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Barry B, Dolivet G, Clatot F, Huguet F, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Coste F, Cupissol D, Cuvelier P, De Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, De Raucourt D. [French national standard for the treatment of squamous cell carcinoma of upper aero-digestive tract - General principles of treatment]. Bull Cancer 2024; 111:393-415. [PMID: 38418334 DOI: 10.1016/j.bulcan.2023.12.007] [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: 07/03/2023] [Revised: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVES The management of upper aerodigestive tract cancers is a complex specialty. It is essential to provide an update to establish optimal care. At the initiative of the INCa and under the auspices of the SFORL, the scientific committee, led by Professor Béatrix Barry, Dr. Gilles Dolivet, and Dr. Dominique De Raucourt, decided to develop a reference framework aimed at defining, in a scientific and consensus-based manner, the general principles of treatment for upper aerodigestive tract cancers applicable to all sub-locations. METHODOLOGY To develop this framework, a multidisciplinary team of practitioners was formed. A systematic analysis of the literature was conducted to produce recommendations classified by grades, in accordance with the standards of the French National Authority for Health (HAS). RESULTS The grading of recommendations according to HAS standards has allowed the establishment of a reference for patient care based on several criteria. In this framework, patients benefit from differentiated care based on prognostic factors they present (age, comorbidities, TNM status, HPV status, etc.), conditions of implementation, and quality criteria for indicated surgery (operability, resectability, margin quality, mutilation, salvage surgery), as well as quality criteria for radiotherapy (target volume, implementation time, etc.). The role of medical and postoperative treatments was also evaluated based on specific criteria. Finally, supportive care must be organized from the beginning and throughout the patients' care journey. CONCLUSION All collected data have led to the development of a comprehensive framework aimed at harmonizing practices nationally, facilitating decision-making in multidisciplinary consultation meetings, promoting equality in practices, and providing a state-of-the-art and reference practices for assessing the quality of care. This new framework is intended to be updated every 5 years to best reflect the latest advances in the field.
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Affiliation(s)
- Béatrix Barry
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | - Gilles Dolivet
- Institut de cancérologie de Lorraine, ORL et CCF, Nancy (54), France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Olivier Duffas
- Centre hospitalier de Libourne, ORL et CMF, Libourne, France
| | | | | | | | - Diane Evrard
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | | | - Nicolas Fakhry
- Assistance publique-Hôpitaux de Marseille, ORL et CCF, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Didier Salvan
- Centre hospitalier Sud Francilien, ORL et CCF, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
| | - Véronique Block
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
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Dolivet G, Barry B, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Clatot F, Coste F, Cupissol D, Cuvelier P, de Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Huguet F, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, de Raucourt D. [National standard for the treatment of squamous cell carcinoma of upper aerodigestive tract]. Bull Cancer 2024; 111:327-332. [PMID: 38336530 DOI: 10.1016/j.bulcan.2023.08.015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Gilles Dolivet
- ORL et CCF, Institut de cancérologie de Lorraine, Nancy, France.
| | - Béatrix Barry
- ORL et CCF, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | | | | | | | | | | | | | | | | | | | - Philippe Cuvelier
- ORL et CCF libéral à Bayonne et centre hospitalier Oloron, Oloron-Sainte-Marie, France
| | | | | | - Olivier Duffas
- ORL et CMF, centre hospitalier de Libourne, Libourne, France
| | | | | | | | - Diane Evrard
- ORL et CCF, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | | | - Nicolas Fakhry
- ORL et CCF, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sophie Renard
- ORL et CCF, Institut de cancérologie de Lorraine, Nancy, France
| | - Didier Salvan
- ORL et CCF, centre hospitalier sud francilien, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif spécifique régional du cancer Grand Est - NEON, Nancy, France
| | - Véronique Block
- Dispositif spécifique régional du cancer Grand Est - NEON, Nancy, France
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Difoum F, Schernberg A, Vanquaethem H, Picchi H, Roy AL, Vuagnat P, Helissey C. Prognostic factors of toxicity of immune checkpoint inhibitors in nonsmall cell lung cancer and small cell lung cancer patients: The ToxImmune study. Cancer Rep (Hoboken) 2023; 6:e1760. [PMID: 36494190 PMCID: PMC10363797 DOI: 10.1002/cnr2.1760] [Citation(s) in RCA: 1] [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: 07/17/2022] [Revised: 10/07/2022] [Accepted: 11/27/2022] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Immunotherapy alone or in combination has clearly improved the survival of patients with lung cancer. However, it may also be responsible for adverse events impacting these patients' quality of life. The ToxImmune study aims to identify prognostic factors that can help to predict immune-related adverse events. METHODS We included all patients aged 18 years and older who had received at least one dose of immune checkpoint inhibitors, with or without other therapy, between June 2015 and December 2020 and were diagnosed with nonsmall cell lung cancer or small-cell lung cancer. Patients' baseline demographic characteristics, biological blood markers, and imaging by PET-scanner were collected from electronic medical records. All adverse events (AEs) and immune-related AEs (irAEs) were recorded (Common Terminology Criteria For Adverse Events V.5.0). RESULTS Sixty-four patients were included, of whom 60 (94%) presented at least one irAE. The incidence of Common Terminology Criteria for Adverse Events (CTCAE) grade 2 and grade 3-4 was 34% and 8% respectively. Female sex, Primitive Tumor Standardized Uptake Value Max (SUVmax) <5, number of metastases ≥3 and immunotherapy received after the first line were found to be significant risk factors for immune-related adverse events. Based on the number of risk factors, the ToxImmune score predicts the risk of having a grade ≥2 adverse event (primitive tumor SUV ≥ 5 = 0 vs. primitive tumor SUV <5 = 1, number of metastases <3 = 0 vs. number of metastases ≥3 = 1 and L1 = 0 vs. L1 ≥ 1). The incidence of grade ≥2 adverse events was 20%, 55% and 90% with ToxImmune scores 0, 1 and = 2 respectively (p = .003). Median progression-free survival (PFS) times were 19.2 months, 6.64 months and 2.63 months for ToxImmune scores 0, 1 and = 2 respectively, p = .13. Median overall survival times were 22.6 months, 16.4 months and 9.8 months for ToxImmune scores 0, 1 and ≥2 respectively, p = .24. The disease control rate (DRR) was 78% in ToxIummune score 0 group, and 50% in ToxImmune score 1 and ≥2 groups (p = .363). CONCLUSION The ToxImmune score, which is grounded on objective clinical parameters, indicates that cases with a high score had an advanced threat of severe adverse events. The ToxImmune score could therefore be used in clinical practice to identify patients treated for lung cancer with immunotherapy and at risk of severe AE.
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Affiliation(s)
- Francoise Difoum
- Clinical Research unit, Military Hospital Begin, Saint-Mandé, France
| | | | - Hélène Vanquaethem
- Department of Internal Medicine, Military Hospital Begin, Saint-Mandé, France
| | - Hugo Picchi
- Department of Medical oncology, Military Hospital Begin, Saint-Mandé, France
| | - Audrey Le Roy
- Department of Medical oncology, Military Hospital Begin, Saint-Mandé, France
| | - Perrine Vuagnat
- Clinical Research unit, Military Hospital Begin, Saint-Mandé, France
| | - Carole Helissey
- Clinical Research unit, Military Hospital Begin, Saint-Mandé, France
- Department of Medical oncology, Military Hospital Begin, Saint-Mandé, France
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Helissey C, Parnot C, Rivière C, Duverger C, Schernberg A, Becherirat S, Picchi H, Le Roy A, Vuagnat P, Pristavu R, Vanquaethem H, Brureau L. Effectiveness of electronic patient reporting outcomes, by a digital telemonitoring platform, for prostate cancer care: the Protecty study. Front Digit Health 2023; 5:1104700. [PMID: 37228301 PMCID: PMC10203955 DOI: 10.3389/fdgth.2023.1104700] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/12/2023] [Indexed: 05/27/2023] Open
Abstract
Research aim and purpose The benefits of Electronic Patient -Reported Outcomes (e-PRO) for telemonitoring are well established, allowing early detection of illnesses and continuous monitoring of patients. The primary objective of the PROTECTY study was to assess the compliance with patient use of the telemonitoring platform Cureety. An exploratory objective was to assess if the first-month health status is a prognostic factor of progression free-survival (PFS) and overall survival (OS) for prostate cancer patient. Methods This prospective study was conducted at the Military Hospital Bégin on prostate cancer patients. Patients were allowed to respond to a symptomatology questionnaire based on CTCAE v.5.0, personalized to their pathology and treatment. An algorithm evaluates the health status of the patient based on the reported adverse events, with a classification into 2 different states: Good Health Status (GHS) and Poor Health status (PHS). Results Sixty-one patients were enrolled between July 1st, 2020 and September 30th, 2021. The median age was 74.0 (range 58.0-94.0). 78% presented a metastatic stage, and the most represented cancer was mHSPC. Overall, 2,457 questionnaires were completed by the patients, 4.0% resulted in a health classification in to monitor or critical state. 87% of patients were classified in the GHS group. The compliance was 72% in the overall population during the first month, 71% in GHS group and 75% in PHS group. The median follow-up was 8 months. PFS at 6 months was 84% in GHS group vs. 57% in PHS group, p = 0.19. OS at 6 months was 98% in GHS group vs. 83% in PHS group, p = 0.31. Conclusions Our study showed that compliance was satisfactory. The feasibility of remote monitoring for prostate cancer patients means that they should benefit from its implementation. Our study is also the first to assess the correlation between treatment tolerance and survival. The initial results suggest that e-PRO assessment could help identify in the early stages the patients that require further health assessment and potential therapeutic changes. While further follow-up of more patients will be required, our study highlights the importance of e-PRO in cancer patient care.
