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Camps-Malea A, Pointreau Y, Chapet S, Calais G, Barillot I. Stereotactic body radiotherapy for mediastinal lymph node with CyberKnife®: Efficacy and toxicity. Cancer Radiother 2023; 27:225-232. [PMID: 37080855 DOI: 10.1016/j.canrad.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 04/22/2023]
Abstract
PUPRPOSE Stereotactic body radiotherapy is more and more used for treatment of oligometastatic mediastinal lymph nodes. The objective of this single-centre study was to evaluate its efficacy in patients with either a locoregional recurrence of a pulmonary or oesophageal cancer or with distant metastases of extrathoracic tumours. PATIENTS AND METHODS Patients with oligometastatic mediastinal lymph nodes treated with CyberKnife from June 2010 to September 2020 were screened. The primary endpoint was to assess local progression free survival and induced toxicity. Secondary endpoints were overall survival and progression free survival. The delay before introduction of systemic treatment in the subgroup of patients who did not receive systemic therapy for previous progression was also evaluated. RESULTS Fifty patients were included: 15 with a locoregional progression of a thoracic primary tumour (87% pulmonary) and 35 with mediastinal metastasis of especially renal tumour (29%). Median follow-up was 27 months (6-110 months). Local progression free survival at 6, 12 and 18 months was respectively 94, 88 and 72%. The rate of local progression was significantly lower in patients who received 36Gy in six fractions (66% of the cohort) versus other treatment schemes. Two grade 1 acute oesophagitis and one late grade 2 pulmonary fibrosis were described. Overall survival at 12, 18 and 24 months was respectively 94, 85 and 82%. Median progression free survival was 13 months. Twenty-one patients were treated by stereotactic body irradiation alone without previous history of systemic treatment. Among this subgroup, 11 patients (52%) received a systemic treatment following stereotactic body radiotherapy with a median introduction time of 17 months (5-52 months) and 24% did not progress. CONCLUSION Stereotactic body irradiation as treatment of oligometastatic mediastinal lymph nodes is a well-tolerated targeted irradiation that leads to a high control rate and delay the introduction of systemic therapy in selected patients.
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Affiliation(s)
- A Camps-Malea
- Service de radiothérapie, centre Henry-S-Kaplan, CHRU Bretonneau, Tours, France.
| | - Y Pointreau
- Service de radiothérapie, centre Henry-S-Kaplan, CHRU Bretonneau, Tours, France; Institut Inter-régional de cancérologie, centre Jean-Bernard, clinique Victor-Hugo, Le Mans, France
| | - S Chapet
- Service de radiothérapie, centre Henry-S-Kaplan, CHRU Bretonneau, Tours, France
| | - G Calais
- Service de radiothérapie, centre Henry-S-Kaplan, CHRU Bretonneau, Tours, France
| | - I Barillot
- Service de radiothérapie, centre Henry-S-Kaplan, CHRU Bretonneau, Tours, France
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Claude L, Bolle S, Morelle M, Huchet A, Vigneron C, Escande A, Chapet S, Leseur J, Bernier V, Carrie C, Barry A, Vizoso S, Blanc E, Laprie A, Supiot S. Hypofractionated stereotactic body radiation therapy (SBRT) in pediatric patients: results of a national prospective multicenter study. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.043] [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: 11/16/2022]
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Castelli J, Benezery K, Hasbini A, Gery B, Berger A, Liem X, Guihard S, Chapet S, Thureau S, Auberdiac P, Pommier P, Thariat J, Campillo B, de Crevoisier R. OC-0831 Results of ARTIX phase III study: adaptive radiotherapy versus standard IMRT in head and neck cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02695-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Debbi K, Loganadane V G, Kinj R, Chapet S, Janoray G, Benezery K, Barillot I, Calais G. Stereotactic Ablative Radiation Therapy (CyberKnife) for Lung Oligometastases from Head and Neck Squamous Cell Carcinoma (HNSCC): Bi-Institutional Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1396] [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: 10/23/2022]
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Debbi K, Chapet S, Kinj R, Janoray G, Rajasingham R, Bénézéry K, Barillot I, Calais G. Radiothérapie stéréotaxique par CyberKnife® des oligométastases pulmonaires des cancers de la tête et du cou : survie et facteurs pronostiques, une étude rétrospective multicentrique. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Scher N, Janoray G, Riet FG, Le Bayon AG, Debbi K, Lévy S, Louisot P, Garaud P, Chajon E, Barillot I, Salamé É, de Crevoisier R, Chapet S, Calais G. [Stereotactic body radiation therapy for hepatocellular carcinoma: Results from a retrospective multicentre study]. Cancer Radiother 2019; 23:104-115. [PMID: 30952560 DOI: 10.1016/j.canrad.2018.07.138] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/24/2018] [Accepted: 07/29/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this paper was to describe local control, overall survival, progression-free survival and toxicity of CyberKnife®-based stereotactic body radiation therapy of hepatocellular carcinoma. MATERIAL AND METHODS Records of all the patients treated for hepatocellular carcinoma at the Eugene-Marquis cancer centre, Rennes and the Bretonneau hospital, Tours (France), between November 2010 and December 2016, were reviewed. Radiation therapy was performed as a salvage treatment, while awaiting liver transplantation or if no other treatment was possible. RESULTS One hundred and thirty-six patients were consecutively included in the study. The median follow-up was 13months. Median total dose prescribed, fractionation and overall treatment time were respectively 45Gy, three fractions and 5 days. Overall survival, progression-free survival and local control rates at 1year and 2years were 79.8 % and 63.5 %, 61.3 % and 39.4 %; 94.5 % and 91 %. Two grade 3 acute toxicity events and two grade 4 late toxicity events corresponding to a duodenal ulcer have been reported. Seven patients underwent classic radiation-induced hepatitis and 13 patients showed non-classical radiation-induced hepatitis. Barcelona Clinic Liver Cancer stage, World Health Organisation grade and planning target volume were correlated with overall survival in univariate Cox analysis. CONCLUSION Stereotactic body radiation therapy is effective and well-tolerated for inoperable hepatocellular carcinoma or as a bridge to liver transplantation. Toxicity is mainly related to cirrhotic background and requires a selection of patients and strict dose constraints.
