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Dhamelincourt E, Descourt R, Rousseau-Bussac G, Doubre H, Decroisette C, Demontrond P, Le Garff G, Falchero L, Huchot E, Vieillot S, Corre R, Kazulinski L, Bizieux A, Bigay-Gamé L, Morel H, Molinier O, Chouaïd C, Guisier F. Clinical Characteristics of Patients with Advanced ALK-Translocated Non-small Cell Lung Cancers and Long-Term Responses to Crizotinib (CRIZOLONG GFPC 05-19 Study). Target Oncol 2023; 18:905-914. [PMID: 37966566 DOI: 10.1007/s11523-023-01014-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Although ALK-translocated (ALK+) advanced non-small cell lung cancers (aNSCLCs) are currently treated with second- or third-generation ALK inhibitors (ALK-TKIs), some patients respond durably to the first-generation ALK-TKI crizotinib. OBJECTIVE This study aimed to describe the clinical characteristics of these long-term responders. PATIENTS AND METHODS This national, multicenter, retrospective, non-interventional study included patients with ALK+ aNSCLCs and long-term responses to first (L1)- or subsequent (≥ L2)-line crizotinib, defined, respectively, as treatments lasting > 18 and > 10 months. Median treatment duration (mDOT) was the primary endpoint. RESULTS A total of 85 patients (32 L1 and 53 ≥ L2 responders) from 23 centers were included (receiving crizotinib between 10/24/2011-10/02/2018): median age of 59 years, 83.6% non-smokers or ex-smokers, 85.9% performance status (PS) 0/1, 94.1% with adenocarcinomas, median of one metastatic site, and 22.4% with brain metastases (BMs). After median follow-up of 73.4 [95% confidence interval, 67.5-79.9] months, respective L1 and ≥ L2 mDOTs were 43.3 [26.7-56.8] and 29.6 [22.6-35.8] months, with overall survival (OS) not reached (NR) and 116.2 [83.4-NR] months. BM presence or absence did not affect mDOT (31.4 versus 32.9 months) but significantly impacted median OS (70.6 versus 158.6 months; p = 0.0008). Progression on crizotinib was paucisymptomatic (74.1%) and oligometastatic (34.8%), especially BMs (42.4%). After crizotinib discontinuation, 65 (76.5%) patients received subsequent systemic therapy: 57 (67.1%) with second-generation ALK-TKIs. Respective mDOTs of first- and second-line post-crizotinib ALK-TKIs lasted 19.4 [14.9-25.6] and 11.1 [4.8-17.9] months, respectively. CONCLUSIONS Most ALK+ aNSCLC patients with prolonged crizotinib efficacy had paucisymptomatic and oligometastatic disease without BMs. They subsequently benefited from a sequential strategy with other ALK-TKIs.
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Affiliation(s)
| | - Renaud Descourt
- Institut de Cancérologie, Hôpital Morvan, CHU de Brest, Brest, France
| | | | - Hélène Doubre
- Service d'Oncologie Thoracique, Hôpital Foch, Suresnes, France
| | | | | | | | - Lionel Falchero
- Service de Pneumologie, Hôpital Nord-Ouest de Villefranche-sur-Saône, Gleizé, France
| | - Eric Huchot
- Service de Pneumologie, CHU Saint-Pierre, La Réunion, France
| | - Sabine Vieillot
- Service d'Oncologie, Clinique Saint Pierre, Perpignan, France
| | - Romain Corre
- Service de Pneumologie, CH Quimper, Quimper, France
| | - Laure Kazulinski
- Service de Pneumologie, CH du Cotentin Cherbourg, Cherbourg, France
| | - Acya Bizieux
- Service de Pneumologie, CH La Roche-sur-Yon, La Roche-sur-Yon, France
| | | | - Hugues Morel
- Service de Pneumologie, CH Orléans, Orléans, France
| | | | - Christos Chouaïd
- Service de Pneumologie, Centre Hospitalier Intercommunal, Créteil, France
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Decroisette C, Greillier L, Curcio H, Pérol M, Ricordel C, Auliac JB, Falchero L, Veillon R, Vieillot S, Guisier F, Marcq M, Justeau G, Bigay-Game L, Bernardi M, Doubre H, Pinsolle J, Amrane K, Chouaïd C, Descourt R. Three-Year Overall Survival of Patients With Advanced Non-Small-Cell Lung Cancers With ≥50% PD-L1 Expression Treated With First-Line Pembrolizumab Monotherapy in a Real-World Setting (ESCKEYP GFPC Study). J Immunother 2023:00002371-990000000-00069. [PMID: 37807621 DOI: 10.1097/cji.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/16/2023] [Indexed: 10/10/2023]
Abstract
Outside clinical trials, few data are available on the effect of long-term first-line pembrolizumab in patients with advanced non-small-cell lung cancers with ≥50% of tumor cells expressing programmed cell death ligand 1 (PD-L1). This French, multicenter study included consecutive advanced patients with non-small-cell lung cancer given first-line pembrolizumab alone between May 2017 (authorization date for this indication) and November 2019 (authorization date for pembrolizumab-chemotherapy combination). Information was collected from patients' medical files, with a local evaluation of the response and progression-free survival (PFS). Overall survival (OS) was calculated from pembrolizumab onset using the Kaplan-Meier method. The analysis concerned 845 patients, managed in 33 centers: median age: 65 (range: 59-72) years, 67.8% men, 78.1% Eastern Cooperative Oncology Group performance status 0/1, 38.9%/51.5%/6.6% active, ex or never-smokers, respectively, 10.9%/16.8% taking or recently took corticosteroids/antibiotics, 69.6% nonsquamous histology, 48.9% ≥75% PD-L1-positive, and 20.8% had brain metastases at diagnosis. After a median (95% CI) follow-up of 45 (44.1-45.9) months, respective median (95% CI) PFS and OS lasted 8.2 (6.9-9.2) and 22 (8.5-25.9) months; 3-year PFS and OS rates were 25.4% and 39.4%, respectively. Multivariate analysis retained never-smoker status, adenocarcinoma histology, Eastern Cooperative Oncology Group performance status ≥2, and neutrophil/lymphocyte ratio >4 as being significantly associated with shorter survival, but not brain metastases at diagnosis or <75% PD-L1 tumor-cell expression. These long-term results of pembrolizumab efficacy based on a nationwide "real-world" cohort reproduced those obtained in clinical trials.
