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González-Stegmaier R, Cereceda K, Briones JL, Beltran-Pávez C, Oyarzún-Arrau A, Riquelme-Barrios S, Selman C, Yarad F, Mahave M, Caglevic C, Morales R, Aguirre A, Valiente-Echeverría F, Soto-Rifo R, Marsiglia H, Gazitua R, Villarroel-Espindola F. Seroconversion and Abundance of IgG Antibodies against S1-RBD of SARS-CoV-2 and Neutralizing Activity in the Chilean Population. J Immunol Res 2021; 2021:6680337. [PMID: 33644235 PMCID: PMC7901042 DOI: 10.1155/2021/6680337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/03/2021] [Accepted: 01/24/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is a pandemic caused by SARS-CoV-2. In Chile, half a million people have been infected and more than 16,000 have died from COVID-19. As part of the clinical trial NCT04384588, we quantified IgG against S1-RBD of SARS-CoV-2 (anti-RBD) in recovered people in Santiago and evaluated their suitability as COVID-19 convalescent plasma donors. ELISA and a luminescent SARS-CoV-2 pseudotype were used for IgG and neutralizing antibody quantification. 72.9% of the convalescent population (468 of 639) showed seroconversion (5-55 μg/mL anti-RBD IgG) and were suitable candidates for plasma donation. Analysis by gender, age, and days after symptom offset did not show significant differences. Neutralizing activity correlated with an increased concentration of anti-RBD IgG (p < 0.0001) and showed a high variability between donors. We confirmed that the majority of the Chilean patients have developed anti-SARS-CoV-2 antibodies. The quantification of anti-RBD IgG in convalescent plasma donors is necessary to increase the detection of neutralizing antibodies.
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Affiliation(s)
- R. González-Stegmaier
- Translational Medicine Laboratory, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - K. Cereceda
- Translational Medicine Laboratory, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - J. L. Briones
- Haematology Department, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - C. Beltran-Pávez
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Chile
- HIV/AIDS Work Group, Faculty of Medicine, Universidad de Chile, Chile
| | - A. Oyarzún-Arrau
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Chile
- HIV/AIDS Work Group, Faculty of Medicine, Universidad de Chile, Chile
| | - S. Riquelme-Barrios
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Chile
- HIV/AIDS Work Group, Faculty of Medicine, Universidad de Chile, Chile
| | - C. Selman
- Diagnostic Units, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
- Biobank, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - F. Yarad
- Diagnostic Units, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - M. Mahave
- Medical Oncology Department, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - C. Caglevic
- Cancer Research Department, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - R. Morales
- Internal Medicine Department, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - A. Aguirre
- Translational Medicine Laboratory, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - F. Valiente-Echeverría
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Chile
- HIV/AIDS Work Group, Faculty of Medicine, Universidad de Chile, Chile
| | - R. Soto-Rifo
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Chile
- HIV/AIDS Work Group, Faculty of Medicine, Universidad de Chile, Chile
| | - H. Marsiglia
- Radiotherapy Department, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - R. Gazitua
- Haematology Department, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - F. Villarroel-Espindola
- Translational Medicine Laboratory, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
- Cancer Research Department, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
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Fariña A, Alfonso D, Fernandez A, Carvajal F, Ciudad AM, Martínez C, Pérez C, González P, Marsiglia H. Abstract PS15-17: Hypofractionated versus conventional intensity modulated postmastectomy radiotherapy: Toxicity and quality of life in patients with tissue-expander breast reconstruction. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps15-17] [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
Introduction: Hypofractionation (HF) in breast cancer is a radiotherapy regimen frequently used in recent years. Greater toxicity has been described in irradiated patients with heterologous breast reconstruction procedures, but it is unknown if this greater toxicity could be avoided by using hypofractionated intensity modulated radiotherapy (IMRT). The objective of this study is to describe the toxicity and complications presented in breast cancer patients that were reconstructed with a tissue expander (EXP) treated with IMRT and to determine if there are differences according to the used fractionation regimen.
Method: All patients with breast cancer reconstructed with expander and treated with adjuvant IMRT to the chest wall and regional lymph nodes were included, using conventional fractionation (CF) dose of 50 Gy in 25 fractions or hypofractionated (HF) regimen dose of 45 Gy in 20 fractions. Acute and late toxicity, during treatment and at the end of follow-up, were recorded according to RTOG / EORTC and CTCAE 4.0 criteria and the BREAST Q 2.0 quality of life survey postoperative reconstruction module (QoL) was applied in the last follow-up visit.
Results: 33 patients were analyzed. With a median follow-up of 17 months, 31 were treated with Tomotherapy and 2 with VMAT. CF was used in 20 and HF in 13. There was no G3 acute toxicity, and G2 was observed in only 1 patient with HF (7.6%) and in 3 with CF (15%), mainly determined by radiodermatitis. Regarding late toxicity (LT), there was only one G3 event which occurred in a patient with CF and full axillary irradiation. Grade 2 LT was not observed in patients treated with HF, whereas with CF 2 cases (10%) were reported. During the expander period, 1 patient with HF presented a complication (7,6%) and 3 with CF (15%), 2 of the latter required unscheduled surgical intervention (USI). 12 patients in the HF group underwent prosthetic replacement (92%) and 15 in the CF group (75%). After the replacement 4 patients with CF required an USI (26.6%) and none of the patients in the HF group had post replacement complications that required hospitalization. None of the previously mentioned differences were statistically significant. Regarding QoL, the patients with HF had a better late toxicity score, with an average of 96.7 vs. 82.4 points (p <0.005), and better physical well-being of the chest, with an average of 81.7 vs. 66 points, which did not reach statistical significance (p = 0.052). The rest of the scales within the module did not show any differences. Conclusions: Postmastectomy IMRT in patients with heterologous reconstruction is associated with low toxicity and complications. The use of hypofractionation presents a toxicity profile similar to that of conventional fractionation, with a tendency to less frequent complications associated with reconstruction. HF is also associated with a better QoL score in late toxicity and physical well-being of the chest. Prospective studies are required to confirm whether hypofractionation using IMRT could decrease complications and improve quality of life in patients undergoing total mastectomy and tissue-expander breast reconstruction.
Citation Format: Ariel Fariña, Dagmar Alfonso, Aroldo Fernandez, Felipe Carvajal, Ana María Ciudad, Celmira Martínez, Camila Pérez, Pablo González, Hugo Marsiglia. Hypofractionated versus conventional intensity modulated postmastectomy radiotherapy: Toxicity and quality of life in patients with tissue-expander breast reconstruction [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS15-17.
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Affiliation(s)
- Ariel Fariña
- 1Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Dagmar Alfonso
- 2Instituto Nacional de Oncología y Radiobiología, La Habana, Cuba
| | | | | | | | - Celmira Martínez
- 1Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Camila Pérez
- 1Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Pablo González
- 1Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Hugo Marsiglia
- 1Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
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Chahuan B, Soza-Ried C, Fariña A, Calvo FA, Marangoni F, Ciudad AM, Hurtado M, Marin L, Torzsok K, Marsiglia H. Management plan for breast cancer during the COVID-19 pandemic. A single-institution alternative to treat early breast cancer patients in a short time. Breast J 2020; 26:1603-1605. [PMID: 32767407 PMCID: PMC7436727 DOI: 10.1111/tbj.13943] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Badir Chahuan
- Instituto Oncológico, Fundación Arturo López Pérez, Santiago, Chile
| | - Cristian Soza-Ried
- Instituto Oncológico, Fundación Arturo López Pérez, Santiago, Chile.,Escuela de Bioquímica, Facultad de Ciencia, Universidad San Sebastián, Santiago, Chile
| | - Ariel Fariña
- Instituto Oncológico, Fundación Arturo López Pérez, Santiago, Chile
| | - Felipe A Calvo
- Departamento de Oncología Radioterápica, Clínica Universidad de Navarra, Madrid, España
| | | | - Ana María Ciudad
- Instituto Oncológico, Fundación Arturo López Pérez, Santiago, Chile
| | - Mabel Hurtado
- Instituto Oncológico, Fundación Arturo López Pérez, Santiago, Chile
| | - Luis Marin
- Instituto Oncológico, Fundación Arturo López Pérez, Santiago, Chile
| | - Karla Torzsok
- Instituto Oncológico, Fundación Arturo López Pérez, Santiago, Chile
| | - Hugo Marsiglia
- Instituto Oncológico, Fundación Arturo López Pérez, Santiago, Chile
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Selman C, Hurtado M, Chahuan B, Mella F, Marsiglia H. Prevalence of BRCA1 and BRCA 2 and other mutations in Chilean population. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e13553] [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
e13553 Background: Arturo López Pérez Foundation (FALP) is a Chilean Institution aimed to treatment of cancer patients. Since 2016 it has an Unit for Oncological Genetic Counseling (AGO) for patients with warning flags of potential cases of cancer of genetic origin AGO Unit is aimed to capture patients with warning flags and deliver information through pre-test counseling, offer possibility of a genetic test and post-test counseling. The purpose of this review is to provide relevant results of four years of this Unit. Methods: A descriptive study was carried out from patient care in the Oncological Genetic Counseling Unit of FALP between 2016 and 2019. It was considered those cases in which the process of pretest/post-test counseling was performed. Six "warningflags" were established: cancer in patients under 50 years of age, triple negative breast cancer, breast cancer in men, ovarian cancer, history of 2 or more primary cancers and a family history of cancer The number of test performed was analyzed. The results were expressed in positive pathogenic variants, uncertain variants and negative results. Results: 365 genetic counseling processes were carried out during the period. The average consultation age was 43.2 years (20.8 and 75.5) and 90.1% (329 attentions ) were female. Of the patients, 79.7% (294) perform the genetic test. 18.5% tested positive for a pathogenic variant, 6.5% for a pathogenic variant plus an uncertain variable, and 2.8% for two pathogenic variants. The mutations found were BRCA2 32.6% BRCA1 29.1%, ATM 10.1% RAD51C 6.7% CDKN2 A 5.6%, MUTYH 3.4% TP53 3.4%, MSH2 3.4% RAD51D 2.4%), NF1 1.1%, NTHL1 1.1%, RET 1.1% A 64.9% (237 patients) had cancer diagnosed at the time of the consultation, versus 33.1% of healthy care. 2% had no information. The type of cancer present was 79.7% breast cancer (189), 8.0% ovarian cancer, 2.1% thyroid cancer, 1.7% breast and ovarian cancer, 0.9% colon and/or endometrial cancer and 7.6% other cancers. The warning flags present were 41.2% age below 50 years, 26.2% family history, 15.4% relatives of people with positive results, 8.5% patients with triple-negative breast cancer, 5.3% patients with ovarian cancer, 2.8% patients with 2 or more primary cancers, and 0.6% male breast cancer patients. Conclusions: The highest percentage of patient care was for women with breast cancer, under 50 years of age. The overall test positivity rate is a cumulative 29%. Mutations in BRCA 1 and BRCA 2 were the most detected mutations, as reported in the literature. The slight predominance of BRCA 2 may be due to a familiar component. This is the largest report made in the Chilean population.
