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Lambaudie E, Bogart E, Le Deley MC, El Hajj H, Gauthier T, Hebert T, Collinet P, Classe JM, Lecuru F, Motton S, Conri V, Ferrer C, Marchal F, Ferron G, Probst A, Jauffret C, Narducci F. The Influence of Surgical Complexity and Center Experience on Postoperative Morbidity After Minimally Invasive Surgery in Gynecologic Oncology: Lessons Learned from the ROBOGYN-1004 Trial. Ann Surg Oncol 2024:10.1245/s10434-024-15265-1. [PMID: 38616209 DOI: 10.1245/s10434-024-15265-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/22/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND This study was a secondary analysis of the ROBOGYN-1004 trial conducted between 2010 and 2015. The study aimed to identify factors that affect postoperative morbidity after either robot-assisted laparoscopy (RL) or conventional laparoscopy (CL) in gynecologic oncology. METHODS The study used two-level logistic regression analyses to evaluate the prognostic and predictive value of patient, surgery, and center characteristics in predicting severe postoperative morbidity 6 months after surgery. RESULTS This analysis included 368 patients. Severe morbidity occurred in 49 (28 %) of 176 patients who underwent RL versus 41 (21 %) of 192 patients who underwent CL (p = 0.15). In the multivariate analysis, after adjustment for the treatment group (RL vs CL), the risk of severe morbidity increased significantly for patients who had poorer performance status, with an odds ratio (OR) of 1.62 for the 1-point difference in the WHO performance score (95 % CI 1.06-2.47; p = 0.027) and according to the type of surgery (p < 0.001). A focus on complex surgical acts showed significant more morbidity in the RL group than in the CL group at the less experienced centers (OR, 3.31; 95 % CI 1.0-11; p = 0.05) compared with no impact at the experienced centers (OR, 0.87; 95 % CI 0.38-1.99; p = 0.75). CONCLUSION The findings suggest that the center's experience may have an impact on the risk of morbidity for patients undergoing complex robot-assisted surgical procedures.
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Affiliation(s)
| | | | - Marie-Cécile Le Deley
- Oscar Lambret Cancer Center, Lille, France
- Université Paris-Sud, UVSQ, CESP, INSERM, Université Paris-Saclay, Villejuif, France
| | - Houssein El Hajj
- Paoli Calmettes Institute, Marseille, France.
- Oscar Lambret Cancer Center, Lille, France.
| | | | | | | | | | | | | | | | | | - Frederic Marchal
- CRAN, UMR 7039, CNRS Institut de Cancérologie de Lorraine Vandoeuvre les-Nancy, Université de Lorraine, Nancy, France
| | - Gwenael Ferron
- Institut Claudius Regaud Cancer Center-Toulouse, Toulouse, France
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Trentesaux V, Maiezza S, Bogart E, Le Deley MC, Meyer E, Vanquin L, Pasquier D, Mortier L, Mirabel X. Stereotactic body radiotherapy as a viable treatment on extracranial oligometastases in melanoma patients: a retrospective multicentric study. Front Oncol 2024; 14:1322515. [PMID: 38505592 PMCID: PMC10949887 DOI: 10.3389/fonc.2024.1322515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/14/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Stereotactic radiotherapy (SBRT) potentially has a role in the management of oligometastatic melanoma. However, literature with data specific to this management is very limited. The objectives of this study were to evaluate the time to local control (LC) of extra-cranial melanoma metastases after SBRT treatment and to help establish if SBRT is a useful therapy for oligometastatic melanoma. Methods A retrospective study was conducted with data collected from two referral centers in France between 2007 and 2020. The oligometastatic status of patients was reported based on the latest recommendations with a maximum of three lesions prior to treatment. Results A total of 69 patients receiving SBRT for 88 oligometastatic melanoma metastases were included. The median follow-up time was 42.6 months. Most patients were treated for metachronous oligometastatic lesions. Occurrence of oligoprogression, oligorecurrence, and oligopersistence was reported in 42.0%, 39.1%, and 17.4% of cases, respectively. Treated lesions were mostly pulmonary (40.6%), followed by lymph node (34.8%) and hepatic sites (24.6%). Progression-free survival at 1, 2, and 3 years were 47.0% (35-59), 27.0% (16-39), and 25.0% (15.0-37.0), respectively. Time to LC rates at 1, 2, and 3 years were 94.2% (87.0-98.1), 90.3% (81.3-96.1), and 90.3% (81.3-96.1), respectively. Overall survival at 1, 2, and 3 years were 87% (76.0-93.0), 74.0% (76.0-93.0), and 61.0% (47.0-73.0), respectively. Only 17.4% of patients experienced acute, grade 1 or grade 2 toxicities with no reports of grade 3 or higher toxicities. Conclusion SBRT demonstrated efficacy in managing melanoma patients with extracranial oligometastases and showed an overall low toxicity profile. Future randomized studies are needed to establish the role of SBRT in therapeutic approaches for patients with oligometastatic melanoma.
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Affiliation(s)
| | - Sophie Maiezza
- Department of Dermatology, Hôpital Claude Huriez du Centre hospitalo-universitaire (CHU) de Lille, Lille, France
| | - Emilie Bogart
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | | | - Emmanuel Meyer
- Department of Radiotherapy, Centre Francois Baclesse, Caen, France
| | - Ludovic Vanquin
- Department of Medical Physics, Centre Oscar Lambret, Lille, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
- Centre de Recherche en Informatique, Signal et Automatique de Lille (CRIStAL), Centre national de recherche scientifique (CNRS-UMR) 9189, University of Lille, Lille, France
| | - Laurent Mortier
- Department of Dermatology, Hôpital Claude Huriez du Centre hospitalo-universitaire (CHU) de Lille, Lille, France
- Department of Medicine, University of Lille, Lille, France
| | - Xavier Mirabel
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
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Delerue C, Pasquier D, Bogart E, Mirabel X, Laffarguette J, Lals S, Barthoulot M, Lartigau E, Liem X. Stereotactic reirradiation in the treatment of head and neck cancers: A retrospective study on the long-term experience of the Oscar Lambret Center. Radiother Oncol 2024; 190:110029. [PMID: 38007041 DOI: 10.1016/j.radonc.2023.110029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 10/18/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND AND PURPOSE Stereotactic radiotherapy potentially treats unresectable recurrences of previously irradiated head and neck (H&N) cancer. This study aimed to assess its efficacy and safety and evaluate prognostic factors. MATERIALS AND METHODS We conducted a large retrospective series that included 110 patients who had undergone 36-Gy, six-fraction stereotactic reirradiation (CyberKnife®) for recurrent/secondary H&N cancer between 2007 and 2020 at the Oscar Lambret Center. Patient characteristics and toxicities were assessed. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. RESULTS Median follow-up time was 106.3 months. The 2-year OS rate was 43.8 % (95 % confidence interval, 95 % CI, 34.3-52.9) and the median survival was 20.8 months (95 % CI, 16.5-26.3). The cumulative 2-year local-recurrence, regional-recurrence, and distant-metastasis rates were 52.2 % (95 % CI, 42.4-61.1 %), 12.8 % (95 % CI, 7.4-19.8 %), and 11 % (95 % CI, 6.0-17.6 %), respectively. 73 patients received concomitant cetuximab, and it was not significantly beneficial (HR = 1.34; 95 % CI, 0.80-2.26; p = 0.26). The cumulative incidences of grade ≥ 2 late toxicity was 42 % (CI95%: 33-51) at 24 months. Two grade 4 bleedings and no treatment-related deaths were reported. CONCLUSION In a large retrospective series of SBRT reirradiation for recurrent or second primary H&N cancers, we observed a median OS of 20.8 months, with a cumulative incidence of grade ≥ 2 late toxicity of 42 % at 24 months. Such a treatment is feasible. However, local recurrence rates remain non-negligible, warranting further research. Radiosensitizer use is currently under study. Therefore, establishing a balance between therapeutic modifications and toxicity is essential.
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Affiliation(s)
- Chloé Delerue
- Oscar Lambret Center, Academic Department of Radiation Oncology, Lille, France
| | - David Pasquier
- Oscar Lambret Center, Academic Department of Radiation Oncology, Lille, France; CRIStAL UMR 9189, University of Lille ,Lille, France
| | - Emilie Bogart
- Oscar Lambret Center, Department of Clinical Research and Innovation, Department of Methodology and Biostatistics, Lille, France
| | - Xavier Mirabel
- Oscar Lambret Center, Academic Department of Radiation Oncology, Lille, France
| | | | - Séverine Lals
- Oscar Lambret Center, Academic Department of Radiation Oncology, Lille, France
| | - Maël Barthoulot
- Oscar Lambret Center, Department of Clinical Research and Innovation, Department of Methodology and Biostatistics, Lille, France
| | - Eric Lartigau
- Oscar Lambret Center, Academic Department of Radiation Oncology, Lille, France
| | - Xavier Liem
- Oscar Lambret Center, Academic Department of Radiation Oncology, Lille, France.
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Sevrin F, Kolesnikov-Gauthier H, Cougnenc O, Bogart E, Schleiermacher G, Courbon F, Gambart M, Giraudet AL, Corradini N, Badel JN, Rault E, Oudoux A, Deley MCL, Valteau-Couanet D, Defachelles AS. Phase II study of 131 I-metaiodobenzylguanidine with 5 days of topotecan for refractory or relapsed neuroblastoma: Results of the French study MIITOP. Pediatr Blood Cancer 2023; 70:e30615. [PMID: 37574821 DOI: 10.1002/pbc.30615] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE We report the results of the French multicentric phase II study MIITOP (NCT00960739), which evaluated tandem infusions of 131 I-metaiodobenzylguanidine (mIBG) and topotecan in children with relapsed/refractory metastatic neuroblastoma (NBL). METHODS Patients received 131 I-mIBG on day 1, with intravenous topotecan daily on days 1-5. A second activity of 131 I-mIBG was given on day 21 to deliver a whole-body radiation dose of 4 Gy, combined with a second course of topotecan on days 21-25. Peripheral blood stem cells were infused on day 31. RESULTS Thirty patients were enrolled from November 2008 to June 2015. Median age at diagnosis was 5.5 years (2-20). Twenty-one had very high-risk NBL (VHR-NBL), that is, stage 4 NBL at diagnosis or at relapse, with insufficient response (i.e., less than a partial response of metastases and more than three mIBG spots) after induction chemotherapy; nine had progressive metastatic relapse. Median Curie score at inclusion was 6 (1-26). Median number of prior lines of treatment was 3 (1-7). Objective response rate was 13% (95% confidence interval [CI]: 4-31) for the whole population, 19% for VHR-NBL, and 0% for progressive relapses. Immediate tolerance was good, with nonhematologic toxicity limited to grade-2 nausea/vomiting in eight patients. Two-year event-free survival was 17% (95% CI: 6-32). Among the 16 patients with VHR-NBL who had not received prior myeloablative busulfan-melphalan consolidation, 13 had at least stable disease after MIITOP; 11 subsequently received busulfan-melphalan; four of them were alive (median follow-up: 7 years). CONCLUSION MIITOP showed acceptable tolerability in this heavily pretreated population and encouraging survival rates in VHR-NBL when followed by busulfan-melphalan.
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Affiliation(s)
- François Sevrin
- Department of Pediatric Oncology, Oscar Lambret Center, Lille, France
| | | | - Olivier Cougnenc
- Department of Clinical Pharmacy, Oscar Lambret Center, Lille, France
| | - Emilie Bogart
- Department of Methodology and Biostatistics, Oscar Lambret Center, Lille, France
| | | | - Frederic Courbon
- Service de Médecine Nucléaire, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Marion Gambart
- Hematology and Oncology Unit, Children's Hospital, CHU Toulouse, Toulouse, France
| | | | - Nadège Corradini
- Institute of Pediatric Hematology and Oncology, Léon Bérard Center, Lyon, France
| | - Jean-Noël Badel
- Department of Nuclear Medicine, Léon Bérard Center, Lyon, France
| | - Erwann Rault
- Department of Medical Physics, Oscar Lambret Center, Lille, France
| | - Aurore Oudoux
- Department of Nuclear Medicine, Oscar Lambret Center, Lille, France
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Serouart B, Cordoba A, Martinez-Gomez C, Bogart E, Le Deley MC, Leblanc É, Hudry D, Escande A, Le Tinier F, Pasquesoone C, Taieb S, El Hajj H, Narducci F. Results of a 20 Year Retrospective Analysis of Early-Stage Cervical Cancer: Should 3 cm Be Considered the New Ariadne's Thread in Early Cervical Cancer Treatment? Cancers (Basel) 2023; 15:cancers15051570. [PMID: 36900360 PMCID: PMC10001182 DOI: 10.3390/cancers15051570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
(1) This study aims to evaluate the overall survival (OS) and recurrence-free survivals (RFS) and assess disease recurrence of early-stage cervical cancer (ESCC) patients treated with minimally invasive surgery (MIS). (2) This single-center retrospective analysis was performed between January 1999 and December 2018, including all patients managed with MIS for ESCC. (3) All 239 patients included in the study underwent pelvic lymphadenectomy followed by radical hysterectomy without the use of an intrauterine manipulator. Preoperative brachytherapy was performed in 125 patients with tumors measuring 2 to 4 cm. The 5-year OS and RFS rates were 92% and 86.9%, respectively. Multivariate analysis found two significant factors associated with recurrence: previous conization with HR = 0.21, p = 0.01, and tumor size > 3 cm with HR = 2.26, p = 0.031. Out of the 33 cases of disease recurrence, we witnessed 22 disease-related deaths. Recurrence rates were 7.5%, 12.9%, and 24.1% for tumors measuring ≤ 2 cm, 2 to 3 cm, and > 3 cm, respectively. Tumors ≤ 2 cm were mostly associated with local recurrences. Tumors > 2 cm were frequently associated with common iliac or presacral lymph node recurrences. (4) MIS may still be considered for tumors ≤ 2 cm subject to first conization followed by surgery with the Schautheim procedure and extended pelvic lymphadenectomy. Due to the increased rate of recurrence, a more aggressive approach might be considered for tumors > 3 cm.
