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Azria E, Haaser T, Schmitz T, Froeliger A, Bouchghoul H, Madar H, Pineles BL, Sentilhes L. The ethics of induction of labor at 39 weeks in low-risk nulliparas in research and clinical practice. Am J Obstet Gynecol 2024; 230:S775-S782. [PMID: 37633577 DOI: 10.1016/j.ajog.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/28/2023]
Abstract
The "A Randomized Trial of Induction Versus Expectant Management" trial (ARRIVE trial) published in 2018 suggested that induction of labor can be considered a "reasonable option" for low-risk nulliparous women at ≥39 weeks of gestation. The study results led some professional societies to endorse the option for elective induction of labor at 39 weeks of gestation in low-risk nulliparas, and this has begun to change obstetrical practice. The ARRIVE trial provided valuable information supporting the benefits of induction of labor; however, the trial is insufficient to serve as the primary justification for widespread elective induction of labor at 39 weeks of gestation in low-risk nulliparas because of concerns about external validity. Thus, the French ARRIVE trial was designed to test the hypothesis in a different setting that elective induction of labor at 39 weeks of gestation in low-risk nulliparas leads to a lower cesarean delivery rate than expectant management. This ongoing trial has been criticized as "pseudoscientific" and telling "women where, when, and how to give birth." We reject these allegations and extensively examine the ethical framework that should govern clinical and research interventions, including elective induction of labor at 39 weeks of gestation in low-risk nulliparas. This study aimed to discuss the ethical issues that emerge from randomized trials of elective induction of labor at 39 weeks of gestation in low-risk nulliparas and the ethics of the clinical practice itself. The analysis of existing evidence shows the importance of further research on induction of labor at 39 weeks of gestation in low-risk women. Certain aspects of research ethics in this area, particularly the consent of pregnant women in a context where autonomy remains fragile, call for vigilance. In addition, we emphasize that childbirth is not only a medical object but also a social phenomenon that cannot be regarded only from the perspective of a health risk to be managed by clinical research. Further research on this issue is needed to allow pregnant women to make informed decisions, and the results should be integrated with social issues. The perspective of women is required in constructing, evaluating, and implementing medical interventions in childbirth, such as induction of labor at 39 weeks of gestation.
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Affiliation(s)
- Elie Azria
- Maternity Unit, Hospital Paris Saint-Joseph, FHU PREMA, Paris, France; Obstetrical Perinatal and Pediatric Epidemiology Research Team, CRESS, EPOPé, INSERM, INRA, Université de Paris Cité, Paris, France
| | - Thibaud Haaser
- Health and Research Ethics Centre, University Hospital of Bordeaux, Bordeaux, France; Sciences, Philosophie, Humanités, Université de Bordeaux-Université Bordeaux-Montaigne, Domaine Universitaire, Pessac, France
| | - Thomas Schmitz
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, CRESS, EPOPé, INSERM, INRA, Université de Paris Cité, Paris, France; Department of Obstetrics and Gynaecology, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Alizée Froeliger
- Department of Obstetrics and Gynecology, University Hospital of Bordeaux, Bordeaux, France
| | - Hanane Bouchghoul
- Department of Obstetrics and Gynecology, University Hospital of Bordeaux, Bordeaux, France
| | - Hugo Madar
- Department of Obstetrics and Gynecology, University Hospital of Bordeaux, Bordeaux, France
| | - Beth L Pineles
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, University Hospital of Bordeaux, Bordeaux, France.
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Haaser T, Lahmi L, Osman D, Gesbert C, Cheval V, Constantinides Y, de Crevoisier R, Dejean C, Escande A, Ghannam Y, Lorchel F, Thureau S, Lagrange JL, Durdux C, Huguet F. [Ethical stakes of information in radiation oncology: Thinking the risk and building the therapeutic alliance]. Cancer Radiother 2023; 27:480-486. [PMID: 37573195 DOI: 10.1016/j.canrad.2023.06.006] [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: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 08/14/2023]
Abstract
Informing patients before receiving radiation therapy is a fundamental ethical imperative. As a condition of the possibility of autonomy, information allows people to make health decisions concerning themselves, which is required by French law. This information includes in particular the potential risks due to radiation therapy. It is therefore necessary to think about what risk is, and how to define and assess it, in order to finally communicate it. The practice of informing people involves many ethical issues relating to the very content of the information, the form in which it is transmitted or even the intention that leads the health professional to say (or not to say) the risk. The transmission of information also questions the way to build a relationship of trust with the patients and how to integrate their own representations about these treatments. Between the risks of paternalism or even defensive medicine, this practice is at the heart of our professional practice.
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Affiliation(s)
- T Haaser
- Service d'oncologie radiothérapie, hôpital Haut Lévêque, centre hospitalier universitaire de Bordeaux, avenue Magellan, 33600 Pessac, France; Centre éthique et recherche en santé de Bordeaux, centre hospitalier universitaire de Bordeaux, Bordeaux, France; EA 4574 sciences, philosophie, humanités, universités de Bordeaux et Bordeaux Montaigne, Pessac, France.
