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Hennequin C, Azria D, Blanchard P, Créhange G, Deutsch É, Lisbona A, Moyal É, Pasquier D, Roca L, Supiot S, Giraud P. Specificities of clinical research in radiotherapy. Cancer Radiother 2021; 26:104-107. [PMID: 34953712 DOI: 10.1016/j.canrad.2021.11.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this review is to present the specificities of clinical research in radiation oncology. Objectives are similar to all research in oncology: to improve the efficacy and to decrease toxic effects. Phase III trials remain the main methodology to demonstrate an improvement in efficiency, but phase I-II and registers are also important tools to validate an improvement in the therapeutic index with new technologies. In this article we discuss the special features of end-points, selection of population, and design for radiation oncology clinical trials. Quality control of delivered treatments is an important component of these protocols. Financial issues are also discussed, in the particular context of France.
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Affiliation(s)
- C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, université de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - D Azria
- IRCM Inserm U1194, Fédération universitaire d'oncologie radiothérapie Montpellier-Nîmes (Forom), Institut du cancer de Montpellier (ICM), université de Montpellier, 34000 Montpellier, France
| | - P Blanchard
- Institut Gustave-Roussy, 94800 Villejuif, France
| | - G Créhange
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - É Deutsch
- Institut Gustave-Roussy, 94800 Villejuif, France
| | - A Lisbona
- Institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - É Moyal
- Inserm UMR1037, CRCT, Institut universitaire du cancer, Oncopôle, 31000 Toulouse, France
| | - D Pasquier
- Cristal UMR 9189, département universitaire de radiothérapie, centre Oscar-Lambret, Lille, université de Lille, 59000 Lille, France
| | - L Roca
- Institut du cancer Montpellier (ICM), 34000 Montpellier, France
| | - S Supiot
- Institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - P Giraud
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, université de Paris, 20, rue Leblanc, 75015 Paris, France
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Peyraga G, Ducassou A, Arnaud FX, Lizée T, Pouédras J, Moyal É. [Radiotherapy and spinal toxicity: News and perspectives]. Cancer Radiother 2020; 25:55-61. [PMID: 33303351 DOI: 10.1016/j.canrad.2020.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/26/2020] [Accepted: 05/01/2020] [Indexed: 01/21/2023]
Abstract
Radiation-induced myelopathy is a devastating late effect of radiotherapy. Fortunately, this late effect is exceptional. The clinical presentation of radiation myelopathy is aspecific, typically occurring between 6 to 24 months after radiotherapy, and radiation-induced myelopathy remains a diagnosis of exclusion. Magnetic resonance imaging is the most commonly used imaging tool. Radiation oncologists must be extremely cautious to the spinal cord dose, particularly in stereotactic radiotherapy and reirradiation. Conventionally, a maximum dose of 50Gy is tolerated in normofractionated radiotherapy (1.8 to 2Gy per fraction). Repeat radiotherapies lead to consider cumulative doses above this recommendation to offer individualized reirradiation. Several factors increase the risk of radiation-induced myelopathy, such as concomitant or neurotoxic chemotherapy. The development of predictive algorithms to prevent the risk of radiation-induced myelopathy is promising. However, radiotherapy prescription should be cautious, regarding to ALARA principle (as low as reasonably achievable). As the advent of immunotherapy has improved patient survival data and the concept of oligometastatic cancer is increasing in daily practice, stereotactic treatments and reirradiations will be increasingly frequent indications. Predict the risk of radiation-induced myelopathy is therefore a major issue in the following years, and remains a daily challenge for radiation oncologists.
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Affiliation(s)
- G Peyraga
- Service de radiothérapie, groupe de radiothérapie et d'oncologie des Pyrénées (Grop), chemin de l'Ormeau, 65000 Tarbes, France.