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Casadiego-Peña C, Torres-Minacapilli M, Najera M, Ferrer P, Chajon E, Marsiglia H. Difference in toxicity between HIV-positive and HIV-negative patients with squamous-cell cancer of the anal canal treated with concomitant radio-chemotherapy. J Gastrointest Oncol 2020; 11:23-35. [PMID: 32175102 DOI: 10.21037/jgo.2020.01.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The incidence of squamous cell carcinoma of the anal canal has been increasing over the last 30 years. HIV has been found to be a risk factor for the development of this disease; radio-chemotherapy (RTCT) may also be more toxic than in HIV-negative patients. The study aims at assessing whether there are any differences in terms of toxicity between HIV-positive and HIV-negative patients treated with concomitant RTCT. Methods Search in MEDLINE, EMBASE, CENTRAL (via Cochrane Library-Wiley), DARE, LILACS bibliographic databases. Experimental and analytical observational studies with at least two comparative arms were included: squamous-cell (SC) anal-canal cancer (ACC) treated with RTCT in HIV-positive vs. HIV-negative patients. Results Fifteen publications, 14 retrospective studies and 1 systematic review, were found. All radiotherapy (RT) techniques and all chemotherapeutic agents used to manage this disease were included. No differences were found in terms of duration (P=0.67) and dose (P=0.53) of RT, while CT results were contradictory. Acute and hematological toxicities were significantly higher in HIV-positive patients, while gastrointestinal, dermatological and chronic toxicities did not significantly differ between the two groups. Given the high heterogeneity of the studies, no objective comparison could be made between studies that included antiretrovirals and those that did not. Conclusions HIV-positive patients may be at higher risk for acute and hematological toxicity than HIV-negative patients. A precise conclusion cannot be drawn on the use of antiretrovirals, given the high heterogeneity of data.
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Affiliation(s)
- Camila Casadiego-Peña
- International Master in Advanced Radiotherapy, International Atomic Energy Agency (IAEA)-Fundacion Arturo Lopez Perez (FALP)-Los Andes University, Santiago, Chile
| | - Marcelo Torres-Minacapilli
- International Master in Advanced Radiotherapy, International Atomic Energy Agency (IAEA)-Fundacion Arturo Lopez Perez (FALP)-Los Andes University, Santiago, Chile
| | - Manuel Najera
- Instituto Oncologico Fundacion Arturo Lopez Perez (FALP), Santiago, Chile
| | - Pedro Ferrer
- Instituto Oncologico Fundacion Arturo Lopez Perez (FALP), Santiago, Chile
| | | | - Hugo Marsiglia
- International Master in Advanced Radiotherapy, International Atomic Energy Agency (IAEA)-Fundacion Arturo Lopez Perez (FALP)-Los Andes University, Santiago, Chile.,Instituto Oncologico Fundacion Arturo Lopez Perez (FALP), Santiago, Chile
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Sallabanda K, Yañez L, Sallabanda M, Santos M, Calvo FA, Marsiglia H. Stereotactic Radiosurgery for the Treatment of Recurrent High-grade Gliomas: Long-term Follow-up. Cureus 2019; 11:e6527. [PMID: 31911881 PMCID: PMC6939967 DOI: 10.7759/cureus.6527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 12/31/2019] [Indexed: 11/05/2022] Open
Abstract
High-grade gliomas (HGG) are the most frequent primary central nervous system tumors; treatment of HCGs includes surgery and post-operative conformal radiotherapy associated with temozolomide (TMZ or procarbazine/lomustine/vincristine [PCV], specifically in patients with anaplastic oligodendrogliomas or anaplastic oligoastrocytomas). However, recurrence is common. Re-irradiation has been utilized in this setting for years and remains a feasible option, although there is always a concern regarding toxicity. Modern high-precision conformal techniques, including stereotactic radiosurgery (SRS), could improve the therapeutic ratio by delivering high biologically equivalent doses while reducing high-dose radiotherapy (RT) to normal brain tissue. In this paper, we present the results obtained after prolonged follow-up in patients who underwent SRS as a treatment for recurrent high-grade gliomas at San Francisco Hospital in Madrid, Spain.
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Affiliation(s)
- Kita Sallabanda
- Radiosurgery/ Neurosurgery, Hospital Clinico Universitario San Carlos, Madrid, ESP
| | - Loreto Yañez
- Radiotherapy, Fundación Arturo López Pérez, Rancagua, CHL
| | - Morena Sallabanda
- Radiation Oncology, Hospital Universitario Puerta de Hierro, Madrid, ESP
| | - Marcos Santos
- Neurosurgery, Instituto Madrileño De Oncología, Madrid, ESP
| | | | - Hugo Marsiglia
- Radiation Oncology, Fundación Arturo López Pérez (Santiago de Chile), Santiago de Chile, CHL
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Soza-Ried C, Bustamante E, Caglevic C, Rolfo C, Sirera R, Marsiglia H. Oncogenic role of arsenic exposure in lung cancer: A forgotten risk factor. Crit Rev Oncol Hematol 2019; 139:128-133. [PMID: 30878179 DOI: 10.1016/j.critrevonc.2019.01.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 01/11/2019] [Accepted: 01/17/2019] [Indexed: 12/14/2022] Open
Abstract
Several drinkable water sources worldwide have been highly contaminated with arsenic, which means that an estimated 160 million people have been exposed to this chemical agent. If we analyse exposure by region, we will find a high correlation between arsenic contamination and the incidence of lung cancer (among other malignancies). In order to determine what the risks of these exposures are, we need to understand how this chemical is processed in our body and how it is linked to cancer. In this article we reviewed how biotransformation of ingested arsenic may lead to cancer by modulating the activation of several essential signalling pathways such as EGFR, PI3K/AKT, RTK/Ras/PI3K, JNK/STAT3 and Nrf2-KEAP1; by producing epigenetics modifications and by disrupting normal expression of miRNAs. In order to design effective health policies, educational strategies, decontaminations plans and effective medical treatments are necessary to understand the impact of arsenic pollution and the relevance of the environment in our health.