| | - L Lahmi
- Service d'oncologie radiothérapie, institut Curie, Paris, France
| | - D Osman
- Service de médecine intensive-réanimation, hôpital de Bicêtre, AP-HP, DMU Correve, université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France
| | - C Gesbert
- Direction de la qualité, des services aux patients et des parcours, centre hospitalier de Versailles, Versailles, France
| | - V Cheval
- Service universitaire d'oncologie radiothérapie, centre Oscar-Lambret, faculté de médecine Henri-Warembourg, laboratoire CRIStAL, UMR9189, université de Lille, Lille, France
| | - Y Constantinides
- Espace éthique Île-de-France, Paris université Sorbonne Nouvelle, Paris, France
| | - R de Crevoisier
- Service d'oncologie radiothérapie, centre Eugène-Marquis, Rennes, France
| | - C Dejean
- Service d'oncologie radiothérapie, unité de physique médicale, centre Antoine-Lacassagne, Nice, France
| | - A Escande
- Service universitaire d'oncologie radiothérapie, centre Oscar-Lambret, faculté de médecine Henri-Warembourg, laboratoire CRIStAL, UMR9189, université de Lille, Lille, France
| | - Y Ghannam
- Service d'oncologie radiothérapie, hôpital Tenon, centre de recherche Saint-Antoine UMR_S 938, institut universitaire de cancérologie, AP-HP, Sorbonne université, Paris, France
| | - F Lorchel
- Service d'oncologie radiothérapie, centre hospitalier universitaire Lyon-Sud, Lyon, France; Centre d'oncologie radiothérapie et oncologie de Mâcon (Orlam), Mâcon, France
| | - S Thureau
- Service d'oncologie radiothérapie, Quantis Litis EA 4108, centre Henri-Becquerel, Rouen, France
| | - J L Lagrange
- Université Paris-Est Créteil Val-de-Marne, Paris, France
| | - C Durdux
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Paris, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, centre de recherche Saint-Antoine UMR_S 938, institut universitaire de cancérologie, AP-HP, Sorbonne université, Paris, France
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de Crevoisier R, Leseur J, Bouvet C, Huguet F, Lagrange JL, Haaser T, Pasquier D, Créhange G, Supiot S, Pommier P, Roy A, Berna A, Blanchard P, Marcucci L. Compréhension/acceptation de la radiothérapie : un dilemme éthique résolu par une éthique de la considération et de la sollicitude. Cancer Radiother 2023; 27:115-125. [PMID: 37011968 DOI: 10.1016/j.canrad.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 03/02/2023]
Abstract
PURPOSE Ethical questions are poorly investigated specifically in radiation oncology. The objective of the study was to identify and understand the main ethical issue in radiation oncology. MATERIALS AND METHODS A quantitative analysis was based on the answers to a questionnaire of 200 professionals from 22 radiation oncology departments. The questionnaire mainly aimed to characterize the main ethical issue. A monocentric qualitative analysis was based on semi-structured interviews focused on the main identified ethical issue, carried out with eight technologists, and 20 patients undergoing radiotherapy. RESULTS The main ethical issue was the understanding and/or acceptance of the treatment by the patients (71 %), which frequently arises (more than once a month) (52 %), and corresponds to an ethical tension between the principles of respect for autonomy and beneficence (the good as viewed by the patient) as defined by Beauchamp and Childress. The technologists, wish the patient to be fully involved in his treatment, with the even possibility of refusing it. However, excluding paternalism and autonomic relentlessness, the technologists have the feeling of acting for the good of the patients by treating them with radiation, even if the patients are not always aware of it, because they are within a situation of vulnerability. If the hierarchy of principles is a compromise alternative, this problem is finally well resolved by the effective implementation of an ethic of consideration and solicitude, restoring the patient capabilities, i.e. the maximum development of his potentialities in his situation of vulnerability. Beyond the legal dimension, patient information is crucial and must consider the specific temporality of the patient. CONCLUSION The main ethical issue in radiation oncology is the understanding and/or acceptance of the treatment involving the development of an ethic of consideration and solicitude.
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Thurin NH, Rouyer M, Jové J, Gross-Goupil M, Haaser T, Rébillard X, Soulié M, de Pouvourville G, Capone C, Bazil ML, Messaoudi F, Lamarque S, Bignon E, Droz-Perroteau C, Moore N, Blin P. Abiraterone acetate versus docetaxel for metastatic castration-resistant prostate cancer: a cohort study within the French Nationwide Claims Database. Expert Rev Clin Pharmacol 2022; 15:1139-1145. [PMID: 35984212 DOI: 10.1080/17512433.2022.2115356] [Citation(s) in RCA: 2] [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] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To conduct the direct comparison of abiraterone acetate and docetaxel for first-line treatment of metastatic castration-resistant prostate cancer (mCRPC) in real-life settings. METHODS Data were extracted from the French nationwide claims database (SNDS) on all men aged ≥40 years starting first-line treatment with abiraterone acetate or docetaxel for mCRPC in 2014. A high-dimensional propensity score including 100 baseline characteristics was used to match patients of both groups and form two comparative cohorts. Three-year overall survival and treatment discontinuation-free survival were determined using Kaplan-Meier analysis. RESULTS In 2014, 2,444 patients started abiraterone for treatment of mCRPC and 1,214 started docetaxel. After trimming and matching, 716 patients were available in each group. Median overall survival tended to be longer in the abiraterone acetate cohort (23.8 months, 95% confidence interval = [21.5; 26.0]) than in the docetaxel cohort (20.3 [18.4; 21.6] months). Survival at 36 months was 34.6% for abiraterone acetate and 27.9% for docetaxel (p = 0.0027). Treatment discontinuation-free median was longer in the abiraterone acetate cohort compared to the docetaxel cohort (10.8 [10.1; 11.7] versus 7.4 [7.0; 8.0] months). CONCLUSION The findings underline the interest of oral abiraterone acetate over intravenous docetaxel as the first-line treatment option in mCRPC.
