1
|
Pereira S, Deneuve S, Iacovelli NA, Duclos M, Cavallo A, Nokovitch L, Roux PE, Girodet D, Poupart M, Zrounba P, Claude L, Ferella L, Valdagni R, Foray N, Orlandi E, Rancati T. Predicting Acute Radio-Induced Toxicity for Head and Neck Cancer Patients: Combining Dosimetry with Biomarker Data, Disclosing a Synergistic Effect. Int J Radiat Oncol Biol Phys 2023; 117:e615. [PMID: 37785847 DOI: 10.1016/j.ijrobp.2023.06.1993] [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) We aimed to establish the added value of combining dosimetry with a binary blood assay for radiosensitivity based on quantification of pATM protein (RADIODTECT©) to predict acute radiotherapy (RT) induced mucositis (MUC) and dysphagia (DYS) in head & neck cancer patients (pts). MATERIALS/METHODS We enrolled 101 pts prospectively scored for acute toxicity with CTCAE. We considered four endpoints: grade≥2 (G2+) and grade≥3 (G3+) MUC, G2+, and G3+ DYS. We dichotomized the pATM concentration to define radiosensitive (RS) vs. radioresistant (RR) pts using previously described cutoffs for G2+ (57.8 ng/mL) and G3+ toxicity (46 ng/mL). We did RADIODTECT© and toxicity scoring blindly. We considered two already published NTCP models, including (i) the Equivalent Uniform Dose to the oral cavity (n = 0.05, EUD_OC, Odds Ratio [OR] = 1.02) and the mean dose to the parotid glands (Dmean_PG, OR = 1.06) for MUC and (ii) EUD_OC (OR = 1.04), the glottic larynx EUD (n = 0.35, EUD_GL, OR = 1.02) and the volume of pharyngeal constrictor muscles receiving>50Gy (V50Gy_CM, OR = 1.02) for DYS. To account for the association of toxicity with the dose distribution in multiple organs at risk (OARs), we derived a "Weighted Dose Score" (WDS) as a linear combination of the dose factors, using their β-coefficients (= lnOR) as weights. WDS for MUC (WDS_OM) = 0.06*Dmean_PG + 0.02*EUD_OC WDS for DYS (WDS_DYS) = 0.02*V50Gy_CM + 0.02*EUD_GL + 0.04*EUD_OC We used WDS as a comprehensive dose feature to fit a dose response and allowed WDS50 (i.e., the WDS associated with 50% toxicity probability) to be different for RR (WDS50_RR) and RS pts (WDS50_RS). The dose-modifying factor (DMF) is the ratio of WDS50_RS/WDS50_RR. It measures the horizontal shift of the dose-response curve when comparing RS vs. RR pts. RESULTS We scored G2+ and G3+ MUC in 80 and 41 pts; G2+ and G3+ DYS in 73 and 35 pts. The average concentration of pATM was 57.4ng/mL (sd 22.3ng/mL): 53/101 pts were classified as RS for G2+ toxicity and 35/101 as RS for G3+. On the whole cohort, the RADIODTECT© did not significantly associate with the risk of toxicity. However, we found two different dose-response curves at low WDS. There, the intrinsic biological sensitivity significantly affects the toxicity probability: ORs for RADIODTECT© are 2.6/2.4 for G2+/G3+ DYS, 6.4/2.9 for G2+/G3+ MUC. Furthermore, the difference in the incidence of side effects in RR vs. RS pts decreases as the WDS increases, reaching a region where the doses of OARs play a significant role. When combined with WDS, the RADIODTECT© effectively predicted RS pts, with DMF ranging from 0.77 for G3+ DYS to 0.40 for G2+ MUC. CONCLUSION These findings support the hypothesis that dose and biomarkers act synergistically; biologically based radiosensitivity plays a significant role when OARs are exposed at lower doses, while high doses of OARs determine toxicity irrespective of the underlying single pt biological characterization.
