). CONCLUSION While awaiting the results of ongoing studies, our ESTRO ACROP Delphi consensus may serve as a practical guidance for salvage SBRT. Future research should address the existing disagreements on this promising approach.
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Affiliation(s)
- Barbara A Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Simone Giovanni Gugliandolo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy; Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Dario Zerini
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Corso
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Centre for Analysis Decisions and Society (CADS), Human Technopole, Department of Mathematics (DMAT) - MOX Laboratory, Politecnico di Milano, Milan, Italy
| | - Sara Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Filippo Alongi
- Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy; University of Brescia, Brescia, Italy
| | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - Philip Cornford
- Liverpool University Hospitals Foundation NHS Trust, Liverpool, UK
| | - Berardino De Bari
- Radiation Oncology, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland; University of Lausanne (UniL), Lausanne, Switzerland
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Bradley R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - Stefano Arcangeli
- Department of Radiation Oncology, S. Gerardo Hospital, University of Milan Bicocca, Milan, Italy
| | - Donald B Fuller
- Department of Radiation Oncology, Genesis Health Care Partners, Inc, San Diego, CA, USA
| | - Ciro Franzese
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice, France
| | - Guillaume Janoray
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium; University François-Rabelais, Tours, France
| | | | - Young Kwok
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lorenzo Livi
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Mauro Loi
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | | | - David Pasquier
- Academic Department of Radiation Oncology, Centre O. Lambret, Lille, France; CRIStAL UMR 9189, Lille University, Lille, France
| | - Michael Pinkawa
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Nathaliel Scher
- Hartmann Radiotherapy Institute, Hartmann Oncology Radiotherapy Group, Levallois-Perret, France; Rafael Institute Center for Predictive Medicine, Levallois-Perret, France
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alain Toledano
- Hartmann Radiotherapy Institute, Hartmann Oncology Radiotherapy Group, Levallois-Perret, France; Rafael Institute Center for Predictive Medicine, Levallois-Perret, France
| | - Nicholas van As
- Department of Clinical Oncology, St Thomas' Hospital, London, UK
| | - Andrea Vavassori
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Matteo Pepa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
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Hannoun-Levi JM, Chamorey E, Boulahssass R, Polgar C, Strnad V. Endocrine therapy with accelerated Partial breast irradiati On or exclusive ultra-accelerated Partial breast irradiation for women aged ≥ 60 years with Early-stage breast cancer (EPOPE): The rationale for a GEC-ESTRO randomized phase III-controlled trial. Clin Transl Radiat Oncol 2021; 29:1-8. [PMID: 33997321 PMCID: PMC8102143 DOI: 10.1016/j.ctro.2021.04.005] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 11/20/2022] Open
Abstract
Epidemiologic data confirm the increase of breast cancer incidence in the elderly. The risk of recurrence of breast cancer is basically low. De-escalation breast cancer adjuvant therapy is justified in selected elderly patients. Ultra-accelerated breast irradiation with endocrine therapy omission is under debate. Prospective randomized trial is warranted.
Purpose Breast cancer in the elderly has become a public health concern; there is a need to re-design its treatment with a view to de-escalation. Our paper sets out the rationale for a phase 3 randomized trial to evaluate less burdensome adjuvant procedures that remain effective and efficient. Materials and methods For low-risk breast cancer in the elderly, adjuvant treatment has been adjusted in order to make it more suitable and efficient. Hypofractionated radiation therapy based on accelerated or non-accelerated regimens as well as accelerated and ultra-accelerated partial breast irradiation (APBI) protocols were reviewed. Withdrawal of radiation (RT) or endocrine therapies (ET) from the adjuvant procedure were also investigated. Based on molecular and APBI classifications, inclusion criteria were discussed. Results Phase 3 randomized trials which compared standard vs. accelerated/non-accelerated hypofractionated regimens confirmed that the latter were non-inferior in terms of local control. Similarly, except for intraoperative-based techniques, APBI achieved non-inferior local control rates compared to whole breast irradiation for low-risk breast cancer. In phase 2 prospective trials using ultra APBI, encouraging results were observed regarding oncological outcome and toxicity profile. In phase 3 trials, adjuvant ET without RT significantly increased the rate of local relapse with no impact on overall survival while RT alone proved effective. Elderly patients aged 60 or more with low-risk, luminal A breast cancer were chosen as the target population in a phase 3 randomized trial comparing APBI + 5-year ET vs. uAPBI (16 Gy 1f) alone. Conclusion To investigate de-escalation adjuvant treatment for elderly breast cancer patients, we have defined a road map for testing more convenient strategies. This EPOPE phase 3 randomized trial is supported by the GEC-ESTRO breast cancer working group.
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Key Words
- ABS, American Brachytherapy Society
- APBI, Accelerated and partial breast irradiation
- ASTRO, American Society of Radiation Oncology
- BCS, Breast cancer surgery
- BCWG, Breast Cancer Working Group
- Brachytherapy
- Breast cancer in the elderly
- DCIS, Ductal carcinoma in situ
- DFS, Disease-free survival
- EPOPE, Endocrine therapy with accelerated Partial breast irradiatiOn or exclusive ultra-accelerated Partial breast irradiation for women aged ≥ 60 years with Early stage breast cancer
- EQD2, Equivalent Dose in 2Gy fractions
- ET, Endocrine therapy
- Endocrine therapy
- GEC-ESTRO, Groupe Européen de Curiethérapie/European Society for Therapeutic Radiation and Oncology
- HDB, High-dose rate Brachytherapy
- LCIS, Lobular carcinoma in situ
- MAPBI, Molecular and APBI GEC-ESTRO
- MIB, Multicatheter Interstitial Brachytherapy
- Oncogeriatric assessment
- QoL, Quality of Life
- RT, Radiotherapy
- Radiation therapy
- WBI, Whole breast irradiation
- uAPBI, ultra-Accelerated Partial Breast Irradiation
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Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University of Côte d'Azur, Nice, France
| | - Emmanuel Chamorey
- Department of Epidemiology and Biostatistics, Antoine Lacassagne Cancer Centre, University of Cote d'Azur, Nice, France
| | - Rabia Boulahssass
- Geriatric Unit. CHU de NICE, FHU ONCOAGE, University of Cote d'Azur, Nice, France
| | - Csaba Polgar
- Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
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Hannoun-Levi JM, Gal J, Van Limbergen E, Chand ME, Schiappa R, Smanyko V, Kauer-Domer D, Pasquier D, Lemanski C, Racadot S, Houvenaeghel G, Guix B, Belliere-Calandry A, Loessl K, Polat B, Gutierrez C, Galalae R, Polgar C, Strnad V. Salvage Mastectomy Versus Second Conservative Treatment for Second Ipsilateral Breast Tumor Event: A Propensity Score-Matched Cohort Analysis of the GEC-ESTRO Breast Cancer Working Group Database. Int J Radiat Oncol Biol Phys 2020; 110:452-461. [PMID: 33383125 DOI: 10.1016/j.ijrobp.2020.12.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Second conservative treatment has emerged as an option for patients with a second ipsilateral breast tumor event after conserving surgery and breast irradiation. We aimed to address the lack of evidence regarding second breast event treatment by comparing oncologic outcomes after conservative treatment or mastectomy. METHODS AND MATERIALS Oncologic outcomes were analyzed using a propensity score-matched cohort analysis study on patients who received a diagnosis of a second breast event between January 1995 and June 2017. Patient data were collected from 15 hospitals/cancer centers in 7 European countries. Patients were offered mastectomy or lumpectomy plus brachytherapy. Propensity scores were calculated with logistic regression and multiple imputations. Matching (1:1) was achieved using the nearest neighbor method, including 10 clinical/pathologic data related to the second breast event. The primary endpoint was 5-year overall survival from the salvage surgery date. Secondary endpoints were 5-year cumulative incidence of third breast event, regional relapse and distant metastasis, and disease-free and specific survival. Complications and 5-year incidence of mastectomy were investigated in the conservative treatment cohort. RESULTS Among the 1327 analyzed patients (mastectomy, 945; conservative treatment, 382), 754 were matched by propensity score (mastectomy, 377; conservative treatment, 377). The median follow-up was 75.4 months (95% confidence interval [CI], 65.4-83.3) and 73.8 months (95% CI, 67.5-80.8) for mastectomy and conservative treatment, respectively (P = .9). In the matched analyses, no differences in 5-year overall survival and cumulative incidence of third breast event were noted between mastectomy and conservative treatment (88% [95% CI, 83.0-90.8] vs 87% [95% CI, 82.1-90.2], P = .6 and 2.3% [95% CI, 0.7-3.9] vs 2.8% [95% CI, 0.8-4.7], P = .4, respectively). Similarly, no differences were observed for all secondary endpoints. Five-year cumulative incidence of mastectomy was 3.1% (95% CI, 1.0-5.1). CONCLUSIONS To our knowledge, this is the largest matched analysis of mastectomy and conservative treatment combining lumpectomy with brachytherapy for second breast events. Compared with mastectomy, conservative treatment does not appear to be associated with any differences in terms of oncologic outcome. Consequently, conservative treatment could be considered a viable option for salvage treatment.