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Affiliation(s)
- Nicolas H Thurin
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Magali Rouyer
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Jérémy Jové
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Marine Gross-Goupil
- Medical Oncology Department, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
| | - Thibaud Haaser
- Radiotherapy Department, Hôpital Haut Lévêque, Bordeaux University Hospital, Pessac, France
| | | | - Michel Soulié
- Urology Department, Hôpital Rangueil, Toulouse University Hospital, Toulouse, France
| | | | | | | | | | - Stéphanie Lamarque
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Emmanuelle Bignon
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | | | - Nicholas Moore
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Patrick Blin
- University of Bordeaux, INSERM CIC-P 1401, Bordeaux PharmacoEpi, Bordeaux, France
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Haaser T, Bouteloup V, Berdaï D, Saux MC. The Multidimensional Nature of Research Ethics: Letters Issued by a French Research Ethics Committee Included Similar Proportions of Ethical and Scientific Queries. J Empir Res Hum Res Ethics 2022; 17:242-253. [PMID: 35414297 DOI: 10.1177/15562646221093218] [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: 11/15/2022]
Abstract
Debate is ongoing concerning the activities and functioning of Research Ethics Committees (REC), especially a possible science-or-ethics dichotomy in research ethics review. We retrospectively analyzed 145 letters issued by a French REC over 18 months. All queries were classified in three levels: qualification (definition of the problem), category (aggregation of broader topics) and finally fields (ethical, scientific, or administrative). Overall, 971 queries were identified, of which 407 (42%), 379 (39%), and 135 (14%) were deemed ethical, scientific, and administrative queries, respectively. The most frequent concern was about participants' information. The main influencing factor was the profession of the reporting readers-scientific queries were more frequently raised by a methodologist, whereas ethical queries were more frequently raised by an ethicist. These results indicate that research ethics review is a multidimensional task that should be considered a collaborative effort.
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Affiliation(s)
- Thibaud Haaser
- Service d'Oncologie Radiothérapie, Hôpital Haut Lévêque, 158435Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,EA 4574 "Sciences, Philosophie, Humanités" Université de Bordeaux - Université Bordeaux Montaigne, Pessac, France.,Comité de Protection des Personnes Sud-Ouest et Outre-Mer III, Service de Pharmacologie Clinique, Hôpital Pellegrin, 158435Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Vincent Bouteloup
- Comité de Protection des Personnes Sud-Ouest et Outre-Mer III, Service de Pharmacologie Clinique, Hôpital Pellegrin, 158435Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Bordeaux Health Population, Inserm 1219, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux - CHU de Bordeaux, Bordeaux, France
| | - Driss Berdaï
- Comité de Protection des Personnes Sud-Ouest et Outre-Mer III, Service de Pharmacologie Clinique, Hôpital Pellegrin, 158435Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Service de Pharmacologie Clinique, Hôpital Pellegrin, 158435Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Marie-Claude Saux
- Comité de Protection des Personnes Sud-Ouest et Outre-Mer III, Service de Pharmacologie Clinique, Hôpital Pellegrin, 158435Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Faculté de Pharmacie, Université de Bordeaux, Bordeaux, France
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Leseur J, Créhange G, Pasquier D, Supiot S, Pommier P, Latorzeff I, Blanchard P, Mahé M, Sargos P, Colliaux J, Huguet F, Haaser T, Clavère P, Peiffert D, Lartigau É, Giraud P, Noël G, Simon JM, Hasbini A, Chauveinc L, Hennequin C, Lagrange J, de Crevoisier R. Évaluation du questionnement éthique en radiothérapie. Cancer Radiother 2021. [DOI: 10.1016/j.canrad.2021.07.031] [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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Haaser T, Constantinides Y, Huguet F, De Crevoisier R, Dejean C, Escande A, Ghannam Y, Lahmi L, Le Tallec P, Lecouillard I, Lorchel F, Thureau S, Lagrange JL. [Ethical stakes in palliative care in radiation oncology]. Cancer Radiother 2021; 25:699-706. [PMID: 34400087 DOI: 10.1016/j.canrad.2021.07.004] [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: 07/13/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
In 2021, the Ethics Commission of the SFRO has chosen the issue of the practice of palliative care in radiotherapy oncology. Radiation oncology plays a central role in the care of patients with cancer in palliative phase. But behind the broad name of palliative radiotherapy, we actually find a large variety of situations involving diverse ethical issues. Radiation oncologists have the delicate task to take into account multiple factors throughout a complex decision-making process. While the question of the therapeutic indication and the technical choice allowing it to be implemented remains central, reflection cannot be limited to these decision-making and technical aspects alone. It is also a question of being able to create the conditions for a singularity focused care and to build an authentic care relationship, beyond technicity. It is through this daily ethical work, in close collaboration with patients, and under essential conditions of multidisciplinarity and multiprofessionalism, that our fundamental role as caregiver can be deployed.
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Affiliation(s)
- T Haaser
- Service d'Oncologie Radiothérapie, Hôpital Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, avenue Magellan, 33600 Pessac, France.