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Affiliation(s)
- N Scher
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
| | - G Janoray
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - F-G Riet
- Département de radiothérapie, centre de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - A-G Le Bayon
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - K Debbi
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - S Lévy
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - P Louisot
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - P Garaud
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - E Chajon
- Département de radiothérapie, centre de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - I Barillot
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - É Salamé
- Département de chirurgie digestive, oncologique et transplantation hépatique, CHRU de Tours, 37044 Chambray-lès-Tours, France
| | - R de Crevoisier
- Département de radiothérapie, centre de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - S Chapet
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - G Calais
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
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Scher N, Riet F, Janoray G, Debbi K, Levy S, Louisot P, Chajon E, Salame E, Barillot I, De Crevoisier R, Calais G, Chapet S. EP-1414 SBRT for the treatment of hepatocellular carcinoma: a retrospective multicenter study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31834-1] [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: 11/27/2022]
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Scher N, Chapet S, Riet FG, Janoray G, Debbi K, Lévy S, Chajon E, Barillot I, de Crevoisier R, Calais G. Radiothérapie en conditions stéréotaxiques du carcinome hépatocellulaire : étude rétrospective multicentrique. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.022] [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: 10/28/2022]
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Lévy S, Chapet S, Scher N, Debbi K, Ruffier A, Bernadou G, Pointreau Y, Calais G. Reirradiation of gliomas under stereotactic conditions: Prognostic factors for survival without relapse or side effects, a retrospective study at Tours regional university hospital (France). Cancer Radiother 2017; 21:759-765. [PMID: 29128197 DOI: 10.1016/j.canrad.2017.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 01/19/2017] [Revised: 05/06/2017] [Accepted: 05/16/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE To search for factors correlated with relapse-free survival following stereotactic reirradiation in patients with recurrent glioma following radiochemotherapy and evaluate tolerance to this treatment. PATIENTS AND METHODS Initial radiotherapy was given according to the protocol of Stupp and al. Reirradiation was performed using the CyberKnife® system. Patients could have had surgical resection initially and at the time of recurrence. We analysed 13 patients treated between July 2010 and September 2014. The median age was 55 years. The doses delivered ranged from 20 to 36Gy, in one to ten fractions. RESULTS Median survival after stereotactic radiotherapy was 14 months. Survival without relapse was 3.7 months. Factors significantly influencing duration of relapse-free survival were: age (P=0.04), total dose (P=0.02), dose per fraction (P=0.04) and number of fractions (P=0.01). We found no correlation between gross tumour volume, clinical target volume, grade of tumour or prescription isodose and relapse-free survival following radiochemotherapy. Three patients developed radionecrosis. CONCLUSION Reirradiation under stereotactic conditions is well tolerated. A dose of more than 30Gy delivered in 5 or more fractions seems to prolong relapse-free survival.
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Affiliation(s)
- S Lévy
- Radiotherapy Department, CHRU de Tours, Corad, 2, boulevard Tonnelé, 37000 Tours, France.
| | - S Chapet
- Radiotherapy Department, CHRU de Tours, Corad, 2, boulevard Tonnelé, 37000 Tours, France
| | - N Scher
- Radiotherapy Department, CHRU de Tours, Corad, 2, boulevard Tonnelé, 37000 Tours, France
| | - K Debbi
- Radiotherapy Department, CHRU de Tours, Corad, 2, boulevard Tonnelé, 37000 Tours, France
| | - A Ruffier
- Radiotherapy Department, CHRU de Tours, Corad, 2, boulevard Tonnelé, 37000 Tours, France
| | - G Bernadou
- Radiotherapy Department, CHRU de Tours, Corad, 2, boulevard Tonnelé, 37000 Tours, France
| | - Y Pointreau
- Radiotherapy Department, CHRU de Tours, Corad, 2, boulevard Tonnelé, 37000 Tours, France; Institut interrégional de cancérologie centre Jean-Bernard, clinique Victor-Hugo, 9, rue Beauverger, 72000 Le Mans, France
| | - G Calais
- Radiotherapy Department, CHRU de Tours, Corad, 2, boulevard Tonnelé, 37000 Tours, France
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Robert A, Pointreau Y, Janoray G, Bardet É, Fesneau M, Garaud P, Chapet S, Lafond C, Dupuis O, Calais G. A large French multicenter retrospective series of T1-T2N0 vocal cords carcinomas treated with exclusive irradiation. Cancer Radiother 2017; 21:286-290. [DOI: 10.1016/j.canrad.2017.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 10/19/2022]
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Thariat J, Sun X, Tao Y, Maingon P, Deloge SR, Huguet F, Wiazzane N, Franck D, Bollet M, Chapet S, Bosset M, Guichard F, Alfonsi M, Phare O, Gaudaire S, Vulquin N, Rouvier J, Michel C, Bourhis J. Quality Assurance (QA) of Randomized Phase 2 GORTEC Trial 2014-04 of Stereotactic Irradiation in Patients With Oligometastatic Squamous Cell Carcinomas of the Head and Neck. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2150] [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: 11/27/2022]
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Janoray G, Pointreau Y, Garaud P, Chapet S, Alfonsi M, Sire C, Jadaud E, Calais G. Résultats à long terme de l’essai de phase III Gortec 2000-01 sur la chimiothérapie d’induction par cisplatine, 5-fluorouracile avec ou sans docétaxel pour la préservation laryngée. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.114] [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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Théron A, Chapet S, Bernadou G, Calais G, Morinière S, Pointreau Y. Réirradiation en condition stéréotaxiques par CyberKnife® des cancers des sinus de la face récidivants. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Demoor-Goldschmidt C, Claude L, Carrie C, Bolle S, Helfre S, Alapetite C, Jouin A, Padovani L, Ducassou A, Vigneron C, Le Prisé É, Huchet A, Stefan D, Kerr C, Nguyen TD, Truc G, Chapet S, Bondiau PY, Coche B, Muracciole X, Laprie A, Noël G, Leseur J, Habrand JL, Potet H, Ruffier A, Supiot S, Mahé MA, Bernier V. [French organization of paediatric radiation treatment: Results of a survey conducted by the radiotherapy Committee of the French Society of Paediatric Cancers (SFCE)]. Cancer Radiother 2016; 20:395-9. [PMID: 27421622 DOI: 10.1016/j.canrad.2016.05.016] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/22/2016] [Accepted: 05/06/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Radiotherapy is a rare indication in paediatric oncology, with 800 to 900 children in treatment per year in France. Child cancers represent approximately 1% of cancers in France and half occur before the age of 5 years. Paediatric radiation requires appropriate tools, local, time and specific training. In France, in 2015, 18 centres are accredited by the French National Cancer Institute (INCa) for this activity. MATERIAL AND METHODS Survey conducted in February 2015 on the care of children (0 to 18 years) in radiotherapy departments in France. The survey was sent to the radiation oncologists involved in the 18 centres. The questions concerned the qualitative and quantitative aspect, medical and organizational aspects, and the involvement of assistant practitioners in the management of this activity. RESULTS Seventeen centres responded. In 2014, 889 children under 18 were treated in radiotherapy departments. These departments are working together with one to four paediatric oncology departments. Regarding access to general anaesthesia: three centres perform one to seven treatment(s) under anaesthesia per year, three centres eight to ten treatments under anaesthesia per year, three centres ten to 24 treatments under anaesthesia per year and nine centres out of 17 use hypnosis techniques. In terms of human resources, in 2015, 29 radiation therapists have a paediatric radiotherapy activity. Involvement of assistant practitioners is growing and specific training are desired. Regarding treatment preparation and delivery, 13 centres have specific paediatric contentions, 14 of 16 centres employ radiation intensity modulated if dosimetry is more satisfying with 11 regularly to the craniospinal irradiation. Radiotherapy on moving areas with respiratory gating or hypofractionation is under developed. CONCLUSION Paediatric radiation therapy is a specific activity requiring a dedicated management, both in human, organizational, medical and scientific aspects.