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Affiliation(s)
- Chantal Decroisette
- Department of Pneumology, Annecy Genevois Hospital, Annecy, France
- Department of Medical Oncology, Léon-Bérard Cancer Center, Lyon, France
| | - Laurent Greillier
- Department of Multidisciplinary Oncology and Therapeutic Innovations, Aix-Marseille University, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Marseille, France
| | - Hubert Curcio
- Departement of Oncology, Centre Anti-Cancer Francois-Baclesse, Caen, France
| | - Maurice Pérol
- Department of Medical Oncology, Léon-Bérard Cancer Center, Lyon, France
| | - Charles Ricordel
- Department of Pneumology, Rennes University Hospital, Rennes, France
| | | | - Lionel Falchero
- Department of Pneumology, Villefranche-sur-Saône Hospital, Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | - Remi Veillon
- Department of Pneumology, Bordeaux University Hospital, Bordeaux, France
| | - Sabine Vieillot
- Department of Oncology, Perpignan Hospital, Perpignan, France
| | - Florian Guisier
- Department of Pneumology, Rouen University Hospital, Rouen, France
| | - Marie Marcq
- Department of Pneumology, La Roche-sur-Yon Hospital, La Roche-sur-Yon, France
| | - Grégoire Justeau
- Department of Oncology, Angers University Hospital, Angers, France
| | | | - Marie Bernardi
- Department of Pneumology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - Hélène Doubre
- Department of Pneumology, Hôpital Foch, Suresnes, France
| | - Julian Pinsolle
- Department of Pneumology, Métropole Savoie Hospital, Chambéry, France
| | - Karim Amrane
- Department of Oncology, Morlaix Hospital, Morlaix, France
| | - Christos Chouaïd
- Department of Pneumology, Créteil University Hospital, Créteil, France
| | - Renaud Descourt
- Department of Oncology, Brest University Hospital, Brest, France
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3
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Thomas-Joulié A, Houillier C, Antoni D, Créhange G, Jouglar E, Colin P, Benchalal M, Lang P, Alfonsi M, Hamidou H, Coutte A, Ahrweiller F, Dadoun N, Pointreau Y, Ammarguellat H, Bernier-Chastagner V, Belkacemi Y, Vieillot S, Hoang-Xuan K, Soussain C, Jacob J, Feuvret L. Brain radiotherapy in patients treated for a newly diagnosed primary central nervous system lymphoma: professional practice evaluation in 19 French centers. Acta Oncol 2023; 62:648-656. [PMID: 37338525 DOI: 10.1080/0284186x.2023.2225146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION The objective of this study was a multicentric evaluation of professional practices, analyzing the irradiation technique itself and its impact on survival and recurrence sites, in primary central nervous system lymphomas (PCNSLs). METHODS We retrospectively analyzed the technical and clinical records of 79 PCNSL patients included in the database of the national expert network for oculocerebral lymphoma ('LOC') who were treated with brain radiotherapy as first-line treatment for newly diagnosed primary central nervous system lymphoma between 2011 and 2018. RESULTS The number of patients treated with brain radiotherapy gradually decreased over time. The heterogeneity of radiotherapy prescriptions was significant, and 55% of them did not comply with published recommendations in terms of irradiation dose and/or volume. The proportion of complete responders to induction chemotherapy treated with reduced-dose radiotherapy increased over time. Partial brain radiotherapy was associated with significantly lower overall survival in univariate analysis. In partial responders to induction chemotherapy, increasing the total dose to the brain >30 Gy and adding a boost to the WBRT induced a trend toward improved progression-free and overall survival. Five recurrences (13%) occurred exclusively in the eyes, all in patients whose eyes had been excluded from the irradiation target volume and including 2 patients without ocular involvement at diagnosis. CONCLUSION The visibility of recommendations for prescribing brain radiotherapy for the treatment of newly diagnosed primary central nervous system lymphoma needs to be improved to harmonize practices and improve their quality. We propose an update of the recommendations.