| | - Y Constantinides
- Espace Éthique Ile de France, Paris Université Sorbonne Nouvelle, Paris, France
| | - F Huguet
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Centre de Recherche Saint-Antoine UMR_S 938, Institut Universitaire de Cancérologie, AP-HP, Sorbonne Université, Paris, France
| | - R De Crevoisier
- Service d'Oncologie Radiothérapie, Centre Eugène Marquis, Rennes, France
| | - C Dejean
- Service d'Oncologie Radiothérapie, Unité de Physique Médicale, Centre Antoine Lacassagne, Nice, France
| | - A Escande
- Service universitaire d'Oncologie Radiothérapie, Centre Oscar Lambret, Faculté de médecine Henri Warembourg, Laboratoire CRIStAL, UMR9189, Université de Lille, Lille, France
| | - Y Ghannam
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Centre de Recherche Saint-Antoine UMR_S 938, Institut Universitaire de Cancérologie, AP-HP, Sorbonne Université, Paris, France
| | - L Lahmi
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Centre de Recherche Saint-Antoine UMR_S 938, Institut Universitaire de Cancérologie, AP-HP, Sorbonne Université, Paris, France
| | - P Le Tallec
- Service d'Oncologie Radiothérapie, Quantis Litis EA 4108, Centre Henri Becquerel, Rouen, France
| | - I Lecouillard
- Service d'Oncologie Radiothérapie, Centre Eugène Marquis, Rennes, France
| | - F Lorchel
- Service d'Oncologie Radiothérapie, Centre Hospitalier Universitaire Lyon-Sud, Lyon, France; Centre d'Oncologie Radiothérapie et Oncologie de Mâcon - ORLAM, Mâcon, France
| | - S Thureau
- Service d'Oncologie Radiothérapie, Quantis Litis EA 4108, Centre Henri Becquerel, Rouen, France
| | - J L Lagrange
- Université Paris-Est Créteil Val de Marne, Paris, France
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Thurin N, Rouyer M, Gross-Goupil M, Haaser T, Rébillard X, Soulié M, de Pouvourville G, Messaoudi F, Stitou El Amine Demnati H, Bignon E, Jové J, Lamarque S, Droz-Perroteau C, Moore N, Blin P. Impact de la séquence première-deuxième ligne de traitement, acétate d’abiraterone-docétaxel versus docétaxel-acétate d’abiratérone, sur la survie dans le cancer de la prostate résistant à la castration et métastatique ; Étude de cohorte dans le SNDS. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.05.027] [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] Open
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Gross-Goupil M, Thurin NH, Rouyer M, Haaser T, Rebillard X, Soulie M, de Pouvourville G, Messaoudi F, Capone C, Bignon E, Jové J, Lamarque S, Droz-Perroteau C, Moore N, Blin P. Impact of treatment sequence on survival outcome in patients with a second treatment line for metastatic castration-resistant prostate cancer: A new user design in the French nationwide claims database. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
91 Background: Abiraterone acetate in association with prednisone/prednisolone and docetaxel can both be used as first or second line treatments for metastatic castration-resistant prostate cancer (mCRPC). As a result, one may wonder if it is better to start with an abiraterone acetate first line followed by a docetaxel second line (ABI–DOCE sequence) or to use the inverse sequence DOCE-ABI. Methods: A new user cohort study design with a 3-year follow-up: patients initiating a first-line treatment for mCRPC in 2014 followed by a second treatment line were identified from the French nationwide claims database (SNDS), which covers about 86% of the population at the time of the study. Patients with sequence ABI–DOCE and those with DOCE-ABI were 1:1 matched on prostate cancer stage before mCRPC status, duration from prostate cancer diagnosis, and a high-dimensional propensity score. The 36-month overall survival and the 36-month survival time until treatment switch or death (proxy of progression-free survival) were compared using Cox proportional hazards risk model. Results: Out of the 3 949 mCRPC patients that initiated a first-line treatment in 2014, 1 162 died during this first line, and 2 283 had a second-line treatment. Among them, 693 received the sequence ABI–DOCE and 354 DOCE–ABI. A total of 159 patients per group were 1:1 matched. The median duration of the first treatment line was 8.4 months in the ABI–DOCE sequence and 6.6 months in the DOCE–ABI sequence. The median duration of the second line was 6.3 months and 6.5 months in the ABI–DOCE and DOCE–ABI sequences, respectively. Results are presented in the table below. Median survivals were similar in both groups with no significant differences observed in the 36-month survival probabilities. Around 60% of the patients received a third-line treatment in both groups. Conclusions: In real life settings, treatment sequences (ABI–DOCE versus DOCE–ABI) seem to have no differential impact on survival outcome in mCRPC patients sharing same characteristics. [Table: see text]
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Affiliation(s)
- Marine Gross-Goupil
- Centre Hospitalier Universitaire de Bordeaux-Hôpital Saint-André, Bordeaux, France
| | - Nicolas H. Thurin
- Bordeaux PharmacoEpi, INSERM CIC1401, Univ. Bordeaux, Bordeaux, France
| | - Magali Rouyer
- Bordeaux PharmacoEpi, INSERM CIC1401, Univ. Bordeaux, Bordeaux, France
| | | | | | - Michel Soulie
- Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | | | | | | | - Emmanuelle Bignon
- Bordeaux PharmacoEpi, INSERM CIC1401, Univ. Bordeaux, Bordeaux, France
| | - Jérémy Jové
- Bordeaux PharmacoEpi, INSERM CIC1401, Univ. Bordeaux, Bordeaux, France
| | | | | | - Nicholas Moore
- Bordeaux PharmacoEpi, INSERM CIC1401, Univ. Bordeaux, CHU Bordeaux, Bordeaux, France
| | - Patrick Blin
- Bordeaux PharmacoEpi, INSERM CIC1401, Univ. Bordeaux, Bordeaux, France
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Thurin NH, Rouyer M, Gross-Goupil M, Rebillard X, Soulié M, Haaser T, Roumiguié M, Le Moulec S, Capone C, Pierrès M, Lamarque S, Jové J, Bignon E, Droz-Perroteau C, Moore N, Blin P. Epidemiology of metastatic castration-resistant prostate cancer: A first estimate of incidence and prevalence using the French nationwide healthcare database. Cancer Epidemiol 2020; 69:101833. [PMID: 33068878 DOI: 10.1016/j.canep.2020.101833] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/04/2020] [Revised: 09/07/2020] [Accepted: 09/25/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is a lack of information about the burden of metastatic castration-resistant prostate cancer (mCRPC). The present work aims to estimate the incidence and prevalence of mCRPC in 2014 using the French nationwide healthcare database (SNDS). METHODS Prevalence and incidence were estimated based on an SNDS extraction of men covered by the general healthcare insurance (86 % of the French population), and aged ≥40. Patients with mCRPC were identified amongst prostate cancer cases using an algorithm estimating a date of first metastasis management and a date of castration resistance. This algorithm was validated by clinical experts through a blind review of 200 anonymized medical charts from SNDS data. Prevalence and incidence were standardized on the European Standard Population (2013 edition). RESULTS Prevalence and incidence of mCRPC were estimated as, respectively, 62 and 21 cases per 100 000 men in 2014. Less than one mCRPC case per 100 000 was observed in men aged 40-49. Maximum mCRPC incidence was in men aged 80-89 (175 per 100 000). The algorithm used for mCRPC identification had 97 % positive and 99 % negative predictive values. CONCLUSION The good performances of the algorithm for mCRPC identification and the consistency of the generated results with the existing data highlight the robustness of these first estimates of mCRPC prevalence and incidence. Future updates will call for algorithm adjustment as practices evolve over time. These first real-life data will serve for future follow-up of the impact of changes in the management of prostate cancer.
