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Guillemin F, Blanchard P, Boisselier P, Brahimi Y, Calugaru V, Coutte A, Gillon P, Graff P, Liem X, Modesto A, Pointreau Y, Racadot S, Sun XS, Bellini R, Pham Dang N, Saroul N, Bourhis J, Thariat J, Biau J, Lapeyre M. [Proposal for the delineation of postoperative primary clinical target volumes in maxillary sinus and nasal cavity cancers]. Cancer Radiother 2024; 28:218-227. [PMID: 38599940 DOI: 10.1016/j.canrad.2023.12.001] [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: 11/20/2023] [Accepted: 12/31/2023] [Indexed: 04/12/2024]
Abstract
In this article, we propose a consensus delineation of postoperative clinical target volumes for the primary tumour in maxillary sinus and nasal cavity cancers. These guidelines are developed based on radioanatomy and the natural history of those cancers. They require the fusion of the planning CT with preoperative imaging for accurate positioning of the initial GTV and the combined use of the geometric and anatomical concepts for the delineation of clinical target volume for the primary tumour. This article does not discuss the indications of external radiotherapy (nor concurrent systemic treatment) but focuses on target volumes when there is an indication for radiotherapy.
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Affiliation(s)
- F Guillemin
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - P Blanchard
- Département de radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - P Boisselier
- Département de radiothérapie, Institut régional cancer de Montpellier, parc Euromedecine, 208, rue des Apothicaires, 34090 Montpellier, France
| | - Y Brahimi
- Département de radiothérapie, institut de cancérologie Strasbourg Europe (ICANS), 13, rue Albert-Calmette, 67200 Strasbourg, France
| | - V Calugaru
- Département de radiothérapie, institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - A Coutte
- Département de radiothérapie, CHU d'Amiens-Picardie, 30, avenue de la Croix-Jourdain, 80054 Amiens cedex 1, France
| | - P Gillon
- Département de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - P Graff
- Département de radiothérapie, institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - X Liem
- Pôle de radiothérapie curiethérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59020 Lille cedex, France
| | - A Modesto
- Département de radiothérapie, IUCT Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - Y Pointreau
- Département de radiothérapie, institut interrégional de cancérologie (ILC), centre Jean-Bernard, centre de cancérologie de la Sarthe (CCS), 64, rue de Degré, 72000 Le Mans, France
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - X S Sun
- Département de radiothérapie, hôpital Nord Franche-Comté de Montbéliard, CHRU de Besançon, 1, rue Henri-Becquerel, 25200 Montbéliard, France
| | - R Bellini
- Département de radiodiagnostic, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - N Pham Dang
- Département de chirurgie maxillofaciale, centre hospitalier universitaire Estaing, 63003 Clermont-Ferrand cedex 1, France
| | - N Saroul
- Département de chirurgie ORL, centre hospitalier universitaire Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France
| | - J Bourhis
- Département de radiothérapie, centre hospitalier universitaire vaudois (CHUV), rue du Bugnon 46, 1005 Lausanne, Suisse
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France.
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Allali S, Carton M, Everhard S, Rivera S, Ghannam Y, Peignaux K, Guilbert P, De La Lande B, Chara-Brunaud C, Blanchecotte J, Pasquier D, Racadot S, Bourgier C, Cottu P, André F, Kirova Y. CANTO skin: Evaluation of skin toxicity risk factors in patients treated for breast cancer. Int J Cancer 2023; 153:1797-1808. [PMID: 37572223 DOI: 10.1002/ijc.34664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 08/14/2023]
Abstract
Skin reaction is a common toxicity during oncology management, especially followed during the radiotherapy. Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients treated for an early breast cancer (BC). We evaluated 8561 patients during their overall management for a BC. We focus on specific skin toxicities: erythema, fibrosis, telangiectasia and changes of skin colour. These toxicities were assessed at the baseline defined as 0-3-6 (M0), 12 (M12), 36 (M36) and 60 (M60) months. The prevalence of toxicities of interest varied over time, so at M0, 30.4% of patients had erythema while 17.7% of patients had fibrosis. At M60, the prevalence of erythema was 2%, while fibrosis remained stable at about 19%. After adjustments, at M0, there was a significant association between the onset of cutaneous erythema and obesity, the presence of axillary dissection, the type of surgery and the tumour phenotype RH+/HER2+. Concerning fibrosis, a significant association was found, at M12, with the age of the patient, obesity, Charlson score and type of surgery. Concerning the modification of skin colour at M12, we find a link between the age of the patient, obesity, tobacco consumption and alcohol consumption. The prevention of this toxicity is a major issue for the quality of life. Our results allow us to understand the risk of developing skin toxicity in a patient, depending on her intrinsic, tumour or therapeutic characteristics and to implement adapted means of prevention and monitoring.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - David Pasquier
- Centre Oscar Lambret, Academic Department of Radiation Oncology, Lille, France
- Université de Lille, CHU Lille, CNRS, Centrale Lille, Lille, France
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Costea M, Zlate A, Serre AA, Racadot S, Baudier T, Chabaud S, Grégoire V, Sarrut D, Biston MC. Evaluation of different algorithms for automatic segmentation of head-and-neck lymph nodes on CT images. Radiother Oncol 2023; 188:109870. [PMID: 37634765 DOI: 10.1016/j.radonc.2023.109870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/27/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To investigate the performance of 4 atlas-based (multi-ABAS) and 2 deep learning (DL) solutions for head-and-neck (HN) elective nodes (CTVn) automatic segmentation (AS) on CT images. MATERIAL AND METHODS Bilateral CTVn levels of 69 HN cancer patients were delineated on contrast-enhanced planning CT. Ten and 49 patients were used for atlas library and for training a mono-centric DL model, respectively. The remaining 20 patients were used for testing. Additionally, three commercial multi-ABAS methods and one commercial multi-centric DL solution were investigated. Quantitative evaluation was assessed using volumetric Dice Similarity Coefficient (DSC) and 95-percentile Hausdorff distance (HD95%). Blind evaluation was performed for 3 solutions by 4 physicians. One recorded the time needed for manual corrections. A dosimetric study was finally conducted using automated planning. RESULTS Overall DL solutions had better DSC and HD95% results than multi-ABAS methods. No statistically significant difference was found between the 2 DL solutions. However, the contours provided by multi-centric DL solution were preferred by all physicians and were also faster to correct (1.1 min vs 4.17 min, on average). Manual corrections for multi-ABAS contours took on average 6.52 min Overall, decreased contour accuracy was observed from CTVn2 to CTVn3 and to CTVn4. Using the AS contours in treatment planning resulted in underdosage of the elective target volume. CONCLUSION Among all methods, the multi-centric DL method showed the highest delineation accuracy and was better rated by experts. Manual corrections remain necessary to avoid elective target underdosage. Finally, AS contours help reducing the workload of manual delineation task.
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Affiliation(s)
- Madalina Costea
- Centre Léon Bérard, 28 rue Laennec, LYON 69373 Cedex 08, France; CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France
| | | | | | | | - Thomas Baudier
- Centre Léon Bérard, 28 rue Laennec, LYON 69373 Cedex 08, France; CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France
| | - Sylvie Chabaud
- Unité de Biostatistique et d'Evaluation des Thérapeutiques, Centre Léon Bérard, Lyon 69373, France
| | | | - David Sarrut
- Centre Léon Bérard, 28 rue Laennec, LYON 69373 Cedex 08, France; CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France
| | - Marie-Claude Biston
- Centre Léon Bérard, 28 rue Laennec, LYON 69373 Cedex 08, France; CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France.
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Allali S, Carton M, Sarrade T, Everhard S, Rivera S, Ghannam Y, Peignaux K, Guilbert P, Chara-Brunaud C, Blanchecotte J, Pasquier D, Racadot S, Bourgier C, Cottu P, Kirova Y. CANTO: Skin Toxicities Evaluation of a Multicenter Large Prospective Cohort of Irradiated Patients for Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e163. [PMID: 37784763 DOI: 10.1016/j.ijrobp.2023.06.995] [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) Skin damage is a common toxicity during oncology management. Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients treated for an early breast cancer (BC). MATERIALS/METHODS CANTO (NCT01993498) is a prospective, multicentric, clinical cohort study of 11 400 patients with stage I-III BC, treated in 26 French cancer centers. In this study, we will evaluate the 8561 patients during their overall management for a BC. We are focus on specifical skin toxicities: Erythema, fibrosis, telangiectasia and skin color (CTCAE v4.0). These toxicities were assessed at 3-6 (M0), 12 (M12), 36 (M36), 60 (M60) months. RESULTS The prevalence of toxicities of interest varied over time, so at M0, 30.4% of patients had erythema while 17.7% of patients had fibrosis. At M12, M36 and M60, the prevalence of erythema decreased from 5.5 % to 2.5 % then to 2 %, respectively, while fibrosis remained stable at about 19 %. The prevalence of telangiectasia increased from 0.8 % to 7 % from M0 to M60. While the modification of skin color was 51.1 % at M0, and 10.6 % at M60. After adjustments, at M0, there was a statistically significant association between the onset of cutaneous erythema and obesity, the presence of axillary dissection, the type of surgery the age of the patient as well as the tumor phenotype RH+/HER2+ [OR: 0.79 [0.67; 0.93]]. Concerning fibrosis, a statistically significant association was found, at M12, with the age of the patient, obesity, tumor grade, Charlson score, type of surgery and mitotic index. Obesity and the age of the patient represent at M12 and M36 a risk significantly associated with the onset of telangiectasia. Concerning the modification of skin color at M12, we find a link between the age of the patient, obesity, tobacco consumption, tumor grade, Charlson score, type of surgery, and alcohol consumption [OR: 0.69 [0.51; 0.91]]. CONCLUSION In this study we identified several risk factors for acute and late skin toxicity. The knowledge of its predictive factors allows a personalized management of the patient by adapting our treatments and our monitoring according to these different factors.
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Affiliation(s)
- S Allali
- Institut Curie Paris, Paris, France
| | | | - T Sarrade
- Gustave Roussy, Cancer Campus, Villejuif, France
| | | | - S Rivera
- Gustave Roussy, Cancer Campus, Villejuif, France
| | - Y Ghannam
- Gustave Roussy, Cancer Campus, Villejuif, France
| | - K Peignaux
- Centre Georges-François Leclerc, Dijon, France
| | | | - C Chara-Brunaud
- Institut de cancérologie de Lorraine, Vandoeuvre les Nancy, France
| | - J Blanchecotte
- Institut de Cancérologie de L'ouest - Paul Papin, Angers, France
| | | | | | - C Bourgier
- Institut du Cancer de Montpellier, Montpellier, France
| | - P Cottu
- Institut Curie, Paris, France
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Bollet MA, Racadot S, Rivera S, Arnaud A, Bourgier C. [Breast cancer radiation therapy: Current questions in 2023]. Cancer Radiother 2023; 27:524-530. [PMID: 37541797 DOI: 10.1016/j.canrad.2023.07.005] [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: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 08/06/2023]
Abstract
Radiation therapy is a corner stone of breast cancer treatment as it has been shown postoperatively that it improves local control and overall survival. In recent years, multidisciplinary therapeutic strategies have evolved considerably for early-stage breast cancer, both surgically and in terms of systemic treatments or radiation therapy. Each of these developments affects other treatment components and open up new questions allowing even more personalized treatments. Essentially normofractionated a few years ago, breast radiation therapy is today very largely moderately or even ultra hypofractionated. De-escalation of the surgery of the axilla has changed the indications for lymph node radiation therapy keeping similar efficacy with reduced toxicity. Indications for radiation therapy after neoadjuvant chemotherapy remain based on pre-chemotherapy staging pending the results of ongoing randomized studies. The addition of a boost to the tumor bed significantly reduces the risk of local recurrence, but the magnitude of this benefit decreases with increasing age. The main risk factors for local recurrence are young age, the associated extended ductal in situ component, hormone receptor negative and high-grade status. The results of the simultaneous integrated boost (SIB) seem similar with normo- or moderately hypofractionated radiation therapy regimen.
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Affiliation(s)
- M A Bollet
- Institut de radiothérapie Hartmann, 4, rue Kléber, 92300 Levallois-Perret, France; Institut français du sein, 15, rue Jean-Nicot, 75007 Paris, France
| | - S Racadot
- Département d'oncologie radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - S Rivera
- Département d'oncologie radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; UMR 1030, université Paris-Saclay, Gustave-Roussy, 94805 Villejuif, France.
| | - A Arnaud
- Institut du cancer Sainte-Catherine, Avignon, France
| | - C Bourgier
- Fédération universitaire d'oncologie radiothérapie de Méditerranée Occitanie, Institut du cancer de Montpellier (ICM), université de Montpellier, Inserm U1194, IRCM, Montpellier, France
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Racadot S, Arnaud A, Schiffler C, Metzger S, Pérol D, Kirova Y. Cicaderma® in radiation-related dermatitis of breast cancer: Results from the multicentric randomised phase III CICA-RT. Clin Transl Radiat Oncol 2023; 41:100647. [PMID: 37441546 PMCID: PMC10334129 DOI: 10.1016/j.ctro.2023.100647] [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: 03/28/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 07/15/2023] Open
Abstract
Background and purpose To prevent the occurrence of grade ≥ 2 radiodermatitis after post-operative breast irradiation in patients with non metastatic breast cancer. Methods This prospective randomised open-label multicenter study allocated patients from 3 French institutions, ≥18 years, requiring postoperative radiotherapy for histologically proven, early-stage (non-metastatic) unilateral breast adenocarcinoma or in situ breast cancer, with R0 or R1 post-operative status, to receive hygiene rules, associated with either Cicaderma® (Arm A), or preventive treatment according to the investigator preference (mainly hyaluronic acid (ialuset®), essential oils, or water spray, or no medication (Arm B). The primary outcome was to compare the efficacy of Cicaderma® versus local standard management in preventing the occurrence of grade ≥ 2 radiodermatitis. Main secondary objectives include Cicaderma® impact on radiotherapy discontinuation and on skin toxicity (pruritus), pain, quality of life, satisfaction. Results The CICA-RT study enrolled from June 2020 to April 2021, 258 women with a median age of 61 (22-91) years in 3 institutions. Patients received either Cicaderma® (A: N = 130) or standard practice (B: N = 128). In the 123 patients who initiated radiotherapy in each arm, 95 (77%, 95%CI 68.8%-84.3%) patients did not develop grade ≥ 2 dermatitis. Sensitivity and per-protocol analyses confirmed the absence of differences between arms. Conclusion This prospective study did not meet its primary endpoint of superiority of Cicaderma® over routine practice skin care in terms of prevention of acute radioinduced dermatitis of grade 2 or higher. However, Cicaderma® showed a significant decrease in the occurrence of pruritus with less patients reporting at least once grade ≥ 2 pruritus (A: N = 38, 31%; B: N = 58, 47%; p = 0.009).ClinicalTrials.gov identifier NCT04300829.