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Affiliation(s)
- Cristian Soza-Ried
- Escuela de Bioquímica, Facultad de Ciencia, Universidad San Sebastián, Santiago, Chile; Fundación Oncoloop, Santiago, Chile
| | - Eva Bustamante
- Instituto Oncológico Fundación Arturo López, Santiago, Chile.
| | - Christian Caglevic
- Departamento Oncología Médica, Clínica Alemana, Santiago, Chile; Instituto Oncológico Fundación Arturo López, Santiago, Chile
| | - Christian Rolfo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, USA
| | - Rafael Sirera
- Departamento de Biotecnología, Universitat Politenica de Valencia, España
| | - Hugo Marsiglia
- Instituto Oncológico Fundación Arturo López, Santiago, Chile
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Yanez L, Ciudad AM, Mehta MP, Marsiglia H. What is the evidence for the clinical value of SBRT in cancer of the cervix? Rep Pract Oncol Radiother 2018; 23:574-579. [PMID: 30534021 PMCID: PMC6277353 DOI: 10.1016/j.rpor.2018.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/11/2018] [Accepted: 08/11/2018] [Indexed: 01/28/2023] Open
Abstract
AIM The aim of this review is to describe and analyze indications and results of the use of SBRT in uterine cervix cancer, reviewing articles published from January 2010 up to August 2017, for any one of the four indications listed:1Patient refusal or anatomic impediments to interstitial or intracavitary brachytherapy (BCT), i.e. SBRT as an "alternative" for BCT;2Patients with voluminous tumors, or asymmetric tumors where BCT alone would not achieve curative doses, i.e. SBRT as a primary adjunct to BCT;3Pelvic and para aortic adenopathy where SBRT could be used as a boost, i.e. SBRT as a primary adjunct to external beam pelvic radiotherapy;4Small volume recurrences (postoperative or post radiotherapy), i.e. SBRT for salvage. BACKGROUND Cervix cancer standard treatment involves pelvic irradiation and chemotherapy, recent advances in irradiation techniques might offer new possible approaches. MATERIAL AND METHODS Systematic review of the English language literature about Cervix cancer, SBRT, published from January 2010 to January 2018 identified through a database search of PubMed, and Ovid MEDLINE, using pre-defined search phrases. RESULTS The results in the literature, in general, demonstrate rather weak efficacy of SBRT. In this review, we did not find strong evidence to recommend routine SBRT as a primary treatment for cervico-uterine cancers, i.e. as a replacement for BCT; in highly selected cases it might be considered useful as salvage therapy for relapsed cervix cancer. CONCLUSION The existing data to not warrant recommending SBRT for the definitive treatment of cervix cancer, but may have some value in the recurrent/relapsed setting.
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Affiliation(s)
- Loreto Yanez
- Radiotherapy Dept., Fundación Arturo López Pérez, Santiago, Chile
| | - Ana M. Ciudad
- Radiotherapy Dept., Fundación Arturo López Pérez, Santiago, Chile
| | | | - Hugo Marsiglia
- Radiotherapy Dept., Fundación Arturo López Pérez, Santiago, Chile
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Rovirosa A, Marsiglia H, Lartigau E, Zimmermann P, Chirat E, Delapierre M, Briot E, Gerbaulet A. Endoluminal High-Dose-Rate Brachytherapy with a Palliative aim in Esophageal Cancer: Preliminary Results at the Institut Gustave Roussy. Tumori 2018; 81:359-63. [PMID: 8804454 DOI: 10.1177/030089169508100511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ten patients with advanced esophageal carcinoma were treated with endoluminal high-dose-rate brachytherapy at the Institut Gustave Roussy. Eight of them had recurrences after external beam radiotherapy. They were treated with a high-dose rate iridium-192 source. Five patients received 6 sessions of 4 Gy, 4 patients 3 sessions of 4 Gy, and 1 patient received 3 sessions of 8 Gy. The interval time between each session was 1 week. Seventy percent of patients improved their dysphagia, with 80% endoscopic tumor response. The Karnofsky index was improved in most of the patients. The mean survival was 4 months, and dysphagiafree survival was 2.5 months. Two patients had treatment toxicity but only a transitory WHO G1 esophagitis. Endoesophageal high-dose-rate curietherapy seems an effective technique in palliative treatments. We found low toxicity and an excellent tolerance to treatment in previously irradiated patients. The efficacy of the treatment is highly dependent on a precise tumor volume evaluation.
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Affiliation(s)
- A Rovirosa
- Servicio De Oncología Radoterápica, Hospital Clinic I Universitari, Barcelona, Spain
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Ghilezan M, Ivaldi G, Cattani F, Greco C, Castiglioni S, Leonardi MC, Tosi G, Marsiglia H, Orecchia R. 3D-Conformal Radiation Therapy in Prostate Cancer. Technical Considerations after 5 Years of Experience and 334 Patients Treated at the Istituto Europeo Di Oncologia of Milan, Italy. Tumori 2018; 87:317-23. [PMID: 11765181 DOI: 10.1177/030089160108700508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background To report the technique of 3D-conformal radiation therapy (3D-CRT) currently used at our Institute for the treatment of prostate cancer with a curative intent. A critical review of the technical aspects of the technique is provided. Methods and Study Design Between December 1995 and October 2000, 334 patients with biopsy-proven adenocarcinoma of the prostate were treated with 3D-CRT. All patients were treated in a prone position with 15 MV X-ray beams and a 6-field technique for all but 20 patients, who were treated with a 3-field technique. Patients were simulated with the rectum and bladder empty. To ensure reproducible positioning, custom-made polyurethane foam or thermoplastic casts were produced for each patient. Subsequently, consecutive CT scan slices were obtained. The clinical target volume and critical organs (rectum and bladder) were identified on each CT slice. The beam's eye view technique was used to spatially display these structures, and the treatment portals were manually shaped based on the images obtained. The beam apertures were initially realized by conventional Cerrobend blocks (48 patients), which were replaced in October 1997 by a computer-driven multi-leaf collimator. The total target dose prescribed at the ICRU point is 76 Gy, delivered in 38 fractions and 54 days. The seminal vesicles are excluded at 70 Gy. Dose-volume histograms were obtained for all patients. If more than 30% of the bladder and/or more than 20% of the rectum receive >95% of the prescribed total dose, the treatment plan is judged as unsatisfactory and is adjusted. The dose-volume histogram can be improved by changing the beam's arrangement and/or weights or by introducing or modifying the wedge filters. Conclusions 3D-CRT in prostate cancer patients is a highly sophisticated and time-consuming method of dose delivery. Important technical issues remain to be clarified.
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Affiliation(s)
- M Ghilezan
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
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Gorka N, Lopez Guerra J, Krumina E, Marsiglia H, Vila M, Miró A, Garcia A, Gómez E, Azinovic I. EP-2260: High dose rate brachytherapy delivered in two fractions within one day for prostate cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32569-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Chajon E, Castelli J, Marsiglia H, De Crevoisier R. The synergistic effect of radiotherapy and immunotherapy: A promising but not simple partnership. Crit Rev Oncol Hematol 2017; 111:124-132. [PMID: 28259287 DOI: 10.1016/j.critrevonc.2017.01.017] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/21/2016] [Accepted: 01/25/2017] [Indexed: 12/20/2022] Open
Abstract
Radiotherapy (RT) is one of the main components in the treatment of cancer. The better understanding of the immune mechanisms associated with tumor establishment and how RT affects inflammation and immunity has led to the development of novel treatment strategies. Several preclinical studies support the use of RT in combination with immunotherapy obtaining better local and systemic tumor control. Current ongoing studies will provide information about the optimal RT approach, but the development of reliable predictors of the response from the preclinical and the early phases of clinical studies is necessary to avoid discarding treatment strategies with significant clinical benefit. This review summarize the current concepts of the synergism between RT and immunotherapy, the molecular effects of RT in the tumor microenvironment, their impact on immune activation and its potential clinical applications in trials exploring this important therapeutic opportunity. Finally, the potential predictors of clinical response are discussed.
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Affiliation(s)
- Enrique Chajon
- Department of Radiation Oncology, Centre Eugene Marquis, Rennes, F-35000, France.
| | - Joël Castelli
- Department of Radiation Oncology, Centre Eugene Marquis, Rennes, F-35000, France; Université de Rennes 1, LTSI, INSERM, Rennes U1099, France
| | - Hugo Marsiglia
- Department of Radiation Oncology, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago de Chile, 7500921, Chile
| | - Renaud De Crevoisier
- Department of Radiation Oncology, Centre Eugene Marquis, Rennes, F-35000, France; Université de Rennes 1, LTSI, INSERM, Rennes U1099, France
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Caglevic C, Gallardo J, de la Torre M, Mahave M, Müller B, Solé S, Moscoso Y, De La Fuente H, Roa JC, Hoefler S, Butte JM, González M P, O'Connor JM, Torres J, Pérez Encalada V, Alarcón Cano D, Ubillos L, Rolfo C, Lingua A, Díaz Romero C, Padilla Rosciano A, Cuartero V, Calderillo Ruiz G, Schwartsmann G, Kon Jara X, Andrade G A, Mas López L, Barajas O, Carballido M, Lembach H, Morillas G L, Roca E, Lobatón J, Montenegro B P, Yepes A, Marsiglia H. [Recommendations for the management of pancreatic cancer type adenocarcinoma: A consensus statement reached during the 2015 Latin American Symposium on Gastroenterological Oncology]. Rev Med Chil 2017; 144:1305-1318. [PMID: 28074986 DOI: 10.4067/s0034-98872016001000010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pancreatic cancer is a malignancy of great impact in developed countries and is having an increasing impact in Latin America. Incidence and mortality rates are similar for this cancer. This is an important reason to offer to the patients the best treatments available. During the Latin American Symposium of Gastroenterology Oncology (SLAGO) held in Viña del Mar, Chile, in April 2015, a multidisciplinary group of specialists in the field met to discuss about this disease. The main conclusions of this meeting, where practitioners from most of Latin American countries participated, are listed in this consensus that seek to serve as a guide for better decision making for patients with pancreatic cancer in Latin America.