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Affiliation(s)
- Nicolas H Thurin
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, 33076, Bordeaux, France.
| | - Magali Rouyer
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, 33076, Bordeaux, France
| | - Marine Gross-Goupil
- Department of Medical Oncology, Hôpital Saint André, CHU de Bordeaux, 1 rue Jean Burguet, 33075, Bordeaux, France
| | - Xavier Rebillard
- Department of Urology, Clinique Beau Soleil, 119 Avenue de Lodeve, 34070, Montpellier, France
| | - Michel Soulié
- Department of Urology, University Hospital of Rangueil, CHU de Toulouse, 9 Place Lange, 31059, Toulouse, France
| | - Thibaud Haaser
- Department of Radiotherapy, Hôpital Haut-Lévêque, CHU de Bordeaux, Avenue Magellan, 33600, Pessac, France
| | - Mathieu Roumiguié
- Department of Urology, University Hospital of Rangueil, CHU de Toulouse, 9 Place Lange, 31059, Toulouse, France
| | - Sylvestre Le Moulec
- Department of Oncology, Clinique Marzet, 40 Boulevard d'Alsace, 64000, Pau, France
| | - Camille Capone
- Janssen, 1 rue Camille Desmoulins, 92130, Issy-les-Moulineaux, France
| | - Marie Pierrès
- Janssen, 1 rue Camille Desmoulins, 92130, Issy-les-Moulineaux, France
| | - Stéphanie Lamarque
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, 33076, Bordeaux, France
| | - Jérémy Jové
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, 33076, Bordeaux, France
| | - Emmanuelle Bignon
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, 33076, Bordeaux, France
| | - Cécile Droz-Perroteau
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, 33076, Bordeaux, France
| | - Nicholas Moore
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, 33076, Bordeaux, France
| | - Patrick Blin
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, 146 rue Léo Saignat, 33076, Bordeaux, France
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Haaser T, Constantinidès Y, Dejean C, Escande A, Le Tallec P, Lorchel F, Marty S, Thureau S, Huguet F, Lagrange JL. [Health democracy: Patient partnership]. Cancer Radiother 2020; 24:736-743. [PMID: 32861610 DOI: 10.1016/j.canrad.2020.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 11/20/2022]
Abstract
In 2019, the scientific committee of the French society of radiation oncology (SFRO) created an ethics committee. Its mission is to provide our professional community with food for thought on ethical issues, and to identify its specificities within the radiation oncology departments. For the 2020 annual conference, the commission looked into the evolution of the patient-carer relationship, and more particularly to the strong idea of patient partnership. Indeed, the writing of the White Book of Cancer gave voice to sick people and stressed the need for new devices, such as the Caregiving Time. Patients can no longer be considered as objects of care but as people whose dignity and autonomy must be imperatively respected. The acquisition of knowledge allows a bilateral exchange, prerequisite of a dynamic collaboration. Patients can be partners in their own care, partners in training and research (expert patient), but also partners in health institutions and policies. It is this notion of partnership and involvement of the person in their path of care in radiation oncology that we will analyse here. It will be about defining it, by developing the concept of autonomy, and bringing out its complexity and ambivalence through two examples from our clinical practice: the shared decision-making process for patients with localized prostate cancer and the patient's involvement in the success of his radiotherapy.
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Affiliation(s)
- T Haaser
- Service de radiothérapie, hôpital Haut-Lévêque, centre hospitalier universitaire de Bordeaux, Pessac, France.