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Affiliation(s)
| | - Antoine Arnaud
- Radiotherapy Department, Institut Sainte-Catherine, Avignon, France
| | - Camille Schiffler
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Séverine Metzger
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - David Pérol
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Youlia Kirova
- Radiotherapy Department, Institut Curie, Paris, France
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Gueiderikh A, Sarrade T, Kirova Y, De La Lande B, De Vathaire F, Auzac G, Martin AL, Everhard S, Meillan N, Bourgier C, Benyoucef A, Lacornerie T, Pasquier D, Racadot S, Moignier A, Paris F, André F, Deutsch E, Duchemann B, Allodji RS, Rivera S. Radiation-induced lung injury after breast cancer treatment: incidence in the CANTO-RT cohort and associated clinical and dosimetric risk factors. Front Oncol 2023; 13:1199043. [PMID: 37456251 PMCID: PMC10342531 DOI: 10.3389/fonc.2023.1199043] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/26/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Radiation-induced lung injury (RILI) is strongly associated with various clinical conditions and dosimetric parameters. Former studies have led to reducing radiotherapy (RT) doses to the lung and have favored the discontinuation of tamoxifen during RT. However, the monocentric design and variability of dosimetric parameters chosen have limited further improvement. The aim of our study was to assess the incidence of RILI in current practice and to determine clinical and dosimetric risk factors associated with RILI occurrence. Material and methods Data from 3 out of the 10 top recruiting centers in CANTO-RT, a subset of the CANTO prospective longitudinal cohort (NCT01993498), were retrospectively analyzed for RILI occurrence. This cohort, which recruited invasive cT0-3 cN0-3 M0 breast cancer patients from 2012 to 2018, prospectively recorded the occurrence of adverse events by questionnaires and medical visits at the end of, and up to 60 months after treatment. RILI adverse events were defined in all patients by the association of clinical symptoms and compatible medical imaging. Results RILI was found in 38/1565 (2.4%) patients. Grade II RILI represented 15/38 events (39%) and grade III or IV 2/38 events (6%). There were no grade V events. The most frequently used technique for treatment was 3D conformational RT (96%). In univariable analyses, we confirmed the association of RILI occurrence with pulmonary medical history, absence of cardiovascular disease medical history, high pT and pN, chemotherapy use, nodal RT. All dosimetric parameters were highly correlated and had close predictive value. In the multivariable analysis adjusted for chemotherapy use and nodal involvement, pulmonary medical history (OR=3.05, p<0.01) and high V30 Gy (OR=1.06, p=0.04) remained statistically significant risk factors for RILI occurrence. V30 Gy >15% was significantly associated with RILI occurrence in a multivariable analysis (OR=3.07, p=0.03). Conclusion Our study confirms the pulmonary safety of breast 3D RT in CANTO-RT. Further analyses with modern radiation therapy techniques such as IMRT are needed. Our results argue in favor of a dose constraint to the ipsilateral lung using V30 Gy not exceeding 15%, especially in patients presenting pulmonary medical history. Pulmonary disease records should be taken into account for RT planning.
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Affiliation(s)
- Anna Gueiderikh
- Gustave Roussy, Radiation Therapy Department, Villejuif, France
| | | | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
- University Versailles, St. Quentin, France
| | | | - Florent De Vathaire
- Gustave Roussy, Comprehensive Cancer Research Center, Villejuif, France
- Centre for Research in Epidemiology and Population Health, U1018 Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
- Paris-Saclay University, Unité Mixte de Recherche (UMR) 1018, Villejuif, France
| | - Guillaume Auzac
- Gustave Roussy, Radiation Therapy Department, Villejuif, France
| | | | | | - Nicolas Meillan
- Centre for Research in Epidemiology and Population Health, U1018 Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
- Paris-Saclay University, Gustave Roussy, Institut National de la Santé et de la Recherche Médicale (INSERM) 1030, Villejuif, France
- Radiation Therapy Department, CH Victor Dupouy, Argenteuil, France
| | - Celine Bourgier
- Montpellier University, Montpellier, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM), Institut National de la Santé et de la Recherche Médicale (INSERM) U1194, Montpellier, France
- Fédération Universitaire d’Oncologie Radiothérapie d’Occitanie Méditerranée, Institut régional du Cancer Montpellier (ICM), Montpellier, France
| | - Ahmed Benyoucef
- Radiation Therapy Department, Henri Becquerel Center, Rouen, France
| | - Thomas Lacornerie
- Centre Oscar Lambret, Academic Department of Radiation Oncology, 3 rue Combemale, Lille, France
| | - David Pasquier
- Centre Oscar Lambret, Academic Department of Radiation Oncology, 3 rue Combemale, Lille, France
- Univ. Lille, &, Centre National de la Recherche Scientifique (CNRS), Centrale Lille, Unité Mixte de Recherche (UMR) 9189 – Centre de Recherche en Informatique, Signal et Automatique de Lille (CRIStAL), Lille, France
| | | | - Alexandra Moignier
- Radiotherapy Department, Institut de Cancérologie de l’Ouest, Nantes, France
| | - François Paris
- Radiotherapy Department, Institut de Cancérologie de l’Ouest, Nantes, France
- Nantes Université, Nantes - Angers Cancer and Immunology Research Center (CRCI2NA), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Nantes, France
| | - Fabrice André
- Gustave Roussy, Medical Oncology Department, Villejuif, France
- Paris-Saclay University, Gustave Roussy, Institut National de la Santé et de la Recherche Médicale (INSERM) U981, Villejuif, France
| | - Eric Deutsch
- Gustave Roussy, Radiation Therapy Department, Villejuif, France
- Paris-Saclay University, Gustave Roussy, Institut National de la Santé et de la Recherche Médicale (INSERM) 1030, Villejuif, France
| | | | - Rodrigue Setcheou Allodji
- Gustave Roussy, Comprehensive Cancer Research Center, Villejuif, France
- Centre for Research in Epidemiology and Population Health, U1018 Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
- Paris-Saclay University, Unité Mixte de Recherche (UMR) 1018, Villejuif, France
| | - Sofia Rivera
- Gustave Roussy, Radiation Therapy Department, Villejuif, France
- Paris-Saclay University, Gustave Roussy, Institut National de la Santé et de la Recherche Médicale (INSERM) 1030, Villejuif, France
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Sarrade T, Allodji R, Ghannam Y, Auzac G, Everhard S, Kirova Y, Peignaux K, Guilbert P, Pasquier D, Racadot S, Bourgier C, Ducornet S, André F, De Vathaire F, Rivera S. CANTO-RT: One of the Largest Prospective Multicenter Cohort of Early Breast Cancer Patients Treated with Radiotherapy including Full DICOM RT Data. Cancers (Basel) 2023; 15:cancers15030751. [PMID: 36765709 PMCID: PMC9913384 DOI: 10.3390/cancers15030751] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
This article describes the methodology used and provides a characterization of the study population in CANTO-RT (CANcer TOxicities RadioTherapy). CANTO (NCT01993498) is a prospective clinical cohort study including patients with stage I-III BC from 26 French cancer centers. Patients matching all CANTO inclusion and exclusion criteria who received RT in one of the 10 top recruiting CANTO centers were selected. Individual full DICOM RT files were collected, pseudo-anonymized, structured and analyzed on the CANTO-RT/UNITRAD web platform. CANTO-RT included 3875 BC patients with a median follow-up of 64 months. Among the 3797 patients with unilateral RT, 3065 (80.4%) had breast-conserving surgery, and 2712 (71.5%) had sentinel node surgery. Tumor bed boost was delivered in 2658 patients (68.5%) and lymph node RT in 1356 patients (35%), including internal mammary chain in 844 patients (21.8%). Most patients (3691 (95.3%)) were treated with 3D conformal RT. Target volumes, organs at risk contours and dose/volume histograms were extracted after quality-control procedures. CANTO-RT is one of the largest early BC prospective cohorts with full individual clinical, biological, imaging and DICOM RT data available. It is a valuable resource for the identification and validation of clinical and dosimetric predictive factors of RT and multimodal treatment-related toxicities.
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Affiliation(s)
- Thomas Sarrade
- Radiotherapy Department, Gustave Roussy, 94805 Villejuif, France
- Department of Radiation Oncology, Tenon Hospital, Paris Sorbonne University, 75020 Paris, France
| | | | - Youssef Ghannam
- Radiotherapy Department, Gustave Roussy, 94805 Villejuif, France
| | - Guillaume Auzac
- Radiotherapy Department, Gustave Roussy, 94805 Villejuif, France
| | | | | | | | | | | | | | | | | | | | | | - Sofia Rivera
- Radiotherapy Department, Gustave Roussy, 94805 Villejuif, France
- Inserm UMR 1030, Molecular Radiotherapy and Therapeutic Innovation, Paris-Saclay University, 94805 Villejuif, France
- Correspondence: ; Tel.: +33-(0)14-211-5106
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9
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Racadot S, Thennevet I, Ouldbey Y, Kaminsky MC, Bosset M, Martin L, Tao Y, Sire C, de Raucourt D, Alfonsi M, Malaurie E, Tourani JM, Fournel P, Vauleon E, Modesto A, Rolland F, Metzger S, Pommier P, Chabaud S, Dussart S. Afatinib maintenance therapy following post-operative radiochemotherapy in head and neck squamous cell carcinoma: Results from the phase III randomised double-blind placebo-controlled study BIB2992ORL (GORTEC 2010-02). Eur J Cancer 2023; 178:114-127. [PMID: 36434888 DOI: 10.1016/j.ejca.2022.10.023] [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: 08/04/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We investigated the efficacy and safety of afatinib maintenance therapy in patients with head and neck squamous cell carcinoma (HNSCC) with macroscopically complete resection and adjuvant radiochemotherapy (RCT). METHODS This French multicentric randomised phase III double-blind placebo-controlled study included adult patients with ECOG-PS≤2, normal haematological, hepatic and renal functions, and non-metastatic, histologically confirmed HNSCC of the oral cavity, oropharynx, larynx or hypopharynx, with macroscopically complete resection and adjuvant RCT (≥2 cycles of cisplatin 100 mg/m2 J1, J22, J43 and 66Gy (2Gy/fraction, 5 fractions/week, conventional or intensity modulated radiotherapy ≥60Gy). Randomised patients were planned to receive either afatinib (afa arm) or placebo (control arm (C)) as maintenance therapy for one year. Primary endpoint was disease free survival (DFS). A 15% improvement in DFS was expected at 2 years with afatinib (from 55 to 70%). RESULTS Among the 167 patients with resected HNSCC included in 19 cancer centres and hospitals from Dec 2011, 134 patients were randomised to receive one-year maintenance afatinib or placebo (afa:67; C:67). Benefit/risk ratio was below assumptions and independent advisory committee recommended to stop the study in Feb 2017, the sponsor decided premature study discontinuation, with a 2-year follow-up for the last randomised patient. 2y-DFS was 61% (95% CI 0.48-0.72) in the afatinib group and 64% (95% CI 0.51-0.74) in the placebo group (HR 1.12, 95% CI 0.70-1.80). CONCLUSION Maintenance therapy with afatinib compared with placebo following post-operative RCT in patients with HNSCC did not significantly improve 2y-DFS and should not be recommended in this setting outside clinical trials. CLINICALTRIALS gov identifier NCT01427478.
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Affiliation(s)
- Séverine Racadot
- Department of Radiotherapy, Leon Berard Cancer Center, Lyon, France.
| | | | - Yaelle Ouldbey
- Department of Clinical Research and Innovation, Leon Berard Cancer Center, Lyon, France
| | | | - Mathieu Bosset
- Department of Radiotherapy, Centre de radiothérapie Marie Curie, Hopital privé Drôme Ardèche, Valence, France
| | - Laurent Martin
- Department of Radiotherapy, Centre Guillaume le Conquérant, Le Havre, France
| | - Yungan Tao
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - Christian Sire
- Department of Radiotherapy, Centre Hospitalier de Bretagne Sud, Hôpital du Scorff, Lorient, France
| | | | - Marc Alfonsi
- Department of Radiotherapy, Institut Sainte Catherine, Avignon, France
| | - Emmanuelle Malaurie
- Department of Radiotherapy, Centre Hospitalier Intercommunal, Créteil, France
| | | | - Pierre Fournel
- Department of Radiotherapy, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France
| | - Elodie Vauleon
- Department of Oncology, Centre Eugène Marquis, Rennes, France
| | - Anouchka Modesto
- Department of Radiotherapy, Institut Claudius Régaud, Toulouse Oncopôle, Toulouse, France
| | - Frédéric Rolland
- Department of Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Séverine Metzger
- Department of Clinical Research and Innovation, Leon Berard Cancer Center, Lyon, France
| | - Pascal Pommier
- Department of Radiotherapy, Leon Berard Cancer Center, Lyon, France
| | - Sylvie Chabaud
- Department of Clinical Research and Innovation, Leon Berard Cancer Center, Lyon, France
| | - Sophie Dussart
- Department of Clinical Research and Innovation, Leon Berard Cancer Center, Lyon, France
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10
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Merlotti A, Alterio D, Orlandi E, Racadot S, Bonomo P, Franco P, D'Angelo E, Ursino S, Pointreau Y, Lapeyre M, Graff P, Di Rito A, Argenone A, Musio D, De Felice F, Dionisi F, Fanetti G, D'Onofrio I, Belgioia L, Maddalo M, Scricciolo M, Bourhis J, Russi E, Thariat J. AIRO GORTEC consensus on postoperative radiotherapy (PORT) in low-intermediate risk early stages oral squamous cell cancers (OSCC). Radiother Oncol 2022; 177:95-104. [PMID: 36336113 DOI: 10.1016/j.radonc.2022.10.035] [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: 07/11/2022] [Revised: 10/19/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
Evidence on the efficacy of postoperative radiotherapy (PORT) in low-intermediate risk squamous cell carcinoma of the oral cavity (OSCC) remains inconclusive. Members of a task force from two national radio-oncology Associations (AIRO and GORTEC) defined 14 clinically relevant questions to identify "gray areas" pertinent to the indication for PORT in this clinical setting. Consequently, a literature review was performed on the topic. The resulting statements were then rated by an Expert Panel (EP) using a modified Delphi method. Only radiation oncologists were part of the discussion and voting on the scenarios. There was agreement on the 14 statements at the first round of voting. The task force then decided to propose clinical cases for the two more controversial statements that had received a lower agreement to better capture the Experts' attitudes. The clinical cases highlighted a more significant decisional heterogeneity. However, the good level of consensus reached among the two Associations gives relevant support in informing clinical choices while acknowledging general indications cannot fit all clinical situations and do not replace multidisciplinary discussion.
