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Belkacemi Y, Debbi K, Besnard C, Grellier N, Fonteneau G, Colson-Durand L, Lerouge D, Durdux C, Campana F, Pons P, Flandin I, Pasquier D, de Crevoisier R, Wachter T, Thureau S, Noël G, Conzague-Casabianca L, Petit A, Supiot S, Azria D. [The morbidity and mortality review meetings in radiotherapy departments: Procedure, implementation and prospects of the "Proust" French national project]. Cancer Radiother 2023; 27:474-479. [PMID: 37507286 DOI: 10.1016/j.canrad.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023]
Abstract
Radiation-induced acute and late toxicity depends on several parameters. The type, severity and duration of morbidity are mainly related to irradiated volume, total dose and its fractionation and the intrinsic radiosensitivity of the patients. The follow-up of these toxicities is essential. However, unlike many specialties, morbidity and mortality reviews procedures are not developed as part of quality governance programs in radiation therapy departments for the monitoring of toxicity which sometimes hinder the patients' quality of life. One French survey published within the framework of the project entitled Prospective Registration of Morbidity and Mortality, Individual Radiosensitivity and Radiation Technique (Proust), conclude that there was a lack of knowledge of morbidity and mortality reviews and considerable confusion between these reviews and other quality processes without perspective for the local morbidity and mortality reviews development in a large number of the participated centers. In this article, we will discuss the procedure of the "ideal morbidity and mortality reviews" and its implementation through a monocentric experience started in 2015. Thus, the Proust project is a unique opportunity to implement and standardize a national morbidity and mortality reviews implementation in radiation therapy departments by involving the French regions.
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Affiliation(s)
- Y Belkacemi
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Équipe i-Biot, unité 955, Inserm, IMRB, université Paris-Est Créteil, Créteil, France.
| | - K Debbi
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Équipe i-Biot, unité 955, Inserm, IMRB, université Paris-Est Créteil, Créteil, France
| | - C Besnard
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - N Grellier
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - G Fonteneau
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - L Colson-Durand
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Service d'oncologie-radiothérapie, Institut oncologique Paris-Nord, Sarcelles, France
| | - D Lerouge
- Service d'oncologie-radiothérapie, centre François-Baclesse, Caen, France
| | - C Durdux
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, AP-HP, université Paris-Cité, Paris, France
| | - F Campana
- Service d'oncologie-radiothérapie, institut Hartmann, Levallois-Perret, France
| | - P Pons
- Service d'oncologie-radiothérapie, institut Hartmann, Levallois-Perret, France
| | - I Flandin
- Service d'oncologie-radiothérapie, centre hospitalier universitaire de Grenoble, Grenoble, France
| | - D Pasquier
- Département universitaire d'oncologie-radiothérapie, centre Oscar-Lambret, UMR 9189, université de Lille, Centre de recherche en informatique, signal et automatique de Lille (Cristal), Lille, France
| | - R de Crevoisier
- Service d'oncologie-radiothérapie, centre Eugène-Marquis, Rennes, France
| | - T Wachter
- Service d'oncologie-radiothérapie, centre hospitalier général d'Orléans, Orléans, France
| | - S Thureau
- Service d'oncologie-radiothérapie, centre Henri-Becquerel, QuantIF Litis unit EA 4108, université de Rouen, Rouen, France
| | - G Noël
- Service d'oncologie-radiothérapie, institut de cancérologie Strasbourg Europe (ICANS), université de Strasbourg, Strasbourg, France
| | | | - A Petit
- Service d'oncologie-radiothérapie, institut Bergonié, Bordeaux, France
| | - S Supiot
- Service d'oncologie-radiothérapie, institut de cancérologie de l'Ouest, centre René-Gauducheau, université de Nantes, Nantes, France
| | - D Azria
- Service d'oncologie-radiothérapie, Institut du cancer de Montpellier (ICM), université de Montpellier, Institut de recherche sur le cancer de Montpellier (IRCM), unit 1194, Inserm, Montpellier, France
