1
|
Pozo RA, Cusack JJ, Acebes P, Malo JE, Traba J, Iranzo EC, Morris-Trainor Z, Minderman J, Bunnefeld N, Radic-Schilling S, Moraga CA, Arriagada R, Corti P. Reconciling livestock production and wild herbivore conservation: challenges and opportunities. Trends Ecol Evol 2021; 36:750-761. [PMID: 34103191 DOI: 10.1016/j.tree.2021.05.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/20/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
Increasing food security and preventing further loss of biodiversity are two of humanity's most pressing challenges. Yet, efforts to address these challenges often lead to situations of conflict between the interests of agricultural production and those of biodiversity conservation. Here, we focus on conflicts between livestock production and the conservation of wild herbivores, which have received little attention in the scientific literature. We identify four key socio-ecological challenges underlying such conflicts, which we illustrate using a range of case studies. We argue that addressing these challenges will require the implementation of co-management approaches that promote the participation of relevant stakeholders in processes of ecological monitoring, impact assessment, decision-making, and active knowledge sharing.
Collapse
Affiliation(s)
- R A Pozo
- Escuela de Agronomía, Pontificia Universidad Católica de Valparaíso, Quillota, 2260000, Chile.
| | - J J Cusack
- Centro de Modelación y Monitoreo de Ecosistemas, Universidad Mayor, Santiago, Chile.
| | - P Acebes
- Terrestrial Ecology Research Group (TEG-UAM), Departamento de Ecología, Universidad Autónoma de Madrid, Madrid, España; Centro de Investigación en Biodiversidad y Cambio Global (CIBC-UAM), Universidad Autónoma de Madrid, Madrid, España
| | - J E Malo
- Terrestrial Ecology Research Group (TEG-UAM), Departamento de Ecología, Universidad Autónoma de Madrid, Madrid, España; Centro de Investigación en Biodiversidad y Cambio Global (CIBC-UAM), Universidad Autónoma de Madrid, Madrid, España
| | - J Traba
- Terrestrial Ecology Research Group (TEG-UAM), Departamento de Ecología, Universidad Autónoma de Madrid, Madrid, España; Centro de Investigación en Biodiversidad y Cambio Global (CIBC-UAM), Universidad Autónoma de Madrid, Madrid, España
| | - E C Iranzo
- Terrestrial Ecology Research Group (TEG-UAM), Departamento de Ecología, Universidad Autónoma de Madrid, Madrid, España; Centro de Investigación en Biodiversidad y Cambio Global (CIBC-UAM), Universidad Autónoma de Madrid, Madrid, España; Laboratorio de Manejo y Conservación de Vida Silvestre, Instituto de Ciencia Animal y Programa de Investigación Aplicada en Fauna Silvestre, Facultad de Ciencias Veterinarias, Universidad Austral de Chile, Valdivia, Chile
| | - Z Morris-Trainor
- School of Biological Sciences, University of Aberdeen, Aberdeen, UK
| | - J Minderman
- Biological and Environmental Sciences, University of Stirling, Stirling, UK
| | - N Bunnefeld
- Biological and Environmental Sciences, University of Stirling, Stirling, UK
| | - S Radic-Schilling
- Departamento de Ciencias Agropecuarias y Acuícolas, Universidad de Magallanes, Punta Arenas, Chile
| | - C A Moraga
- Departamento de Ciencias Agropecuarias y Acuícolas, Universidad de Magallanes, Punta Arenas, Chile; School of Natural Resources and Environment, and Wildlife Ecology and Conservation Department, University of Florida, FL, USA; Centro de Estudios del Cuaternario de Fuego-Patagonia y Antártica (Fundación CEQUA), Punta Arenas, Chile
| | - R Arriagada
- Department of Ecosystems and Environment, Millennium Nucleus Center for the Socioeconomic Impact of Environmental Policies (CESIEP), Pontificia Universidad Católica de Chile, Santiago, Chile; Center for Applied Ecology and Sustainability (CAPES), Pontificia Universidad Católica de Chile, Santiago, Chile; Center for Climate and Resilience Research (CR(2)), Universidad de Chile, Santiago, Chile
| | - P Corti
- Laboratorio de Manejo y Conservación de Vida Silvestre, Instituto de Ciencia Animal y Programa de Investigación Aplicada en Fauna Silvestre, Facultad de Ciencias Veterinarias, Universidad Austral de Chile, Valdivia, Chile
| |
Collapse
|
2
|
Riet F, Fayard F, Arriagada R, Santos M, Bourgier C, Ferchiou M, Heymann S, Delaloge S, Mazouni C, Dunant A, Rivera S. Preoperative radiotherapy in breast cancer patients: 32 years of follow-up. Eur J Cancer 2017; 76:45-51. [DOI: 10.1016/j.ejca.2017.01.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 01/15/2017] [Accepted: 01/24/2017] [Indexed: 11/16/2022]
|
3
|
De Ruysscher D, Lueza B, Le Péchoux C, Johnson DH, O'Brien M, Murray N, Spiro S, Wang X, Takada M, Lebeau B, Blackstock W, Skarlos D, Baas P, Choy H, Price A, Seymour L, Arriagada R, Pignon JP. Impact of thoracic radiotherapy timing in limited-stage small-cell lung cancer: usefulness of the individual patient data meta-analysis. Ann Oncol 2016; 27:1818-28. [PMID: 27436850 PMCID: PMC5035783 DOI: 10.1093/annonc/mdw263] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/24/2016] [Accepted: 06/28/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chemotherapy (CT) combined with radiotherapy is the standard treatment of 'limited-stage' small-cell lung cancer. However, controversy persists over the optimal timing of thoracic radiotherapy and CT. MATERIALS AND METHODS We carried out a meta-analysis of individual patient data in randomized trials comparing earlier versus later radiotherapy, or shorter versus longer radiotherapy duration, as defined in each trial. We combined the results from trials using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival. RESULTS Twelve trials with 2668 patients were eligible. Data from nine trials comprising 2305 patients were available for analysis. The median follow-up was 10 years. When all trials were analysed together, 'earlier or shorter' versus 'later or longer' thoracic radiotherapy did not affect overall survival. However, the HR for overall survival was significantly in favour of 'earlier or shorter' radiotherapy among trials with a similar proportion of patients who were compliant with CT (defined as having received 100% or more of the planned CT cycles) in both arms (HR 0.79, 95% CI 0.69-0.91), and in favour of 'later or longer' radiotherapy among trials with different rates of CT compliance (HR 1.19, 1.05-1.34, interaction test, P < 0.0001). The absolute gain between 'earlier or shorter' versus 'later or longer' thoracic radiotherapy in 5-year overall survival for similar and for different CT compliance trials was 7.7% (95% CI 2.6-12.8%) and -2.2% (-5.8% to 1.4%), respectively. However, 'earlier or shorter' thoracic radiotherapy was associated with a higher incidence of severe acute oesophagitis than 'later or longer' radiotherapy. CONCLUSION 'Earlier or shorter' delivery of thoracic radiotherapy with planned CT significantly improves 5-year overall survival at the expense of more acute toxicity, especially oesophagitis.