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Affiliation(s)
| | | | - Marcela de la Torre
- Centro Especializado en Terapia Radiante, Hospital Clínicas San José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Mauricio Mahave
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile,
| | | | | | - Yuri Moscoso
- Unidad de Cuidados Paliativos, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | | | | | | | - Jean M Butte
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | | | - Juan Manuel O'Connor
- Sección de Tumores Gastrointestinales, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Javiera Torres
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Luis Ubillos
- Servicio de Oncología Clínica, Hospital de Clínicas, Montevideo, Uruguay
| | - Christian Rolfo
- Unidad de Desarrollo Temprano de Drogas-Estudios Fase I, Hospital Universitario de Antwerp, Amberes, Bélgica
| | - Alejo Lingua
- Área Oncología Digestiva, Clínica Privada Universitaria Reina Fabiola, Córdoba, Argentina
| | - Consuelo Díaz Romero
- Unidad Funcional de Tumores Digestivos, Instituto Nacional de Cancerología, México, México
| | | | | | | | | | | | | | - Luis Mas López
- Instituto Nacional de Enfermedades Neoplásicas,Lima,Perú
| | - Olga Barajas
- Instituto Oncológico Fundación Arturo López Pérez,Santiago,Chile
| | - Marcela Carballido
- Hospital de Gastroenterologia Dr. Carlos Bonorino Udaondo,Buenos Aires,Argentina
| | | | - Lena Morillas G
- Centro de Enfermedades Neoplásicas ONCOVIDA, La Paz, Bolivia
| | - Enrique Roca
- Hospital de Gastroenterologia Dr. Carlos Bonorino Udaondo,Buenos Aires,Argentina
| | | | | | - Andrés Yepes
- Fundación Colombiana de Cancerología, Medellín,Colombia
| | - Hugo Marsiglia
- nstituto Oncológico Fundación Arturo López Pérez,Santiago,Chile
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Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, Collette L, Fourquet A, Maingon P, Valli M, De Winter K, Marnitz S, Barillot I, Scandolaro L, Vonk E, Rodenhuis C, Marsiglia H, Weidner N, van Tienhoven G, Glanzmann C, Kuten A, Arriagada R, Bartelink H, Van den Bogaert W. Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer. N Engl J Med 2015. [PMID: 26200978 DOI: 10.1056/nejmoa1415369] [Citation(s) in RCA: 705] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall irradiation after surgery on survival among women with early-stage breast cancer is unknown. METHODS We randomly assigned women who had a centrally or medially located primary tumor, irrespective of axillary involvement, or an externally located tumor with axillary involvement to undergo either whole-breast or thoracic-wall irradiation in addition to regional nodal irradiation (nodal-irradiation group) or whole-breast or thoracic-wall irradiation alone (control group). The primary end point was overall survival. Secondary end points were the rates of disease-free survival, survival free from distant disease, and death from breast cancer. RESULTS Between 1996 and 2004, a total of 4004 patients underwent randomization. The majority of patients (76.1%) underwent breast-conserving surgery. After mastectomy, 73.4% of the patients in both groups underwent chest-wall irradiation. Nearly all patients with node-positive disease (99.0%) and 66.3% of patients with node-negative disease received adjuvant systemic treatment. At a median follow-up of 10.9 years, 811 patients had died. At 10 years, overall survival was 82.3% in the nodal-irradiation group and 80.7% in the control group (hazard ratio for death with nodal irradiation, 0.87; 95% confidence interval [CI], 0.76 to 1.00; P=0.06). The rate of disease-free survival was 72.1% in the nodal-irradiation group and 69.1% in the control group (hazard ratio for disease progression or death, 0.89; 95% CI, 0.80 to 1.00; P=0.04), the rate of distant disease-free survival was 78.0% versus 75.0% (hazard ratio, 0.86; 95% CI, 0.76 to 0.98; P=0.02), and breast-cancer mortality was 12.5% versus 14.4% (hazard ratio, 0.82; 95% CI, 0.70 to 0.97; P=0.02). Acute side effects of regional nodal irradiation were modest. CONCLUSIONS In patients with early-stage breast cancer, irradiation of the regional nodes had a marginal effect on overall survival. Disease-free survival and distant disease-free survival were improved, and breast-cancer mortality was reduced. (Funded by Fonds Cancer; ClinicalTrials.gov number, NCT00002851.).
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Affiliation(s)
- Philip M Poortmans
- From the Department of Radiation Oncology, Radboud University Medical Center, Nijmegen (P.M.P.), Department of Radiation Oncology, Institute Verbeeten, Tilburg (P.M.P., K.D.W.), Department of Radiation Oncology, Medisch Centrum Haaglanden, The Hague (H.S.), Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (H.S., C.R.), Department of Radiation Oncology, Institute for Radiation Oncology Radiotherapeutisch Instituut Stedendriehoek en Omstreken, Deventer (E.V.), Department of Radiation Oncology, Academic Medical Center (G.T.), and Department of Radiation Oncology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (H.B.), Amsterdam - all in the Netherlands; European Organization for Research and Treatment of Cancer (EORTC) Headquarters (S.C., L.C.) and Department of Radiation Oncology, University Hospital Saint-Luc, Université Catholique de Louvain (C.K.), Brussels, and Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven (E.V.L., W.V.B.) - all in Belgium; Department of Radiation Oncology, Charité University Medicine Berlin, Berlin (V.B., S.M.), and Department of Radiation Oncology, University Hospital, Tübingen (N.W.) - both in Germany; Department of Radiation Oncology, Institut Curie, Paris (A.F.), Department of Radiation Oncology, Centre Georges-François Leclerc, Dijon (P.M., I.B.), Department of Radiation Oncology, Université François Rabelais, Tours (I.B.), and Department of Radiation Oncology, Gustave Roussy Cancer Center, Villejuif (H.M.) - all in France; Department of Radiation Oncology, Ospedale Regionale di Bellinzona e Valli, Bellinzona (M.V.), and Department of Radiation Oncology, University Hospital Zurich (C.G.) - both in Switzerland; Department of Radiation Oncology, Sant'Anna Hospital, Como, Italy (M.V., L.S.); Department of Radiation Oncology, Rambam Medical Center, Haifa, Israel (A.K.); and Grupo Oncológico Cooperativo Chileno de Investigación, Santiago, Chile (R.A.)
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Calvo FA, Sole CV, Marsiglia H, Alvarado E, Ferrer C, Czito B. Intraoperative radiotherapy for gastrointestinal malignancies: contemporary outcomes with multimodality therapy. Curr Oncol Rep 2015; 17:419. [PMID: 25416313 DOI: 10.1007/s11912-014-0419-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The integration of intraoperative radiotherapy (IORT) into the multimodal treatment of gastrointestinal cancer is feasible and leads to high rates of local control. In-field tumoral control using IORT-containing strategies can be achieved in over 90 % of most cases, regardless of the site or status of the tumor (primary or recurrent). Electron beam IORT, or intraoperative electron radiation therapy, is the dominant technology used in institutions reporting data in publications the 21st century. Neither surgery nor systemic therapy is compromised by the integration of IORT-containing radiotherapy.
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Affiliation(s)
- Felipe A Calvo
- Department of Oncology, Hospital General Universitario Gregorio Marañón, Ave. Doctor Esquerdo 46, 28007, Madrid, Spain
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Mansouri S, Naim A, Glaria L, Marsiglia H. Dosimetric evaluation of 3-D conformal and intensity-modulated radiotherapy for breast cancer after conservative surgery. Asian Pac J Cancer Prev 2015; 15:4727-32. [PMID: 24969911 DOI: 10.7314/apjcp.2014.15.11.4727] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancers are becoming more frequently diagnosed at early stages with improved long term outcomes. Late normal tissue complications induced by radiotherapy must be avoided with new breast radiotherapy techniques being developed. The aim of the study was to compare dosimetric parameters of planning target volume (PTV) and organs at risk between conformal (CRT) and intensity-modulated radiation therapy (IMRT) after breast-conserving surgery. MATERIALS AND METHODS A total of 20 patients with early stage left breast cancer received adjuvant radiotherapy after conservative surgery, 10 by 3D-CRT and 10 by IMRT, with a dose of 50 Gy in 25 sessions. Plans were compared according to dose-volume histogram analyses in terms of PTV homogeneity and conformity indices as well as organs at risk dose and volume parameters. RESULTS The HI and CI of PTV showed no difference between 3D-CRT and IMRT, V95 gave 9.8% coverage for 3D-CRT versus 99% for IMRT, V107 volumes were recorded 11% and 1.3%, respectively. Tangential beam IMRT increased volume of ipsilateral lung V5 average of 90%, ipsilateral V20 lung volume was 13%, 19% with IMRT and 3D-CRT respectively. Patients treated with IMRT, heart volume encompassed by 60% isodose (30 Gy) reduced by average 42% (4% versus 7% with 3D-CRT), mean heart dose by average 35% (495 cGy versus 1400 cGy with 3D-CRT). In IMRT minimal heart dose average is 356 cGy versus 90 cGy in 3D-CRT. CONCLUSIONS IMRT reduces irradiated volumes of heart and ipsilateral lung in high-dose areas but increases irradiated volumes in low-dose areas in breast cancer patients treated on the left side.