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Affiliation(s)
- Alice Thomas-Joulié
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
- Department of Radiation Oncology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France
| | - Caroline Houillier
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Paris, France
| | - Delphine Antoni
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Gilles Créhange
- Department of Radiation Oncology, Institut Curie, PSL Research University, Paris, France
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest, Nantes-Saint-Herblain, France
| | - Emmanuel Jouglar
- Department of Radiation Oncology, Institut Curie, PSL Research University, Paris, France
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest, Nantes-Saint-Herblain, France
| | - Philippe Colin
- Department of Radiation Oncology, Institut du Cancer Courlancy, Rouen, France
| | - Mohamed Benchalal
- Department of Radiation Oncology, Centre Eugène Marquis, Rennes, Bretagne, France
| | - Philippe Lang
- Federation Universitaire d'oncologie radiothérapie d'Occitanie, ICG CHU Caremeau, Nîmes, France
| | | | - Hadji Hamidou
- Department of Radiation Oncology, ICO Cancer Center, Centre Paul Papin, Angers, France
| | - Alexandre Coutte
- Department of Radiation Oncology, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Flora Ahrweiller
- Institut de cancérologie et radiothérapie bretillien, Saint Malo, France
| | - Nathalie Dadoun
- Department of Radiation Oncology, Centre de la Baie, Avranches, France
| | - Yohan Pointreau
- Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France
| | - Hanifa Ammarguellat
- Department of Radiation Oncology, Centre Hospitalier Simone Veil, Beauvais, France
| | | | - Yazid Belkacemi
- Department of Radiation Oncology, Hôpital Universitaire Henri Mondor, Créteil, France
| | - Sabine Vieillot
- Department of Radiation Oncology, Centre Catalan d'Oncologie, Perpignan, France
| | - Khê Hoang-Xuan
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Paris, France
| | - Carole Soussain
- Department of Hematology, Institut Curie site de Saint-Cloud, Paris, France
- INSERM U932 Institut Curie, PSL Research University, Paris, France
| | - Julian Jacob
- Department of Radiation Oncology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France
| | - Loïc Feuvret
- Department of Radiation Oncology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France
- Department of Radiation Oncology, Centre Hospitalier Universitaire Lyon Sud, Lyon, France
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Descourt R, Greillier L, Perol M, Ricordel C, Auliac JB, Falchero L, Gervais R, Veillon R, Vieillot S, Guisier F, Marcq M, Justeau G, Bigay-Game L, Bernardi M, Fournel P, Doubre H, Pinsolle J, Amrane K, Chouaïd C, Decroisette C. First-line single-agent pembrolizumab for PD-L1-positive (tumor proportion score ≥ 50%) advanced non-small cell lung cancer in the real world: impact in brain metastasis: a national French multicentric cohort (ESCKEYP GFPC study). Cancer Immunol Immunother 2023; 72:91-99. [PMID: 35729418 DOI: 10.1007/s00262-022-03232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/25/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Few real-world data are available in patients with advanced metastatic non-small cell lung cancer (NSCLC) treated with first-line immunotherapy, particularly in those with brain metastases at treatment initiation. METHODS This was a national, retrospective, multicenter study that consecutively included all patients with PD-L1-positive (tumor proportion score ≥ 50%) advanced NSCLC who initiated first-line treatment with pembrolizumab as a single agent between May 2017 (date of availability of pembrolizumab in this indication in France) to November 22, 2019 (approval of the pembrolizumab-chemotherapy combination). Data were collected from medical records with local response assessment. RESULTS The cohort included 845 patients and 176 (20.8%) had brain metastases at diagnosis. There were no significant differences in outcomes for patients with and without brain metastases: 9.2 (95% CI 5.6-15) and 8 (95% CI 6.7-9.2, p = 0.3) months for median progression-free survival (PFS) and, 29.5 (95% CI 17.2-NA) and 22 (95% CI 17.8-27.1, p = 0.3) months for median overall survival (OS), respectively. Overall response rates were 47% and 45% in patients with and without cerebral metastases. In multivariate analysis, performance status 2-4 vs. 0-1 and neutrophil-to-lymphocyte ratio ≥ 4 vs. < 4 were the main independent negative factors for OS; brain metastasis was not an independent factor for OS. CONCLUSION In this large multicenter cohort, nearly 20% of patients initiating pembrolizumab therapy for advanced NSCLC had cerebral metastases. There was no significant difference in response rates, PFS and OS between patients with and without brain metastases.
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Affiliation(s)
- Renaud Descourt
- Oncology Department, Brest University Hospital, Brest, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Aix Marseille University, Marseille, France
| | - Maurice Perol
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Charles Ricordel
- Pneumology Department, Rennes University Hospital, Rennes, France
| | - Jean-Bernard Auliac
- Pneumology Department, Creteil University Hospital, CHI Créteil, 40 Avenue de Verdun, 94010, Creteil, France
| | - Lionel Falchero
- Pneumology Department, Hôpital Nord-Ouest, Villefranche-sur-Saône Hospital, Gleize, France
| | - Radj Gervais
- Oncology Department, Caen François-Baclesse Cancer Center, Caen, France
| | - Rémi Veillon
- Pneumology Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Florian Guisier
- Pneumology Department, Rouen University Hospital, Rouen, France
| | - Marie Marcq
- Pneumology Department, La Roche-sur-Yon Hospital, La Roche-sur-Yon, France
| | | | | | - Marie Bernardi
- Pneumology Department, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - Pierre Fournel
- Oncology Department, Institut de Cancérologie de La Loire Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Hélène Doubre
- Pneumology Department, Hôpital Foch, Suresnes, France
| | - Julian Pinsolle
- Pneumology Department, Chambéry Métropole Savoie Hospital, Chambéry, France
| | - Karim Amrane
- Oncology Department, Morlaix Hospital, Morlaix, France
| | - Christos Chouaïd
- Pneumology Department, Creteil University Hospital, CHI Créteil, 40 Avenue de Verdun, 94010, Creteil, France.