Collapse
Affiliation(s)
- D De Ruysscher
- Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands Department of Oncology, Experimental Radiation Oncology, KU Leuven, Leuven, Belgium
| | - B Lueza
- Department of Biostatistics and Epidemiology and "Ligue Nationale Contre le Cancer" meta-analysis platform, Gustave Roussy, Villejuif, France CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif
| | - C Le Péchoux
- Department of Oncology and radiation therapy, Gustave Roussy, Villejuif Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - D H Johnson
- UT Southwestern University School of Medicine, Dallas, USA
| | - M O'Brien
- EORTC Data Center, Brussels, Belgium
| | - N Murray
- British Columbia Cancer Agency, Vancouver, Canada
| | - S Spiro
- University College London Hospitals, London, UK
| | - X Wang
- Alliance Data and Statistical Center, Duke University, Durham, USA
| | - M Takada
- Osaka Prefectural Habikino Hospital, Osaka, Japan
| | - B Lebeau
- Hôpital St Antoine, Paris, France
| | - W Blackstock
- Wake Forest University School of Medicine, Winston-Salem, USA
| | - D Skarlos
- Second Department of Medical Oncology, Metropolitan Hospital N. Faliro, Athens, Greece
| | - P Baas
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Choy
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, USA
| | - A Price
- NHS Lothian and University of Edinburgh, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - L Seymour
- NCIC Clinical Trials Group and Queen's University, Kingston, Canada
| | - R Arriagada
- Gustave Roussy, Villejuif, France Karolinska Institutet, Stockholm, Sweden
| | - J-P Pignon
- Department of Biostatistics and Epidemiology and "Ligue Nationale Contre le Cancer" meta-analysis platform, Gustave Roussy, Villejuif, France CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif
| |
Collapse
|
4
|
Arriagada R, De Thé H, Thomas F, de Cremoux H, Dewar J, Sancho-Garnier H, Le Chevalier T. Prognostic value of initial chemotherapy doses in limited small cell lung cancer. Antibiot Chemother (1971) 2015; 41:194-8. [PMID: 2854440 DOI: 10.1159/000416203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
5
|
Thomas F, Le Chevalier T, Arriagada R, Ruffié P, Baldeyrou P. Should chemotherapy response be evaluated separately in sequential chemotherapy-radiotherapy schedules in locally advanced nonsmall-cell lung carcinoma? Antibiot Chemother (1971) 2015; 41:138-41. [PMID: 2854433 DOI: 10.1159/000416194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- F Thomas
- Institut Gustave-Roussy, Villejuif, France
| | | | | | | | | |
Collapse
|
6
|
Arriagada R. Review of unconventional combinations of radiotherapy and chemotherapy in lung cancer. Antibiot Chemother (1971) 2015; 41:150-4. [PMID: 3072914 DOI: 10.1159/000416196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
7
|
Le Chevalier T, Arriagada R, Thomas F, Baldeyrou P, Ruffie P, de Cremoux H, Martin M, Cerrina ML, De Thé H, Tarayre M. Experience of the Institut Gustave-Roussy in alternating radiotherapy and chemotherapy schedules as induction treatment in limited small-cell lung cancer. Antibiot Chemother (1971) 2015; 41:190-3. [PMID: 2854439 DOI: 10.1159/000416202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
8
|
Arriagada R, Bertino JR, Bleehen NM, Brodin O, Feld R, Goldie JH, Hansen HH, Ihde DC, Le Chevalier T, Souhami RL. Consensus report on combined radiotherapy and chemotherapy modalities in lung cancer. Antibiot Chemother (1971) 2015; 41:232-41. [PMID: 2854445 DOI: 10.1159/000416210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- R Arriagada
- Radiotherapy Department, Institut Gustave-Roussy, Villejuif, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Riet F, Fayard F, Arriagada R, Santos M, Bourgier C, Ferchiou M, Heymann S, Delaloge S, Mazouni C, Dunant A, Rivera S. PD-0432: Preoperative radiotherapy in breast cancer patients: 32-year follow-up. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40428-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
10
|
Rotolo F, Dunant A, Le Chevalier T, Pignon JP, Arriagada R. Adjuvant cisplatin-based chemotherapy in nonsmall-cell lung cancer: new insights into the effect on failure type via a multistate approach. Ann Oncol 2014; 25:2162-2166. [PMID: 25193990 DOI: 10.1093/annonc/mdu442] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Adjuvant cisplatin-based chemotherapy has become the standard therapy against resected nonsmall-cell lung cancer (NSCLC). Because of variable results on its late effect, we reanalyze the long-term data of the International Adjuvant Lung Cancer Trial (IALT) to describe in details the role of adjuvant chemotherapy. PATIENTS AND METHODS In the IALT, 1867 patients were randomized between adjuvant cisplatin-based chemotherapy and control, who were followed up for a median of 7.5 years. Of these, 1687 patients were enrolled from 132 centers accepting to report the times to cancer events. We used event history methodology to estimate the effects of adjuvant chemotherapy on the risks of local relapse, distant metastasis, and death. RESULTS Adjuvant chemotherapy was highly effective against local relapses [HR = 0.73; 95% confidence interval (CI) 0.60-0.90; P = 0.003] and nonbrain metastases (HR = 0.79; 95% CI 0.66-0.94; P = 0.008) but not against brain metastases (HR = 1.1; 95% CI 0.82-1.4; P = 0.61). The effect on noncancer mortality was nonsignificant during the first 5 years (HR = 1.1; 95% CI 0.81-1.5; P = 0.29), whereas the risk of noncancer mortality was subsequently higher with treatment (HR = 3.6; 95% CI 2.2-5.9; P < 0.001). This harmful effect, however, potentially concerned only about 2% of the patients at 8 years. CONCLUSION Adjuvant cisplatin-based chemotherapy reduced the risk of local relapse and of nonbrain metastasis, thereby improving survival. This treatment exerted no residual effect on mortality during the first 5 years, but a higher risk of noncancer mortality was found thereafter. Detailed long-term follow-up is strongly recommended for all patients in randomized trials evaluating adjuvant treatments in NSCLC.