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Affiliation(s)
- Benjamin Serouart
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Abel Cordoba
- Department of Radiotherapy, Oscar Lambret Center, 59000 Lille, France
| | | | - Emilie Bogart
- Department of Biostatistics, Oscar Lambret Center, 59000 Lille, France
| | | | - Éric Leblanc
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Delphine Hudry
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Alexandre Escande
- Department of Radiotherapy, Oscar Lambret Center, 59000 Lille, France
| | | | | | - Sophie Taieb
- Department of Imaging, Oscar Lambret Center, 59000 Lille, France
| | - Houssein El Hajj
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
- Correspondence: ; Tel.: +33-7-69-21-12-99
| | - Fabrice Narducci
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
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Adenis A, Piessen G, Le Sourd S, Bogart E, Paumier A, Vendrely V, Glehen O, Dahan L, Simmet V, Bergeat D, Samalin E, Chauvenet M, d'Journo XB, Hiret S, Gronnier C, Baty M, Pannier D, Veziant J, Le Deley MC, Mirabel X. Trimodality therapy with carboplatin/paclitaxel (CP) or FOLFOX (FFX) for esophageal/esogastric junctional cancer (EC/EGJ): Expanded safety and efficacy data from PROTECT. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.370] [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: 01/25/2023] Open
Abstract
370 Background: When combined to preoperative radiation therapy (RT), CP and FFX regimen provide both high complete resection (R0) rate for EC/EGJ cancer (Adenis, ASCO 2022). However, it appeared that neoadjuvant chemoradiation (nCRT) with CP is associated with a severe postoperative morbidity rate higher than expected. We present here the expanded safety and efficacy analyses from the PROTECT trial. Methods: PROTECT is a randomized, phase 2 trial which included stage II/III and ECOG PS ≤2 EC or Siewert I-II EGJ cancers. Patients (pts) received FFX or CP with concurrent RT (41.4Gy, 1.8Gy, 23 fractions), followed by surgery 4-8 weeks after completion of nCRT (Messager, BMC Cancer 2016). Co-primary endpoints were proportion of R0 rate and proportion of Clavien-Dindo severe postoperative morbidity. Main secondary endpoints were nCRT and postoperative safety (NCI CTCAE v.4), DFS and OS. Results: 41/50 (82%) and 39/50 (78 %) pts received the planned chemo cycles and concurrent RT in FFX and CP arms, respectively. Grade (gr.) 3–4 AEs related to nCRT (FFX 14/50, 28%; CP 14/50, 28%) occurring in ≥5% of pts included lymphopenia (n=3, 6%; n=4, 8%), neutropenia (n=1, 2%; n=3, 6%), fatigue (n=2, 4%; n=0) and esophagitis-related to RT (n=1, 2%; n=1, 2%). No death was reported during nCRT. Surgery (FFX and CP; mini invasive: 15 and 15, hybrid: 22 and 21, open: 7 and 12) was performed in 44 and 48 pts, in FFX and CP groups, respectively. The main gr. III-V surgical complications (Clavien-Dindo scale) occurring in ≥5% of pts included esophageal fistula (n=2/43 evaluable pts, 6%; 8/48, 17%), conduit necrosis (n=2, 5%; n=1, 2%), ARDS (n=3, 7%; n=3, 6%), pleural effusion (n=3, 7%; n=4, 8%), and haemorrhage (n=0; n=3, 6%). There were no postoperative deaths. With a median follow-up of 54m, median DFS were 12.3m and 20m (HR=0.84; 95%CI: 0.52-1.35; p=0.48) and median OS were 31.7m and 45.8m (HR=0.79; 95%CI: 0.47-1.32; p=0.36) in FFX and CP arms, respectively. Prognostic factors significantly associated to DFS in univariate analysis were: R0 resection, TRG1-2 and ypT0N0 status. Conclusions: A higher than expected number of severe esophageal fistula was observed in the CP arm. We could not demonstrate a significant benefit of CP compared to FFX in terms of survival outcomes, but the study was not primarily designed to specifically address this issue. Clinical trial information: NCT02359968 .
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Affiliation(s)
- Antoine Adenis
- Institut du Cancer de Montpellier and IRCM, Université de Montpellier, Montpellier, France
| | | | | | | | - Amaury Paumier
- Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | | | | | | | | | - Emmanuelle Samalin
- Institut du Cancer de Montpellier and IRCM, Université de Montpellier, Montpellier, France
| | | | | | - Sandrine Hiret
- Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | | | - Diane Pannier
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
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Hotton J, Bogart E, Le Deley MC, Lambaudie E, Narducci F, Marchal F. Ergonomic Assessment of the Surgeon's Physical Workload During Robot-Assisted Versus Standard Laparoscopy in a French Multicenter Randomized Trial (ROBOGYN-1004 Trial). Ann Surg Oncol 2023; 30:916-923. [PMID: 36175710 DOI: 10.1245/s10434-022-12548-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Standard laparoscopy (SL) is responsible for musculoskeletal disorders in surgeons because of poor ergonomic positions, which could be reduced by robot-assisted laparoscopy (RAL) owing to the surgeons' seated position. One of the aims of the ROBOGYN-1004 study (NCT01247779) was to evaluate surgeons' workloads during real-time procedures of gynecological oncological surgery. METHODS Patients with gynecological cancer eligible for minimally invasive surgery were recruited from 13 French centers between December 2010 and December 2015. Physical workload was evaluated using the Borg scale every hour over the surgery duration and the perception of workload evaluated using NASA-TLX at the end of surgery. RESULTS A total of 369 patients were recruited, of whom 176 underwent RAL and 193 underwent SL (per-protocol analysis). Posture during SL was significantly more challenging for all body parts except the back. There was an increase in discomfort over time (up to 4 h) for the hands and arms, neck, and legs in SL compared with RAL. Perceived physical activity and abilities were rated higher in SL than in RAL (p < 0.01), whereas perceived personal performance was higher in SL (p < 0.01). Perceived physical effort during surgery was lower in RAL than in SL. CONCLUSIONS RAL improves the perception of physical workload. Compared with SL, the perceived effort is lower in RAL regardless of the complexity of the surgery.
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Affiliation(s)
| | - Emilie Bogart
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Marie-Cécile Le Deley
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Eric Lambaudie
- Surgical Department, Institut Paoli-Calmette, Marseille, France
| | | | - Frédéric Marchal
- Surgical Department, CRAN, UMR 7039, CNRS Institut de Cancérologie de Lorraine, Université de Lorraine, Vandoeuvre-les-Nancy, France
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Hotton J, Bogart E, Le Deley MC, Lambaudie E, Narducci F, Marchal F. ASO Visual Abstract: Ergonomic Assessment of the Surgeon's Physical Workload During Robot-Assisted Versus Standard Laparoscopy in a French Multicenter Randomized Trial (ROBOGYN-1004 Trial). Ann Surg Oncol 2023; 30:924-925. [PMID: 36402895 DOI: 10.1245/s10434-022-12608-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | - Emilie Bogart
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Marie-Cécile Le Deley
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Eric Lambaudie
- Surgical Department, Institut Paoli-Calmette, Marseille, France
| | | | - Frédéric Marchal
- Surgical Department, CRAN, UMR 7039, Université de Lorraine, CNRS Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France
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Dworczak M, Bogart E, Adenis A, Le Deley MC, Thenot A, Piessen G, Lacornerie T, Lartigau E, Mirabel X, Pasquier D. Effect of dosimetric parameters on postoperative respiratory morbidity in locally advanced esophageal cancer treated with preoperative chemoradiotherapy (CRT). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16075] [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
e16075 Background: Postoperative pulmonary complications are common after neoadjuvant CRT of locally advanced esophageal cancers. Using data from the French multicenter randomized phase II PROTECT trial (NCT02359968), we aimed to evaluate the dosimetric parameters which could be associated with the occurrence of postoperative respiratory morbidities in patients (pts) who underwent preoperative CRT. Methods: Key eligibility criteria for the PROTECT trial were stage II or III resectable adenocarcinoma or squamous cell carcinoma of the esophagus located below the carina. Pts received FOLFOX or Carboplatin-Paclitaxel, combined with radiotherapy (RT): total dose of 41.4 Gy, 5 fractions of 1.8 Gy per week, starting at day 1 of chemotherapy. The patient's position and definition of the target volumes and organs at risk were the same as in the CROSS trial (van Hagen, 2012). Pts were treated using 3D conformal RT or IMRT. Surgery occurred 4 to 8 weeks after completion of CRT through a transthoracic or mini-invasive approach with a two field extended lymphadenectomy. Pts recruited in the PROTECT trial up to Sept. 2019 who underwent surgery after CRT were eligible for this ancillary study. The primary endpoint of our translational study was the occurrence of postoperative respiratory morbidity, of any grade (Clavien-Dindo classification for early morbidity < 31 days; NCI-CTCAE v4 for later events), up to 1 year following surgery, considering disease progression or death as competing events. Cause-specific Cox models were used to model the risk of respiratory morbidity, considering the following factors: performance status, BMI, smoking, histological subtype, tumor site, FEV1, RT technique, time interval between CRT and surgery, and dosimetric parameters derived from the Dose-Volume Histogram analysis (mean lung dose, V10Gy, V20Gy and V30Gy, as other parameters strongly correlated to these 4 ones). Results: Among the 98 pts recruited in the PROTECT trial from Feb. 2015 to Sept. 2019, 78 underwent surgery after CRT and were included in our translational study. Median age was 63.5 years (range 33 to 79). Tumor was located at the middle or lower third of the esophagus for 67% of pts. Mean lung dose was 10.2 Gy (sd = 3.2). Mean PTV volume was 566 cc (sd = 272). A total of 33 pts experienced at least one respiratory morbidity (16 pneumonia, 7 pleural effusion, 4 ARDS, 21 miscellaneous events). The cumulative incidence of respiratory morbidity was 42% one month after surgery (95% CI, 32-54), 44% at 3 months (32-54), and 46% at 6 months (35-57). None of the dosimetric parameters and other studied factors appeared associated with postoperative respiratory morbidity. Conclusions: We did not identify dosimetric factors that could predict the risk of postoperative respiratory morbidity after treatment with preoperative CRT with FOLFOX or Carboplatin-Paclitaxel. Clinical trial information: NCT02359968.
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Affiliation(s)
| | | | - Antoine Adenis
- Department of Medical Oncology, Montpellier Cancer Institute (ICM), Montpellier, France
| | | | | | - Guillaume Piessen
- University of Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | | | - Eric Lartigau
- Oscar Lambret Comprehensive Cancer Center, Lille, France
| | | | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
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Adenis A, Le Sourd S, Mirabel X, Paumier A, Bogart E, Vendrely V, Glehen O, Dahan L, Simmet V, Bergeat D, Samalin E, Chauvenet M, d'Journo XB, Hiret S, Gronnier C, Gnep K, Vanseymortier M, El Hajbi F, Le Deley MC, Piessen G. Preoperative chemoradiation (CRT) with carboplatin (CBP)/paclitaxel (PCL) (CP) or with 5-fluorouracil (FU)/oxaliplatin (OX) (Fx) for esophageal or junctional cancer: A randomized phase 2 trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4015 Background: Preoperative CRT with a FU/platinum regimen has been used for years for esophageal or junctional cancer before the CP regimen became a standard of care following the results of the CROSS study (van Hagen 2012). We aimed at evaluating the complete resection (R0) rate and severe postoperative morbidity rate associated with these 2 neoadjuvant regimens, each being combined with the radiation (RT) regime used in the CROSS trial. Methods: PROTECT is a multicenter, randomized, non-comparative, phase 2 trial (NCT02359968) in patients (pts) with resectable esophageal or Siewert type I-II junctional cancer, stage II (T1-2N1 or T3N0) or stage III (T3N1 or T4anyN) tumors (UICC-7 classification), and ECOG PS ≤2. Following randomization (balanced by ECOG PS 0 vs 1-2, stage II vs III, squamous-cell (SCC) vs adenocarcinoma (ADK), center), pts received CP (AUC2 CBP plus PCL 50mg/m² / week x 5 weeks), or Fx (FU 400 mg/m² bolus Day 1, then FU 1600 mg/m² continuous infusion over 2 days, plus OX 85 mg/m², and Folinic acid 200 mg/m², 2-h infusion, Day 1; 3 cycles every 2 weeks). RT technique was similar in both arms: 3D-conformal as published in the CROSS trial or IMRT (n = 35); total dose of 41.4Gy, 5 fractions of 1.8Gy / week, starting at Day 1 of chemotherapy. Surgery was performed 4 to 8 weeks after completion of CRT through a transthoracic or mini-invasive approach with a two field extended lymphadenectomy. Co-primary endpoints were R0 (failure: R1 or disease progression under CRT), and severe postoperative morbidity rate ≤30 days after surgery (Clavien-Dindo grade ≥ III). Based on a Bryant and Day 2-stage design (p0 = 75% and p1 = 90% for resection; p0 = 45% and p1 = 25% for morbidity; α = 10% and β = 15%), 48 evaluable pts were required by arm. Results: 100/104 pts recruited from 02/2015 to 08/2020, started the study treatment: 50 CP & 50 Fx. Overall, median age = 64 (range, 33-79); 82/100 males; 62 ADK and 38 SCC; 66 esophageal and 34 junctional site; 31 stage II; 68 stage III, 1 Nx. R0 resection was obtained in 46/50 CP pts (92.0%, 95% CI: 80.8-97.8%), and in 42/48 Fx pts (87.5%, 74.8-95.3%); 2 non evaluable pts because of event unrelated to disease progression. Severe postoperative adverse events (AEs) occurred in 34/91 pts who underwent surgery: 21/48 CP (43.8%, 29.5-58.8%) and 13/43 Fx (30.2%, 17.2-46.1%). Severe AEs were respiratory disorders (CP 26%; Fx 26%), esophageal fistula (CP 18%; Fx 6%), infection (CP 5%; Fx 3%), haemorrhage (CP 5%; Fx 0%) and gastric tube necrosis (CP 6%; Fx 3%). 5 pts died from AEs (3 CP, 2 Fx). A TRG1-2 was observed in 29/48 (60.4%, 95% CI: 44.3-74.2%) CP pts, and in 19/43 (44.2%, 29.1-60.1%) Fx pts. Conclusions: When combined to preoperative radiation therapy at 41.4Gy, both regimens (CP and Fx) provided short-term benefit on R0 resection; however, CP is associated with a severe postoperative morbidity rate higher than expected. Clinical trial information: NCT02359968.