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Decroisette C, Monnet I, Ricordel C, Demaegdt A, Falchero L, Bylicki O, Geier M, Justeaux G, Bernardi M, Andre M, Guisier F, Fournel P, Vieillot S, Hauss P, Schott R, Crequit J, Auliac J, Chouaid C, Greillier L. 1035P A phase II trial of nivolumab and denosumab association as second-line treatment for stage IV non-small-cell lung cancer (NSCLC) with bone metastases: DENIVOS study (GFPC 06-2017). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1161] [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] Open
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Descourt R, Greillier L, Perol M, Ricordel C, Auliac JB, Falchero L, Demontrond P, Veillon R, Vieillot S, Guisier F, Marcq M, Justeau G, Bigay Game L, Bernardi M, Fournel P, Doubre H, Pinsolle J, Amrane K, Chouaid C, Decroisette C. First-line pembrolizumab monotherapy for PD-L1-positive (TPS ≥ 50%) advanced non-small cell lung cancer (aNSCLC) in the real world: A national French bispective multicentric cohort—ESCKEYP trial (GFPC 05-2018). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9091] [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
9091 Background: To determine real-world outcomes with first line pembrolizumab monotherapy, for aNSCLC with PD-L1 TPS ≥50%. Methods: Bispective, national and multicentric study including consecutively aNSCLC patients who initiated first-line pembrolizumab monotherapy from May 5, 2017 (marketing authorization of pembrolizumab monotherapy in France) to Nov 22, 2019 (marketing authorization of pembrolizumab-chemotherapy for non-squamous aNSCLC). Data were collected on medical charts. Responses were locally assessed according to RECIST v1.1; overall survival (OS) and real-world progression-free survival (rwPFS) were assessed by Kaplan-Meier method. Results: 845 patients (pts) were included by 33 centres: 67.8% were men, PS 0/1/≥2: 25.5%/46.9%/27.6%, active/former/nonsmokers: 39.1%/51.7%/6.4%, adenocarcinoma: 70.8%; stage IV at diagnosis: 91.6%; median number of metastatic sites at baseline: 2±1 (brain (20.8%), liver (13.9%) and bone (35%)); KRAS mutated: 27.7%, PDL1 TPS > 75%: 53.7% At the cut off date (31 December 2020), on the 783/845 (92.7%) evaluable pts, CR, PR, disease stabilization and progression were reported on 4.7%, 42.6%, 24.1% and 28.6% of cases, respectively; 588 (69.6%) pts had discontinued pembrolizumab, 390 (66.4%) had a first disease progression; 320/390 (82.1%) received a second line treatment, mainly platinum-based chemotherapy (90.6%). With a median follow up of 25,8 [95%CI: 24,8-26,7] months, median rwPFS and median OS were 8,2 [95%CI: 6,9-9,5] and 22,6 [95%CI: 18,5-27,4] months, respectively; 6, 12, 18-months survival rates were 76,8%, 64,8% and 54,3%. 835 adverse events were reported in 48% of the patients, grade ≥3 in 13.8% of cases, mainly asthenia, colitis, pneumonitis. For evaluable patients receiving a platinum-based doublet in second line (266/290, 89%), CR, PR, disease stabilization and progression were reported on 1.9%, 41%, 35.3% and 21.8% of cases, respectively. Uni and multivariate analysis of factors related to OS will be presented at the congress. Conclusions: Despite a less stringent selection of patients, pembrolizumab as a single agent achieves similar tumor shrinkage, rwPFS and OS than those of pivotal clinical trials.
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Affiliation(s)
- Renaud Descourt
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations, Hôpital Nord, Marseille, France
| | - Maurice Perol
- Centre Léon Bérard, Department of Medical Oncology, Lyon, France
| | | | | | - Lionel Falchero
- Pneumology Department, Hopital Nord Ouest Villefranche Sur Saone, Villefranche Sur Saone, France
| | | | - Remi Veillon
- CHU Bordeaux, Service Des Maladies Respiratoires, Bordeaux, France
| | | | | | - Marie Marcq
- Centre Hospitalier, La Roche-Sur-Yon, France
| | | | | | | | - Pierre Fournel
- Pneumology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-En-Jarez, France
| | | | | | | | - Christos Chouaid
- Pneumology, Centre Hospitalier Intercommunal (CHI) Creteil, Créteil, France
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7
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Monnet I, Vergnenègre A, Robinet G, Berard H, Lamy R, Falchero L, Vieillot S, Schott R, Ricordel C, Chouabe S, Thomas P, Gervais R, Madroszyk A, Abdiche S, Chiappa AM, Greillier L, Decroisette C, Auliac JB, Chouaïd C. Phase III randomized study of carboplatin pemetrexed with or without bevacizumab with initial versus "at progression" cerebral radiotherapy in advanced non squamous non-small cell lung cancer with asymptomatic brain metastasis. Ther Adv Med Oncol 2021; 13:17588359211006983. [PMID: 33948123 PMCID: PMC8053829 DOI: 10.1177/17588359211006983] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/11/2021] [Indexed: 12/25/2022] Open
Abstract
Background: The role and timing of whole or stereotaxic brain radiotherapy (BR) in patients with advanced non-small cell lung cancer (aNSCLC) and asymptomatic brain metastases (aBMs) are not well established. This study investigates whether deferring BR until cerebral progression was superior to upfront BR for patients with aNSCLC and aBM. Methods: This open-label, multicenter, phase III trial, randomized (1:1) aNSCLC patients with aBMs to receive upfront BR and chemotherapy: platin–pemetrexed and bevacizumab in eligible patients, followed by maintenance pemetrexed with or without bevacizumab, BR arm, or the same chemotherapy with BR only at cerebral progression, chemotherapy (ChT) arm. Primary endpoint was progression-free survival (PFS), secondary endpoints were overall survival (OS), global, extra-cerebral and cerebral objective response rate (ORR), toxicity, and quality of life [ClinicalTrials.gov identifier: NCT02162537]. Results: The trial was stopped early because of slow recruitment. Among 95 included patients, 91 were randomized in 24 centers: 45 to BR and 46 to ChT arms (age: 60 ± 8.1, men: 79%, PS 0/1: 51.7%/48.3%; adenocarcinomas: 92.2%, extra-cerebral metastases: 57.8%, without differences between arms.) Significantly more patients in the BR-arm received BR compare with those in the ChT arm (87% versus 20%; p < 0.001); there were no significant differences between BR and ChT arms for median PFS: 4.7, 95% confidence interval (CI):3.4–7.5 versus 4.8, 95% CI: 2.4–6.5 months, for median OS: 8.5, 95% CI:.6–11.1 versus 8.3, 95% CI:4.5–11.5 months, cerebral and extra-cerebral ORR (27% versus 13%, p = 0.064, and 30% versus 41%, p = 0.245, respectively). The ChT arm had more grade 3/4 neutropenia than the BR arm (13% versus 6%, p = 0.045); others toxicities were comparable. Conclusion: The significant BR rate difference between the two arms suggests that upfront BR is not mandatory in aNSCLC with aBM but this trial failed to show that deferring BR for aBM is superior in terms of PFS from upfront BR.
