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Llacer-Moscardo C, Moureau-Zabotto L, Ollivier L, Helfré S, Ducassou A, Bonvalot S, Sunyach MP, Sargos P, Gillon P, Firmin N, Le Péchoux C, Thariat J. Management of oligometastatic/metastatic sarcomas and place of local treatments with focus on modern radiotherapy approaches. Cancer Radiother 2024; 28:93-102. [PMID: 38212215 DOI: 10.1016/j.canrad.2023.06.029] [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: 04/14/2023] [Revised: 05/09/2023] [Accepted: 06/29/2023] [Indexed: 01/13/2024]
Abstract
Soft tissue sarcomas are a rare and heterogeneous disease. For localized disease, treatment is based on surgery and radiotherapy with or without chemotherapy depending on risk factors. Upfront metastases are present in 7 to 20% of cases, and are localized to the lungs in most of cases. Disseminated disease is generally considered incurable but in selected cases, aggressive local treatment of metastases allowed long survival. Treatment of primary tumour is often debated. Our purpose is to evaluate the literature concerning the role of radiotherapy in the management of primary metastatic soft tissue sarcomas.
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Affiliation(s)
- C Llacer-Moscardo
- Radiation oncology department, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France.
| | - L Moureau-Zabotto
- Department of radiotherapy, centre de radiothérapie du Pays d'Aix, avenue Henri-Pontier, 13100 Aix-en-Provence, France
| | - L Ollivier
- Department of radiotherapy, institut de cancérologie de l'Ouest (ICO), centre René-Gauducheau, Saint-Herblain, France
| | - S Helfré
- Department of radiotherapy, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Ducassou
- Department of radiotherapy, IUCT Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - S Bonvalot
- Department of oncological surgery, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - M-P Sunyach
- Department of radiotherapy, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - P Sargos
- Department of radiotherapy, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - P Gillon
- Department of radiotherapy, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - N Firmin
- Radiation oncology department, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - C Le Péchoux
- Department of radiotherapy, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - J Thariat
- Department of radiotherapy, centre François-Baclesse, 12, rue Jean-Baptiste-Colbert, 14000 Caen, France
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Le Péchoux C, Llacer C, Sargos P, Moureau-Zabotto L, Ducassou A, Sunyach MP, Biston MC, Thariat J. Conformal radiotherapy in management of soft tissue sarcoma in adults. Cancer Radiother 2021; 26:377-387. [PMID: 34961656 DOI: 10.1016/j.canrad.2021.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present the update of the recommendations of the French society of radiation oncology on soft tissue sarcomas. Currently, the initial management of sarcomas is very important as it may impact on patients' quality of life, especially in limb soft tissue sarcomas, and on overall survival in trunk sarcomas. Radiotherapy has to be discussed within a multidisciplinary board meeting with results of biopsy, eventually reexamined by a dedicated sarcoma pathologist. The role of radiotherapy varies according to localization of soft tissue sarcoma. It is part of the standard treatment in grade 2 and 3 sarcomas of the extremities and superficial trunk>5cm. In case of R1 or R2 resection, reexcision should be discussed. In such cases, it may be delivered preoperatively (50Gy/25 fractions of 2Gy) or postoperatively. In retroperitoneal sarcomas, preoperative conformal radiotherapy with or without modulated intensity cannot be proposed systematically in daily practice. Concomitant chemoradiotherapy cannot be considered a standard treatment. Intensity-modulated radiotherapy has become widely available. Other soft tissue sarcoma sites such as trunk, head and neck and gynaecological soft tissue sarcomas will be addressed, as well as other techniques that may be used such as brachytherapy and proton therapy.
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Affiliation(s)
- C Le Péchoux
- Département d'oncologie radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - C Llacer
- Département d'oncologie radiothérapie, Institut régional du cancer Montpellier (ICM), université de Montpellier, rue Croix-Verte, 34070 Montpellier, France
| | - P Sargos
- Département d'oncologie radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - L Moureau-Zabotto
- Département d'oncologie radiothérapie, institut Paoli-Calmettes, 13000 Marseille, France
| | - A Ducassou
- Département d'oncologie radiothérapie, institut Claudius-Regaud, 31300 Toulouse, France
| | - M-P Sunyach
- Département d'oncologie radiothérapie, centre Léon-Bérard, 69008 Lyon, France
| | - M-C Biston
- Service de physique médicale, centre Léon-Bérard, 69008 Lyon, France
| | - J Thariat
- Département d'oncologie radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 14000 Caen, France
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Peiffert D, Huguet F, Vendrely V, Moureau-Zabotto L, Rivin Del Campo E, Créhange G, Dietmann AS, Moignier A. Radiotherapy of anal canal cancer. Cancer Radiother 2021; 26:279-285. [PMID: 34955416 DOI: 10.1016/j.canrad.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We present the update of the recommendations of the French society for radiation oncology on external radiotherapy and brachytherapy of anal canal carcinoma. The following guidelines are presented: indications, treatment procedure, as well as dose and dose-constraints objectives, immediate postoperative management, post-treatment evaluation, and long-term follow-up.
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Affiliation(s)
- D Peiffert
- Département de radiothérapie, Institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France.
| | - F Huguet
- Service de radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - V Vendrely
- Service d'oncologie-radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33600 Pessac, France; Inserm U1035, université de Bordeaux, 33000 Bordeaux, France
| | - L Moureau-Zabotto
- Service de radiothérapie, institut Paoli-Calmettes, 13000 Marseille, France
| | - E Rivin Del Campo
- Service de radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - G Créhange
- Département d'oncologie radiothérapie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
| | - A-S Dietmann
- Département de radiothérapie, Institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | - A Moignier
- Service de physique médicale, Institut de cancérologie de l'Ouest centre René-Gauducheau, 44805 Saint-Herblain, France
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Ducassou A, Llacer C, Sargos P, Moureau-Zabotto L, Sunyach MP, Thariat J, Le Péchoux C. [Rôle of radiotherapy for sarcomas]. Cancer Radiother 2021; 25:598-602. [PMID: 34215521 DOI: 10.1016/j.canrad.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022]
Abstract
The quality of the initial management of sarcomas is fundamental because it conditions the patient's quality of life and his overall survival. Radiotherapy should be discussed in a multidisciplinary consultation meeting within the framework of the Netsarc+network. The place of radiotherapy in patients with soft tissue or bone sarcoma depends on the histology and tumour location, knowing that it is most often associated with surgery which remains the main treatment. It is part of the standard treatment for grade II and III deep limb sarcomas of 5cm or greater in size and Ewing's sarcomas. In these indications, conformal radiotherapy with modulation of intensity is used routinely, in combination with IGRT. In other locations, such as retroperitoneal sarcomas or uterine sarcomas, radiotherapy is not a standard of care and must be discussed according to the prognostic criteria related to the patient, the tumour, and the previously received treatments. New techniques, such as proton therapy, hadron therapy (carbon ions) are techniques particularly suited to bone sarcomas considered to be radioresistant. However, large prospective trials are lacking in these rare indications, explaining the lack of recommendations of a high level of evidence.