Collapse
Affiliation(s)
- F Rotolo
- Department of Biostatistics and Epidemiology.
| | - A Dunant
- Department of Biostatistics and Epidemiology
| | | | - J-P Pignon
- Department of Biostatistics and Epidemiology
| | - R Arriagada
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | | |
Collapse
|
11
|
Rotolo F, Dunant A, Le Chevalier T, Pignon J, Arriagada R. New Insights Into the Effect of Adjuvant Cisplatin-Based Chemotherapy on the Type of Failure in Non-Small-Cell Lung Cancer. a Competing-Risk and Multistate Approach. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu347.12] [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
|
12
|
Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M, Godwin J, Gray R, Pierce L, Whelan T, Wang Y, Peto R. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 2011; 378:1707-16. [PMID: 22019144 PMCID: PMC3254252 DOI: 10.1016/s0140-6736(11)61629-2] [Citation(s) in RCA: 2525] [Impact Index Per Article: 194.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND After breast-conserving surgery, radiotherapy reduces recurrence and breast cancer death, but it may do so more for some groups of women than for others. We describe the absolute magnitude of these reductions according to various prognostic and other patient characteristics, and relate the absolute reduction in 15-year risk of breast cancer death to the absolute reduction in 10-year recurrence risk. METHODS We undertook a meta-analysis of individual patient data for 10,801 women in 17 randomised trials of radiotherapy versus no radiotherapy after breast-conserving surgery, 8337 of whom had pathologically confirmed node-negative (pN0) or node-positive (pN+) disease. FINDINGS Overall, radiotherapy reduced the 10-year risk of any (ie, locoregional or distant) first recurrence from 35·0% to 19·3% (absolute reduction 15·7%, 95% CI 13·7-17·7, 2p<0·00001) and reduced the 15-year risk of breast cancer death from 25·2% to 21·4% (absolute reduction 3·8%, 1·6-6·0, 2p=0·00005). In women with pN0 disease (n=7287), radiotherapy reduced these risks from 31·0% to 15·6% (absolute recurrence reduction 15·4%, 13·2-17·6, 2p<0·00001) and from 20·5% to 17·2% (absolute mortality reduction 3·3%, 0·8-5·8, 2p=0·005), respectively. In these women with pN0 disease, the absolute recurrence reduction varied according to age, grade, oestrogen-receptor status, tamoxifen use, and extent of surgery, and these characteristics were used to predict large (≥20%), intermediate (10-19%), or lower (<10%) absolute reductions in the 10-year recurrence risk. Absolute reductions in 15-year risk of breast cancer death in these three prediction categories were 7·8% (95% CI 3·1-12·5), 1·1% (-2·0 to 4·2), and 0·1% (-7·5 to 7·7) respectively (trend in absolute mortality reduction 2p=0·03). In the few women with pN+ disease (n=1050), radiotherapy reduced the 10-year recurrence risk from 63·7% to 42·5% (absolute reduction 21·2%, 95% CI 14·5-27·9, 2p<0·00001) and the 15-year risk of breast cancer death from 51·3% to 42·8% (absolute reduction 8·5%, 1·8-15·2, 2p=0·01). Overall, about one breast cancer death was avoided by year 15 for every four recurrences avoided by year 10, and the mortality reduction did not differ significantly from this overall relationship in any of the three prediction categories for pN0 disease or for pN+ disease. INTERPRETATION After breast-conserving surgery, radiotherapy to the conserved breast halves the rate at which the disease recurs and reduces the breast cancer death rate by about a sixth. These proportional benefits vary little between different groups of women. By contrast, the absolute benefits from radiotherapy vary substantially according to the characteristics of the patient and they can be predicted at the time when treatment decisions need to be made. FUNDING Cancer Research UK, British Heart Foundation, and UK Medical Research Council.
Collapse
|
13
|
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]
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Le Péchoux C, Laplanche A, Faivre-Finn C, Ciuleanu T, Wanders R, Lerouge D, Keus R, Hatton M, Videtic GM, Senan S, Wolfson A, Jones R, Arriagada R, Quoix E, Dunant A. Clinical neurological outcome and quality of life among patients with limited small-cell cancer treated with two different doses of prophylactic cranial irradiation in the intergroup phase III trial (PCI99-01, EORTC 22003-08004, RTOG 0212 and IFCT 99-01). Ann Oncol 2010; 22:1154-1163. [PMID: 21139020 DOI: 10.1093/annonc/mdq576] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We recently published the results of the PCI99 randomised trial comparing the effect of a prophylactic cranial irradiation (PCI) at 25 or 36 Gy on the incidence of brain metastases (BM) in 720 patients with limited small-cell lung cancer (SCLC). As concerns about neurotoxicity were a major issue surrounding PCI, we report here midterm and long-term repeated evaluation of neurocognitive functions and quality of life (QoL). PATIENTS AND METHODS At predetermined intervals, the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and brain module were used for self-reported patient data, whereas the EORTC-Radiation Therapy Oncology Group Late Effects Normal Tissue-Subjective, Objective, Management, Analytic scale was used for clinicians' assessment. For each scale, the unfavourable status was analysed with a logistic model including age, grade at baseline, time and PCI dose. RESULTS Over the 3 years studied, there was no significant difference between the two groups in any of the 17 selected items assessing QoL and neurological and cognitive functions. We observed in both groups a mild deterioration across time of communication deficit, weakness of legs, intellectual deficit and memory (all P < 0.005). CONCLUSION Patients should be informed of these potential adverse effects, as well as the benefit of PCI on survival and BM. PCI with a total dose of 25 Gy remains the standard of care in limited-stage SCLC.
Collapse
Affiliation(s)
| | - A Laplanche
- Biostatistics and Epidemiology Unit, Institut Gustave-Roussy, Villejuif, France
| | - C Faivre-Finn
- Department of Clinical Oncology, The Christie, Manchester, UK
| | - T Ciuleanu
- Medical Oncology Department, Institutul Oncologic I. Chiricuta, Cluj-Napoca, Romania
| | - R Wanders
- Radiation Oncology Department, MAASTRO Clinic, Maastricht, The Netherlands
| | - D Lerouge
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | - R Keus
- Radiation Oncology Department, Arnhem's Radiotherapeutisch Instituut, Arnhem, The Netherlands
| | - M Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - G M Videtic
- Radiation Oncology Department, Cleveland Clinic Foundation, Cleveland, USA
| | - S Senan
- Radiation Oncology Department, VU University Medical Centre, Amsterdam, The Netherlands
| | - A Wolfson
- Radiation Oncology Department, University of Miami School of Medicine, Miami, USA
| | - R Jones
- Department of Clinical Oncology, Beatson Oncology Centre, Glasgow, UK
| | - R Arriagada
- Radiation Oncology Department, Karolinska Institutet, Stockholm, Sweden
| | - E Quoix
- Department of Pneumology, Hôpital Lyautey, Strasbourg, France
| | - A Dunant
- Biostatistics and Epidemiology Unit, Institut Gustave-Roussy, Villejuif, France
| | | |
Collapse
|
16
|
Lima Pessoa E, Dunant A, Heymann S, Delaloge S, Spielmann M, Uzan C, Mathieu M, Arriagada R, Marsiglia H, Bourgier C. Twenty-year results of alternating radiotherapy and chemotherapy in nonmetastatic inflammatory breast cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
17
|
Arriagada R, Auperin A, Burdett S, Higgins JP, Johnson DH, Le Chevalier T, Le Pechoux C, Parmar MKB, Pignon JP, Souhami RL, Stephens RJ, Stewart LA, Tierney JF, Tribodet H, van Meerbeeck J. Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data. Lancet 2010; 375:1267-77. [PMID: 20338627 PMCID: PMC2853682 DOI: 10.1016/s0140-6736(10)60059-1] [Citation(s) in RCA: 460] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Many randomised controlled trials have investigated the effect of adjuvant chemotherapy in operable non-small-cell lung cancer. We undertook two comprehensive systematic reviews and meta-analyses to establish the effects of adding adjuvant chemotherapy to surgery, or to surgery plus radiotherapy. METHODS We included randomised trials, not confounded by additional therapeutic differences between the two groups and that started randomisation on or after Jan 1, 1965, which compared surgery plus adjuvant chemotherapy versus surgery alone, or surgery plus adjuvant radiotherapy and chemotherapy versus surgery plus adjuvant radiotherapy. Updated individual patient data were collected, checked, and included in meta-analyses stratified by trial. The primary endpoint was overall survival, defined as time from randomisation until death by any cause. All analyses were by intention to treat. FINDINGS The first meta-analysis of surgery plus chemotherapy versus surgery alone was based on 34 trial comparisons and 8447 patients (3323 deaths). We recorded a benefit of adding chemotherapy after surgery (hazard ratio [HR] 0.86, 95% CI 0.81-0.92, p<0.0001), with an absolute increase in survival of 4% (95% CI 3-6) at 5 years (from 60% to 64%). The second meta-analysis of surgery plus radiotherapy and chemotherapy versus surgery plus radiotherapy was based on 13 trial comparisons and 2660 patients (1909 deaths). We recorded a benefit of adding chemotherapy to surgery plus radiotherapy (HR 0.88, 95% CI 0.81-0.97, p=0.009), representing an absolute improvement in survival of 4% (95% CI 1-8) at 5 years (from 29% to 33%). In both meta-analyses we noted little variation in effect according to the type of chemotherapy, other trial characteristics, or patient subgroup. INTERPRETATION The addition of adjuvant chemotherapy after surgery for patients with operable non-small-cell lung cancer improves survival, irrespective of whether chemotherapy was adjuvant to surgery alone or adjuvant to surgery plus radiotherapy. FUNDING UK Medical Research Council, Institut Gustave-Roussy, Programme Hospitalier de Recherche Clinique (AOM 05 209), Ligue Nationale Contre le Cancer, and Sanofi-Aventis.