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Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University of Côte d'Azur, Nice, France.
| | - Jocelyn Gal
- Department of Epidemiology and Biostatistics, Antoine Lacassagne Cancer Centre, University of Cote d'Azur, Nice, France
| | - Erik Van Limbergen
- Department of Radiation Oncology, Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Marie-Eve Chand
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University of Côte d'Azur, Nice, France
| | - Renaud Schiappa
- Department of Epidemiology and Biostatistics, Antoine Lacassagne Cancer Centre, University of Cote d'Azur, Nice, France
| | - Viktor Smanyko
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Daniela Kauer-Domer
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - David Pasquier
- Department of Radiation Oncology, Oscar Lambret Cancer Centre, Lille University, Lille, France
| | - Claire Lemanski
- Department of Radiation Oncology, Montpellier Cancer Institute, Montpellier, France
| | - Séverine Racadot
- Department of Radiation Oncology, Leon Berard Cancer Centre, Lyon, France
| | - Gilles Houvenaeghel
- Department of Surgical Oncology, Paoli-Calmettes Cancer Institute, Marseille, France
| | - Benjamin Guix
- Department of Radiation Oncology, Medical Institute for Radiotherapy & Oncology, Barcelona, Spain
| | | | - Kristina Loessl
- Department of Radiation Oncology, Radiation Oncology, Inselspital, Bern University Hospital, Switzerland
| | - Bulent Polat
- Department of Radiation Oncology, Wurzburg University, Wurzburg, Germany
| | - Cristina Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
| | - Razvan Galalae
- MedAustron Centre for Ion Therapy and Research, Wiener Neustadt, Austria
| | - Csaba Polgar
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
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Sumodhee S, Pujalte M, Gal J, Cham Kee DL, Gautier M, Schiappa R, Chand ME, Hannoun-Levi JM. Accelerated partial breast irradiation in the elderly: 8-year oncological outcomes and prognostic factors. Brachytherapy 2020; 20:146-154. [PMID: 33132071 DOI: 10.1016/j.brachy.2020.08.012] [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: 07/09/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of the study is to evaluate long-term clinical outcomes and prognostic factors after accelerated partial breast irradiation (APBI) in the elderly using high-dose-rate interstitial multicatheter brachytherapy (HIBT). METHODS AND MATERIALS Between 2005 and 2018, 109 patients underwent APBI using HIBT (34 Gy/10f/5d or 32 Gy/8f/4d). Based on a prospective database, outcomes were retrospectively analyzed (local relapse-free survival, metastatic-free survival, specific survival (SS), and overall survival (OS)). Prognostic factors were investigated. Late toxicity and cosmetic evaluation were reported. RESULTS With a median followup of 97 months [7-159], median age was 81.7 years [58-89]. In accordance with the GEC-ESTRO APBI classification, 72.5%, 11.9%, and 15.6% were classified as low, intermediate, and high risk, respectively. The histological type was mainly invasive ductal carcinoma (87.1%). The median tumor size was 10 mm [range 1-35]. Eight-year local relapse-free survival, SS, and OS were 96.7% [95% confidence interval (CI) [0.923; 1]), 96.7% [95% CI [0.924; 1], and 72% [95% CI [0.616; 0.837], respectively. In univariate analysis, APBI classification was not considered as prognostic factor, whereas molecular classification was prognostic factor for OS (p < 0.0001), SS (p = 0.007), and metastatic-free survival (p = 0.009) but not for local recurrence (p = 0.586). No Grade ≥3 late toxicity was observed, whereas 61 patients (88.4%) and 8 patients (11.6%) presented Grade 1 and 2 toxicities, respectively. The cosmetic outcome was excellent/good for 96.4%. CONCLUSIONS Long-term followup confirms that HIBT is safe and effective for elderly early breast cancer. Our results suggest that selected elderly women presenting with high-risk breast cancer could be also considered for APBI.
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Affiliation(s)
- Shakeel Sumodhee
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, Nice, France
| | - Marc Pujalte
- Department of Medical Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Jocelyn Gal
- Biostatistics Unit, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Daniel Lam Cham Kee
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, Nice, France
| | - Mathieu Gautier
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, Nice, France
| | - Renaud Schiappa
- Department of Medical Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Marie-Eve Chand
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, Nice, France.
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Benezery K, Montagne L, Evesque L, Schiappa R, Hannoun-Levi JM, Francois E, Thamphya B, Gerard JP. Clinical response assessment after contact X-Ray brachytherapy and chemoradiotherapy for organ preservation in rectal cancer T2-T3 M0: The time/dose factor influence. Clin Transl Radiat Oncol 2020; 24:92-98. [PMID: 32695890 PMCID: PMC7363626 DOI: 10.1016/j.ctro.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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: 05/06/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 12/27/2022] Open
Abstract
Treatment initiation of T2-T3 rectal cancers with Contact (CXB) provides a fast clinical complete response. In T2N0< 3 cm tumors, CXB first with chemoradiotherapy can achieve local control in more than 85%. The Phase III OPERA trial should bring robust data in favor of CXB as initial treatment of T2N0< 3 cm.