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Affiliation(s)
- C Demoor-Goldschmidt
- Radiothérapie, institut de cancérologie de l'Ouest-Nantes, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Inserm U1018, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - L Claude
- Radiothérapie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - C Carrie
- Radiothérapie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - S Bolle
- Radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - S Helfre
- Radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - C Alapetite
- Radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Jouin
- Radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - L Padovani
- Radiothérapie, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - A Ducassou
- Radiothérapie, IUCT Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - C Vigneron
- Radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67000 Strasbourg, France
| | - É Le Prisé
- Radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - A Huchet
- Radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - D Stefan
- Radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - C Kerr
- Radiothérapie, institut du cancer de Montpellier, 208, avenue des Apothicaires, 34298 Montpellier, France
| | - T-D Nguyen
- Radiothérapie, institut Jean-Godinot, 1, rue du Général-Koenig, 51100 Reims, France
| | - G Truc
- Radiothérapie, institut Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - S Chapet
- Radiothérapie, Corad, hôpital Bretonneau, CHRU de Tours, 2 boulevard Tonnellé, 37000 Tours, France
| | - P-Y Bondiau
- Radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06100 Nice, France
| | - B Coche
- Radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - X Muracciole
- Radiothérapie, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - A Laprie
- Radiothérapie, IUCT Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - G Noël
- Radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67000 Strasbourg, France
| | - J Leseur
- Radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - J-L Habrand
- Radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - H Potet
- Radiothérapie, institut Jean-Godinot, 1, rue du Général-Koenig, 51100 Reims, France
| | - A Ruffier
- Radiothérapie, Corad, hôpital Bretonneau, CHRU de Tours, 2 boulevard Tonnellé, 37000 Tours, France
| | - S Supiot
- Radiothérapie, institut de cancérologie de l'Ouest-Nantes, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - M-A Mahé
- Radiothérapie, institut de cancérologie de l'Ouest-Nantes, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - V Bernier
- Radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67000 Strasbourg, France
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Llacer-Moscardo C, Le Pechoux C, Sunyach M, Thezenas S, Ducassou A, Delannes M, Noel G, Thariat J, Vogin G, Fourquet J, Vilotte F, Sargos P, Kantor G, Chapet S, Moureau-Zabotto L. PO-0768: Evaluation of RT practice for limb soft tissue sarcomas and its impact on prognosis and toxicity. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bernadou G, Barillot I, Régnault-Bougnoux A, Calais G, Chapet S, Ruffier-Loubière A. Analyse comparative de la toxicité tardive de la curiethérapie de haut débit de dose et de celle de bas débit de dose du cancer de l’endomètre. Cancer Radiother 2015. [DOI: 10.1016/j.canrad.2015.07.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ruffier-Loubière A, Janoray G, Chapet S, de Calan L, Dumont P, Dorval É, Orain I, Calais G. [Long-term outcome of neoadjuvant radiochemotherapy followed by surgery for esophageal cancer: a single institution retrospective study of 102 patients]. Cancer Radiother 2015. [PMID: 26215366 DOI: 10.1016/j.canrad.2015.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE AND OBJECTIVES To report survival and morbidity of a large homogeneous cohort of patients with a locally advanced esophageal or cardia carcinoma and put in evidence predictive factors of locoregional control and survival. PATIENTS AND METHODS Hundred and two patients were treated at the university hospital of Tours between 1990 and 2010 and received neo-adjuvant chemoradiation therapy with external irradiation (40Gy-44Gy) and two courses of chemotherapy (5-fluoro-uracile and cisplatine). Esophagectomy associated with lymph node dissection was performed about ten weeks after the end of chemoradiation therapy. RESULTS The median follow-up was 22.4 months [6-185 months]. The overall survival rates at 2 and 5years were 53% and 27%, respectively. The median overall survival was estimated at 27months. The overall 2-year survival between patients "responders" and patients "non-responders" was 67% vs 26%, respectively (P<0.0001). In case of histological response, there was a benefit in terms of overall survival (P<0.0001), locoregional control (P<0.0036) and disease-free survival (P<0.001). Overall survival at 2years was 64% for ypN0 group vs 32% for ypN1 group (P<0.0001). The median survival was estimated at 37months against 15months in the absence of lymph node involvement (P<0.0001). CONCLUSION Our results in terms of survival, tolerance and morbidity and mortality were comparable to those in the literature. Complete histological response of lymph node was associated with an improvement of local control, disease-free survival and overall survival.
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Affiliation(s)
- A Ruffier-Loubière
- Clinique d'oncologie-radiothérapie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - G Janoray
- Clinique d'oncologie-radiothérapie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
| | - S Chapet
- Clinique d'oncologie-radiothérapie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - L de Calan
- Service de chirurgie digestive, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - P Dumont
- Service de chirurgie thoracique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - É Dorval
- Service de gastroentérologie, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - I Orain
- Service d'anatomopathologie, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - G Calais
- Clinique d'oncologie-radiothérapie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
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Abstract
Gliomas are the most frequent primary brain tumors. Their care is difficult because of the proximity of organs at risk. The treatment of glioblastoma includes surgery followed by chemoradiation with the protocol of Stupp et al. The addition of bevacizumab allows an increase in progression-free survival by 4 months but it does not improve overall survival. This treatment is reserved for clinical trials. Intensity modulation radiotherapy may be useful to reduce the neurocognitive late effects in different types of gliomas. In elderly patients an accelerated radiotherapy 40 Gy in 15 fractions allows a similar survival to standard radiotherapy. O(6)-methylguanine-DNA methyltransferase (MGMT) status may help to choose between chemotherapy and radiotherapy. There is no standard for the treatment of recurrent gliomas. Re-irradiation in stereotactic conditions allows a median survival of 8 to 12.4 months. Anaplastic gliomas with 1p19q mutation have a greater sensibility to chemotherapy by procarbazine, lomustine and vincristine. Chemoradiotherapy in these patients has become the standard treatment. Many studies are underway testing targeted therapies, their place in the therapeutic management and new radiotherapy techniques.