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Affiliation(s)
- Anna Merlotti
- Radiotherapy Department, S. Croce & Carle Teaching Hospital, Cuneo, Italy.
| | - Daniela Alterio
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Ester Orlandi
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Séverine Racadot
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, 28100 Novara, Italy
| | - Elisa D'Angelo
- Radiation Oncology, University Hospital of Modena, Modena, Italy
| | - Stefano Ursino
- Department of Radiation Oncology, Santa Chiara University Hospital, Pisa 56126, Italy
| | - Yoann Pointreau
- Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France
| | - Michel Lapeyre
- Radiation Oncology Department, Centre Jean-Perrin, Unicancer, Clermont-Ferrand, France
| | - Pierre Graff
- Department of Radiation Oncology, Institut Curie, PSL Research University, Paris - Saint Cloud-Orsay, France
| | - Alessia Di Rito
- Radiation Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Angela Argenone
- Division of Radiation Oncology, Azienda Ospedaliera di Rilievo Nazionale San Pio, Benevento, Italy
| | - Daniela Musio
- Radiotherapy Department, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | | | - Giuseppe Fanetti
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
| | - Ida D'Onofrio
- Unit of Radiation Oncology, Ospedale del Mare, ASL Napoli 1 Centro, 80147 Naples, Italy
| | - Liliana Belgioia
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Maddalo
- Department of Radiation Oncology, University of Brescia and Spedali Civili, Brescia, Italy
| | | | - Jean Bourhis
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Elvio Russi
- Radiotherapy Department, S. Croce & Carle Teaching Hospital, Cuneo, Italy
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, Baclesse / ARCHADE, Caen, France
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11
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Beddok A, Guzene L, Coutte A, Thomson D, Yom SS, Calugaru V, Blais E, Gilliot O, Racadot S, Pointreau Y, Corry J, Jensen K, Porceddu S, Khalladi N, Bastit V, Lasne-Cardon A, Marcy PY, Carsuzaa F, Nioche C, Bourhis J, Salleron J, Thariat J. International assessment of interobserver reproducibility of flap delineation in head and neck carcinoma. Acta Oncol 2022; 61:672-679. [PMID: 35139735 DOI: 10.1080/0284186x.2022.2036367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/11/2021] [Accepted: 01/23/2022] [Indexed: 11/01/2022]
Abstract
Background: Several reports have suggested that radiotherapy after reconstructive surgery for head and neck cancer (HNC), could have deleterious effects on the flaps with respect to functional outcomes. To predict and prevent toxicities, flap delineation should be accurate and reproducible. The objective of the present study was to evaluate the interobserver variability of frequent types of flaps used in HNC, based on the recent GORTEC atlas.Materials and methods: Each member of an international working group (WG) consisting of 14 experts delineated the flaps on a CT set from six patients. Each patient had one of the five most commonly used flaps in HNC: a regional pedicled pectoralis major myocutaneous flap, a local pedicled rotational soft tissue facial artery musculo-mucosal (FAMM) (2 patients), a fasciocutaneous radial forearm free flap, a soft tissue anterolateral thigh (ALT) free flap, or a fibular free flap. The WG's contours were compared to a reference contour, validated by a surgeon and a radiologist specializing in HNC. Contours were considered as reproducible if the median Dice Similarity Coefficient (DSC) was > 0.7.Results: The median volumes of the six flaps delineated by the WG were close to the reference contour value, with approximately 50 cc for the pectoral, fibula, and ALT flaps, 20 cc for the radial forearm, and up to 10 cc for the FAMM. The volumetric ratio was thus close to the optimal value of 100% for all flaps. The median DSC obtained by the WG compared to the reference for the pectoralis flap, the FAMM, the radial forearm flap, ALT flap, and the fibular flap were 0.82, 0.40, 0.76, 0.81, and 0.76, respectively.Conclusions: This study showed that the delineation of four main flaps used for HNC was reproducible. The delineation of the FAMM, however, requires close cooperation between radiologist, surgeon and radiation oncologist because of the poor visibility of this flap on CT and its small size.
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Affiliation(s)
- Arnaud Beddok
- Department of Radiation Oncology, Institut Curie, Paris - Orsay, France
- Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Université Paris Saclay/Inserm/Institut Curie, Orsay, France
| | - Leslie Guzene
- Department of Radiation Oncology, University Hospital of Amiens, Amiens, France
| | - Alexandre Coutte
- Department of Radiation Oncology, University Hospital of Amiens, Amiens, France
| | - David Thomson
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, USA
| | - Valentin Calugaru
- Department of Radiation Oncology, Institut Curie, Paris - Orsay, France
| | - Eivind Blais
- Department of Radiation Oncology, Polyclinique Marzet, Pau, France
| | - Olivier Gilliot
- Department of Radiation Oncology, Polyclinique Marzet, Pau, France
| | - Séverine Racadot
- Department of Radiation Oncology, Centre Léon Bérard Lyon, France
| | - Yoann Pointreau
- Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France
| | - June Corry
- Department of Radiation Oncology, GenesisCare. St Vincent's Hospital, Fitzroy, Australia
| | - Kenneth Jensen
- Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Danemark
| | - Sandro Porceddu
- Department of Radiation Oncology, Princess Alexandra Hospital Southside Clinical Unit, Australia
| | - Nazim Khalladi
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
| | - Vianney Bastit
- Department of Head and Neck Surgery, Centre François Baclesse, Caen, France
| | | | | | - Florent Carsuzaa
- Department of Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Christophe Nioche
- Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Université Paris Saclay/Inserm/Institut Curie, Orsay, France
| | - Jean Bourhis
- Department of Radiation Oncology, University Hospital of Vaudois, Lausanne, Swiss
| | - Julia Salleron
- Department of Statistics, Lorraine Cancer Institute, Vandoeuvre-lès-Nancy, France
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
- Laboratoire de physique Corpusculaire IN2P3/ENSICAEN/CNRS UMR 6534 - Normandie Université, Caen, France
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12
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Allali S, Carton M, Sarrade T, Querel O, Jacquet A, Rivera S, Ghannam Y, Peignaux K, Guilbert P, Chara-Brunaud C, Blanchecotte J, Pasquier D, Racadot S, Bourgier C, Labib A, Geffrelot J, Benyoucef A, Paris F, Cottu P, André F, Kirova Y. CANTO-RT: Skin toxicities evaluation of a multicenter large prospective cohort of irradiated patients for early-stage breast cancer. Int J Cancer 2022; 151:1098-1108. [PMID: 35489021 DOI: 10.1002/ijc.34057] [Citation(s) in RCA: 4] [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: 03/01/2022] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 11/09/2022]
Abstract
Skin damage is the most common and most important toxicity during and after radiotherapy. Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients irradiated for an early breast cancer CANTO is a prospective clinical cohort study of 10 150 patients with stage I-III BC treated from 2012-2017 in 26 cancer centers. In this study, we used CANTO-RT, a sub-cohort of CANTO, including 3480 patients who received RT. We are focus on specifical skin toxicities: Erythema, fibrosis, telangiectasia, and cutaneous pigmentation The prevalence of toxicities of interest varied over time, so at M3-6, 41.1% of patients had erythema while 24.8% of patients had fibrosis. At M12 and M36, the prevalence of erythema decreased respectively while fibrosis remains stable. The prevalence of telangiectasia increases from 1% to 7.1% from M3-6 to M36. After adjustments, we showed an association between the occurrence of skin erythema and obesity; the type of surgery; the presence of axillary dissection; the use of taxane-based CT and the 3DvsIMRT irradiation technique. Regarding fibrosis, an association is found, at M3-6, with age at diagnosis, obesity, tobacco, and the use of boost. Only obesity and the type of surgery received by the patient remained statistically significant at M12 and M36. In this study we identified several risk factors for acute and late skin. The use of a boost was mainly related to the occurrence of fibrosis while the use of IMRT-type technique decreased the occurrence of skin erythema.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - François Paris
- Centre de Recherche en Cancérologie Immunologie Nantes Angers (CRCINA) UMR Inserm 1232, Université de Nantes, Nantes
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13
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Ghannam Y, Meglio AD, Sarrade T, Jacquet A, Everhard S, Kirova Y, Peigneaux K, Guilbert P, Chara-Brunaud C, Blanchecotte J, Crehange G, Pasquier D, Racadot S, Bourgier C, Geffrelot J, Benyoucef A, Paris F, Auzac G, Vaz-Luis I, Rivera S. Abstract P4-11-07: Improfib: Impact of radiotherapy on fatigue in breast cancer survivors. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-11-07] [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: 11/16/2022]
Abstract
Abstract
Background Fatigue is a common and disabling symptom experienced by patients (pts) after breast cancer (BC) treatment, significantly impacting their quality of life. However, this complex and multidimensional symptom often remains poorly managed. Previous studies identified some treatment-related factors associated with increased risk of developing severe and persistent fatigue. A better understanding of the relationship between treatment modalities and fatigue may help prevention and management strategies.Multimodal BC treatment often includes radiotherapy (RT) to the breast and/or nodal areas. RT modalities are now increasingly personalized. While an association between receipt of RT and fatigue after BC was previously suggested, large-scale data analyzing the impact of distinct RT modalities on fatigue are lacking.Our aim was to assess the impact of RT modalities on fatigue one year after treatment among patients with early-stage BC. Methods CANcer TOxicity (CANTO; NCT01993498) is a large multicentric nationwide prospective cohort of patients with stage I-III BC diagnosed from June 2012 to February 2017. The present analysis was performed in CANTO-RT, a sub-cohort of CANTO including 3875 patients who received RT in one of the 10 top recruiting CANTO centers. Among those patients, we selected 3797 patients who received unilateral RT.Our primary outcome was severe global fatigue 1 year after RT completion, defined by EORTC QLQ-C30 score ≥ 40/100. Secondary outcomes included severe physical, emotional and cognitive dimensions of fatigue (EORTC QLQ-FA12). The following RT-related variables were used as independent variables: Technique (3D vs IMRT), type of fractionation: Normofractionation (NF) vs Hypofractionation (HF), Boost to tumor bed (Yes vs No), Nodal RT (Yes vs No) and internal mammary chain (IMC) RT (Yes vs No). Multivariable logistic regression models assessed associations between RT-related variables and fatigue, adjusting for clinical, tumor, and BC treatment-related covariates collected at BC diagnosis. Results Our analytic cohort included 3797 patients. Among them, 2348 patients were postmenopausal (63%), 2030 received chemotherapy (52%), and 3068 endocrine therapy (81%). The prevalence of severe global fatigue 1 year after treatment was 33.3%. In addition, 33.1%, 20.4%, and 12.9% of patients reported severe physical, emotional and cognitive fatigue, respectively. Conformal 3D RT was delivered in 3635 patients (96%) mostly NF (2Gy/fraction) (n=2707; 93%). The majority of patients (n=2600; 68%) received a boost. Nodal RT was delivered in 1317 patients (35%) including 819 patients (22%) with IMC RT. After correction for age, BMI, comorbidities, income, smoke behavior, anxiety, depression, receipt of chemo and endocrine therapy, there was a significant relationship between specific RT modalities and severe global fatigue. Specifically, receipt of IMC RT (adjusted OR vs. no 1.57 [95% CI 1.10-2.25; p=0.0134]) and NF RT (adjusted OR vs. HF 1.77 [95% CI 1.01-3.11; p=0.048]) were associated with increased odds of severe global fatigue.In addition, there was a significant association between NF RT (adjusted OR vs. HF 1.75 [95% CI 1.01-3.07; p=0.049]) and an increased likelihood of severe physical fatigue, whereas none of the investigated RT modalities seemed to be associated with emotional and cognitive fatigue dimensions. Conclusions More than one third of patients in this RT-treated cohort reported severe fatigue 1 year after treatment. We found a significant association between RT modalities, such as IMC RT and NF, and increased likelihood of severe global fatigue. NF was also associated with physical fatigue. Our data add to the current understanding of treatment-related factors that can impact fatigue after BC, and inform personalized interventions to improve prevention and management of this disabling symptom.
Citation Format: Youssef Ghannam, Antonio Di Meglio, Thomas Sarrade, Alexandra Jacquet, Sibille Everhard, Youlia Kirova, Karine Peigneaux, Philippe Guilbert, Claire Chara-Brunaud, Julien Blanchecotte, Gilles Crehange, David Pasquier, Séverine Racadot, Céline Bourgier, Julien Geffrelot, Ahmed Benyoucef, Francois Paris, Guillaume Auzac, Inès Vaz-Luis, Sofia Rivera. Improfib: Impact of radiotherapy on fatigue in breast cancer survivors [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-07.
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Affiliation(s)
| | - Antonio Di Meglio
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Thomas Sarrade
- Radiotherapy Department, Gustave Roussy, Villejuif, France
| | | | | | | | | | | | | | | | | | - David Pasquier
- Radiotherapy Department, Gustave Roussy, Villejuif, France
| | | | | | | | | | | | | | - Inès Vaz-Luis
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Sofia Rivera
- Radiotherapy Department, Gustave Roussy, Villejuif, France
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Sarrade T, Allodji R, Ghannam Y, Auzac G, Everhard S, Querel O, Kirova Y, Peignaux K, Guilbert P, Charra-Brunaud C, Blanchecotte J, Belshi R, Pasquier D, Racadot S, Bourgier C, Ducornet S, Gibon D, André F, De Vathaire F, Rivera S. Abstract P3-19-01: CANTO RT: The largest prospective multicenter cohort of early breast cancer patients treated with radiotherapy including full DICOM RT data. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p3-19-01] [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: 11/16/2022]
Abstract
Abstract
Purpose: In this paper, we describe the methodology used, and provide a first characterization of the study population and radiotherapy (RT) data in CANTO-RT (CANcer TOxicities Radiotherapy), the largest available multicenter prospective cohort of early breast cancer (BC) patients treated with RT that aims to identify predictors of development, and persistence of long-term toxicities. Methods: CANTO (NCT01993498) is a French prospective clinical cohort study of 10 150 patients with stage I-III BC from 26 cancer centers. Patients matching all CANTO inclusion and exclusion criteria, who received RT and were still in follow up, in the 10 top recruiting CANTO centers, with a minimum follow up of 3 years, were selected for CANTO-RT. Eligible patients had breast/chest wall +/- lymph node RT with curative intent. Individual full DICOM RT files (CT, RT Structure, RT Dose, RT Plan) were collected, anonymized, structured and analyzed on the CANTO-RT/UNITRAD web platform using AQUILAB Share Place™ and Analytics Dose module. Characteristics of the patients and tumors (including TNM, histology, HER2, estrogen and progesterone receptor) were recorded at baseline. Characteristics of the treatments, skin, lung, cardiovascular, neurological, musculoskeletal toxicities (CTCAE v4.0), QOL (BR23, QLQC30), cosmetic, and oncological outcomes were assessed at diagnosis (baseline), 3-6 (M0), 12 (M12), 36 (M36) and 60 (M60) months after completion of primary surgery, chemotherapy or radiotherapy whichever came last together, with blood, plasma and serum tests. Results: CANTO-RT enrolled 3875 BC patients between June 2012 and February 2017 with a median follow-up of 64 months :1947 (50.2%) left side, 1850 (47.8%) right side and 78 (2%) bilateral BC. The vast majority of patients had hormone receptor-positive tumors 3321 (85.7%) and 553 (14.3%) had human epidermal growth factor 2 (HER2) positive tumors; 2586 (66.7%) had stage pT1 and 2525 (65.2%) pN0 disease; 2087 (53.8%) neoadjuvant or adjuvant chemotherapy, 477 (12.3%) adjuvant trastuzumab and 3138 (81%) adjuvant endocrine therapy. Among 3797 patients with unilateral RT, 3065 (80.4%) had breast conserving surgery, 747 (19.6%) total mastectomy; 2712 (71.5%) sentinel node and 1080 (28.5%) axillary dissection. Tumor bed boost was delivered in 2658 patients (68.5%) and lymph node RT in 1356 patients (35%) including internal mammary chain in 844 patients (21.8%). Most patients 3691 (95.3%) were treated with 3D conformal RT and 184 (4.7%) with intensity-modulated RT. Normofractionated RT (2Gy/fraction) was mostly used (69.9%). Clinical target (breast, chest wall, lymph nodes) and contoured organs at risk (heart, left anterior descending coronary, lung, spinal cord, esophagus, thyroid, brachial plexus, contralateral breast, humeral head) contours and dose/volume histograms were automatically extracted after quality control procedure excluding corrupted files and inconsistencies 36 (1%) (Table 1). Conclusion: CANTO-RT is the largest early breast cancer prospective cohort with full individual clinical and DICOM RT data available. CANTO-RT is a valuable resource, open for collaborative projects, for identification and validation of clinical and dosimetric predictive factors of RT related toxicities. Further long term follow up is ongoing.