Collapse
|
18
|
Rubino C, Arriagada R, Delaloge S, Lê MG. Relation of risk of contralateral breast cancer to the interval since the first primary tumour. Br J Cancer 2010; 102:213-9. [PMID: 19920826 PMCID: PMC2813760 DOI: 10.1038/sj.bjc.6605434] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 10/06/2009] [Accepted: 10/17/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is no consensus on how to separate contralateral breast cancer (CBC) occurring as distant spread of the primary breast cancer (BC) from an independent CBC. METHODS We used standardised incidence ratios (SIRs) to analyse the variations in the risk of CBC over time among 6629 women with BC diagnosed between 1954 and 1983. To explore the most appropriate cutoff to separate the two types of CBC, we analysed the deviance between models including different cutoff points as compared with the basal model with no cutoff date. We also performed a prognostic study through a Cox model. RESULTS The SIR was much higher during the first 2 years of follow-up than afterwards. The best cutoff appeared to be 2 years. The risk of early CBC was linked to tumour spread and the risk of late CBC was linked to age and to the size of the tumour. Radiotherapy was not selected by the model either for early or late CBC risk. CONCLUSION A clearer pattern of CBC risk might appear if studies used a similar cutoff time after the initial BC.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnosis
- Breast Neoplasms/epidemiology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/secondary
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Combined Modality Therapy
- Diagnosis, Differential
- Female
- Follow-Up Studies
- Humans
- Incidence
- Lymphatic Irradiation
- Mastectomy
- Middle Aged
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/epidemiology
- Neoplasms, Radiation-Induced/epidemiology
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/epidemiology
- Prognosis
- Proportional Hazards Models
- Radiotherapy/adverse effects
- Radiotherapy Dosage
- Risk
- Time Factors
- Young Adult
Collapse
Affiliation(s)
- C Rubino
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unit 605, Villejuif Cedex 94805, France.
| | | | | | | |
Collapse
|
19
|
Khodari W, Vataire A, Delaloge S, André F, Uzan C, Garbay J, Dunant A, Arriagada R, Marsiglia H, Bourgier C. The role of radiation therapy as part of local-regional treatment in breast cancer patients with metastatic disease at diagnosis. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
20
|
Le Chevalier T, Dunant A, Arriagada R, Bergman B, Chabowski M, LePechoux C, Kozlowski M, Tarayre M, Pignon JP. Long-term results of the International Adjuvant Lung Cancer Trial (IALT) evaluating adjuvant cisplatin-based chemotherapy in resected non-small cell lung cancer (NSCLC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7507] [Citation(s) in RCA: 26] [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] [Indexed: 11/20/2022] Open
|
21
|
Conforti R, Boulet T, Tomasic G, Spielmann M, Delaloge S, Arriagada R, Veillard AS, Zitvogel L, Michiels S, André F. Predictive value of MRP2, p53, bcl2 and topoisomerase II immunostainings for the efficacy of anthracyclines-based adjuvant chemotherapy in breast cancer: Results from two randomized trials. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
22
|
Le Pechoux C, Hatton M, Kobierska A, Guichard F, Dunant A, Senan S, Jones R, Arriagada R, Wolfson A. Randomized trial of standard dose to a higher dose prophylactic cranial irradiation (PCI) in limited-stage small cell cancer (SCLC) complete responders (CR): Primary endpoint analysis (PCI99–01, IFCT 99–01, EORTC 22003–08004, RTOG 0212). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.lba7514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
23
|
Arriagada R. International expert consensus on radiotherapy of early breast cancer. Ann Oncol 2007; 18:2043-4; author reply 2044-5. [PMID: 18006897 DOI: 10.1093/annonc/mdm505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
24
|
Bourgier C, Garbay JR, Pichenot C, Uzan C, Delaloge S, André F, Spielmann M, Arriagada R, Lefkopoulos D, Marsiglia H. Irradiation conformationnelle tridimensionnelle partielle accélérée dusein: étude defaisabilité dosimétrique. Cancer Radiother 2007. [DOI: 10.1016/j.canrad.2007.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
Mangoni M, Castaing M, Folino E, Livi L, Dunant A, Mathieu MC, Biti GP, Arriagada R, Marsiglia H. Tumeurs phyllodes mammaires borderline etmalignes: analyse rétrospective de37cas traités àl'institut Gustave-Roussy. Cancer Radiother 2007. [DOI: 10.1016/j.canrad.2007.09.026] [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: 10/22/2022]
|
26
|
Conforti R, Boulet T, Tomasic G, Taranchon E, Arriagada R, Spielmann M, Ducourtieux M, Soria JC, Tursz T, Delaloge S, Michiels S, Andre F. Breast cancer molecular subclassification and estrogen receptor expression to predict efficacy of adjuvant anthracyclines-based chemotherapy: a biomarker study from two randomized trials. Ann Oncol 2007; 18:1477-83. [PMID: 17515403 DOI: 10.1093/annonc/mdm209] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the predictive value of breast cancer molecular subclassification regarding the benefit of adjuvant anthracycline-based chemotherapy. PATIENTS AND METHODS Tumor samples from 823 patients included in two randomized trials that compared an anthracycline-based chemotherapy with no treatment were used to construct a tissue array. Estrogen receptor (ER), Her2, epidermal growth factor receptor, cytokeratine 5/6 expressions were determined by immunohistochemistry (IHC). The potential predictive factors of treatment effect on disease-free survival (DFS) were assessed by interaction tests and multivariate analysis. RESULTS Sixty-four (8%), 98 (12%), 109 (14%) and 527 (66%) patients presented a Her2+/ER-, basal-like, Her2-/ER-/nonbasal and luminal-like breast cancer. ER expression, when assessed by IHC, was an independent predictive factor for the benefit of chemotherapy on DFS (test for interaction, P = 0.0015). The molecular subclassification significantly predicted the efficacy of chemotherapy (test for interaction, P = 0.01), but had no significant added value (P = 0.32) as compared to the ER by treatment interaction. Adjuvant chemotherapy was associated with an adjusted hazard ratio for relapse or death of 0.42 [95% confidence interval (CI): 0.17-1.05], 0.54 (95% CI: 0.27-1.08), 0.35 (95% CI: 0.18-0.68), 1.07 (95% CI: 0.81-1.41) for patients with Her2+/ER-, basal-like, Her2-/ER-/nonbasal and luminal-like tumors, respectively. CONCLUSION The breast cancer molecular subclassification was predictive for chemotherapy efficacy in adjuvant setting, but did not provide significant additional information to ER.