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Affiliation(s)
- C. Helissey
- Clinical Research Unit, Department of Oncology, Military Hospital Begin, Saint-Mandé, France
- Department of Medical Oncology, Military Hospital Begin, Saint-Mandé, France
| | - C. Parnot
- Clinical Research Department, Cureety, 33 rue de l’Amirauté, Dinan, France
| | - C. Rivière
- Clinical Research Unit, Department of Oncology, Military Hospital Begin, Saint-Mandé, France
| | - C. Duverger
- Clinical Research Unit, Department of Oncology, Military Hospital Begin, Saint-Mandé, France
| | - A. Schernberg
- Clinical Research Unit, Department of Oncology, Military Hospital Begin, Saint-Mandé, France
| | - S. Becherirat
- Clinical Research Unit, Department of Oncology, Military Hospital Begin, Saint-Mandé, France
| | - H. Picchi
- Department of Medical Oncology, Military Hospital Begin, Saint-Mandé, France
| | - A. Le Roy
- Department of Medical Oncology, Military Hospital Begin, Saint-Mandé, France
| | - P. Vuagnat
- Clinical Research Unit, Department of Oncology, Military Hospital Begin, Saint-Mandé, France
| | - R. Pristavu
- Department of Medical Oncology, Military Hospital Begin, Saint-Mandé, France
| | - H. Vanquaethem
- Department of Internal Medicine, Military Hospital Begin, Saint-Mandé, France
| | - L. Brureau
- CHU de Pointe-à-Pitre, Univ Antilles, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)—UMR-S 1085, Pointe-à-Pitre, France
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Sarrade T, Gautier M, Schernberg A, Jenny C, Orthuon A, Maingon P, Huguet F. Educative Impact of Automatic Delineation Applied to Head and Neck Cancer Patients on Radiation Oncology Residents. J Cancer Educ 2023; 38:578-589. [PMID: 35359258 DOI: 10.1007/s13187-022-02157-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2022] [Indexed: 05/20/2023]
Abstract
To evaluate the educational impact on radiation oncology residents in training when introducing an automatic segmentation software in head and neck cancer patients regarding organs at risk (OARs) and prophylactic cervical lymph node level (LNL) volumes. Two cases treated by exclusive intensity-modulated radiotherapy were delineated by an expert radiation oncologist and were considered as reference. Then, these cases were delineated by residents divided into two groups: group 1 (control group), experienced residents delineating manually, group 2 (experimental group), young residents on their first rotation trained with automatic delineation, delineating manually first (M -) and then after using the automatic system (M +). The delineation accuracy was assessed using the Overlap Volume (OV). Regarding the OARs, mean OV was 0.62 (SD = 0.05) for group 1, 0.56 (SD = 0.04) for group 2 M - , and 0.61 (SD = 0.03) for group 2 M + . Mean OV was higher in group 1 compared to group 2 M - (p = 0.01). There was no OV difference between group 1 and group 2 M + (p = 0.67). Mean OV was higher in the group 2 M + compared to group 2 M - (p < 0.003). Regarding LNL, mean OV was 0.53 (SD = 0.06) in group 1, 0.54 (SD = 0.03) in group 2 M - , and 0.58 (SD = 0.04) in group 2 M + . Mean OV was higher in group 2 M + for 11 of the 12 analysed structures compared to group 2 M - (p = 0.016). Prior use of the automatic delineation software reduced the average contouring time per case by 34 to 40%. Prior use of atlas-based automatic segmentation reduces the delineation duration, and provides reliable OARs and LNL delineations.
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Affiliation(s)
- Thomas Sarrade
- Department of Radiation Oncology, Tenon Hospital, AP-HP.Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
| | - Michael Gautier
- Department of Medical Physics, AP-HP.Sorbonne Université, Paris, France
| | - Antoine Schernberg
- Department of Radiation Oncology, Tenon Hospital, AP-HP.Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
| | - Catherine Jenny
- Department of Medical Physics, AP-HP.Sorbonne Université, Paris, France
| | - Alexandre Orthuon
- Department of Medical Physics, AP-HP.Sorbonne Université, Paris, France
| | - Philippe Maingon
- Department of Radiation Oncology, Pitié-Salpêtrière Hospital, AP-HP.Sorbonne Université, Paris, France
- Institut Universitaire de Cancérologie, Sorbonne Université, Paris, France
| | - Florence Huguet
- Department of Radiation Oncology, Tenon Hospital, AP-HP.Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.
- Institut Universitaire de Cancérologie, Sorbonne Université, Paris, France.
- Centre de Recherche Saint-Antoine, Inserm UMR_S 938, Saint-Antoine Hospital, Paris, France.
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Helissey C, Cavallero S, Guitard N, Thery H, Parnot C, Schernberg A, Mondot S, Christopoulos C, Malek K, Malaurie E, Chargari C, Francois S. Urinary proteome as a prognostic factor in the deterioration of the quality of life of patients with localized prostate cancer during radiotherapy: Radiotoxicity Bladder Biomarkers (RABBIO) prospective trial. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.344] [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: 03/16/2023] Open
Abstract
344 Background: Despite improvements in radiation techniques, pelvic radiotherapy is responsible for acute and delayed bladder adverse events, defined as radiation cystitis (CysR). About 50% of irradiated patients present acute symptoms and experience a significant decrease in their quality of life (QOL). The pathophysiology of CysR is not well understood, which limits our ability to study this process and develop treatments. The RABBIO study evaluates the correlation of urinary biomarkers with the intensity of acute CysR and the QOL of patients, assessed with the digital telemonitoring platform Cureety. Methods: Patients with intermediate-risk localized prostate cancer eligible for localized radiotherapy were included. Urinary biomarkers were analyzed before the start of radiotherapy, and at weeks (W) 4, 12 and 48 of irradiation. Between sample collection visits, patients completed various questionnaires related to radiation cystitis symptoms and QOL using a digital remote monitoring platform. Upon receipt of the questionnaires, an algorithm processed the information and classify patients according to the severity of symptoms and adverse events reported according to CTCAE. We also collected FACT-P questionnaires at baseline, W4 and W12. We correlated the levels of urinary biomarkers with the severity of acute CysR symptoms and patient-reported QOL. Results: The study started in March 2022, with 15 patients included to date. The median age was 76 (range 65-99). 80% (15/17) presented a localized prostate cancer de novo and 20% presented a biochemical recurrence. The compliance was 100% at baseline, 93% at W4 and 100% at W12. We collected a total of 172 AE questionnaires over the duration of the study so far, of which 61.0% (105/172) indicated a correct health status and 31.4% (54/172) a compromised status. The mean (range) FACT-P score at baseline for all patients was 33.9 (24 – 40), which changed to 29.8 (20 – 35) at W4, and 38.7 (37 – 42) at W12. Elevated SHBG (p=0.019, r=-0.93) and decreased IL8 (p=0.034, r=0.91) at baseline correlated with worse FACT-P score at W4. Conclusions: This prospective study is the first to explore the overexpression of inflammatory proteins in fluid biopsies from patients with symptoms of acute CysR. Our first results revealed that an elevated SHBG and a decreased IL8 in urine at baseline were a prognostic factor in the deterioration of QOL for localized prostate cancer patients during radiotherapy. The results of this study will allow us to develop strategies to limit radiation damage to the bladder and improve the QOL of patients. Clinical trial information: NCT05246774 .
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Affiliation(s)
- Carole Helissey
- Clinical Research Unit, Department of Medical Oncology, HIA Bégin, Saint-Mandé, Paris, France
| | - Sophie Cavallero
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-Sur-Orge, France
| | - Nathalie Guitard
- French Armed Forces Biomedical Research Institute- IRBA, Bretigny, France
| | - Hélène Thery
- French Armed Forces Biomedical Research Institute- IRBA, Bretigny, France
| | | | | | | | | | - Karim Malek
- Le-Raincy Montfermeil General Hospital, Montfermeil, France
| | | | - Cyrus Chargari
- French Armed Forces Biomedical Research Institute- IRBA, Bretigny, France
| | - Sabine Francois
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-Sur-Orge, France
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Rivière C, Brureau L, Parnot C, Becherirat S, Duverger C, Picchi H, Le Roy A, Vuagnat P, Schernberg A, Vanquaethem H, Helissey C. Effectiveness of a digital telemonitoring platform for cancer care of older patients: The ConnectElderlyPatientToDoctor study. Int J Cancer 2023; 152:504-510. [PMID: 35770377 DOI: 10.1002/ijc.34196] [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: 03/11/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023]
Abstract
While telemedicine has been shown to improve the quality of care for cancer patients, it remains underused for older patients (OP), partly due to the assumption that OPs are unabled or unwilling to use digital tools. However, more than 50% of new cancers are diagnosed in people over 70. The ConnectElderlyPatientToDoctor study aimed to evaluate the OP compliance with the use of the digital telemonitoring platform Cureety in oncology. All cancer patients followed at the Military Hospital Bégin were eligible for the study. Patients were invited to respond to a symptomatology questionnaire personalized to their pathology and treatment. An algorithm evaluated the health status of the patient based on the reported adverse events. The population was divided into two groups, OP and younger patients (YP), based on a cut-off at 70 years. The primary endpoint was to assess the compliance of OPs with the use of the digital oncology platform Cureety, compared to YP. From July 2020 to September 2021, a total of 117 patients were included in our study. We found that 66% of the patients were compliant, with no difference between the two groups (71.2% of YP, 61.7% of OP, P = .29). In OPs, progression free survival (PFS) ratio at 6-months was 64.6% in the tolerant patients vs 23.4% in the nontolerant patients (HR = 0.1980, 95% CI = 0.04431-0.8845, P = .0339). The median PFS was 23.3 months in the tolerant group vs 3.3 months in the nontolerant group (P = .0339). The data of overall survival are immature. OPs had a clear benefit from using this platform, similar to what was observed for YP. Patients felt less isolated and felt that they benefited from personalized care with early ambulatory medical care of adverse events. We also found that the health indicators collected with the platform in the first month of treatment are predictive of the progression of the disease. This solution makes it possible to streamline and improve the care pathway of OP.