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Affiliation(s)
- A Ducassou
- IUCT-oncopole, département d'oncologie radiothérapie, institut Claudius-Regaud, 31300 Toulouse, France.
| | - C Llacer
- Département d'oncologie radiothérapie, institut régional du cancer de Montpellier, 34070 Montpellier, France
| | - P Sargos
- Département d'oncologie radiothérapie, institut Bergonié, 33000 Bordeaux, France
| | - L Moureau-Zabotto
- Département d'oncologie radiothérapie, Centre de radiothérapie du Pays d'Aix, 13100 Aix-en-Provence, France
| | - M-P Sunyach
- Département d'oncologie radiothérapie, centre Léon-Bérard, 69008 Lyon, France
| | - J Thariat
- Département d'oncologie radiothérapie, centre François-Baclesse, 14000 Caen, France
| | - C Le Péchoux
- Département d'oncologie radiothérapie, Gustave-Roussy, 94805 Villejuif, France
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Farnault B, Favrel V, Moureau-Zabotto L, Rolland J, Tallet A, Fau P. EP-1815 MCO in VMAT treatment planning for locally advanced head and neck cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32235-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sargos P, Charleux T, Haas R, Michot A, Llacer C, Moureau-Zabotto L, Vogin G, Le Péchoux C, Verry C, Ducassou A, Delannes M, Mervoyer A, Wiazzane N, Thariat J, Sunyach M, Benchalal M, Laredo J, Kind M, Gillon P, Kantor G. Pre- and postoperative radiotherapy for extremity soft tissue sarcoma: Evaluation of inter-observer target volume contouring variability among French sarcoma group radiation oncologists. Cancer Radiother 2018; 22:131-139. [DOI: 10.1016/j.canrad.2017.09.004] [Citation(s) in RCA: 4] [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: 08/07/2017] [Revised: 08/24/2017] [Accepted: 09/07/2017] [Indexed: 01/08/2023]
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Mineur L, Deplanque G, Desseigne F, Moureau-Zabotto L, Boulat O, Jalali K, Smith D, Obled S, Belkacemi M. P-284 NESC Multicenter phase II trial in the Preoperative Treatment of gastric adenocarcinoma consisting of chemotherapy using docetaxel-cisplatin-5FU + lenograstim followed by chemoradiation (RTCT) based 5FU and oxaliplatin and surgery. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.274] [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: 11/13/2022] Open
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Moureau-Zabotto L, Delannes M, Le Péchoux C, Sunyach M, Kantor G, Sargos P, Thariat J, Llacer-Moscardo C. Prise en charge des sarcomes des tissus mous des membres par radiothérapie externe. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.02.002] [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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Moureau-Zabotto L, Delannes M, Le Péchoux C, Sunyach M, Kantor G, Sargos P, Thariat J, Llacer-Moscardo C. Prise en charge des sarcomes des tissus mous des membres par radiothérapie externe. Cancer Radiother 2016; 20:133-40. [DOI: 10.1016/j.canrad.2015.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 09/25/2015] [Accepted: 10/13/2015] [Indexed: 01/15/2023]
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Llacer-Moscardo C, Le Pechoux C, Sunyach M, Thezenas S, Ducassou A, Delannes M, Noel G, Thariat J, Vogin G, Fourquet J, Vilotte F, Sargos P, Kantor G, Chapet S, Moureau-Zabotto L. PO-0768: Evaluation of RT practice for limb soft tissue sarcomas and its impact on prognosis and toxicity. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Moureau-Zabotto L, Delannes M, Le Péchoux C, Sunyach M, Kantor G, Sargos P, Thariat J, Llacer-Moscardo C. Prise en charge des sarcomes des tissus mous des membres par radiothérapie externe. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.02.001] [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: 11/29/2022]
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Moureau-Zabotto L, Gal J, Resbeut M, Mineur L, Teissier É, Hébuterne X, Muyldermans P, Francois É, Chamorey E, Gérard JP. [Management and clinical outcome in patients over 80 years with rectal cancer treated between 2006 and 2008 in Southern France (PACA region)]. Cancer Radiother 2015; 19:725-32. [PMID: 26548601 DOI: 10.1016/j.canrad.2015.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 05/19/2015] [Accepted: 05/22/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE Rectal cancer is increasingly prevalent in elderly patients. Their clinical history and outcome after treatment are poorly described. This retrospective study was undertaken to provide more data and to compare therapeutic strategies to the standard of care for younger patients. PATIENTS AND METHODS Patients concerned were aged 80 years or older, with a rectal cancer diagnosed between 2006 and 2008 and treated in Provence-Alpes-Côte-d'Azur (PACA), irrespective of stage and treatment of the disease. Overall survival and relapse-free-survival were correlated with patients' characteristics and treatment. The adopted therapeutic strategy was then compared to the standard-of-care for younger patients. RESULTS With a median follow-up of 36 months, among the 160 patients included, the 3-year overall survival and relapse-free survival were 59.2% and 76.6%, respectively for the 117 patients who received a treatment with curative intent. In the multivariate analysis, node status and surgery independently influenced overall survival, while relapse-free survival was influenced by age, N status, and gender. For T0-T2 tumours, patients were treated similarly to younger patients with an overall survival of 83.6% and a relapse-free survival of 95.2%. For T3-T4 tumours, the 3-year relapse-free survival was 65%, even with a less aggressive strategy. CONCLUSION Surgical resection after evaluation using the Comprehensive Geriatric Assessment (CGA) test should be the standard treatment for localized rectal cancer (T0-T2) in elderly patients, as it is in younger patients. For locally advanced lesions (T3-T4), results obtained after a conservative approach suggest that a non-surgical strategy can be used in elderly patients.
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Affiliation(s)
- L Moureau-Zabotto
- Département de radiothérapie, institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France.
| | - J Gal
- Département de biostatistiques, centre Antoine-Lacassagne, 133, avenue de Valombrose, 06189 Nice, France
| | - M Resbeut
- Département de radiothérapie, institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Centre de radiothérapie Saint-Louis, Croix-Rouge française, rue André-Blondel, 83100 Toulon, France
| | - L Mineur
- Service d'oncologie-radiothérapie, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS 800005, 84918 Avignon cedex 9, France
| | - É Teissier
- Centre azuréen de cancérologie, 1, place Docteur-Jean-Luc-Broquerie, 06250 Mougins, France
| | - X Hébuterne
- Service de gastro-entérologie, centre hospitalier universitaire de Nice, 151, route Saint-Antoine-de-Ginestière, 06202 Nice, France
| | - P Muyldermans
- Centre de radiothérapie du Pays-d'Aix, avenue Henri-Pontier, 13100 Aix-en Provence, France
| | - É Francois
- Département d'oncologie médicale, centre Antoine-Lacassagne, 133, avenue de Valombrose, 06189 Nice, France
| | - E Chamorey
- Centre de radiothérapie Saint-Louis, Croix-Rouge française, rue André-Blondel, 83100 Toulon, France
| | - J-P Gérard
- Département de radiothérapie, centre Antoine-Lacassagne, 133, avenue de Valombrose, 06189 Nice, France
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Falk AT, Moureau-Zabotto L, Ouali M, Penel N, Italiano A, Bay JO, Olivier T, Sunyach MP, Boudou-Roquette P, Salas S, Le Maignan C, Ducassou A, Isambert N, Kalbacher E, Pan C, Saada E, Bertucci F, Thyss A, Thariat J. Effect on survival of local ablative treatment of metastases from sarcomas: a study of the French sarcoma group. Clin Oncol (R Coll Radiol) 2015; 27:48-55. [PMID: 25300878 DOI: 10.1016/j.clon.2014.09.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [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: 05/18/2014] [Revised: 07/31/2014] [Accepted: 09/04/2014] [Indexed: 01/08/2023]
Abstract
AIMS Recent data suggest that patients with pulmonary metastases from sarcomas might benefit from ablation of their metastases. Some data are available regarding osteosarcomas/angiosarcomas and lung metastases. The purpose of this study was to assess the efficacy of local ablative treatment on the survival of patients with oligometastases (one to five lesions, any metastatic site, any grade/histology) from sarcomas. MATERIALS AND METHODS A multicentric retrospective study of the French Sarcoma Group was conducted in sarcoma patients with oligometastases who were treated between 2000 and 2012. Survival was analysed using multivariate sensitivity analyses with propensity scores to limit bias. RESULTS Of the 281 patients evaluated, 164 patients received local treatment for oligometastases between 2000 and 2012. The groups' characteristics were similar in terms of tumour size and remission of the primary tumours. The median follow-up was 25.7 months; 129 (45.9%) patients had died at this point. The median overall survivals were 45.3 (95% confidence interval = 34-73) months for the local treatment group and 12.6 for the other group (95% confidence interval = 9.33-22.9). Survival was better among patients who received local treatment (hazard ratio = 0.47; 95% confidence interval = 0.29-0.78; P < 0.001). Subgroup analyses revealed similar findings in the patients with single oligometastases (hazard ratio = 0.48; 95% confidence interval = 0.28-0.82; P = 0.007); a significant benefit was observed for grade 3, and a trend was observed for grade 2. CONCLUSION Local ablative treatment seemed to improve the overall survival of the patients who presented with oligometastatic sarcomas, including soft tissue and bone sarcomas. The survival benefit remained after repeated local treatments for several oligometastatic events. Surgery yielded the most relevant results, but alternative approaches (i.e. radiofrequency ablation and radiotherapy) seemed to be promising. The relevance of these results is strengthened by our analysis, which avoided biases by restricting the population to patients with oligometastatic disease and used propensity scores.