| | - A Ducassou
- Service de radiothérapie, Institut universitaire du cancer de Toulouse (Oncopole), 1, avenue Irène-Joliot-Curie, 31000 Toulouse, France
| | - F-X Arnaud
- Service de radiothérapie, Institut universitaire du cancer de Toulouse (Oncopole), 1, avenue Irène-Joliot-Curie, 31000 Toulouse, France
| | - T Lizée
- Service de radiothérapie, Institut cancérologique de l'ouest, centre Paul-Papin, 15, rue André-Bocquel, 49055 Angers, France
| | - J Pouédras
- Service de radiothérapie, Institut universitaire du cancer de Toulouse (Oncopole), 1, avenue Irène-Joliot-Curie, 31000 Toulouse, France
| | - É Moyal
- Service de radiothérapie, Institut universitaire du cancer de Toulouse (Oncopole), 1, avenue Irène-Joliot-Curie, 31000 Toulouse, France
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Modesto A, Dalmasso C, Chaltiel L, Pagès C, Boulinguez S, Sibaud V, Chira C, Latorzeff I, Lubrano V, Moyal É, Meyer N. Le traitement local intracrânien des métastases cérébrales de mélanome allonge la survie globale des patients pris en charge par immunothérapie ou anti-Braf. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.058] [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: 12/01/2022]
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Modesto A, Chira C, Sol JC, Lubrano V, Boulinguez S, Pagès C, Sibaud V, Gomez-Roca C, Moyal É, Meyer N. Prise en charge des patients atteints de métastases cérébrales de mélanome. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Modesto A, Chira C, Sol JC, Lubrano V, Boulinguez S, Pagès C, Sibaud V, Gomez-Roca C, Moyal É, Meyer N. Prise en charge des patients atteints de métastases cérébrales de mélanome. Cancer Radiother 2019; 23:147-150. [DOI: 10.1016/j.canrad.2018.05.006] [Citation(s) in RCA: 2] [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] [Received: 01/22/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 11/29/2022]
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Modesto A, Chira C, Sol JC, Lubrano V, Boulinguez S, Pagès C, Sibaud V, Gomez-Roca C, Moyal É, Meyer N. Prise en charge des patients atteints de métastases cérébrales de mélanome. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.03.004] [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: 10/27/2022]
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Aboudaram A, Meyer N, Chaltiel L, Gomez-Roca C, Boulinguez S, Sibaud V, Delord JP, Chira C, Delannes M, Moyal É, Modesto A. Radiothérapie et immunothérapie anti-PD-1 concomitante chez les patients atteints d’un mélanome métastatique : données préliminaires d’efficacité et de tolérance. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.098] [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: 11/16/2022]
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Aoulad N, Massabeau C, de Lafontan B, Vieillevigne L, Hangard G, Ciprian C, Chaltiel L, Moyal É, Izar F. Toxicité aiguë de la tomothérapie des cancers mammaires. Cancer Radiother 2017; 21:180-189. [DOI: 10.1016/j.canrad.2016.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/19/2016] [Accepted: 11/25/2016] [Indexed: 11/29/2022]
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Laprie A, Hu Y, Alapetite C, Carrie C, Habrand J, Bolle S, Bondiau P, Ducassou A, Huchet A, Bertozzi A, Perel Y, Moyal É, Balosso J. Paediatric brain tumours: A review of radiotherapy, state of the art and challenges for the future regarding protontherapy and carbontherapy. Cancer Radiother 2015. [DOI: 10.1016/j.canrad.2015.09.004] [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]
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Laprie A, Hu Y, Alapetite C, Carrie C, Habrand J, Bolle S, Bondiau P, Ducassou A, Huchet A, Bertozzi A, Perel Y, Moyal É, Balosso J. Paediatric brain tumours: A review of radiotherapy, state of the art and challenges for the future regarding protontherapy and carbontherapy. Cancer Radiother 2015. [DOI: 10.1016/j.canrad.2015.09.003] [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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Laprie A, Hu Y, Alapetite C, Carrie C, Habrand JL, Bolle S, Bondiau PY, Ducassou A, Huchet A, Bertozzi AI, Perel Y, Moyal É, Balosso J. Paediatric brain tumours: A review of radiotherapy, state of the art and challenges for the future regarding protontherapy and carbontherapy. Cancer Radiother 2015; 19:775-89. [PMID: 26548600 DOI: 10.1016/j.canrad.2015.05.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 12/17/2014] [Revised: 05/18/2015] [Accepted: 05/21/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Brain tumours are the most frequent solid tumours in children and the most frequent radiotherapy indications in paediatrics, with frequent late effects: cognitive, osseous, visual, auditory and hormonal. A better protection of healthy tissues by improved beam ballistics, with particle therapy, is expected to decrease significantly late effects without decreasing local control and survival. This article reviews the scientific literature to advocate indications of protontherapy and carbon ion therapy for childhood central nervous system cancer, and estimate the expected therapeutic benefits. MATERIALS AND METHODS A systematic review was performed on paediatric brain tumour treatments using Medline (from 1966 to March of 2014). To be included, clinical trials had to meet the following criteria: age of patients 18 years or younger, treated with radiation, and report of survival. Studies were also selected according to the evidence level. A secondary search of cited references found other studies about cognitive functions, quality of life, the comparison of photon and proton dosimetry showing potential dose escalation and/or sparing of organs at risk with protontherapy; and studies on dosimetric and technical issues related to protontherapy. RESULTS A total of 7051 primary references published were retrieved, among which 40 clinical studies and 60 papers about quality of life, dose distribution and dosimetry were analysed, as well as the ongoing clinical trials. These papers have been summarized and reported in a specific document made available to the participants of a final 1-day workshop. Tumours of the meningeal envelop and bony cranial structures were excluded from the analysis. Protontherapy allows outstanding ballistics to target the tumour area, while substantially decreasing radiation dose to the normal tissues. There are many indications of protontherapy for paediatric brain tumours in curative intent, either for localized treatment of ependymomas, germ-cell tumours, craniopharyngiomas, low-grade gliomas; or panventricular irradiation of pure non-secreting germinoma; or craniospinal irradiation of medulloblastomas and metastatic pure germinomas. Carbon ion therapy is just emerging and may be studied for highly aggressive and radioresistant tumours, as an initial treatment for diffuse brainstem gliomas, and for relapse of high-grade gliomas. CONCLUSION Both protontherapy and carbon ion therapy are promising for paediatric brain tumours. The benefit of decreasing late effects without altering survival has been described for most paediatric brain tumours with protontherapy and is currently assessed in ongoing clinical trials with up-to-date proton devices. Unfortunately, in 2015, only a minority of paediatric patients in France can receive protontherapy due to the lack of equipment.