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Affiliation(s)
- Antoine Adenis
- Department of Medical Oncology, Montpellier Cancer Institute (ICM), Montpellier, France
| | - Samuel Le Sourd
- Medical Oncology Department, Centre Eugène-Marquis, Rennes, France
| | | | | | | | - Veronique Vendrely
- Centre Hospitalier et Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Olivier Glehen
- Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | | | | | - Damien Bergeat
- Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | - Marion Chauvenet
- Hospices Civils De Lyon, Cancer Research Center of Lyon, Claude Bernard University Lyon, Pierre Béninte, France
| | | | - Sandrine Hiret
- Institut de Cancérologie de l’Ouest, Saint-Herblain, France
| | | | | | | | | | | | - Guillaume Piessen
- University of Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
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Defachelles AS, Bogart E, Casanova M, Merks JHM, Bisogno G, Calareso G, Melcon SG, Gatz SA, Le Deley MC, McHugh K, Probst A, Rocourt N, van Rijn RR, Minard-Colin V, Chisholm JC. Reply to H. B et al. J Clin Oncol 2022; 40:1030-1032. [PMID: 35130027 DOI: 10.1200/jco.21.02612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anne-Sophie Defachelles
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Emilie Bogart
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Michela Casanova
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Johannes H M Merks
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Gianni Bisogno
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Giuseppina Calareso
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Soledad Gallego Melcon
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Susanne Andrea Gatz
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Marie-Cécile Le Deley
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Kieran McHugh
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Alicia Probst
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Nathalie Rocourt
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Rick R van Rijn
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Véronique Minard-Colin
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Julia C Chisholm
- Anne-Sophie Defachelles, MD and Emilie Bogart, MD, Centre Oscar Lambret, Lille, France; Michela Casanova, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Johannes H.M. Merks, MD, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Gianni Bisogno, MD, PhD, Department of Women and Children Health, University Hospital of Padova, Padova, Italy; Giuseppina Calareso, MD, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Soledad Gallego Melcon, MD, PhD, University Hospital Vall d'Hebron, Barcelona, Spain; Susanne Andrea Gatz, MD, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Marie-Cécile Le Deley, MD, Centre Oscar Lambret, Lille, France; Kieran McHugh, MD, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Alicia Probst, MSc, and Nathalie Rocourt, MD, Centre Oscar Lambret, Lille, France; Rick R. van Rijn, MD, PhD, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Véronique Minard-Colin, MD, PhD, Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France; and Julia C. Chisholm, MD, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
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Mailliez A, Pigny P, Bogart E, Keller L, D'orazio E, Vanseymortier M, le Deley MC, Decanter C. Is ovarian recovery after chemotherapy in young patients with early breast cancer influenced by controlled ovarian hyperstimulation for fertility preservation or tumor characteristics? Results of a prospective study in 126 patients. Int J Cancer 2022; 150:1850-1860. [PMID: 35038360 DOI: 10.1002/ijc.33933] [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] [Received: 06/18/2021] [Revised: 10/29/2021] [Accepted: 12/01/2021] [Indexed: 11/06/2022]
Abstract
Young individuals, aged <40 years, represent 7% of all patients with early breast cancer (EBC), most of whom receive chemotherapy. Preserving future fertility in these patients has become a major concern. This prospective study assessed ovarian function during and after chemotherapy according to patient and tumor characteristics and evaluated the outcome of controlled ovarian hyperstimulation (COH). Ovarian reserve was evaluated in terms of amenorrhea duration and by longitudinal serum anti-Müllerian hormone (AMH) level variations measured at study entry, during treatment, and until 24 months thereafter. COH has been proposed for patients receiving adjuvant chemotherapy. We studied the association between clinical factors and ovarian function using Cox models and logistic regression. In this young population (age <38 years, median=32), 85 of 90 evaluable patients (94%) experienced chemo-induced amenorrhea, including six persistent amenorrhea and one chemotherapy-induced definitive ovarian failure. Overall, 33% of patients still had undetectable AMH values 12 months after the end of chemotherapy, although most had recovered spontaneous and regular menstrual function. No specific factor was associated with clinical or biological late ovarian dysfunction, except for age and baseline AMH value. Overall, 58 patients underwent COH. The mean number of total retrieved oocytes and metaphase II oocytes were of 11.7 and 6.9, respectively. Thus, our study confirms the importance of fertility preservation in young patients with EBC. Our findings indicates that sequential chemotherapy is associated with a higher risk of persistent amenorrhea. There was no significant association between tumor characteristics, fertility preservation, or recovery of ovarian reserve. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Audrey Mailliez
- Breast Cancer Unit, Medical Oncology Department, Oscar Lambret Center, Lille, France
| | - Pascal Pigny
- Laboratoire de Biochimie « Hormonologie, Métabolisme-Nutrition & Oncologie » Centre de Biologie Pathologie, Centre Hospitalier Régional Universitaire, Lille, France.,INSERM UMR-S1277 CANTHER, Université de Lille, Lille, France
| | - Emilie Bogart
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | - Laura Keller
- Institut de Biologie de la Reproduction-Spermiologie-CECOS, hôpital Jeanne de Flandre, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Emmanuelle D'orazio
- Centre d'Assistance médicale à la Procréation et de Préservation de la Fertilité, Hôpital Jeanne de Flandre, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Marie Vanseymortier
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | | | - Christine Decanter
- Centre d'Assistance médicale à la Procréation et de Préservation de la Fertilité, Hôpital Jeanne de Flandre, Centre Hospitalier Universitaire de Lille, Lille, France.,EA 4308 Gamétogénèse et qualité du gamète, Centre Hospitalier Universitaire de Lille, Lille, France
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Régis C, Le Deley MC, Bogart E, Leguillette C, Boulanger L, Chauvet MP, Viard R, Thery J, Bosc R, Delmaire C. ASO Visual Abstract: Functional Cerebral MRI Evaluation of the Integration of Breast Reconstruction into the Body Schema. Ann Surg Oncol 2021. [PMID: 34853943 DOI: 10.1245/s10434-021-11147-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Claudia Régis
- Department of Surgery, Centre Oscar Lambret, 3 rue F.-Combemale, 59020, Lille cedex, France.
| | - Marie-Cécile Le Deley
- Biostatisitcs Unit, Centre Oscar Lambret, 3 rue F.-Combemale, 59020, Lille cedex, France.,Université Paris-Saclay, Universite´ Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Emilie Bogart
- Biostatisitcs Unit, Centre Oscar Lambret, 3 rue F.-Combemale, 59020, Lille cedex, France
| | - Clémence Leguillette
- Biostatisitcs Unit, Centre Oscar Lambret, 3 rue F.-Combemale, 59020, Lille cedex, France
| | - Loic Boulanger
- Department of Surgery, Centre Oscar Lambret, 3 rue F.-Combemale, 59020, Lille cedex, France
| | - Marie- Pierre Chauvet
- Department of Surgery, Centre Oscar Lambret, 3 rue F.-Combemale, 59020, Lille cedex, France
| | - Romain Viard
- University in Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, 59000, Lille, France.,University in Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, 59000, Lille, France
| | - Julien Thery
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | - Romain Bosc
- Department of Plastic, Reconstructive, Aesthetic and maxillofacial Surgery, Henry Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Christine Delmaire
- Imagering Department of Adolphe Rotschild Fondation, 75019, Paris, France
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Régis C, Le Deley MC, Bogart E, Leguillette C, Boulanger L, Chauvet MP, Viard R, Thery J, Bosc R, Delmaire C. Functional Cerebral MRI Evaluation of Integration of Breast Reconstruction into the Body Schema. Ann Surg Oncol 2021; 29:2652-2661. [PMID: 34839425 DOI: 10.1245/s10434-021-11048-0] [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] [Received: 06/30/2021] [Accepted: 10/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objective of breast reconstruction (BR) is to erase the after-effects of total mastectomy by allowing patients to restore their breast shape. The aim of our study was to investigate the body map integration of different types of BR using functional magnetic resonance (fMRI). PATIENTS AND METHODS We prospectively enrolled all women undergoing BR for breast cancer to the Remasco study (NCT02553967). Participants were categorized into four groups according to the standard of care they required: immediate BR (IBR), delayed BR (DBR), flap (autologous), or implant BR. Each patient performed sensorimotor tasks during the fMRI acquisition. RESULTS Data of 38 patients were analyzed. We identified the cingulate region as the area of interest in the brain. In the case of DBR, the brain area activated during palpation of the total mastectomy scar (before BR) was different from the brain area activated during palpation of the reconstructed breast (Brodmann areas 31 versus 32). Palpation of the native breast and reconstructed breast activated the same Brodmann area 32. Comparing the brain activation signal during palpation of the native breast and the reconstructed breast did not reveal any significant difference in the overall population (P = 0.41) or in the groups: autologous (P = 0.32), implant (P = 0.10), IBR (P = 0.72), or DBR (P = 0.10). CONCLUSIONS This experimental study allowed us to describe and understand the brain plasticity processes that accompany BR. The results suggest that the reconstructed breast is integrated into the body schema, regardless of the type of BR or the timing.
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Affiliation(s)
- Claudia Régis
- Department of Surgery, Centre Oscar Lambret, 3 rue F.-Combemale, Lille cedex, France.
| | - Marie-Cécile Le Deley
- Biostatisitcs Unit, Centre Oscar Lambret, 3 rue F.-Combemale, Lille cedex, France.,Université Paris-Saclay, Universite´ Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Emilie Bogart
- Biostatisitcs Unit, Centre Oscar Lambret, 3 rue F.-Combemale, Lille cedex, France
| | - Clémence Leguillette
- Biostatisitcs Unit, Centre Oscar Lambret, 3 rue F.-Combemale, Lille cedex, France
| | - Loic Boulanger
- Department of Surgery, Centre Oscar Lambret, 3 rue F.-Combemale, Lille cedex, France
| | - Marie- Pierre Chauvet
- Department of Surgery, Centre Oscar Lambret, 3 rue F.-Combemale, Lille cedex, France
| | - Romain Viard
- University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, Lille, France.,University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Julien Thery
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | - Romain Bosc
- Department of Plastic, Reconstructive, Aesthetic and maxillofacial Surgery, Henry Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, France
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Lemoine P, Bruand M, Kammerer E, Bogart E, Comte P, Royer P, Thariat J, Pasquier D. Stereotactic Body Radiation Therapy for Oligometastatic Breast Cancer: A Retrospective Multicenter Study. Front Oncol 2021; 11:736690. [PMID: 34778049 PMCID: PMC8581293 DOI: 10.3389/fonc.2021.736690] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Stereotactic radiotherapy may improve the prognosis of oligometastatic patients. In the literature, there is very little data available that is specific to breast cancer. MATERIALS AND METHODS We conducted a multicenter retrospective study. The primary objective was to estimate progression-free survival after stereotactic body radiotherapy (SBRT) using Cyberknife of breast cancer oligometastases. The secondary objectives were to estimate overall survival, local control, and toxicity. The inclusion criteria were oligometastatic breast cancer with a maximum of five lesions distributed in one to three different organs, diagnosed on PET/CT and/or MRI, excluding brain metastases and oligoprogressions. This was combined with systemic medical treatment. FINDINGS Forty-four patients were enrolled from 2007 to 2017, at three high-volume cancer centers. The patients mostly had one to two lesion(s) whose most widely represented site was bone (24 lesions or 44.4%), particularly in the spine, followed by liver (22 lesions or 40.7%), then pulmonary lesions (six lesions or 11.1%). The primary tumor expressed estrogen receptors in 33 patients (84.6%); the status was HER2+++ in 7 patients (17.9%). The median dose was 40 Gy (min-max: 15-54) prescribed at 80% isodose, the median number of sessions was three (min-max: 3-10). The median D50% was 42 Gy (min max 17-59). After a median follow-up of 3.4 years, progression-free survival (PFS) at one year, two years, and three years was 81% (95% CI: 66-90%), 58% (95% CI: 41-72%), and 45% (95% CI: 28-60%), respectively. The median PFS was 2.6 years (95% CI: 1.3 - 4.9). Overall survival at three years was 81% (95% CI: 63-90%). The local control rate at two and three years was 100%. Three patients (7.3%) experienced G2 acute toxicity, no grade ≥3 toxicity was reported. CONCLUSION The PFS of oligometastatic breast cancer patients treated with SBRT appears long, with low toxicity. Local control is high. SBRT for oligometastases is rarely applied in breast cancer in light of the population in our study. Phase III studies are ongoing.
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Affiliation(s)
- Pauline Lemoine
- Academic Department of Radiation Oncology, O. Lambret Center, Lille, France
- University of Lille, H. Warembourg School of Medicine, Lille, France
| | - Marie Bruand
- Department of Radiation Therapy, Lorraine Institute of Oncology, Nancy, France
| | - Emmanuel Kammerer
- Department of Radiation Oncology, Centre Francois Baclesse, Caen, France
| | - Emilie Bogart
- Biostatistics department, Oscar Lambret Center, Lille, France
| | - Pauline Comte
- Department of Medical Physics, O. Lambret Center, Lille, France
| | - Philippe Royer
- Department of Radiation Therapy, Lorraine Institute of Oncology, Nancy, France
| | - Juliette Thariat
- Department of Radiation Oncology, Centre Francois Baclesse, Caen, France
- Advanced Resource Centre for Hadrontherapy (ARCHADE Research Community), Caen, France
- Laboratory of High-Energy Particle Physics, Institut National de Physique Nucléaire et de Physique des Particules, The National Engineering School of Caen (IN2P3/ENSICAEN), CNRS UMR 6534—Normandy University, Caen, France
| | - David Pasquier
- Academic Department of Radiation Oncology, O. Lambret Center, Lille, France
- University of Lille, H. Warembourg School of Medicine, Lille, France
- CRIStAL (Centre de Recherche en Informatique, Signal et Automatique de Lille [Research center in Computer Science, Signal and Automatic Control of Lille] UMR 9189, Lille University, Lille, France
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Roquette I, Bogart E, Lacornerie T, Ningarhari M, Bibault JE, Le Deley MC, Lartigau É, Mirabel X, Pasquier D. Radiothérapie stéréotaxique pour le carcinome hépatocellulaire : efficacité et tolérance. Cancer Radiother 2021. [DOI: 10.1016/j.canrad.2021.07.027] [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: 10/20/2022]
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17
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Latorzeff I, Bruguière E, Bogart E, Le Deley MC, Lartigau E, Marre D, Pasquier D. Use of a Biodegradable, Contrast-Filled Rectal Spacer Balloon in Intensity-Modulated Radiotherapy for Intermediate-Risk Prostate Cancer Patients: Dosimetric Gains in the BioPro-RCMI-1505 Study. Front Oncol 2021; 11:701998. [PMID: 34513681 PMCID: PMC8427159 DOI: 10.3389/fonc.2021.701998] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/21/2021] [Indexed: 01/12/2023] Open
Abstract
Background/purpose Dose-escalated external beam radiotherapy (RT) is effective in the control of prostate cancer but is associated with a greater incidence of rectal adverse events. We assessed the dosimetric gain and safety profile associated with implantation of a new biodegradable rectal spacer balloon. Materials/methods Patients scheduled for image-guided, intensity-modulated RT for intermediate-risk prostate cancer were prospectively included in the French multicenter BioPro-RCMI-1505 study (NCT02478112). We evaluated the dosimetric gain, implantation feasibility, adverse events (AEs), and prostate-cancer-specific quality of life associated with use of the balloon spacer. Results After a scheduled review of the initial recruitment target of 50 patients by the study's independent data monitoring committee (IDMC), a total of 24 patients (including 22 with dosimetry data) were included by a single center between November 2016 and May 2018. The interventional radiologist who implanted the balloons considered that 86% of the procedures were easy. 20 of the 24 patients (83.3%) received IMRT and 4 (16.7%) received volumetric modulated arc therapy (78-80 Gy delivered in 39 fractions). The dosimetric gains associated with spacer implantation were highly significant (p<0.001) for most variables. For the rectum, the median (range) relative gain ranged from 15.4% (-9.2-47.5) for D20cc to 91.4% (36.8-100.0) for V70 Gy (%). 15 patients (62%) experienced an acute grade 1 AE, 8 (33%) experienced a late grade 1 AE, 1 (4.2%) experienced an acute grade 2 AE, and 3 experienced a late grade 2 AE. No grade 3 AEs were reported. Quality of life was good at baseline (except for sexual activity) and did not markedly worsen during RT and up to 24 months afterwards. Conclusion The use of a biodegradable rectal spacer balloon is safe, effective and associated with dosimetric gains in modern RT for intermediate-risk prostate cancer.