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Affiliation(s)
- Safae Mansouri
- Radiotherapy Oncology Center Talavera, Grupo IMO, Spain E-mail :
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Cascales Garcia M, Acevedo-Henao C, Mangoni M, Castaing M, Dunant A, Livi L, Mathieu M, Marsiglia H, Bourgier C, Rivera S. Borderline and Malignant Phylloides Tumors of the Breast: A Retrospective Analysis of 37 Cases. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sole CV, Calvo FA, Ferrer C, Pascau J, Marsiglia H. Bibliometrics of intraoperative radiotherapy: analysis of technology, practice and publication tendencies. Strahlenther Onkol 2014; 190:1111-6. [PMID: 24928250 DOI: 10.1007/s00066-014-0695-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/14/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE To analyze the performance and quality of intraoperative radiation therapy (IORT) publications identified in medical databases during a recent period in terms of bibliographic metrics. MATERIALS AND METHODS A bibliometric search was conducted for IORT papers published in the PubMed database between 1997 and 2013. Publication rate was used as a quantity indicator; the 2012 Science Citation Index Impact Factor as a quality indicator. Furthermore, the publications were stratified in terms of study type, scientific topic reported, year of publication, tumor type and journal specialty. We performed a one-way analysis of variance (ANOVA) to determine differences between the means of the analyzed groups. RESULTS Among the total of 207 journals, articles were reported significantly more frequently in surgery (n = 399, 41 %) and radiotherapy journals (n = 273, 28 %; p < 0.01). The highest impact factor was achieved by clinical oncology journals (p < 0.01). The majority of identified articles were retrospective cohort reports (n = 622, 64 %), followed by review articles (n = 204, 21 %; p < 0.001). Regarding primary topic, reports on cancer outcome following specific tumor therapy were most frequently published (n = 661, 68 %; p < 0.001) and gained the highest mean impact factor (p < 0.01). Gastrointestinal tumor reports were represented most frequently (n = 456, 47 %; p < 0.001) and the mean superior impact factor was earned by breast and gynecologic publications (p < 0.01). CONCLUSION We identified a consistent and sustained scientific productivity of international IORT expert groups. Most publications appeared in journals with surgical and radiooncological content. The highest impact factor was achieved by medical oncology journals.
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Affiliation(s)
- Claudio V Sole
- Service of Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile
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Samblas J, Luis Lopez Guerra J, Bustos J, Angel Gutierrez-Diaz J, Wolski M, Peraza C, Marsiglia H, Sallabanda K. Stereotactic radiosurgery in patients with multiple intracranial meningiomas. J BUON 2014; 19:250-255. [PMID: 24659672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Stereotactic radiosurgery (SRS) delivers a potent, highly focused dose of radiation to the tumor while sparing the surrounding normal tissues. The purpose of this study was to assess the outcome of patients with intracranial meningiomas treated with SRS. METHODS A total of 73 patients with 221 benign meningiomas treated between 1991 and 2005 with SRS and followed up for more than a year were reviewed. Fifty patients (68%) were treated with SRS to the primary meningioma while 23 (32%) received SRS to relapsing tumors adjacent or distant from the site of the initial meningioma that was previously treated with surgery alone. Mean tumor margin dose was 14 Gy (range 10-16). SRS was delivered after surgery in 117 meningiomas (55 patients). RESULTS The median age at diagnosis was 47 years (range 16-74) and the median follow-up 5.8 years (range 1-13.6). The 3- and 5-year overall survival (OS) rates for all patients were 95% and 90%, respectively. The mean gross tumor volume decreased from 4.17 cm3 to 3.23 cm(3) after SRS (p=0.057). Twenty-two (10%) meningiomas increased after SRS. In addition, clinical symptoms improved in 36% and remained stable in 45% of the patients. With regard to morbidity of SRS, only 7 patients (9.6%) had late complications, including edema (N=4), brain necrosis (N=4), gliosis (N=1), and paresis of the III pair nerve (N=1). There was no treatment-related mortality. CONCLUSION SRS for patients with multiple intracranial meningiomas is effective yielding a high rate of local tumor control, whereas treatment-related morbidity remains low.
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Affiliation(s)
- Jose Samblas
- Department of Neurosurgery, Istituto Madrileno de Oncologia/Grupo IMO, Madrid, Spain
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Cao KI, Lebas N, Gerber S, Levy C, Le Scodan R, Marsiglia H, Bourgier C, Pierga JY, Gobillion A, Savignoni A, Kirova YM. Abstract P6-11-01: A randomized phase II clinical trial of whole-brain radiation therapy plus concomitant temozolomide in treatment of brain metastases from breast cancer: Six-month follow-up results. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-11-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Despite of therapeutics progress in advanced breast cancer, brain metastases occurrence remain a frequent and delicate situation. The efficacy of whole-brain radiation therapy (WBRT), still considered as the standard local treatment in case of multiple brain metastases, is limited. Recently, several phase II studies have shown some efficacy of the association of WBRT and temozolomide (TMZ), an oral alkylating agent already known as a radiosensitizer, with improved brain control rate (44 to 96%). Patients with breast cancer were underrepresented and none of these trials have studied this combined treatment issue in this specific population. The aim of this study was to assess the efficacy and safety of WBRT combined with temozolomide in the treatment of brain metastases from breast cancer.
Materials and Methods: A prospective randomized multicenter phase II study was developed, using a modified two-stage Fleming design. Patients with newly diagnosed intraparenchymal brain metastases from breast cancer, not suitable for surgery nor radiosurgery, were included. All patients received conformational WBRT (3 Gy x 10 to 30 Gy). They were randomized to WBRT plus concomitant TMZ administered 75 mg/m2/day during radiation period versus WBRT alone. The primary endpoint was radiologic objective response at six weeks after the end of treatment, defined as a partial or complete response on systematic brain MRI (WHO modified criteria). We also evaluated neurologic symptoms, tolerance, safety, progression free survival (PFS) and overall survival (OS) as secondary endpoints. A longer clinical-brain MRI follow-up was planned, each three months during a two-year period. All of the patients gave their written informed consent to be part of the study, which was approved by the local committee.
Results: One hundred patients were enrolled between February 2008 and December 2010 (50 in the WBRT + TMZ arm, 50 in the WBRT arm). The median age was 55 [29 -79]. Eighty (80) patients had brain metastases as single secondary localization. About one third of patients had a triple negative breast cancer subtype (38,3% in the association arm and 35,71% in the WBRT alone arm). There were 26,7% and 14,6% of HER2 positive subtype respectively. The median follow-up was 30 months [range 6-60]. At six months from brain metastases diagnosis (three months after the end of the treatment), objective response rate seems better in the WBRT + TMZ arm: 52% versus 40% in the arm WBRT alone but was not statistically significant (p = 0,54). No complete response was observed. In the WBRT + TMZ group, median PFS and OS at six-months were respectively 55,6% [range 46-7 – 66,0] and 67,7% [range 59,1 – 77,6]. No improvement in neurologic symptoms was noticed. In multivariate analysis, initial TNM status was significantly correlated with PFS and OS. The concurrent use of TMZ with WBRT was well-tolerated. The most frequent upper grade II acute toxicity was reversible leucopenia in the association arm.
Conclusion: The addition of temozolomide to WBRT in patients with brain metastases from breast cancer did not improve local control or survival at six months follow-up.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-11-01.