Table 1.Baseline characteristics of the CANTO RT breast cancer patients.CharacteristicsBreast Cancer Patients [N(%) or Mean (range)]Age at enrolmentMean (range), years56.5 (23.3-85.8)Tumour size (pT)T037 (1)T12586 (66.7)T21058 (27.3)T3177 (4.6)Missing17 (0.4)Nodal status (pN)02525 (65.2)11035 (26.7)2223 (5.8)379 (2)Missing13 (0.3)Tumour histologyInfiltrating Ductal3011 (77.7)Lobular473 (12.2)Others (including mixed)381 (9.8)Missing10 (0.3)Hormone Receptors positiveNegative541 (14)Positive3321 (85.7)Missing13 (0.3)HER2Negative3305 (85.3)Positive553 (14.3)Missing17 (0.4)Type of chemotherapyNo chemotherapy1788 (46.1)Neoadjuvant chemotherapy450 (11.6)Adjuvant chemotherapy1629 (42)Peri-adjuvant chemotherapy (neo + adjuvant)8 (0.2)Hormonal therapyNo730 (18.8)Yes3138 (81)Missing7 (0.2)Herceptin treatmentNo or Not applicable3378 (87.2)Yes477 (12.3)Missing20 (0.5)Type of breast surgerylumpectomy3113 (80.3)Mastectomy734 (18.9)Right lumpectomy and Left mastectomy13 (0.3)Right mastectomy and Left lumpectomy9 (0.2)None6 (0.2)Type of lymph node surgerySentinel node2746 (70.9)Axillary dissection1086 (28)Right sentinel node, Left axillary dissection20 (0.5)Right axillary dissection, left sentinel node12 (0.3)None11 (0.3)Radiation therapyRight Side1850 (47.8)Left Side1947 (50.2)Bilateral78 (2.0)Patients with boostNo or Not applicable1217 (31.4)Yes2658 (68.6)Lymph node levels treatedNone2519 (65)Yes1356 (35)Level 1284 (20.9)Level 2340 (25.1)Level 31072 (79.1)Level 41348 (99.4)Internal mammary chain844 (62.2)Irradiation techniques3D3691 (95.3)IMRT184 (4.7)Fractionation regimensNormofractionation 25-fractions2707 (69.9)Hypofractionation 15-16 fractions166 (4.3)Hypofractionation and Partial breast irradiation51 (1.3)Unspecified fractionation - CTV breast or chest wall not delineated951 (24.5)
Citation Format: Thomas Sarrade, Rodrigue Allodji, Youssef Ghannam, Guillaume Auzac, Sibille Everhard, Ophélie Querel, Youlia Kirova, Karine Peignaux, Philippe Guilbert, Claire Charra-Brunaud, Julien Blanchecotte, Rezart Belshi, David Pasquier, Séverine Racadot, Céline Bourgier, Sandrine Ducornet, David Gibon, Fabrice André, Florent De Vathaire, Sofia Rivera. CANTO RT: The largest prospective multicenter cohort of early breast cancer patients treated with radiotherapy including full DICOM RT data [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-19-01.
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Affiliation(s)
- Thomas Sarrade
- Radiotherapy Department, Gustave Roussy, Villejuif, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sofia Rivera
- Radiotherapy Department, Molecular Radiotherapy and Therapeutic Innovation Unit INSERM UMR 1030 - Université Paris-Saclay, Gustave Roussy, Villejuif, France
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15
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Lapeyre M, Racadot S, Renard S, Biau J, Moreira JF, Biston MC, Pointreau Y, Thariat J, Graff-Cailleaud P. Radiotherapy for oral cavity cancers. Cancer Radiother 2021; 26:189-198. [PMID: 34953711 DOI: 10.1016/j.canrad.2021.11.012] [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] [Indexed: 10/19/2022]
Abstract
Intensity modulated radiation therapy and brachytherapy are standard techniques of irradiation for the treatment of oral cavity cancers. These techniques are detailed in terms of indication, planning, delineation and selection of the volumes of interest, dosimetry and patients positioning control. This is an update of the guidelines of the French Society of Radiotherapy Correspondence.
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Affiliation(s)
- M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France.
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - S Renard
- Département de radiothérapie, Institut de cancérologie de Lorraine, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France
| | - J F Moreira
- Service de physique médicale, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France
| | - M C Biston
- Service de physique médicale, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Y Pointreau
- Radiothérapie, Institut interrégional de cancérologie (ILC), centre Jean-Bernard, 9, rue Beauverger, 72000 Le Mans, France
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - P Graff-Cailleaud
- Département de radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France
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16
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Hennequin C, Belkacémi Y, Bourgier C, Cowen D, Cutuli B, Fourquet A, Hannoun-Lévi JM, Pasquier D, Racadot S, Rivera S. Radiotherapy of breast cancer. Cancer Radiother 2021; 26:221-230. [PMID: 34955414 DOI: 10.1016/j.canrad.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Adjuvant radiotherapy is an essential component of the treatment of breast cancer. After conservative surgery for an infiltrating carcinoma, radiotherapy must be systematically performed, regardless of the characteristics of the disease, because it decreases the rate of local recurrence and by this way, specific mortality. A boost dose over the tumour bed is required if the patient is younger than 50 years-old. Partial breast irradiation could be routinely proposed as an alternative to whole breast irradiation, but only in selected and informed patients. For ductal carcinoma in situ, adjuvant radiotherapy must be also systematically performed after lumpectomy. After mastectomy, chest wall irradiation is required for pT3-T4 tumours and if there is an axillary nodal involvement, whatever the number of involved lymph nodes. After neoadjuvant chemotherapy and mastectomy, in case of pN0 disease, chest wall irradiation is recommended if there is a clinically or radiologically T3-T4 or node positive disease before chemotherapy. Axillary irradiation is recommended only if there is no axillary surgical dissection and a positive sentinel lymph node. Supra- and infraclavicular irradiation is advised in case of positive axillary nodes. Internal mammary irradiation must be discussed case by case, according to the benefit/risk ratio (cardiac toxicity). Hypofractionation regimens (42.5Gy in 16 fractions, or 41,6Gy en 13 or 40Gy en 15) are equivalent to conventional irradiation and must prescribe after tumorectomy in selected patients. Delineation of the breast, the chest wall and the nodal areas are based on clinical and radiological evaluations. 3D-conformal irradiation is the recommended technique, intensity-modulated radiotherapy must be proposed only in specific clinical situations. Respiratory gating could be useful to decrease the cardiac dose. Concomitant administration of chemotherapy in unadvised, but hormonal treatment could be start with or after radiotherapy.
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Affiliation(s)
- C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Y Belkacémi
- Hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - C Bourgier
- Institut du cancer Montpellier (ICM), 34000 Montpellier, France
| | - D Cowen
- Hôpital La Timone, AP-HM, 13000 Marseille, France
| | - B Cutuli
- Polyclinique Courlancy, 51000 Reims, France
| | - A Fourquet
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - J-M Hannoun-Lévi
- Centre Antoine-Lacassagne, 33, avenue Valombrose, 06000 Nice, France
| | - D Pasquier
- Centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - S Racadot
- Centre Léon-Bérard, 69000 Lyon, France
| | - S Rivera
- Institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
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17
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Abstract
Nasopharyngeal cancers are a rarity in France. Radiotherapy is the cornerstone of treatment, frequently combined with chemotherapy. The technical modality of radiotherapy is complex in this disease, which is located in the vicinity of numerous organs at risk. In this article, we will present the updated guidelines of the French society for radiation oncology (Société française de radiothérapie oncologique, SFRO) on the indications, and technical details of radiotherapy in nasopharyngeal cancers.
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Affiliation(s)
- P Blanchard
- Département de radiothérapie oncologique, Gustave-Roussy, université Paris Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, Sorbonne Université, IUC, Paris, France
| | - S Racadot
- Centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex 08, France; Creatis, CNRS UMR5220, Inserm U1044, Insa-Lyon, université Lyon 1, 69621 Villeurbanne cedex, France
| | - C Berthold
- Département de radiothérapie oncologique, Gustave-Roussy, université Paris Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - S Wong-Hee-Kam
- Service d'oncologie radiothérapie, Assistance publique-hôpitaux de Marseille, 13000 Marseille, France
| | - M-C Biston
- Centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex 08, France; Creatis, CNRS UMR5220, Inserm U1044, Insa-Lyon, université Lyon 1, 69621 Villeurbanne cedex, France
| | - P Maingon
- Service d'oncologie radiothérapie, CHU Pitié-Salpêtrière, 75013 Paris, France
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18
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Rowinski E, Magné N, Fayette J, Daguenet E, Racadot S, Pommier P, Méry B, Vallard A, Tinquaut F, Neidhardt-Berard EM, Cassier P, Attignon V, Pissaloux D, Wang Q, Sohier E, Pérol D, Blay JY, Trédan O. Radioresistance and genomic alterations in head and neck squamous cell cancer: Sub-analysis of the ProfiLER protocol. Head Neck 2021; 43:3899-3910. [PMID: 34643313 DOI: 10.1002/hed.26891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/25/2021] [Accepted: 09/21/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Genome analysis could provide tools to assess predictive molecular biomarkers of radioresistance. METHODS Head and neck squamous cell carcinoma patients included in ProfiLER study and who underwent a curative radiotherapy were screened. Univariate and Cox multivariate analyses were performed to explore the relationships between molecular abnormalities, infield relapse and complete tumor response after radiation. RESULTS One hundred and forty-three patients were analyzed. PIK3CA mutation and genomic instability of MAP kinases pathway were found to be prognostic factors of loco-regional relapse in multivariate analysis with respectively HR 0.33, 95% CI 0.13-0.83, p = 0.005 and HR 0.61, 95% CI 0.38-0.96, p = 0.025. Instability of apoptosis pathway was found to be a prognostic factor of complete response after radiotherapy with HR 0.24, 95% CI 0.07-0.88, p = 0.04. CONCLUSION This sub analysis suggests that PIK3CA mutation, variation of copy number of MAP kinases and apoptosis pathways play a significant role in the radioresistance phenomenon.
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Affiliation(s)
- Elise Rowinski
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Nicolas Magné
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France.,Laboratory of Molecular and Cellular Radiobiology, CNRS UMR 5822, Institut de Physique Nucléaire de Lyon (IPNL), Lyon, France
| | - Jérôme Fayette
- Department of Medical Oncology, Léon Bérard Cancer Centre, Lyon, France
| | - Elisabeth Daguenet
- University Department of Research and Teaching, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Séverine Racadot
- Department of Radiation Oncology, Léon Bérard Cancer Centre, Lyon, France
| | - Pascal Pommier
- Department of Radiation Oncology, Léon Bérard Cancer Centre, Lyon, France
| | - Benoîte Méry
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Alexis Vallard
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Fabien Tinquaut
- University Department of Research and Teaching, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | | | - Philippe Cassier
- Department of Medical Oncology, Léon Bérard Cancer Centre, Lyon, France.,Department of Translational Research and Innovation, Léon Bérard Cancer Centre, Lyon, France
| | - Valéry Attignon
- Department of Translational Research and Innovation, Léon Bérard Cancer Centre, Lyon, France
| | - Daniel Pissaloux
- Department of Translational Research and Innovation, Léon Bérard Cancer Centre, Lyon, France
| | - Qing Wang
- Department of Translational Research and Innovation, Léon Bérard Cancer Centre, Lyon, France
| | - Emilie Sohier
- Department of Translational Research and Innovation, Léon Bérard Cancer Centre, Lyon, France
| | - David Pérol
- Department of Clinical Research and Innovation, Léon Bérard Cancer Centre, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Léon Bérard Cancer Centre, Lyon, France.,Department of Translational Research and Innovation, Léon Bérard Cancer Centre, Lyon, France
| | - Olivier Trédan
- Department of Medical Oncology, Léon Bérard Cancer Centre, Lyon, France.,Department of Translational Research and Innovation, Léon Bérard Cancer Centre, Lyon, France
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19
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Khalladi N, Dejean C, Bosset M, Pointreau Y, Kinj R, Racadot S, Castelli J, Huguet F, Renard S, Guihard S, Tao Y, Rouvier JM, Johnson A, Bourhis J, Xu Shan S, Thariat J. A priori quality assurance using a benchmark case of the randomized phase 2 GORTEC 2014-14 in oligometastatic head and neck cancer patients. Cancer Radiother 2021; 25:755-762. [PMID: 34565664 DOI: 10.1016/j.canrad.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE A Benchmark Case (BC) was performed as part of the quality assurance process of the randomized phase 2 GORTEC 2014-14 OMET study, testing the possibility of multisite stereotactic radiation therapy (SBRT) alone in oligometastatic head and neck squamous cell carcinoma (HNSCC) as an alternative to systemic treatment and SBRT. MATERIAL AND METHODS Compliance of the investigating centers with the prescription, delineation, planning and evaluation recommendations available in the research protocol was assessed. In addition, classical dosimetric analysis was supplemented by quantitative geometric analysis using conformation indices. RESULTS Twenty centers participated in the BC analysis. Among them, four major deviations (MaD) were reported in two centers. Two (10%) centers in MaD had omitted the satellite tumor nodule and secondarily validated after revision. Their respective DICE indexes were 0.37 and 0 and use of extracranial SBRT devices suboptimal There were significant residual heterogeneities between participating centers, including those with a similar SBRT equipment, with impact of plan quality using standard indicators and geometric indices. CONCLUSION A priori QA using a BC conditioning the participation of the clinical investigation centers showed deviations from good SBRT practice and led to the exclusion of one out of the twenty participating centers. The majority of centers have demonstrated rigorous compliance with the research protocol. The use of quality indexes adds a complementary approach to improve assessment of plan quality.