Collapse
Affiliation(s)
- R Conforti
- Translational research unit, Unite Propre de Recherche de l'enseignement supérieur, équipe d'accueil 03535, Villejuif, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Aupérin A, Le Péchoux C, Pignon JP, Koning C, Jeremic B, Clamon G, Einhorn L, Ball D, Trovo MG, Groen HJM, Bonner JA, Le Chevalier T, Arriagada R. Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC): A meta-analysis of individual data from 1764 patients. Ann Oncol 2006; 17:473-83. [PMID: 16500915 DOI: 10.1093/annonc/mdj117] [Citation(s) in RCA: 236] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite several randomised trials comparing radiotherapy alone with concomitant radio-chemotherapy in patients with locally advanced non-small cell lung cancer (NSCLC), it is not clear whether the addition of chemotherapy improves survival. PATIENTS AND METHODS This meta-analysis was based on individual patient data from published and unpublished randomised trials which compared radiotherapy alone with the same radiotherapy combined with concomitant cisplatin- or carboplatin-based chemotherapy. Trials with accrual completed after 2000 were excluded. Trials were sought in electronic databases, clinical trial registries and by additional manual searches. The primary endpoint was overall survival analysed using the log-rank test stratified by trials. RESULTS There were twelve eligible trials that included a total of 1921 patients. The data from 3 trials were not available. Therefore, the analysis was based on 9 trials including 1764 patients. Median follow-up was 7.2 years. The hazard ratio of death among patients treated with radio-chemotherapy compared to radiotherapy alone was 0.89 (95% confidence interval, 0.81-0.98; P = 0.02) corresponding to an absolute benefit of chemotherapy of 4% at 2 years. There was some evidence of heterogeneity among trials and sensitivity analyses did not lead to consistent results. The combination of platin with etoposide seemed more effective than platin alone. CONCLUSIONS Concomitant platin-based radio-chemotherapy may improve survival of patients with locally advanced NSCLC. However, the available data are insufficient to accurately define the size of such a potential treatment benefit and the optimal schedule of chemotherapy.
Collapse
Affiliation(s)
- A Aupérin
- Unit of Biostatistics and Epidemiology, Radiation Oncology and Medicine, Institut Gustave-Roussy, Villejuif, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Arriagada R. Impact of delaying radiotherapy in early breast cancer. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)80045-5] [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: 10/24/2022] Open
|
29
|
Arriagada R, Kleinman S, Orlandi L, Roth B, del Castillo C, Gutiérrez J, Zuñiga M, Baeza R. P-191 Induction chemotherapy (CT) followed by acceleratedradiotherapy and concurrent cisplatin in locally advanced non-small cell lung cancer (NSCLC). Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
30
|
Rouzier R, Andre F, Arriagada R, Pusztai L, Spielmann M, Mathieu MC, Marsiglia H, Dunant A, Hortobagyi GN, Delaloge S. Individual benefits from adjuvant anthracycline-based chemotherapy can be predicted from a predictive nomogram created from primary chemotherapy (PC) data: Results of a randomized trial. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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)
- R. Rouzier
- Inst Gustave Roussy/MD Anderson Cancer Ctr, Villejuif/Houston, TX; Inst Gustave Roussy, Villejuif, France; MD Anderson Cancer Ctr, Houston, TX
| | - F. Andre
- Inst Gustave Roussy/MD Anderson Cancer Ctr, Villejuif/Houston, TX; Inst Gustave Roussy, Villejuif, France; MD Anderson Cancer Ctr, Houston, TX
| | - R. Arriagada
- Inst Gustave Roussy/MD Anderson Cancer Ctr, Villejuif/Houston, TX; Inst Gustave Roussy, Villejuif, France; MD Anderson Cancer Ctr, Houston, TX
| | - L. Pusztai
- Inst Gustave Roussy/MD Anderson Cancer Ctr, Villejuif/Houston, TX; Inst Gustave Roussy, Villejuif, France; MD Anderson Cancer Ctr, Houston, TX
| | - M. Spielmann
- Inst Gustave Roussy/MD Anderson Cancer Ctr, Villejuif/Houston, TX; Inst Gustave Roussy, Villejuif, France; MD Anderson Cancer Ctr, Houston, TX
| | - M.-C. Mathieu
- Inst Gustave Roussy/MD Anderson Cancer Ctr, Villejuif/Houston, TX; Inst Gustave Roussy, Villejuif, France; MD Anderson Cancer Ctr, Houston, TX
| | - H. Marsiglia
- Inst Gustave Roussy/MD Anderson Cancer Ctr, Villejuif/Houston, TX; Inst Gustave Roussy, Villejuif, France; MD Anderson Cancer Ctr, Houston, TX
| | - A. Dunant
- Inst Gustave Roussy/MD Anderson Cancer Ctr, Villejuif/Houston, TX; Inst Gustave Roussy, Villejuif, France; MD Anderson Cancer Ctr, Houston, TX
| | - G. N. Hortobagyi
- Inst Gustave Roussy/MD Anderson Cancer Ctr, Villejuif/Houston, TX; Inst Gustave Roussy, Villejuif, France; MD Anderson Cancer Ctr, Houston, TX
| | - S. Delaloge
- Inst Gustave Roussy/MD Anderson Cancer Ctr, Villejuif/Houston, TX; Inst Gustave Roussy, Villejuif, France; MD Anderson Cancer Ctr, Houston, TX
| |
Collapse
|
31
|
Arriagada R, Lê MG, Spielmann M, Mauriac L, Bonneterre J, Namer M, Delozier T, Hill C, Tursz T. Randomized trial of adjuvant ovarian suppression in 926 premenopausal patients with early breast cancer treated with adjuvant chemotherapy. Ann Oncol 2005; 16:389-96. [PMID: 15677625 DOI: 10.1093/annonc/mdi085] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The aim of this multicenter trial was to evaluate the role of ovarian suppression in patients with early breast cancer previously treated with local surgery and adjuvant chemotherapy. PATIENTS AND METHODS Nine hundred and twenty-six premenopausal patients with completely resected breast cancer and either axillary node involvement or histological grade 2 or 3 tumors were randomized after surgery to adjuvant chemotherapy alone (control arm) or adjuvant chemotherapy plus ovarian suppression (ovarian suppression arm). Ovarian suppression was obtained by either radiation-induced ovarian ablation or triptorelin for 3 years. The analyses were performed with Cox models stratified by center. RESULTS Median follow-up was 9.5 years. Mean age was 43 years. Ninety per cent of patients had histologically proven positive axillary nodes, 63% positive hormonal receptors and 77% had received an anthracycline-based chemotherapy regimen. Ovarian suppression was by radiation-induced ovarian ablation (45% of patients) or with triptorelin (48%). At the time of randomization, all patients had regular menses or their follicle-stimulating hormone and estradiol levels indicated a premenopausal status. The 10-year disease-free survival rates were 49% [95% confidence interval (CI) 44% to 54%] in both arms (P = 0.51). The 10-year overall survival rates were 66% (95% CI 61% to 70%) for the ovarian suppression arm and 68% (95% CI 63% to 73%) for the control arm (P = 0.19). There were no variations in the treatment effect according to age, hormonal receptor status or ovarian suppression modality. However, in patients <40 years of age and with estrogen receptor-positive tumors, ovarian suppression significantly decreased the risk of recurrence (P = 0.01). CONCLUSIONS The results of this trial, after at least 10 years of follow-up, do not favor the use of ovarian suppression after adjuvant chemotherapy. The potential beneficial effect in younger women with hormono-dependent tumors should be further assessed.