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Affiliation(s)
- KI Cao
- Institut Curie - Site Saint Cloud, Saint Cloud, France, Metropolitan; Institut Curie - Site Paris, Paris, France, Metropolitan; Centre François Baclesse, Caen, France, Metropolitan; Institut Gustave Roussy, Villejuif, France, Metropolitan
| | - N Lebas
- Institut Curie - Site Saint Cloud, Saint Cloud, France, Metropolitan; Institut Curie - Site Paris, Paris, France, Metropolitan; Centre François Baclesse, Caen, France, Metropolitan; Institut Gustave Roussy, Villejuif, France, Metropolitan
| | - S Gerber
- Institut Curie - Site Saint Cloud, Saint Cloud, France, Metropolitan; Institut Curie - Site Paris, Paris, France, Metropolitan; Centre François Baclesse, Caen, France, Metropolitan; Institut Gustave Roussy, Villejuif, France, Metropolitan
| | - C Levy
- Institut Curie - Site Saint Cloud, Saint Cloud, France, Metropolitan; Institut Curie - Site Paris, Paris, France, Metropolitan; Centre François Baclesse, Caen, France, Metropolitan; Institut Gustave Roussy, Villejuif, France, Metropolitan
| | - R Le Scodan
- Institut Curie - Site Saint Cloud, Saint Cloud, France, Metropolitan; Institut Curie - Site Paris, Paris, France, Metropolitan; Centre François Baclesse, Caen, France, Metropolitan; Institut Gustave Roussy, Villejuif, France, Metropolitan
| | - H Marsiglia
- Institut Curie - Site Saint Cloud, Saint Cloud, France, Metropolitan; Institut Curie - Site Paris, Paris, France, Metropolitan; Centre François Baclesse, Caen, France, Metropolitan; Institut Gustave Roussy, Villejuif, France, Metropolitan
| | - C Bourgier
- Institut Curie - Site Saint Cloud, Saint Cloud, France, Metropolitan; Institut Curie - Site Paris, Paris, France, Metropolitan; Centre François Baclesse, Caen, France, Metropolitan; Institut Gustave Roussy, Villejuif, France, Metropolitan
| | - J-Y Pierga
- Institut Curie - Site Saint Cloud, Saint Cloud, France, Metropolitan; Institut Curie - Site Paris, Paris, France, Metropolitan; Centre François Baclesse, Caen, France, Metropolitan; Institut Gustave Roussy, Villejuif, France, Metropolitan
| | - A Gobillion
- Institut Curie - Site Saint Cloud, Saint Cloud, France, Metropolitan; Institut Curie - Site Paris, Paris, France, Metropolitan; Centre François Baclesse, Caen, France, Metropolitan; Institut Gustave Roussy, Villejuif, France, Metropolitan
| | - A Savignoni
- Institut Curie - Site Saint Cloud, Saint Cloud, France, Metropolitan; Institut Curie - Site Paris, Paris, France, Metropolitan; Centre François Baclesse, Caen, France, Metropolitan; Institut Gustave Roussy, Villejuif, France, Metropolitan
| | - YM Kirova
- Institut Curie - Site Saint Cloud, Saint Cloud, France, Metropolitan; Institut Curie - Site Paris, Paris, France, Metropolitan; Centre François Baclesse, Caen, France, Metropolitan; Institut Gustave Roussy, Villejuif, France, Metropolitan
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Mansouri S, Naim A, Glaria L, Marsiglia H. Radiothérapie avec modulation d’intensité dans le traitement conservateur du sein. Cancer Radiother 2013. [DOI: 10.1016/j.canrad.2013.07.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Poortmans P, Marsiglia H, De Las Heras M, Algara M. Clinical and technological transition in breast cancer. Rep Pract Oncol Radiother 2013; 18:345-52. [PMID: 24416578 DOI: 10.1016/j.rpor.2013.08.002] [Citation(s) in RCA: 11] [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: 05/03/2013] [Revised: 07/08/2013] [Accepted: 08/05/2013] [Indexed: 12/01/2022] Open
Abstract
This article is a summary of the conference "Clinical and technological transition in breast cancer" that took place in the Congress of the Spanish Society of Radiation Oncology, placed in Vigo (Spain) on June 21, 2013. Hugo Marsiglia and Philip Poortmanns were the speakers, the first discussed about "Clinical and technological transition" and the second about "EORTC clinical trials and protocols".
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Affiliation(s)
- Philip Poortmans
- Radiotherapy Department, Institute Verbeeten, Tilburg, The Netherlands
| | - Hugo Marsiglia
- Radiotherapy Department, Instituve Gustave Roussy, Villejuif, France
| | | | - Manuel Algara
- Radiotherapy Department, Parc de Salut Mar, Barcelona, Spain
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Hannoun-Levi JM, Gourgou-Bourgade S, Belkacemi Y, Chara-Bruneau C, Hennequin C, Quetin P, Orsini C, Brain E, Marsiglia H. GERICO-03 phase II trial of accelerated and partial breast irradiation in elderly women: Feasibility, reproducibility, and impact on functional status. Brachytherapy 2013; 12:285-92. [DOI: 10.1016/j.brachy.2012.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/08/2012] [Accepted: 06/15/2012] [Indexed: 11/12/2022]
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Safae M, Naim A, Glaria L, Marsiglia H. Dosimetric evaluation of 3-D conformal radiotherapy and intensity-modulated radiotherapy for left breast cancer after conservative surgery. Rep Pract Oncol Radiother 2013. [DOI: 10.1016/j.rpor.2013.03.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Sole CV, Lopez Guerra JL, Matute R, Jaen J, Puebla F, Rivin E, Sanchez-Reyes A, Beltran C, Bourgier C, Calvo FA, Marsiglia H. Stereotactic ablative radiotherapy delivered by image-guided helical tomotherapy for extracranial oligometastases. Clin Transl Oncol 2012; 15:484-91. [PMID: 23143953 DOI: 10.1007/s12094-012-0956-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 10/02/2012] [Indexed: 01/24/2023]
Abstract
PURPOSE To investigate the outcomes and risk factors of patients treated with stereotactic ablative radiotherapy (SABR) delivered by image-guided helical tomotherapy (HT) for extracranial oligometastases. METHODS From August 2006 through July 2011, 42 consecutive patients (median age 69 years [range 16-87]) with oligometastases (≤3) received HT to all known cancer sites (lung, n = 28; liver, n = 12; adrenal, n = 2). Prognostic factors were assessed by Cox's proportional hazards regression analysis. RESULTS A total of 60 lesions were treated with hypofractionated HT (median dose 39 Gy [range 36-72.5]; median dose per fraction 12 Gy [range 5-20]). Complete or partial response was observed in 40 (54 %) patients. With a median follow-up period of 15 months, 1- and 2-year overall survival (OS) was 84 and 63 %, respectively; and 1- and 2-year local control (LC) was 92 and 86 %, respectively. Four patients had pneumonitis Grade ≥2 and two patients had lower gastrointestinal toxicity Grade ≥2. Only the lack of complete/partial response was associated with higher risk of mortality on univariate (HR = 3.8, P = 0.04) and multivariate (HR = 6.6, P = 0.01) analyses. CONCLUSIONS SABR delivered by image-guided HT is well tolerated and offers adequate LC with low acute morbidity in patients with extracranial oligometastatic disease. We found that the response to HT was the only predictor for OS.
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Affiliation(s)
- C V Sole
- Department of Radiation Oncology, Instituto Madrileño de Oncología/Grupo IMO, 28010, Madrid, Spain
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Sole C, Guerra JL, Matute R, Jaen J, Puebla F, Sanchez-Reyes A, Minguez C, Bourgier C, Marsiglia H. Stereotactic Ablative Radiation Therapy Delivered by Helical Tomotherapy for Early-Stage Non-small Cell Lung Cancer: Dosimetric Evaluation and Toxicity. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.2194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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27
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Sole C, Guerra JL, Jaen J, Matute R, Puebla F, Sanchez-Reyes A, Beltran C, Bourgier C, Marsiglia H. Stereotactic Ablative Radiation Therapy Delivered by Image-guided Helical Tomotherapy for Extracranial Oligometastasis. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.527] [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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Acevedo-Henao CM, Heymann S, Rossier C, Garbay JR, Arnedos M, Balleyguier C, Ferchiou M, Marsiglia H, Bourgier C. Irradiation partielle accélérée conformationnelle du sein : état des lieux. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.05.002] [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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Bourgier C, Dumas I, Marsiglia H, Rossier C, Taright N, Biron B, Auzac G. Irradiation partielle accélérée du cancer du sein : aspect théorique. Cancer Radiother 2012; 16:470-2. [DOI: 10.1016/j.canrad.2012.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
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Lopez Guerra JL, Isa N, Kim MM, Bourgier C, Marsiglia H. New perspectives in radiation oncology: Young radiation oncologist point of view and challenges. Rep Pract Oncol Radiother 2012; 17:251-4. [PMID: 24669303 PMCID: PMC3885889 DOI: 10.1016/j.rpor.2012.07.002] [Citation(s) in RCA: 12] [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: 12/17/2011] [Revised: 06/14/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022] Open
Abstract
AIM To assess the role of the young radiation oncologist in the context of important recent advancements in the field of radiation oncology, and to explore new perspectives and competencies of the young radiation oncologist. BACKGROUND Radiation oncology is a field that has rapidly advanced over the last century. It holds a rich tradition of clinical care and evidence-based practice, and more recently has advanced with revolutionary innovations in technology and computer science, as well as pharmacology and molecular biology. MATERIALS AND METHODS Several young radiation oncologists from different countries evaluated the current status and future directions of radiation oncology. RESULTS For young radiation oncologists, it is important to reflect on the current practice and future directions of the specialty as it relates to the role of the radiation oncologist in the comprehensive management of cancer patients. Radiation oncologists are responsible for the radiation treatment provided to patients and its subsequent impact on patients' quality of life. Young radiation oncologists must proactively master new clinical, biological and technical information, as well as lead radiation oncology teams consisting of physicists, dosimetrists, nurses and technicians. CONCLUSIONS The role of the young radiation oncologist in the field of oncology should be proactive in developing new competencies. Above all, it is important to remember that we are dealing with the family members and loved ones of many individuals during the most difficult part of their lives.