| | - Y Constantinidès
- Espace éthique Île-de-France, Paris Université Sorbonne Nouvelle, Paris, France
| | - C Dejean
- Service de radiothérapie, unité de physique médicale, centre Antoine-Lacassagne, Nice, France
| | - A Escande
- Service universitaire de radiothérapie, laboratoire CRIStAL, UMR9189, centre Oscar-Lambret, faculté de médecine Henri-Warembourg, université de Lille, Lille, France
| | - P Le Tallec
- Service de radiothérapie, Quantis Litis EA 4108, centre Henri-Becquerel, Rouen, France
| | - F Lorchel
- Centre de radiothérapie et oncologie de Mâcon - Orlam, Mâcon, France; Service de radiothérapie, centre hospitalier universitaire Lyon-Sud, Lyon, France
| | - S Marty
- Centre de coordination en cancérologie, centre hospitalier universitaire de Bordeaux, Pessac, France
| | - S Thureau
- Service de radiothérapie, Quantis Litis EA 4108, centre Henri-Becquerel, Rouen, France
| | - F Huguet
- Service d'oncologie radiothérapie, centre de recherche Saint-Antoine UMR_S 938, Sorbonne université, hôpital Tenon, institut universitaire de cancérologie, AP-HP, Paris, France
| | - J-L Lagrange
- Université Paris-Est Créteil Val-de-Marne, Paris, France
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Thurin N, Rouyer M, Jové J, Gross-Goupil M, Haaser T, Rebillard X, Soulié M, De Pouvourville G, Capone C, Pierres M, Lamarque S, Bignon E, Droz-Perroteau C, Moore N, Blin P. Changes in therapeutic strategy in metastatic castration resistant prostate cancer (mCRPC) between 2012 and 2014 from the French nationwide claims database (SNDS). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33183-9] [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] Open
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13
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Haaser T, Berdaï D, Trouette R, Dupin C, Marty S, L'Azou B, Berger V, Saux MC. [Research ethics: French regulations and applications in radiation oncology]. Cancer Radiother 2020; 24:306-315. [PMID: 32499188 DOI: 10.1016/j.canrad.2020.02.012] [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: 11/29/2019] [Revised: 01/31/2020] [Accepted: 02/24/2020] [Indexed: 01/10/2023]
Abstract
French regulations about research ethics are based on the so-called Jardé law, which defines researches involving human beings. Researches involving human beings require the submission of research protocols to a committee for protection of persons with a precise list of documents to submit for a favourable opinion. This law describes different categories of researches and determines the ethical procedures to apply before setting up a research protocol. This issue of categorisation is central and must be taken into account by researchers from the beginning of the research process. Researches considered as not involving human beings also require a set of ethical precautions focused on patients' information and the collection of their non-opposition (due to the application of the General Data Protection Regulation adopted by the European Parliament). Thus, many regulations exist and they require a real work for researchers to meet these requirements in research ethics. This article aims to summarise French regulations. Selected examples are specifically taken into the field of radiation oncology research.
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Affiliation(s)
- T Haaser
- Service d'oncologie radiothérapie, hôpital Haut-Lévêque, centre hospitalier universitaire de Bordeaux, avenue Magellan, 33600 Pessac, France; EA 4574 « Sciences, philosophie, humanités », université de Bordeaux-université Bordeaux-Montaigne, domaine universitaire, 33607 Pessac, France; Service de pharmacologie médicale, comité de protection des personnes Sud-Ouest et outre-mer III, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, 33076 Bordeaux, France.
| | - D Berdaï
- Service de pharmacologie médicale, comité de protection des personnes Sud-Ouest et outre-mer III, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, 33076 Bordeaux, France; Faculté de pharmacie, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - R Trouette
- Service d'oncologie radiothérapie, hôpital Haut-Lévêque, centre hospitalier universitaire de Bordeaux, avenue Magellan, 33600 Pessac, France
| | - C Dupin
- Service d'oncologie radiothérapie, hôpital Haut-Lévêque, centre hospitalier universitaire de Bordeaux, avenue Magellan, 33600 Pessac, France
| | - S Marty
- Centre de coordination de cancérologie, hôpital Saint-André, centre hospitalier universitaire de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France; Unité de recherche en soins et en sciences humaines, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, 33076 Bordeaux, France
| | - B L'Azou
- Faculté de pharmacie, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - V Berger
- Unité de recherche en soins et en sciences humaines, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, 33076 Bordeaux, France
| | - M-C Saux
- Service de pharmacologie médicale, comité de protection des personnes Sud-Ouest et outre-mer III, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, 33076 Bordeaux, France; Faculté de pharmacie, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
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Haaser T. Is clinical examination for prostate cancer becoming redundant? Indian J Med Ethics 2020; -:1-3. [PMID: 32546462 DOI: 10.20529/ijme.2020.061] [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: 06/11/2023]
Abstract
Prostate cancer is a paradigmatic example of the impact of technological change on current medical practice, because biological and radiological assessments appear more reliable compared to clinical examination. Thus, the prostate specific antigen blood-test is the key factor for patients' follow-up and for medical decisions. In this context, the possibility arises of medicine without clinical examination; and if, indeed, it would be ethical to perform clinical examinations such as digital rectal examination if it has no direct consequences for care. However, clinical examination could have a residual value for clinical practice, no more as a central factor for medical decision making, but as a key element in shaping the patient-physician relationship. Attention must be focused on identifying the changing role of clinical examination and on discussing its ethical acceptability.
Keywords: Prostate cancer, screening, urooncology, clinical examination, digital rectal examination, care relationship.