Collapse
MESH Headings
- Adult
- Age Factors
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Chemotherapy, Adjuvant
- Estradiol/blood
- Female
- Follicle Stimulating Hormone/blood
- Humans
- Luteolytic Agents/therapeutic use
- Lymphatic Metastasis
- Middle Aged
- Neoplasm Recurrence, Local
- Ovary/radiation effects
- Premenopause
- Receptors, Estrogen
- Risk Factors
- Survival Analysis
- Treatment Outcome
- Triptorelin Pamoate/therapeutic use
Collapse
Affiliation(s)
- R Arriagada
- Institut Gustave-Roussy, Bureau 607 A, +1, rue Camille Desmoulins, 94805 Villejuif Cedex, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Le Pechoux C, Pignon J, Quoix E, Kosatova K, Bellenis I, Abratt R, Morere J, Smickoska S, Gralla R, Bitenc M, Arriagada R. Impact of adjuvant chemotherapy (CT) on survival and local-control in non-small cell lung cancer (NSCLC): Results of the international adjuvant lung cancer trial (IALT). Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.06.202] [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: 11/30/2022]
|
33
|
Fayette J, Soria JC, Lassalle M, Wartelle M, Tarayre M, Le Pechoux C, Ruffié P, Arriagada R, Pignon JP, Le Chevalier T. Prognostic factors in limited small-cell lung cancer (SCLC): Results of a large retrospective study in a monocentric setting. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7215] [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)
- J. Fayette
- Institut Gustave Roussy, Villejuif, France
| | | | | | | | - M. Tarayre
- Institut Gustave Roussy, Villejuif, France
| | | | - P. Ruffié
- Institut Gustave Roussy, Villejuif, France
| | | | | | | |
Collapse
|
34
|
Rouzier R, Slimane K, Garbay JR, Arriagada R, Marsiglia H, Mathieu MC, Andre F, Delaloge S, Spielmann M. Prognostic role of serum Ca 15–3 and circumstances of diagnostic in advanced breast cancer: Data from a prospective randomized trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.810] [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)
- R. Rouzier
- MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Villejuif, France
| | - K. Slimane
- MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Villejuif, France
| | - J.-R. Garbay
- MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Villejuif, France
| | - R. Arriagada
- MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Villejuif, France
| | - H. Marsiglia
- MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Villejuif, France
| | - M.-C. Mathieu
- MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Villejuif, France
| | - F. Andre
- MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Villejuif, France
| | - S. Delaloge
- MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Villejuif, France
| | - M. Spielmann
- MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Villejuif, France
| |
Collapse
|
35
|
Arriagada R, Lê M, Dunant A. Reply to Letter to the Editor “Late local recurrences in a randomized trial comparing conservative treatment with total mastectomy in early breast cancer patients: the impact of receptor status on local relapse” by Altundag et al. (Ann Oncol 2004: 15; 990). Ann Oncol 2004. [DOI: 10.1093/annonc/mdh226] [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
|
36
|
Arriagada R, Lê MG, Guinebretière JM, Dunant A, Rochard F, Tursz T. Late local recurrences in a randomised trial comparing conservative treatment with total mastectomy in early breast cancer patients. Ann Oncol 2004; 14:1617-22. [PMID: 14581268 DOI: 10.1093/annonc/mdg452] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A randomised trial was conducted comparing wide lumpectomy and breast irradiation with modified radical mastectomy. As the follow-up was long (mean duration 22 years), we analysed the variation in the effect of treatment over time. PATIENTS AND METHODS The trial included 179 patients with a breast cancer measuring </=2 cm at macroscopic examination. Eighty-eight patients had breast-conserving surgery and radiotherapy, and 91 underwent mastectomy. All patients had axillary dissection. The analyses were based on Cox models with time-dependent treatment effects. RESULTS The effect of treatment on death or metastasis did not vary with time. The risk of local recurrence was lower during the first 5 years for the breast-conserving surgery group as compared with the mastectomy group, but higher after 5 years (P = 10(-4) for a different treatment effect over time). Similar results were found in a database including 1847 patients with small breast tumours at diagnosis. In this analysis, late breast recurrences were also more frequent in the breast-conserving surgery group and this treatment effect was greater among younger patients (</=40 years at the time of diagnosis). CONCLUSIONS Late breast recurrences were more frequently observed in younger patients treated with breast-conserving treatment compared with those submitted to mastectomy. These results require confirmation in other randomised studies so that younger patients with early breast cancer can receive adequate counselling and so that a more stringent long-term follow-up policy can be adopted when breast-conserving treatment is planned.