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Benderitter M, Caviggioli F, Chapel A, Coppes RP, Guha C, Klinger M, Malard O, Stewart F, Tamarat R, van Luijk P, Limoli CL. Stem cell therapies for the treatment of radiation-induced normal tissue side effects. Antioxid Redox Signal 2014; 21:338-55. [PMID: 24147585 PMCID: PMC4060814 DOI: 10.1089/ars.2013.5652] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
SIGNIFICANCE Targeted irradiation is an effective cancer therapy but damage inflicted to normal tissues surrounding the tumor may cause severe complications. While certain pharmacologic strategies can temper the adverse effects of irradiation, stem cell therapies provide unique opportunities for restoring functionality to the irradiated tissue bed. RECENT ADVANCES Preclinical studies presented in this review provide encouraging proof of concept regarding the therapeutic potential of stem cells for treating the adverse side effects associated with radiotherapy in different organs. Early-stage clinical data for radiation-induced lung, bone, and skin complications are promising and highlight the importance of selecting the appropriate stem cell type to stimulate tissue regeneration. CRITICAL ISSUES While therapeutic efficacy has been demonstrated in a variety of animal models and human trials, a range of additional concerns regarding stem cell transplantation for ameliorating radiation-induced normal tissue sequelae remain. Safety issues regarding teratoma formation, disease progression, and genomic stability along with technical issues impacting disease targeting, immunorejection, and clinical scale-up are factors bearing on the eventual translation of stem cell therapies into routine clinical practice. FUTURE DIRECTIONS Follow-up studies will need to identify the best possible stem cell types for the treatment of early and late radiation-induced normal tissue injury. Additional work should seek to optimize cellular dosing regimes, identify the best routes of administration, elucidate optimal transplantation windows for introducing cells into more receptive host tissues, and improve immune tolerance for longer-term engrafted cell survival into the irradiated microenvironment.
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Affiliation(s)
- Marc Benderitter
- 1 Laboratory of Radiopathology and Experimental Therapies, IRSN , PRP-HOM, SRBE, Fontenay-aux-Roses, France
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Voswinkel J, Francois S, Simon JM, Benderitter M, Gorin NC, Mohty M, Fouillard L, Chapel A. Use of mesenchymal stem cells (MSC) in chronic inflammatory fistulizing and fibrotic diseases: a comprehensive review. Clin Rev Allergy Immunol 2014; 45:180-92. [PMID: 23296948 DOI: 10.1007/s12016-012-8347-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Mesenchymal stem cells (MSC), multipotent adult stem cells, feature the potential to regenerate tissue damage and, in parallel, inhibit inflammation and fibrosis. MSC can be safely transplanted in autologous and allogeneic ways as they are non-immunogenic, and consequently represent a therapeutic option for refractory connective tissue diseases, fibrosing diseases like scleroderma and fistulizing colitis like in Crohn's disease. Actually, there are more than 200 registered clinical trial sites for evaluating MSC therapy, and 22 are on autoimmune diseases. In irradiation-induced colitis, MSC accelerate functional recovery of the intestine and dampen the systemic inflammatory response. In order to provide rescue therapy for accidentally over-irradiated prostate cancer patients who underwent radiotherapy, allogeneic bone marrow-derived MSC from family donors were intravenously infused to three patients with refractory and fistulizing colitis resembling fistulizing Crohn's disease. Systemic MSC therapy of refractory irradiation-induced colitis was safe and effective on pain, diarrhoea, hemorrhage, inflammation and fistulization accompanied by modulation of the lymphocyte subsets towards an increase of T regulatory cells and a decrease of activated effector T cells. The current data indicate that MSC represent a promising alternative strategy in the treatment of various immune-mediated diseases. Encouraging results have already been obtained from clinical trials in Crohn's disease and SLE as well as from case series in systemic sclerosis. MSC represent a safe therapeutic measure for patients who suffer from chronic and fistulizing colitis. These findings are instructional for the management of refractory inflammatory bowel diseases that are characterized by similar clinical and immunopathological features.