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Affiliation(s)
- A T Falk
- Centre Antoine Lacassagne, Nice, France
| | | | - M Ouali
- Centre Claudius Regaud, Toulouse, France
| | - N Penel
- Centre Oscar Lambret, Lille, France
| | | | - J-O Bay
- Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - T Olivier
- Institut régional du cancer de Montpellier, Montpellier, France
| | | | | | - S Salas
- Paris Descartes University, Paris, France
| | | | | | - N Isambert
- Centre Georges-François Leclerc, Dijon, France
| | - E Kalbacher
- Centre Hospitalier Universitaire, Besançon, France
| | - C Pan
- CHU Henri Mondor, Creteil, France
| | - E Saada
- Centre Antoine Lacassagne, Nice, France
| | - F Bertucci
- Institut Paoli-Calmettes, Marseille, France
| | - A Thyss
- Centre Antoine Lacassagne, Nice, France
| | - J Thariat
- Centre Antoine Lacassagne, Nice, France.
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Falk A, Moureau-Zabotto L, Penel N, Italiano A, Bay J, Sunyach M, Ducassou M, Olivier T, Thyss A, Thariat J. Improved Outcomes With Iterative Local Treatments of Oligometastases in Sarcomas: A French Sarcoma Group Study. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1624] [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: 11/29/2022]
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15
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Moureau-Zabotto L, Resbeut M, Gal J, Mineur L, Teissier E, Hebuterne X, Muyldermans P, Francois E, Chamorey E, Gerard JP. Management and clinical outcome of rectal cancer in patients ≥80 years treated in southern France (PACA region) between 2006 and 2008. J Surg Oncol 2013; 108:450-6. [DOI: 10.1002/jso.23428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/10/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | - M. Resbeut
- Departement de Radiotherapie; Institut Paoli Calmettes; France
- Croix Rouge Francaise, Centre de Radiothérapie Saint Louis; Toulon France
| | - J. Gal
- Centre Antoine Lacassagne; Nice France
| | - L. Mineur
- Institut Sainte Catherine; Avignon France
| | - E. Teissier
- Centre Azureen de Cancérologie; Mougins France
| | | | - P. Muyldermans
- Centre de Radiotherapie du Pays d'Aix; Aix-en-Provence France
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Gonçalves A, Gilabert M, François E, Dahan L, Perrier H, Lamy R, Re D, Largillier R, Gasmi M, Tchiknavorian X, Esterni B, Genre D, Moureau-Zabotto L, Giovannini M, Seitz JF, Delpero JR, Turrini O, Viens P, Raoul JL. BAYPAN study: a double-blind phase III randomized trial comparing gemcitabine plus sorafenib and gemcitabine plus placebo in patients with advanced pancreatic cancer. Ann Oncol 2012; 23:2799-2805. [PMID: 22771827 DOI: 10.1093/annonc/mds135] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sorafenib is an oral anticancer agent targeting Ras-dependent signaling and angiogenic pathways. A phase I trial demonstrated that the combination of gemcitabine and sorafenib was well tolerated and had activity in advanced pancreatic cancer (APC) patients. The BAYPAN study was a multicentric, placebo-controlled, double-blind, randomized phase III trial comparing gemcitabine/sorafenib and gemcitabine/placebo in the treatment of APC. PATIENTS AND METHODS The patient eligibility criteria were locally advanced or metastatic pancreatic adenocarcinoma, no prior therapy for advanced disease and a performance status of zero to two. The primary end point was progression-free survival (PFS). The patients received gemcitabine 1000 mg/m(2) i.v., weekly seven times followed by 1 rest week, then weekly three times every 4 weeks plus sorafenib 200 mg or placebo, two tablets p.o., twice daily continuously. RESULTS Between December 2006 and September 2009, 104 patients were enrolled on the study (52 pts in each arm) and 102 patients were treated. The median and the 6-month PFS were 5.7 months and 48% for gemcitabine/placebo and 3.8 months and 33% for gemcitabine/sorafenib (P = 0.902, stratified log-rank test), respectively. The median overall survivals were 9.2 and 8 months, respectively (P = 0.231, log-rank test). The overall response rates were similar (19 and 23%, respectively). CONCLUSION The addition of sorafenib to gemcitabine does not improve PFS in APC patients.
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Affiliation(s)
- A Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Cancer Research Center of Marseille, U1068 INSERM, CNRS UMR7258; Aix-Marseille University, Marseille; Clinical Investigation Center 9502, Marseille.
| | - M Gilabert
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - E François
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice
| | - L Dahan
- Aix-Marseille University, Marseille; Clinical Investigation Center 9502, Marseille; Department of Digestive Oncology, Hôpital de le Timone, Assistance Publique-Hôpitaux de Marseille, Marseille
| | - H Perrier
- Digestive Oncology Unit, Hôpital Saint-Joseph, Marseille
| | - R Lamy
- Department of Oncology, Centre Hospitalier Bretagne Sud (Lorient), Lorient
| | - D Re
- Medicine Unit, Centre Hospitalier Antibes Juan-les-Pins, Antibes
| | - R Largillier
- Department of Oncology, Centre azuréen de cancérologie, Mougins
| | - M Gasmi
- Department of Gastro-enterology, Hôpital Nord APHM, Marseille
| | - X Tchiknavorian
- Department of Medical Oncology, Centre Hospitalier Toulon, Toulon, France
| | - B Esterni
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Clinical Investigation Center 9502, Marseille
| | - D Genre
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Clinical Investigation Center 9502, Marseille
| | | | - M Giovannini
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - J-F Seitz
- Aix-Marseille University, Marseille; Clinical Investigation Center 9502, Marseille; Department of Digestive Oncology, Hôpital de le Timone, Assistance Publique-Hôpitaux de Marseille, Marseille
| | - J-R Delpero
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Cancer Research Center of Marseille, U1068 INSERM, CNRS UMR7258; Aix-Marseille University, Marseille; Clinical Investigation Center 9502, Marseille
| | - O Turrini
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Cancer Research Center of Marseille, U1068 INSERM, CNRS UMR7258; Aix-Marseille University, Marseille
| | - P Viens
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Cancer Research Center of Marseille, U1068 INSERM, CNRS UMR7258; Aix-Marseille University, Marseille; Clinical Investigation Center 9502, Marseille
| | - J-L Raoul
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille; Cancer Research Center of Marseille, U1068 INSERM, CNRS UMR7258
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Moureau-Zabotto L, Turrini O, Bertucci F, Raoul JL, Giovannini M, Bories E, Poizat F, Sarran A, Delpero JR, Resbeut M. Prise en charge du cholangiocarcinome extrahépatique par chimioradiothérapie concomitante : à propos d’une série rétrospective de 30 patients. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.07.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Farnault B, Bories E, De Chaisemartin C, Raoul JL, Lelong B, Poizat F, Pesenti C, Delpero JR, Giovannini M, Moureau-Zabotto L. Fiabilité de l’échoendoscopie dans l’évaluation de la réponse tumorale après chimioradiothérapie concomitante pour un cancer du rectum localement évolué. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.07.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moureau-Zabotto L, Ortholan C, Hannoun-Lévi JM, Tessier E, Cowen D, Salem N, Lemanski C, Ellis S, Resbeut M. Influence du boost en curiethérapie dans la prise en charge des cancers du canal anal avec envahissement ganglionnaire initial (étude CORS-03). Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.07.118] [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: 11/29/2022]