Collapse
Affiliation(s)
- S Pereira
- Neolys Diagnostics, LYON CEDEX 08, France
| | | | - N A Iacovelli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Radiation Oncology, Milan, Italy
| | - M Duclos
- Neolys Diagnostics, Entzheim, France
| | - A Cavallo
- Fondazione IRCCS Istituto Nazionale dei Tumori, Division of Medical Physics, Milan, Italy
| | | | - P E Roux
- Centre Léon Bérard, LYON, France
| | | | - M Poupart
- Centre Léon Bérard, Radiation Oncology Department, Lyon, France
| | | | - L Claude
- Centre Léon Bérard, Radiation Oncology Department, Lyon, France
| | | | | | | | - E Orlandi
- National Center for Oncological Hadrontherapy (CNAO), Radiation Oncology Clinical Department, Pavia, Italy
| | - T Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Data Science Unit, Milan, Italy
| |
Collapse
|
2
|
Rancati T, Deneuve S, Bastogne T, Duclos M, Bois P, Bachmann P, Nokovitch L, Roux P, Girodet D, Puopart M, Zrounba P, Claude L, Ferella L, Orlandi E, Foray N, Perreira S. PD-0784 Predicting toxicity after RT for head and neck cancer: combining dosimetry with a biomarker. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
3
|
Nokovitch L, Peyrachon B, Chaux-Bodard AG, Poupart M, Roux PE, Devauchelle B, Deneuve S. Reverse blood flow in cervicofacial veins after venous ligations: Potential implications in microsurgery. J Plast Reconstr Aesthet Surg 2020; 74:2042-2049. [PMID: 33455872 DOI: 10.1016/j.bjps.2020.12.066] [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: 10/01/2020] [Revised: 12/10/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The consequences on the cervicofacial venous circulation of major cervicofacial vein ligations are poorly known. We aimed to highlight by using Doppler Ultrasound flow differences in the cervicofacial venous network in the case of unilateral or bilateral ligation of main venous collector trunks (external jugular vein [EJV] and internal jugular vein [IJV]) METHODS: A Doppler ultrasound was performed on 10 healthy volunteers, 8 patients with previous bilateral ligation of the EJV, 8 with a unilateral ligation of the EJV, and 8 with a unilateral ligation of the EJV and IJV, after modified radical neck dissection. The diameter, the flow direction and the peak systolic velocity (PSV) of the superficial temporal vein, the facial vein (FV) and the IJV were measured. RESULTS Healthy patients had a similar right and left PSV for all the veins studied, with always antegrade flows. Patients with previous ligations had some significant right/left differences and retrograde flows. CONCLUSION A redistribution of venous blood flow on the contralateral side of the face and neck seems to take place in the case of unilateral ligation of the EJV and/or IJV. Retrograde flows are sometimes observed in the case of previous ligation of the EJV and/or IJV and might compromise the success of venous microanastomoses.
Collapse
Affiliation(s)
- L Nokovitch
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France.
| | - B Peyrachon
- Vascular Medicine Department, Hôpital Privé Jean Mermoz, Lyon, France
| | | | - M Poupart
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France
| | - P-E Roux
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France
| | - B Devauchelle
- Maxillo-Facial Surgery Department, University Hospital of Amiens, Amiens, France
| | - S Deneuve
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France
| |
Collapse
|
4
|
Nokovitch L, Brantus JF, Vaz G, Deneuve S. Arguments for osteoporosis screening when free fibular flap reconstruction is being considered for head and neck patients. Br J Oral Maxillofac Surg 2020; 58:377-379. [PMID: 32113725 DOI: 10.1016/j.bjoms.2020.02.003] [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: 11/20/2019] [Accepted: 02/06/2020] [Indexed: 10/24/2022]
Affiliation(s)
- L Nokovitch
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France.
| | - J-F Brantus
- Medical Department, Centre Léon Bérard, Lyon, France
| | - G Vaz
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France
| | - S Deneuve
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France
| |
Collapse
|