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Affiliation(s)
- Igor Latorzeff
- Department of Radiotherapy, Clinique Pasteur, Toulouse, France
| | - Eric Bruguière
- Department of Imaging, Clinique Pasteur, Toulouse, France
| | - Emilie Bogart
- Methodology and Biostatistics Unit, Centre Oscar Lambret, Lille, France
| | | | - Eric Lartigau
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.,CRIStAL UMR CNRS 9189, Lille University, Lille, France
| | - Delphine Marre
- Department of Physics, Clinique Pasteur, Toulouse, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.,CRIStAL UMR CNRS 9189, Lille University, Lille, France
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Defachelles AS, Bogart E, Casanova M, Merks JHM, Bisogno G, Calareso G, Gallego Melcon S, Gatz SA, Le Deley MC, McHugh K, Probst A, Rocourt N, van Rijn RR, Wheatley K, Minard-Colin V, Chisholm JC. Randomized Phase II Trial of Vincristine-Irinotecan With or Without Temozolomide, in Children and Adults With Relapsed or Refractory Rhabdomyosarcoma: A European Paediatric Soft tissue Sarcoma Study Group and Innovative Therapies for Children With Cancer Trial. J Clin Oncol 2021; 39:2979-2990. [PMID: 34343032 DOI: 10.1200/jco.21.00124] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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
PURPOSE The VIT-0910 trial was conducted to evaluate efficacy and safety of the vincristine-irinotecan combination with and without temozolomide (VIT and VI, respectively) in relapsed or refractory rhabdomyosarcoma (RMS). METHODS In this randomized European phase II trial, patients age 0.5-50 years received 21-day cycles combining vincristine (1.5 mg/m2 once a day on day 1 and day 8) and irinotecan (50 mg/m2 once a day from day 1 to day 5) with and without temozolomide (125 mg/m2 once a day from day 1 to day 5 and 150 mg/m2 once a day from cycle 2), until progression or unacceptable toxicity. The primary end point was objective response rate after two cycles. Secondary end points included best response, progression-free survival, overall survival, and adverse events. A Simon 2-stage design was initially planned to separately analyze 40 patients/arm. After amendment, the trial sample size was increased to 120 and a comparison between arms, adjusted for confounding factors, was added to the statistical plan (ClinicalTrials.gov, NCT01355445). RESULTS Overall, 120 patients (60 per arm) were recruited in 37 European centers. The median age was 11 years (range, 0.75-45); 89% of patients had a relapsed RMS. The objective response rate was 44% (24 of 55 evaluable patients) for VIT versus 31% (18 of 58) for VI (adjusted odds ratio, 0.50; 95% CI, 0.22 to 1.12; P = .09). The VIT arm achieved significantly better overall survival (adjusted hazard ratio, 0.55; 95% CI, 0.35 to 0.84; P = .006) compared with VI, with consistent progression-free survival results (adj-hazard ratio, 0.68; 95% CI, 0.46 to 1.01; P = .059). Overall, patients experienced adverse events ≥ grade 3 more frequently with VIT than VI (98% v 78%, respectively; P = .009), including a significant excess of hematologic toxicity (81% v 61%; P = .025). CONCLUSION The addition of temozolomide to VI improved chemotherapy efficacy for patients with relapsed RMS, with manageable increase in toxicity. VIT is considered the new standard treatment in these patients in the European paediatric Soft Tissue Sarcoma Group and will be the control arm in the next randomized trial.
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Affiliation(s)
- Anne-Sophie Defachelles
- Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | | | | | - Gianni Bisogno
- Department of Women and Children Health, University Hospital of Padova, Padova, Italy
| | | | | | - Susanne Andrea Gatz
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Kieran McHugh
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | | | | | - Rick R van Rijn
- Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Véronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Julia C Chisholm
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
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Roquette I, Bogart E, Lacornerie T, Ningarhari M, Le Deley M, Lartigau E, Mirabel X, Pasquier D. PH-0498 Stereotactic body radiation therapy for the management of hepatocellular carcinoma. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07349-7] [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: 10/20/2022]
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El Hajj H, Vanseymortier M, Hudry D, Bogart E, Abdeddaim C, Leblanc E, Le Deley MC, Narducci F. Rationale and study design of the CHIPPI-1808 trial: a phase III randomized clinical trial evaluating hyperthermic intraperitoneal chemotherapy (HIPEC) for stage III ovarian cancer patients treated with primary or interval cytoreductive surgery. ESMO Open 2021; 6:100098. [PMID: 33819750 PMCID: PMC8047490 DOI: 10.1016/j.esmoop.2021.100098] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background Ovarian cancer remains the most lethal gynecologic malignancy with high recurrence rates. Because recurrence involves primarily the peritoneum, intraperitoneal chemotherapy is being evaluated as a new approach to treat microscopic peritoneal disease. One trial showed that cisplatin–paclitaxel intraperitoneal chemotherapy with intravenous paclitaxel improved survival but increased morbidity. Another trial reported a significant improvement in overall survival (OS) and disease-free survival (DFS) without increasing the morbidity (P = 0.76) or mortality rates (hazard ratio 0.67, P = 0.02) after adding hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreduction. The current trial aims to evaluate the impact of adding HIPEC to primary or interval cytoreductive surgery for epithelial ovarian cancer (EOC) on the efficacy, safety, treatment feasibility, and quality of life. Patients and methods This is an international, multicenter, open-label, randomized (1 : 1), two-arm, phase III clinical trial that will enroll 432 patients with newly diagnosed International Federation of Gynecology and Obstetrics (FIGO) stage III EOC. Patients are randomized to receive or not HIPEC with the standard of care. Inclusion criteria include patients with FIGO stage III EOC, Fallopian tube carcinoma or primary peritoneal cancer who undergo complete primary or interval cytoreduction. The primary objective is to assess DFS of the addition of HIPEC. Secondary objectives are the assessment of OS, safety, return to intended oncologic treatment, quality of life and the trade-off between efficacy and morbidity. Conclusions The results might help extend the indications of HIPEC to include patients undergoing primary cytoreduction, providing a standardized protocol for HIPEC in EOC management and reliable information on the quality of life after adding HIPEC. Ovarian cancer remains the most lethal gynecologic cancer with high rates of recurrence involving primarily the peritoneum. Intraperitoneal chemotherapy is being evaluated as a new therapeutic approach to treat microscopic peritoneal disease. This trial evaluates the impact of adding HIPEC to primary or interval cytoreductive surgery for EOC. This trial evaluates the efficacy, safety, treatment feasibility and quality of life after the addition of HIPEC. This is an international, multicenter, open label, randomized, phase III clinical trial.
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Affiliation(s)
- Houssein El Hajj
- Gynecologic Oncology Department, Oscar Lambret Cancer Centre, Lille, France.
| | - M Vanseymortier
- Clinical Research and Innovation Department, Oscar Lambret Cancer Centre, Lille, France
| | - D Hudry
- Gynecologic Oncology Department, Oscar Lambret Cancer Centre, Lille, France
| | - E Bogart
- Clinical Research and Innovation Department, Oscar Lambret Cancer Centre, Lille, France
| | - C Abdeddaim
- Medical Oncology Department, Oscar Lambret Cancer Center, Lille, France
| | - E Leblanc
- Gynecologic Oncology Department, Oscar Lambret Cancer Centre, Lille, France
| | - M C Le Deley
- Paris-Saclay University, Paris-Sud University, UVSQ, CESP, INSERM, Villejuif, France
| | - F Narducci
- Gynecologic Oncology Department, Oscar Lambret Cancer Centre, Lille, France
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21
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Latorzeff I, Bogart E, Marre D, Le Deley M, Lartigau É, Pasquier D. Étude prospective « BioPro-RCMI » sur l’utilisation du ballonnet Bioprotect® comme espaceur rectal pour la radiothérapie avec modulation d’intensité de l’adénocarcinome prostatique de risque intermédiaire. Cancer Radiother 2020. [DOI: 10.1016/j.canrad.2020.08.042] [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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22
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Villain A, Sakji I, Bogart E, Strobbe G, Marliot G, Feutry F. Optimisation of the preparation of chemotherapy based on 5-fluorouracil by the use of peristaltic pumps. Pharmaceutical Technology in Hospital Pharmacy 2020. [DOI: 10.1515/pthp-2020-0003] [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: 11/15/2022] Open
Abstract
Abstract ObjectivesPreparation of 5-FU elastomeric pumps is a time-consuming activity inducing musculoskeletal disorders (MSDs). Our unit has developed an automated filling system consisting of two peristaltic pumps (one for the diluent, one for the cytotoxic drug). The objective was to validate the accuracy of the assembly and evaluate the impact of automation on the compounding time, occurrence of MSDs and cost of preparation.MethodsAccuracy was determined by calculating the total error on the volumes injected by the pumps. Measurements were made for 2 brands (AMF, Baxter), 3 different volumes; repeated 3 times at 3 times of the day. The time-saving study compared 24 measurements in manual filling and 24 in automated mode. Impact of automation on the occurrence of MSDs was evaluated by a self-assessment questionnaire. Finally, a comparison between the price of a manually prepared elastomeric pump and an automated prepared elastomeric pump was performed.ResultsVolumes administered by the pumps were accurate (total error < 2.5%). Preparation time was divided by 2. Occurrence of MSD decreased (8.7 manual filling vs. 23.5/28 automated filling). Overcost was moderate (14.7% for AMF; 10.3% for Baxter).ConclusionsUsing peristaltic pumps, 5FU preparation was optimized for moderate additional cost.
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Affiliation(s)
| | - Ilyes Sakji
- Centre Oscar Lambret, Pharmacy, Lille, France
| | - Emilie Bogart
- Centre Oscar Lambret, Methodology and Biostatistic Unit, Lille, France
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Narducci F, Bogart E, Hebert T, Gauthier T, Collinet P, Classe JM, Lecuru F, Delest A, Motton S, Conri V, Ferrer C, Marchal F, Ferron G, Probst A, Thery J, Le Deley MC, Lefebvre D, Francon D, Leblanc E, Lambaudie E. Severe perioperative morbidity after robot-assisted versus conventional laparoscopy in gynecologic oncology: Results of the randomized ROBOGYN-1004 trial. Gynecol Oncol 2020; 158:382-389. [PMID: 32467054 DOI: 10.1016/j.ygyno.2020.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 12/13/2019] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In gynecologic oncology, minimally invasive surgery using conventional laparoscopy (CL) decreases the incidence of severe morbidity compared to open surgery. In 2005, robot-assisted laparoscopy (RL) was approved for use in gynecology in the US. This study aimed to assess whether RL is superior to CL in terms of morbidity incidence. METHODS ROBOGYN-1004 (ClinicalTrials.gov, NCT01247779) was a multicenter, phase III, superiority randomized trial that compared RL and CL in patients with gynecologic cancer requiring minimally invasive surgery. Patients were recruited between 2010 and 2015. The primary endpoint was incidence of severe perioperative morbidity (severe complications during or 6 months after surgery). RESULTS Overall, 369 of 385 patients were included in the as-treated analysis: 176 and 193 underwent RL and CL, respectively. The median operating time for RL was 190 (range, 75-432) minutes and for CL was 145 (33-407) minutes (p < 0.001). The blood loss volumes for the corresponding procedures were 100 (0-2500) and 50 (0-1000) mL (p = 0.003), respectively. The overall rates of conversion to open surgery for the corresponding procedures were 7% (10/176) and 5% (10/193), respectively (p = 0.52). Severe perioperative morbidity occurred in 28% (49/176) and 21% (41/192) of patients who underwent RL and CL, respectively (p = 0.15). At a median follow-up of 25.1 months (range, 0.6-78.2), no significant differences in overall and disease-free survival were observed between the groups. CONCLUSIONS RL was not found superior to CL with regard to the incidence of severe perioperative morbidity in patients with gynecologic cancer. In addition, RL involved a longer operating time than CL.
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Affiliation(s)
| | | | | | | | | | | | | | - Alain Delest
- Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | | | | | - Frederic Marchal
- CRAN, UMR 7039, Université de Lorraine, CNRS Institut de Cancérologie de Lorraine Vandoeuvre-les-Nancy, France
| | - Gwenael Ferron
- Institut Claudius Regaud Cancer Center, Toulouse, France
| | | | | | - Marie-Cécile Le Deley
- Oscar Lambret Cancer Center, Lille, France; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | | | - Daniel Francon
- Institut Paoli Calmettes Cancer Center, Marseille, France
| | | | - Eric Lambaudie
- Institut Paoli Calmettes Cancer Center, Marseille, France
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Durand-Labrunie J, Baumann AS, Ayav A, Laurent V, Boleslawski E, Cattan S, Bogart E, Le Deley MC, Steen V, Lacornerie T, Peiffert D, Mirabel X. Curative Irradiation Treatment of Hepatocellular Carcinoma: A Multicenter Phase 2 Trial. Int J Radiat Oncol Biol Phys 2020; 107:116-125. [PMID: 32001057 DOI: 10.1016/j.ijrobp.2019.12.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 11/15/2019] [Accepted: 12/10/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Liver transplantation is the standard definitive treatment for nonmetastatic hepatocellular carcinoma (HCC). However, less than 5% of patients are ultimately candidates as a result of frequent comorbidities and graft shortage. The aim of this study was to evaluate stereotactic body radiation therapy (SBRT) as an ablative treatment for inoperable HCC. METHODS AND MATERIALS A prospective phase 2 trial included newly diagnosed single HCC lesions that were without extrahepatic extension and that were deemed unsuitable for standard locoregional therapies, with a tumor size ranging from 1 to 6 cm. The SBRT dose was 45 Gy in 3 fractions. Primary endpoint was the local control of irradiated HCC at 18 months, defined by Response Evaluation Criteria in Solid Tumors. RESULTS Forty-three patients were treated and evaluable. Median follow-up was 4.0 years (range, 1.2-4.6 years). All 43 patients had cirrhosis; 37 (88%) were Child-Pugh grade A and 5 (12%) grade B (1 missing data). No patients had received prior local treatment. Thirteen patients (31%) presented grade ≥3 acute adverse events, including 8 patients with an abnormality of the liver function tests (19%). Three patients (10%) experienced a decline in Child-Pugh at 3 months post-SBRT. The 18-month local control rate was 98% (95% confidence interval, 85%-99%). The 18-month overall survival rate was 72% (range, 56%-83%). Median overall survival was 3.5 years. CONCLUSIONS Local control and overall survival after SBRT for untreated solitary HCC were excellent despite candidates being unfit for transplantation, resection, ablation, or embolization treatments. SBRT should be considered as a bridge to transplant or as definitive therapy for those ineligible for transplant.