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Luporsi E, Kamioner D, Moureau-Zabotto L, Barry B, Bensadoun R, Gangneux J. Diagnostic et traitement de la candidose oropharyngée de l’adulte : proposition de consensus multidisciplinaire. J Mycol Med 2012. [DOI: 10.1016/j.mycmed.2012.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Thariat J, Moureau-Zabotto L, Penel N, Italiano A, Bay JO, Sunyach MP, Ducassou M, Aldabbagh K, Pan Q, Thyss A. Sarcoligo, impact du traitement local ablatif (chirurgie, radiothérapie, radiofréquence, etc.) des oligométastases sur la survie globale des patients atteints de sarcomes. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Farnault B, Moureau-Zabotto L, de Chaisemartin C, Giovannini M, Monges G, Delpero J, Viens P, Resbeut M. Accuracy of endorectal ultrasonography in evaluation of response to chemoradiation in locally advanced rectal cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3543] [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: 11/20/2022] Open
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23
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Goncalves A, Viret F, François E, Dahan L, Perrier H, Lamy R, Re D, Largillier R, Gasmi M, Tchiknavorian X, Turrini O, Moureau-Zabotto L, Delpero J, Viens P. BAYPAN study: A double-blind, phase III randomized trial of gemcitabine plus sorafenib versus gemcitabine plus placebo in patients with advanced pancreatic cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Farnault B, Moureau-Zabotto L, de Chaisemartin C, Esterni B, Lelong B, Viret F, Giovannini M, Monges G, Delpero JR, Bories E, Turrini O, Viens P, Resbeut M. [Predictive factors of tumour response after neoadjuvant chemoradiation for locally advanced rectal cancer and correlation of these factors with survival]. Cancer Radiother 2011; 15:279-86. [PMID: 21515083 DOI: 10.1016/j.canrad.2011.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 01/24/2011] [Accepted: 01/28/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE Neoadjuvant chemoradiation followed by surgery is the standard of care for locally advanced rectal cancer. The aim of this study was to correlate tumour response to survival and to identify predictive factors for tumour response after chemoradiation. PATIENTS AND METHODS From 1998 to 2008, 168 patients with histologically-proven locally advanced adenocarcinoma treated by preoperative chemoradiation before total mesorectal excision were retrospectively studied. They received a radiation dose of 45 Gy with a concomitant 5-fluoro-uracil-based chemotherapy. Analysis of tumour response was based on the lowering of T stage between pre-treatment endorectal ultrasound and pathologic specimens. Overall and progression-free survival was correlated with tumour response. Tumour response was analysed with predictive factors. RESULTS The median follow-up was 34 months. Five-year disease-free survival and overall survival were respectively of 44.4% and 74.5% in the whole population, 83.4% and 83.4% in patients with pathological complete response, 38.6% and 71.9% in patients with tumour downstaging, 29.1% and 58.9% in patients with absence of response. A pre-treatment concentration of carcinoembryonnic antigen below 5 ng/mL was significantly associated with tumour downstaging and significantly independently associated with pathologic complete tumour response (P = 0.019). CONCLUSION Downstaging and complete response after chemoradiation improved progression-free survival and overall survival of locally advanced rectal adenocarcinoma. In multivariate analysis, a pre-treatment concentration of carcinoembryonnic antigen below 5 ng/mL was associated with complete tumour response, hence with tumour downstaging.
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Affiliation(s)
- B Farnault
- Département de radiothérapie, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France.
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Moureau-Zabotto L, Viret F, Giovaninni M, Lelong B, Bories E, Delpero J, Pesenti C, Caillol F, de Chaisemartin C, Minsat M, Monges G, Sarran A, Resbeut M. Is neoadjuvant chemotherapy prior to radio-chemotherapy beneficial in T4 anal carcinoma? J Surg Oncol 2011; 104:66-71. [DOI: 10.1002/jso.21866] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 12/21/2010] [Indexed: 01/09/2023]
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Turrini O, Ychou M, Moureau-Zabotto L, Rouanet P, Giovannini M, Moutardier V, Azria D, Delpero JR, Viret F. Neoadjuvant docetaxel-based chemoradiation for resectable adenocarcinoma of the pancreas: New neoadjuvant regimen was safe and provided an interesting pathologic response. Eur J Surg Oncol 2010; 36:987-92. [DOI: 10.1016/j.ejso.2010.07.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 07/12/2010] [Accepted: 07/15/2010] [Indexed: 01/18/2023] Open
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Turrini O, Viret F, Moureau-Zabotto L, Guiramand J, Moutardier V, Lelong B, Giovannini M, Delpero JR. Neoadjuvant chemoradiation and pancreaticoduodenectomy for initially locally advanced head pancreatic adenocarcinoma. Eur J Surg Oncol 2009; 35:1306-11. [PMID: 19576722 DOI: 10.1016/j.ejso.2009.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 06/03/2009] [Accepted: 06/08/2009] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The most accepted treatment for locally advanced pancreatic adenocarcinoma (LAPA) is chemoradiotherapy (CRT). We sought to determine the benefit of pancreaticoduodenectomy (PD) in patients with LAPA initially treated by neoadjuvant CRT. METHODS From January 1996 to December 2006, 64 patients with LAPA (borderline, n=49; unresectable, n=15) received 5-fluorouracil-cisplatin-based CRT. Of the 64 patients, 47 had progressive disease at restaging. Laparotomy was performed for 17 patients, and PD was performed in 9 patients (resected group). Fifty-five patients had CRT followed by gemcitabine-based chemotherapy (unresected group). RESULTS The median survival and overall 5 years survival duration of all 64 patients were 14 months and 12%, respectively. The mean delay between diagnosis and surgical resection was 5.5 months. Mortality and morbidity from PD were 0% and 33%, respectively. The median survival of the resected group vs. the unresected group was 24 months vs. 13 months. Three specimens presented a major pathological response at histological examination. No involved margins were found and positive lymph nodes were found in one patient. Resected patients developed distant metastases. CONCLUSIONS PD after CRT was safe and resected patients had interesting survival rates. However, resected patients developed metastatic disease and new neoadjuvant regimens are needed to improve the survival of these patients.
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Affiliation(s)
- O Turrini
- Department of Surgical Oncology, Institut Paoli-Calmettes and Université de Méditerranée Marseille, France.