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Affiliation(s)
- Jose Luis Lopez Guerra
- Department of Radiation Oncology, Instituto Madrileño de Oncologia/Grupo IMO, Madrid, Spain
| | - Nicolas Isa
- Department of Radiation Oncology, Instituto Madrileño de Oncologia/Grupo IMO, Madrid, Spain
- Department of Radiation Oncology, Instituto Nacional del Cancer de Santiago de Chile, Santiago, Chile
| | - Michelle M. Kim
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Celine Bourgier
- Department of Radiation Oncology, Institut de cancérologie Gustave Roussy, Villejuif, Paris, France
| | - Hugo Marsiglia
- Department of Radiation Oncology, Instituto Madrileño de Oncologia/Grupo IMO, Madrid, Spain
- Department of Radiation Oncology, Institut de cancérologie Gustave Roussy, Villejuif, Paris, France
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Bourgier C, Acevedo-Henao C, Dunant A, Rossier C, Levy A, El Nemr M, Dumas I, Delaloge S, Mathieu MC, Garbay JR, Taghian A, Marsiglia H. Higher toxicity with 42 Gy in 10 fractions as a total dose for 3D-conformal accelerated partial breast irradiation: results from a dose escalation phase II trial. Radiat Oncol 2012; 7:141. [PMID: 22913640 PMCID: PMC3502482 DOI: 10.1186/1748-717x-7-141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/13/2012] [Indexed: 11/25/2022] Open
Abstract
Objective Recent recommendations regarding indications of accelerated partial breast irradiation (APBI) have been put forward for selected breast cancer (BC) patients. However, some treatment planning parameters, such as total dose, are not yet well defined. The Institut Gustave Roussy has initiated a dose escalation trial at the 40 Gy/10 fractions/5 days and at a further step of total dose (TD) of 42 Gy/10 fractions/ 5 days. Here, we report early results of the latest step compared with the 40 Gy dose level. Methods and materials From October 2007 to March 2010, a total of 48 pT1N0 BC patients were enrolled within this clinical trial: 17 patients at a TD of 42 Gy/10f/5d and 31 at a TD of 40 Gy/10f/5d. Median follow-up was 19 months (min-max, 12–26). All the patients were treated by APBI using a technique with 2 minitangents and an “enface” electrons delivering 20% of the total dose. Toxicities were systematically assessed at 1; 2; 6 months and then every 6 months. Results Patients’ recruitment of 42 Gy step was ended owing to persistent grade 3 toxicity 6 months after APBI completion (n = 1). Early toxicities were statistically higher after a total dose of 42 Gy regarding grade ≥2 dry (p = 0.01) and moist (p = 0.05) skin desquamation. Breast pain was also statistically higher in the 42 Gy step compared to 40 Gy step (p = 0.02). Other late toxicities (grade ≥2 fibrosis and telangectasia) were not statistically different between 42 Gy and 40 Gy. Conclusions Early toxicities were more severe and higher rates of late toxicities were observed after 42 Gy/10 fractions/5 days when compared to 40 Gy/10 fractions/5 days. This data suggest that 40 Gy/10 fractions/ 5 days could potentially be the maximum tolerance for PBI although longer follow-up is warranted to better assess late toxicities.
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Affiliation(s)
- Celine Bourgier
- Department of Radiation Oncology, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94 805, Villejuif, France.
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Usychkin S, Calvo F, dos Santos MA, Samblás J, de Urbina DO, Bustos JC, Diaz JAG, Sallabanda K, Sanz A, Yélamos C, Peraza C, Delgado JM, Marsiglia H. Intra-operative electron beam radiotherapy for newly diagnosed and recurrent malignant gliomas: feasibility and long-term outcomes. Clin Transl Oncol 2012; 15:33-8. [PMID: 22855176 DOI: 10.1007/s12094-012-0892-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/06/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intra-operative electron beam radiotherapy (IOERT) is an alternative to dose escalation for the treatment of central nervous system tumors. The objective of this study was to describe the feasibility and long-term outcomes of IOERT in the treatment of primary and recurrent gliomas. MATERIALS AND METHODS From January 1992 through December 2002, all patients treated with IOERT at the Hospital San Francisco de Asis, Madrid/Spain were retrospectively reviewed. The selection criteria included patients with superficial tumors, KPS >70 % and lesions <6 cm. Irradiation was administered in one section. The prescribed dose considered the amount of post-resection residual tumor, previous radiotherapy and the tolerance level of brain structures exposed to IOERT. RESULTS There were 17 patients (53 %) with newly diagnosed malignant brain gliomas and 15 patients with recurrent tumors. The delivered dose varied from 8 to 20 Gy (median 12.5 Gy) for primary and from 8 to 16 Gy (median 10 Gy) for recurrent tumors. The median overall survival for the entire cohort was 13 months (14 and 10.4 months for the primary and recurrent, respectively). Three patients presented with radionecrosis, one patient with osteomyelitis at the craniotomy bone flap, one with intracerebral hemorrhage, and another patient experienced a pulmonary embolism. CONCLUSIONS IOERT is a feasible technique and can be viewed as a tool in the treatment of newly diagnosed or recurrent brain gliomas.
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El-Nemr M, Rimareix F, Karsenti G, Acevedo-Henao C, El Husseiny G, Marsiglia H, Heymann S, Bourgier C. Reconstruction mammaire et irradiation adjuvante des cancers du sein. Cancer Radiother 2012; 16:302-8. [DOI: 10.1016/j.canrad.2012.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 02/16/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022]
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El-Nemr M, Rimareix F, Karsenti G, Acevedo-Henao C, El Husseiny G, Marsiglia H, Heymann S, Bourgier C. Reconstruction mammaire et irradiation adjuvante des cancers du sein. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.04.002] [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: 11/17/2022]
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Sole C, Ovalle V, Russo M, Lopez J, Marsiglia H, Rocha S. 1114 Combined Modality Treatment in Anal Canal Carcinoma – Impact of Full Dose Treatment and Clinical Stage Category on Outcomes. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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36
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El-Nemr M, Rimareix F, Karsenti G, Acevedo-Henao C, El Husseiny G, Marsiglia H, Heymann S, Bourgier C. Reconstruction mammaire et irradiation adjuvante des cancers du sein. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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37
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Acevedo-Henao CM, Heymann S, Rossier C, Garbay JR, Arnedos M, Balleyguier C, Ferchiou M, Marsiglia H, Bourgier C. [Conformal accelerated partial breast irradiation: state of the art]. Cancer Radiother 2012; 16:641-9. [PMID: 22727723 DOI: 10.1016/j.canrad.2012.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/09/2012] [Accepted: 03/27/2012] [Indexed: 11/26/2022]
Abstract
Breast conserving treatment (breast conserving surgery followed by whole breast irradiation) has commonly been used in early breast cancer since many years. New radiation modalities have been recently developed in early breast cancers, particularly accelerated partial breast irradiation. Three-dimensional conformal accelerated partial breast irradiation is the most commonly used modality of radiotherapy. Other techniques are currently being developed, such as intensity-modulated radiotherapy, arctherapy, and tomotherapy. The present article reviews the indications, treatment modalities and side effects of accelerated partial breast irradiation.