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Affiliation(s)
- Thibaud Haaser
- Service de Radiothérapie, Hôpital du Haut Lévêque, Avenue Magellan, 33600 Pessac, FRANCE, and University Hospital of Bordeaux, EA 4574, Sciences, Philosophie, Humanités, 33400 FRANCE
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Gross-Goupil M, Thurin NH, Rouyer M, Jové J, Haaser T, Rebillard X, Soulie M, de Pouvourville G, Pierrès M, Capone C, Lamarque S, Bignon E, Droz-Perroteau C, Moore N, Blin P. Survival outcome in patients with metastatic castration-resistant prostate cancer according to first-line treatment. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.5570] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5570 Background: Therapeutic strategy in metastatic castration-resistant prostate cancer (mCRPC) has evolved significantly with the introduction of abiraterone acetate in association with prednisone/prednisolone in first-line treatment in December 2012. This work aimed to compare the effectiveness of abiraterone acetate and docetaxel as first-line treatments for mCRPC, in real-life setting. Methods: Patients with mCRPC were identified in the main scheme of the National Healthcare System database (SNDS), which covers about 86% of the French population, and capturing all reimbursed healthcare expenditures and hospital discharge summaries. Those initiating docetaxel or abiraterone acetate in 1st line in 2014 were included and 1:1 matched on the previous prostate cancer stage before mCRPC status, the delay from the date of initial diagnosis and a high-dimensional propensity score. The 36-month overall survival and the 36-month discontinuation-free survival (i.e. survival time until treatment switch or death) were compared using Cox proportional hazards risk model. Results: In 2014, out of the 12,951 patients with prevalent mCRPC, 1,214 initiated docetaxel in 1st line and 2 444 initiated abiraterone. A total of 716 patients per group were matched with good comparability (C-statistic = 0.6). The median duration of docetaxel–defined as the time between the first and the last infusion–was 7.3 months with a median of 6 infusions. The median duration of abiraterone acetate–corresponding to the period covered by the dispensed drug–was 9.1 months. Near 70% of the docetaxel and 62% of the abiraterone acetate patients received a 2nd line of treatment. Results related to the main survival outcomes are presented in the table below. Conclusions: First-line treatment with abiraterone acetate in mCRPC patients results in a better 36-month overall survival and discontinuation-free survival compared to docetaxel in real-life setting. [Table: see text]
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Affiliation(s)
| | - Nicolas H. Thurin
- Bordeaux PharmacoEpi, INSERM CIC1401, Univ. Bordeaux, Bordeaux, France
| | - Magali Rouyer
- Bordeaux PharmacoEpi, INSERM CIC1401, Univ. Bordeaux, Bordeaux, France
| | - Jérémy Jové
- Bordeaux PharmacoEpi, INSERM CIC1401, Univ. Bordeaux, Bordeaux, France
| | | | | | - Michel Soulie
- Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | | | | | | | | | - Emmanuelle Bignon
- Bordeaux PharmacoEpi, INSERM CIC1401, Univ. Bordeaux, Bordeaux, France
| | | | - Nicholas Moore
- Bordeaux PharmacoEpi, INSERM CIC1401, Univ. Bordeaux, CHU Bordeaux, Bordeaux, France
| | - Patrick Blin
- Bordeaux PharmacoEpi, INSERM CIC1401, Univ. Bordeaux, Bordeaux, France
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Thurin N, Rouyer M, Gross-Goupil M, Rebillard X, Soulié M, Haaser T, De Pouvourville G, Pierrès M, Chevalier J, Lamarque S, Jové J, Bignon E, Droz-Perroteau C, Moore N, Blin P. Épidémiologie du cancer de la prostate résistant à la castration et métastatique : données françaises à partir du SNDS. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.139] [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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17
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Haaser T. Limites de la technique : enjeux éthiques. Cancer Radiother 2019; 23:322-327. [DOI: 10.1016/j.canrad.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 11/25/2022]
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Dupin C, Arsène-Henry A, Charleux T, Haaser T, Trouette R, Vendrely V. Prévalence et attentes de l’utilisation des « médecines alternatives et complémentaires » pendant la radiothérapie en 2016 : étude prospective. Cancer Radiother 2018; 22:682-687. [DOI: 10.1016/j.canrad.2018.06.016] [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] [Received: 06/14/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
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Thurin N, Blin P, Rouyer M, Jové J, Gross–Goupil M, Haaser T, Rébillard X, Soulié M, Capone C, Droz–Perroteau C, Moore N. Identification des cas de cancer de la prostate résistants à la castration et métastatiques dans la base du Système national des données de santé (SNDS) : étude CAMERRA. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.04.028] [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] Open
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20
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Salabert L, Gross-Goupil M, Haaser T, Bernhard JC, Palussière J, Ravaud A. Impact of metastatic local treatment in the strategy of metastatic renal cell carinoma including sterotactic radiotherapy, surgery, and radiofrequency in an expert center. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
596 Background: Standard treatment of metastatic renal clear cell carcinoma is based upon nephrectomy, and systemic treatment with targeted agents. These drugs induce frequent side effects that may compromise observance and quality of life. Considering a focal treatment of one or more metastases can lead to a drug-holidays, or allow to postpone systemic treatment start in oligometastatic disease. Such focal treatment techniques are surgery, radiofrequency ablation (RFA) or stereotactic radiotherapy (SRT). Methods: In this retrospective, monocentric and analytic study, we analyzed progression-free survival (PFS) and overall survival (OS) after a focal treatment in a cohort of patients from Bordeaux University Hospital, involving similar staff members along time. We have also reported local control, complications and potential predictive factors associated with a better outcome. Results: Seventy-one patients with 78 focal treatments (23 RFA, 47 metastasectomy and 8 SRT) have been included in our study. For 44 patients, the disease was oligometastatic, (1 to sites, less than 5 metastases) including 15 patients with a partial response to systemic treatment before the focal approach, and 12 patients with a dissociated response to systemic treatment. Progression post focal treatment occurred in 53 (74.6 %) of patients. Median PFS was 14 months (95 % confidence interval [CI], - 8-16 months); and median OS was 77 months (95 % CI, 41 months-not reach). Local control rate was 83.3 %, and complication rate was 36.3 % due to local treatments, without death related to iatrogenic events. A diagnosis of metachrone metastases and a disease-free interval between the first diagnosis and the occurrence of the metastases of at least one year seemed to be associated with better outcomes. Conclusions: Data observed in our study are consistent with those reported in literature. The prolonged OS and PFS post focal treatment should encourage clinical oncologists to discuss this multimodal approach (association of systemic and focal treatments). This approach should be also evaluated in the context of the immunocheckpoint inhibitor in the future.