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De Rauglaudre G, Courdi A, Delaby-Chagrin F, d’Hombres A, Hannoun-Levi JM, Moureau-Zabotto L, Richard-Tallet A, Rouah Y, Salem N, Thomas O, Nocera T, Mery S, Merial-Kieny C. Tolérance de l’association de sucralfate / sels de Cu-Zn dans les radiodermites. Ann Dermatol Venereol 2008; Spec No 1:11-5. [DOI: 10.1016/s0151-9638(08)70092-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Minsat M, Moureau-Zabotto L, Giovannini M, Lelong B, Viret F, Bories E, Tallet A, Salem N. Traitement conservateur descarcinomes épidermoïdes ducanal anal parirradiation externe suivie decuriethérapie de bas débit dedose parIridium 192. Cancer Radiother 2007. [DOI: 10.1016/j.canrad.2007.09.123] [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: 11/15/2022]
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Moureau-Zabotto L, Minsat M, Giovannini M, Lelong B, Viret F, Borries E, Tallet A, Salem N. Conservative Management of Squamous Cell Anal Carcinoma With External Beam Radiation Therapy and Low Dose 192Ir Interstitial Brachytherapy. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Moureau-Zabotto L, Phélip J, Afchain P, Mineur L, André T, Vendrely V, Lledo G, Dupuis O, Touboul E, Balosso J. Concomitant administration of weekly oxaliplatin, 5FU continuous infusion and radiotherapy in locally advanced pancreatic cancer (LAPC): A GERCOR phase II study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4039] [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
4039 Background: According to previous GERCOR studies in LAPC, concomitant chemoradiation therapy (CCRT) is indicated for non-progressive patients (pts) after systemic chemotherapy (CT). In order to improve the results of a classical 5FU-based CCRT, this study was designed to assess the efficacy and toxicity of weekly oxaliplatin (Ox), 5FU continuous infusion (c.i.) and radiation therapy (RT) in LAPC pts. Methods: Eligibility criteria included non resectable pathologically-proven LAPC, age > 18 yrs, PS < 2, and no prior CT or RT. All patients were first treated with 4 cycles of GEMOX (gemcitabine 1000 mg/m2, 100 min IV, d1; Ox 100 mg/m2, 2h IV, d2, every 2 wk). One month after cycle 4, non-progressive pts with PS < 2 received 45 Gy (25 fractions, 5 d/wk) + 10 Gy (concomitant boost in macroscopic tumor during wks 4 & 5, six hours apart large volume irradiation), combined with 250 mg/m2/d 5FU c.i. and weekly Ox. Initial 50 mg/m2 Ox dose was increased to 60 mg/m2 in absence of unacceptable toxicity after the 3 first included pts. Results: 60 pts were included (29 F/ 31 M, age 65.8 ± 9.6 yrs, range 37 - 80). 50 pts (83%) received CCRT, while 10 did not for the following reasons: metastatic progression (7 pts), OMS>2 (1), and CT toxicity (2). 44 pts (73 %) received the full planned CCRT dose-intensity. NCI-CTC grade 3–4 toxicities during CCRT and the following month (% of pts) were : neutropenia (14%), thrombocytopenia (10%), nausea-vomiting (20%), diarrhea (12%) and neuropathy (2%). 2 toxic deaths occurred during CCRT. With a median follow up of 15 mo, median progression-free survival (PFS) and overall survival (OS) of the whole population were 7.6 mo and 13.8 mo, respectively. For pts who received CCRT, median PFS and OS were 9.4 and 13.9 mo, respectively (2.6 and 9.9 mo, respectively, for pts who did not received CCRT). Conclusion: Chemotherapy before CCRT can identify pts who might potentially benefit of CCRT. Concomitant administration of weekly Ox, continuous IV FU and RT in LAPC is feasible with an acceptable toxicity. The results in terms of PFS and OS compare favourably with a classical 5FU-based CCRT. [Table: see text]
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Affiliation(s)
- L. Moureau-Zabotto
- Hôpital Tenon, Paris, France; Centre Hospitalo-Universitaire de Grenoble, La Tronche, France; Centre Hospitalo-Universitaire Saint-Antoine, Paris, France; Institut Sainte Catherine, Avignon, France; Centre Hospitalo-Universitaire Saint André, Bordeaux, France; Clinique St. Jean, Lyon, France; Clinique Victor Hugo, Le Mans, France
| | - J. Phélip
- Hôpital Tenon, Paris, France; Centre Hospitalo-Universitaire de Grenoble, La Tronche, France; Centre Hospitalo-Universitaire Saint-Antoine, Paris, France; Institut Sainte Catherine, Avignon, France; Centre Hospitalo-Universitaire Saint André, Bordeaux, France; Clinique St. Jean, Lyon, France; Clinique Victor Hugo, Le Mans, France
| | - P. Afchain
- Hôpital Tenon, Paris, France; Centre Hospitalo-Universitaire de Grenoble, La Tronche, France; Centre Hospitalo-Universitaire Saint-Antoine, Paris, France; Institut Sainte Catherine, Avignon, France; Centre Hospitalo-Universitaire Saint André, Bordeaux, France; Clinique St. Jean, Lyon, France; Clinique Victor Hugo, Le Mans, France
| | - L. Mineur
- Hôpital Tenon, Paris, France; Centre Hospitalo-Universitaire de Grenoble, La Tronche, France; Centre Hospitalo-Universitaire Saint-Antoine, Paris, France; Institut Sainte Catherine, Avignon, France; Centre Hospitalo-Universitaire Saint André, Bordeaux, France; Clinique St. Jean, Lyon, France; Clinique Victor Hugo, Le Mans, France
| | - T. André
- Hôpital Tenon, Paris, France; Centre Hospitalo-Universitaire de Grenoble, La Tronche, France; Centre Hospitalo-Universitaire Saint-Antoine, Paris, France; Institut Sainte Catherine, Avignon, France; Centre Hospitalo-Universitaire Saint André, Bordeaux, France; Clinique St. Jean, Lyon, France; Clinique Victor Hugo, Le Mans, France
| | - V. Vendrely
- Hôpital Tenon, Paris, France; Centre Hospitalo-Universitaire de Grenoble, La Tronche, France; Centre Hospitalo-Universitaire Saint-Antoine, Paris, France; Institut Sainte Catherine, Avignon, France; Centre Hospitalo-Universitaire Saint André, Bordeaux, France; Clinique St. Jean, Lyon, France; Clinique Victor Hugo, Le Mans, France
| | - G. Lledo
- Hôpital Tenon, Paris, France; Centre Hospitalo-Universitaire de Grenoble, La Tronche, France; Centre Hospitalo-Universitaire Saint-Antoine, Paris, France; Institut Sainte Catherine, Avignon, France; Centre Hospitalo-Universitaire Saint André, Bordeaux, France; Clinique St. Jean, Lyon, France; Clinique Victor Hugo, Le Mans, France
| | - O. Dupuis
- Hôpital Tenon, Paris, France; Centre Hospitalo-Universitaire de Grenoble, La Tronche, France; Centre Hospitalo-Universitaire Saint-Antoine, Paris, France; Institut Sainte Catherine, Avignon, France; Centre Hospitalo-Universitaire Saint André, Bordeaux, France; Clinique St. Jean, Lyon, France; Clinique Victor Hugo, Le Mans, France
| | - E. Touboul
- Hôpital Tenon, Paris, France; Centre Hospitalo-Universitaire de Grenoble, La Tronche, France; Centre Hospitalo-Universitaire Saint-Antoine, Paris, France; Institut Sainte Catherine, Avignon, France; Centre Hospitalo-Universitaire Saint André, Bordeaux, France; Clinique St. Jean, Lyon, France; Clinique Victor Hugo, Le Mans, France
| | - J. Balosso
- Hôpital Tenon, Paris, France; Centre Hospitalo-Universitaire de Grenoble, La Tronche, France; Centre Hospitalo-Universitaire Saint-Antoine, Paris, France; Institut Sainte Catherine, Avignon, France; Centre Hospitalo-Universitaire Saint André, Bordeaux, France; Clinique St. Jean, Lyon, France; Clinique Victor Hugo, Le Mans, France
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Moureau-Zabotto L, Ricci S, Lefranc JP, Coulet F, Genestie C, Antoine M, Uzan S, Lotz JP, Touboul E, Lacave R. Prognostic impact of multidrug resistance gene expression on the management of breast cancer in the context of adjuvant therapy based on a series of 171 patients. Br J Cancer 2006; 94:473-80. [PMID: 16434992 PMCID: PMC2361174 DOI: 10.1038/sj.bjc.6602958] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [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] [Indexed: 12/14/2022] Open
Abstract
Study of the prognostic impact of multidrug resistance gene expression in the management of breast cancer in the context of adjuvant therapy. This study involved 171 patients treated by surgery, adjuvant chemotherapy±radiotherapy±hormonal therapy (mean follow-up: 55 months). We studied the expression of multidrug resistance gene 1 (MDR1), multidrug resistance-associated protein (MRP1), and glutathione-S-transferase P1 (GSTP1) using a standardised, semiquantitative rt–PCR method performed on frozen samples of breast cancer tissue. Patients were classified as presenting low or high levels of expression of these three genes. rt-PCR values were correlated with T stage, N stage, Scarff–Bloom–Richardson (SBR) grade, age and hormonal status. The impact of gene expression levels on 5-year disease-free survival (DFS) and overall survival (OS) was studied by univariate and multivariate Cox analysis. No statistically significant correlation was demonstrated between MDR1, MRP1 and GSTP1 expressions. On univariate analysis, DFS was significantly decreased in a context of low GSTP1 expression (P=0.0005) and high SBR grade (P=0.003), size ⩾5 cm (P=0.038), high T stage (P=0.013), presence of intravascular embolus (P=0.034), and >3 N+ (P=0.05). On multivariate analysis, GSTP1 expression and the presence of ER remained independent prognostic factors for DFS. GSTP1 expression did not affect OS. The levels of MDR1 and MRP1 expression had no significant influence on DFS or OS. GSTP1 expression can be considered to be an independent prognostic factor for DFS in patients receiving adjuvant chemotherapy for breast cancer.