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Affiliation(s)
- Jan Voswinkel
- Department of Hematology, Saint Antoine Hospital APHP and UPMC University, UMRS 938, 184 rue Faubourg Saint Antoine, 75012, Paris, France,
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Voswinkel J, Francois S, Simon JM, Benderitter M, Gorin NC, Mohty M, Fouillard L, Chapel A. Use of mesenchymal stem cells (MSC) in chronic inflammatory fistulizing and fibrotic diseases: a comprehensive review. Clin Rev Allergy Immunol 2013. [PMID: 23296948 DOI: 10.1007/s12016-012-8347-6.] [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] [Indexed: 11/29/2022]
Abstract
Mesenchymal stem cells (MSC), multipotent adult stem cells, feature the potential to regenerate tissue damage and, in parallel, inhibit inflammation and fibrosis. MSC can be safely transplanted in autologous and allogeneic ways as they are non-immunogenic, and consequently represent a therapeutic option for refractory connective tissue diseases, fibrosing diseases like scleroderma and fistulizing colitis like in Crohn's disease. Actually, there are more than 200 registered clinical trial sites for evaluating MSC therapy, and 22 are on autoimmune diseases. In irradiation-induced colitis, MSC accelerate functional recovery of the intestine and dampen the systemic inflammatory response. In order to provide rescue therapy for accidentally over-irradiated prostate cancer patients who underwent radiotherapy, allogeneic bone marrow-derived MSC from family donors were intravenously infused to three patients with refractory and fistulizing colitis resembling fistulizing Crohn's disease. Systemic MSC therapy of refractory irradiation-induced colitis was safe and effective on pain, diarrhoea, hemorrhage, inflammation and fistulization accompanied by modulation of the lymphocyte subsets towards an increase of T regulatory cells and a decrease of activated effector T cells. The current data indicate that MSC represent a promising alternative strategy in the treatment of various immune-mediated diseases. Encouraging results have already been obtained from clinical trials in Crohn's disease and SLE as well as from case series in systemic sclerosis. MSC represent a safe therapeutic measure for patients who suffer from chronic and fistulizing colitis. These findings are instructional for the management of refractory inflammatory bowel diseases that are characterized by similar clinical and immunopathological features.
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Affiliation(s)
- Jan Voswinkel
- Department of Hematology, Saint Antoine Hospital APHP and UPMC University, UMRS 938, 184 rue Faubourg Saint Antoine, 75012, Paris, France,
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Meyrieux C, Garcia R, Pourel N, Mège A, Bodez V. [FMEA applied to the radiotherapy patient care process]. Cancer Radiother 2012; 16:613-8. [PMID: 23092808 DOI: 10.1016/j.canrad.2012.07.188] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 07/13/2012] [Accepted: 07/17/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Failure modes and effects analysis (FMEA), is a risk analysis method used at the Radiotherapy Department of Institute Sainte-Catherine as part of a strategy seeking to continuously improve the quality and security of treatments. PATIENTS AND METHODS The method comprises several steps: definition of main processes; for each of them, description for every step of prescription, treatment preparation, treatment application; identification of the possible risks, their consequences, their origins; research of existing safety elements which may avoid these risks; grading of risks to assign a criticality score resulting in a numerical organisation of the risks. Finally, the impact of proposed corrective actions was then estimated by a new grading round. RESULTS For each process studied, a detailed map of the risks was obtained, facilitating the identification of priority actions to be undertaken. For example, we obtain five steps in patient treatment planning with an unacceptable level of risk, 62 a level of moderate risk and 31 an acceptable level of risk. CONCLUSION The FMEA method, used in the industrial domain and applied here to health care, is an effective tool for the management of risks in patient care. However, the time and training requirements necessary to implement this method should not be underestimated.
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Affiliation(s)
- C Meyrieux
- Secteur qualité - gestion des risques, institut Sainte-Catherine, Avignon cedex, France.
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