Collapse
|
37
|
Affiliation(s)
- R Arriagada
- Instituto de Radiomedicina, Santiago, Chile.
| | | | | |
Collapse
|
38
|
Cox JD, Le Chevalier T, Arriagada R, Choy H, Curran WJ, Fukuoka M, Harper P, Komaki R, Le Pechoux C, Lievens Y, Rami-Porta R, Ready N, Sause W, Stuschke M, Thatcher N. Management of unresectable non-small cell carcinoma of the lung (NSCLC). Lung Cancer 2003; 42 Suppl 1:S15-6. [PMID: 14708518 DOI: 10.1016/s0169-5002(03)00298-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J D Cox
- Department of Radiation Oncology, M. D. Anderson Cancer Center, Houston, TX, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
|
40
|
Arriagada R, Spielmann M, Koscielny S, Le Chevalier T, Delozier T, Ducourtieux M, Tursz T, Hill C. Patterns of failure in a randomized trial of adjuvant chemotherapy in postmenopausal patients with early breast cancer treated with tamoxifen. Ann Oncol 2002; 13:1378-86. [PMID: 12196363 DOI: 10.1093/annonc/mdf299] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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: 11/14/2022] Open
Abstract
BACKGROUND We studied the effect of adjuvant anthracycline-based chemotherapy in postmenopausal patients with resected early breast cancer treated with adjuvant tamoxifen. PATIENTS AND METHODS The trial included 835 patients with either axillary lymph node involvement, or tumors with histological grade II or III. They were randomized after local surgery to receive either tamoxifen (TAM group) or tamoxifen plus chemotherapy (TAM-CT group) consisting of six courses of 5-fluorouracil, doxorubicin and cyclophosphamide (FAC), or 5-fluorouracil, epidoxorubicin and cyclophosphamide (FEC). Radiotherapy was given after completion of adjuvant chemotherapy in the TAM-CT group and after surgery in the TAM group. RESULTS The 5-year disease-free survival (DFS) rates were 73% in the TAM group and 79% in the TAM-CT group (log-rank test, P = 0.06). The 5-year overall survival rates were 82% and 87%, respectively (P = 0.06). The 5-year distant metastasis rates were 22% and 16% (P = 0.02), and the 5-year local recurrence rates were 6% and 4%, respectively (P = 0.23). There were no significant differences for contralateral breast cancer or other new primary malignancies. Chemotherapy tended to be more effective for patients who had tumors without estrogen receptors (trend test, P = 0.05). CONCLUSIONS Anthracycline-based chemotherapy administered to postmenopausal patients receiving adjuvant tamoxifen gave a borderline significant benefit on overall and DFS, mainly by a reduction in distant metastases. Delaying radiotherapy after six courses of chemotherapy did not affect local control after up to 10 years of follow-up.
Collapse
|
41
|
Arriagada R, Lê MG, Contesso G, Guinebretière JM, Rochard F, Spielmann M. Predictive factors for local recurrence in 2006 patients with surgically resected small breast cancer. Ann Oncol 2002; 13:1404-13. [PMID: 12196366 DOI: 10.1093/annonc/mdf227] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Analyses of predictive factors for local recurrences are important, as an increasing number of patients with early breast cancer opt for a breast-conserving procedure. This study investigates whether factors predictive of local recurrence differ between patients treated with conservative or radical surgery. PATIENTS AND METHODS Two thousands and six patients with invasive breast carcinoma (< or =25 mm) were included. Of these patients, 717 were treated conservatively (lumpectomy and breast irradiation) and 1289 were treated with total mastectomy. All patients had axillary dissection and received lymph node irradiation if axillary nodes were positive. Most patients did not receive adjuvant chemotherapy or additive hormonal treatments. The mean duration of follow-up was 20 years. The main end point was the total local recurrence rate. The risk factors of local recurrence were estimated by multivariate analyses and interaction tests were used for intergroup comparisons. RESULTS Statistically significant predictive factors for mastectomized patients were histological grade, extensive axillary node involvement (10 nodes or more), and inner quadrant tumors, which were of borderline significance. Young age, however, was not a prognostic indicator for local recurrence. The main statistically significant factor for patients treated with a conservative approach was young age (< or =40 years). These younger patients had a five-fold increased risk of developing a breast recurrence compared with patients older than 60 years. CONCLUSIONS Younger patients with early breast cancer treated with breast-conserving surgery should in particular be followed up at regular intervals so that any sign of local failure can be diagnosed early.
Collapse
MESH Headings
- Adult
- Age Distribution
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Chile
- Cohort Studies
- Combined Modality Therapy
- Female
- Humans
- Incidence
- Lymph Nodes/pathology
- Lymphatic Metastasis
- Mastectomy/methods
- Mastectomy, Segmental
- Multivariate Analysis
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Predictive Value of Tests
- Probability
- Prognosis
- Retrospective Studies
- Risk Assessment
- Survival Analysis
Collapse
Affiliation(s)
- R Arriagada
- Institut Gustave-Roussy (IGR), Villejuif, France.
| | | | | | | | | | | |
Collapse
|
42
|
Arriagada R, Le Chevalier T, Rivière A, Chomy P, Monnet I, Bardet E, Santos-Miranda JA, Le Péhoux C, Tarayre M, Benhamou S, Laplanche A. Patterns of failure after prophylactic cranial irradiation in small-cell lung cancer: analysis of 505 randomized patients. Ann Oncol 2002; 13:748-54. [PMID: 12075744 DOI: 10.1093/annonc/mdf123] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [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: 12/12/2022] Open
Abstract
BACKGROUND Prophylactic cranial irradiation (PCI) has a beneficial effect on overall survival in patients with small-cell lung cancer (SCLC) in complete remission as shown in a worldwide meta-analysis. The current analysis aimed to evaluate PCI effects on patterns of failure in this patient category. PATIENTS AND METHODS The Institut Gustave-Roussy coordinated two parallel randomized studies including a total of 511 patients with SCLC. Patients were randomly assigned to either PCI (24 Gy in eight fractions and 12 days) or no PCI. Patterns of failure were analyzed according to (i) total event rates and (ii) isolated first site of relapse using a competing risk approach. RESULTS Five hundred and five patients were analyzed. The 5-year cumulative rate of brain metastasis as an isolated first site of relapse was 37% in the control group and 20% in the PCI group (P < 0.001). The overall 5-year rates of brain metastasis were 59% and 43%, respectively [relative risk (RR) 0.50; P < 0.001]. The 5-year overall survival rates were 15% in the control group and 18% in the PCI group (RR 0.84; P = 0.06). CONCLUSIONS PCI decreased significantly the risk of brain metastasis. Other events were not influenced. The relative death risk reduction was of borderline significance. Results reported as isolated first cause of failure and subsequent competing events may explain why a major treatment effect on brain metastases rate has a rather moderate effect on survival.
Collapse
|
43
|
|
44
|
Grunenwald DH, André F, Le Péchoux C, Girard P, Lamer C, Laplanche A, Tarayre M, Arriagada R, Le Chevalier T. Benefit of surgery after chemoradiotherapy in stage IIIB (T4 and/or N3) non-small cell lung cancer. J Thorac Cardiovasc Surg 2001; 122:796-802. [PMID: 11581616 DOI: 10.1067/mtc.2001.116472] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate postchemoradiotherapy surgery in stage IIIB non-small cell lung cancer. METHODS Forty patients with stage IIIB non-small cell lung cancer were included in this phase II study. A preoperative diagnosis of stage IIIB cancer was based on mediastinoscopy or a thoracotomy in all patients. Induction treatment included two cycles of cisplatin (100 mg/m(2), day 1), 5-fluorouracil (1 g/m(2), days 1-3), and vinblastine (4 mg/m(2), day 1) combined with 42 Gy of hyperfractionated radiotherapy delivering 21 Gy in two sessions. Patients with a clinical response were offered surgery. RESULTS The minimum follow-up for survivors was 48 months. Thirty patients had a T4 lesion and 18 had N3 disease. Twenty-nine patients (73%) had a clinical objective tumor response after induction treatment. These 29 patients underwent thoracotomy, and a complete resection was performed in 23 (58%). Two postoperative deaths occurred (7%). Four patients had a pathologic complete response at the time of surgery (10%). The 5-year survival is 19% for the overall population. When only patients who had persistent viable tumor cells at surgery are considered (n = 25), the 5-year survival is 28%. The 5-year survival is 42% for patients having no mediastinal lymph node involvement at the time of surgery and being treated with complete resection. CONCLUSION This study shows that surgery, when feasible, is associated with a 28% long-term survival for patients in whom chemoradiotherapy alone fails to control disease.