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Affiliation(s)
- L Moureau-Zabotto
- Service d'Oncologie Radiothérapie, Hôpital Tenon, AP-HP, Cancerest, GHU EST, Université Paris VI, 4 rue de la Chine, Paris 75020, France.
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Moureau-Zabotto L, Bouchet C, Cesari D, Uzan S, Lefranc JP, Antoine M, Genestie C, Deniaud-Alexandre E, Bernaudin JF, Touboul E, Fleury-Feith J. [Combined flow cytometry determination of S-phase fraction and DNA ploidy is an independent prognostic factor in node-negative invasive breast carcinoma: review of a series of 271 patients with stage I and II breast cancer]. Cancer Radiother 2005; 9:575-86. [PMID: 16243560 DOI: 10.1016/j.canrad.2005.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 03/09/2005] [Revised: 08/16/2005] [Accepted: 09/14/2005] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the significance of S-phase fraction (SPF) and DNA ploidy evaluated by DNA flow cytometry as prognostic markers in stage I or II breast cancer. PATIENTS AND METHODS A series of 271 patients, treated by surgery, radiotherapy+/-systemic therapy was analysed (median follow up: 64 months). Standardized flow cytometry cell preparation from frozen samples and consensus rules for data interpretation were followed. Three SPF classes were defined on the basis of tertiles after adjustment for ploidy. Four groups were defined based on combinations of DNA ploidy (DIP: diploid; ANEUP: aneuploid) and SPF: DIP and low SPF (DL, N=37), DIP and medium or high SPF (DMH, N=76), ANEUP and low SPF (AL, N=24), ANEUP and medium or high SPF (AMH, N=68). Local control rate (LCR), disease-free survival (DFS), metastasis-free survival (MFS), and overall survival (OS) were correlated with DNA ploidy, SPF, DL to AMH groups, T and N stages, SBR grading, age, and hormonal status on univariate and multivariate analysis (Cox model). RESULTS On univariate analysis, DFS and LCR were higher for DIP tumours. High SPF values were associated with shorter DFS. LCR, MFS, DFS, and OS rates were significantly different with an increasingly poorer prognosis from DL to AMH. On multivariate analysis, groups DL to AMH, histological node involvement and T stage were independently associated with MFS, and DFS. In N- patients, DL to AMH remained independent for MFS and DFS. For SBR III tumours, MFS and OS were significantly different in DL to AMH groups. These results strongly support the use of combined evaluation of DNA ploidy and SPF as independent parameters in clinical trials for N- stage I and II breast cancer.
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Affiliation(s)
- L Moureau-Zabotto
- Service d'oncologie radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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Moureau-Zabotto L, Bouchet C, Cesari D, Uzan S, Lefranc JP, Antoine M, Genestie C, Deniaud-Alexandre E, Bernaudin JF, Touboul E, Fleury-Feith J. Combined flow cytometry determination of S-phase fraction and DNA ploidy is an independent prognostic factor in node-negative invasive breast carcinoma: analysis of a series of 271 patients with stage I and II breast cancer. Breast Cancer Res Treat 2005; 91:61-71. [PMID: 15868432 DOI: 10.1007/s10549-004-7047-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the significance of S-phase fraction (SPF) and DNA ploidy evaluated by DNA flow cytometry as prognostic markers in stage I or II breast cancer. PATIENTS AND METHODS A series of 271 patients, treated by surgery, radiotherapy +/- systemic therapy was analyzed (median follow up: 64 months). Standardized flow cytometry cell preparation from frozen samples and consensus rules for data interpretation were followed. Three SPF classes were defined on the basis of tertiles after adjustment for ploidy. Four groups were defined based on combinations of DNA ploidy (DIP: diploid; ANEUP: aneuploid) and SPF: DIP and low SPF (DL, n=37), DIP and medium or high SPF (DMH, n=76), ANEUP and low SPF (AL, n=24), ANEUP and medium or high SPF (AMH, n=68). Local control rate (LCR), disease-free survival (DFS), metastasis-free survival (MFS), and overall survival (OS) were correlated with DNA ploidy, SPF, DL to AMH groups, T and N stages, SBR grading, age, and hormonal status on univariate and multivariate analysis (Cox model). RESULTS On univariate analysis, DFS and LCR were higher for DIP tumours. High SPF values were associated with shorter DFS. LCR, MFS, DFS, and OS rates were significantly different with an increasingly poorer prognosis from DL to AMH. On multivariate analysis, groups DL to AMH, histological node involvement and T stage were independently associated with MFS, and DFS. In N- patients, DL to AMH remained independent for MFS and DFS. For SBR III tumours, MFS and OS were significantly different in DL to AMH groups. These results strongly support the use of combined evaluation of DNA ploidy and SPF as independent parameters in clinical trials for N- stage I and II breast cancer.
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Moureau-Zabotto L, Touboul E, Lerouge D, Deniaud-Alexandre E, Grahek D, Foulquier JN, Petenief Y, Grès B, El Balaa H, Kerrou K, Montravers F, Keraudy K, Tiret E, Gendre JP, Grange JD, Hourry S, Talbot JN. Tomographie par émission de positons et fusion d'images de simulation virtuelle par tomodensitométrie. Impact sur la planification de la radiothérapie conformationnelle des cancers de l'œsophage. Cancer Radiother 2005; 9:152-60. [PMID: 16023043 DOI: 10.1016/j.canrad.2005.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 03/07/2005] [Revised: 03/18/2005] [Accepted: 04/01/2005] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the impact of fused (18)F-fluoro-deoxy-D-glucose (FDG)-hybrid positron emission tomography (PET) and computed tomography (CT) images on conformal radiation therapy (CRT) planning for patients with esophageal carcinoma. PATIENTS AND METHODS Thirty-four patients with esophageal carcinoma were referred for concomitant radiotherapy and chemotherapy with radical intent. Each patient underwent CT and FDG-hybrid PET for simulation treatment in the same radiation treatment position. PET-images were coregistered using five fiducial markers. Target delineation was initially performed on CT images and the corresponding PET data were subsequently used as an overlay to CT data to define the target volume. RESULTS FDG-PET identified previously undetected distant metastatic disease in 2 patients, making them ineligible for curative CRT. The Gross Tumor Volume (GTV) was decreased by CT and FDG image fusion in 12 patients (35%) and was increased in 7 patients (20.5%). The GTV reduction was >or=25% in 4 patients due to reduction of the length of the esophageal tumor. The GTV increase was >or=25% with FDG-PET in 2 patients due to the detection of occult mediastinal lymph node involvement in one patient and an increased length of the esophageal tumor in the other patient. Modifications of the GTV affected the planning treatment volume (PTV) in 18 patients. Modifications of delineation of GTV and displacement of the isocenter of PTV by FDG-PET also affected the percentage of total lung volume receiving more than 20 Gy (VL20) in 25 patients (74%), with a dose reduction in 12 patients and a dose increase in 13 patients. CONCLUSION In our study, CT and FDG-PET image fusion appeared to have an impact on treatment planning and management of patients with esophageal carcinoma related to modifications of GTV. The impact on treatment outcome remains to be demonstrated.