Introduction A neoadjuvant treatment aimed at rectal preservation should achieve a clinical complete response. This study comparing neoadjuvant treatment initiated with Contact X-ray (CXB) or External Beam radiotherapy (EBRT) is evaluating the influence of the time/dose parameter on clinical response during the first six months. Materials and methods This retrospective consecutive series included T2-3 rectal adenocarcinoma staged using digital examination (DRE), endoscopy, magnetic radiation imaging and/or endorectal ultrasound. All patients were treated with organ preservation intent. Treatment protocol combined CXB (80–110 Gy/3–4 fractions) and EBRT ± concurrent capecitabine. In tumor exceeding 3.5 cm treatment was often initiated using EBRT. Clinical response was assessed (DRE, proctoscopy ± imaging) at very close interval between 2 weeks and 6 months after treatment initiation. Results Between 2002 and 2017, 61 patients (T2: 31; T3: 30) M0 (median age: 76 years) were treated. Treatment was initiated in 40 patients (T2: 28, T3: 12) with contact X-ray and in 21 (T2: 4, T3: 17) with EBRT. Using contact X-ray or EBRT first treatment, clinical complete (or near complete) response at week 14(±1) was respectively 88% [95CI:74–96] and 33% [95CI:15–57]. In multivariate analysis the treatment chronology was the most significant factor influencing cCR (OR: 7.53). At 6 months, with contact X-ray first all patients were in clinical complete response and five with EBRT remained in partial response. With 61 months median follow-up time, the local recurrence rate was 10% [95% CI: 6–16] at 5 years. T3 and fungating tumors were at higher risk of local recurrence. Organ preservation with good function was achieved in 95% of cases. Conclusion This non randomized study tends to show that in early T2-3 tumors, a strategy using upfront contact therapy, which is reducing the overall treatment time, is an option allowing a more favorable outcome than EBRT first.
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Affiliation(s)
- Karen Benezery
- Department of Radiotherapy, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Lucile Montagne
- Department of Radiotherapy, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Ludovic Evesque
- Department of Medical Oncology, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Renaud Schiappa
- Department of Statistics, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Brice Thamphya
- Department of Statistics, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Jean-Pierre Gerard
- Department of Radiotherapy, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
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Montagne L, Hannoun A, Hannoun-Levi JM. Second conservative treatment for second ipsilateral breast tumor event: A systematic review of the different re-irradiation techniques. Breast 2020; 49:274-280. [PMID: 31945697 PMCID: PMC7375668 DOI: 10.1016/j.breast.2020.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/29/2019] [Accepted: 01/07/2020] [Indexed: 12/27/2022] Open
Abstract
AIM To address the different partial breast re-irradiation techniques available in the context of second conservative treatment (SCT), as an alternative to salvage mastectomy, for 2nd ipsilateral breast tumor event (IBTE) and summarize their respective oncological and toxicity outcomes. MATERIAL AND METHODS A literature search was made based on MeSH/PubMed, including papers from 1995 to 2019. Each article was described according to the main irradiation technique, fractionation, oncological results and grade 3 toxicities related to the salvage conservative treatment. RESULTS Twenty-two articles were identified, reporting the outcomes of over 1 000 patients. MIB Brachytherapy was the most used re-irradiation technique in case of SCT, with a median 3rdIBTE-FS rate of 88% and summed up grade 3 toxicities of 6%. As for IORT, the average rate of 3rdIBTE-FS was about Finally, external beam partial re-irradiation was recently tested in this indication with encouraging results in terms of tolerance. CONCLUSION When presenting a 2ndIBTE, a SCT can safely be proposed to carefully selected and well-informed patients, as an alternative to salvage mastectomy. MIB appears to be the first intention and most robust choice. IORT, external beam radiotherapy and balloon brachytherapy are interesting alternatives but have only been tested in small series. Further investigations are required and their use should be limited to clinical trial only.
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Affiliation(s)
- Lucile Montagne
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote D'Azur, Nice, France
| | | | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote D'Azur, Nice, France.
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Hannoun-Levi JM, Lam Cham Kee D, Hannoun A, Chand ME. In Regard to Khan et al. Int J Radiat Oncol Biol Phys 2019; 104:698-699. [PMID: 31162063 DOI: 10.1016/j.ijrobp.2019.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/11/2019] [Accepted: 03/16/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Daniel Lam Cham Kee
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | | | - Marie-Eve Chand
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
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Rivin Del Campo E, Matzinger O, Haustermans K, Peiffert D, Glynne-Jones R, Winter KA, Konski AA, Ajani JA, Bosset JF, Hannoun-Levi JM, Puyraveau M, Chakravarthy AB, Meadows H, Northover J, Collette L, Christiaens M, Maingon P. Pooled Analysis of external-beam RADiotherapy parameters in phase II and phase III trials in radiochemotherapy in Anal Cancer (PARADAC). Eur J Cancer 2019; 121:130-143. [PMID: 31574418 PMCID: PMC6924923 DOI: 10.1016/j.ejca.2019.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 05/20/2019] [Revised: 08/16/2019] [Accepted: 08/24/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Concomitant external-beam radiochemotherapy (5-fluorouracil-mitomycin C) has become the standard of care in anal cancer since the '90s. A pooled analysis of individual patient data from 7 major trials was performed quantifying the effect of radiation therapy (RT)-related parameters on the outcome of patients with anal cancer. MATERIALS AND METHODS Pooling databases from combined modality trials, the impact of RT parameters (total dose, gap duration, OTT: overall treatment time) on outcome including locoregional failure (LRF), 5-year progression free survival (PFS) and toxicities were investigated. Individual patient data were received for 10/13 identified published studies conducted from 1987 to 2008 (n = 3031). A Cox regression model was used (landmark = 3 months after RT for first follow-up). RESULTS After data inspection indicating severe heterogeneity between trials, only 1343 patients from 7/10 studies received were analysed (the most recent ones, since 1994; median follow-up = 4.1 years). A higher overall 5-year LRF rate [22.8% (95% confidence interval [CI] 22.3-27.3%)] significantly correlated with longer OTT (p = 0.03), larger tumour size (p < 0.001) and male gender (p = 0.045). Although significant differences were not observed, subset analyses for LRF (dose range: 50.4-59 Gy) seemed to favour lower doses (p = 0.412), and when comparing a 2-week gap versus 3 (dose: 59.4 Gy), results suggested 3 weeks might be detrimental (p = 0.245). For a 2-week gap versus none (dose range: 55-59.4 Gy), no difference was observed (p = 0.89). Five-year PFS was 65.7% (95% CI: 62.8-68.5%). Higher PFS rates were observed in women (p < 0.001), smaller tumour sizes (p < 0.001) and shorter OTT (p = 0.025). Five-year overall survival [76.7% (95% CI: 73.9%-79.3%)] correlated positively with female gender (p < 0.001), small tumour size (p = 0.027) and short OTT (p = 0.026). Descriptive toxicity data are presented. CONCLUSION For patients receiving concurrent external-beam doublet chemoradiation, a longer OTT seems detrimental to outcome. Further trials involving modern techniques may better define optimal OTT and total dose.