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Affiliation(s)
- S Lévy
- Service de radiothérapie oncologique, centre Henry-Kaplan, université François-Rabelais, CHRU de Tours, 2, boulevard Tonnelé, 37000 Tours, France
| | - S Chapet
- Service de radiothérapie oncologique, centre Henry-Kaplan, université François-Rabelais, CHRU de Tours, 2, boulevard Tonnelé, 37000 Tours, France
| | - J-J Mazeron
- Service de radiothérapie oncologique, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex, France; Université Paris VI, 75651 Paris cedex, France.
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Raimbault A, Cazals X, Lauvin MA, Destrieux C, Chapet S, Cottier JP. Radionecrosis of malignant glioma and cerebral metastasis: a diagnostic challenge in MRI. Diagn Interv Imaging 2014; 95:985-1000. [PMID: 25001364 DOI: 10.1016/j.diii.2014.06.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Detecting a new area of contrast-enhancement at MRI after irradiation of malignant brain tumor arises the problem of differential diagnosis between tumor recurrence and radiation necrosis induced by the treatment. The challenge for imaging is to distinguish the two diagnoses given: the prognostic and therapeutic issues. Various criteria have been proposed in the literature based on morphological, functional or metabolic MRI. The purpose of this study was to perform an analysis of these tools to identify MRI best criteria to differentiate radiation necrosis lesions from malignant gliomas and brain metastases recurrence. For gliomas, the morphology of the contrast-enhancement cannot guide the diagnosis and the use of perfusion techniques and spectroscopy (multivoxels if possible) are necessary. In the follow-up of metastasis, a transient increase and moderate lesion volume is possible with a good prognosis. Morphological characteristics (volume ratio T2/T1Gd) and perfusion analysis provide valuable tools for approaching the diagnosis of radionecrosis.
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Affiliation(s)
- A Raimbault
- General Radiology - Diagnostic and Therapeutic Neuroradiology, Bretonneau Hospital, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - X Cazals
- General Radiology - Diagnostic and Therapeutic Neuroradiology, Bretonneau Hospital, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - M-A Lauvin
- General Radiology - Diagnostic and Therapeutic Neuroradiology, Bretonneau Hospital, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - C Destrieux
- Department of Neurosurgery, Bretonneau Hospital, Tours University Hospitals, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - S Chapet
- Department of radiotherapy, Bretonneau Hospital, Tours University Hospitals, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - J-P Cottier
- General Radiology - Diagnostic and Therapeutic Neuroradiology, Bretonneau Hospital, 2, boulevard Tonnellé, 37044 Tours cedex, France.
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Janoray G, Chapet S, Ruffier-Loubière A, Bernadou G, Pointreau Y, Calais G. Robotic stereotactic body radiation therapy for tumors of the liver: radiation-induced liver disease, incidence and predictive factors. Cancer Radiother 2014; 18:191-7. [PMID: 24837351 DOI: 10.1016/j.canrad.2014.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 02/20/2014] [Revised: 03/13/2014] [Accepted: 03/26/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Robotic stereotactic body radiation therapy is a new option to treated unresecable liver tumours. The objectives were to assess the tolerance of this technique, to identify predictive factors for toxicity and evaluate the efficiency of this treatment. PATIENTS AND METHODS From June 2010 to November 2012, robotic stereotactic body radiation therapy was proposed for 56 patients with unresecable hepatocellular carcinomas (23 patients) or hepatic metastases (41 patients). Two or less hepatic lesions, lesion size under 75 mm and WHO score under 3 were selection criteria. The prescribed dose was 45 Gy/3 fractions or 60 Gy/3 fractions. The primary end-point was toxicity, using the radiation-induced liver disease definition and to identify predictive factors. Secondary end-points were in-field local control and overall survival. RESULTS The median follow-up was 12.5 months. The one-year local control rate and the one-year overall survival rate were 64% [CI95%: 48.2 to 76.5%] and 89% [CI95%: 76 to 95%], respectively. For patient treated with a total dose of 60 Gy, no one experienced recurrence. According to the definition we took, radiation-induced liver disease rate was 0 or 9%. A lesion size at least 35 mm was a predictive factor to liver toxicity (P=0.01). CONCLUSION Using robotic stereotactic body radiation therapy, the incidence of radiation-induced liver disease is weak and spontaneously reversible. Prospective studies are required to put in evidence other predictive factors of radiation-induced liver disease and confirm the optimal dose treatment.
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Affiliation(s)
- G Janoray
- Oncology-Radiotherapy Department, Henry S. Kaplan Cancer Center, CHRU de Tours, 2 boulevard Tonnellé, 37000 Tours, France.