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Affiliation(s)
| | - Laurent Brureau
- CHU de Pointe-à-Pitre, Univ Antilles, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR-S 1085, Pointe-à-Pitre, France
| | | | - Selma Becherirat
- Clinical Research Unit, Military Hospital Begin, Saint-Mandé, France
| | - Claire Duverger
- Clinical Research Unit, Military Hospital Begin, Saint-Mandé, France
| | - Hugo Picchi
- Department of Medical Oncology, Military Hospital Begin, Saint-Mandé, France
| | - Audrey Le Roy
- Department of Medical Oncology, Military Hospital Begin, Saint-Mandé, France
| | - Perrine Vuagnat
- Clinical Research Unit, Military Hospital Begin, Saint-Mandé, France
| | | | - Hélène Vanquaethem
- Department of Internal Medicine, Military Hospital Begin, Saint-Mandé, France
| | - Carole Helissey
- Clinical Research Unit, Military Hospital Begin, Saint-Mandé, France.,Department of Medical Oncology, Military Hospital Begin, Saint-Mandé, France
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Leung T, Cavallero S, Mondot S, Parnot C, Yssaad H, Becherirat S, Guitard N, Thery H, Schernberg A, Breitwiller H, Chargari C, Francois S. Correlation Between Serum and Urine Biomarkers and the Intensity of Acute Radiation Cystitis in Patients Treated With Radiation Therapy for Localized Prostate Cancer: Protocol for the Radiotoxicity Bladder Biomarkers (RABBIO) Study. JMIR Res Protoc 2023; 12:e38362. [PMID: 36626198 PMCID: PMC9874987 DOI: 10.2196/38362] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Despite improvements in radiation techniques, pelvic radiotherapy is responsible for acute and delayed bladder adverse events, defined as radiation cystitis. The initial symptoms of bladder injury secondary to pelvic irradiation are likely to occur during treatment or within 3 months of radiotherapy in approximately 50% of irradiated patients, and have a significant impact on their quality of life. The pathophysiology of radiation cystitis is not well understood, particularly because of the risk of complications associated with access to bladder tissue after irradiation, which limits our ability to study this process and develop treatments. OBJECTIVE It is an original study combining digital data collection to monitor patients' symptoms and biological markers during irradiation. The main objective of our study is to evaluate the correlation of biological biomarkers with the intensity of acute radiation cystitis and the quality of life of patients, assessed with the digital telemonitoring platform Cureety. METHODS Patients with intermediate-risk localized prostate cancer who are eligible for localized radiotherapy will be included. Inflammatory biomarkers will be analyzed in urine and blood samples before the start of radiotherapy and at weeks 4, 12, and 48 of irradiation, through quantitative methods such as a multiplex Luminex assay, flow cytometry, and enzyme-linked immunosorbent assay. We will also characterize the patients' gut and urine microbiota composition using 16S ribosomal RNA sequencing technology. Between sample collection visits, patients will complete various questionnaires related to radiation cystitis symptoms (using the International Prostate Symptom Score), adverse events, and quality of life (using the Functional Assessment of Cancer Therapy-Prostate questionnaire), using the Cureety digital remote monitoring platform. Upon receipt of the questionnaires, an algorithm will process the information and classify patients in accordance with the severity of symptoms and adverse events reported on the basis of Common Terminology Criteria for Adverse Events and International Prostate Symptom Score standards. This will allow us to correlate levels of urinary, blood, and fecal biomarkers with the severity of acute radiation cystitis symptoms and patient-reported quality of life. RESULTS The study started in March 2022. We estimate a recruitment period of approximately 18 months, and the final results are expected in 2024. CONCLUSIONS This prospective study is the first to explore the overexpression of inflammatory proteins in fluid biopsies from patients with symptoms of acute radiation cystitis. In addition, the 1-year follow-up after treatment will allow us to predict which patients are at risk of late radiation cystitis and to refer them for radioprotective treatment. The results of this study will allow us to develop strategies to limit radiation damage to the bladder and improve the quality of life of patients. TRIAL REGISTRATION ClinicalTrials.gov NCT05246774; https://clinicaltrials.gov/ct2/show/NCT05246774?term=NCT05246774. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38362.
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Affiliation(s)
| | - Sophie Cavallero
- Institut de Recherche Biomédicale des Armées, Bretigny sur Orge, France
| | - Stanislas Mondot
- Paris-Saclay university, Institut National de Recherche pour l'Agriculture, Jouy-en-Josas, France
| | | | | | | | - Nathalie Guitard
- Institut de Recherche Biomédicale des Armées, Bretigny sur Orge, France
| | - Hélène Thery
- Institut de Recherche Biomédicale des Armées, Bretigny sur Orge, France
| | | | | | - Cyrus Chargari
- Institut de Recherche Biomédicale des Armées, Bretigny sur Orge, France
| | - Sabine Francois
- Institut de Recherche Biomédicale des Armées, Bretigny sur Orge, France
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Helissey C, Difoum F, Vanquaethem H, Vuagnat P, Picchi H, Le Roy A, Schernberg A. Predictive factors of toxicity of immune checkpoint inhibitors (ICI) in older patients with lung cancer: The ToxImmune study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12048] [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
12048 Background: Immunotherapy (Im) improved the survival of patients with lung cancer. It may be responsible for adverse events impacting these patients' quality of life. We have few data on the tolerance of older cancer patients (OP) to immunotherapy. The Toximmune study aims to describe the safety of older lung cancer patients to Im and identify clinical, biological and radiological markers that can help to predict immune-related adverse events for OP. Methods: All patients aged 60 years and older who had received at least one dose of ICI between June 2015 and December 2020 and diagnosed with lung cancer were included. We collected patients' baseline demographic characteristics, biological blood markers and imaging by PET-scanner. All adverse events (AEs) and immune-related AEs (irAEs) were recorded (CTCAE V.5.0). Results: 49 patients were included, median age was 71 (range 61-97). The incidence of grade 2 and grade 3-4 was 34% and 6% respectively. The main irAEs reported were: asthenia in 51% patients after 13.5 months median delay (grade ≥2 in 22%),musculoskeletal disorders in 45% after 21 months median delay (grade ≥2 in 10%), pneumonitis in 37% after 21 months median delay (grade ≥2 in 10%), and colitis in 35% after 21 months median delay (grade ≥2 in 6%). Female sex, primitive tumor SUV max < 5, number of metastases ≥ 3, prior systemic therapy > 1, PLR < 250 were significantly associated with a risk of toxicity in univariate analysis (p < 0.05) We developed the ToxImmune score (0, 1, or ≥2) to predict the risk of having a grade ≥2 adverse event by adding the following risk factors: Primitive Tumor SUV < 5 = 1, Number of metastases ≥3 = 1, And L1 = 0 vs > L1 = 1. The incidence of grade ≥2 adverse events was 31%, 35% and 86% with ToxImmune scores 0, 1 and 2 respectively (p = 0.032). Median overall survival times (OS) & progression-free survival (PFS) were 21.8 & 21 months, 15.1 & 6.6 months, and 9.8 & 2.1 months for ToxImmune scores 0, 1 and ≥ 2 respectively (p = 0.06 & p = 0.001). There was significant association between the ToxImmune score and the risk of "progressive disease" at the first assessment of the disease: 16% for score = 0, 48% for score = 1, and 71% for score = 2, (p = 0.01). Conclusions: The quality of life is our goal for OP care. The ToxImmune score, which is based on objective clinical parameters, identifies OP with a significant higher risk of severe adverse events. Also, this score was significantly associated with patients’ PFS risk of developing rapid tumor progression. It could be used in clinical practice to personalize toxicity surveillance in OP treated for lung cancer with immunotherapy. This score will be validated in larger prospective cohorts.
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Affiliation(s)
- Carole Helissey
- Clinical Research Unit, Military Hospital Begin, Saint-Mandé, France
| | | | | | - Perrine Vuagnat
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | - Hugo Picchi
- Military Hospital Begin, Saint-Mandé, France
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Atallah S, Marc M, Schernberg A, Huguet F, Wagner I, Mäkitie A, Baujat B. Beyond Surgical Treatment in Adenoid Cystic Carcinoma of the Head and Neck: A Literature Review. Cancer Manag Res 2022; 14:1879-1890. [PMID: 35693117 PMCID: PMC9176735 DOI: 10.2147/cmar.s355663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/24/2022] [Indexed: 12/16/2022] Open
Abstract
Introduction Adenoid cystic carcinoma (AdCC) is a rare tumour as it accounts for about 10% of all salivary gland neoplasms. It occurs in all age groups with a predominance of women, but no risk factors have been identified to date. Although AdCC behaves as a slow-growing tumour, it is characterized by multiple and late recurrences. Therefore, we aim to update the knowledge of the treatment options in advanced and recurrent cases. Materials and Methods We performed a systematic literature review to provide a synthesis of the practical knowledge required for AdCC non-surgical management. Altogether, 99 out of the 1208 available publications were selected for analysis. Results AdCC is described as a basaloid tumour consisting of epithelial and myoepithelial cells. Immunohistochemistry is useful for diagnosis (PS100, Vimentin, CD117, CKit, muscle actin, p63) and for prognosis (Ki67). Identified mutations could lead to therapeutic opportunities (MYB-NFIB, Notch 1). The work-up is mainly based on neck and chest CT scan and MRI, and PET-CT with 18-FDG or PSMA can be considered. Surgical treatment remains the gold standard in resectable cases. Post-operative intensity modulated radiotherapy is the standard of care, but hadron therapy may be used in specific situations. Based on the available literature, no standard chemotherapy regimen can be recommended. Conclusion There is currently no consensus on the use of chemotherapy in AdCC, either concomitantly to RT in a postoperative setting or at a metastatic stage. Further, the available targeted therapies do not yet provide significant tumour response.
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Affiliation(s)
- Sarah Atallah
- Department of Otorhinolaryngology–Head and Neck Surgery, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
- Doctoral School of Public Health, University of Paris Sud, CESP, INSERM U1018, University of Paris-Saclay, UVSQ, Villejuif, France
- Correspondence: Sarah Atallah, Hôpital Tenon, AP-HP, 4 rue de la Chine, Paris, 75020, France, Tel +33 156016417, Email
| | - Morgane Marc
- Department of Otorhinolaryngology–Head and Neck Surgery, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Antoine Schernberg
- Department of Radiotherapy, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Florence Huguet
- Department of Radiotherapy, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Isabelle Wagner
- Department of Otorhinolaryngology–Head and Neck Surgery, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Bertrand Baujat
- Department of Otorhinolaryngology–Head and Neck Surgery, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
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Helissey C, Riviere C, Parnot C, Duverger C, Becheriat S, Vuagnat P, Schernberg A, Picchi H, Le Roy A, Vanquaethem H, Brureau L. Early patient-reported outcomes are a promising predictive factor of cancer progress and outcome in older patients: The EPROFECY study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12045] [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
12045 Background: Contrary to commonly-held beliefs, older patients (OPs, aged 70 or more) in oncology are compliant with the use of a telemonitoring digital platform. Such a tool allows the medical team to gain detailed knowledge of the tolerance profile of patients, and help monitor and maintain their quality of life, which is a particularly important goal for older patients. The EPROFECY study assesses the predictive power of the patient health status in the first month of treatment, evaluated with the digital telemonitoring platform Cureety, on survival. Methods: This prospective study was conducted at the Military Hospital Bégin on OPs. Patients were allowed to respond to a symptomatology questionnaire based on CTCAE v.5.0, personalized to their pathology and treatment. An algorithm evaluated the patient status based on reported adverse events: correct (A), compromised (B), to be monitored (C) and critical state (D). For A/B (good health status), the patient received therapeutic advice to help manage each of the reported adverse events. For C/D (poor health status), the patient was invited to call the hospital. To assess the early tolerance of patience to their treatments, we determined the health status in the 1st month after initiation of treatment, which was classified as “Good health” (GH, majority of A/B reports) or “Poor health” (PH, majority of C/D reports). The primary endpoint was to assess if the first-month tolerance is a predictive factor of progression free-survival (PFS). The secondary endpoint was to assess if the first-month tolerance is a predictive factor of overall survival (OS). Results: Sixty-one patients were enrolled between July 1st, 2020 and September 30th, 2021. The median age was 78.0 years (range 70.0 – 99.0), with 81% presenting a metastatic stage, and the most represented cancer being prostate cancer. The median follow-up was 8.2 months. Overall, 2299 ePRO were completed, 89% (n= 2036) corresponding to a "correct" or a "compromised" state and only 11% (n=263) corresponding to a state "to be monitored" or "critical". Based on the first month of questionnaires, 62% of the patients were classified in the GH group, and 38% in the PH group. The PFS ratio at 6 months was 64.6 % in GH vs 23.4 % in PH (HR = 0.1980, 95% CI = 0.04431–0.8845, p = 0.0339). The OS ratio at 6 months was 100% in GH versus 95.5 % in PH (HR: 0.69, 95 % CI = 0.06 – 8.29, p = 0.77). Conclusions: This is the first study that assesses the use of PRO-based tolerance as a predictive factor of treatment response in older individuals. We demonstrated here a significant 80% reduction in the risk of progression in OPs that exhibited a good first-month tolerance. This suggests that e-PRO follow-up might be an effective predictor of response and a tool to treatment plan.