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Affiliation(s)
- Eleonor Rivin Del Campo
- Department of Radiation Oncology, Tenon University Hospital, Sorbonne University, Paris, France.
| | - Oscar Matzinger
- Department of Radiation Oncology, Genolier Clinic, Genolier, Switzerland
| | - Karin Haustermans
- Department of Radiation Oncology, UZ Leuven University Hospital, Leuven, Belgium
| | - Didier Peiffert
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - Robert Glynne-Jones
- Department of Radiation Oncology, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Kathryn A Winter
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Andre A Konski
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Leonard Davis Institute of Health Economics, West Chester, PA, USA; Department of Radiation Oncology, The Chester County Hospital, West Chester, PA, USA
| | - Jaffer A Ajani
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-François Bosset
- Department of Radiation Oncology, Jean Minjoz University Hospital, Besançon, France
| | | | - Marc Puyraveau
- Department of Statistics, Jean Minjoz University Hospital, Besançon, France
| | - A Bapsi Chakravarthy
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Helen Meadows
- Cancer Research UK & UCL Cancer Trials Centre, London, United Kingdom
| | - John Northover
- Department of Surgery, The London Clinic and St Marks Hospital, London, United Kingdom
| | | | - Melissa Christiaens
- Department of Radiation Oncology, UZ Leuven University Hospital, Leuven, Belgium
| | - Philippe Maingon
- Department of Radiation Oncology, La Pitié Salpêtrière - Charles Foix University Hospital, Sorbonne University, Paris, France
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Hannoun-Levi JM, Hannoun A. Downs-Canner S, Zabor EC, Wind T, Cobovic A, McCormick B, Morrow M, Heerdt A—Radiation Therapy After Breast-Conserving Surgery in Women 70 Years of Age and Older: How Wisely Do We Choose? In Regard to Downs-Canner et al. Ann Surg Oncol 2019; 26:859-860. [DOI: 10.1245/s10434-019-07762-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Indexed: 11/18/2022]
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Boulahssass R, Gonfrier S, Ferrero JM, Champigny N, Rambaud C, Largillier R, Chauviere D, Barranger E, Bereder JM, Benizri E, Borchiellini D, Durand M, Baque P, Delotte J, Barriere J, Hannoun-Levi JM, Guigay J, Piche T, FRANCOIS E, Guerin O. Guided geriatric interventions (GI) in older adults with cancer: What, how, and for whom? The French PACA EST Cohort Experience. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11548 Background: Some previous studies in geriatric oncology have described the GI and their adherence. Today’s challenge is to screen patients needing specific GI and repeated Comprehensive Geriatric Assessments (CGA). We recently analyzed a phenotype of patients requiring more GI (Boulahssass et al, Cancers 2019). The main purpose of the present study is to compare types of GI implemented, according to patient frailty levels, in order to better understand the necessary care plan. Methods: Between April 2012 and May 2018, 3530 consecutive patients with solid tumors were enrolled in this multicentric, prospective cohort. 3140 patients (mean age:82y) were finally included and a CGA was performed at Baseline. Twelve GI were standardized, individualized or based on experience if no guidelines were available. Within 1 month, geriatricians including patients in the cohort received standardized training. Logistic regression was performed to compare types of GI in the 3 groups using the Balducci Score (B1/B2/B3). Results: 8819 GI were implemented for the 3140 patients. On average, fit patients had 1.5 GI (n = 146), vulnerable patients 2.4 GI (n = 1568) and frail patients 3.3 GI (n = 1426). We observed no significant differences between the 3 groups concerning specific pain management (Fit vs B2: p = 0.19; Fit vs B3: p = 0.57) and psychological care (Fit vs B2:p = 0.03; Fit vs B3:p = 0.24). In vulnerable and frail patients, we recorded more significant GI for nutritional care, delirium prevention, comorbidity management, nursing interventions, social worker interventions, treatment modifications for optimization or iatrogenic disorders and physiotherapy, with the highest Odds Ratio for nursing interventions (Fit vs B2 OR:2.9 p = 0.011; Fit vs B3 OR:9 P < 0.001) and physiotherapy (Fit vs B2:OR 4.3 p < 0.001; Fit vs B3:OR:9 p < 0.001). B3 patients had significantly more GI on care pathways modifications (OR:3.1, p = 0.002) and caregiver care (OR:2, p = 0.049). Conclusions: Fit patients also needed GI. We observed differences in types of GI between the groups. However, the aims and levels also seemed to differ and need further studies to analyze their impact.
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Affiliation(s)
- Rabia Boulahssass
- Centre Hospitalier Universitaire de Nice, Hôpital de Cimiez, Nice, France
| | | | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joel Guigay
- Department of Medical Oncology, Antoine Lacassagne Comprehensive Cancer Centre, FHU OncoAge, Université Côte d'Azur, Nice, France
| | | | - Eric FRANCOIS
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Olivier Guerin
- Department of Geriatric Medicine, Cimiez Hospital, FHU Oncoage, University Côte d’Azur, Nice, France
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Hannoun-Levi JM, Hannoun A. In Regard to Jethwa et al. Int J Radiat Oncol Biol Phys 2019; 104:1176-1177. [PMID: 31039419 DOI: 10.1016/j.ijrobp.2019.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 03/31/2019] [Accepted: 04/13/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
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Montagne L, Gal J, Chand ME, Schiappa R, Falk AT, Kinj R, Gauthier M, Hannoun-Levi JM. GEC-ESTRO APBI classification as a decision-making tool for the management of 2nd ipsilateral breast tumor event. Breast Cancer Res Treat 2019; 176:149-157. [PMID: 30949798 DOI: 10.1007/s10549-019-05221-z] [Citation(s) in RCA: 10] [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] [Received: 11/20/2018] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
AIM Second ipsilateral breast tumor event (2ndIBTE) occurring after primary radio-surgical treatment can be treated by either salvage mastectomy or 2nd conservative treatment (2ndCT) including an accelerated partial breast re-irradiation (APBrI). We analyzed the impact of the GEC-ESTRO APBI classification (GAC) on the oncological outcome after APBrI. MATERIALS AND METHODS Between 2000 and 2016, 159 patients (pts) underwent a 2ndCT. After lumpectomy, APBrI was performed using either low-dose (30-55 Gy reference isodose) or high-dose rate brachytherapy (28-34 Gy). Oncological outcome including 3rdIBTE, regional (RFS) or metastasis-free survival (MFS), specific (SS) and overall survival (OS) was analyzed according to GAC. Univariate (UVA) and multivariate analyses (MVA) were conducted to identify significant prognostic factors for 3rdIBTE. RESULTS With a median follow-up of 71 months (range 62-85 months), 60 pts (42%), 61 pts (42.7%) and 22 pts (15.4%) were classified as low-risk (LR), intermediate-risk (IR) and high-risk (HR), respectively. For the whole cohort, 6-year 3rdIBTE-free survival, RFS, MFS, SS and OS rates were 97.4, 96.4, 90.3, 92.9 and 91.2%, respectively. Six-year 3rdIBTE-free survival rates for LR, IR and HR were 100, 95.8 and 92.9%, respectively (p = 0.003), while no significant differences were found between the three GAC groups for RFS, MFS, SS. In UVA, lympho-vascular invasion (p = 0.009), positive margins (p = 0.0001) and GAC high-risk group (p = 0.001) were considered as significant prognostic factors for 3rdIBTE, while, in MVA, high-risk group (p = 0.009) was the only prognostic factor. CONCLUSION In case of 2ndIBTE, GAC could be used as a decision helping tool to discuss conservative or radical treatment options. Patient information remains crucial in order to accurately define the salvage therapy modalities.