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Affiliation(s)
- L Moureau-Zabotto
- Service d'oncologie-radiothérapie, hôpital Tenon AP-HP, 4, rue de la Chine, 75020 Paris et CancerEst, université Paris-VI, GHU Est, France
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Touboul E, Deniaud-Alexandre E, Moureau-Zabotto L, Lerouge D. [The impact of integrating images of positron emission tomography with computed tomography simulation on radiation therapy planning]. Cancer Radiother 2004; 8 Suppl 1:S29-35. [PMID: 15679244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The coregistration of planning CT and 18F-fluoro-deoxy-2-glucose (FDG) positron emission tomography (PET) with patient in the same treatment position is the principally well-established tool for improving the target coverage defined and the target planning volume to treat the metabolic target volume. Most of the interest in the coresgistred CT/PET images on volume delineation has focused on conformal radiation therapy of non-small cell lung cancer. In spite of technical difficulties related to the target volume displacements, and the sensitivity and the specificity of FDG-PET images < 100%, the target volume delineation is significantly changed by the coregistration of FDG-PET images and planning CT by either reduction of the radiation volume (excluding atelectasis or mediastinal lymph node) or the increasing of mediastinal lymph node involvement. Image fusion technique reduces the interobserver variability in target volume delineation. Furthermore, after induction chemotherapy image fusion leads to improve the patient management by detecting locoregional progression disease or the presence of metastatic disease. Other anatomic tumor sites are going to investigate such as: head-and-neck cancer, gynecologic cancer, oesophageal cancer, anal cancer, Hodgkin's disease, and non-Hodgkin's lymphoma. The impact on treatment outcome remains to be demonstrated.
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Affiliation(s)
- E Touboul
- Service d'oncologie-radiothérapie, hôpital Tenon AP-HP, Cancerest, université Paris-VI, GHU-Est, 4, rue de la Chine, 75020 Paris, France.
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Moureau-Zabotto L, Thomas L, Bui BN, Chevreau C, Stockle E, Martel P, Bonneviale P, Marques B, Coindre JM, Kantor G, Matsuda T, Delannes M. Prise en charge des sarcomes des tissus mous en première rechute locale isolée : étude rétrospective de 83 cas. Cancer Radiother 2004; 8:279-87. [PMID: 15561593 DOI: 10.1016/j.canrad.2004.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2004] [Revised: 09/13/2004] [Accepted: 09/15/2004] [Indexed: 11/18/2022]
Abstract
PURPOSE To analyse the management and clinical outcome of patients treated for a first isolated local recurrence of soft tissue sarcoma (trunk or extremities) and to identify prognosis factors. PATIENTS AND MATERIAL This is a retrospective study of 83 adult patients treated between 1980 and 1999. Mean tumor size was 6 cm. Most sarcomas were located in extremities (N =74), were deep (N =60), and proximal (N =53). Thirty involved nerves or vessels. Histologic subtypes were mainly grade 2 (42%) or 3 (36%) histocytofibrosarcomas (49%) and liposarcomas (20%). Surgical treatment of recurrences consisted in wide excision (32 cases), marginal resection (46 cases), five patients requiring amputation. Final results were R0 (N =33), R1 (N =47) or R2 (N =3) resection. Beside surgery, six patients received neoadjuvant and seven others adjuvant chemotherapy. Twenty-three patients received postoperative external beam radiotherapy (EBRT) (mean dose 55 Gy) and 26 interstitial (192)Ir low dose rate brachytherapy (BCT) (mean dose 45 Gy for BCT alone, 22 Gy when associated with EBRT), 19 patients being re-irradiated. RESULTS Mean follow up was 59 months. Thirty-seven (45%) tumors relapsed, 62% locally as first event. Nineteen patients developed secondary distant metastases. Multivariate analysis showed only tumour depth (P =0.05) and re-resection for primary R1 resection for the recurrence (P =0.018) being independent prognosis factors for tumour control, radiotherapy (EBRT and/or BCT) being significant in univariate analysis (P =0.05). Overall survival rate was 73, 54, and 47% at respectively 3, 5 and 10 years, and was 65, 35 and 32% after a further local recurrence. Multivariate analysis showed trunk (P =0.0001) or inferior extremity locations (P =0.023), symptomatic (P =0.001), high grade (P =0.01), deep (P = 0.01) tumours, and the occurrence of a further local failure (P =0.004) as unfavourable characteristics for overall survival. CONCLUSION Because of the high relapse rate in this series, a first isolated local recurrence of STS increases mainly the risk of a subsequent local relapse. Quality of local treatment for the first local relapse is decisive. When a conservative treatment is feasible, it should combine surgical resection and radiotherapy, brachytherapy being the best suited in previously irradiated patients. Efforts have to be pursued to increase quality of the treatment of primary tumours, at best performed in centers that have expertise in this field.
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Affiliation(s)
- L Moureau-Zabotto
- Département d'oncologie radiothérapie, institut Clandius-Regaud, Toulouse, France.
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Lerouge D, Touboul E, Lefranc JP, Genestie C, Moureau-Zabotto L, Blondon J. [Locally advanced non inflammatory breast cancer treated by combined chemotherapy and preoperative irradiation: updated results in a series of 120 patients]. Cancer Radiother 2004; 8:155-67. [PMID: 15217583 DOI: 10.1016/j.canrad.2004.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 09/29/2003] [Revised: 01/07/2004] [Accepted: 01/16/2004] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate our updated data concerning survival and locoregional control in a study of locally advanced non inflammatory breast cancer after primary chemotherapy followed by external preoperative irradiation. PATIENTS AND METHODS Between 1982 and 1998, 120 patients (75 stage IIIA, 41 stage IIIB, and 4 stage IIIC according to AJCC staging system 2002) were consecutively treated by four courses of induction chemotherapy with anthracycline-containing combinations followed by preoperative irradiation (45 Gy to the breast and nodal areas) and a fifth course of chemotherapy. Three different locoregional approaches were proposed, depending on tumour characteristics and tumour response. After completion of local therapy, all patients received a sixth course of chemotherapy and a maintenance adjuvant chemotherapy regimen without anthracycline. The median follow-up from the beginning of treatment was 140 months. RESULTS Mastectomy and axillary dissection were performed in 49 patients (with residual tumour larger than 3 cm in diameter or located behind the nipple or with bifocal tumour), and conservative treatment in 71 patients (39 achieved clinical complete response or partial response >90% and received additional radiation boost to initial tumour bed; 32 had residual mass <or=3 cm in diameter and were treated by wide excision and axillary dissection followed by a boost to the excision site). Ten-year actuarial local failure rate was 13% after irradiation alone, 23% after wide excision and irradiation, and 4% after mastectomy (p =0.1). After multivariate analysis, possibility of breast-conserving therapy was related to initial tumour size (<6 vs. >or=6 cm in diameter, p =0.002). Ten-year overall metastatic disease-free survival rate was 61%. After multivariate analysis, metastatic disease-free survival rates were significantly influenced by clinical stage (stage IIIA-B vs. IIIC, p =0.0003), N-stage (N0 vs. N1-2a, and 3c, p =0.017), initial tumour size (<6 vs. >or=6 cm in diameter, p =0.008), and tumour response after induction chemotherapy and preoperative irradiation (clinically complete response + partial response vs. non-response, p =0.0015). In the non conservative breast treatment group, of the 32 patients with no change in clinical tumour size after induction chemotherapy, the 10-year metastatic disease-free survival rate was 59% with only one local relapse. Arm lymphedema was noted in 17% (14 of 81) following axillary dissection and in 2.5% (1 of 39) without axillary dissection. Cosmetic results were satisfactory in 70% of patients treated by irradiation alone and in 51.5% of patients after wide excision and irradiation. CONCLUSION Despite the poor prognosis of patients with locally advanced non inflammatory breast cancer resistant to primary anthracycline-based regimen, aggressive locoregional management using preoperative irradiation and mastectomy with axillary dissection offers a possibility of long term survival with low local failure rate for patients without extensive nodal disease. On the other hand, the rate of local failure seems to be high in patients with clinical partial tumour response following induction chemotherapy and breast-conserving treatment combining preoperative irradiation and large wide excision.