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Affiliation(s)
| | - Anne-Sophie Baumann
- Département de radiothérapie et de curiethérapie, Institut de cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Ahmet Ayav
- Service de chirurgie digestive, hépatobiliaire et cancérologique, CHRU, Nancy, France
| | - Valérie Laurent
- Service de Radiologie Brabois adultes, Hôpitaux de Brabois, CHRU Nancy, Vandoeuvre les Nancy, France
| | | | - Stéphane Cattan
- Service des Maladies de l'Appareil Digestif, CHRU, Lille, France
| | - Emilie Bogart
- Délégation à la recherche clinique et à l'innovation, Centre Oscar Lambret, Lille, France
| | - Marie-Cécile Le Deley
- Délégation à la recherche clinique et à l'innovation, Centre Oscar Lambret, Lille, France
| | - Valentine Steen
- Délégation à la recherche clinique et à l'innovation, Centre Oscar Lambret, Lille, France
| | | | - Didier Peiffert
- Département de radiothérapie et de curiethérapie, Institut de cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Xavier Mirabel
- Département Universitaire de Radiothérapie, Centre Oscar Lambret, Lille, France
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Bataille B, Escande A, Le Tinier F, Parent A, Bogart E, Collinet P, Bresson L, Narducci F, Leblanc E, Lemaire AS, Taieb S, Lartigau E, Mirabel X, Cordoba A. Outcomes of pre-operative brachytherapy followed by hysterectomy for early cervical cancer. Int J Gynecol Cancer 2019; 30:181-186. [PMID: 31871113 DOI: 10.1136/ijgc-2019-000617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE The standard of care for early cervical cancer is radical hysterectomy; however, consideration of pre-operative brachytherapy has been explored. We report our experience using pre-operative brachytherapy plus Wertheim-type hysterectomy to treat early stage cervical cancer. METHODS This single-center study evaluated consecutive patients with histologically proven node-negative early stage cervical cancer (International Federation of Gynecology and Obstetrics 2009 stage IB1-IIB) that was treated using pre-operative brachytherapy and hysterectomy. Pre-brachytherapy staging was performed using magnetic resonance imaging (MRI) and pelvic lymph node assessment was performed using lymphadenectomy. The tumor and cervical tissues were treated using brachytherapy (total dose 60 Gy) followed by Wertheim-type hysterectomy. The study included patients from January 2000 to December 2013. RESULTS A total of 80 patients completed a median follow-up of 6.7 years (range 5.4-8.5). The surgical specimens revealed a pathological complete response for 61 patients (76%). Patients with incomplete responses generally had less than 1 cm residual tumor at the cervix, and only one patient had lymphovascular space involvement. The estimated 5-year rates were 88% for overall survival (95% CI 78% to 94%) and 82% for disease-free survival (95% CI 71% to 89%). Toxicities were generally mild-to-moderate, including 26 cases (33%) of grade 2 late toxicity and 10 cases (13%) of grade 3 late toxicity. Univariate analyses revealed that poor disease-free survival was associated with overweight status (≥25 kg/m2, HR 3.05, 95% CI 1.20 to 7.76, p=0.019) and MRI tumor size >3 cm (HR 3.05, 95% CI 1.23 to 7.51, p=0.016). CONCLUSIONS Pre-operative brachytherapy followed by Wertheim-type hysterectomy may be safe and effective for early stage cervical cancer, although poorer outcomes were associated with overweight status and MRI tumor size >3 cm.
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Affiliation(s)
- Benoit Bataille
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Alexandre Escande
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Florence Le Tinier
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Audrey Parent
- Methodology and Biostatistics Department, Centre Oscar Lambret, Lille, France
| | - Emilie Bogart
- Methodology and Biostatistics Department, Centre Oscar Lambret, Lille, France
| | - Pierre Collinet
- Gynecological Surgery Department, Hopital Jeanne de Flandre, Lille, Hauts-de-France, France
| | - Lucie Bresson
- Gynecological Surgery Department, Centre Oscar Lambret, Lille, France
| | - Fabrice Narducci
- Gynecological Surgery Department, Centre Oscar Lambret, Lille, France
| | - Eric Leblanc
- Gynecological Surgery Department, Centre Oscar Lambret, Lille, France
| | | | - Sophie Taieb
- Medical Imaging Department, Centre Oscar Lambret, Lille, France
| | - Eric Lartigau
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Xavier Mirabel
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
| | - Abel Cordoba
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France
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Pasquier D, Martinage G, Janoray G, Rojas DP, Zerini D, Goupy F, De Crevoisier R, Bogart E, Calais G, Toledano A, Chauveinc L, Scher N, Bondiau PY, Hannoun-Levi JM, Silva M, Meyer E, Nickers P, Lacornerie T, Jereczek-Fossa BA, Lartigau E. Salvage Stereotactic Body Radiation Therapy for Local Prostate Cancer Recurrence After Radiation Therapy: A Retrospective Multicenter Study of the GETUG. Int J Radiat Oncol Biol Phys 2019; 105:727-734. [DOI: 10.1016/j.ijrobp.2019.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/11/2019] [Accepted: 07/15/2019] [Indexed: 12/12/2022]
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Bataille B, Le Tinier F, Escande A, Parent A, Bogart E, Narducci F, Leblanc E, Hudry D, Lemaire A, Lesoin A, Chevalier A, Taieb S, Ben Haj Amor M, Lartigau E, Mirabel X, Cordoba A. Intracavitary Preoperative Brachytherapy Followed By Whertheim-Type Hysterectomy in Localized Cervical Cancer: Clinical Data and Toxicity Results from a Single Institution Experience. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vanlemmens L, Anota A, Bogart E, Nerich V, Cauchois D, Dewitte A, Dormeuil E, Lartigau E, Le Gall F, Mocaer H, Thenot A, Brochard MA, Le Deley MC. eMouvoir: Randomized study estimating the impact of a personalized and remote support centered on physical activity (PA) for patients (pts) after breast cancer (BC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps11631] [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
TPS11631 Background: BC pts can reduce their health-related quality of life (HRQoL) encompassing physical, psychological and social components due to cancer and treatments (trts). Despite the strong evidence of the beneficial effects of EPA for BC pts on HRQoL, the cancer pts’ EPA levels most often decline after diagnosis and trts due to physical and psychological components, accessibility to exercise programs, time constraints. Connected watches can now contribute to pts’ deeper commitment to their program by providing reliable trends of their EPA metrics. Notwithstanding this recent progress, cancer pts keep facing challenges to maintain a regular EPA. We aim at evaluating a holistic intervention including a physical activity educator, coaching pts remotely for 4 months (mo), to improve HRQoL after BC. Methods: eMouvoir is a multicenter randomized, controlled phase 3 trial started 4-6 mo after the end of trt among non-metastatic BC pts. It assesses the benefit of a personalized remote EPA coaching, including a connected watch, access to a digital platform, personalized objectives, ≥2 messages per week, weekly lessons, for a 4-mo duration, compared to the standard supportive approach (recommendations for EPA made during visits with the oncologist) in terms of HRQoL. The randomization is balanced 1:1 and controlled for HRQoL at inclusion, trts, exercise practice, age, access to the Internet and center. Main eligibility criteria are: age ≥18; adjuvant or neoadjuvant trt for non-metastatic BC; medical certificate for sports practice. Patients without a connected device are eligible. HRQoL is evaluated using the SF-36 questionnaire, at 4, 8 and 12 mo. Both components (physical and mental summary) at 12 mo are used as co-primary endpoints. The study includes a health-economics evaluation, using EQ-5D and EQ VAS, to estimate the incremental cost-utility ratio. Based on the following assumptions: expected mean difference for each SF-36 component at 12 mo =3 points, standard deviation=15, power=90%, 2-sided alpha=2.5%, 10% drop-outs, 1242 evaluable pts are required, leading to 1380 pts. The trial is funded by the French ministry of health and should open enrollment soon.
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Affiliation(s)
| | - Amelie Anota
- Methodology and Quality of Life Unit, Department of Oncology, INSERM UMR 1098, University Hospital of Besancon; French National Platform Quality of Life and Cancer, Besançon, France
| | | | - Virginie Nerich
- Institut Régional Federatif de Cancerologie, Besançon, France
| | | | | | | | - Eric Lartigau
- Oscar Lambret Comprehensive Cancer Center, Lille, France
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Defachelles AS, Bogart E, Casanova M, Merks H, Bisogno G, Calareso G, Gallego Melcon S, Gatz S, Le Deley MC, McHugh K, Probst A, Rocourt N, van Rijn RR, Wheatley K, Minard-Colin V, Chisholm J. Randomized phase 2 trial of the combination of vincristine and irinotecan with or without temozolomide, in children and adults with refractory or relapsed rhabdomyosarcoma (RMS). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10000] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10000 Background: Vincristine with Irinotecan (VI) is effective in patients with relapsed RMS but outcomes remain poor. The addition of temozolomide to VI (VIT) is attractive owing to different resistance mechanisms and distinct toxicity profiles. Methods: The VIT-0910 trial, an EpSSG-ITCC randomized phase 2 trial, evaluated efficacy and safety of VI and VIT in patients (pts) aged 0.5-50 years with relapsed/refractory RMS. Pts received Vincristine 1.5 mg/m2 d1, d8, Irinotecan 50mg/m2 d1-d5 +/- Temozolomide 125 mg/m² d1-d5 (150 mg/m² from cycle 2 if no toxicity > grade 2); 21-day cycles were given until progression/unacceptable toxicity. The primary endpoint was centrally reviewed objective response rate (ORR) after 2 cycles (primary lesion, WHO response criteria: metastatic sites, RECIST 1.1 ). Secondary endpoints included progression-free survival (PFS), overall survival (OS) and adverse events (NCI-CTCAE v4). Initially a Simon 2-stage design was used to analyse separately 40 pts/arm. After amendment, the trial sample size was increased to 120, and a comparison between arms, adjusted for confounding factors, was added to the statistical plan. Results: 120 pts (60 VIT, 60 VI) were recruited in 37 European centers from 03/2012-04/2018. Median age was 11 years (0.75-46), 89% pts relapsed RMS. ORR was 24/55 (44%) for VIT vs 18/58 (31%) for VI; adjusted odds ratio =0.50, 95%CI, 0.22-1.12, p=0.09. The VIT arm achieved significantly better PFS (adjusted Hazard Ratio (HR)=0.65, 95%Cl, 0.43-0.97, p=0.036) and OS (HR=0.53, 95%CI, 0.33-0.83, p=0.005) compared to VI. PFS and OS results were similar when only relapsed patients were included. Adverse events ≥ grade 3 were more frequent in VIT compared to VI, but only hematological toxicity was significantly increased (81% for VIT, 59% for VI, odds ratio=1.36, 95%CI, 1.06-1.76, P=0.02). Conclusions: The addition of temozolomide to VI improves PFS and OS of pts with relapsed/refractory RMS. VIT is now standard treatment for relapsed RMS in Europe. Clinical trial information: NCT01355445.
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Affiliation(s)
| | | | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Hans Merks
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Gianni Bisogno
- Department of Women and Children Health, University Hospital of Padova, Padova, Italy
| | - Giuseppina Calareso
- Radiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Susanne Gatz
- The Institute of Cancer Research, London, United Kingdom
| | | | - Kieran McHugh
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | - Julia Chisholm
- Children and Young People’s Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Lebellec L, Bimbai A, Bogart E, Le Deley M. Double randomisation séquentielle. Peut-on encore interpréter les résultats de la première randomisation ? Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Jouin A, Helfre S, Bolle S, Claude L, Laprie A, Bogart E, Vigneron C, Potet H, Ducassou A, Claren A, Riet FG, Castex MP, Faure-Conter C, Fresneau B, Defachelles AS, Orbach D. Adapted strategy to tumor response in childhood nasopharyngeal carcinoma: the French experience. Strahlenther Onkol 2019; 195:504-516. [PMID: 30963203 DOI: 10.1007/s00066-019-01461-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/30/2018] [Accepted: 03/25/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to retrospectively study survival and long-term morbidities of children with nasopharyngeal carcinoma (NPC) treated by induction chemotherapy and concurrent chemoradiation (CRT). The total dose of radiation was adapted to the response following neoadjuvant chemotherapy. METHODS Children with non-metastatic NPC treated in France between 1999 and 2015 were retrospectively included in the study. The strategy combined neoadjuvant platinum-based chemotherapy, followed by adapted CRT to tumor response. RESULTS In total, 95 patients (median age 15 years [range, 7-23 years], male-to-female ratio 1.8) with undifferentiated NPC were included; 59% of patients had TNM stage IV. Intensity-modulated radiotherapy (IMRT) was delivered to 57 patients (60%), while the other patients were treated with conformal RT (3D-RT). After a median follow-up of 4.5 years [range, 3.6-5.5 years], 13 relapses and seven deaths had occurred. The 3‑year overall and relapse-free survival (RFS) were 94% [95% CI, 85-97%] and 86% [77-92%], respectively. The locoregional failure rate was 6% [95% CI, 2-14]. Long-term treatment-related sequelae of grade 2+ were reported by 37 (50%) patients; odynophagia was significantly reduced treated by IMRT vs. conventional 3D-RT (7% vs. 55%, p = 0.015). Using a reduction dose of 59.4 Gy, 54 Gy, and 45 Gy, respectively, to the primary, involved, and uninvolved neck nodes, after a favorable tumor response, was not associated with an increased locoregional failure rate. CONCLUSIONS The survival rates for NPC have been considerably improved by means of multimodal therapy, but long-term locoregional morbidity remains common. Use of IMRT may induce less residual odynophagia. Radiation dose reduction adapted to chemotherapy response does not have a negative impact on outcome. These findings support the use of an RT protocol adapted to the tumor response to neoadjuvant chemotherapy for a long-lasting improvement in the patient's quality of life.