Collapse
Affiliation(s)
- D H Grunenwald
- Thoracic Department, Institut Mutualiste Montsouris, Paris, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Kibenge FS, Gárate ON, Johnson G, Arriagada R, Kibenge MJ, Wadowska D. Isolation and identification of infectious salmon anaemia virus (ISAV) from Coho salmon in Chile. Dis Aquat Organ 2001; 45:9-18. [PMID: 11411649 DOI: 10.3354/dao045009] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The isolation of infectious salmon anaemia virus (ISAV) from asymptomatic wild fish species including wild salmon, sea trout and eel established that wild fish can be a reservoir of ISAV for farmed Atlantic salmon. This report characterizes the biological properties of ISAV isolated from a disease outbreak in farmed Coho salmon in Chile and compares it with ISAV isolated from farmed Atlantic salmon in Canada and Europe. The virus that was isolated from Coho salmon tissues was initially detected with ISAV-specific RT-PCR (reverse transcription-polymerase chain reaction). The ability of the virus to grow in cell culture was poor, as cytopathology was not always conspicuous and isolation required passage in the presence of trypsin. Virus replication in cell culture was detected by RT-PCR and IFAT (indirect fluorescent antibody test), and the virus morphology was confirmed by positive staining electron microscopy. Further analysis of the Chilean virus revealed similarities to Canadian ISAV isolates in their ability to grow in the CHSE-214 cell line and in viral protein profile. Sequence analysis of genome segment 2, which encodes the viral RNA polymerase PB1, and segment 8, which encodes the nonstructural proteins NS1 and NS2, showed the Chilean virus to be very similar to Canadian strains of ISAV. This high sequence similarity of ISAV strains of geographically distinct origins illustrates the highly conserved nature of ISAV proteins PB1, NS1 and NS2 of ISAV. It is noteworthy that ISAV was associated with disease outbreaks in farmed Coho salmon in Chile without corresponding clinical disease in farmed Atlantic salmon. This outbreak, which produced high mortality in Coho salmon due to ISAV, is unique and may represent the introduction of the virus to a native wild fish population or a new strain of ISAV.
Collapse
Affiliation(s)
- F S Kibenge
- Department of Pathology and Microbiology, University of Prince Edward Island, Charlottetown, Canada.
| | | | | | | | | | | |
Collapse
|
46
|
|
47
|
Abstract
Adjuvant radiotherapy decreases the risk of locoregional recurrences threefold, according to the results of many randomized trials and overviews. In patients treated with total mastectomy, the risk of local recurrence is mainly related to the number of involved axillary nodes, i.e. about 25%, 35% and 55% at 10 years when 1-3, 4-9 and 10 or more nodes are involved, respectively. In contrast, at 10 years, less than 15% of patients with negative axillary nodes relapse locally. The effect of adjuvant radiotherapy on distant metastases and overall survival is a controversial issue. On the one hand, recent results are compatible with the existence of a mechanism of secondary dissemination generated from locoregional tumor nests. The beneficial effect of radiotherapy can be observed whether with or without adjuvant systemic treatment. On the other hand, a deleterious late toxic effect, mainly cardiac, has also been shown. The importance of improvements in radiation techniques and quality assurance to obtain a positive balance in terms of overall survival is emphasized.
Collapse
|
48
|
Grunenwald D, Andre F, Lepechoux C, Girard P, Tarayre M, Laplanche A, Arriagada R, Le Chevalier T. Concurrent radiochemotherapy followed by surgery for stage IIIB non small cell lung cancer patients: Long-term follow-up of the CEBI 142 study. Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80423-7] [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: 11/28/2022]
|
49
|
Affiliation(s)
- R Arriagada
- Department of Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile.
| | | |
Collapse
|
50
|
Hasbini A, Le Péchoux C, Roche B, Pignol JP, Zelek L, Abdulkarim B, Arriagada R, Guinebretière JM, Tardivon A, Spielmann M, Habrand JL. [Alternating chemotherapy and hyperfractionated accelerated radiotherapy in non-metastatic inflammatory breast cancer]. Cancer Radiother 2000; 4:265-73. [PMID: 10994390 DOI: 10.1016/s1278-3218(00)80004-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/28/2022]
Abstract
PURPOSE Based on encouraging results reported in alternating radiotherapy and chemotherapy in inflammatory breast carcinoma, we have tried in this study to optimize locoregional treatment with a hyperfractionated accelerated radiotherapy schedule alternating with chemotherapy. PATIENTS AND METHODS From May 1991 to May 1995, 54 patients, previously untreated, with non-metastatic inflammatory breast cancer were entered in an alternating protocol consisting of eight courses of combined chemotherapy and two series of loco-regional hyperfractionated accelerated radiotherapy with a total dose of 66 Gy. Hyperfractionated accelerated radiotherapy was started after three courses of neoadjuvant chemotherapy (Adriamycin, Vincristine, Cyclophosphamide, Methotrexate, 5-fluoro-uracile) administered every 21 days +/- G.CSF. The first series delivered 45 Gy/three weeks to the breast, the axillary, subclavicular and internal mammary nodes, with two daily sessions of 1.5 Gy separated by an interval of eight hours; the second series consisted of a boost (21 Gy/14 fractions/10 d) alternating with another regimen of anthracycline-based-chemotherapy (a total of five cycles every three weeks). Hormonal treatment was given to all patients. RESULTS Of the 53 patients evaluated at the end of the treatment, 44 (83%) had a complete clinical response, seven (13%) had a partial response (> 50%) and two (4%) had tumoral progression. Of the 51 patients who were locally controlled, 18 (35%) presented a locoregional recurrence (LRR); eight (15%) had to undergo a mastectomy. All the patients but two with LRR developed metastases or died of local progressive disease and 26 (50%) developed metastases. With a median follow-up of 39 months (range: 4-74 months), survival rates at three and five years were respectively, 66 and 45% for overall survival and 45 and 36% for disease-free survival. CONCLUSION Alternating a combination of chemotherapy and hyperfractionated accelerated radiotherapy is a well-tolerated regimen which provides acceptable local control. The systemic dissemination remains the major problem of inflammatory breast carcinoma and further clinical trials using alternative drug regimens are warranted.
Collapse
Affiliation(s)
- A Hasbini
- Département de radiothérapie, institut Gustave-Roussy, Villejuif, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|