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Affiliation(s)
- A Laprie
- Université Paul-Sabatier, Toulouse, France; Institut Claudius-Regaud, institut universitaire du cancer de Toulouse (IUCT)-Oncopole, radiation oncology, 1, avenue Irene-Joliot-Curie, 31059 Toulouse, France; Périclès-France-Hadron, Toulouse, France.
| | - Y Hu
- GCS-Étoile-France-Hadron, Lyon, France
| | - C Alapetite
- Institut Curie Paris Orsay (ICPO)-France-Hadron, Orsay, France
| | - C Carrie
- GCS-Étoile-France-Hadron, Lyon, France; Centre Léon-Bérard, Lyon, France
| | - J-L Habrand
- Institut Curie Paris Orsay (ICPO)-France-Hadron, Orsay, France; Université Paris Sud, Orsay, France; Archade-France-Hadron, Caen, France; Centre François-Baclesse, Caen, France; Gustave-Roussy, Villejuif, France
| | - S Bolle
- Institut Curie Paris Orsay (ICPO)-France-Hadron, Orsay, France; Impact-France-Hadron, Nice, France
| | - P-Y Bondiau
- Centre Antoine-Lacassagne, Nice, France; CHU de Bordeaux, Bordeaux, France
| | - A Ducassou
- Institut Claudius-Regaud, institut universitaire du cancer de Toulouse (IUCT)-Oncopole, radiation oncology, 1, avenue Irene-Joliot-Curie, 31059 Toulouse, France; Périclès-France-Hadron, Toulouse, France
| | - A Huchet
- Hôpital des Enfants, Toulouse, France
| | - A-I Bertozzi
- Périclès-France-Hadron, Toulouse, France; Université Grenoble Alpes, Grenoble, France
| | - Y Perel
- Université Grenoble Alpes, Grenoble, France
| | - É Moyal
- Université Paul-Sabatier, Toulouse, France; Institut Claudius-Regaud, institut universitaire du cancer de Toulouse (IUCT)-Oncopole, radiation oncology, 1, avenue Irene-Joliot-Curie, 31059 Toulouse, France; Périclès-France-Hadron, Toulouse, France
| | - J Balosso
- GCS-Étoile-France-Hadron, Lyon, France; CHU de Grenoble, Grenoble, France
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Martin V, Moyal É, Delannes M, Padovani L, Sunyach MP, Feuvret L, Dhermain F, Noël G, Laprie A. Radiothérapie des tumeurs cérébrales : quelles marges ? Cancer Radiother 2013; 17:434-43. [DOI: 10.1016/j.canrad.2013.07.136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 07/09/2013] [Indexed: 01/15/2023]
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Camilleri J, Laprie A, Sors A, Kerjean P, Kerjean JC, Gros-Dagnac H, Moyal É, Delannes M, Franceries X. Doit-on changer la technique d’utilisation des bolus en radiothérapie des cancers cutanés ? Cancer Radiother 2011. [DOI: 10.1016/j.canrad.2011.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Supper C, Vieillevigne L, Franceries X, Ken S, Simon L, Rives M, Moyal É, Delannes M, Noël A, Laprie A. Optimisation de la balistique en modulation d’intensité avec intégration d’un boost concomitant pour la radiothérapie des glioblastomes. Cancer Radiother 2010. [DOI: 10.1016/j.canrad.2010.07.505] [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: 11/16/2022]
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