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Affiliation(s)
- Anaïs Jouin
- Radiotherapy department, Centre Oscar Lambret, Lille, France
| | - Sylvie Helfre
- Radiotherapy department, Institut Curie, Paris, France
| | - Stéphanie Bolle
- Gustave Roussy, Department of Radiotherapy Oncology, Université Paris-Saclay, 94805, Villejuif, France
| | - Line Claude
- Radiotherapy department, Centre Lyon Bérard, Lyon, France
| | - Anne Laprie
- Radiotherapy department, IUCT Oncopole, Toulouse, France
| | - Emilie Bogart
- Biostatistics department, Centre Oscar Lambret, Lille, France
| | - Céline Vigneron
- Radiotherapy department, Centre Paul Strauss, Strasbourg, France
| | - Hélène Potet
- Radiotherapy department, Centre Antoine Lacassagne, Nice, France
| | - Anne Ducassou
- Radiotherapy department, IUCT Oncopole, Toulouse, France
| | - Audrey Claren
- Radiotherapy department, Centre Antoine Lacassagne, Nice, France
| | - François Georges Riet
- Gustave Roussy, Department of Radiotherapy Oncology, Université Paris-Saclay, 94805, Villejuif, France
| | | | | | - Brice Fresneau
- Gustave Roussy-Grand Campus, Pediatric department, University Paris-Saclay, Villejuif, France
- CESP, INSERM, Paris-Saclay University, Paris-Sud University, Villejuif, France
| | | | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with cancer), PSL Research University, French Pediatric Rare Tumor group (Fracture group), Institut Curie, 26, rue d'Ulm, 75005, Paris, France.
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Martinage G, Geffrelot J, Stefan D, Bogart E, Rault E, Reyns N, Emery E, Martinage Makhloufi S, Mouttet Audouard R, Basson L, Mirabel X, Lartigau E, Pasquier D. EP-1257 Post-operative hypo-fractionated SBRT in a large series of patients with brain metastases. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31677-9] [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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Adenis A, Bennouna J, Etienne P, Bogart E, Francois E, Galais M, Ben Abdelghani M, Michel P, Metges J, Dahan L, Conroy T, Ghiringhelli F, Drouillard A, El Hajbi F, Samalin E, Hiret S, Delaine-Clisant S, Mariette C, Penel N, Piessen G, Le Deley M. Continuation versus discontinuation of first-line chemotherapy in patients with metastatic squamous cell oesophageal cancer: A randomised phase II trial (E-DIS). Eur J Cancer 2019; 111:12-20. [DOI: 10.1016/j.ejca.2019.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 11/26/2022]
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Martinage G, Geffrelot J, Stefan D, Bogart E, Rault E, Reyns N, Emery E, Makhloufi-Martinage S, Mouttet-Audouard R, Basson L, Mirabel X, Lartigau E, Pasquier D. Efficacy and Tolerance of Post-operative Hypo-Fractionated Stereotactic Radiotherapy in a Large Series of Patients With Brain Metastases. Front Oncol 2019; 9:184. [PMID: 30984617 PMCID: PMC6448411 DOI: 10.3389/fonc.2019.00184] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim of this study was to assess, in a large series, the efficacy and tolerance of post-operative adjuvant hypofractionated stereotactic radiation therapy (HFSRT) for brain metastases (BMs). Materials and Methods: Between July 2012 and January 2017, 160 patients from 2 centers were operated for BM and treated by HFSRT. Patients had between 1 and 3 BMs, no brainstem lesions or carcinomatous meningitis. The primary endpoint was local control. Secondary endpoints were distant brain control, overall survival (OS) and tolerance to HFSRT. Results: 73 patients (46%) presented with non-small cell lung cancer (NSCLC), 23 (14%) had melanoma and 21 (13%) breast cancer. Median age was 58 years (range, 22–83 years). BMs were synchronous in 50% of the cases. The most frequent prescription regimens were 24 Gy in 3 fractions (n = 52, 33%) and 30 Gy in 5 fractions (n = 37, 23%). Local control rates at 1 and 2 years were 88% [95%CI, 81–93%] and 81% [95%CI, 70–88%], respectively. Distant control rate at 1 year was 48% [95%CI, 81–93%]. In multivariate analysis, primary NSCLC was associated with a significant reduction in the risk of death compared to other primary sites (HR = 0.57, p = 0.007), the number of extra-cerebral metastatic sites (HR = 1.26, p = 0.003) and planning target volumes (HR = 1.15, p = 0.012) were associated with a lower OS. There was no prognostic factor of time to local progression. Median OS was 15.2 months [95%CI, 12.0–17.9 months] and the OS rate at 1 year was 58% [95% CI, 50–65%]. Salvage radiotherapy was administered to 72 patients (45%), of which 49 received new HFSRT. Ten (7%) patients presented late grade 2 and 4 (3%) patients late grade 3 toxicities. Thirteen (8.9%) patients developed radiation necrosis. Conclusions: This large multicenter retrospective study shows that HFSRT allows for good local control of metastasectomy tumor beds and that this technique is well-tolerated by patients.
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Affiliation(s)
- Geoffrey Martinage
- Academic Department of Radiation Oncology, Centre Oscar Lambret, University Lille II, Lille, France
| | - Julien Geffrelot
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
| | - Dinu Stefan
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
| | - Emilie Bogart
- Department of Biostatistics, Centre Oscar Lambret, Lille, France
| | - Erwan Rault
- Department of Medical Physics, Centre Oscar Lambret, Lille, France
| | - Nicolas Reyns
- Department of Neurosurgery, CHRU Lille, Lille, France
| | - Evelyne Emery
- Neurosurgical Department, Universitary Hospital Caen, Caen, France
| | | | | | - Laurent Basson
- Academic Department of Radiation Oncology, Centre Oscar Lambret, University Lille II, Lille, France
| | - Xavier Mirabel
- Academic Department of Radiation Oncology, Centre Oscar Lambret, University Lille II, Lille, France
| | - Eric Lartigau
- Academic Department of Radiation Oncology, Centre Oscar Lambret, University Lille II, Lille, France.,CRIStAL UMR CNRS 9189, Lille University, Lille, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, University Lille II, Lille, France.,CRIStAL UMR CNRS 9189, Lille University, Lille, France
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Hannebicque K, Renaudeau C, Giard S, Regis C, Boulanger L, Bogart E, Le Deley MC, Ceugnart L, Chauvet MP. Abstract P5-16-04: Evaluation of autologous fat grafting local morbidity (fat necrosis and biopsy rates) in breast reconstruction after breast cancer: A retrospective study on 257 patients in Oscar Lambret Center. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-16-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background.Autologous fat grafting (AFG) is a widely used procedure in breast reconstruction after breast cancer. Indications are in constant increase but there is a lack of dataabout global morbidity, especially fat necrosis and management of local complications. The purpose of this study was to evaluate the complications rate in term of abnormal clinical examination or imaging and the proportion of additional explorations.
Methods. We retrospectively reviewed the computerized files of consecutive patients who underwent AFG for breast reconstruction after breast cancer or for preventive surgery and aesthetic sequelae after lumpectomy in the Oscar Lambret center between January 2013 and December 2016. Fat grafts were harvested with a fat trap then processed and injected according the Coleman technique. We collected demographics, operative details, local complications, incidence of palpable masses and/or suspicious breast imaging findings leading to additional explorations (breast imaging or biopsy), and locoregional cancer recurrence. Descriptive statistics were generated.
Results. Over a 4-year period, 257 women underwent autologous fat grafting for breast reconstruction and aesthetic sequelae after lumpectomy. Their mean age was 50 years [range 28-75], the mean BMI was 25 [range 18-44], 26% (n=66) were smoking and 74% (n=190) underwent radiotherapy. A total of 303 breasts were operated by 270 mastectomies (89%) or33 lumpectomies (11%). The reconstruction was delayed in 63% (n=171) and the main techniques used were breast implant (44%, n=119) and autologous latissimus dorsi (31%, n=84). The mean number of fat grafting procedures was 1,9 per patient [range 1-7] with a mean volume of 181 mL [range 30-535]. The mean time interval between cancer diagnosis and first fat graft session was 56 months [range 3-285], and the follow-up ranged from 0 to 51 months (mean=16). The prevalence of donor site complications was 6% (n=16) and infections was 2% (n=5). Sixty six (25,6%) patients had a clinically palpable lesion and 54 (21%) underwent additional imagings, mostly by ultrasounds (53 patients, 98%) except the usual follow-up. Twenty one biopsies (8%) were performed and showed 16 benign results (76,2%) and 5 malignant results (23,8%) leading to 6,2% of fat necrosis and 1,9% of locoregional recurrence after AFG in our study.Tobacco (p=0.45), BMI (p=0.95), radiotherapy (p=0.56) and amount of fat grafted ( p=0.09) didn't appear to be risk factors for fat necrosis.
Conclusions. A good knowledge of local complications by surgeons and radiologists enables to avoid systematic and repeated further imaging explorations. Multicentric, prospective studies with long term follow up and evaluation of patients reported outcomes are needed to evaluate anxiety generated by biopsies and costs generated by repeated imagings.
Key words: autologous fat grafting, breast cancer, local morbidity, fat necrosis.
Citation Format: Hannebicque K, Renaudeau C, Giard S, Regis C, Boulanger L, Bogart E, Le Deley M-C, Ceugnart L, Chauvet M-P. Evaluation of autologous fat grafting local morbidity (fat necrosis and biopsy rates) in breast reconstruction after breast cancer: A retrospective study on 257 patients in Oscar Lambret Center [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-04.
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Affiliation(s)
| | | | - S Giard
- Oscar Lambret Center, Lille, Nord, France
| | - C Regis
- Oscar Lambret Center, Lille, Nord, France
| | | | - E Bogart
- Oscar Lambret Center, Lille, Nord, France
| | | | - L Ceugnart
- Oscar Lambret Center, Lille, Nord, France
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Mailliez A, Pigny P, Bogart E, Diomande S, Jeazet Tiotsia H, Bonneterre J, Le Deley MC, Decanter C. Abstract P1-11-06: Systematic evaluation of ovarian reserve in young breast cancer patients treated by sequential chemotherapy. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-11-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Most women in reproductive age diagnosed with breast cancer receive (neo)adjuvant chemotherapy. Fertility preservation is part of the standard of care for these young women.
Patients and methods
We report preliminary results of a prospective multicentric cohort evaluating ovarian reserve during and after chemotherapy and fertility preservation in young (≤ 38 years old) in women aged ≤ 38 years, treated for a breast cancer with (neo)adjuvant anthracyclins and taxanes based chemotherapy, between July 2011 and December 2016. Fertility preservation was offered in patients (pts) who received adjuvant chemotherapy. The median duration of follow up was 2,6 years (4 months-5,3 years).
The aim of this study was to evaluate the ovarian reserve assessed by antimullerian hormone and antral follicular count. The incidence of amenorrhea (defined by absence of menses ≥ 3 months), ovarian failure (absence of menses ≥ 12 months), chemotherapy induced menopause (absence of menses ≥ 24 months) was collected.
Results
One hundred and thirty-two pts were included in 10 centers. Data are available for 127 pts. For 4 pts, the scheduled chemotherapy was not received. One pt withdrew her consent. Chemotherapy was neoadjuvant for 43 pts and adjuvant for the 84 others. Fifty-eight asked for fertility preservation and received ovarian stimulation (all in adjuvant setting).
Median age was 32 years (23-37). Eighty pts had a previous pregnancy. Three of them remained nulliparous. Among the 77 others, 36 had 1 child, 31 had 2 children and 10 pts 3 or more children respectively. At the time of diagnosis, 90% had regular menses and 75% had a contraception.
The median initial antral follicular count was 21.5 (Min 1- Max 100). The AMH level significantly decreased during chemotherapy with no secondary return to baseline value over the first 9 months after end of treatment: median of 20.9 pmol/l (0.5-223) before chemotherapy, 12,8 (0,5-120) at the second cycle of chemotherapy (C2), 3 (0,5-20) at C4, 0,5 (0,5-4,4) at C6, 0,5 (0,5-25,1) 3 months after the end of chemotherapy (M3), 0,6 (0,5-29) at M6, and 3 (0,5-29,8) at M9.
At last follow-up, 46% of pts experienced amenorrhea, 7% an ovarian failure and 3% a chemo-induced menopause. The highest incidence of amenorrhea (61%) was at M3. At M12, 7% of pts remained amenorrhoeic. The AMH initial level was not significantly lower in pts who experienced amenorrhea compared to those who did not (25.5 versus 35.1, p = 0,087). Ovarian stimulation and BRCA status did not impact risk of amenorrhea.
At 2 years, overall survival rate was 96% and progression free survival rate was 90% (6 deaths and 18 progression events).
Conclusion
(Neo)adjuvant sequential breast cancer chemotherapy is associated with a decrease of AMH level and amenorrhea. Our results suggest a significant risk of premature ovarian failure. Fertility preservation has to be proposed to these young patients.
Citation Format: Mailliez A, Pigny P, Bogart E, Diomande S, Jeazet Tiotsia H, Bonneterre J, Le Deley MC, Decanter C. Systematic evaluation of ovarian reserve in young breast cancer patients treated by sequential chemotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-06.
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Affiliation(s)
- A Mailliez
- Centre Oscar Lambret, Lille, France; Centre de Biologie Pathologie, CHRU, Lille, France; Hôpital Jeanne de Flandre, CHRU, Lille, France
| | - P Pigny
- Centre Oscar Lambret, Lille, France; Centre de Biologie Pathologie, CHRU, Lille, France; Hôpital Jeanne de Flandre, CHRU, Lille, France
| | - E Bogart
- Centre Oscar Lambret, Lille, France; Centre de Biologie Pathologie, CHRU, Lille, France; Hôpital Jeanne de Flandre, CHRU, Lille, France
| | - S Diomande
- Centre Oscar Lambret, Lille, France; Centre de Biologie Pathologie, CHRU, Lille, France; Hôpital Jeanne de Flandre, CHRU, Lille, France
| | - H Jeazet Tiotsia
- Centre Oscar Lambret, Lille, France; Centre de Biologie Pathologie, CHRU, Lille, France; Hôpital Jeanne de Flandre, CHRU, Lille, France
| | - J Bonneterre
- Centre Oscar Lambret, Lille, France; Centre de Biologie Pathologie, CHRU, Lille, France; Hôpital Jeanne de Flandre, CHRU, Lille, France
| | - MC Le Deley
- Centre Oscar Lambret, Lille, France; Centre de Biologie Pathologie, CHRU, Lille, France; Hôpital Jeanne de Flandre, CHRU, Lille, France
| | - C Decanter
- Centre Oscar Lambret, Lille, France; Centre de Biologie Pathologie, CHRU, Lille, France; Hôpital Jeanne de Flandre, CHRU, Lille, France
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Pannier D, Adenis A, Bogart E, Dansin E, Clisant-Delaine S, Decoupigny E, Lesoin A, Amela E, Ducornet S, Meurant JP, Le Deley MC, Penel N. Once weekly paclitaxel associated with a fixed dose of oral metronomic cyclophosphamide: a dose-finding phase 1 trial. BMC Cancer 2018; 18:775. [PMID: 30064401 PMCID: PMC6069824 DOI: 10.1186/s12885-018-4678-x] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary aim of this trial was to determine the recommended phase II dose (RP2D) of weekly paclitaxel (wP) administered in combination with oral metronomic cyclophosphamide (OMC). METHODS Patients ≥ 18 years of age with refractory metastatic cancers were eligible if no standard curative measures existed. Paclitaxel was administered IV weekly (D1, D8, D15; D1 = D28) in combination with a fixed dose of OMC (50 mg twice a day). A 3 + 3 design was used for dose escalation of wP (40 to 75 mg/m2) followed by an expansion cohort at RP2D. Dose-limiting toxicity (DLT) was defined over the first 28-day cycle as grade ≥ 3 non-hematological or grade 4 hematological toxicity (NCI-CTCAE v4.0) or any toxicity leading to a dose reduction. RESULTS In total, 28 pts. (18 in dose-escalation phase and 10 in expansion cohort) were included, and 16/18 pts. enrolled in the dose-escalation phase were evaluable for DLT. DLT occurred in 0/3, 1/6 (neuropathy), 0/3 and 2/4 pts. (hematological toxicity) at doses of 40, 60, 70 and 75 mg/m2 of wP, respectively. The RP2D of wP was 70 mg/m2; 1/10 patients in the expansion phase had a hematological DLT. At RP2D (n = 14), the maximal grade of drug-related adverse event was Gr1 in three patients, Gr2 in six patients, Gr3 in one patient and Gr4 in one patient (no AE in three patients). At RP2D, a partial response was observed in one patient with lung adenocarcinoma. CONCLUSION The combination of OMC and wP resulted in an acceptable safety profile, warranting further clinical evaluation. TRIAL REGISTRATION TRN: NCT01374620 ; date of registration: 16 June 2011.