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Affiliation(s)
- D Lerouge
- Service d'oncologie-radiothérapie, hôpital Tenon AP-HP, 4, rue de la Chine, 75020 Paris, France
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Lerouge D, Touboul E, Lefranc JP, Uzan S, Jannet D, Moureau-Zabotto L, Genestie C, Antoine M, Jamali M. Association concomitante préopératoire de radiothérapie et de chimiothérapie dans les cancers du col utérin opérables de stades IB2, IIA et IIB proximal de gros volume. Cancer Radiother 2004; 8:168-77. [PMID: 15217584 DOI: 10.1016/j.canrad.2004.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2003] [Revised: 02/11/2004] [Accepted: 02/14/2004] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate preliminary results in terms of toxicity, local tumour control, and survival after preoperative concomitant chemoradiation for operable bulky cervical carcinomas. PATIENTS AND METHODS Between December 1991 and October 2001, 42 patients (pts) with bulky cervical carcinomas stage IB2 (11 pts), IIA (15 pts), and IIB (16 pts) with 1/3 proximal parametrial invasion. Median age was 45 years (range: 24-75 years) and clinical median cervical tumour size was 5 cm (range: 4.1-8 cm). A clinical pelvic lymph node involvement has been observed in 10 pts. All patients underwent preoperative external beam pelvic radiation therapy (EBPRT) and concomitant chemotherapy during the first and the fourth radiation weeks combining 5-fluorouracil and cisplatin. The pelvic dose was 40.50 Gy over 4.5 weeks. EBPRT was followed by low-dose-rate uterovaginal brachytherapy with a total dose of 20 Gy in 17 pts. After a rest period of 5-6 weeks, all pts underwent class II modified radical hysterectomy with bilateral lymphadenectomy. Para-aortic lymphadenectomy was performed in eight pts without pathologic para-aortic lymph node involvement. Twenty-one of 25 pts who had not received preoperative uterovaginal brachytherapy underwent postoperative low-dose-rate vaginal brachytherapy of 20 Gy. The median follow-up was 31 months (range: 3-123 months). RESULTS Pathologic residual tumour or lymph node involvement was observed in 23 pts. Among the 22 pts with pathologic residual cervical tumour (<0.5 cm: nine pts; >or=0.5 to <or=1 cm: three pts; >1 cm: 10 pts), seven underwent preoperative EBRT followed by uterovaginal brachytherapy vs. 15 treated with preoperative EBRT alone (P = 0.23). Four pts had pathologic lymph node involvement, three pts had vaginal residual tumour, and four pts had pathologic parametrial invasion. The 2- and 5-year overall survival rates were 85% and 74%, respectively. The 2- and 5-year disease-free survival (DFS) rates were 80% and 71%, respectively. After multivariate analysis, the pathologic residual cervical tumour size was the single independent factor decreasing the probability of DFS (P = 0.0054). The 5-year local control rate and metastatic failure rate were 90% and 83.5%, respectively. Haematological effects were moderate. However, six pts had grade 3 acute intestinal toxicity. Four severe late complications requiring surgical intervention were observed (one small bowel complication, three ureteral complications). CONCLUSION Primary concomitant chemoradiation followed surgery for bulky operable stage I-II cervical carcinomas can be employed with acceptable toxicity. However, systematic preoperative uterovaginal brachytherapy should increase local tumour control.
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Affiliation(s)
- D Lerouge
- Service d'oncologie-radiothérapie, hôpital Tenon, AP-HP, 75020 Paris cedex 20, France
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Deniaud-Alexandre E, Lauratet B, Lefranc JP, Genestié C, Lerouge D, Moureau-Zabotto L, Touboul E. Rechute locale isolée après traitement conservateur pour un carcinome mammaire de stade I ou II, à propos de 57 patientes. Cancer Radiother 2004; 8:95-107. [PMID: 15063877 DOI: 10.1016/j.canrad.2004.01.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2003] [Revised: 01/19/2004] [Accepted: 01/29/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE - To identify predicting factors of local control and survival after isolate local failure by statistical analysis of the data after breast-conserving treatment for early breast cancer. METHODS AND PATIENTS - In time of local failure, mean age was 54.7 years old, mean tumor size was 19.3 mm and recurrence was more often infiltrating ductal carcinoma (88%). Local recurrence was unifocal in 44 cases and localised outside of the site of the primary tumorectomy in 35 cases. Local failure treatment was a radical mastectomy or parietectomy (53 patients). Hormonotherapy was delivered in 36 patients and chemotherapy was delivered in 26 patients. Mean follow-up was 62 months. RESULTS - Fifteen patients developed second local recurrence in a mean time of 36 months. Five years local control rate was 68% after the first local failure. Surgery treatment (non-conservative surgery vs. conservative surgery) was the only factor which influenced local control. Six patients developed homolateral axillary and/or supraclavicular node recurrence. Twelve patients underwent metastasis in a mean time of 36 months after the first local recurrence. Five years metastasis free survival rate was 80%. Peritumoral vascular invasion in time of the first local failure increased metastasis risk and node recurrence. Second local failure did not alter metastasis free survival. CONCLUSION - Peritumoral vascular invasion in time of the first local failure decreased node and metastasis free survival. Surgery should be radical, but the place of chemotherapy and hormonotherapy was not definite.
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MESH Headings
- Adult
- Age Factors
- Aged
- Breast/pathology
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Chemotherapy, Adjuvant
- Chi-Square Distribution
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Lymphatic Metastasis
- Mastectomy, Radical
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Metastasis
- Neoplasm Recurrence, Local
- Prognosis
- Radiotherapy Dosage
- Recurrence
- Risk Factors
- Survival Analysis
- Time Factors
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Affiliation(s)
- E Deniaud-Alexandre
- Service d'oncologie-radiothérapie, hôpital Tenon AP-HP, 4, rue de la Chine, 75020 Paris, France.
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Touboul E, Moureau-Zabotto L, Lerouge D, Pène F, Deniaud-Alexandre E, Tiret E, Sezeur A, Houry S, Gallot D, Parc R, Schlienger M, Laugier A. [Radiotherapy of carcinomas of the anal canal. Tenon Hospital experience]. Cancer Radiother 2003; 7 Suppl 1:91s-99s. [PMID: 15124550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Since 1980, curative-intent radiation therapy of epidermoid carcinoma of the anal canal is the standard first line treatment. The combined concomitant chemotherapy and radiation therapy is presently established for locally advanced tumors more than 4 cm in length and/or with nodal involvement. We report the Tenon hospital experience since 1972 concerning the long term results after radiation therapy, the modifications of the radiation technique, and the evolution of treatment strategy.
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MESH Headings
- Aged
- Anal Canal/pathology
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/therapeutic use
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Anus Neoplasms/drug therapy
- Anus Neoplasms/mortality
- Anus Neoplasms/pathology
- Anus Neoplasms/radiotherapy
- Anus Neoplasms/surgery
- Brachytherapy
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/radiotherapy
- Carcinoma, Transitional Cell/surgery
- Cisplatin/administration & dosage
- Cisplatin/therapeutic use
- Combined Modality Therapy
- Female
- Fluorouracil/administration & dosage
- Fluorouracil/therapeutic use
- Follow-Up Studies
- Humans
- Iridium Radioisotopes
- Male
- Middle Aged
- Neoplasm Metastasis
- Neoplasm Recurrence, Local
- Particle Accelerators
- Radiotherapy Dosage
- Retrospective Studies
- Time Factors
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Affiliation(s)
- E Touboul
- Service d'oncologie-radiothérapie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
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