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Affiliation(s)
| | | | | | - Henri Berard
- Service de Pneumologie, Hôpital d'instruction des armées Sainte-Anne, Toulon, France
| | - Regine Lamy
- Service de Pneumologie, CH Bretagne Sud, Lorient, France
| | - Lionel Falchero
- Service de Pneumologie, Centre Hospitalier de Villefranche de Rouergue, Villefranche, France
| | | | - Roland Schott
- Service d'Oncologie, Centre Paul Strauss, Strasbourg, France
| | | | - Stephane Chouabe
- Service de Pneumologie, CH Charleville Mézière, Charleville Mézière, France
| | | | - Radj Gervais
- Service d'Oncologie, Centre François Baclesse, Caen, France
| | - Anne Madroszyk
- Service d'Oncologie, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Laurent Greillier
- Department of Multidisciplinary Oncology and Therapeutic Innovations, APHM, Hôpital Nord, Marseille, France
| | | | | | - Christos Chouaïd
- Service de Pneumologie, CHI Créteil, 40 avenue de Verdun, Créteil, 94010, France
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de Meric de Bellefon M, Lemanski C, Castan F, Samalin E, Mazard T, Lenglet A, Demontoy S, Riou O, Llacer-Moscardo C, Fenoglietto P, Aillères N, Thezenas S, Debrigode C, Vieillot S, Gourgou S, Azria D. Long-term follow-up experience in anal canal cancer treated with Intensity-Modulated Radiation Therapy: Clinical outcomes, patterns of relapse and predictors of failure. Radiother Oncol 2019; 144:141-147. [PMID: 31809980 DOI: 10.1016/j.radonc.2019.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/02/2019] [Accepted: 11/14/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE To assess the long-term outcomes of patients with squamous cell carcinoma of the anal canal (SCCAC) treated with Intensity-Modulated Radiation Therapy (IMRT). MATERIAL AND METHODS From 2007 to 2015, 193 patients were treated by IMRT for SCCAC. Radiotherapy delivered 45 Gy in 1.8 Gy daily-fractions to the primary tumor and elective nodal areas, immediately followed by a boost of 14.4-20 Gy to the primary tumor and involved nodes. Concurrent chemotherapy with 5-FU-mitomycin (MMC) or cisplatin was added for locally advanced tumors. Survivals were estimated by Kaplan-Meier method. Locoregional (LR) relapses were precisely assessed. Prognostic factors were evaluated by uni- and multivariate analyses. Late toxicity was scored according to the Common Toxicity Criteria for Adverse Events v4.0. RESULTS Median follow-up was 70 months (range, 1-131). Forty-nine men (25%) and 144 women (75%) were analyzed. Median age was 62 years. Tumor stages were I, II, III and IV in 7%, 24%, 63% and 6% of cases, respectively. Chemotherapy was delivered in 167 patients (87%), mainly MMC (80%). Five-year OS, DFS, CFS and LR control rates were 74%, 68%, 66% and 85%, respectively. Forty-one patients (21%) had a relapse: 22 were LR, mostly in-field (68%). Predictors for LR failure were exclusive radiotherapy, chemotherapy lacking MMC and treatment breaks >3 days. Overall late toxicity ≥grade 2 occurred in 43% of patients, with 24% grade 3 and one case of grade 4 (hematuria). CONCLUSION CRT with IMRT assures excellent local control in locally advanced SCCAC with manageable long-term toxicity. Multicentric prospective trials are required to reinforce those results.
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Affiliation(s)
- Maïlys de Meric de Bellefon
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France.