| | - S Chapet
- Oncology-Radiotherapy Department, Henry S. Kaplan Cancer Center, CHRU de Tours, 2 boulevard Tonnellé, 37000 Tours, France
| | - A Ruffier-Loubière
- Oncology-Radiotherapy Department, Henry S. Kaplan Cancer Center, CHRU de Tours, 2 boulevard Tonnellé, 37000 Tours, France
| | - G Bernadou
- Oncology-Radiotherapy Department, Henry S. Kaplan Cancer Center, CHRU de Tours, 2 boulevard Tonnellé, 37000 Tours, France
| | - Y Pointreau
- Oncology-Radiotherapy Department, Henry S. Kaplan Cancer Center, CHRU de Tours, 2 boulevard Tonnellé, 37000 Tours, France
| | - G Calais
- Oncology-Radiotherapy Department, Henry S. Kaplan Cancer Center, CHRU de Tours, 2 boulevard Tonnellé, 37000 Tours, France
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Calais G, Janoray G, Chapet S, Ruffier-Loubiere A, Pichon E, Diot P, Bernadou G, Barillot I. EP-1387: Pulmonary oligometastases: Stereotactic Body Radiation Therapy as a new option? Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31505-x] [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: 11/27/2022]
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Janoray G, Chapet S, Ruffier-Loubière A, Bernadou G, Barillot I, Calais G. Oligométastases pulmonaires : la radiothérapie stéréotaxique robotisée comme une nouvelle option ? Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2013.10.439] [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: 10/25/2022]
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Calais G, Chapet S, Ruffier-Loubière A, Bernadou G. Cancers des voies aérodigestives supérieures : le retour de la chimiothérapie néoadjuvante ? Cancer Radiother 2013; 17:498-501. [DOI: 10.1016/j.canrad.2013.06.038] [Citation(s) in RCA: 2] [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] [Received: 06/11/2013] [Accepted: 06/19/2013] [Indexed: 11/28/2022]
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Janoray G, Chapet S, Ruffier-Loubière A, Bernadou G, Pointreau Y, Calais G. Radiothérapie stéréotaxique des métastases hépatiques et des hépatocarcinomes. Hépatopathie radio-induite, incidence, facteurs prédictifs et résultats carcinologiques. Cancer Radiother 2013. [DOI: 10.1016/j.canrad.2013.07.013] [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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Munier O, Barillot I, Calais G, Bera G, Pointreau Y, Ruffier-Loubière A, Chapet S. Irradiation stéréotaxique robotisée des tumeurs primitives pulmonaires de stade T1 T2 N0 inopérables. Expérience préliminaire du centre hospitalier universitaire de Tours. Cancer Radiother 2013. [DOI: 10.1016/j.canrad.2013.07.057] [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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Pointreau Y, Debelleix C, Garaud P, Chapet S, Sire C, Tuchais C, Tortochaux J, Faivre S, Guérif S, Alfonsi M, Calais G. 135 oral LONG TERM RESULTS OF THE GORTEC 2000-01 LARYNX PRESERVATION RANDOMIZED TRIAL USING A COMPOSITE FUNCTIONAL ENDPOINT. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Calais G, Chapet S, Pointreau Y, Bardet E, Sire C, Germain T. Radiation alone (RT) versus RT with concomitant chemotherapy (CT) in stages III and IV oropharynx carcinoma: Ten-year results of the 94-01 GORTEC randomized study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Calais G, Pochat-Jimenez G, Chapet S, Morinière S, Beutter P. Cervical Lymph Node Metastasis from Squamous Cell Carcinoma with Unknown Primary Site: Bilateral versus Ipsilateral Irradiation. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Debelleix C, Pointreau Y, Chapet S, Sire C, Tuchais C, Faivre S, Alfonsi M, Lefèbvre JL, Calais G. Évaluation à long terme de la voix et de la déglutition dans le cadre de l’essai de phase III randomisé de préservation laryngée 2000–01 du Gortec. Cancer Radiother 2009. [DOI: 10.1016/j.canrad.2009.08.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fesneau M, Chapet S, Martin L, Pommier P, Alfonsi M, Laguerre B, Feham N, Berger C, Calais G. Carboplatin, Tegafur-uracil, Leucovorin and Concurrent Radiotherapy for Locally Advanced Head and Neck Squamous Cell Carcinoma. Results of the 2003–01 Phase II GORTEC Study. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Muracciole X, Cuilliere J, Hoffstetter S, Alapetite C, Quetin P, Baron M, Gaci Z, Maire J, Chapet S, Carrie C. Quality assurance of a French multicentric conformal radiotherapy protocol for low-stage medulloblastoma : variability in target volume delineation. Int J Radiat Oncol Biol Phys 2002. [DOI: 10.1016/s0360-3016(02)03315-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chapet S, Alcaraz L, Louisot P, Reynaud-Bougnoux A, Bourlier P, Dorval E, Le Floch O, Calais G. Predictive factors for late toxic effects following high dose rate brachytherapy (HDRB) boost for esophageal cancer (EC). Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)02311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Carrie C, Hoffstetter S, Gomez F, Moncho V, Doz F, Alapetite C, Murraciole X, Maire JP, Benhassel M, Chapet S, Quetin P, Kolodie H, Lagrange JL, Cuillere JC, Habrand JL. Impact of targeting deviations on outcome in medulloblastoma: study of the French Society of Pediatric Oncology (SFOP). Int J Radiat Oncol Biol Phys 1999; 45:435-9. [PMID: 10487567 DOI: 10.1016/s0360-3016(99)00200-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To correlate targeting deviation in external beam radiation therapy with site of relapse in a prospective study of 174 patients treated for medulloblastoma. METHODS AND MATERIALS Between February 1992 and February 1998 the radiotherapy treatment records were reviewed by a panel of radiation oncologists for 174 children treated with radiation therapy for medulloblastoma. The review was done without knowledge of patient outcome. Patterns of relapse were correlated with the results of the quality control review. RESULTS Among the 174 patients five relapsed before the start of radiotherapy. One hundred sixty-nine patients were evaluable for correlation between targeting deviation and site of relapse. Number of major deviations in radiation therapy treatment is strongly correlated with the risk of tumor relapse (67% [95% CI: 28-91] of 3-year relapse rate in patient group with 2 major deviations and 78% [95% CI: 35-96] with 3 major deviations). This is particularly correlated with relapse in the frontal region of the brain: 5 relapses occurred in the frontal region in patients with major deviation in this area. An erroneous choice of electron beam energy is also linked with craniospinal fluid (CSF) relapse (3-year relapse rate of 68% [95% CI: 42-86]). Minor deviations in therapy technique are slightly associated with an increased risk of relapse in the same range as the group with only one major deviation. CONCLUSION The quality of medulloblastoma radiation therapy technique is strongly correlated with outcome. Pretreatment central quality assurance review or standardized computer-designed blocks would improve survival to an extent equivalent to that attributed to adjuvant chemotherapy.
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Affiliation(s)
- C Carrie
- Radiotherapy Department, Centre Léon Bérard, Lyon, France
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Berger C, de Muret A, Garaud P, Chapet S, Bourlier P, Reynaud-Bougnoux A, Dorval E, de Calan L, Huten N, Le Floch O, Calais G. [Effect radiotherapy on postoperative staging and residual tumor cell density in rectal cancers]. Cancer Radiother 1997; 1:240-8. [PMID: 9295879 DOI: 10.1016/s1278-3218(97)89771-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine predictive factors and prognostic value of tumor downstaging and sterilization after preoperative radiotherapy for rectal cancer. PATIENTS AND METHODS Between 1977 and 1994, 167 patients with a histologically proven adenocarcinoma underwent preoperative radiotherapy (median dose, 44 Gy; mean time before surgery, 5 weeks). Pathologic specimens were reviewed by the same pathologist in order to specify the modified Astler Coller classification (MAC) and to quantify residual tumor cell density (RTCD). RESULTS According to the MAC, there were nine stage 0 (5%), 10 stage A (6%), 103 stage B1-B3 (62%) and 45 stage C1-C3 (27%) tumors. Seventeen per cent and 56% of the patients who received a dose > or = 44 Gy presented with stage 0-A and stage B1-B3 tumors, respectively, compared to 4 and 69% of those who received a dose < 44 Gy (P = 0.04). Tumor differentiation and a longer interval before surgery were significantly associated with more frequent downstaging. According to the RTCD, 62 tumors (37%) showed no or only rare foci of residual tumor cells; 62 (37%) showed an intermediate RTCD and 43 (26%) a high RTCD. No predictive factor of RTCD was statistically significant. Only post-operative staging was a significant prognostic factor (P < 0.01). CONCLUSION The favourable influence of higher doses of preoperative radiotherapy on pathologic stage has been observed. Tumor differentiation and time before surgery were the other significant predictive factors of tumor downstaging. Even after preoperative radiotherapy, post-operative staging retained its prognostic value.