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Affiliation(s)
- Carole Helissey
- Clinical Research Unit, Military Hospital Begin, Saint-Mandé, France
| | | | | | | | | | - Perrine Vuagnat
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | | | - Hugo Picchi
- Military Hospital Begin, Saint-Mandé, France
| | | | | | - Laurent Brureau
- Universuty Hospital of Pointe-à-Pitre, Pointe-a-Pitre, Guadeloupe
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Helissey C, Cavallero S, Blanchard P, Bauduceau O, Schernberg A, Christopoulos C, Bouaita R, Mondot S, Monnier L, Popotte H, Besson N, Durand B, TA MH, Parnot C, Chargari C, Francois S. Prospective study of biomarkers predictive of radiation-induced bladder toxicity in patients treated with radiotherapy for localized prostate cancer: RABBIO (Radiotoxicity Bladder BIOmarkers). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps12142] [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
TPS12142 Background: Despite improvements in irradiation techniques, pelvic radiotherapy is responsible for acute and late adverse events in the bladder, defined as radiation cystitis (CysR). The early symptoms of bladder lesions secondary to pelvic irradiation are likely to occur during treatment or after radiotherapy in approximately 50% of irradiated patients. Acute radiation-related injuries are the first step of the fibrosis process. Fibrosis causes loss of bladder function and has a significant impact on the quality of life of the patients.The pathophysiology of CysR is not well understood, in particular because of the risks of complications caused by accessing the bladder tissue after irradiation, thereby limiting our ability to investigate this process and develop treatments. The main objective of our study is to assess the correlation of biologic biomarkers with the intensity of acute CysR and the quality of life of patients, evaluated with the digital telemonitoring platform Cureety. Methods: Patients with intermediate-risk localized prostate cancer and eligible for localized radiotherapy will be included. Inflammatory biomarkers will be analyzed on urine and blood samples before the initiation of radiotherapy, at week 4, 12 and 48 of irradiation, by quantitative methods such as the Multiplex Luminex assay, cytometry in flow and enzyme-linked immunosorbent assay ELISA. We will also characterize the gut and urinary microbiota in stool and urine samples using 16S rRNA sequencing technology. This is in order to assess the impact of the fecal and urinary microbiota in acute CysR. Between sample collection visits, patients will answer various questionnaires relating to the symptoms of radiation cystitis (IPSS), adverse events and quality of life (FACT-P), using the digital telemonitoring platform Cureety. Upon receipt of the questionnaires, an artificial intelligence algorithm will process the information and classify the patients according to the severity of symptoms and adverse reactions reported in accordance with CTCAE / IPSS. This will ultimately allow us to correlate urinary, blood and fecal biomarker levels with the severity of acute CysR symptoms and the quality of life reported by the patients. Conclusion: This prospective study is the first to explore the overexpression of inflammatory proteins in fluid biopsies from patients with symptoms of acute CysR. In addition, the 1-year post-treatment follow-up will allow us to predict which patients are at risk for late CysR and to stratify these patients towards radioprotective treatment. The results of this study will allow us to develop strategies to limit radiation damage to the bladder and improve the quality of life of patients. Clinical trial information: 2021A0319635.
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Affiliation(s)
- Carole Helissey
- Clinical Research Unit, Military Hospital Begin, Saint-Mandé, France
| | - Sophie Cavallero
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-Sur-Orge, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sabine Francois
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-Sur-Orge, France
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13
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Meghiref Y, Parnot C, Duverger C, Difoum F, Gourden A, Yssaad H, Leiterer C, Bedekovic C, Blanchard J, Nait Ammar H, Schernberg A, Vanquaethem H, Helissey C. Implementation of telemedicine in cancer clinical trials: Connectpatienttodoctor study. JMIR Cancer 2021; 8:e31255. [PMID: 34921544 PMCID: PMC8832259 DOI: 10.2196/31255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/10/2021] [Accepted: 12/08/2021] [Indexed: 12/26/2022] Open
Abstract
Background Telemedicine is currently being adopted for the management of patients in routine care. However, its use remains limited in the context of clinical trials. Objective This study aimed to demonstrate the feasibility of telemonitoring and patient-reported outcomes collection in the context of clinical trials. Methods The patients who were included in an interventional oncology clinical trial were eligible. The patients were registered with a digital tool to respond to a patient-reported outcomes questionnaire (ePRO) based on CTCAE (The Common Terminology Criteria for Adverse Events, National Cancer Institute), version 5.0, personalized to their pathology and treatment. An algorithm evaluated the health status of the patient based on the reported adverse events, with a classification in 4 different states (correct, compromise, state to be monitored, or critical state). The main objective was to evaluate the feasibility of remote monitoring via a connected platform of patients included in a clinical trial. Results From July 1, 2020, to March 31, 2021, 39 patients were included. The median age was 71 years (range 41-94); 74% (n=29) were male, and 59% (n=23) had metastatic disease. Out of the 969 ePRO questionnaires completed over the course of the study, 77.0% (n=746) were classified as “correct,” 10.9% (n=106) as “compromised,” and 12.1% (n=117) as “to be monitored” or “critical.” The median response time was 7 days (IQR 7-15.5), and 76% (25/33) of the patients were compliant. Out of the 35 patients who answered a satisfaction questionnaire, 95% (n=33) were satisfied or very satisfied with the tool, and 85% (n=30) were satisfied with their relationship with the health care team. There were 5 unscheduled hospitalizations during the study period. Conclusions Remote monitoring in clinical trials is feasible, with a high level of patient participation and satisfaction. It benefits patients, but it also ensures the high quality of the trial through the early management of adverse events and better knowledge of the tolerance profile of experimental treatments. This e-technology will likely be deployed more widely in our clinical trials.
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Affiliation(s)
| | | | - Claire Duverger
- Military Hospital Begin, 69 avenue de Paris, Saint-Mandé, FR
| | | | - Audrey Gourden
- Military Hospital Begin, 69 avenue de Paris, Saint-Mandé, FR
| | - Halima Yssaad
- Military Hospital Begin, 69 avenue de Paris, Saint-Mandé, FR
| | | | | | | | | | | | | | - Carole Helissey
- Military Hospital Begin, 69 avenue de Paris, Saint-Mandé, FR
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Assouline A, Schernberg A, del Mar Amador M, Morelot-Panzini C, Gonzalez-Bermejo J, Lenglet T, Forestier NL, Bruneteau G, Hesters A, Salachas F, Delanian S, Pradat P. A Retrospective Analysis of 235 Patients and 281 Radiotherapy Plans for Sialorrhea Treatment in Amyotrophic Lateral Sclerosis and Parkinson Patients. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.338] [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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15
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Assouline A, Schernberg A, Huet de Froberville H, Dinh P, Biggs E, Henry O, Cadot P, Lievre C, Weirich L, Delanian S, Pradat PF. Radiothérapie des glandes salivaires pour le traitement de la sialorrhée au cours de la sclérose latérale amyotrophique et la maladie de Parkinson : analyse de 281 cas. Cancer Radiother 2021. [DOI: 10.1016/j.canrad.2021.07.012] [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]
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Assouline A, Schernberg A, del Mar Amador M, Morelot-Panzini C, Gonzalez-Bermejo J, Lenglet T, Le Forestier N, Bruneteau G, Salachas F, Delanian S, Pradat P. OC-0409 Salivary gland Radiotherapy for Sialorrhea Treatment in Amyotrophic Lateral Sclerosis patients. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06896-1] [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: 10/20/2022]
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17
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Schernberg A, Vernerey D, Goldstein D, Van Laethem JL, Glimelius B, van Houtte P, Bonnetain F, Louvet C, Hammel P, Huguet F. Predictive Value of Neutrophils Count for Local Tumor Control After Chemoradiotherapy in Patients With Locally Advanced Pancreatic Carcinoma. Int J Radiat Oncol Biol Phys 2021; 110:1022-1031. [PMID: 33548338 DOI: 10.1016/j.ijrobp.2021.01.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Baseline neutrophil count may predict overall survival (OS) in patients with locally advanced pancreatic cancer (LAPC). METHODS AND MATERIALS The international multicenter randomized LAP07 phase 3 trial has enrolled 442 patients with LAPC. We analyzed the prognostic value of both baseline neutrophilia (neutrophil count >7 g/L) and elevated or increasing neutrophil count as (1) neutrophilia or (2) increased absolute neutrophil count after induction chemotherapy versus baseline for OS, progression-free survival, and local control (LC). A Cox proportional hazard model was used to assess elevated or increasing neutrophil count status by randomly assigned treatment interactions for each endpoint. RESULTS Among the 442 patients, 47 patients (11%) with baseline neutrophilia had worse OS (median 8.9 vs 13.3 months; P = .01). After induction chemotherapy, among the 235 patients whose blood counts were available, 90 patients (38%) had elevated or increasing neutrophil count associated with poorer OS in univariate (median 14.4 vs 17.9 months; P = .001) and multivariate analysis (P = .004). Elevated or increasing neutrophil count was also predictive of a decreased benefit of chemoradiation therapy on LC. In 126 patients without elevated or increasing neutrophil count, 1-year LC was 80% in the chemoradiation arm versus 54% in the chemotherapy arm (P < .001; interaction test P = .015). CONCLUSIONS In this study, baseline neutrophilia and increased absolute neutrophil count were associated with worse OS in this large series of patients with LAPC. In addition, the counts were an independent prognosis factor and a strong predictive LC biomarker for chemoradiation therapy benefit. An assessment of neutrophils counts can help to improve the selection of patients who might benefit from chemoradiation therapy after induction chemotherapy.