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Affiliation(s)
- N Khalladi
- Centre François Baclesse, 3, avenue General Harris, 14076 Caen, France
| | - C Dejean
- Centre Antoine Lacassagne, Nice, France
| | - M Bosset
- Centre Marie Curie, Valence, France
| | | | - R Kinj
- Centre Antoine Lacassagne, Nice, France
| | | | | | - F Huguet
- Centre hospitalier et universitaire Tenon, Paris, France
| | - S Renard
- Institut de Cancérologie de Lorraine, Nancy, France
| | - S Guihard
- Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Y Tao
- Institut Gustave Roussy, Villejuif, France
| | - J M Rouvier
- Centre hospitalier régional et universitaire, Besançon-Montbéliard, France
| | - A Johnson
- Centre François Baclesse, 3, avenue General Harris, 14076 Caen, France
| | - J Bourhis
- Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - S Xu Shan
- Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - J Thariat
- Centre François Baclesse, 3, avenue General Harris, 14076 Caen, France; Corpuscular Physics Laboratory-Normandy University, Caen, France.
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20
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Giraud P, Racadot S, Vernerey D, Goldstein D, Glimelius B, Van Houtte P, Gubanski M, Spry N, Van Laethem JL, Hammel P, Huguet F. Investigation of Relation of Radiation Therapy Quality With Toxicity and Survival in LAP07 Phase 3 Trial for Locally Advanced Pancreatic Carcinoma. Int J Radiat Oncol Biol Phys 2021; 110:993-1002. [PMID: 33561507 DOI: 10.1016/j.ijrobp.2021.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/22/2021] [Accepted: 01/30/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE The LAP07 multicenter randomized study assessed whether chemoradiation therapy increases overall survival versus continuation chemotherapy in patients whose locally advanced pancreatic cancer was controlled after 4 months of induction chemotherapy. This analysis investigated whether failure to adhere to radiation therapy (RT) guidelines influenced survival and toxicity. METHODS AND MATERIALS This is a planned analysis of secondary objectives in the framework of a randomized international phase 3 trial. The protocol included detailed written RT guidelines. All participating institutions undertook an initial benchmark case to check adherence to protocol guidelines. Centers with major deviation were not allowed to include patients until they achieved a significant improvement and rigorously followed the guidelines. On-trial RT quality assurance consisted of a central review of treatment plan with dose-volume histograms for each patient. Adherence to guidelines was graded as per protocol (PP), minor deviation (MiD), or major deviation (MaD). RESULTS Fifty-seven benchmark cases were evaluated, 26% were classified as PP, 60% were MiD, and 14% were MaD. Among the 442 included patients, 133 patients were randomized in the chemoradiation therapy arm, and 117 patients were assessable for RT quality analysis. RT quality was graded as PP in 38.5% of patients, MiD in 43.6% of patients, and MaD in 17.9% of patients. The most frequent protocol violations were dose distribution heterogeneities. Median overall survival was 17 months with PP and MiD versus 13.4 months with MaD (hazard ratio [HR], 1.63; 95% confidence interval [CI], 0.99-2.71; P = .055). There was no difference in terms of progression-free survival (HR, 1.09; 95% CI, 0.66-1.8; P = .72). Patients with MaD had more nausea than patients treated PP or with MiD (P = .0045). CONCLUSIONS MaD was associated with a trend for worst survival. There was no difference in terms of progression-free survival. Because of the low rate of major deviations, their effects on the LAP07 trial results may be negligeable.
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Affiliation(s)
- Paul Giraud
- Department of Radiation Oncology, Tenon Hospital, Institut Universitaire du Cancer, AP-HP, Sorbonne Université, Paris, France
| | - Séverine Racadot
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Dewi Vernerey
- Methodology and Quality of Life in Oncology Unit (EA 3181) and Quality of Life and Cancer Clinical Research Platform, CHU de Besançon, Besançon, France
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Paul Van Houtte
- Department of Radiation Oncology, Institut Jules-Bordet, Brussels, Belgium
| | - Michael Gubanski
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Nigel Spry
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Jean Luc Van Laethem
- Department of Gastroenterology and Gastrointestinal cancer Unit, Erasme Hospital, Université Libre Bruxelles, Brussels, Belgium
| | - Pascal Hammel
- Service de Gastroentérologie-Pancréatologie, Beaujon Hospital, AP-HP, Clichy, France
| | - Florence Huguet
- Department of Radiation Oncology, Tenon Hospital, Institut Universitaire du Cancer, AP-HP, Sorbonne Université, Paris, France.
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21
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Leleu T, Bastit V, Doré M, Kammerer E, Florescu C, Alfonsi M, Troussier I, Bensadoun RJ, Biau J, Blais E, Coutte A, Deberne M, Wiazzane N, Dupin C, Faivre JC, Giraud P, Graff P, Guihard S, Huguet F, Janoray G, Liem X, Pointreau Y, Racadot S, Schick U, Servagi-Vernat S, Sun XS, Thureau S, Villa J, Vulquin N, Wong S, Patron V, Thariat J. Histosurgical mapping of endoscopic endonasal surgery of sinonasal tumours to improve radiotherapy guidance. Cancer Radiother 2021; 26:440-444. [PMID: 34175228 DOI: 10.1016/j.canrad.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/21/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Endoscopic endonasal surgery (EES) is becoming a standard for most malignant sinonasal tumours. Margin analysis after piecemeal resection is complex and optimally relies on accurate histosurgical mapping. Postoperative radiotherapy may be adapted based on margin assessment mapping to reduce the dose to some sinonasal subvolumes. We assessed the use of histosurgical mapping by radiation oncologists (RO). MATERIAL AND METHODS A French practice survey was performed across 29 ENT expert RO (2 did not answer) regarding integration of information on EES, as well as quality of operative and pathology reportsto refine radiotherapy planning after EES. This was assessed through an electronic questionnaire. RESULTS EES was ubiquitously performed in France. Operative and pathology reports yielded accurate description of EES samples according to 66.7% of interviewed RO. Accuracy of margin assessment was however insufficient according to more than 40.0% of RO. Additional margins/biopsies of the operative bed were available in 55.2% (16/29) of the centres. In the absence of additional margins, quality of resection after EES was considered as microscopically incomplete in 48.3% or dubious in 48.3% of RO. As performed, histosurgical mapping allowed radiotherapy dose and volumes adaptation according to 26.3% of RO only. CONCLUSIONS Standardized histosurgical mapping with margin and additional margin analysis could be more systematic. Advantages of accurate EES reporting could be dose painting radiotherapy to further decrease morbidity in sinonasal tumours.
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Affiliation(s)
- T Leleu
- Department of radiation oncology, centre François-Baclesse, Caen, France
| | - V Bastit
- Department of surgery, centre François-Baclesse, Caen, France
| | | | - E Kammerer
- Department of radiation oncology, centre François-Baclesse, Caen, France
| | - C Florescu
- Department of radiation oncology, centre François-Baclesse, Caen, France
| | | | | | | | - J Biau
- CJP, Clermont-Ferrand, France
| | - E Blais
- AP-HP, Pitié-Salpêtrière, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - X S Sun
- CHU, Besançon Montbéliard, France
| | | | | | | | | | - V Patron
- Department of ENT surgery, CHU Caen, Caen, France
| | - J Thariat
- Department of radiation oncology, centre François-Baclesse, Caen, France; Unicaen, Normandie Université, Caen, France; GORTEC, France.
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22
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Meillan N, Orthuon A, Chauchat P, Atlani D, Bouche O, Chaulin B, David C, Deberne M, Debrigode C, Kao W, Keller A, Laharie H, Lamezec B, Lemanski C, Magné N, Mahé MA, Mere P, Moureau-Zabotto L, Peiffert D, Pointreau Y, Quéro L, Racadot S, Roca S, Sargos P, Servagi S, Tang E, Vendrely V, Doyen J, Huguet F. Locoregional relapses in the ACCORD 12/0405-PRODIGE 02 study: Dosimetric study and risk factors. Radiother Oncol 2021; 161:198-204. [PMID: 34144078 DOI: 10.1016/j.radonc.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/21/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study is to correlate locoregional relapse with radiation therapy volumes in patients with rectal cancer treated with neoadjuvant chemoradiation in the ACCORD 12/0405-PRODIGE 02 trial. PATIENTS AND METHODS We identified patients who had a locoregional relapse included in ACCORD 12's database. We studied their clinical, radiological, and dosimetric data to analyze the dose received by the area of relapse. RESULTS 39 patients (6.5%) presented 54 locoregional relapses. Most of the relapses were in-field (n = 21, 39%) or marginal (n = 13, 24%) with only six out-of-field (11%), 14 could not be evaluated. Most of them happened in the anastomosis, the perirectal space, and the usual lymphatic drainage areas (presacral and posterior lateral lymph nodes). Only patients treated for a lower rectum adenocarcinoma had a relapse outside of the treated volume. 2 patients with T4 tumors extending into anterior pelvic organs had relapses in anterior lateral and external iliac lymph nodes. CONCLUSIONS Lowering the upper limit of the treatment field for low rectal tumors increased the risk of out of the field recurrence. For very low tumors, including the inguinal lymph nodes in the treated volume should be considered. Recording locoregional involvement, treated volumes, and relapse areas in future prospective trials would be of paramount interest to refine delineation guidelines.
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Affiliation(s)
- Nicolas Meillan
- APHP, Pitié-Salpêtrière Hospital, Department of Radiation Oncology, Paris, France; Sorbonne Université, AP-HP, Pitié Salpêtrière Hospital, Department of Radiation Oncology, Paris, France.
| | | | - Paul Chauchat
- APHP, Pitié Salpêtrière Hospital, Department of Medical Physics, Paris, France
| | - David Atlani
- Department of Radiation Oncology, Civil Colmar Hospital, Colmar, France
| | - Olivier Bouche
- Department of Gastroenterology, Reims University Hospital, France
| | - Bertrand Chaulin
- Department of Radiation Oncology, Bordeaux Nord Aquitaine Polyclinic, France
| | - Céline David
- Department of Medical Physics, Mulhouse and South Alsace Hospital, France
| | - Mélanie Deberne
- Department of Radiation Oncology, South Lyon Hospital, France
| | | | - William Kao
- Department of Radiation Oncology, François Baclesse Cancer Center, Caen, France
| | - Audrey Keller
- Department of Radiation Oncology, ICANS, Strasbourg, France
| | - Hortense Laharie
- Department of Radiation Oncology, Tivoli Ducos Clinic, Bordeaux, France
| | - Bruno Lamezec
- Department of Radiation Oncology, Armorican Radiation Therapy, Radiology and Oncology Center, Plérin, France
| | - Claire Lemanski
- Department of Radiation Oncology, Montpellier-Val d'Aurelles Cancer Institute, France
| | - Nicolas Magné
- Department of Radiation Oncology, Loire Cancer Institute Saint-Priest-en-Jarez France
| | - Marc-André Mahé
- Department of Radiation Oncology, Western Cancer Institute, Nantes, France
| | - Pascale Mere
- Department of Radiation Oncology, Jean Mermoz Private Hospital, Lyon, France
| | | | - Didier Peiffert
- Department of Radiation Oncology, Lorraine Cancer Institute, Nancy, France
| | - Yoann Pointreau
- Department of Radiation Oncology, Inter-régionaL Cancer Institute (ILC) - Jean Bernard Center-Victor Hugo Clinic, Le Mans, France
| | - Laurent Quéro
- Department of Radiation Oncology, Saint-Louis Hospital, APHP, Paris, France
| | - Séverine Racadot
- Department of Radiation Oncology, Léon Bérard Center, Lyon, France
| | - Sophie Roca
- Department of Medical Oncology, Sainte-Anne Clinic, Langon, France
| | - Paul Sargos
- Department of Radiation Oncology, Bergonié Institute, Bordeaux, France
| | - Stéphanie Servagi
- Department of Radiation Oncology, Jean Godinot Institute, Reims, France
| | - Eliane Tang
- Hôpitaux Universitaires Henri Mondor, APHP, Henri Mondor Hospital, Department of Radiation Oncology, Paris, France
| | - Véronique Vendrely
- Department of Radiation Oncology, Bordeaux University Hospital, France; INSERM 1035, University of Bordeaux, France
| | - Jérôme Doyen
- Department of Radiation Oncology, Antoine Lacassagne Center, Nice, France
| | - Florence Huguet
- Sorbonne Université, AP-HP, Pitié Salpêtrière Hospital, Department of Radiation Oncology, Paris, France; UMR_S 938, Centre de Recherche de Saint Antoine, Paris, France; APHP, Tenon Hospital, Department of Radiation Oncology, Paris, France
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23
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Guillemin F, Miroir J, Piram L, Bellini R, Saroul N, Pham Dang N, Boisselier P, Bourhis J, Calugaru V, Coutte A, Graff P, Pointreau Y, Racadot S, Sun XS, Thariat J, Biau J, Lapeyre M. [Proposal for the delineation of postoperative primary clinical target volumes in ethmoid cancers]. Cancer Radiother 2021; 25:200-205. [PMID: 33546996 DOI: 10.1016/j.canrad.2020.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/20/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022]
Abstract
It is proposed to delineate the anatomo-clinical target volumes of primary tumor (CTV-P) in ethmoid cancers treated with post-operative radiotherapy. This concept is based on the use of radioanatomy and the natural history of cancer. It is supported by the repositioning of the planning scanner with preoperative imaging for the replacement of the initial GTV and the creation of margins around it extended to the microscopic risk zones according to the anatomical concept. This article does not discuss the indications of external radiotherapy but specifies the volumes to be delineated if radiotherapy is considered.