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Affiliation(s)
- C Berger
- Unité de traitement des cancers digestifs, clinique Sainte Catherine, BP 846, Avignon, France
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Calais G, Dorval E, Louisot P, Bourlier P, Klein V, Chapet S, Reynaud-Bougnoux A, Huten N, De Calan L, Aget H, Le Floch O. Radiotherapy with high dose rate brachytherapy boost and concomitant chemotherapy for Stages IIB and III esophageal carcinoma: results of a pilot study. Int J Radiat Oncol Biol Phys 1997; 38:769-75. [PMID: 9240645 DOI: 10.1016/s0360-3016(97)00077-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Radiotherapy (RT) and concomitant chemotherapy (CT) is the standard treatment for non resectable esophageal cancer. Usual total radiation dose is 50 Gy. In order to enhance local control rate a Phase II study was initiated to evaluate the feasibility of a combined treatment with an external radiation dose of 60 Gy and three cycles of concomitant CT, using the three main active drugs (CDDP, 5 FU and MMC), followed by a high dose rate (HDR) brachytherapy delivering 10 Gy. METHODS AND MATERIALS Fifty-three patients, 48 men and 5 women, were entered in this study. Stages were evaluated with CT scan and with endoscopic sonography. Fifteen were Stage IIB, 38 Stage III. Treatment consisted of conventional fractionated RT to a total dose of 60 Gy delivered with 2 Gy per fraction, one fraction per day and five fractions per week. The CT regimen was a combination of Cisplatinum (CDDP) 20 mg/m2 and 5 Fluorouracil (5FU) 600 mg/m2 continuous infusion, from days 1-4 Mitomycin C (MMC) was given at 6 mg/m2 on day 1. Three cycles were administered on days 1, 22, and 43. Brachytherapy was delivered one week after the end of external radiation therapy. RESULTS Full radiation therapy dose was delivered for 94% of the patients. CT compliance, evaluated on the mean relative dose-intensity was 85% for CDDP, 81% for 5FU and 51% for MMC. Overall grade 3 and 4 WHO toxicity rates were 23% and 7%, respectively. Haematologic toxicity was the most limiting factor. One patient died from treatment toxicity. Local control rate at one year was 74%. Three-year actuarial survival rate was 27%. Distant metastasis was the main cause of treatment failure. Swallowing score was good for 75% of the patients. Stage, performance status and weight loss were prognostic factors. CONCLUSION This regimen with high dose RT, HDR brachytherapy and concomitant CT is feasible; however, a high level of haematologic toxicity was observed with the CDDP, 5FU and MMC regimen. Despite a poor compliance with CT, treatment results are very encouraging for patients with locally advanced disease.
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Affiliation(s)
- G Calais
- Clinique d'Oncologie et Radiothérapie, Centre Hospitalier et Universitaire de Tours, France
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Berger C, de Muret A, Garaud P, Chapet S, Bourlier P, Reynaud-Bougnoux A, Dorval E, de Calan L, Huten N, le Folch O, Calais G. Preoperative radiotherapy (RT) for rectal cancer: predictive factors of tumor downstaging and residual tumor cell density (RTCD): prognostic implications. Int J Radiat Oncol Biol Phys 1997; 37:619-27. [PMID: 9112461 DOI: 10.1016/s0360-3016(96)00577-9] [Citation(s) in RCA: 145] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine predictive factors and prognostic value of tumor downstaging and tumor sterilization after preoperative RT for rectal cancer. METHODS AND MATERIALS Between 1977 and 1994, 167 patients with a histologically proven adenocarcinoma (70 T2, 65 T3, 29 T4, and 3 local recurrences) underwent preoperative RT. Median dose was 44 Gy (5-73 Gy). Surgery was performed in a mean time of 5 weeks after RT. Pathologic specimens have been reviewed by the same pathologist in order to specify the modified Astler Coller classification (MAC), and to quantify the residual tumor cell density (RTCD). RESULTS According to the MAC, there was 9 stage 0 (5%), 10 stage A (6%), 103 stage B1-B3 (62%), and 45 stage C1-C3 (27%) tumors. Seventeen percent and 56% of the patients who received a dose > or = 44 Gy had respectively a 0-A and a B tumor, compared to 4 and 69% in those who received a dose < 44 Gy (p = 0.04). Tumor differentiation and a longer interval before surgery were significantly associated with a more frequent downstaging, and preoperative staging correlated well to the postoperative pathological findings. According to the RTCD, 62 tumors (37%) showed no or only rare foci of residual tumor cells (Group 1); 62 (37%) showed an intermediate RTCD (Group 2); and 43 (26%) a high RTCD (Group 3). No predictive factor of RTCD was statistically significant. In univariate analysis, postoperative staging was a significant prognostic factor, with corresponding 5-year overall survival rates in 0-A, B, and C stages of 92, 67, and 26% (p < 0.01). RTCD was not a prognostic factor. However, overall and disease-free survival rates for patients with complete pathologic response of 83% at 2 and 5 years suggested a better outcome in this subgroup of patients. CONCLUSION The favorable influence of higher doses of preoperative RT on pathologic stage has been observed. Tumor differentiation, preoperative classification and time before surgery were the other predictive factors of tumor downstaging. However, there was no predictive factor of complete pathologic response. Even after preoperative RT, postoperative staging remained a prognostic factor.