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Affiliation(s)
| | - Dewi Vernerey
- Methodological and Quality of Life in Oncology Unit, INSERM UMR 1098, University Hospital of Besancon, France
| | - David Goldstein
- Kinghorn Cancer Centre and Garvan Institute of Medical Research, Darlinghurst, Sydney, Australia
| | | | - Bengt Glimelius
- Department of Oncology, University of Uppsala, Akademiska Sjukhuset, Sweden
| | | | - Franck Bonnetain
- Methodological and Quality of Life in Oncology Unit, INSERM UMR 1098, University Hospital of Besancon, France; Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France
| | - Christophe Louvet
- Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France; Département d'Oncologie Médicale, Institut Mutualiste Montsouris, Paris, France
| | - Pascal Hammel
- Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France; Service d'Oncologie Digestive, Hôpital Beaujon, Clichy, France
| | - Florence Huguet
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Paris, France; Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France
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Fallet V, Matton L, Schernberg A, Canellas A, Cornelis FH, Cadranel J. Local ablative therapy in oncogenic-driven oligometastatic non-small cell lung cancer: present and ongoing strategies-a narrative review. Transl Lung Cancer Res 2021; 10:3457-3472. [PMID: 34430380 PMCID: PMC8350076 DOI: 10.21037/tlcr-20-1152] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/02/2021] [Indexed: 01/09/2023]
Abstract
Oligometastatic (OM) disease is defined by a low metastatic tumor spread. OM non-small cell lung cancer (NSCLC) treatment aims to improve the patient's prognosis and quality of life, in an attempt-to-cure objective. Oncogenic-driven metastatic NSCLC accounts for about 20-25% of NSCLCs, with an ever-increasing number of potentially druggable molecular alterations. Due to specific targeted therapy, the care and prognosis of mutated NSCLC is quite different from non-oncogenic-driven NSCLC. However, OM-NSCLC treatment guidelines do not specifically discuss oncogenic-driven OM-NSCLC patients. We conducted a narrative review regarding retrospective and prospective studies published from inception to May 2020 dealing with oncogenic-driven OM-NSCLC in order to: (I) describe the specific patterns of metastatic spread of oncogenic-driven NSCLC (i.e., bone and pleural tropism in EGFR mutated NSCLC and serous and brain metastases in ALK NSCLC); (II) review the low level of current evidence for local ablative therapy (LAT) strategies in patients with oncogenic-driven OM-NSCLC, focusing on the benefit/risk of tyrosine kinase inhibitors (TKI) and LATs combination and (III) present strategies to help to select the best candidate for an attempt-to-cure approach. Finally, the optimal strategy may be to introduce a targeted therapy, then treat all tumor sites with LAT, and finally continue TKI for unknown prolonged duration in an attempt to prolong progression free survival in most patients, improve overall survival for some patients, and potentially lead to a cancer cure for a few patients.
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Affiliation(s)
- Vincent Fallet
- Department of Pneumology and Thoracic Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon and GRC 4, Theranoscan, Sorbonne Université, Paris, France
| | - Lise Matton
- Department of Pneumology and Thoracic Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon and GRC 4, Theranoscan, Sorbonne Université, Paris, France
| | - Antoine Schernberg
- Department of Radiation Oncology, DMU Orphé, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Anthony Canellas
- Department of Pneumology and Thoracic Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon and GRC 4, Theranoscan, Sorbonne Université, Paris, France
| | - François H. Cornelis
- Department of Interventional Radiology and Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Jacques Cadranel
- Department of Pneumology and Thoracic Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon and GRC 4, Theranoscan, Sorbonne Université, Paris, France
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Sarrade T, Schernberg A, Gautier M, Jenny C, Orthuon A, Maingon P, Huguet F. Educative Impact Of Automatic Head And Neck Cancer Patients Delineation On Radiation Oncology Residents. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.227] [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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Brureau L, Cessot A, Boudin L, Romeo E, Prieux C, Ghebriou D, Schernberg A, Grellier N, Joly C, Bauduceau O, Thibault C, Mamou E, Raynal G, Serey Eiffel S, Le Floch H, Ricard D, Helissey C. Évaluation des pratiques médicales en oncologie dans le contexte de la pandémie de COVID-19 en France. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.012] [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: 11/26/2022]
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Fabien M, Schernberg A, Gouy S, Maulard A, Alexandra L, Genestie C, Pierre A, Kissel M, Fumagalli I, Pautier P, Deutsch E, Haie-Meder C, Morice P, Chargari C. PD-0655: Comprehensive analysis of patient outcome after local relapse of locally advanced cervical cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00677-0] [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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22
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Fabien M, Schernberg A, Arsene Henry A, Vignon M, Bouscary D, Kirova Y. OC-0462: Solitary plasmacytoma treated by Lenalidomide-Dexamethasone in combination with radiation therapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00484-9] [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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Helissey C, Cessot A, Boudin L, Romeo E, Prieux C, Ghebriou D, Schernberg A, Grellier N, Joly C, Bauduceau O, Thibault C, Mamou E, Raynal G, Serey Eiffel S, Le Floch H, Ricard D, Brureau L. Evaluation of medical practices in oncology in the context of the COVID-19 pandemic in France: Physicians' point of view: the PRATICOVID study. Cancer Med 2020; 9:8875-8883. [PMID: 33022134 PMCID: PMC7675575 DOI: 10.1002/cam4.3503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/05/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023] Open
Abstract
The cancer population seems to be more susceptible to COVID‐19 infection and have worse outcomes. We had to adapt our medical practice to protect our patients without compromising their cancer prognosis. The national PRATICOVID study aims to describe the adaptation of cancer patient care for this population. We analyzed data from nine different institutions. The primary endpoint was to assess the prevalence of adapted patient care during the pandemic. The secondary endpoints were to describe the point of view of clinicians and patients during and after the pandemic. We analyzed 435 medical procedures between 9th of March and 30th of April. Because of the COVID‐19 pandemic, 47.6% of the outpatients received modified patient care. Twenty‐four percent of scheduled surgeries were postponed, or were performed without perioperative chemotherapy, 18.4% followed a hypofractioned schedule, and 57% had an adaptive systemic protocol (stopped, oral protocol, and spacing between treatments). Seventy percent of physicians used telemedicine. During this period, 67% of the physicians did not feel distressed taking care of their patients. However, 70% of physicians are worried about the aftermath of the lockdown, as regards future patient care. The PRATICOVID study is the first to assess modification of patient care in cancer outpatients during an epidemic. With this unprecedented crisis, physicians were able to adapt their practice in order to protect their patients against the virus while ensuring continuity of patient care. But physicians are worried about the aftereffects of the lockdown specifically in regard to care pathway issues.
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Affiliation(s)
- Carole Helissey
- Clinical Research unit, Military Hospital Begin, Saint-Mandé, France
| | - Anatole Cessot
- Department of Medical oncology, Clinique HARTMANN, Neuilly-sur-Seine, France
| | - Laurys Boudin
- Department of Medical oncology, Military Hospital Sainte-Anne, Toulon, France
| | - Emile Romeo
- Department of Medical oncology, Military Hospital Sainte-Anne, Toulon, France
| | - Caroline Prieux
- Department of Gastroenterology, Military Hospital Percy, Clamart, France
| | - Djamel Ghebriou
- Department of Oncology, Tenon University Hospital, Institut Universitaire de Cancérologie AP-HP. Sorbonne Université, Paris, France
| | | | - Noemie Grellier
- Department of Radiation oncology, Hôpital Henri Mondor, Créteil, France
| | - Charlotte Joly
- Department of Medical Oncology, Hôpital Henri Mondor, Créteil, France
| | - Olivier Bauduceau
- Department of Radiation Oncology, Clinique HARTMANN, Neuilly-sur-Seine, France
| | | | - Elodie Mamou
- Clinical Research unit, Military Hospital Begin, Saint-Mandé, France
| | - Gauthier Raynal
- Department of Urology, Clinque Métivet, Saint-Maur-des Fossés, France
| | | | - Hervé Le Floch
- Department of Pulmonology, Military Hospital Percy, Clamart, France
| | - Damien Ricard
- Department of Neurology, Military Hospital Percy, Clamart, France
| | - Laurent Brureau
- CHU de Pointe-à-Pitre, Univ Antilles, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR-S 1085, Pointe-à-Pitre, France
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Sarrade T, Gautier M, Schernberg A, Jenny C, Orthuon A, Maingon P, Huguet F. Impact éducatif sur les internes en oncologie radiothérapie de la délinéation automatique des patients atteints d’un cancer de la tête et du cou. Cancer Radiother 2020. [DOI: 10.1016/j.canrad.2020.08.028] [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]
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25
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Helissey C, Cessot A, Boudin L, Romeo E, Prieux C, Ghebriou D, Schernberg A, Grellier N, Joly C, Bauduceau O, Thibault C, Mamou E, Raynal G, Setey Eiffel S, Le Floch H, Ricard D, Brureau L. 1728P Evaluation of medical practices in oncology in a context of COVID-19 pandemic in France: Point of view of physicians, PRATICOVID study. Ann Oncol 2020. [PMCID: PMC7506459 DOI: 10.1016/j.annonc.2020.08.1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Espenel S, Kissel M, Garcia MA, Schernberg A, Gouy S, Bockel S, Limkin E, Fabiano E, Meillan N, Magné N, Leary A, Pautier P, Morice P, Fumagalli I, Haie-Meder C, Chargari C. Implementation of image-guided brachytherapy as part of non-surgical treatment in inoperable endometrial cancer patients. Gynecol Oncol 2020; 158:323-330. [PMID: 32475773 DOI: 10.1016/j.ygyno.2020.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/28/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study assessed outcomes of inoperable endometrial cancer (IEC) patients treated with definitive external beam radiation therapy (EBRT) followed by a 3D image-guided brachytherapy boost. METHODS All consecutive patients treated with EBRT followed by 3D image-guided brachytherapy for IEC were retrospectively included. EBRT delivered a dose of 45Gy. Then, patients had an uterovaginal brachytherapy guided by 3D imaging. Clinical target volume (CTVBT) included the whole uterus and the initial disease extent. Gross tumour volume (GTVres) included the residual disease at time of brachytherapy. RESULTS Twenty-seven patients were identified. Causes of inoperability were comorbidities (37%) or tumour loco regional extent (63%). Including EBRT and brachytherapy, the median D90 (minimal dose delivered to 90% of the volume) was 60.7 GyEQD2 (IQR = 56.4-64.2) for the CTVBT, and was 73.6 GyEQD2 (IQR = 64.1-83.7) for the GTVres. The median overall treatment time was 50 days (IQR = 46-54). The mean follow-up was 36.5 months (SD = 30.2). The cumulative incidence of local, pelvic and distant failures was 19% (n = 5), 7% (n = 2) and 26% (n = 7), respectively. Five-year overall survival was 63% (95% CI = 43-91). Late urinary and gastro intestinal toxicities ≥ grade 2 were reported in four (15%) and two patients (7%) respectively. No vaginal toxicity ≥ grade 2 was reported. CONCLUSIONS EBRT followed by intracavitary brachytherapy seems to be an effective option for IEC. The implementation of 3D concepts at time of brachytherapy may contribute to high local control probability and low toxicity profile. Large scale retrospective or prospective data are needed to confirm these early data.
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Affiliation(s)
- S Espenel
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - M Kissel
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - M A Garcia
- Department of Public Health, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez, France
| | - A Schernberg
- Department of Radiation Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France
| | - S Gouy
- Department of Surgery, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - S Bockel
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - E Limkin
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - E Fabiano
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - N Meillan
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - N Magné
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez, France.
| | - A Leary
- Department of Medical Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - P Pautier
- Department of Medical Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - P Morice
- Department of Surgery, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Paris Saclay University, Kremlin Bicêtre, 63 Rue Gabriel Péri, 94270 Le Kremlin-Bicêtre, France.
| | - I Fumagalli
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - C Haie-Meder
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - C Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Paris Saclay University, Kremlin Bicêtre, 63 Rue Gabriel Péri, 94270 Le Kremlin-Bicêtre, France; Institut de Recherche Biomédicale des Armées, D19, 91220 Brétigny sur Orge, France.