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Affiliation(s)
- Diane Pannier
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France
| | - Antoine Adenis
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France
| | - Emilie Bogart
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | - Eric Dansin
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France
| | | | - Emilie Decoupigny
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France
| | - Anne Lesoin
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France
| | - Eric Amela
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France
| | - Sandrine Ducornet
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | - Jean-Pierre Meurant
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | - Marie-Cécile Le Deley
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France.,INSERM CESP Oncostat Team, Paris-Sud, Paris-Saclay University, Orsay, France
| | - Nicolas Penel
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France. .,Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France. .,Medical School, Lille-Nord-de-France University, EA2694 Research Unit, Lille, France.
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Hutt E, Da Silva A, Bogart E, Le Lay-Diomande S, Pannier D, Delaine-Clisant S, Le Deley MC, Adenis A. Impact of early palliative care on overall survival of patients with metastatic upper gastrointestinal cancers treated with first-line chemotherapy: a randomised phase III trial. BMJ Open 2018; 8:e015904. [PMID: 29362244 PMCID: PMC5786132 DOI: 10.1136/bmjopen-2017-015904] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Palliative care (PC) has usually been offered at the end-of-life stage, although the WHO recommends providing PC as early as possible in the course of the disease. A recent study has shown that early PC (EPC) provides a more meaningful effect on quality of life and, surprisingly, on overall survival (OS) than standard treatment for patients with metastatic lung cancer. Whether EPC benefits also apply to patients with metastatic upper gastrointestinal (GI) cancers is unknown. METHODS AND ANALYSIS EPIC is a randomised phase III trial comparing EPC plus standard oncologic care versus standard oncologic care in patients with metastatic upper GI cancers. Its primary objective is to evaluate the efficacy of EPC in terms of OS. Its secondary objectives are to assess the effects of EPC on patient-reported outcomes (quality of life, depression and anxiety) and the effect of EPC on the number of patients receiving chemotherapy in their last 30 days of life. Assuming an exponential distribution of survival time, 381 deaths are required to ensure an 80% power for an absolute difference of 10% in 1 year OS rates (40% vs 50.3%, HR=0.75; log rank test two-sided alpha=5%), leading to a planned sample size of 480 patients enrolled over 3 years and a final analysis at 4 years. The main analysis will be performed on the intent-to-treat dataset. ETHICS AND DISSEMINATION This study was approved by the 'Comité de Protection des Personnes Nord-Ouest I' (4 April 2016), complies with the Helsinki declaration and French laws and regulations and follows the International Conference on Harmonisation E6 (R1) Guideline for Good Clinical Practice. The trial results, even if they are inconclusive, will be presented at international oncology congresses and published in peer-reviewed journals. TRIAL REGISTRATION NUMBERS EudraCT: 2015-A01943-46; Pre-results. NCT02853474.
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Affiliation(s)
- Emilie Hutt
- Department of Gastrointestinal Oncology, Centre Oscar Lambret, Lille, France
| | | | - Emilie Bogart
- Methodology and Biostatistic Unit, Centre Oscar Lambret, Lille, France
| | | | - Diane Pannier
- Department of Gastrointestinal Oncology, Centre Oscar Lambret, Lille, France
| | | | - Marie-Cécile Le Deley
- Methodology and Biostatistic Unit, Centre Oscar Lambret, Lille, France
- CESP, INSERM, Faculté de médecine, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Antoine Adenis
- Department of Gastrointestinal Oncology, Centre Oscar Lambret, Lille, France
- Catholic University, Lille, France
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Hutt E, Da silva A, Pannier D, Bogart E, El-Hajbi F, Villet S, Clisant S, Le Deley MC, Adenis A. Impact of early palliative care on overall survival of patients with metastatic upper gastrointestinal cancers treated with first-line chemotherapy: Phase III EPIC trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.162] [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: 11/14/2022] Open
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Leroy T, Lacornerie T, Bogart E, Nickers P, Lartigau E, Pasquier D. Salvage robotic SBRT for local prostate cancer recurrence after radiotherapy: preliminary results of the Oscar Lambret Center. Radiat Oncol 2017; 12:95. [PMID: 28599663 PMCID: PMC5466739 DOI: 10.1186/s13014-017-0833-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 06/02/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Currently, there is no standard option for local salvage treatment for local prostate cancer recurrence after radiotherapy. Our objective was to investigate the feasibility and efficiency of Robotic Stereotactic Body Radiation Therapy (SBRT) in this clinical setting. METHODS/MATERIALS We retrospectively reviewed patients who were treated at our institution with SBRT for local prostate cancer recurrence after External Beam Radiation Therapy (EBRT) or brachytherapy. Multidisciplinary staff approved the treatment, and recurrence was biopsy-proven when feasible. A dose of 36 Gy was prescribed in six fractions. Treatment was delivered every other day. RESULTS Between August 2011 and February 2014, 23 patients were treated with SBRT for intra-prostate cancer recurrence with a median follow up of 22 months (6 to 40). Twenty patients had biopsy-proven recurrence. For 19 patients, EBRT was the initial treatment and in four patients, brachytherapy was the initial treatment; the median relapse-time from initial treatment was 65 months (28 to 150). At relapse, 10 patients had an extra-capsular extension. Fourteen patients were treated with androgen deprivation that could be stopped after a median of 1 month after SBRT (range 0-24). A PSA decrease occurred in 82.6% of the patients after SBRT. The 2-year disease-free survival and overall survival rates were 54 and 100%, respectively. Disease progression was observed for nine patients (39.1%) (five local, three metastatic and one nodal progression) after a median of 20 months (7-40 months). The median nadir PSA was 0.35 ng/ml and was achieved after a median of 8 months (1 to 30) after treatment. We observed no grade 4 or 5 toxicity. Two patients presented with grade 3 toxicities (two Cystitis and one neuralgia). Other toxicities included urinary toxicities (five grade 2 and nine grade 1) and rectal toxicities (two grade 2 and two grade 1). CONCLUSION SBRT for local prostate cancer recurrence seems feasible and well tolerated with a short follow up. Prospective evaluation is needed.
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Affiliation(s)
- Thomas Leroy
- Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
| | - Thomas Lacornerie
- Department of Radiation Physics, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
| | - Emilie Bogart
- Department of Statistic, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
| | - Philippe Nickers
- Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
| | - Eric Lartigau
- Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
- Université de Lille-CRIStAL UMR 9189, 59650 Villeneuve d’Ascq, France
| | - David Pasquier
- Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille cedex, France
- Université de Lille-CRIStAL UMR 9189, 59650 Villeneuve d’Ascq, France
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Pannier D, Adenis A, Tresch-Bruneel E, Bogart E, El Hajbi F, Dansin E, Kotecki N, Ceugnart L, Ryckewaert T, Delaine SC, Lauridant Philippin G, Lesoin A, Ducornet S, Vanseymortier M, Decoupigny E, Le Deley MC, Penel N. Paclitaxel once weekly (wP) combined with fixed dose of oral metronomic cyclophosphamide (OMC): A dose-escalating phase I trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e14015] [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
e14015 Background: OMC, as continuous administration of low doses of chemotherapy acts as direct cytotoxic as well as antiangiogenetic agent. wP also induces antiangiogenic effects in mouse models. The aims of this trial were to determine the recommended Phase 2 dose (RP2D) of wP given in combination with OMC, and estimate activity and safety of the combination. Methods: Methods This is a single-center, phase 1 trial. Patients (pts) > 18 years with refractory metastatic cancers were eligible if no standard curative measures existed. Paclitaxel was administered IV weekly (D1, D8, D15; D1 = D28) in combination with a fixed dose of OMC (50mg x2/day). A 3+3 design was used for Dose-Escalation of wP (40 mg/m² to 75 mg/m²), followed by an expansion cohort at RP2D. The primary endpoint was the dose-limiting toxicity (DLT), defined as grade > 3 non-hematological or grade 4 hematological toxicity (NCI-CTCAE v4.0) occurring in the first 28 days, or any toxicity leading to a dose reduction. Results: 28 pts (18 in dose-escalation phase and 10 in expansion cohort) were included between May 2011 and December 2013. The sex ratio was 2:1, the median age was 54.5 (range, 26-67); the most common primary tumors were colorectal cancers (n = 9), sarcomas (n = 4), Head & Neck (n = 3). 16/18 pts enrolled in the dose-escalation phase were evaluable for DLT. DLT occurred in 0/3, 1/6 (neuropathy), 0/3 and 2/4 pts (hematological toxicity) at dose 40, 60, 70 and 75 mg/m² of wP, respectively. The RP2D of wP was 70 mg/m2; 1/10 pts in the expansion phase had an hematological DLT. At RP2D (n = 14), the maximal grade of adverse events (AE), regardless of causality, was Gr2 in 3 pts, Gr3 in 7 pts, Gr4 in 3 pts and Gr5 in 1 pt; the maximal grade of treatment-related AE was Gr1 in 1 pt, Gr2 in 8 pts, Gr3 in 3 pts and Gr4 in 1 pt (no AE in 1 pt). At RP2D, the median PFS was 2.8 mo and Growth Modulation index was ≥1.33 in 4/14 pts (29%). There was 1 objective response (1/14; 7%): 1 pt with lung adenocarcinoma achieved a partial response. Conclusions: The combination of OMC and wP resulted in an acceptable safety profile. Further evaluation of this combination with wP at 70mg/m² could be warranted in a phase 2 trial. Clinical trial information: NCT01374620.
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Berry V, Basson L, Bogart E, Mir O, Blay JY, Italiano A, Bertucci F, Chevreau C, Clisant-Delaine S, Liegl-Antzager B, Tresch-Bruneel E, Wallet J, Taieb S, Decoupigny E, Le Cesne A, Brodowicz T, Penel N. REGOSARC: Regorafenib versus placebo in doxorubicin-refractory soft-tissue sarcoma-A quality-adjusted time without symptoms of progression or toxicity analysis. Cancer 2017; 123:2294-2302. [PMID: 28295221 PMCID: PMC5485075 DOI: 10.1002/cncr.30661] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND In a placebo‐controlled, randomized phase 2 trial (ClinicalTrials.gov identifier NCT01900743), regorafenib improved progression‐free survival (PFS) for patients with doxorubicin‐pretreated advanced nonadipocytic sarcoma. A quality‐adjusted time without symptoms of progression or toxicity (Q‐TWiST) post hoc exploratory analysis was applied to provide an integrated measure of its clinical benefit. METHODS In the base‐case analysis, each patient's overall survival (OS) was partitioned into 3 mutually exclusive health states: the time with a grade 3 or 4 adverse event (TOX), the time without symptoms of disease or grade 3 or 4 toxicity from treatment, and the time after tumor progression or relapse. The time spent in each state was weighted with a health‐state utility associated with that state and was summed to calculate the Q‐TWiST. The stability of the base‐case analysis was explored with several sensitivity analyses. RESULTS In nonadipocytic sarcoma, the PFS was (4.0 months [2.6‐5.5 months] with regorafenib vs 1.0 month [0.9‐1.8 months] with a placebo; hazard ratio, 0.36 [0.25‐0.53]; P < .0001); the OS was 13.4 months (8.6‐17.3 months) with regorafenib and 9.0 months (6.8‐12.5 months) with a placebo (hazard ratio, 0.67 [0.44‐1.02]). With the classic definition of TOX (including all grade 3 and 4 clinical adverse events), the Q‐TWiSTs were 8.0 months (7.0‐9.0 months) with regorafenib and 5.7 months (4.9‐6.4 months) with a placebo (P < .001). CONCLUSIONS For patients with doxorubicin‐pretreated soft‐tissue sarcoma, regorafenib significantly improved quality‐adjusted survival in comparison with a placebo. Cancer 2017;123:2294–2302. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. In patients with doxorubicin‐pretreated nonadipocytic soft‐tissue sarcoma, regorafenib significantly improves quality‐adjusted survival in comparison with a placebo (8.0 vs 5.7 mo; P < .001). See also pages 2200‐2.