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Affiliation(s)
- F Guillemin
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - J Miroir
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - L Piram
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - R Bellini
- Département de radiodiagnostic, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - N Saroul
- Département de chirurgie ORL, centre hospitalier universitaire Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France
| | - N Pham Dang
- Département de chirurgie maxillofaciale, centre hospitalier universitaire Estaing, 63003 Clermont-Ferrand cedex 1, France
| | - P Boisselier
- Département de radiothérapie, Institut régional cancer de Montpellier, parc Euromédecine, 208 rue des Apothicaires, 34090 Montpellier, France
| | - J Bourhis
- Département de radiothérapie, Centre hospitalier universitaire vaudois, rue du Bugnon 46, 1005 Lausanne, Suisse
| | - V Calugaru
- Département de radiothérapie, institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - A Coutte
- Département de radiothérapie, CHU Amiens-Picardie, 30, avenue de la Croix-Jourdain, 80054 Amiens cedex 1, France
| | - P Graff
- Département de radiothérapie, Institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - Y Pointreau
- Département de radiothérapie, Institut inter-régional de cancérologie (ILC), centre Jean-Bernard, 9, rue Beauverger, 72000 Le Mans, France
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - X S Sun
- Département de radiothérapie, hôpital Nord Franche-Comté de Montbéliard, CHRU de Besançon, 1 rue Henri-Becquerel, 25200 Montbéliard, France
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France.
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24
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Lacas B, Carmel A, Landais C, Wong SJ, Licitra L, Tobias JS, Burtness B, Ghi MG, Cohen EEW, Grau C, Wolf G, Hitt R, Corvò R, Budach V, Kumar S, Laskar SG, Mazeron JJ, Zhong LP, Dobrowsky W, Ghadjar P, Fallai C, Zakotnik B, Sharma A, Bensadoun RJ, Ruo Redda MG, Racadot S, Fountzilas G, Brizel D, Rovea P, Argiris A, Nagy ZT, Lee JW, Fortpied C, Harris J, Bourhis J, Aupérin A, Blanchard P, Pignon JP. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group. Radiother Oncol 2021; 156:281-293. [PMID: 33515668 DOI: 10.1016/j.radonc.2021.01.013] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [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: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE The Meta-Analysis of Chemotherapy in squamous cell Head and Neck Cancer (MACH-NC) demonstrated that concomitant chemotherapy (CT) improved overall survival (OS) in patients without distant metastasis. We report the updated results. MATERIALS AND METHODS Published or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT + CT or adding another timing of CT to LRT + CT (main question), or comparing induction CT + radiotherapy to radiotherapy + concomitant (or alternating) CT (secondary question) were eligible. Individual patient data were collected and combined using a fixed-effect model. OS was the main endpoint. RESULTS For the main question, 101 trials (18951 patients, median follow-up of 6.5 years) were analyzed. For both questions, there were 16 new (2767 patients) and 11 updated trials. Around 90% of the patients had stage III or IV disease. Interaction between treatment effect on OS and the timing of CT was significant (p < 0.0001), the benefit being limited to concomitant CT (HR: 0.83, 95%CI [0.79; 0.86]; 5(10)-year absolute benefit of 6.5% (3.6%)). Efficacy decreased as patients age increased (p_trend = 0.03). OS was not increased by the addition of induction (HR = 0.96 [0.90; 1.01]) or adjuvant CT (1.02 [0.92; 1.13]). Efficacy of induction CT decreased with poorer performance status (p_trend = 0.03). For the secondary question, eight trials (1214 patients) confirmed the superiority of concomitant CT on OS (HR = 0.84 [0.74; 0.95], p = 0.005). CONCLUSION The update of MACH-NC confirms the benefit and superiority of the addition of concomitant CT for non-metastatic head and neck cancer.
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Affiliation(s)
- Benjamin Lacas
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France
| | | | | | | | | | | | | | | | | | - Cai Grau
- H. Lee Moffitt Cancer Center & Research Institute, USA
| | | | | | - Renzo Corvò
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer, India
| | - Volker Budach
- State University of New York Downstate Medical Center, USA
| | | | | | | | | | | | - Pirus Ghadjar
- Johns Hopkins Univ/Sidney Kimmel Cancer Center, MD, USA
| | - Carlo Fallai
- Centre Hospitalier Universitaire de Tours, France
| | | | - Atul Sharma
- Cancer Research UK & UCL Cancer Trials Centre, UK
| | | | | | - Séverine Racadot
- Princess Margaret Cancer Centre/University of Toronto, Ontario, Canada
| | | | | | - Paolo Rovea
- Kragulevac University Hospital, Yugoslavia, Serbia
| | | | | | | | | | | | - Jean Bourhis
- Institut Saint Catherine, France; Stanford University School of Medicine, CA, USA
| | - Anne Aupérin
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France
| | - Pierre Blanchard
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France; University of Texas-MD Anderson Cancer Center, USA.
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25
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Vaugier L, Mirabel X, Martel-Lafay I, Racadot S, Carrie C, Vendrely V, Mahé MA, Senellart H, Raoul JL, Campion L, Rio E. Radiosensitizing Chemotherapy (Irinotecan) with Stereotactic Body Radiation Therapy for the Treatment of Inoperable Liver and/or Lung Metastases of Colorectal Cancer. Cancers (Basel) 2021; 13:cancers13020248. [PMID: 33440832 PMCID: PMC7827408 DOI: 10.3390/cancers13020248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Stereotactic body radiotherapy (SBRT) is a recognized treatment for liver or lung metastases, but radiosensitivity of colorectal cancer could be lower than other primary cancers. We postulated that local responses could be improved by SBRT with a concomitant radiosensitizing agent (irinotecan). RADIOSTEREO-CAMPTO was a prospective multi-center phase 2 trial conducted between 2008 and 2013. We confirmed that SBRT-Irinotecan was a short, effective and well-tolerated treatment, with no worsening of the quality of life. It allowed for several months of chemotherapy-free periods despite most patients receiving multiple prior lines of treatment. Radiosensitizing irinotecan was able to compensate for lower SBRT dose than nowadays used for liver and lung metastases and could be an interesting regimen in case of tumour-surrounding healthy tissues requiring limited radiation dose. Abstract Background: Stereotactic body radiotherapy (SBRT) is a recognized treatment for colorectal cancer (CRC) metastases. We postulated that local responses could be improved by SBRT with a concomitant radiosensitizing agent (irinotecan). Methods: RADIOSTEREO-CAMPTO was a prospective multi-center phase 2 trial investigating SBRT (40–48 Gy in 4 fractions) for liver and/or lung inoperable CRC oligometastases (≤3), combined with two weekly intravenous infusions of 40 mg/m2 Irinotecan. Primary outcome was the objective local response rate as per RECIST. Secondary outcomes were early and late toxicities, EORTC QLQ-C30 quality of life, local control and overall survival. Results: Forty-four patients with 51 lesions (liver = 39, lungs = 12) were included. Median age was 69 years (46–84); 37 patients (84%) had received at least two prior chemotherapy treatments. Median follow-up was 48.9 months. One patient with two lung lesions was lost during follow-up. Assuming maximum bias hypothesis, the objective local response rate in ITT was 86.3% (44/51—95% CI: [76.8–95.7]) or 82.4% (42/51—95% CI: [71.9–92.8]). The observed local response rate was 85.7% (42/49—95% CI: [75.9–95.5]). The 1 and 2-year local (distant) progression-free survivals were 84.2% (38.4%) and 67.4% (21.3%), respectively. The 1 and 2-year overall survivals were 97.5% and 75.5%. There were no severe acute or late reactions. The EORTC questionnaire scores did not significantly worsen during or after treatment. Conclusions: SBRT with irinotecan was well tolerated with promising results despite heavily pretreated patients.
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Affiliation(s)
- Loïg Vaugier
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, 44800 St-Herblain, France; (L.V.); (M.-A.M.)
| | - Xavier Mirabel
- Department of Radiation Oncology, Centre Oscar Lambret, 59000 Lille, France;
| | - Isabelle Martel-Lafay
- Department of Radiation Oncology, Institut Léon Bérard, 69008 Lyon, France; (I.M.-L.); (S.R.); (C.C.)
| | - Séverine Racadot
- Department of Radiation Oncology, Institut Léon Bérard, 69008 Lyon, France; (I.M.-L.); (S.R.); (C.C.)
| | - Christian Carrie
- Department of Radiation Oncology, Institut Léon Bérard, 69008 Lyon, France; (I.M.-L.); (S.R.); (C.C.)
| | - Véronique Vendrely
- Department of Radiation Oncology, Centre Hospitalo-Universitaire Hôpital Saint André, 33000 Bordeaux, France;
| | - Marc-André Mahé
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, 44800 St-Herblain, France; (L.V.); (M.-A.M.)
| | - Hélène Senellart
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest, 44800 St-Herblain, France; (H.S.); (J.-L.R.)
| | - Jean-Luc Raoul
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest, 44800 St-Herblain, France; (H.S.); (J.-L.R.)
| | - Loïc Campion
- Department of Biostatistics, Institut de Cancérologie de l’Ouest, 44800 St-Herblain, France;
- Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), UMR 1232 Inserm—6299 CNRS, Institut de Recherche en Santé de l’Université de Nantes, 44000 Nantes, France
| | - Emmanuel Rio
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, 44800 St-Herblain, France; (L.V.); (M.-A.M.)
- Correspondence: ; Tel.: +33-240-679-900
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26
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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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27
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Lapeyre M, Biau J, Miroir J, Moreau J, Gleyzolle B, Brun L, Racadot S, Graff-Cailleaud P. [Concurrent chemoradiotherapy for head neck cancers. Should organs at risk dose constraints be revisited ?]. Cancer Radiother 2020; 24:586-593. [PMID: 32861607 DOI: 10.1016/j.canrad.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/14/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 01/16/2023]
Abstract
Concurrent chemoradiotherapy improves the outcome of locally advanced head and neck cancers and the current reference chemotherapy is cisplatin. These results are obtained at the cost of increased toxicities. To limit the risk of toxicity, organ at riskdose constraints have been established starting with 2D radiotherapy, then 3D radiotherapy and intensity-modulated radiotherapy. Regarding grade ≥3 acute toxicities, the scientific literature attests that concurrent chemoradiotherapy significantly increases risks of mucositis and dysphagia. Constraints applied to the oral mucosa volume excluding the planning target volume, the pharyngeal constrictor muscles and the larynx limit this adverse impact. Regarding late toxicity, concurrent chemoradiotherapy increases significantly the risk of postoperative neck fibrosis and hearing loss. However, for some organs at risk, concurrent chemotherapy appears to increase late radiation induced effect, even though the results are less marked (brachial plexus, mandible, pharyngeal constrictor muscles, parotid gland). This additional adverse impact of concomitant chemotherapy may be notable only when organs at risk receive less than their usual dose thresholds and this would be vanished when those thresholds are exceeded as seems to be the situation for the parotid glands. Until the availability of more robust data, it seems appropriate to apply the principle of delivering dose to organs at risk as low as reasonably achievable.
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Affiliation(s)
- M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France.
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - J Miroir
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - J Moreau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - B Gleyzolle
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - L Brun
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P Graff-Cailleaud
- Département de radiothérapie, institut universitaire du cancer de Toulouse, 1, avenue Irene Joliot-Curie, 31100 Toulouse, France
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Racadot S, Vérillaud B, Serre AA, Le Guevelou J, Guzene L, Laude C, Grégoire V, Deneuve S, Larnaudie A, Lasne-Cardon A, Thariat J. [Impact of reconstructive or minimal invasive surgery on the assessment of current definitions of postoperative clinical target volume for head and neck cancers]. Cancer Radiother 2020; 24:649-657. [PMID: 32782167 DOI: 10.1016/j.canrad.2020.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/15/2020] [Revised: 05/20/2020] [Accepted: 05/30/2020] [Indexed: 10/23/2022]
Abstract
Advances in the reconstructive surgery and minimally invasive endonasal endoscopic surgery of head and neck is poorly evaluated in terms of their impact on radiotherapy planning and outcomes. These surgical advances have resulted in reduced morbidity with equivalent or better tumor control. In the absence of a recommendation on how to delineate target volumes in patients with flaps or to consider margins after endoscopic endonasal surgery, radiotherapy practices are inevitably heterogeneous. Efforts are needed to increase the therapeutic index of postoperative radiotherapy in these situations. We analysed the rare existing literature and outlined a preliminary basis for a recommendation. Strengthening of multidisciplinarity to accurately define target volumes in these complex and relatively new situations, and "delineation concertation meetings" between radiologists, surgeons and radiation oncologists could probably contribute to improved outcomes.
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Affiliation(s)
- S Racadot
- Radiation Oncology Department, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - B Vérillaud
- Department of Otolaryngology-Head and Neck Surgery/Skull Base Surgery, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; Université Paris-Diderot, 5, rue Thomas-Mann, 75013 Paris, France
| | - A-A Serre
- Radiation Oncology Department, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - J Le Guevelou
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France
| | - L Guzene
- Radiation Oncology Department, CHU d'Amiens, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - C Laude
- Radiation Oncology Department, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - V Grégoire
- Radiation Oncology Department, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - S Deneuve
- Oncologic Surgery Department, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - A Larnaudie
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France
| | - A Lasne-Cardon
- Oncologic Surgery Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France
| | - J Thariat
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue General-Harris, 14000 Caen, France.
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Tallet A, Racadot S, Boher JM, Cohen M, Barrou J, Houvenaeghel G, Gutowski M, Delmond L, Lemanski C. The actual benefit of intraoperative radiation therapy using 50 kV x-rays in early breast cancer: A retrospective study of 676 patients. Breast J 2020; 26:2145-2150. [PMID: 32233012 DOI: 10.1111/tbj.13827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 01/22/2023]
Abstract
This French study reports the 5-year results of partial-breast irradiation using intraoperative radiation therapy (IORT) with 50 kV x-rays, in select early breast cancer patients. We report a retrospective analysis of 676 consecutive early breast cancer patients treated between November 2011 and December 2015 by partial-breast irradiation using the INTRABEAM® system. Patients were highly selected based on the ASTRO and GEC-ESTRO criteria and underwent breast-conservative surgery and IORT, completed with additional whole-breast irradiation (WBI) when unexpected unfavorable prognostic factors were found at the final pathology report. Patients' outcomes relative to local and distant control, overall and breast cancer-specific survival, and toxicity are presented, as well as rates of additional WBI. Additional WBI was mandatory in one third of patients (31%), mainly due to lymph node involvement and extensive intraductal component. With a median follow-up time of 54 months, the 5-year local recurrence rate was 1.7% [95%CI: 0.9-3.3]; the median time to local recurrence was 23 months; ipsilateral breast recurrences mainly occurred in the same quadrant (7/11); in the restricted population, meeting all predefined criteria and treated with IORT alone (406 patients), the local recurrence rate was 1.5% [95%CI: 0.6-3.6]. Five-year distant tumor control was 98.6% [95%CI: 97.2-99.3], and the median time to distant recurrence was 22 months. Five-year overall survival was 96.5% [95%CI: 94.2-97.8], and 5-year breast cancer-specific survival was 98.9% [95%CI: 97.6-99.7]. In patients treated with IORT alone, there was no grade 3 toxicity, only four grade 3 (mainly fibrosis) affected patients treated with IORT and WBI. Grade 1-2 toxicity rates were 14% and 34.4% in patients treated with IORT alone and IORT plus WBI, respectively. Partial-breast irradiation using IORT by a 50 kV photon device is safe and well-tolerated in select patients with early breast cancer and is a valuable option in patients reluctant for adjuvant WBI.