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Affiliation(s)
- Lucile Montagne
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, 33 Avenue Valombrose, 06107, Nice Cedex, France
| | - Jocelyn Gal
- Biostatistic Unit, Antoine Lacassagne Cancer Center & University of Cote d'Azur, Nice, France
| | - Marie-Eve Chand
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, 33 Avenue Valombrose, 06107, Nice Cedex, France
| | - Renaud Schiappa
- Biostatistic Unit, Antoine Lacassagne Cancer Center & University of Cote d'Azur, Nice, France
| | - Alexander T Falk
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, 33 Avenue Valombrose, 06107, Nice Cedex, France
| | - Rémy Kinj
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, 33 Avenue Valombrose, 06107, Nice Cedex, France
| | - Mathieu Gauthier
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, 33 Avenue Valombrose, 06107, Nice Cedex, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, 33 Avenue Valombrose, 06107, Nice Cedex, France.
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Faivre JC, Peiffert D, Vendrely V, Lemanski C, Hannoun-Levi JM, Mirabel X, Stanbury T, Salleron J, Guillemin F. Prognostic factors of colostomy free survival in patients presenting with locally advanced anal canal carcinoma: A pooled analysis of two prospective trials (KANAL 2 and ACCORD 03). Radiother Oncol 2018; 129:463-470. [PMID: 30172453 DOI: 10.1016/j.radonc.2018.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 04/08/2018] [Revised: 07/30/2018] [Accepted: 08/09/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND To carry out a prognosis study of the prospective studies KANAL 2 and ACCORD 03 in order to highlight new prognostic factors of colostomy-free survival in patients with locally advanced anal canal carcinoma. PATIENTS AND METHODS KANAL 2 and ACCORD 03 were phase 2 and phase 3 multicenter trials with same inclusion criteria: anal canal squamous cell carcinoma of ≥4 cm or pelvic node involvement treated with conformal radiotherapy (45 Gy/25 fractions plus a boost) and concomitant fluorouracyl and cisplatin at weeks 1 and 5. A multivariate analysis of potential factors (patients, tumors, and treatments) was carried out through Cox proportional hazard model. Results were presented as hazard ratio (HR). RESULTS 387 patients were included. In multivariate analysis, age over 55 years (HR = 0.62, p = 0.013), the increase of circumferential tumor spread (between 1/3 and 2/3 and more than 2/3 compared to less than 1/3) (respectively 1.97, p = 0.015 and 2.94, p < 0.001), the skin ulceration (1.57, p = 0.03), the inguinal node involvement (1,98, p < 0.001) and the total radiotherapy dose above 60 Gy (between 60 and 65 Gy (HR = 0.37, p < 0.001) and >65 Gy (HR = 0.61, p = 0.028)) were associated with colostomy-free survival. CONCLUSION Our study highlights new favorable prognostic factors such as circumferential tumor damage of less than two thirds, age over 55 years, dose escalation boost irradiation and possibly a total radiation dose between 60 and 65 Gy (but the BED dose depends on the overall treatment time). These results could be considered for better selection or stratification of the target population in future trials.
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Affiliation(s)
- Jean-Christophe Faivre
- Radiation Department, Institut de Cancérologie de Lorraine Alexis-Vautrin, Vandœuvre-lès-Nancy, France; EA 4360 APEMAC, Université de Lorraine, Nancy, France.
| | - Didier Peiffert
- Radiation Department, Institut de Cancérologie de Lorraine Alexis-Vautrin, Vandœuvre-lès-Nancy, France; EA 4360 APEMAC, Université de Lorraine, Nancy, France
| | - Véronique Vendrely
- Radiation Department, Centre Hospitalier Universitaire de Bordeaux - Hôpital Haut-Lévêque, Pessac, France
| | - Claire Lemanski
- Department of Radiation Oncology, Institut de Cancérologie de Montpellier - Val d'Aurelle, University of Montpellier, France
| | - Jean-Michel Hannoun-Levi
- Radiation Department, Centre Antoine Lacassagne, Nice, France; Université de Nice, Sophia Antipolis, France
| | - Xavier Mirabel
- Radiation Department, Centre Oscar Lambret, Lille, France
| | | | - Julia Salleron
- Biostatistics and Epidemiology Department, Institut de Cancérologie de Lorraine - Alexis-Vautrin, Vandœuvre-lès-Nancy, France
| | - Francis Guillemin
- EA 4360 APEMAC, Université de Lorraine, Nancy, France; Inserm CIC 1433 Clinical Epidemiology, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
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Strnad V, Major T, Polgar C, Lotter M, Guinot JL, Gutierrez-Miguelez C, Galalae R, Van Limbergen E, Guix B, Niehoff P, Lössl K, Hannoun-Levi JM. ESTRO-ACROP guideline: Interstitial multi-catheter breast brachytherapy as Accelerated Partial Breast Irradiation alone or as boost - GEC-ESTRO Breast Cancer Working Group practical recommendations. Radiother Oncol 2018; 128:411-420. [PMID: 29691075 DOI: 10.1016/j.radonc.2018.04.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [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: 03/15/2018] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE This consensus statement from the Breast Cancer Working Group of Groupe Européen de Curiethérapie of European Society for Radiotherapy and Oncology (GEC-ESTRO) aims at generating practical guidelines for multi-catheter image-guided brachytherapy in the conservative management of breast cancer patients used for either Accelerated Partial Breast Irradiation (APBI) or for a breast boost. METHODS Recent advances in techniques of multi-catheter brachytherapy were summarized and all the relevant literature was reviewed by a panel of experts. Panel members of the GEC-ESTRO experts participated in a series of conferences, supplemented their clinical experience, were surveyed to determine their current practices and patterns, performed a literature review, and formulated recommendations for implementing APBI with multi-catheter brachytherapy, focusing on treatment planning issues, catheter insertion, dosimetry and quality assurance. This document was reviewed and approved by the full panel, the GEC-ESTRO executive board and by the ACROP (Advisory Committee on Radiation Oncology Practice). RESULTS Three-dimensional (3D) treatment planning, catheter insertion techniques, dosimetry and methods of quality assurance for APBI and boost with multi-catheter image-guided brachytherapy after breast conserving surgery are described. Detailed recommendations for daily practice including dose constraints are given. CONCLUSIONS Recent standards and guidelines for the use of APBI with different multi-catheter image-guided brachytherapy techniques have been defined. Different techniques are used to insert the catheters. Guidelines are mandatory to assure precise catheter insertion for coverage of the target volume and to guarantee high-quality dosimetry. The same rules apply for brachytherapy based boost irradiation for breast cancer after whole breast irradiation as well as for partial breast re-irradiation.