| | - Claire Lemanski
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Florence Castan
- Biometrics Unit ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Emmanuelle Samalin
- Department of Medical Oncology, ICM, Montpellier Cancer Institute - University of Montpellier, INSERM U1194, IRCM, France
| | - Thibault Mazard
- Department of Medical Oncology, ICM, Montpellier Cancer Institute - University of Montpellier, INSERM U1194, IRCM, France
| | - Alexis Lenglet
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Sylvain Demontoy
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Olivier Riou
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Carmen Llacer-Moscardo
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Pascal Fenoglietto
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Norbert Aillères
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Simon Thezenas
- Biometrics Unit ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - Charles Debrigode
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, CHU Nîmes, France
| | - Sabine Vieillot
- Department of Radiation Oncology, Catalan Oncology Center, Perpignan, France
| | - Sophie Gourgou
- Biometrics Unit ICM, Montpellier Cancer Institute - University of Montpellier, France
| | - David Azria
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute - University of Montpellier, France
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Bylicki O, Guisier F, Monnet I, Doubre H, Gervais R, Janicot H, Pérol M, Fournel P, Le Treut J, Lamy R, Vieillot S, Le Caer H, Auliac J, Chouaid C. P1.04-31 Efficacy and Tolerance of Immune-Checkpoint Inhibitors in EGFR, ALK/ROS 1 Non-Small-Cell-Lung-Cancer (NSCLC): GFPC 03-2016 IMAD Study. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.746] [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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Bylicki O, Guisier F, Monnet I, Doubre H, Gervais R, Janicot H, Perol M, Fournel P, Le Treut JH, Lamy R, Le Caer H, Falchero L, Vieillot S, Descourt R, Decroisette C, Urban T, Locher C, Marcq M, Auliac JB, Chouaid C. Efficacy and tolerance of immune-checkpoint inhibitors in EGR, ALK/ROS 1 non-small-cell-lung-cancer (NSCLC): GFPC 03-2016 IMAD study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21022] [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)
| | | | | | | | | | | | - Maurice Perol
- Department of Thoracic Oncology, Centre Léon Bérard, Lyon, France
| | - Pierre Fournel
- GFPC (France), Institut de Cancérologie de la Loire, St. Priest En Jarez, France
| | | | - Régine Lamy
- Centre Hospitalier Bretagne Sud-Lorient, Lorient, France
| | - Hervé Le Caer
- Centre Hospitalier de Saint Brieuc, Saint-Brieuc, France
| | | | | | | | | | | | | | - Marie Marcq
- Centre Hospitalier, La Roche-Sur-Yon, France
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Troussier I, Huguet F, Servagi-Vernat S, Benahim C, Khalifa J, Darmon I, Ortholan C, Krebs L, Dejean C, Fenoglietto P, Vieillot S, Bensadoun RJ, Thariat J. Place de l’arcthérapie modulée et de la chimiothérapie concomitante dans la prise en charge des cancers du canal anal localement évolués. Cancer Radiother 2015. [DOI: 10.1016/j.canrad.2015.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Vieillot S, Fenoglietto P, Lemanski C, Moscardo CL, Gourgou S, Dubois JB, Aillères N, Azria D. IMRT for locally advanced anal cancer: clinical experience of the Montpellier Cancer Center. Radiat Oncol 2012; 7:45. [PMID: 22445137 PMCID: PMC3342212 DOI: 10.1186/1748-717x-7-45] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 03/23/2012] [Indexed: 12/13/2022] Open
Abstract
Purpose To assess outcomes of patients with carcinoma of the anal canal (CAC) treated with intensity-modulated radiation therapy (IMRT). Method and materials From August 2007 to January 2011, seventy-two patients suffering from CAC were treated with IMRT. Concurrent chemotherapy was added in case of locally advanced tumors. Radiation course consisted in delivering an initial plan to the PTV1 defined as the primary tumor and the risk area including pelvic and inguinal nodes. Forty-five Gy in daily 1.8 Gy-daily fractions were delivered five days a week. A second plan of 14.4-20 Gy to the primary tumor (PTV2) was administered in 1.8-2 Gy-daily fractions, 5 days a week. We present here the results of dosimetry, toxicities, and clinical outcome of the first 39 patients with a median follow-up of 24 months. Results Thirty-one women and eight men were included in the present analysis. Tumors were classified as stages I, II, III and IV in 2, 7, 27 and 2 patients, respectively. Median age was 59 years (range, 38-85). Radiotherapy alone (RT) or combined with chemotherapy (RCT) were delivered in 6 (15%) and 33 (85%) patients, respectively. Six patients (15%) required a treatment break ≥ 3 days, and median time for treatment break was 8 days (range, 3-14 days). Acute grade 3 gastrointestinal (GI) and genitourinary (GU) toxicities were seen in 10 and 5% of patients, respectively. Grade 4 toxicity was only hematologic and occurred in 12% patients receiving RCT. With a median follow-up of 24 months, no patient experienced any late grade 4 toxicity. The 2-year overall survival rate was 89%, the 2-year local relapse free survival was 77% and the 2-year colostomy-free survival rate was 85%. Conclusion IMRT is well tolerated with acceptable treatment interruption allowing dose escalation.
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Affiliation(s)
- Sabine Vieillot
- Département de Cancérologie Radiothérapie, CRLC Val d'Aurelle-Paul Lamarque, Montpellier, France
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Riou O, Regnault de la Mothe P, Azria D, Vieillot S, Ailleres N, Dubois JB, Fenoglietto P. Volumetric modulated arctherapy (VMAT) compared with sliding window intensity-modulated radiotherapy (IMRT) for whole pelvis irradiation (WPI) of locally advanced prostate cancer (LAPC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.171] [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
171 Background: Concurrent radiotherapy to the pelvis plus a prostate boost with long term androgen deprivation is a standard of care for LAPC. IMRT has the ability to deliver highly conformal dose to the target while lowering the irradiation of critical organs around the prostate. However, delivery time is signicantly prolonged with static gantry IMRT. VMAT is able to reduce treatment time but results concerning organ sparing are controversial when compared to static gantry IMRT. Methods: 10 patients with locally advanced prostate cancer were included in this dosimetric study. The planning target volumes (PTV) 1 was defined as the pelvic lymph nodes, the prostate and the seminal vesicles plus set up margins. The PTV 2 consisted of the prostate with set up margins. The aimed dose to PTV1 was 54 Gy in 37 fractions and to PTV2, 74 Gy in 37 fractions, in a single plan using the integrated boost method, by means of a 7 coplanar static split fields IMRT, a one arc (RA1) and a two arc (RA2) Rapidarc planification. Results: All three techniques allow a very good coverage of both PTVs with an acceptable homogeneity. Static IMRT enables a better homogeneity for PTV 2 than Rapidarc techniques. Sliding-window IMRT and VMAT permitted to maintain doses to OAR within acceptable levels with a low risk of side-effects for each organ. Nevertheless, VMAT plans result in clinically and statistically significant reduction in doses to bladder (IMRT Vs RA2: Mean dose: 50.1 ± 4.6 Vs 47.1 ± 3.9 Gy, p = 0.037), rectum (Mean dose: 44 ± 4.5 Vs 41.6 ± 5.5 Gy, p = 0.006) and small bowel (V30: 76,47 ± 14,91% Vs. 47,49 ± 16,91%, p = 0.002). Conclusions: VMAT allows for better OAR sparing as compared to sliding-window IMRT while maintining PTV coverage into acceptable levels for WPI of LAPC.