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Kissel M, Chirat E, Annede P, Burtin P, Fumagalli I, Bronsart E, Mignot F, Schernberg A, Dumas I, Haie-Meder C, Chargari C. Esophageal brachytherapy: Institut Gustave Roussy's experience. Brachytherapy 2020; 19:499-509. [PMID: 32444283 DOI: 10.1016/j.brachy.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Esophageal cancer is characterized by its propension to local evolution, which conditions prognosis and quality of life. Brachytherapy may be a therapeutic option for all stages of esophageal cancer. METHODS AND MATERIALS This retrospective unicentric study included all consecutive patients treated for an esophageal high-dose-rate brachytherapy in our institution from 1992 to 2018. RESULTS Ninety patients were included. They were treated in four distinct indications: exclusive (7 patients), boost after external beam radiotherapy (41), reirradiation (36), or palliative aim (6). Most frequently prescribed schemes were 3 × 5 Gy (boost) or 6 × 5 Gy (exclusive treatment and reirradiation) at applicator's surface or at 5 mm. At the end of follow-up, 50% of patients had presented with local recurrence. Seventeen percent of patients had a metastatic relapse. Median overall survival was 15 months in the whole cohort: 22 months in the boost setting, 25 months for exclusive brachytherapy, 15 months for reirradiation, and only 2 months for palliative treatment. Tumor length at brachytherapy, brachytherapy dose, and interfraction response were significantly associated to overall survival. 40% of patients presented with grade 2+ toxicity, mostly esophagitis, including three toxic deaths. CONCLUSIONS Although local control outcomes are still poor, one must remember that patients are unfit for any curative therapeutic option and that palliative chemotherapy offers mediocre results. The most promising setting probably is reirradiation because brachytherapy offers a remarkable dose gradient allowing best organ at risk sparing, with an encouraging rate of long survivors (19% at 2 years). Esophageal brachytherapy deserves to be further investigated because some patients, even unfit, may benefit from it, with acceptable toxicity.
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Affiliation(s)
- Manon Kissel
- Radiotherapy Department, Gustave Roussy, Villejuif, France.
| | - Erick Chirat
- Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Pierre Annede
- Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Pascal Burtin
- Gastroenterology Department, Gustave Roussy, Villejuif, France
| | | | | | - Fabien Mignot
- Radiotherapy Department, Gustave Roussy, Villejuif, France
| | | | - Isabelle Dumas
- Radiotherapy Department, Gustave Roussy, Villejuif, France
| | | | - Cyrus Chargari
- Radiotherapy Department, Gustave Roussy, Villejuif, France
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28
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Saleh K, Michot JM, Schernberg A, Lazarovici J, Chahine C, Danu A, Khalife-Saleh N, Rossignol J, Ghez D, Martin V, Mazeron R, Fermé C, Boros A, Ribrag V, Girinsky T. Repeated courses of low-dose 2 × 2 Gy radiation therapy in patients with indolent B-cell non-Hodgkin lymphomas. Cancer Med 2020; 9:3725-3732. [PMID: 32249547 PMCID: PMC7286454 DOI: 10.1002/cam4.2796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/17/2019] [Revised: 11/09/2019] [Accepted: 12/06/2019] [Indexed: 11/12/2022] Open
Abstract
Purpose In patients with indolent B‐cell non‐Hodgkin's lymphoma (B‐NHL), one course of low‐dose radiotherapy (LD‐RT) 2 × 2 Gy is emerging as new option of therapy in palliative setting. Efficacy of LD‐RT when repeated remains to be determinate. This study aims to assess the efficacy of repeated LD‐RT given in patients with indolent B‐NHL. Materials and Methods All consecutive adult patients who received two or more courses of LD‐RT 2 × 2 Gy for indolent B‐NHL at Gustave Roussy institution, during the period 1990‐2015 were retrospectively investigated. Results Thirty‐three patients received two or more courses of LD‐RT for indolent B‐NHL during the study period. The median age was 57 (range 37‐80) years, histological types were distributed among follicular lymphoma (n = 24 pts; 73%), marginal‐zone lymphoma (n = 6 pts; 18%), and primary cutaneous follicle center lymphoma (n = 3 pts; 9%). The median number of low‐dose radiation therapy courses given per patients was 2 (range 2‐6). The overall response rates following the first and the second course of LD‐RT were 96% and 88%, respectively (P = .31). The 1‐ and 2‐years local control rates following the first courses of LD‐RT were 94% (CI 95: 86‐100) and 94% (CI 95: 86‐98); and were 91% (CI 95: 82‐100) and 88% (CI 95: 77‐100) following the second course of LD‐RT (P = .39). Conclusion The repeated courses of LD‐RT offered similar efficacy compare with the first course in patients with indolent B‐NHL. LD‐RT repeated is a simple, easy to give, and non‐toxic asset that could be investigated as treatment option in patients with indolent B‐NHL.
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Affiliation(s)
- Khalil Saleh
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jean-Marie Michot
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Drug Development Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Antoine Schernberg
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Julien Lazarovici
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Claude Chahine
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Alina Danu
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Nadine Khalife-Saleh
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Julien Rossignol
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - David Ghez
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Valentine Martin
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Renaud Mazeron
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Christophe Fermé
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Angela Boros
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Vincent Ribrag
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Drug Development Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Theodore Girinsky
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Mignot F, Gouy S, Schernberg A, Bockel S, Espenel S, Maulard A, Leary A, Genestie C, Annede P, Kissel M, Fumagalli I, Pautier P, Deutsch E, Haie-Meder C, Morice P, Chargari C. Comprehensive analysis of patient outcome after local recurrence of locally advanced cervical cancer treated with concomitant chemoradiation and image-guided adaptive brachytherapy. Gynecol Oncol 2020; 157:644-648. [PMID: 32173045 DOI: 10.1016/j.ygyno.2020.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/02/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Since dose escalation allowed by image-guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer (LACC), local relapses have become a rare event. Only scarce data are available on the outcome of patients experiencing a local relapse after IGABT. METHODS Between 2004 and 2016, all consecutive patients treated at Gustave Roussy Institute for LACC and receiving concomitant chemoradiation and IGABT were analysed. Clinical and treatment-related prognostic factors for survival after local relapse were searched, in order to potentially identify patients requiring salvage treatment. RESULTS Two hundred and fifty-nine patients were treated during this period. With a median follow-up of 4.1 years, 10.8% (n = 28) had a local relapse. Among these patients, 53.6% had synchronous lymph nodes or distant metastatic relapse and only 13 patients (5% of all patients) had isolated local relapse. After local relapse, median survival was 47 months and three patients were alive at last follow-up. Only three patients with local relapse could receive salvage surgery (10.7%). Metastases occurrence and pelvic wall involvement were the main contraindications (67.9%) for salvage surgery. Among the three patients treated with surgery, two are still alive at last follow-up without significant complication. Improved survival was observed among the two patients who could have surgery (p = .02). Local progression led to serious symptoms in 75% of patients. Only the time interval between brachytherapy and relapse (<1 year) was prognostic for 2-year overall survival (p = .005). CONCLUSION Salvage surgery is feasible in a very low number of highly selected patients with local relapse following IGABT. Local failure is a major cause of severe local symptoms, confirming that every effort should be done to achieve long-term local control through dose escalation.
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Affiliation(s)
- F Mignot
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France.
| | - S Gouy
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - A Schernberg
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - S Bockel
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - S Espenel
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - A Maulard
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - A Leary
- Department of Medical Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Genestie
- Department of Pathology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - P Annede
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - M Kissel
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - I Fumagalli
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - P Pautier
- Department of Medical Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - E Deutsch
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Haie-Meder
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - P Morice
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Chargari
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France; French Military Health Services Academy, Paris, France; Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France
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30
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Mignot F, Schernberg A, Arsène-Henry A, Vignon M, Bouscary D, Kirova Y. Solitary Plasmacytoma Treated by Lenalidomide-Dexamethasone in Combination with Radiation Therapy: Clinical Outcomes. Int J Radiat Oncol Biol Phys 2019; 106:589-596. [PMID: 31707123 DOI: 10.1016/j.ijrobp.2019.10.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE The study evaluates the results of the concurrent use of lenalidomide-dexamethasone with intensity modulated radiation therapy (IMRT) for solitary plasmacytoma in terms of toxicity and outcome. METHODS AND MATERIALS Forty-six patients were treated for histologically proven solitary plasmacytoma (SP) between June 2007 and June 2018 in our Department (Curie Institute, Paris, France). All patients received IMRT. The median total dose was 40 Gy (range, 40-46). Prescription of concurrent lenalidomide-dexamethasone with radiation therapy was left to the discretion of the referring hematologist-oncologist and started the first day of radiation therapy for 4 cycles. RESULTS Twenty-seven solitary plasmacytoma were treated with IMRT alone and 19 with lenalidomide-dexamethasone in association with IMRT. At 5 years, the local control, multiple myeloma-free survival (MMFS), and progression-free survival (PFS) rates were 96.3%, 85.4%, and 60%. MMFS and PFS were significantly higher in the IMRT plus lenalidomide-dexamethasone group compared with IMRT alone group (100% vs 77.1%, P = .02 and 81.7% vs 48.4%, P = .047, respectively). No major toxicity was found in either group. CONCLUSIONS Lenalidomide-dexamethasone in association with IMRT in the treatment of solitary plasmacytoma is safe and improves MMFS and PFS. Further prospective and comparative studies are needed to confirm these results.
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Affiliation(s)
- Fabien Mignot
- Department of Radiation Oncology, Institut Curie, Paris, France.
| | - Antoine Schernberg
- Department of Radiation Oncology, Institut Curie, Paris, France; Department of Radiation Oncology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Marguerite Vignon
- Department of Hematology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Didier Bouscary
- Department of Hematology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France; Versailles St Quentin University, St Quentin, France
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Schernberg A, Sagaon-Teyssier L, Schwarzinger M. Clinical and economic burden of head and neck cancer: a nationwide retrospective cohort study from France. Clinicoecon Outcomes Res 2019; 11:441-451. [PMID: 31413607 PMCID: PMC6661373 DOI: 10.2147/ceor.s198312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/14/2018] [Accepted: 03/28/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives To evaluate the clinical and economic burden of head and neck squamous cell carcinoma (HNSCC) in France. Methods All 53,255 incident adult patients discharged with a first diagnosis of HNSCC in 2010–2012 were identified from the 2008–2013 French National Hospital Discharge (PMSI) database. We conducted a retrospective longitudinal analysis of prognosis and direct costs attributable to HNSCC. Results Direct medical costs attributable to HNSCC care amounted to 665 million euros in 2012 in France. The majority (62%) of incident patients were 64 years old or less at HNSCC diagnosis and incurred 1.3-fold higher mean direct costs as compared to elderly patients (41,909 vs 32,221 euros over 3 years, respectively; p<0.001). HNSCC stage at initial treatment was the major driver of mean (SD) direct costs over 3 years (p<0.001): 19,819 (23,150) euros in 31% patients diagnosed at early stage; 46,791 (34,841) euros in 60% patients diagnosed at locally advanced stage; and 43,377 (33,953) euros in 9% patients diagnosed with distant metastasis. About half patients died over 3 years at a median (IQR) age of 63 (56–75) years resulting in 10.9 years-of-life lost on average per incident patient. Conclusion The present study suggests that the clinical and economic burden of HNSCC is substantial in France.