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Dirajlal PA, Jambon E, Albat-Esquirou A, Galmiche C, Bernhard JC, Grenier N, Haaser T, Cornelis FH. T2 Star-weighted Angiography (SWAN) Allows to Concomitantly Assess the Prostate Contour While Detecting Fiducials Before MR-based Intensity-modulated Radiation Therapy in Prostate Carcinoma. Acad Radiol 2018; 25:95-101. [PMID: 28844603 DOI: 10.1016/j.acra.2017.07.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the performance of T2 star-weighted angiography (SWAN) to concomitantly assess the prostate contour while detecting fiducials before magnetic resonance (MR)-based intensity-modulated radiation therapy (IMRT) in prostate carcinoma. MATERIALS AND METHODS Forty patients (mean age: 73.1 ± 7.5 years; average Gleason score: 7 ± 1; average prostate-specific antigen: 14.7 ± 11.6 ng/mL) underwent MR and computed tomography imaging before fiducial-based IMRT. MR protocol included SWAN, T2-weighted (T2w) and diffusion-weighted imaging in a first group (n = 20) and SWAN, T2w and T2-star weighted imaging in a second group (n = 20). In group 1, the depiction of fiducials, image sharpness and visibility of prostate boundaries were independently evaluated by 2 readers on SWAN, T2w or diffusion-weighted images. In group 2, a similar evaluation was performed by 2 other readers on SWAN and T2-star images only. Depiction of fiducials was compared to computed tomography findings. RESULTS The median scores of visibility of prostate boundaries, image sharpness and depiction of fiducials by SWAN were above average to excellent for all readers. In group 1, readers correctly located 56 of 57 (98.2%) and 47 of 57 (82.5%) fiducials, respectively; and 50 of 51 (98%), and 48 of 51 (88.2%) fiducials in group 2, respectively. CONCLUSION By allowing adequate visualization of the prostate boundaries and high depiction of fiducial markers concomitantly, SWAN might be used for treatment planning of IMRT. The use of this sequence might simplify the registration process and limit any errors associated with image fusion.
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Affiliation(s)
| | - Eva Jambon
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Agnes Albat-Esquirou
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Chloe Galmiche
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | | | - Nicolas Grenier
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Thibaud Haaser
- Department of Oncology, St André Hospital, Bordeaux, France
| | - François H Cornelis
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France; Department of Radiology, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France.
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Dupin C, Arsène-Henri A, Charleux T, Haaser T, Trouette R, Vendrely V. Prévalence et attentes de l’utilisation des médecines alternatives et complémentaire pendant la radiothérapie en 2016 : étude prospective. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.101] [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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23
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Debaillon-Vesque A, Benech-Faure J, Pouypoudat C, Huchet A, Dupin C, Haaser T, Trouette R, Vendrely V. Évaluation du repositionnement sur prothèse biliaire comparé au repositionnement osseux pendant la radiothérapie chez des patients traités pour un cancer du pancréas : implications pour les marges du volume cible anatomoclinique au volume cible prévisionnel. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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24
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Sagardoy T, Fernandez P, Ghafouri A, Digue L, Haaser T, de Clermont-Galleran H, Castetbon V, de Monès E. Accuracy of (18) FDG PET-CT for treatment evaluation 3 months after completion of chemoradiotherapy for head and neck squamous cell carcinoma: 2-year minimum follow-up. Head Neck 2015; 38 Suppl 1:E1271-6. [PMID: 26315809 DOI: 10.1002/hed.24204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 02/17/2015] [Revised: 06/01/2015] [Accepted: 07/08/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the accuracy of (18) F-fluorodeoxyglucose positron emission tomography ((18) FDG PET)-CT in detecting residual or recurrent disease after nonsurgical treatment for head and neck squamous cell carcinoma (HNSCC). METHODS We conducted a retrospective analysis of patients with oral cavity, oropharynx, larynx, hypopharynx, or cervical lymph node location of SCC treated with chemoradiotherapy. Twelve weeks posttreatment, (18) FDG PET-CT results were compared to histology if residual disease was suspected. Patients with complete response received a minimum of 24-month follow-up. RESULTS Forty-seven patients were included with 40 months of median follow-up: 46 with a squamous cell carcinoma (SCC) at the primary site and 43 in the neck. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 86.7%, 90%, 76.5%, and 93.1%, respectively, at the primary site and 100%, 97.2%, 87.5%, 100%, respectively, in the neck. CONCLUSION (18) FDG PET-CT seems effective in detecting residual disease and in predicting recurrent disease within the first 2 years of follow-up after nonsurgical treatment. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1271-E1276, 2016.
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Affiliation(s)
- Thomas Sagardoy
- Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Philippe Fernandez
- Department of Nuclear Medicine, Pellegrin University Hospital, Bordeaux University, Bordeaux, France.,Bordeaux University, INCIA, CNRS, Bordeaux, France.,CNRS, INCIA, Bordeaux, France
| | - Abdullah Ghafouri
- Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Laurence Digue
- Department of Medical Oncology, St André University Hospital, Bordeaux University, Bordeaux, France
| | - Thibaud Haaser
- Department of Radiotherapy, Hôpital du Haut-Lévêque University Hospital, Bordeaux University, Pessac, France
| | | | - Vincent Castetbon
- Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Erwan de Monès
- Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
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Haaser T, Ouhabrache N, Huchet A, Causse N, Protat B, Trouette R, Vendrely V, Demeaux H, Maire JP. Irradiation cutanée totale: expérience du centre hospitalier universitaire de Bordeaux. Cancer Radiother 2010. [DOI: 10.1016/j.canrad.2010.07.581] [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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