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Affiliation(s)
- Vincent Berry
- Medical Oncology Department, Oscar Lambret Center, Lille, France.,Methodology and Clinical Research Platform, SIRIC OncoLille, Lille, France
| | - Laurent Basson
- Biostatisitics and Methodology Unit, Oscar Lambret Center, Lille, France
| | - Emilie Bogart
- Biostatisitics and Methodology Unit, Oscar Lambret Center, Lille, France
| | - Olivier Mir
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Jean-Yves Blay
- Medical Oncology Department, Léon Bérard Center, Lyon, France
| | - Antoine Italiano
- Medical Oncology Department, Bergonié Institute, Bordeaux, France
| | - François Bertucci
- Medical Oncology Department, Paoli-Calmette Institute, Marseille, France
| | - Christine Chevreau
- Medical Oncology Department, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | - Stéphanie Clisant-Delaine
- Methodology and Clinical Research Platform, SIRIC OncoLille, Lille, France.,Clinical Research Unit, Oscar Lambret Center, Lille, France
| | | | | | - Jennifer Wallet
- Biostatisitics and Methodology Unit, Oscar Lambret Center, Lille, France
| | - Sophie Taieb
- Radiology Department, Oscar Lambret Center, Lille, France
| | - Emilie Decoupigny
- Methodology and Clinical Research Platform, SIRIC OncoLille, Lille, France.,Clinical Research Unit, Oscar Lambret Center, Lille, France
| | - Axel Le Cesne
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | | | - Nicolas Penel
- Medical Oncology Department, Oscar Lambret Center, Lille, France.,Methodology and Clinical Research Platform, SIRIC OncoLille, Lille, France
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Stern N, Bompas E, Bogart E, Laestadius F, Mouillet G, Schlurmann F, Leblanc E, Penel N, Lotz JP, Amela E. Predictors for malignant tissue (MT) in residual masses (RM) of non-seminomatous germ cell tumors (NSGCT) treated by chemotherapy (CT) before surgery. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.405] [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
405 Background: About half of the patients operated for RM after CT for a NSGCT doesn’t benefit from surgery because RM contain only necrosis. We develop and validate a predictive score for identifying MT (teratoma and/or viable cancer cells) after primary CT for disseminated NSGCT. Methods: We have conducted a retrospective study. The development cohort (cohort 1) consists in 193 pts treated with CT and surgery of RM at the Oscar Lambret Cancer Center between 1997 and 2014. The validation cohort (cohort 2) consists in 98 pts treated in 5 other French sites. Size of RM, modification in size after CT, pre- and post-CT AFP levels, pre- and post-CT HCG levels, pre- and post-CT LDH levels were collected. The predictive factors have been first identified using univariate logistic regression analysis and then selected using step-by-step (forward) logistic regression. Discrimination has been assessed using Akaike Information Criterion (AIC) and ROC curve. Results: The rates of MT in the RM were 52% and 68%, in the cohort 1 and 2, respectively. The 1-, 2- and 5-y OS in the development cohort were 99, 97 and 95%, respectively. The 1-, 2 and 5-y relapse-free survival in the development cohort were 96, 92 and 91%, respectively. In univariate analysis, the predictive factors for MT were: size of RM > 15 mm (OR=3.32 [95%-CI: 1.6-6.2], p=0.001), stable RM versus diminution in size of RM (OR=3.0 [1.5-5.9] p=0.001) or increase in size versus diminution in size of RM (OR=8.6 [1.7-41.9] p=0.008) and pre-CT AFP level > ULN (OR=2.9 [1.4-6.3], p=0.006). The multivariate analysis had retained 2 predictors for MT: size of RM and pre-CT AFP level > ULN. The ROC was 0.71 [0.61-0.80] with an AIC=143 in the development cohort, and was 0.59 [IC95% 0.46-0.72] in the validation cohort. The model showed adequate calibration with a Hosmer-Lemeshow test p=0.69. Conclusions: Surgery of RM is part of standard of care of disseminated NSGCT. However, this surgery is morbid and at the end about 50% of pts are free of MT. We have developed and validated a predictive score for identifying pts benefiting of surgery.
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Affiliation(s)
| | - Emmanuelle Bompas
- Department of Medical Oncology, Centre Rene Gauducheau, Nantes St. Herblain, France
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Hannebicque K, Boulanger L, Bogart E, Giard S, Chauvet MP, Houpeau JL. Abstract P2-01-23: Long-term follow-up of persistent breast dermopigmentation after sentinel lymph node identification using superparamagnetic iron oxide particles (SIENNA+®). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-01-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The French Sentimag study evaluated a non-invasive method for the localization of breast cancer sentinel lymph nodes (SLN) using SIENNA+®, a superparamagnetic iron oxide particles (SPIO), in addition to conventional techniques (radiotracer and blue dye). SIENNA+® was injected subcutaneously into the breast and detected by the SENTIMAG® handheld magnetometer probe. The results showed a good SLN identification performance but a skin discoloration was noted during this study after the SIENNA+® injection. This aim of this study was to assess the long-term duration and appearance of this dermopigmentation.
Methods:
56 patients had participated in Sentimag study in our Center, 6 patients who had undergone mastectomy were excluded. We selected 50 patients who had undergone breast conservative surgery. For these patients, SLN localization was performed by both the conventional method (radiotracer and /or blue dye) and magnetic tracer, SIENNA+®. 47 patients were reviewed retrospectively from January 2015 to April 2015, 1.5 to 2 years after surgery and were assessed for skin discoloration.
Results :
Of the 47 patients, a dermopigmentation, from grade 1 (light yellowing) to grade 3 (dark browning) remained visible at the site of injection of SIENNA+® after 20.2 months [14.4-25.9] in 36.1% of the patients (17/47). 6.4% of 47 patients seen had grade 3 skin discoloration and 29.7% had grade 1 or 2 skin discoloration. Interestingly, no patients reported that persistent staining was a cosmetic or psychological problem.
Conclusions :
The use of SIENNA+® appears as an alternative method to radioisotopes for SLN identification in early breast cancer, but it may result in a prolonged-dermopigmentation at the injection site. To avoid dermopigmentation, it would be interesting to compare different techniques of SIENNA+® injection into the breast (intra-tumoral injection or a deeper periareolar injection) through a randomized trial.
Citation Format: Hannebicque K, Boulanger L, Bogart E, Giard S, Chauvet MP, Houpeau JL. Long-term follow-up of persistent breast dermopigmentation after sentinel lymph node identification using superparamagnetic iron oxide particles (SIENNA+®) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-01-23.
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Affiliation(s)
| | | | - E Bogart
- Centre Oscar Lambret, Lille, France
| | - S Giard
- Centre Oscar Lambret, Lille, France
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Kakkos A, Bresson L, Hudry D, Cousin S, Lervat C, Bogart E, Meurant JP, El Bedoui S, Decanter G, Hannebicque K, Regis C, Hamdani A, Penel N, Tresch-Bruneel E, Narducci F. Complication-related removal of totally implantable venous access port systems: Does the interval between placement and first use and the neutropenia-inducing potential of chemotherapy regimens influence their incidence? A four-year prospective study of 4045 patients. Eur J Surg Oncol 2016; 43:689-695. [PMID: 27889197 DOI: 10.1016/j.ejso.2016.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/05/2016] [Accepted: 10/21/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Totally implantable venous access port systems are widely used in oncology, with frequent complications that sometimes necessitate device removal. The aim of this study is to investigate the impact of the time interval between port placement and initiation of chemotherapy and the neutropenia-inducing potential of the chemotherapy administered upon complication-related port removal. PATIENTS AND METHODS Between January 2010 and December 2013, 4045 consecutive patients were included in this observational, single-center prospective study. The chemotherapy regimens were classified as having a low (<10%), intermediate (10-20%), or high (>20%) risk for inducing neutropenia. RESULTS The overall removal rate due to complications was 7.2%. Among them, port-related infection (2.5%) and port expulsion (1%) were the most frequent. The interval between port insertion and its first use was shown to be a predictive factor for complication-related removal rates. A cut-off of 6 days was statistically significant (p = 0.008), as the removal rate for complications was 9.4% when this interval was 0-5 days and 5.7% when it was ≥6 days. Another factor associated with port complication rate was the neutropenia-inducing potential of the chemotherapy regimens used, with removal for complications involved in 5.5% of low-risk regimens versus 9.4% for the intermediate- and high-risk regimens (p = 0.003). CONCLUSION An interval of 6 days between placement and first use of the port reduces the removal rate from complications. The intermediate- and high-risk for neutropenia chemotherapy regimens are related to higher port removal rates from complications than low-risk regimens.
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Affiliation(s)
- A Kakkos
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
| | - L Bresson
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - D Hudry
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - S Cousin
- Department of Medical Oncology, Centre Régional de Lutte Contre le Cancer Institut Bergonié, 229 Cours de l' Argonne, 33076 Bordeaux Cedex, France
| | - C Lervat
- Department of Pediatric Oncology, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - E Bogart
- Department of Methodology and Biostatistics, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - J P Meurant
- Department of Methodology and Biostatistics, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - S El Bedoui
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - G Decanter
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - K Hannebicque
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - C Regis
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - A Hamdani
- Department of Anesthesiology and Reanimation, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - N Penel
- Department of Medical Oncology, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - E Tresch-Bruneel
- Department of Methodology and Biostatistics, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - F Narducci
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
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Brodowicz T, Liegl-Atzwanger B, Tresch-Bruneel E, Bogart E, Mir O, Blay JY, Kashofer K, Le Cesne A, Hamacher R, Penel N. Regorafenib (R) versus placebo (P) in soft tissue sarcomas (STS): analysis of genetic prognostic and predictive factors. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw388.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pannier D, Philippin-Lauridant G, Baranzelli MC, Bertin D, Bogart E, Delprat V, Villain G, Mattot V, Bonneterre J, Soncin F. High expression levels of egfl7 correlate with low endothelial cell activation in peritumoral vessels of human breast cancer. Oncol Lett 2016; 12:1422-1428. [PMID: 27446447 PMCID: PMC4950557 DOI: 10.3892/ol.2016.4791] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 05/24/2016] [Indexed: 12/15/2022] Open
Abstract
Tumor blood vessels participate in the immune response against cancer cells and we previously used pre-clinical models to demonstrate that egfl7 (VE-statin) promotes tumor cell evasion from the immune system by repressing endothelial cell activation, preventing immune cells from entering the tumor mass. In the present study, the expression levels of egfl7 and that of ICAM-1 as a marker of endothelium activation, were evaluated in peritumoral vessels of human breast cancer samples. Breast cancer samples (174 invasive and 30 in situ) from 204 patients treated in 2005 were immunostained for CD31, ICAM-1 and stained for egfl7 using in situ hybridization. The expression levels of ICAM-1 and egfl7 were assessed in peritumoral areas using semi-quantitative scales. There was a strong and significant inverse correlation between the expression of ICAM-1 and that of egfl7 in CD31+ blood vessels. When the ICAM-1 score increased, the egfl7 score reduced significantly (P=0.004), and vice-versa (Cuzick's test for trend across ordered groups). In order to determine which gene influenced the other gene between egfl7 and ICAM-1, the expression levels of either gene were modulated in endothelial cells. Egfl7 regulated ICAM-1 expression while ICAM-1 had no effects on egfl7 expression in the same conditions. Altogether, these results provide further results that egfl7 serves a regulatory role in endothelial cell activation in relation to immune infiltration and that it is a potential therapeutic target to consider for improving anticancer immunotherapies.
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Affiliation(s)
- Diane Pannier
- Senology Department, Oscar Lambret Center, Université de Lille, 59020 Lille, France; Institut Pasteur de Lille, Centre National de la Recherche Scientifique UMR8161, Université de Lille, 59000 Lille, France
| | - Géraldine Philippin-Lauridant
- Senology Department, Oscar Lambret Center, Université de Lille, 59020 Lille, France; Institut Pasteur de Lille, Centre National de la Recherche Scientifique UMR8161, Université de Lille, 59000 Lille, France
| | | | - Delphine Bertin
- Senology Department, Oscar Lambret Center, Université de Lille, 59020 Lille, France
| | - Emilie Bogart
- Senology Department, Oscar Lambret Center, Université de Lille, 59020 Lille, France
| | - Victor Delprat
- Institut Pasteur de Lille, Centre National de la Recherche Scientifique UMR8161, Université de Lille, 59000 Lille, France
| | - Gaëlle Villain
- Institut Pasteur de Lille, Centre National de la Recherche Scientifique UMR8161, Université de Lille, 59000 Lille, France
| | - Virginie Mattot
- Institut Pasteur de Lille, Centre National de la Recherche Scientifique UMR8161, Université de Lille, 59000 Lille, France
| | - Jacques Bonneterre
- Senology Department, Oscar Lambret Center, Université de Lille, 59020 Lille, France
| | - Fabrice Soncin
- Institut Pasteur de Lille, Centre National de la Recherche Scientifique UMR8161, Université de Lille, 59000 Lille, France
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Bennouna J, Etienne PL, Bogart E, Galais MP, Benabdelghani M, Francois E, Michel P, Dahan L, Metges JP, Ghiringhelli F, Conroy T, Kotecki N, Bedenne L, El Hajbi F, Samalin E, Piessen G, Delaine-Clisant S, Penel N, Mariette C, Adenis A. LBA-04 The E-DIS study, a randomized discontinuation trial of first-line chemotherapy (CT) in patients with metastatic squamous-cell esophageal cancer (MSEC): efficacy and quality of life results. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw237.04] [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: 11/12/2022] Open
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Bennouna J, Etienne PL, Bogart E, Galais MP, Benabdelghani M, Francois E, Michel P, Dahan L, Metges JP, Ghiringhelli F, Conroy T, Kotecki N, Bedenne L, El Hajbi F, Samalin E, Piessen G, Delaine-Clisant S, Penel N, Mariette C, Adenis A. LBA-04The E-DIS study, a randomized discontinuation trial of first-line chemotherapy (CT) in patients with metastatic squamous-cell esophageal cancer (MSEC): efficacy and quality of life results. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw237.4] [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: 11/14/2022] Open
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Cabarrou B, Boher JM, Bogart E, Tresch-Bruneel E, Penel N, Ravaud A, Escudier B, Mahier Ait-Oukhatar C, Delord JP, Roché H, Filleron T. How to report toxicity associated with targeted therapies? Ann Oncol 2016; 27:1633-8. [PMID: 27217543 DOI: 10.1093/annonc/mdw218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 05/17/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the era of personalized medicine, molecularly targeted therapies (MTT) have modified the outcome of some cancer types. The price of tumor control needs to be balanced with toxicity since these new therapies are administered continuously for several months or sometimes for several years. For cytotoxic drugs, the incidence of adverse event (AE) was traditionally reported as frequency and intensity. This simple measure is not sufficient to capture the recurrent nature and duration of AE. This paper presents two methods to better describe the toxicity burden across the time: prevalence and Q-TWiST. PATIENTS AND METHODS Limitation of worst-grade method and advantages of prevalence and Q-TWiST in the analysis of toxicity were illustrated using data from a phase II trial and a hypothetically simulated clinical trial. RESULTS Prevalence integrates the recurrent nature of AE. Using prevalence, it is possible to obtain a time profile of AE. Q-TWiST method evaluates the weighted time spent in each health state and also considers the recurrent nature of side-effects in order to assess the 'risk-benefit' ratio of a treatment. When interpreting Q-TWiST results, it is necessary to take into account overall survival and progression-free survival and to define a clinically relevant difference according to the setting. CONCLUSION The two methods presented here capture different effects. They are helpful for physicians in their treatment choice (balance benefit risk), to counsel patients and to optimize supportive care. In order to ensure consistency and provide critical information required for medical decision-making, it is important to encourage the use of alternative statistical methods in the analysis of toxicities associated with MTT. CLINICAL TRIAL NCT00541008.
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Affiliation(s)
- B Cabarrou
- Department of Biostatistics, Institut Claudius Regaud, IUCT-O Toulouse, Toulouse
| | - J M Boher
- Department of Biostatistics, Institut Paoli Calmette, Marseille
| | | | | | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - A Ravaud
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux
| | - B Escudier
- Department of Medical Oncology, Gustave Roussy, Villejuif
| | | | - J P Delord
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O Toulouse, Toulouse, France
| | - H Roché
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O Toulouse, Toulouse, France
| | - T Filleron
- Department of Biostatistics, Institut Claudius Regaud, IUCT-O Toulouse, Toulouse
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