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Affiliation(s)
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,Translational Health Economics Network (THEN), Paris, France
| | - Michaël Schwarzinger
- Translational Health Economics Network (THEN), Paris, France.,Infection Antimicrobials Modeling & Evolution (IAME), UMR 1137, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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Ta MH, Schernberg A, Giraud P, Monnier L, Darai É, Bendifallah S, Schlienger M, Touboul E, Orthuon A, Challand T, Huguet F, Rivin del Campo E. Comparison of 3D conformal radiation therapy and intensity-modulated radiation therapy in patients with endometrial cancer: efficacy, safety and prognostic analysis. Acta Oncol 2019; 58:1127-1134. [PMID: 31017032 DOI: 10.1080/0284186x.2019.1599136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Adjuvant whole-pelvic radiation therapy (WPRT) improves locoregional control for high-intermediate stages I-III endometrial cancer patients. Intensity modulated radiation therapy (IMRT) tends to replace the standard 3D conformal radiation therapy (3DCRT) technique used in trials. Material and methods: Consecutive patients with stages I-IIIc endometrial cancer treated between 2008 and 2014 in our department with post-operative 3DCRT or IMRT WPRT were studied retrospectively. Patients with cervical involvement underwent additional low-dose rate vaginal brachytherapy. The impact of the WPRT technique on local control, tolerance, disease-free survival (DFS) and overall survival (OS) was assessed. Clinicians evaluated routinely acute radiation toxicity each week during radiation therapy and late toxicity during standard follow-up consultations. Results: Median follow-up was 50 months (range: 6-158). Among the 83 patients included, 47 were treated with 3DCRT and 36 with IMRT. There was no difference in patient characteristics between groups. The 5-year locoregional control and DFS rates were 94.5% and 68%, respectively. No significant difference was found between the 3DCRT and IMRT groups in terms of survival, with 5-year OS rates of 74.6% and 78%, respectively. In multivariate analysis, age over 68, stage > T1 and grade 3 were independently associated with shorter DFS and OS. Seven patients (8.4%) had grades 3-4 acute gastrointestinal (GI) toxicity with five patients (10.6%) and two (5.4%) in the 3DCRT and IMRT groups, respectively (p = .69). One case (1.2%) of late grade 3 GI toxicity was observed treated in 3DCRT. Conclusions: IMRT seems to be a safe technique for the treatment of endometrial cancer with a trend towards decreased acute GI toxicities. Results of the phase 3 RTOG 1203 trial are needed to confirm these results.
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Affiliation(s)
- Minh-Hanh Ta
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - Antoine Schernberg
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - Paul Giraud
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - Laurie Monnier
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - Émile Darai
- Department of Obstetric Gynaecology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - Sofiane Bendifallah
- Department of Obstetric Gynaecology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - Michel Schlienger
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - Emmanuel Touboul
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - Alexandre Orthuon
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - Thierry Challand
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - Florence Huguet
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - Eleonor Rivin del Campo
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
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Kumar T, Schernberg A, Busato F, Laurans M, Fumagalli I, Dumas I, Deutsch E, Haie-Meder C, Chargari C. Correlation between pelvic bone marrow radiation dose and acute hematological toxicity in cervical cancer patients treated with concurrent chemoradiation. Cancer Manag Res 2019; 11:6285-6297. [PMID: 31372035 PMCID: PMC6636180 DOI: 10.2147/cmar.s195989] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 11/26/2018] [Accepted: 03/25/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose To evaluate the association between pelvic bone marrow (BM) dose volume parameters and probability of acute hematological toxicity (HT), a cohort of cervical cancer patients receiving definitive chemoradiation (CRT) was assessed. Materials and methods Medical records of patients treated by CRT (45 Gy in 25 fractions, without dose constraints applied to the BM) were reviewed. Baseline and weekly hematological parameters were collected. BM was retrospectively delineated and divided into sub-sites: iliac crests, lower pelvis, lumbosacral region. BM volumes (V) receiving 5, 10, 20, 30, 40 Gy (V5, V10, V20, V30, V40, respectively) and mean dose (Dm) were calculated. Logistic regression was used to analyze associations between HT and dose-volume histograms parameters. Results 114 patients were included. 75.4% were treated with 3D radiation therapy and 24.6% were receiving intensity modulated radiation therapy (IMRT). Neither age, chemotherapy regimen (cisplatin vs carboplatin), number of chemotherapy cycles, performance status, body mass index, or para-aortic irradiation were associated with HT. In univariate analysis, more frequent grade 3+ leukopenia was found in the IMRT group (odds ratio [OR]: 3.5; 95% CI, 1.4–9.1; p=0.007). In multivariate analysis, grade 4 HT was associated with lower pelvis V5>95% (OR 4.1; 95% CI, 1.6–14. p=0.02), lower pelvis V20>45% (OR 3.5; 95% CI, 1.1–13.4; p=0.05), total pelvic bone V20>65%, and iliac crests Dm >31 Gy (OR 4.5; 95% CI, 1.4–14.7; p=0.02). Conclusion The following dose constraints could be proposed to decrease acute HT risk: lower pelvis V5<95%, lower pelvis V20≤45%, total pelvic bone V20<65%, and iliac crests Dm <31 Gy.
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Affiliation(s)
- T Kumar
- Brachytherapy Unit, Gustave Roussy, Cancer Campus, Villejuif, France.,Radiotherapy Department, Gustave Roussy, Villejuif, France.,Radiotherapy Department, University Hospital of Grenoble, Grenoble, France
| | - A Schernberg
- Brachytherapy Unit, Gustave Roussy, Cancer Campus, Villejuif, France.,Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - F Busato
- Brachytherapy Unit, Gustave Roussy, Cancer Campus, Villejuif, France.,Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - M Laurans
- Brachytherapy Unit, Gustave Roussy, Cancer Campus, Villejuif, France.,Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - I Fumagalli
- Brachytherapy Unit, Gustave Roussy, Cancer Campus, Villejuif, France.,Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - I Dumas
- Brachytherapy Unit, Gustave Roussy, Cancer Campus, Villejuif, France.,Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - E Deutsch
- Brachytherapy Unit, Gustave Roussy, Cancer Campus, Villejuif, France.,Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - C Haie-Meder
- Brachytherapy Unit, Gustave Roussy, Cancer Campus, Villejuif, France.,Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - C Chargari
- Brachytherapy Unit, Gustave Roussy, Cancer Campus, Villejuif, France.,Radiotherapy Department, Gustave Roussy, Villejuif, France.,Departement 'Effets Biologiques des Radiations', Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France.,French Military Health Academy, Ecole du Val-de-Grâce, Paris, France
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Annede P, Dumas I, Schernberg A, Tailleur A, Fumagalli I, Bockel S, Mignot F, Kissel M, Deutsch E, Haie-meder C, Chargari C. Radiobiological optimization comparison between pulse-dose-rate and high-dose-rate brachytherapy in patients with locally advanced cervical cancer. Brachytherapy 2019; 18:370-377. [DOI: 10.1016/j.brachy.2018.12.009] [Citation(s) in RCA: 5] [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: 09/19/2018] [Revised: 12/12/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
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Kissel M, Chirat E, Annede P, Burtin P, Fumagalli I, Bronsart E, Mignot F, Schernberg A, Dumas I, Haie-Meder C, Chargari C. OC-0431 Esophageal brachytherapy: Institut Gustave Roussy’s experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30851-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schernberg A, Haie-Meder C, Chargari C. Level of Evidence and Ethical Considerations for Locoregional Treatments in Metastatic Cervical Cancer. JAMA Oncol 2019; 5:574-575. [DOI: 10.1001/jamaoncol.2018.5096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Antoine Schernberg
- Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Christine Haie-Meder
- Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Cyrus Chargari
- Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
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Ta M, Schernberg A, Giraud P, Monnier L, Darai E, Bendifallah S, Schlienger M, Touboul E, Challand T, Huguet F, Rivin Del Campo E. EP-1492 Comparison of 3DCRT and IMRT in endometrial cancer: efficacy, safety, and prognostic analysis. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31912-7] [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: 10/26/2022]
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Seban RD, Robert C, Dercle L, Yeh R, Dunant A, Reuze S, Schernberg A, Sun R, Mignot F, Terroir M, Schlumberger M, Haie-Meder C, Chargari C, Deutsch E. Increased bone marrow SUVmax on 18F-FDG PET is associated with higher pelvic treatment failure in patients with cervical cancer treated by chemoradiotherapy and brachytherapy. Oncoimmunology 2019; 8:e1574197. [PMID: 31069132 PMCID: PMC6492982 DOI: 10.1080/2162402x.2019.1574197] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 09/20/2018] [Revised: 01/07/2019] [Accepted: 01/10/2019] [Indexed: 01/19/2023] Open
Abstract
The aim of this study was to evaluate if bone marrow (BM) SUVmax measured on pre-treatment 18F-FDG PET/CT predicts the clinical outcome of locally advanced cervical cancer (LACC). We recruited retrospectively patients with LACC who underwent staging 18F-FDG PET/CT and had baseline blood tests, then treated by chemoradiation therapy (CRT), followed by image-guided adaptive brachytherapy (IGABT). BM SUVmax was calculated and correlated to inflammatory blood markers. Tumor size and pelvic lymph node involvement were evaluated on baseline MRI. Prognostic value of SUV uptake and blood markers regarding overall survival (OS), pelvic and extra-pelvic recurrence-free survival (PRFS and EPRFS respectively) was assessed using Cox models with adjusted p-values. 116 patients with FIGO stage Ib-IVa cervical cancer, treated between 2005 and 2014, were analyzed. The median follow-up was 75.5 months. BM SUVmax was significantly correlated to tumor SUVmax. In multivariate analysis, PRFS was significantly poorer in patients with high BM SUVmax (>2.8) and neutrophilia (p < .05). Tumor size (>5 vs ≤5 cm) could predict PRFS, EPRFS and OS (p < .05). In our cohort, FIGO stage (I-II vs III-IV), pelvic lymph node involvement and tumor SUVmax (>12 vs ≤12) were not prognostic for OS or pelvic and extra-pelvic relapses. Patients with LACC and high BM SUVmax on 18F-FDG PET have worse PFRS following CRT plus IGABT. These results can be potentially explained by the pro-inflammatory role of the tumor microenvironment and G-CSF expressed by tumor cells. These data support the role of PET as a potential indicator of disease aggressiveness beyond tumor staging.