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Affiliation(s)
- Vratislav Strnad
- Department of Radiation Oncology, University Hospital Erlangen, Germany.
| | - Tibor Major
- Center of Radiotherapy, National Institute of Oncology Budapest, Hungary
| | - Csaba Polgar
- Department of Radiation Oncology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Michael Lotter
- Department of Radiation Oncology, University Hospital Erlangen, Germany
| | - Jose-Luis Guinot
- Department of Radiation Oncology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Razvan Galalae
- Department of Radiation Therapy, Evangelische Kliniken, Gelsenkirchen, Germany
| | - Erik Van Limbergen
- Department of Radiotherapy, University Hospital Gasthuisberg, Leuven, Belgium
| | - Benjamin Guix
- IMOR Foundation, Medical Institute for Radiotherapy and Oncology, Barcelona, Spain
| | - Peter Niehoff
- Department of Radiation Therapy, Sana Hospital Offenbach, Germany
| | - Kristina Lössl
- Department of Radiation Oncology, University Hospital Bern, Inselspital, Switzerland
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Hannoun-Levi JM, Hannoun A. Brachytherapy boost for prostate cancer: A potential conflict of disinterest. Brachytherapy 2017; 16:1081-1082. [DOI: 10.1016/j.brachy.2017.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 05/28/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
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Dubray BM, Salleron J, Guerif SG, Le Prise E, Reynaud-Bougnoux A, Hannoun-Levi JM, Nguyen TD, Hennequin C, Cretin J, Fayolle-Campana M, Lagrange JL, Bachaud JM, Azria D, Grangirard A, Pommier P, Simon JM, Habibian M, Bey P, Beckendorf V. Does short-term androgen depletion add to high dose radiotherapy (80 Gy) in localized intermediate risk prostate cancer? Final analysis of GETUG 14 randomized trial (EU-20503/NCT00104741). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.5021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - David Azria
- Institut Régional du Cancer, Montpellier, France
| | | | | | | | | | - Pierre Bey
- Institut de Cancérologie de Lorraine, Nancy, France
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Trombetta M, Julian TB, Hannoun-Levi JM. Breast Brachytherapy: Brachytherapy in the Management of Ipsilateral Breast Tumor Recurrence. Brachytherapy 2016. [DOI: 10.1007/978-3-319-26791-3_11] [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: 11/25/2022]
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Gérard JP, Doyen J, Bénézery K, Borens B, Hannoun-Levi JM, François É. [Peri-operative treatments for rectal cancer]. Rev Prat 2015; 65:784-788. [PMID: 26298900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Depending on its location or stage, rectal cancer may differ significantly. Before any treatment decision a careful work up is mandatory relying mainly on endoscopy and imaging (MRI). Surgery according to the TME principle is the cornerstone of treatment. Most of the time surgery is associated with external beam radiotherapy often combined with concurrent chemotherapy (capecitabine) according to the neoadjuvant regimen CAP 50 (5 weeks long). It is sometimes possible to escalate safely the dose of irradiation using contact X-ray brachytherapy 50 Kv or Iridium 192 interstitial brachytherapy. Adjuvant chemotherapy may be given in case of pejorative pathological findings but its benefit is not yet proven in contrast with colon cancer. Local recurrences are becoming unusual as is permanent APE surgery with permanent stoma. To reduce the risk of distant metastasis clinical trials are testing first line chemotherapy in T3-4 lesions. For early stage (T2-"small" T3) clinical trials try to achieve organ preservation. Intensification of CAP 50 either with more chemotherapy or radiation dose escalation using contact X-ray aim at achieving a clinical complete response followed by local excision or close surveillance.
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Falk AT, Claren A, Benezery K, François E, Gautier M, Gerard JP, Hannoun-Levi JM. Interstitial high-dose rate brachytherapy as boost for anal canal cancer. Radiat Oncol 2014; 9:240. [PMID: 25377886 PMCID: PMC4229617 DOI: 10.1186/s13014-014-0240-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 10/16/2014] [Indexed: 12/31/2022] Open
Abstract
AIM To assess clinical outcomes of patients treated with a high-dose rate brachytherapy boost for anal canal cancer (ACC). METHODS From August 2005 to February 2013, 28 patients presenting an ACC treated by split-course external beam radiotherapy (EBRT) and HDR brachytherapy with or without chemotherapy in a French regional cancer center in Nice were retrospectively analyzed. RESULTS Median age was 60.6 years [34 - 83], 25 patients presented a squamous cell carcinoma and 3 an adenocarcinoma; 21 received chemotherapy. Median dose of EBRT was 45 Gy [43.2 - 52]. Median dose of HDR brachytherapy was 12 Gy [10 - 15] with a median duration of 2 days. Median overall treatment time was 63 days and median delay between EBRT and brachytherapy was 20 days. Two-year local relapse free, metastatic free, disease free and overall survivals were 83%, 81.9%, 71.8% and 87.7% respectively. Acute toxicities were frequent but not severe with mostly grade 1 toxicities: 37% of genito-urinary, 40.7% of gastro-intestinal and 3.7% of cutaneous toxicities. Late toxicities were mainly G1 (43.1%) and G2 (22%). Two-year colostomy-free survival was 75.1%, one patient had a definitive sphincter amputation. CONCLUSION High-dose rate brachytherapy for anal canal carcinoma as boost represents a feasible technique compared to low or pulsed-dose rate brachytherapy. This technique remains an excellent approach to precisely boost the tumor in reducing the overall treatment time.
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Affiliation(s)
- Alexander Tuan Falk
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center, 33, Avenue de Valombrose, 06189, Nice, Cedex, France. .,University of Nice Sophia-Antipolis, Nice, France.
| | - Audrey Claren
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center, 33, Avenue de Valombrose, 06189, Nice, Cedex, France. .,University of Nice Sophia-Antipolis, Nice, France.
| | - Karen Benezery
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center, 33, Avenue de Valombrose, 06189, Nice, Cedex, France.
| | - Eric François
- Departement of Medical Oncology, Antoine Lacassagne Cancer Center, Nice, France.
| | - Mathieu Gautier
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center, 33, Avenue de Valombrose, 06189, Nice, Cedex, France.
| | - Jean-Pierre Gerard
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center, 33, Avenue de Valombrose, 06189, Nice, Cedex, France.
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center, 33, Avenue de Valombrose, 06189, Nice, Cedex, France. .,University of Nice Sophia-Antipolis, Nice, France.
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Rouscoff Y, Falk AT, Durand M, Gal J, Chand ME, Gautier M, Marsaud A, Chevallier D, Amiel J, Hannoun-Levi JM. High-dose rate brachytherapy in localized penile cancer: short-term clinical outcome analysis. Radiat Oncol 2014; 9:142. [PMID: 24941956 PMCID: PMC4083333 DOI: 10.1186/1748-717x-9-142] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/10/2014] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess clinical outcomes of high-dose rate interstitial brachytherapy (HIB) in localized penile carcinoma. Material and methods From 03/2006 to 08/2013, patients with biopsy-proven T1-T2 (<4 cm) non-metastatic localized penile squamous cell carcinoma underwent HIB. Under general anaesthesia, after Foley catheter placement, needles were placed in the target volume using a dedicated template. Planification was carried out with a post-implant CT-scan to deliver a total dose of 36 Gy in 9 fractions over 5 days (in adjuvant setting) or 39 Gy in 9 fractions over 5 days (as monotherapy). Dose-volume adaptation was manually achieved using graphical optimization. Dosimetric data and clinical outcomes were retrospectively analyzed. Toxicities were graded using the CTC v4.0. Results With a median follow-up of 27 months [5.1-83], 12 patients including 8 T1a, 3 T1b and 1 T2 N0 underwent HIB (sole therapy: 11 pts; adjuvant: 1 pt). The actuarial 5-year relapse-free, cause-specific and overall survival rates were 83%, 100% and 78% respectively. Comparing pre and post treatment evaluation, no IPSS or IIEF-5 changes were reported. Dermatitis was reported systematically 1 month after HIB including 6 G1, 5 G2 and 1 G3. Only 1 experienced long-term G3 successfully treated with hyperbaric oxygen therapy. One urethral meatus stenosis G3 required meatotomy. Conclusion In selected patients with T1-T2 localized penile cancer, HIB may be considered as an optional conservative therapy. Longer follow-up is needed to confirm these encouraging preliminary results.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jean-Michel Hannoun-Levi
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center and University of Nice-Sophia, Nice, France.