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Affiliation(s)
- C Berger
- Clinique d'Oncologie et Radiothérapie, Hôpital Bretonneau, Tours, France
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Berger C, Chapet S, Reynaud-Bougnoux A, Garand G, Le Floch O, Calais G. Enhanced acute toxicity in oropharynx carcinoma treated with radiotherapy and concomitant cisplatin, 5-fluorouracil and mitomycin C. Eur J Cancer 1996; 32A:1707-11. [PMID: 8983278 DOI: 10.1016/0959-8049(96)00173-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to establish the feasibility of giving concomitant radiotherapy and 3 cycles of chemotherapy with cisplatin (CDDP), 5-fluorouracil (5-FU) and mitomycin C (MMC) in locally advanced inoperable oropharyngeal cancer. From March 1990 to September 1993, 27 male patients (mean age 55 years) were included in this study. 3 patients (11%) were T2N0, 19 (70%) T3 (T3N0: n = 9, T3N1: n = 1, T3N2: n = 5, T3N3: n = 4), and 5 (19%) T4 (T4N0: n = 1, T4N1: n = 1, T4N2: n = 2, T4N3: n = 1). All patients received conventional radiotherapy delivering 70 Gy in 35 fractions and 52 days, and three cycles of chemotherapy starting on day 1, 21 and 42 with CDDP 20 mg/m2 and 5-FU 400 mg/m2 day 1 to day 4, and MMC 10 mg/m2 day 1. With a mean follow-up of 34 months (17-59), 10 patients (37%) were alive and free of disease. Among the 17 other patients, 8 died of cancer. Crude locoregional control rate was 78%, and probability of local control at 1 and 2 years was 85 and 80%, respectively. One- and 2-year survival rates were 48 and 31%, respectively, for both overall and disease-free survival. Grade 3 or 4 mucositis occurred in 22 patients (81%); enteral feeding was necessary for 63%; mean weight loss was 5.7 kg. Grade > 2 thrombocytopenia occurred in 11 patients (41%), grade > 2 neutropenia in 8 patients (29%), grade > 2 anaemia in 4 patients (15%). Febrile neutropenia or aplasia occurred in 5 patients (19%). 2 patients (7%) died during treatment of haematological or infectious complications related to the treatment. Another patient died 1 month after treatment with grade 4 thrombocytopenia and septicaemia. In conclusion, a high complete response rate has been achieved with this concomitant chemo- and radiotherapy, but with severe digestive and haematological toxicity. Addition of MMC to 5-FU and CDDP might have been responsible for this increased toxicity. This therapeutic combination is therefore not routinely feasible.
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Affiliation(s)
- C Berger
- Clinique d'Oncologie et Radiothérapie, CHU Tours, France
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Berger C, de Muret A, Garaud P, Chapet S, Bourlier P, Reynaud-Bougnoux A, Dorval E, de Calan L, Huten N, Le Floch O, Calais G. 32 Preoperative radiotherapy (RT) for rectal cancer: Predictive factors of tumor (T) downstaging and residual tumor cell density (RTCD); prognostic implications. Radiother Oncol 1996. [DOI: 10.1016/s0167-8140(96)80039-9] [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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Berger C, Chapet S, Calais G, Reynaud-Bougnoux A, Garand G, le Floch O. [Concomitant radiochemotherapy with cisplatin (CDDP), 5-fluorouracil (5-FU) and mitomycin C (MMC) in locally advanced carcinoma of the oropharynx. Results of a phase II trial]. Bull Cancer 1995; 82:1044-51. [PMID: 8745671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In order to improve loco-regional control in locally advanced oropharyngeal carcinoma, a phase II trial was designed to establish the feasibility of concomitant conventional radiotherapy and three cycles of chemotherapy at day 1, 21 and 42 with cisplatin (CDDP) 20 mg/m2 and 5-fluorouracil (5-FU) 400 mg/m2 day 1 to day 4, and mitomycin C (MMC) 10 mg/m2 day 1. From March 1990 to September 1993, 27 patients (mean age: 55) were included in this study. Three patients (11%) were T2N0, 19 (70%) T3 (T3N0: n = 9, T3N1: n = 1, T3N2: n = 5, T3N3: n = 4), and 5 (19%) T4 (T4N0: n = 1, T4N1: n = 1, T4N2: n = 2, T4N3: n = 1). With a mean follow-up of 34 months (17-59), ten patients (37%) were alive, free of disease; among the 17 other patients, seven died with cancer. Loco-regional control rate was 85%. One and 2-year survival rates were respectively 48 and 31% for overall and disease-free survival; respective corrected overall survival rates were 68 and 61%. Grade 3 or 4 mucositis was 81%; enteral feeding was necessary for 63% of the patients; mean loss of weight was 5.7 kg. Grade > 2 thrombopenia occurred in 11 patients (41%), grade > 2 neutropenia in eight patients (29%) , grade > 2 anemia in four patients (15%). Febrile neutropenia or aplasia occurred in five patients (19%). Two patients (7%) died during treatment of haematological or infectious complications related to the treatment. Another patient died 2 months after treatment with grade 4 thrombopenia and septicemia. Addition of MMC to 5-FU and CDDP might have been partly responsible of this increased toxicity. A high complete response rate has been achieved with this concomitant radio-polychemotherapy, but with a severe digestive and haematological toxicity, which did not allow to conclude to the feasibility of this therapeutic association.
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Affiliation(s)
- C Berger
- Clinique d'oncologie et radiotherapie, 37044 Tours Cedex, France
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Chapet S, Berger C, Calais G, Reynaud-Bougnoux A, Descamps P, Body G, Le Floch O. 1177 Prognostic value of histological tumor regression after irradiation for uterine cervix carcinoma. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)96423-b] [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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Calais G, Dorval E, Chapet S, Berger C, Reynaud-Bougnoux A, Huten N, De Calan L, Le Floch O. 551 High dose radiotherapy (RT), concomitant chemotherapy (CT) and high dose rate brachytherapy for non resectable esophageal cancer. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)95805-g] [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: 11/16/2022]
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Chapet S, Berger C, Fignon A, Calais G, Fetissof F, Reynaud-Bougnoux A, Descamps P, Body G, Lansac J, le Floch O. Abdomino pelvic irradiation after second-look laparotomy for stage III ovarian carcinoma. Eur J Obstet Gynecol Reprod Biol 1995; 62:43-8. [PMID: 7493707 DOI: 10.1016/0301-2115(95)02132-q] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The purpose of this retrospective analysis of 34 patients with stage III ovarian carcinoma was to review results and morbidity of whole abdominal irradiation after surgery and chemotherapy. METHODS AND MATERIALS All of the 34 patients had reached a complete clinical remission after first cytoreductive surgery and chemotherapy. After second-look laparotomy each patient underwent whole abdominal irradiation. Except for two patients with chronic myelosuppression, the dose administered was of 22.5 Gy to the abdominal cavity with a boost of 22.5 Gy added to the pelvis. RESULTS Three and 5-year overall survival rates were 62% and 43%, respectively. Three and 5-year disease-free survival rates were 53% and 38%. Twenty-three patients (68%) developed local relapse or local disease progression. Metastasis occurred in five cases and were always associated with an abdominal cavity recurrence. Residual disease after first cytoreductive surgery appeared as a prognostic factor in univariate analysis. Patients with unresected residuum had a 5-year survival probability of 35% versus 83% for patients without residual disease. We observed 12% grade-3 intestinal toxicities and one fatal case of radiation enteritis. CONCLUSION Despite its curative potential, the long term benefit of whole abdominal irradiation in the multimodality treatment of advanced ovarian carcinoma must be evaluated in well designed controlled trials.