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Affiliation(s)
- Agnès Tallet
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France.,CRCM, Institut Paoli-Calmettes, Marseille, France
| | - Séverine Racadot
- Department of Radiation-Oncology, Centre Leon Bérard, Lyon, France
| | - Jean-Marie Boher
- Biostatistics, Institut Paoli-Calmettes, Marseille, France.,Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Monique Cohen
- Department of Surgical-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Julien Barrou
- Aix-Marseille Univ, CNRS, INSERM, Marseille, France.,Department of Surgical-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Gilles Houvenaeghel
- CRCM, Institut Paoli-Calmettes, Marseille, France.,Aix-Marseille Univ, CNRS, INSERM, Marseille, France.,Department of Surgical-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Marian Gutowski
- Department of Surgical-Oncology, Institut de Cancérologie de Montpellier, Montpellier, France
| | - Laure Delmond
- Department of Surgical-Oncology, Institut de Cancérologie de Montpellier, Montpellier, France
| | - Claire Lemanski
- Department of Radiation-Oncology, Institut de Cancérologie de Montpellier, Montpellier, France
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Aust S, Eberst L, Tredan O, Rousset-Jablonski C, Treilleux I, Méeus P, Chopin N, Beurrier F, Charreton A, Véronique D, Hallouz A, Coulon A, Ricoeur A, Mastier C, Bouhamama A, Racadot S, Devouassoux-Shisheboran M, Haddad V, Ray-Coquard I. Detailed overview on rare malignant ovarian tumors. Bull Cancer 2020; 107:385-390. [PMID: 32115180 DOI: 10.1016/j.bulcan.2020.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/26/2019] [Revised: 12/29/2019] [Accepted: 01/13/2020] [Indexed: 10/24/2022]
Abstract
The group of rare malignant ovarian tumors includes the group of germ cell tumors, sex cords stromal ovarian tumors, small cell carcinoma, malignant Brenner tumors, rare epithelial tumors such as mucinous carcinoma, clear cell carcinoma, or low-grade serous carcinoma, as well as ovarian carcinosarcoma. Together they comprise about 10% of all ovarian tumors. Due to their low prevalence and their heterogeneity, data and treatment recommendations are limited. Even though all ovarian tumors are staged according to the FIGO staging of epithelial ovarian tumors, treatment differs especially in germ cell tumors and sex cords stromal ovarian tumors. Non-epithelial ovarian tumors can arise from a variety of ovarian precursor cells such as germ cells, granulosa cells, theca cells, or stromal fibroblasts. As can be expected already due to their divergent precursor lesions, these malignancies are substantially different but united by their rarity. This overview article gives a comprehensive summary on the pathology and clinical presentation, as well as therapy recommendations of a selection of those rare ovarian tumors, based on the latest national guidelines and related important publications.
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Affiliation(s)
- Stefanie Aust
- Comprehensive Cancer Center, Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Lauriane Eberst
- Department of Medical Oncology, centre Léon-Bérard, Lyon, France
| | - Olivier Tredan
- Department of Medical Oncology, centre Léon-Bérard, Lyon, France
| | | | | | - Pierre Méeus
- Department of Surgery, centre Léon-Bérard, Lyon, France
| | | | - Fred Beurrier
- Department of Surgery, centre Léon-Bérard, Lyon, France
| | | | - Daval Véronique
- Department of Medical Oncology, centre Léon-Bérard, Lyon, France
| | - Amina Hallouz
- Department of Medical Oncology, centre Léon-Bérard, Lyon, France
| | - Agnès Coulon
- Department of Medical Oncology, centre Léon-Bérard, Lyon, France
| | - Alexis Ricoeur
- Department of Interventional Radiology, centre Léon-Bérard, Lyon, France
| | - Charles Mastier
- Department of Interventional Radiology, centre Léon-Bérard, Lyon, France
| | - Amine Bouhamama
- Department of Interventional Radiology, centre Léon-Bérard, Lyon, France
| | | | | | - Véronique Haddad
- Department of Medical Oncology, centre Léon-Bérard, Lyon, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, centre Léon-Bérard, University Claude Bernard (UCBL Lyon1), Lyon, France.
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Biston MC, Jarril J, Dupuis P, Boisbouvier S, Gassa F, Cervellera M, Chabaud S, Racadot S. Comparison among four immobilization devices for whole breast irradiation with Helical Tomotherapy. Phys Med 2020; 69:205-211. [PMID: 31918372 DOI: 10.1016/j.ejmp.2019.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/30/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the repositioning accuracy of 4 immobilization devices (ID) used for whole breast Helical Tomotherapy treatments: arm float with VacFix® (Par Scientific, Denmark), all-in-one® (AIO®) system (Orfit, Belgium), MacroCast thermoplastic mask (Macromedics, The Netherlands) and BlueBag® system with Arm-Shuttle (Elekta, Sweden). MATERIALS AND METHODS Twenty four women with breast cancer with PTV including the breast/chest wall and lymph nodes were involved in this study (6 women per group). Pretreatment registration results were first collected using automatic bone registration + manual adjustment on the vertebra followed by independent registrations on different ROIs representing each treated area (axillary, mammary chain, clavicular, breast/chest wall). The differences in translations and rotations between reference registration and the above mentionned ROIs were calculated. A total of 120 MVCT images were analyzed. RESULTS Significant differences were found between IDs (p < 0.0001), ROIs (p = 0.0002) and the session number (p < 0.0001) on the observed shifts, when examining 3D translation vectors. 3D-vectors were significantly lower for the BlueBag® than for the VacFix® or for the AIO® (p < 0.0001), but differences were not significant compared to the mask (p = 0.674). Finally, setup margins were overall smaller for the BlueBag® than for other IDs, with values ranging from 1.53 to 1.91 mm on the mammary chain area, 4.52-6.07 mm on the clavicular area, 2.71-4.62 mm on the axillary area, and 3.39-5.10 mm on the breast. CONCLUSION We demonstrated in this study that the BlueBag® combined with arm shuttle is a robust solution for breast and nodes immobilization during HT treatments.
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Affiliation(s)
- Marie-Claude Biston
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France; CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France.
| | - Jimmy Jarril
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
| | - Pauline Dupuis
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
| | | | - Frédéric Gassa
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
| | | | - Sylvie Chabaud
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
| | - Séverine Racadot
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
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Pialat PM, Mounié M, Fleury B, Suchaud J, Racadot S, Pommier P. Curiethérapie de rattrapage pour les carcinome épidermoïdes de la cavité orale ou de l’oropharynx en territoire déjà irradiés : résultats d’une étude rétrospective sur 25 patients. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.041] [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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Hannoun-Lévi JM, Van Limbergen E, Gal J, Schiappa R, Polgar C, Kauer-Domer D, Pasquier D, Lemanski C, Racadot S, Houvenaeghel G, Guix B, Bellière-Calandry A, Loessl K, Polat B, Gutierrez C, Galalae R, Strnad V. Mastectomie de rattrapage ou second traitement conservateur pour second évènement tumoral du sein homolatéral : analyse appariée sur score de propension. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Heudel P, Hooijenga D, Phan R, Augusto V, Xie X, Terret C, Faure C, Racadot S, Tredan O, Bachelot T. Analysis of prognostic factors on overall survival in elderly women treated for early breast cancer using data mining and machine learning. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz257.022] [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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Visy A, Bachelot T, Racadot S. Radiation recall syndrome in a patient with breast cancer, after introduction of everolimus. Cancer Radiother 2019; 23:423-425. [DOI: 10.1016/j.canrad.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 01/05/2019] [Accepted: 01/24/2019] [Indexed: 10/26/2022]
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Graff P, Blanchard P, Thariat J, Racadot S, Lapeyre M. [Post-treatment follow-up of head and neck cancer patients]. Cancer Radiother 2019; 23:576-580. [PMID: 31422000 DOI: 10.1016/j.canrad.2019.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/02/2019] [Accepted: 06/26/2019] [Indexed: 12/13/2022]
Abstract
Post-therapeutic follow-up of patients with head and neck cancer involves numerous professionals. The radiation oncologist should play an active role in this process. His oncological knowledge and technical expertise position him as a cornerstone for the detection of recurrences from the treated tumor, the research of second primary cancers and the screening of potential side-effects induced by the different treatments administered. To improve the benefits/costs ratio and allow good patient-compliance, follow-up programs should be built through close collaboration between the different contributors and planned according to a feasible schedule. Paraclinical exams must be arranged to respond to accurate objectives. Patient-education is essential to ensure the patient's full understanding and active participation. Finally, the transfer of the long-term follow-up of cancer survivors from specialists to primary care physicians is relevant but would require a prospective evaluation of its efficiency for this specific population.
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Affiliation(s)
- P Graff
- Département de radiothérapie, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France.
| | - P Blanchard
- Département de radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
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Bondue C, Racadot S, Coutte A, Dupuis P, Biston MC, Grégoire V. Volumetric and dosimetric comparison of two delineation guidelines for the radiation treatment of laryngeal squamous cell carcinoma. Clin Transl Radiat Oncol 2019; 19:1-11. [PMID: 31334365 PMCID: PMC6614748 DOI: 10.1016/j.ctro.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/28/2019] [Revised: 05/31/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022] Open
Abstract
The delineation of target volumes for Head and Neck IMRT is complex. There have been several approaches for the delineation of the primary tumor clinical target volume: the anatomical guidelines, the geometric guidelines and more recently the international guidelines.
Purpose Three methods have been recently proposed for the delineation of the primary tumor clinical target volume (CTV-P) in Head and Neck Cancers: the anatomic method popularized in the French literature by Lapeyre et al. the geometric methods proposed by the DAHANCA group, and more recently the international guidelines promoted by Grégoire et al. integrating the latter two. The aim of this study was to perform a volumetric and dosimetric comparison of the French and the International consensus methods in laryngeal SCC. Patients and methods Two radiation oncologists independently delineated the high dose and low dose primary tumor CTV in four patients with T2 or T3 N0-M0 laryngeal SCC following either the so-called French guidelines or the International guidelines. For the 4 cases, the GTV was delineated by a single radiation oncologist. Nodal CTVs were delineated by one radiation oncologist for the 4 cases using International guidelines. Dose optimization was then performed with VMAT (MONACO version 5.11) using 6 MeV photons. Differences in target volumes and dose distributions in OARs and PTVs were then evaluated with various metrics such as the DICE Similarity Coefficient and the homogeneity index. Results Major differences were observed in the CTV delineation between the 2 delineation methods for the low dose volumes and to a lower extend for the high dose volumes. These differences translated into variations in dose distribution favoring the International guidelines for decreasing dose to various OARs. Such differences toned down when dose distribution on the primary tumors PTVs and nodal PTVs were combined. Conclusion This study demonstrated large differences in CTV delineation between the 2 delineation guidelines. Such differences translated into differences in dose distribution.
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Affiliation(s)
- C Bondue
- Department of Radiation Oncology, University Hospital, Amiens, France
| | - S Racadot
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - A Coutte
- Department of Radiation Oncology, University Hospital, Amiens, France
| | - P Dupuis
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - M C Biston
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - V Grégoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
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Frikha M, Auperin A, Tao Y, Elloumi F, Toumi N, Blanchard P, Lang P, Sun S, Racadot S, Thariat J, Alfonsi M, Tuchais C, Cornely A, Moussa A, Guigay J, Daoud J, Bourhis J. A randomized trial of induction docetaxel-cisplatin-5FU followed by concomitant cisplatin-RT versus concomitant cisplatin-RT in nasopharyngeal carcinoma (GORTEC 2006-02). Ann Oncol 2019; 29:731-736. [PMID: 29236943 DOI: 10.1093/annonc/mdx770] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Concomitant chemotherapy (CT)-radiotherapy (RT) is a standard of care in locally advanced nasopharyngeal carcinoma (NPC) and a role for induction CT is not established. Methods Patients with locally advanced NPC, WHO type 2 or 3, were randomized to induction TPF plus concomitant cisplatin-RT or concomitant cisplatin-RT alone. The TPF regimen consisted of three cycles of Docetaxel 75 mg/m2 day 1; cisplatin 75 mg/m2 day 1; 5FU 750 mg/m2/day days 1-5. RT consisted of 70 Gy in 7 weeks plus concomitant cisplatin 40 mg/m2 weekly. Results A total of 83 patients were included in the study. Demographics and tumour characteristics were well balanced between both arms. Most of the patients (95%) in the TPF arm received three cycles of induction CT. The rate of grade 3-4 toxicity and the compliance (NCI-CTCAE v3) during cisplatin-RT were not different between both arms. With a median follow-up of 43.1 months, the 3-year PFS rate was 73.9% in the TPF arm versus 57.2% in the reference arm [hazard ratio (HR) = 0.44; 95% confidence interval (CI): 0.20-0.97, P = 0.042]. Similarly the 3 years overall survival rate was 86.3% in the TPF arm versus 68.9% in the reference arm (HR = 0.40; 95% CI: 0.15-1.04, P = 0.05). Conclusion In conclusion, several important aspects can be emphasized: the compliance to induction TPF was good and TPF did not compromise the tolerance of the concomitant RT-cisplatin phase. The improved PFS and overall survival rates needs to be confirmed by further trials.
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Affiliation(s)
- M Frikha
- Medical Oncology Department, Sfax University Hospital, Sfax, Tunisia
| | - A Auperin
- Department of Statistics, Gustave-Roussy, Villejuif, France
| | - Y Tao
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France
| | - F Elloumi
- Radiation Oncology Department, Sfax University Hospital, Sfax, Tunisia
| | - N Toumi
- Radiation Oncology Department, Sfax University Hospital, Sfax, Tunisia
| | - P Blanchard
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France
| | - P Lang
- Radiation Oncology Department, Pitié Salpetrière, Paris, France
| | - S Sun
- Radiation Oncology Department, Centre Hospitalier Montbeliard, Montbeliard, France
| | - S Racadot
- Radiation Oncology Department, Centre L. Bérard, Lyon, France
| | - J Thariat
- Department of Oncology, Centre A. Lacassagne, Nice, France
| | - M Alfonsi
- Radiation Oncology Department, Clinique St Catherine, Avignon, France
| | - C Tuchais
- Radiation Oncology Department, Centre C. Papin, Angers, France
| | - A Cornely
- Department of Statistics, Gustave-Roussy, Villejuif, France
| | - A Moussa
- Department of Statistics, Gustave-Roussy, Villejuif, France
| | - J Guigay
- Department of Oncology, Centre A. Lacassagne, Nice, France
| | - J Daoud
- Radiation Oncology Department, Sfax University Hospital, Sfax, Tunisia.
| | - J Bourhis
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France; Radiation Oncology Department, CHUV, Lausanne, Switzerland.