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Boulahssass R, Auben F, Gonfrier S, Mari V, Ferrero JM, Borchiellini D, Bernard JL, Turpin JM, Rambaud C, Gary A, Sacco G, Dittlot C, Mailland V, Benchimol D, Brocker P, Hannoun-Levi JM, Francois E, Guerin O. Treatment decisions for older patients with cancer: Influence of the Comprehensive Geriatric Assessment (CGA) and the choice of the patient and their caregiver. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20518] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Jean-Marc Ferrero
- Centre Antoine Lacassagne, Department d'Oncologie Medicale, Nice, France
| | | | | | | | | | | | | | | | | | | | | | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
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Genebes C, Chand ME, Gal J, Gautier M, Raoust I, Ihrai T, Courdi A, Ferrero JM, Peyrottes I, Hannoun-Levi JM. Accelerated partial breast irradiation in the elderly: 5-year results of high-dose rate multi-catheter brachytherapy. Radiat Oncol 2014; 9:115. [PMID: 24886680 PMCID: PMC4045692 DOI: 10.1186/1748-717x-9-115] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 04/27/2014] [Indexed: 11/10/2022] Open
Abstract
Objective To evaluate clinical outcome after accelerated partial breast irradiation (APBI) in the elderly after high-dose-rate interstitial multi-catheter brachytherapy (HIBT). Methods and materials Between 2005 and 2013, 70 patients underwent APBI using HIBT. Catheter implant was performed intra or post-operatively (referred patients) after lumpectomy and axillary sentinel lymph node dissection. Once the pathological results confirmed the indication of APBI, planification CT-scan was performed to deliver 34 Gy/10f/5d or 32 Gy/8f/4d. Dose-volume adaptation was manually achieved (graphical optimization). Dosimetric results and clinical outcome were retrospectively analyzed. Physician cosmetic evaluation was reported. Results With a median follow-up of 60.9 months [4.6 – 90.1], median age was 80.7 years [62 – 93.1]. Regarding APBI ASTRO criteria, 61.4%, 18.6% and 20% were classified as suitable, cautionary and non-suitable respectively. Axillary sentinel lymph node dissection was performed in 94.3%; 8 pts (11.5%) presented an axillary involvement. A median dose of 34 Gy [32 – 35] in 8 to 10 fractions was delivered. Median CTV was 75.2 cc [16.9 – 210], median D90 EQD2 was 43.3 Gy [35 – 72.6] and median DHI was 0.54 [0.19 – 0.74]. One patient experienced ipsilateral recurrence (5-year local free recurrence rate: 97.6%. Five-year specific and overall survival rates were 97.9% and 93.2% respectively. Thirty-four patients (48%) presented 47 late complications classified grade 1 (80.8%) and grade 2 (19.2%) with no grade ≥ 3. Cosmetic results were considered excellent/good for 67 pts (95.7%). Conclusion APBI using HIBT and respecting strict rules of implantation and planification, represents a smart alternative between no post-operative irradiation and whole breast irradiation delivered over 6 consecutive weeks.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 33, avenue de Valombrose, Nice 06189, France.
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Hannoun-Levi JM, Resch A, Gal J, Kauer-Dorner D, Strnad V, Niehoff P, Loessl K, Kovács G, Van Limbergen E, Polgár C. Accelerated partial breast irradiation with interstitial brachytherapy as second conservative treatment for ipsilateral breast tumour recurrence: Multicentric study of the GEC-ESTRO Breast Cancer Working Group. Radiother Oncol 2013; 108:226-31. [DOI: 10.1016/j.radonc.2013.03.026] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/26/2013] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
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Hannoun-Levi JM, Gourgou-Bourgade S, Belkacemi Y, Chara-Bruneau C, Hennequin C, Quetin P, Orsini C, Brain E, Marsiglia H. GERICO-03 phase II trial of accelerated and partial breast irradiation in elderly women: Feasibility, reproducibility, and impact on functional status. Brachytherapy 2013; 12:285-92. [DOI: 10.1016/j.brachy.2012.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/08/2012] [Accepted: 06/15/2012] [Indexed: 11/12/2022]
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Hannoun-Levi JM, Ihrai T, Courdi A. Local treatment options for ipsilateral breast tumour recurrence. Cancer Treat Rev 2013; 39:737-41. [PMID: 23465859 DOI: 10.1016/j.ctrv.2013.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 01/03/2013] [Revised: 02/04/2013] [Accepted: 02/07/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE In case of ipsilateral breast tumour recurrence (IBTR), radical mastectomy represents the treatment option frequently proposed. A second conservative treatment (2ndCT) has been proposed using either lumpectomy alone or associated with a re-irradiation of the tumor bed. However, in both clinical situations, the proof level of such therapeutic approaches remains low, based on cased-series or retrospective studies (level C). MATERIAL AND METHODS In order to assess the different strategies of local treatment proposed in case of IBTR, a PubMed literature review was performed using the following keywords: breast cancer, ipsilateral recurrence, mastectomy, radiation therapy, brachytherapy. Four different salvage options were analyzed: (a) salvage mastectomy alone; (b) salvage mastectomy with postoperative re-irradiation; (c) 2ndCT with surgery alone; (d) 2ndCT with re-irradiation. RESULTS The rate of second local recurrence is about 10% [3-32%], about 25% [7-36%] and about 10% [2-26%], after salvage mastectomy, salvage lumpectomy alone or combined with a re-irradiation of the tumor bed respectively. However, the 5-year overall survival rates after salvage mastectomy and 2ndCT seem to be equivalent (≈75%) mainly influenced by distant metastatic progression. CONCLUSION In terms of Evidence Based Medicine, different options can be discussed such as Phase III or II randomized trials comparing salvage mastectomy versus 2ndCT, retrospective studies based on a matched-pair analysis or observatory studies. Those study designs need to be carefully analyzed to be able to propose new treatment options for women who experience an IBCR.
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Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, France.