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Affiliation(s)
- C-M Acevedo-Henao
- Département de radiothérapie, institut de cancérologie Gustave-Roussy, Villejuif cedex, France
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Bourgier C, Ghorbel I, Heymann S, Barhi M, Mazouni C, Ghuzlan AA, Balleyguier C, Marsiglia H, Delaloge S. Effect of preoperative rescue concomitant FUN/XUN-based chemo-radiotherapy for neoadjuvant chemotherapy-refractory breast cancer. Radiother Oncol 2012; 103:151-4. [DOI: 10.1016/j.radonc.2012.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 11/18/2011] [Accepted: 01/20/2012] [Indexed: 11/17/2022]
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Jacob J, Heymann S, Dumas I, Riahi E, Lefkopoulos D, Maroun P, Deutsch E, Marsiglia H, Bourhis J, Bourgier C. PO-0889 IMPACT OF THE PATIENT SET-UP IN RADIOTHERAPY FOR BREAST CANCER: A PROSPECTIVE DOSIMETRIC STUDY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71222-7] [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: 11/27/2022]
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40
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Azoury F, Heymann S, Acevedo C, Spielmann M, Vielh P, Garbay JR, Taghian AG, Marsiglia H, Bourgier C. Phase II trial of 3D-conformal accelerated partial breast irradiation: Lessons learned from patients and physicians’ evaluation. Radiother Oncol 2012; 103:193-8. [DOI: 10.1016/j.radonc.2012.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 03/09/2012] [Accepted: 03/20/2012] [Indexed: 11/27/2022]
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Marrone I, Guerra JL, Matute R, Bruna M, Sole C, Minguez C, Sanchez-Reyes A, Puebla F, Beltran C, Marsiglia H. PO-0640 PEDIATRIC MEDULLOBLASTOMA: TOXICITY AND OUTCOME OF PATIENTS TREATED WITH HELICAL TOMOTHERAPY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bourgier C, Pessoa EL, Dunant A, Heymann S, Spielmann M, Uzan C, Mathieu MC, Arriagada R, Marsiglia H. Exclusive Alternating Chemotherapy and Radiotherapy in Nonmetastatic Inflammatory Breast Cancer: 20 Years of Follow-Up. Int J Radiat Oncol Biol Phys 2012; 82:690-5. [DOI: 10.1016/j.ijrobp.2010.11.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 11/08/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022]
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Heymann S, Verstraet R, Pichenot C, Vergne E, Lefkopoulos D, Husson F, Kafrouni H, Mahe J, Kandalaft B, Bourhis J, Marsiglia H, Bourgier C. Modulation d’intensité en radiothérapie mammaire : développement d’une méthode innovante de champ dans le champ à l’institut Gustave-Roussy. Cancer Radiother 2011; 15:663-9. [DOI: 10.1016/j.canrad.2011.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 02/06/2011] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
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Bourgier C, Pichenot C, Verstraet R, El Nemr M, Heymann S, Biron B, Delaloge S, Mathieu MC, Garbay JR, Bourhis J, Taghian AG, Marsiglia H. Early Side Effects of Three-Dimensional Conformal External Beam Accelerated Partial Breast Irradiation to a Total Dose of 40 Gy in One Week (A Phase II Trial). Int J Radiat Oncol Biol Phys 2011; 81:1228-35. [DOI: 10.1016/j.ijrobp.2010.07.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 07/09/2010] [Accepted: 07/13/2010] [Indexed: 11/28/2022]
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El Nemr M, Heymann S, Verstraet R, Biron B, Azoury F, Marsiglia H, Bourgier C. Mixed modality treatment planning of accelerated partial breast irradiation: to improve complex dosimetry cases. Radiat Oncol 2011; 6:154. [PMID: 22074547 PMCID: PMC3262019 DOI: 10.1186/1748-717x-6-154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 11/10/2011] [Indexed: 12/25/2022] Open
Affiliation(s)
- Mohamed El Nemr
- Department of Radiation Oncology, Institut Gustave Roussy, 94805 Villejuif, France
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Santos M, Heymann S, Fayard F, Dunant A, Merlusca V, Zainescu R, Arriagada R, Marsiglia H, Bourgier C. Preoperative Radiotherapy in Locally Advanced Breast Cancer Patients: Tumor Response and Patients Outcome after 26 Years of Median Follow-up. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.188] [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]
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Azoury F, Acevedo C, Heymann S, Levy A, Verstraet R, Taghian A, Marsiglia H, Bourgier C. 3D-CRT for Accelerated Partial Breast Irradiation (APBI): Lessons Learned from Patients' Evaluation in a Phase II Trial. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.447] [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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Santos M, Heymann S, Fayard F, Dunant A, Arriagada R, Marsiglia H, Bourgier C. Preoperative radiotherapy in patients with locally advanced breast cancer: Tumor response and patient outcome after 26 years of median follow-up. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.113] [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
113 Background: Preoperative radiotherapy (PreopRT) in locally advanced breast cancer patients (LABC) has been rarely reported. The purpose of this study was to determine if pathological response to PreopRT could have prognostic value on locoregional control and survival. Methods: From 1970 to 1984, 203 LABC patients were treated by PreopRT, delivering 45Gy in 25 fractions to the breast, supraclavicular fossa, axilla and ipsilateral internal mammary chain. After a median interval of 38 days (range: 5-121 days), radical mastectomy and axillary dissection was performed independently of radiation response. Chemotherapy or endocrine therapy was prescribed according to physician discretion in 28% and 11% of patients, respectively. Premenopausal patients underwent ovarian ablation. Median follow-up was 26 years. Locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) were estimated using the Kaplan-Meier method, the comparison of survival between groups was performed using the log-rank test, multivariate analysis was performed using the Cox model. Results: Thirty-three patients (16.2%) had a pathologic complete response (pCR) in the breast. The 10- and 20-year Kaplan-Meier LC were 90% (95% confidence interval CI: 85-94%) and 84% (95% CI: 77-89%), respectively. The 10 and 20-years DFS were 49% (CI: 42-55%) and 35% (CI: 29-42%), and the 10 and 20-years OS, 56% (CI: 49-63%) and 41% (CI: 35-48%), in that order. Patients with pCR tended to have better DFS (p=0.06) and OS (p=0.07) when compared to patients with partial response or stable/progressive disease. Having a pCR did not significantly influenced LRC (p=0.44). Multivariate analysis showed that a lower number of positive nodes on axillary dissection and younger age were associated with better DFS (p<0.0001 and p=0.02) and OS (p<0.0001 and p=0.007). Conclusions: LCR achieved by PreopRT followed by radical mastectomy in LABC was excellent in this study, despite few patients having adjuvant systemic therapy. Complete pathologic response defined a subgroup of women with a trend toward better DFS and OS. Older patients and those with a higher number of involved axillary nodes had a worse prognosis.
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Affiliation(s)
- M. Santos
- Institut Gustave Roussy, Paris, France; Institut Gustave Roussy, Villejuif, France; Karolinska Hospital Solna Radiumhemmet, Stockholm, Sweden
| | - S. Heymann
- Institut Gustave Roussy, Paris, France; Institut Gustave Roussy, Villejuif, France; Karolinska Hospital Solna Radiumhemmet, Stockholm, Sweden
| | - F. Fayard
- Institut Gustave Roussy, Paris, France; Institut Gustave Roussy, Villejuif, France; Karolinska Hospital Solna Radiumhemmet, Stockholm, Sweden
| | - A. Dunant
- Institut Gustave Roussy, Paris, France; Institut Gustave Roussy, Villejuif, France; Karolinska Hospital Solna Radiumhemmet, Stockholm, Sweden
| | - R. Arriagada
- Institut Gustave Roussy, Paris, France; Institut Gustave Roussy, Villejuif, France; Karolinska Hospital Solna Radiumhemmet, Stockholm, Sweden
| | - H. Marsiglia
- Institut Gustave Roussy, Paris, France; Institut Gustave Roussy, Villejuif, France; Karolinska Hospital Solna Radiumhemmet, Stockholm, Sweden
| | - C. Bourgier
- Institut Gustave Roussy, Paris, France; Institut Gustave Roussy, Villejuif, France; Karolinska Hospital Solna Radiumhemmet, Stockholm, Sweden
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Mesbah L, Matute R, Usychkin S, Marrone I, Puebla F, Mínguez C, García R, García G, Beltrán C, Marsiglia H. Helical tomotherapy in the treatment of pediatric malignancies: a preliminary report of feasibility and acute toxicity. Radiat Oncol 2011; 6:102. [PMID: 21871078 PMCID: PMC3224656 DOI: 10.1186/1748-717x-6-102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 08/26/2011] [Indexed: 01/08/2023] Open
Abstract
Background Radiation therapy plays a central role in the management of many childhood malignancies and Helical Tomotherapy (HT) provides potential to decrease toxicity by limiting the radiation dose to normal structures. The aim of this article was to report preliminary results of our clinical experience with HT in pediatric malignancies. Methods In this study 66 consecutive patients younger than 14 years old, treated with HT at our center between January 2006 and April 2010, have been included. We performed statistical analyses to assess the relationship between acute toxicity, graded according to the RTOG criteria, and several clinical and treatment characteristics such as a dose and irradiation volume. Results The median age of patients was 5 years. The most common tumor sites were: central nervous system (57%), abdomen (17%) and thorax (6%). The most prevalent histological types were: medulloblastoma (16 patients), neuroblastoma (9 patients) and rhabdomyosarcoma (7 patients). A total of 52 patients were treated for primary disease and 14 patients were treated for recurrent tumors. The majority of the patients (72%) were previously treated with chemotherapy. The median prescribed dose was 51 Gy (range 10-70 Gy). In 81% of cases grade 1 or 2 acute toxicity was observed. There were 11 cases (16,6%) of grade 3 hematological toxicity, two cases of grade 3 skin toxicity and one case of grade 3 emesis. Nine patients (13,6%) had grade 4 hematological toxicity. There were no cases of grade 4 non-hematological toxicities. On the univariate analysis, total dose and craniospinal irradiation (24 cases) were significantly associated with severe toxicity (grade 3 or more), whereas age and chemotherapy were not. On the multivariate analysis, craniospinal irradiation was the only significant independent risk factor for grade 3-4 toxicity. Conclusion HT in pediatric population is feasible and safe treatment modality. It is characterized by an acceptable level of acute toxicity that we have seen in this highly selected pediatric patient cohort with clinical features of poor prognosis and/or aggressive therapy needed. Despite of a dosimetrical advantage of HT technique, an exhaustive analysis of long-term follow-up data is needed to assess late toxicity, especially in this potentially sensitive to radiation population.
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Affiliation(s)
- Latifa Mesbah
- Radiotherapy Department, Instituto Madrileño de Oncología (Grupo IMO), Madrid, Spain
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Abstract
Patient. We report a 51-year-old male presenting with Grade
III rhabdomyosarcoma. Discussion. A case of rhabdomyosarcoma which developed in
proximity to a metal surgical implant is described. Few cases have been reported in
the world in humans.The therapeutic approach to the disease is presented, together
with a brief review of literature.
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Affiliation(s)
- G M Gatti
- Division Radiotherapy European Institute of Oncology via Ripamonti 435 Milan I-20141 Italy
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