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Affiliation(s)
- S Chapet
- Clinique d'Oncologie et Radiothérapie, Centre Hospitalier et Universitaire, Tours, France
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Calais G, Berger C, Descamps P, Chapet S, Reynaud-Bougnoux A, Body G, Bougnoux P, Lansac J, Le Floch O. Conservative treatment feasibility with induction chemotherapy, surgery, and radiotherapy for patients with breast carcinoma larger than 3 cm. Cancer 1994; 74:1283-8. [PMID: 8055449 DOI: 10.1002/1097-0142(19940815)74:4<1283::aid-cncr2820740417>3.0.co;2-s] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The traditional surgical treatment for operable breast carcinoma larger than 3 cm is mastectomy. To avoid mutilating surgery, the authors administered primary chemotherapy to 158 patients with operable nonmetastatic large breast carcinoma with a TNM classification of T2 greater than 3 cm and T3 with a lymph node status of N0-N1. Conservative treatment was proposed for patients responding to the chemotherapy and whose tumor was reduced to 3 cm or less. The purpose of the study was to evaluate the feasibility and treatment results of this strategy. METHODS The mean patient age was 50.4 years. Eighty-two patients had T2 carcinomas greater than 3 cm, and 76 had T3 carcinoma. Fifty-four tumors were classified as lymph node status N0, and 104 as N1. Mean tumor size was 5.6 cm. Patients were treated with three courses of the NVCF regimen (mitoxantrone, vindesin, cyclophosphamide, and 5-fluorouracil) or the EVCF regimen, in which mitoxantrone was replaced by epirubicin every 4 weeks, and then administered with a radiosurgical combination. RESULTS The overall response rate to induction chemotherapy was 60.8% with 20.2% complete tumor regression. Twenty-one percent of the patients experienced grade 3 or 4 chemotherapy toxic effects, which were all acceptable and reversible. Breast-conserving treatment was feasible in 48.7% of patients (77 of 158). Forty-five patients (28.5%) were treated with a radiosurgical combination (tumorectomy plus radiation therapy), whereas 32 (20.2%) were treated with radiotherapy alone (external irradiation and brachytherapy). Other patients were treated with mastectomy. Age, tumor stage, histology, hormonal status, and hormonal receptor rate had no influence on the frequency of the observed regressions. Isolated recurrences occurred in 11 patients, 6 who were treated conservatively and 5 who were treated with mastectomy. Metastatic relapses were observed in 38 patients (14.6% in the chemotherapy responders and 38.7% in the nonresponders) (P < 0.02). Five-year actuarial survival was 73.2% and was significantly higher for responders to the induction treatment. CONCLUSION These preliminary results suggest that primary chemotherapy and radiosurgical breast-conserving treatment is feasible and is an alternative to mastectomy for patients with large operable breast carcinoma who are responders to the induction treatment. The long term benefit of this strategy must be evaluated in well designed controlled trials.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/surgery
- Chemotherapy, Adjuvant
- Cobalt Radioisotopes/therapeutic use
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Epirubicin/administration & dosage
- Epirubicin/adverse effects
- Feasibility Studies
- Female
- Fluorouracil/administration & dosage
- Fluorouracil/adverse effects
- Follow-Up Studies
- Humans
- Mastectomy, Modified Radical
- Middle Aged
- Mitoxantrone/administration & dosage
- Mitoxantrone/adverse effects
- Neoplasm Recurrence, Local
- Neoplasm Staging
- Remission Induction
- Survival Rate
- Tamoxifen/administration & dosage
- Treatment Failure
- Vindesine/administration & dosage
- Vindesine/adverse effects
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Affiliation(s)
- G Calais
- Centre Hospitalier et Universitaire, Tours, France
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Descamps P, Calais G, Chapet S, Gillard P, Body G, Lansac J. [Treatment of endometrial cancer]. Rev Prat 1994; 44:1080-4. [PMID: 7939326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- P Descamps
- Département de gynécologie-obstétrique, biologie de la reproduction et médecine foetale, CHRU de Tours, hôpital Bretonneau
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Calais G, Descamps P, Chapet S, Turgeon V, Reynaud-Bougnoux A, Lemarié E, Fignon A, Body G, Bougnoux P, Lansac J. Primary chemotherapy and radiosurgical breast-conserving treatment for patients with locally advanced operable breast cancers. Int J Radiat Oncol Biol Phys 1993; 26:37-42. [PMID: 8387066 DOI: 10.1016/0360-3016(93)90170-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE The traditional surgical treatment for operable breast cancer larger than 3 cm is mastectomy. In order to avoid mutilating surgery, we administered primary chemotherapy to 80 patients with operable non metastatic large breast cancer T2 > 3 cm and T3, N0-N1. The purpose of the study was to evaluate the breast-conserving rate induced by this treatment strategy and determine if it is a safe alternative for women with locally advanced breast carcinomas that are responders to an induction chemotherapy. METHODS AND MATERIALS The mean age was 50.1 years. Forty-three patients were T2 > 3 cm, 37 were T3. Twenty-six were N0 and 54 were N1. Mean tumor size was 5.4 cm. Patients were treated with three courses of the MVCF regimen (Mitoxantrone, Vindesin, Cyclophosphamide, and 5 Fluorouracil) every 4 weeks and then with a radiosurgical combination. RESULTS The overall response rate to induction chemotherapy was 51% with 17.5% complete tumor regression. Twenty-one percent of the patients developed grade 3 or 4 chemotherapy toxic effects, all acceptable and reversible. Breast-conserving treatment was feasible in 42.5% (34/80). Twenty patients (25%) were treated with a radiosurgical combination (tumorectomy+radiation therapy), 14 (17.5%) with radiotherapy alone (external irradiation and brachytherapy). Age, tumor stage, histology, hormonal status, hormonal receptors rate had no influence on the frequency of the observed regressions. Isolated recurrences occurred in five patients, two conservatively treated and three treated with mastectomy. Metastatic relapses were observed in 20 patients (12% in the responders and 38.5% in the non responders to chemotherapy) (p < 0.02). Five-year actuarial survival was 73% and was significantly better for responders to the induction treatment. CONCLUSION These results suggest that primary chemotherapy and radiosurgical breast conserving treatment is a safe alternative to mastectomy for patients with locally advanced operable breast cancer. The long-term benefit of this strategy must be evaluated in well designed controlled trials.
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Affiliation(s)
- G Calais
- Clinique d'Oncologie et Radiothérapie, Centre Hospitalier et Universitaire, Tours, France
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