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Affiliation(s)
- Olivier Riou
- CRLC Val d'Aurelle, Montpellier, France; CHU Poitiers, Poitiers, France
| | | | - David Azria
- CRLC Val d'Aurelle, Montpellier, France; CHU Poitiers, Poitiers, France
| | - Sabine Vieillot
- CRLC Val d'Aurelle, Montpellier, France; CHU Poitiers, Poitiers, France
| | - Norbert Ailleres
- CRLC Val d'Aurelle, Montpellier, France; CHU Poitiers, Poitiers, France
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Vieillot S, Azria D, Riou O, Moscardo CL, Dubois JB, Aillères N, Fenoglietto P. Bilateral kidney preservation by volumetric-modulated arc therapy (RapidArc) compared to conventional radiation therapy (3D-CRT) in pancreatic and bile duct malignancies. Radiat Oncol 2011; 6:147. [PMID: 22040762 PMCID: PMC3213214 DOI: 10.1186/1748-717x-6-147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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: 08/05/2011] [Accepted: 10/31/2011] [Indexed: 02/07/2023] Open
Abstract
Background To compare volumetric-modulated arc therapy plans with conventional radiation therapy (3D-CRT) plans in pancreatic and bile duct cancers, especially for bilateral kidney preservation. Methods A dosimetric analysis was performed in 21 patients who had undergone radiotherapy for pancreatic or bile duct carcinoma at our institution. We compared 4-field 3D-CRT and 2 arcs RapidArc (RA) plans. The treatment plan was designed to deliver a dose of 50.4 Gy to the planning target volume (PTV) based on the gross disease in a 1.8 Gy daily fraction, 5 days a week. Planning objectives were 95% of the PTV receiving 95% of the prescribed dose and no more than 2% of the PTV receiving more than 107%. Dose-volume histograms (DVH) for the target volume and the organs at risk (right and left kidneys, bowel tract, liver and healthy tissue) were compared. Monitor units and delivery treatment time were also reported. Results All plans achieved objectives, with 95% of the PTV receiving ≥ 95% of the dose (D95% for 3D-CRT = 48.9 Gy and for RA = 48.6 Gy). RapidArc was shown to be superior to 3D-CRT in terms of organ at risk sparing except for contralateral kidney: for bowel tract, the mean dose was reduced by RA compared to 3D-CRT (16.7 vs 20.8 Gy, p = 0.0001). Similar result was observed for homolateral kidney (mean dose of 4.7 Gy for RA vs 12.6 Gy for 3D-CRT, p < 0.0001), but 3D-CRT significantly reduced controlateral kidney dose with a mean dose of 1.8 Gy vs 3.9 Gy, p < 0.0007. Compared to 3D-CRT, mean MUs for each fraction was significantly increased with RapidArc: 207 vs 589, (p < 0.0001) but the treatment time was not significantly different (2 and 2.66 minutes, p = ns). Conclusion RapidArc allows significant dose reduction, in particular for homolateral kidney and bowel, while maintaining target coverage. This would have a promising impact on reducing toxicities.
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Affiliation(s)
- Sabine Vieillot
- Département de Cancérologie Radiothérapie et de Radiophysique, CRLC Val d'Aurelle-Paul Lamarque, Montpellier, France
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Ducteil A, Kerr C, Idri K, Fenoglietto P, Vieillot S, Aillères N, Dubois J, Azria D. Arcthérapie volumique des tumeurs gynécologiques : amélioration de la couverture du volume cible sans augmentation de la dose aux organes critiques. Cancer Radiother 2011. [DOI: 10.1016/j.canrad.2011.07.108] [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: 10/17/2022]
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Fenoglietto P, Vieillot S, Llacer Moscardo C, Dubois J, Azria D. Préservation des deux reins dans le cas de traitements de cancer abdominaux avec RapidArc®. Cancer Radiother 2011. [DOI: 10.1016/j.canrad.2011.07.110] [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: 10/17/2022]
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Azria D, Vieillot S, Lemanski C, Ailleres N, Fenoglietto P. Clinical Outcome Of Patients Treated With IMRT For Locally Advanced Anal Canal Cancer. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.598] [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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Vieillot S, Fenoglietto P, Lemanski C, Llacer-Moscardo C, Gourgou S, Dubois JB, Aillères N, Azria D. Radiothérapie avec modulation d’intensité pour le carcinome épidermoïde du canal anal : résultats cliniques et évaluation de la toxicité aiguë et de la toxicité tardive. Cancer Radiother 2011. [DOI: 10.1016/j.canrad.2011.07.142] [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: 10/17/2022]
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Abstract
Cancers of the paranasal sinuses are rare tumors, with treatment based on a multidisciplinary approach. Surgery and radiation therapy, possibly associated with chemotherapy are used to obtain 5 years specific survival rate of 60-70 %. Advances in radiotherapy, including the use of imaging for 3D conformal approach require precise knowledge of the radioanatomy for this type of tumor to determine the different volumes of interest. Purpose of this study was to specify radioanatomy and conformal radiation modalities for cancers of the sinuses, and is illustrated by a case report.