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Hannoun-Levi JM, Chand-Fouche ME, Gautier M, Dejean C, Marcy M, Fouche Y. Interstitial preoperative high-dose-rate brachytherapy for early stage cervical cancer: Dose–volume histogram parameters, pathologic response and early clinical outcome. Brachytherapy 2013; 12:148-55. [DOI: 10.1016/j.brachy.2012.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 04/11/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
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Abstract
Radiotherapy has been driven by constant technological advances since the discovery of X-rays in 1895. Radiotherapy aims to sculpt the optimal isodose on the tumour volume while sparing normal tissues. The benefits are threefold: patient cure, organ preservation and cost-efficiency. The efficacy and tolerance of radiotherapy were demonstrated by randomized trials in many different types of cancer (including breast, prostate and rectum) with a high level of scientific evidence. Such achievements, of major importance for the quality of life of patients, have been fostered during the past decade by linear accelerators with computer-assisted technology. More recently, these developments were augmented by proton and particle beam radiotherapy, usually combined with surgery and medical treatment in a multidisciplinary and personalized strategy against cancer. This article reviews the timeline of 100 years of radiotherapy with a focus on breakthroughs in the physics of radiotherapy and technology during the past two decades, and the associated clinical benefits.
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Affiliation(s)
- Juliette Thariat
- Department of Radiation Oncology, Centre Antoine Lacassagne--University Nice Sophia Antipolis, 33 Avenue Valombrose, 06189 Nice, France
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Hannoun-Levi JM, Polgar C, Van Limbergen E. In regard to Hattangadi et al (Int J Radiat Oncol Biol Phys. Epub Nov 17, 2011): Accelerated Partial Breast Irradiation With Low-Dose-Rate Interstitial Implant Brachytherapy After Wide Local Excision: 12-year Outcomes From a Prospective Trial. Int J Radiat Oncol Biol Phys 2012; 83:481-2. [DOI: 10.1016/j.ijrobp.2012.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Indexed: 10/24/2022]
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Doyen J, Benezery K, Ortholan C, Gérard JP, Hannoun-Levi JM, Follana P, Francois E. Predictive factors of early and late local toxicities in anal cancer treated by radiotherapy in combination with or without chemotherapy. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
667 Background: Treatment of anal cancer is based on combined radiotherapy and chemotherapy (CT). Some patients present early (<2 months) and late (>2 months) toxicities of grade 3 or greater which can strongly impair quality of life. We aimed to identify predictive factors of toxicities in 106 patients treated in a single center between January 2000 and February 2010. Methods: Retrospective analysis of our databases reported severe local toxicities (grade 3 or higher) during treatment of proven localized epidermoid carcinoma of the anal cancer. The following factors were screened as potential predictive factors: gender, age, irradiation dose, HIV status, type of boost (external vs brachytherapy), circumferential extension, type of chemotherapy, invasion of anal margin, clinical T and N stage, and clinical stage. Results: With a median follow-up of 54.1 months (46.8-61.4) early severe local toxicities occurred in 42 patients (pts) (39.6%) whereas late severe toxicities happened in 21 pts (19.8%). Both early and late toxicities were dominated by proctitis (diarrhea and/or rectal bleeding) (7 pts, 6.6% and 6 pts, 5.6% respectively) and recto-anal epithelial toxicities (27 pts, 25.4% and 17 pts, 16% respectively). Two patients got colostomia because of treatment toxicities (1,8%). Predictive factors of increased early toxicities were as follows: clinical stage III/IV (p=0.04), no brachytherapy boost (p=0.008) and type of CT (no CT, 5.9%, CT, 48.8% p=0.001). Brachytherapy boost and presence of CT retained their independency in multivariate analysis (respectively, p=0.001 and p=0.05). Only HIV positivity (p=0.02) was identified as a predictive factor of late toxicities. HIV positivity (p=0.02), invasion of anal margin (p=0.01) and circumferential extension > 33% (p=0.007) correlated with epithelial ulcer. Invasion of anal margin (p<0.001) and circumferential extension (p=0.02) were identified as independent factors in multivariate analysis. Conclusions: In this cohort absence of brachytherapy boost and CT correlated with more severe early local toxicities whereas HIV positivity was the only predictor of local late toxicities.
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Affiliation(s)
- Jerome Doyen
- Department of Radiation Oncology Centre Antoine-Lacassagne, Nice, France; Princess Grace Hospital, Monaco, Monaco; Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Karen Benezery
- Department of Radiation Oncology Centre Antoine-Lacassagne, Nice, France; Princess Grace Hospital, Monaco, Monaco; Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Cecile Ortholan
- Department of Radiation Oncology Centre Antoine-Lacassagne, Nice, France; Princess Grace Hospital, Monaco, Monaco; Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Jean-Pierre Gérard
- Department of Radiation Oncology Centre Antoine-Lacassagne, Nice, France; Princess Grace Hospital, Monaco, Monaco; Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology Centre Antoine-Lacassagne, Nice, France; Princess Grace Hospital, Monaco, Monaco; Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Philippe Follana
- Department of Radiation Oncology Centre Antoine-Lacassagne, Nice, France; Princess Grace Hospital, Monaco, Monaco; Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Eric Francois
- Department of Radiation Oncology Centre Antoine-Lacassagne, Nice, France; Princess Grace Hospital, Monaco, Monaco; Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
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Ortholan C, Resbeut M, Hannoun-Levi JM, Teissier E, Gerard JP, Ronchin P, Zaccariotto A, Minsat M, Benezery K, François E, Salem N, Ellis S, Azria D, Champetier C, Gross E, Cowen D. Anal canal cancer: management of inguinal nodes and benefit of prophylactic inguinal irradiation (CORS-03 Study). Int J Radiat Oncol Biol Phys 2011; 82:1988-95. [PMID: 21570207 DOI: 10.1016/j.ijrobp.2011.02.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 01/16/2011] [Accepted: 02/09/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the benefit of prophylactic inguinal irradiation (PII) in anal canal squamous cell carcinoma (ASCC). METHODS AND MATERIALS This retrospective study analyzed the outcome of 208 patients presenting with ASCC treated between 2000 and 2004 in four cancer centers of the south of France. RESULTS The population study included 35 T1, 86 T2, 59 T3, 20 T4, and 8 T stage unknown patients. Twenty-seven patients presented with macroscopic inguinal node involvement. Of the 181 patients with uninvolved nodes at presentation, 75 received a PII to a total dose of 45-50 Gy (PII group) and 106 did not receive PII (no PII group). Compared with the no PII group, patients in the PII group were younger (60% vs. 41% of patients age <68 years, p = 0.01) and had larger tumor (T3-4 = 46% vs. 27% p = 0.01). The other characteristics were well balanced between the two groups. Median follow-up was 61 months. Fourteen patients in the no PII group vs. 1 patient in the PII group developed inguinal recurrence. The 5-year cumulative rate of inguinal recurrence (CRIR) was 2% and 16% in PII and no PII group respectively (p = 0.006). In the no PII group, the 5-year CRIR was 12% and 30% for T1-T2 and T3-T4 respectively (p = 0.02). Overall survival, disease-specific survival, and disease-free survival were similar between the two groups. In the PII group, no Grade >2 toxicity of the lower extremity was observed. CONCLUSION PII with a dose of 45 Gy is safe and highly efficient to prevent inguinal recurrence and should be recommended for all T3-4 tumors. For early-stage tumors, PII should also be discussed, because the 5-year inguinal recurrence risk remains substantial when omitting PII (about 10%).
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Affiliation(s)
- Cécile Ortholan
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center, Nice, France.
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