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Pierre-Marie P, Mounie M, Fleury B, Racadot S, Suchaud J, Pommier P. PO-1044 Salvage brachytherapy for oral or oropharyngeal tumor in a previously irradiated volume. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31464-1] [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: 11/30/2022]
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Bourgier C, Cowen D, Lemanski C, Castan F, Rivera S, De La Lande B, Peignaux K, Le Blanc-Onfroy M, Benyoucef A, Mege A, Douadi-Gaci Z, Racadot S, Latorzeff I, Schick U, Jacquot S, Massabeau C, Guilbert P, Geffrelot J, Ellis S, Lecouillard I, Breton-Callu C, Richard-Tallet A, Bontemps P, Fenoglietto P, Azria D. OC-0594 Acute toxicity results after breast-conserving therapy in “boost vs no boost (BONBIS)” DCIS trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31014-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Clavier J, Eugene R, Thariat J, Antoni D, Beneyton V, Claude L, Fontbonne J, Gaillot N, Ganansia V, Jamain C, Lepinoy A, Laude C, Mazzara C, Noblet C, Racadot S, Ruffier A, Servagi S, Truntzer P, Guihard S. EP-1662 Multicentric structured medical data production on an OIS for modeling of radiotherapy effects. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32082-1] [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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Guihard S, Eugène R, Thariat J, Beneyton V, Claude L, Fontbonne JM, Gaillot N, Ganansia V, Jamain C, Lepinoy A, Laude C, Mazzara C, Racadot S, Ruffier A, Servagi S, Truntzer P, Clavier J. Dossier structuré commun de radiothérapie basé sur Mosaiq®. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.020] [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: 10/28/2022]
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d’Illiers LBP, Lafay F, Faure C, Klingler S, Pleynet E, Racadot S. Up to 5 years outcomes following intraoperative radiotherapy for early breast cancer. Transl Cancer Res 2018. [DOI: 10.21037/tcr.2018.06.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tao Y, Auperin A, Sire C, Martin L, Khoury C, Maingon P, Bardet E, Kaminsky MC, Lapeyre M, Chatellier T, Alfonsi M, Pointreau Y, Jadaud E, Géry B, Zawadi A, Tourani JM, Laguerre B, Coutte A, Racadot S, Hasbini A, Malaurie E, Borel C, Meert N, Cornely A, Ollivier N, Casiraghi O, Sun XS, Bourhis J. Improved Outcome by Adding Concurrent Chemotherapy to Cetuximab and Radiotherapy for Locally Advanced Head and Neck Carcinomas: Results of the GORTEC 2007-01 Phase III Randomized Trial. J Clin Oncol 2018; 36:JCO2017762518. [PMID: 29878867 DOI: 10.1200/jco.2017.76.2518] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Purpose To investigate the effect of adding concurrent chemotherapy (CT) to cetuximab plus radiotherapy (RT; CT-cetux-RT) compared with cetuximab plus RT (cetux-RT) in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). Patients and Methods In this phase III randomized trial, patients with N0-2b, nonoperated, stage III or IV (nonmetastatic) LA-SCCHN were enrolled. Patients received once-daily RT up to 70 Gy with weekly cetuximab or with weekly cetuximab and concurrent carboplatin and fluorouracil (three cycles). To detect a hazard ratio (HR) of 0.64 for progression-free survival (PFS) with 85% power at a two-sided significance level of P = .05, 203 patients needed to be included in each arm. Results Four hundred six patients were randomly assigned to either CT-cetux-RT or cetux-RT. Patient and tumor characteristics were well balanced between arms, including p16 status. With a median follow-up of 4.4 years, the HR for PFS favored the CT-cetux-RT arm (HR, 0.73; 95% CI, 0.57 to 0.94; P = .015), with 3-year PFS rates of 52.3% and 40.5% and median PFS times of 37.9 and 22.4 months in the CT-cetux-RT and cetux-RT arms, respectively. The HR for locoregional control was 0.54 (95% CI, 0.38 to 0.76; P < .001) in favor of CT-cetux-RT. These benefits were observed regardless of p16 status for oropharynx carcinomas. Overall survival (HR, 0.80; P = .11) and distant metastases rates (HR, 1.19; P = .50) were not significantly different between the two arms. The CT-cetux-RT arm, compared with cetux-RT, had a higher incidence of grade 3 or 4 mucositis (73% v 61%, respectively; P = .014) and of hospitalizations for toxicity (42% v 22%, respectively; P < .001). Conclusion The addition of concurrent carboplatin and fluorouracil to cetux-RT improved PFS and locoregional control, with a nonsignificant gain in survival. To our knowledge, this is the first evidence of a clinical benefit for treatment intensification using cetux-RT as a backbone in LA-SCCHN.
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Affiliation(s)
- Yungan Tao
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Anne Auperin
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Christian Sire
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Laurent Martin
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Cedric Khoury
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Philippe Maingon
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Etienne Bardet
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Marie-Christine Kaminsky
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Michel Lapeyre
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Thierry Chatellier
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Marc Alfonsi
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Yoann Pointreau
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Eric Jadaud
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Bernard Géry
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Ayman Zawadi
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Jean-Marc Tourani
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Brigitte Laguerre
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Alexandre Coutte
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Séverine Racadot
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Ali Hasbini
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Emanuelle Malaurie
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Christian Borel
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Nicolas Meert
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Alexandre Cornely
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Nathalie Ollivier
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Odile Casiraghi
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Xu Shan Sun
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - Jean Bourhis
- Yungan Tao, Anne Auperin, Alexandre Cornely, Nathalie Ollivier, Odile Casiraghi, and Jean Bourhis, Gustave-Roussy Institute, Villejuif; Christian Sire, Centre Hospitalier de Lorient, Lorient; Laurent Martin, Centre Guillaume le Conquérant, Le Havre; Cedric Khoury, Centre Hospitalier de Toulon, Toulon; Philippe Maingon, Centre Georges-François Leclerc, Dijon; Etienne Bardet, Centre René Gauducheau, Nantes; Marie-Christine Kaminsky, Centre Alexis Vautrin, Nancy; Michel Lapeyre, Centre Jean Perrin, Clermont; Thierry Chatellier, Clinique Mutualiste, Saint Nazaire; Marc Alfonsi, Clinique Sainte Catherine, Avignon; Yoann Pointreau, Centre Jean Bernard, Le Mans; Yoann Pointreau, Centre Hospitalier Universitaire (CHU) de Tours, Tours; Eric Jadaud, Centre Paul Papin, Angers; Bernard Géry, Centre François Baclesse, Caen; Ayman Zawadi, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon; Jean-Marc Tourani, CHU, Poitiers; Brigitte Laguerre, Centre Eugène Marquis, Rennes; Alexandre Coutte, CHU, Amiens; Séverine Racadot, Centre Léon Bérard, Lyon; Ali Hasbini, Clinique Armoricaine, Saint-Brieuc; Emanuelle Malaurie, Centre Hospitalier Intercommunal de Créteil, Créteil; Christian Borel, Centre Paul Strauss, Strasbourg; Xu Shan Sun, Hopital Nord Franche-Comté de Montbéliard, Montbéliard; Xu Shan Sun, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France; Nicolas Meert, Centre Hospitalier de Charleroi, Charleroi, Belgium; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
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Supiot S, Campion L, Pommier P, Dore M, Palpacuer C, Racadot S, Rio E, Milano GA, Mahier-Ait Oukhatar C, Carrie C. Combined abiraterone acetate plus prednisone, salvage prostate bed radiotherapy and LH-RH agonists (CARLHA-GEP12) in biochemically-relapsing prostate cancer patients following prostatectomy: A phase I study of the GETUG/GEP. Oncotarget 2018; 9:22147-22157. [PMID: 29774129 PMCID: PMC5955159 DOI: 10.18632/oncotarget.25189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 03/24/2018] [Accepted: 04/04/2018] [Indexed: 12/20/2022] Open
Abstract
Background To establish the maximum tolerated dose of abiraterone acetate plus prednisone (AA) combined with salvage radiotherapy (SRT) and goserelin in a phase 1 study in men with rising PSA following radical prostatectomy. Methods AA was given during one month before SRT at 1000 mg PO once daily, then 750 mg (Dose Level 1, DL1) or 1000 mg (DL2) during 5 months combined with 6-months goserelin by injection on the first day of irradiation (scheme NEO) or one month before starting SRT (scheme CONCO). Results In scheme NEO at DL1, 2/9 patients did not achieve castration levels of testosterone. 4/9 patients (44%) presented with grade 3 liver enzyme elevation. In scheme CONCO testosterone dropped to undetectable levels. At DL1, 6 patients were recruited, with no dose limiting toxicities. At DL2, 2/3 patients presented with grade 3 liver enzyme elevation occurring during SRT. Conclusions When AA was administered without goserilin, only 78% achieved castration levels. AA combined with SRT and goserilin did not increase pelvic toxicity, but lead to an unsuspected high frequency of grade 3 liver toxicity. The phase II recommended dose of AA combined to goserelin and SRT is 750 mg.
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Affiliation(s)
- Stéphane Supiot
- Departments of Radiation Oncology and Biostatistics, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Loic Campion
- Departments of Radiation Oncology and Biostatistics, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Pascal Pommier
- Department of Radiation Oncology, Centre Léon Berard, Lyon, France
| | - Mélanie Dore
- Departments of Radiation Oncology and Biostatistics, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Clément Palpacuer
- Departments of Radiation Oncology and Biostatistics, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Séverine Racadot
- Department of Radiation Oncology, Centre Léon Berard, Lyon, France
| | - Emmanuel Rio
- Departments of Radiation Oncology and Biostatistics, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Gérard A Milano
- Laboratoire d'Oncopharmacologie, Centre Antoine-Lacassagne, Nice, France
| | | | - Christian Carrie
- Department of Radiation Oncology, Centre Léon Berard, Lyon, France
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Tao Y, Faivre L, Laprie A, Boisselier P, Ferron C, Jung G, Racadot S, Gery B, Even C, Breuskin I, Bourhis J, Janot F. OC-0272: Twice daily reirradiation with cetuximab vs once daily chemoRT after surgery in head and neck cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30582-6] [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: 10/14/2022]
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Gobeli M, Rigaud B, Charra-Brunaud C, Renard S, De Rauglaudre G, Beneyton V, Racadot S, Peignaux K, Leseur J, Williaume D, Rannou N, Simon A, Lafond C, Jaksic N, Gnep K, Herve C, Riet F, Pougnet I, De Crevoisier R. PO-1078: CBCT guided adaptive radiotherapy for cervix cancer: Uncertainty of the choice of the plan of the day. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31388-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bernichon E, Vallard A, Wang Q, Attignon V, Pissaloux D, Bachelot T, Heudel PE, Ray-Coquard I, Bonnet E, de la Fouchardière A, Faure C, Chopin N, Beurrier F, Racadot S, Sunyach MP, Rancoule C, Perol D, Corset V, Agrapart V, Tinquaut F, Blay JY, Magné N, Trédan O. Genomic alterations and radioresistance in breast cancer: an analysis of the ProfiLER protocol. Ann Oncol 2017; 28:2773-2779. [PMID: 28945826 DOI: 10.1093/annonc/mdx488] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Breast cancer (BC) patients with comparable prognostic features have heterogeneous outcomes, party related to a possible radiotherapy resistance leading to local-regional recurrences (LRR). The objective of the present study was to identify predictive molecular biomarkers of LRR of BC. PATIENTS AND METHODS Genetic profile of 146 BC patients' tumours included in the ProfiLER clinical trial (NC01774409) between 2013 and 2016 were analysed using next-generation-sequencing and comparative-genomic-hybridization tests. Patients and tumour characteristics were retrospectively collected and analysed for association with genomic rearrangements (mutations, amplification, deletions). Only gene alterations observed in >3% of the tumours were selected. RESULTS A total of 193 genomic rearrangements were identified, and 16 were observed in >3% of tumours. One was statistically correlated to the risk of local relapse. A median loco-regional progression-free survival (LRPFS) of 23.6 years was reported for PIK3CA mutation carriers (n = 31, 21.2%) versus 9.9 years for PIK3CA wild-type patients (HR 0.27, 95% CI 0.12-0.65, P = 0.002 in univariate analysis). PIK3CA mutation was identified as an independent protective factor on LRR using multivariate analysis (HR 0.29, 95% CI 0.09-0.99, P = 0.047). All other mutations, amplifications or deletions were not found associated with LRPFS. CONCLUSION PIK3CA mutation was associated with a lower risk of local relapse in this population of BCs. This is consistent with recent studies suggesting PIK3CA to be part of biological pathways impacting the radiosensitivity.
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MESH Headings
- Adult
- Biomarkers, Tumor/genetics
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/secondary
- Class I Phosphatidylinositol 3-Kinases/genetics
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Gene Rearrangement
- Genomics
- High-Throughput Nucleotide Sequencing
- Humans
- Lymphatic Metastasis
- Middle Aged
- Mutation
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Prognosis
- Prospective Studies
- Radiation Tolerance/genetics
- Retrospective Studies
- Survival Rate
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Affiliation(s)
| | - A Vallard
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez
| | - Q Wang
- Department of Translational Research
| | | | | | | | | | | | | | | | | | | | | | | | | | - C Rancoule
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez
| | - D Perol
- Department of Clinical Research, Léon Bérard Cancer Centre, Lyon
| | - V Corset
- Department of Clinical Research, Léon Bérard Cancer Centre, Lyon
| | - V Agrapart
- Department of Clinical Research, Léon Bérard Cancer Centre, Lyon
| | - F Tinquaut
- Department of Hygée Center, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez
| | - J-Y Blay
- Department of Translational Research; Department of Medical Oncology
| | - N Magné
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez; Department of Laboratoire de Radiobiologie Cellulaire et Moléculaire, CNRS UMR 5822, Institut de Physique Nucléaire de Lyon, IPNL, Lyon Medicine University, Lyon, France.
| | - O Trédan
- Department of Translational Research; Department of Medical Oncology
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Vallard A, Bernichon E, Wang Q, Attignon V, Pissaloux D, Heudel P, Bachelot T, Ray-Coquard I, de la Fouchardière A, Faure C, Chopin N, Beurrier F, Racadot S, Sunyach M, Rancoule C, Perol D, Corset V, Agrapart V, Tinquaut F, Blay JY, Magné N, Trédan O. Altération génétiques et radioresistance du cancer du sein : une analyse de l’essai ProfiLER. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.081] [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: 10/18/2022]
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Pêtre A, Cervellera M, Montbarbon X, Sunyach MP, Beneyton V, Carrie C, Racadot S. Réirradiation pariétale après une mastectomie de rattrapage pour une récidive locale après un traitement conservateur d’un cancer du sein : est-ce toujours d’actualité ? Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.052] [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: 10/18/2022]
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