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Affiliation(s)
- S Vieillot
- Département de cancérologie radiothérapie, Université Montpellier I, CRLC Val d'Aurelle - Paul-Lamarque, Rue Croix-Verte, 34298 Montpellier, cedex 5, France. sabinevieillot@yahoo
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Vieillot S, Fenoglietto P, Ailleres N, Hay MH, Dubois JB, Azria D. Radiothérapie postopératoire du cancer de la prostate. Cancer Radiother 2010; 14 Suppl 1:S174-81. [DOI: 10.1016/s1278-3218(10)70021-4] [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: 11/25/2022]
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Vieillot S, Azria D, Lemanski C, Moscardo CL, Gourgou S, Dubois JB, Aillères N, Fenoglietto P. Plan comparison of volumetric-modulated arc therapy (RapidArc) and conventional intensity-modulated radiation therapy (IMRT) in anal canal cancer. Radiat Oncol 2010; 5:92. [PMID: 20942958 PMCID: PMC2965153 DOI: 10.1186/1748-717x-5-92] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [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: 08/02/2010] [Accepted: 10/13/2010] [Indexed: 02/07/2023] Open
Abstract
Background To compare volumetric-modulated arc therapy (RapidArc) plans with conventional intensity-modulated radiation therapy (IMRT) plans in anal canal cancers. Methods Ten patients with anal canal carcinoma previously treated with IMRT in our institution were selected for this study. For each patient, three plans were generated with the planning CT scan: one using a fixed beam IMRT, and two plans using the RapidArc technique: a single (RA1) and a double (RA2) modulated arc therapy. The treatment plan was designed to deliver in one process with simultaneous integrated boost (SIB) a dose of 59.4 Gy to the planning target volume (PTV2) based on the gross disease in a 1.8 Gy-daily fraction, 5 days a week. At the same time, the subclinical disease (PTV1) was planned to receive 49.5 Gy in a 1.5 Gy-daily fraction. Plans were normalized to 99% of the PTV2 that received 95% of the prescribed dose. Planning objectives were 95% of the PTV1 will receive 95% of the prescribed dose and no more than 2% of the PTV will receive more than 107%. Dose-volume histograms (DVH) for the target volume and the organs at risk (bowel tract, bladder, iliac crests, femoral heads, genitalia/perineum, and healthy tissue) were compared for these different techniques. Monitor units (MU) and delivery treatment time were also reported. Results All plans achieved fulfilled objectives. Both IMRT and RA2 resulted in superior coverage of PTV than RA1 that was slightly inferior for conformity and homogeneity (p < 0.05). Conformity index (CI95%) for the PTV2 was 1.15 ± 0.15 (RA2), 1.28 ± 0.22 (IMRT), and 1.79 ± 0.5 (RA1). Homogeneity (D5% - D95%) for PTV2 was 3.21 ± 1.16 Gy (RA2), 2.98 ± 0.7 Gy (IMRT), and 4.3 ± 1.3 Gy (RA1). RapidArc showed to be superior to IMRT in terms of organ at risk sparing. For bowel tract, the mean dose was reduced of 4 Gy by RA2 compared to IMRT. Similar trends were observed for bladder, femoral heads, and genitalia. The DVH of iliac crests and healthy tissue resulted in comparable sparing for the low doses (V10 and V20). Compared to IMRT, mean MUs for each fraction was significantly reduced with RapidArc (p = 0.0002) and the treatment time was reduced by a 6-fold extent. Conclusion For patients suffering from anal canal cancer, RapidArc with 2 arcs was able to deliver equivalent treatment plan to IMRT in terms of PTV coverage. It provided a better organ at risk sparing and significant reductions of MU and treatment time per fraction.
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Affiliation(s)
- Sabine Vieillot
- Département de Cancérologie Radiothérapie et de Radiophysique, CRLC Val d'Aurelle-Paul Lamarque, Montpellier, France
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Vieillot S, Fenoglietto P, Lemanski C, Llacer Moscardo C, Menkarios C, Gourgou S, Dubois J, Azria D. Bone-marrow Sparing Intensity-modulated Radiation Therapy (BMS-IMRT) for the Treatment of Early and Locally Advanced Carcinoma of the Anal Canal: Planning Procedure and Early Clinical Experience. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Haie-Meder C, Mazeron R, Verezesan O, Dumas I, Monnier L, Vieillot S, Lhommé C, Morice P, Barillot I. Apport des techniques de curiethérapie optimisée grâce à l’imagerie tridimensionnelle dans la prise en charge des patientes atteintes d’un cancer du col utérin. Cancer Radiother 2009; 13:520-4. [DOI: 10.1016/j.canrad.2009.06.010] [Citation(s) in RCA: 10] [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: 06/12/2009] [Revised: 06/16/2009] [Accepted: 06/17/2009] [Indexed: 12/18/2022]
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François G, Dumas I, Mazeron R, Verezesan O, Monnier L, Vieillot S, Gensse MC, Haie-Meder C. Étude comparative moule vaginal/applicateur de Fletcher en curiethérapie de débit pulsé guidé par IRM chez les patientes atteintes d’un cancer du col utérin. Cancer Radiother 2009. [DOI: 10.1016/j.canrad.2009.08.029] [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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Dubois J, Vieillot S, Llacer-Moscardo C, Lemanski C, Gourgou S, Azria D, Fenoglietto P. TREATMENT OF ANAL CANAL CANCER. A PLANNING STUDY TO COMPARE BONE MARROW SPARING WITH RAPIDARC OR SLIDING WINDOW IMRT. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)73109-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vieillot S, Fenoglietto P, Menkarios C, Ailleres N, Llacer Moscardo C, Dubois JB, Lemanski C. Toxicité aiguë de la radiothérapie conformationnelle avec modulation d’intensité dans le traitement des carcinomes épidermoïdes localement évolués du canal anal. Cancer Radiother 2008. [DOI: 10.1016/j.canrad.2008.08.075] [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: 11/29/2022]
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Vieillot S, Pouessel D, de Champfleur NM, Becht C, Culine S. Reversible posterior leukoencephalopathy syndrome after carboplatin therapy. Ann Oncol 2006; 18:608-9. [PMID: 17164233 DOI: 10.1093/annonc/mdl436] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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