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Affiliation(s)
- Romain-David Seban
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Charlotte Robert
- INSERM, Villejuif, France.,Faculté de médecine, Université Paris-Sud, Université Paris-Saclay, France.,Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Department of Medical Physics, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Laurent Dercle
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,INSERM, Villejuif, France.,Department of Radiology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Randy Yeh
- Department of Radiology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Ariane Dunant
- Biostatistics and Epidemiology Unit, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Sylvain Reuze
- INSERM, Villejuif, France.,Faculté de médecine, Université Paris-Sud, Université Paris-Saclay, France.,Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Department of Medical Physics, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Antoine Schernberg
- Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Roger Sun
- INSERM, Villejuif, France.,Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Fabien Mignot
- Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Marie Terroir
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Faculté de médecine, Université Paris-Sud, Université Paris-Saclay, France
| | - Christine Haie-Meder
- Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Cyrus Chargari
- INSERM, Villejuif, France.,Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,French Military Health Services Academy, Paris, France.,Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France
| | - Eric Deutsch
- INSERM, Villejuif, France.,Faculté de médecine, Université Paris-Sud, Université Paris-Saclay, France.,Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Klausner G, Troussier I, Biau J, Jacob J, Schernberg A, Canova CH, Simon JM, Borius PY, Malouf G, Spano JP, Roupret M, Cornu P, Mazeron JJ, Valéry C, Feuvret L, Maingon P. Stereotactic Radiation Therapy for Renal Cell Carcinoma Brain Metastases in the Tyrosine Kinase Inhibitors Era: Outcomes of 120 Patients. Clin Genitourin Cancer 2019; 17:191-200. [PMID: 30926219 DOI: 10.1016/j.clgc.2019.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 08/01/2018] [Revised: 01/11/2019] [Accepted: 02/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of the study was to evaluate the outcomes in terms of efficacy and safety of a large consecutive series of 362 patients with renal cell carcinoma (RCC) brain metastases treated using stereotactic radiosurgery (SRS) in the tyrosine kinase inhibitor (TKI) era. PATIENTS AND METHODS From 2005 to 2015, 362 consecutive patients with brain metastases from RCC were treated using SRS in 1 fraction: 226 metastases (61 patients) using Gamma-Knife at a median of 18 Gy (50% isodose line); 136 metastases (63 patients) using linear accelerator at a median of 16 Gy (70% isodose line). The median patient age was 58 years. At the first SRS, 37 patients (31%) received a systemic treatment. Among systemic therapies, TKIs were the most common (65%). RESULTS The local control rates were 94% and 92% at 12 and 36 months, respectively. In multivariate analysis, a minimal dose >17 Gy and concomitant TKI treatment were associated with higher rates of local control. The overall survival rates at 12 and 36 months were 52% and 29%, respectively. In multivariate analysis, factors associated with poor survival included age ≥65 years, lower score index for SRS, concomitant lung metastases, time between RCC diagnosis and first systemic metastasis ≤4 months, occurrence during treatment with a systemic therapy, no history of neurosurgery, and persistence or occurrence of neurological symptoms at 3 months after SRS. Seventeen patients had Grade III/IV adverse effects of whom 3 patients presented a symptomatic radionecrosis. CONCLUSION SRS is highly effective in patients with brain metastases from RCC. Its association with TKIs does not suggest higher risk of neurologic toxicity.
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Affiliation(s)
- Guillaume Klausner
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France.
| | - Idriss Troussier
- Radio-Oncology Department, Hopital Universitary of Geneva, Geneva, Switzerland
| | - Julian Biau
- Radio-Oncology Department, Lausanne Universitary Hospital (CHUV), Lausanne, Switzerland
| | - Julian Jacob
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Antoine Schernberg
- Radiation Oncology Department, Gustave Roussy Institut, Villejuif, France
| | - Charles-Henri Canova
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Jean-Marc Simon
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Pierre-Yves Borius
- Neurosurgery Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Gabriel Malouf
- Medical Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Jean-Philippe Spano
- Medical Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Morgan Roupret
- Urology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Philippe Cornu
- Neurosurgery Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Jean-Jacques Mazeron
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Charles Valéry
- Neurosurgery Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Loïc Feuvret
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Philippe Maingon
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
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Schernberg A, Canova C, Blanchard P, Gorphe P, Breuskin I, Mirghani H, Moya-Plana A, Janot F, Bidault F, Chargari C, Bellefqih S, Ruffier A, Even C, Nguyen F, Temam S, Tao Y. Prognostic factors in patients with soft palate squamous cell carcinoma. Head Neck 2019; 41:1441-1449. [PMID: 30636178 DOI: 10.1002/hed.25598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/03/2017] [Revised: 10/02/2018] [Accepted: 12/05/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To define the prognostic factors associated with outcome in patients with soft palate squamous cell carcinoma (SCC). METHODS Previously untreated patients with soft palate and uvula SCC treated in our institution between 1997 and 2012 were collected. The prognostic value of clinical, hematological, and treatment characteristics was examined. RESULTS We identified 156 patients, median age 58 years, with 71% drinkers, 91% smokers; 19% had synchronous cancer. Front-line treatment was chemoradiotherapy in 58 (37%), radiotherapy alone in 60 (39%), surgery in 17 (11%), and induction chemotherapy in 21 patients (14%). The 5-year actuarial overall survival (OS) and progression-free survival (PFS) were 41% and 37%, respectively. In univariate analysis, T3-T4 vs T1-T2 stage, N2-N3 vs N0-N1 stage, and neutrophil count >7 g/L were associated with worse OS and PFS (P < .05). CONCLUSION In patients with soft palate SCC, inflammation biomarkers were associated with OS.
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Affiliation(s)
- Antoine Schernberg
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France.,INSERM1030, Gustave Roussy Cancer Campus, Paris, France
| | - Charles Canova
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Pierre Blanchard
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France.,Faculté de Médecine du Kremlin-Bicetre, Université Paris Sud, Université Paris Saclay, Paris, France
| | - Philippe Gorphe
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Ingrid Breuskin
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Haitham Mirghani
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Antoine Moya-Plana
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - François Janot
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Francois Bidault
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Cyrus Chargari
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France.,INSERM1030, Gustave Roussy Cancer Campus, Paris, France.,French Military Health Services Academy, Paris, France.,Institut de Recherche Biomédicale des Armées, Paris, France
| | - Sara Bellefqih
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Amandine Ruffier
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Caroline Even
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - France Nguyen
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Stéphane Temam
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Yungan Tao
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France.,INSERM1030, Gustave Roussy Cancer Campus, Paris, France
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Schernberg A, Bockel S, Fumagalli I, Annede P, Escande A, Mignot F, Kissel M, Morice P, Deutsch E, Haie-Meder C, Chargari C. Tumor Shrinkage during Chemoradiation in Locally Advanced Cervical Cancer Patients: Prognostic Significance, and Impact for Image-Guided Adaptive Brachytherapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schernberg A, Mezquita L, Boros A, Botticella A, Caramella C, Besse B, Escande A, Planchard D, Le Péchoux C, Deutsch E. Neutrophilia as prognostic biomarker in locally advanced stage III lung cancer. PLoS One 2018; 13:e0204490. [PMID: 30304046 PMCID: PMC6179235 DOI: 10.1371/journal.pone.0204490] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 09/10/2018] [Indexed: 01/06/2023] Open
Abstract
Objective To study the prognostic value of baseline leukocytosis or neutrophiliain two retrospective cohorts of stage III Non-Small Cell Lung Cancer (NSCLC) patients. Materials and methods Clinical records of consecutive previously untreated NSCLC patients in our Institution between June 2001 and September 2016 for stage III NSCLC were collected. The prognostic value of pretreatment leucocyte disorders was examined, with focus on patterns of relapse and survival. Leukocytosis and neutrophilia were defined as a leukocyte count or a neutrophil count exceeding 10 and 7 G/L, respectively. Results We identified 238 patients, displaying baseline leukocytosis or neutrophilia in 39% and 40% respectively. Most were diagnosed with adenocarcinoma (48%), and stage IIIB NSCLC (58%). 3-year actuarial overall survival (OS) and progression-free survival (PFS) were 35% and 27% respectively. Local relapses were reported in 100 patients (42%), and distant metastases in 132 patients (55%). In multivariate analysis, leukocytosis, neutrophilia, and induction chemotherapy regimen based on carboplatin/paclitaxel were associated with worse OS and PFS (p<0.05). Neutrophilia independently decreased Locoregional Control (LRC) (HR = 2.5, p<0.001) and Distant Metastasis Control (DMC) (HR = 2.1, p<0.001). Neutrophilia was significantly associated with worse brain metastasis control (p = 0.004), mostly in adenocarcinoma patients (p<0.001). Conclusion In stage III NSCLC patients, treated with concurrent cisplatin-based chemoradiation, baseline leukocytosis and neutrophilia were associated with worse OS, PFS, LRC, and DMC. In addition with previously available markers, this independent cost-effective biomarker could help to stratify stage III NSCLC population with more accuracy.
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Affiliation(s)
- Antoine Schernberg
- Radiation oncology department, Gustave Roussy Cancer Campus, Villejuif, France
- INSERM 1030, Gustave Roussy Cancer Campus, Villejuif, France
| | - Laura Mezquita
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Angela Boros
- Radiation oncology department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Angela Botticella
- Radiation oncology department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Caroline Caramella
- Department of Radiology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Benjamin Besse
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Université Paris Sud, Université Paris Saclay, Faculté de médecine du Kremlin-Bicetre, Le Kremlin-Bicetre, France
| | - Alexandre Escande
- Radiation oncology department, Gustave Roussy Cancer Campus, Villejuif, France
| | - David Planchard
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Cécile Le Péchoux
- Radiation oncology department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Eric Deutsch
- Radiation oncology department, Gustave Roussy Cancer Campus, Villejuif, France
- INSERM 1030, Gustave Roussy Cancer Campus, Villejuif, France
- Department of Radiology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Université Paris Sud, Université Paris Saclay, Faculté de médecine du Kremlin-Bicetre, Le Kremlin-Bicetre, France
- * E-mail:
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Nivet A, Schernberg A, Louvel G, Dumont S, Ammary S, Rehalia-Blanchard A, Clavère P, Parker F, Pallud J, Dhermain F. P01.005 The impact of thrombocytopenia from concomitant and adjuvant temozolomide in patients with glioblastoma. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.047] [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: 11/13/2022] Open
Affiliation(s)
- A Nivet
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
- Department of Radiotherapy, Limoges University Hospital, Limoges, France
| | - A Schernberg
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - G Louvel
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - S Dumont
- Department of Oncology, Gustave Roussy University Hospital, Villejuif, France
| | - S Ammary
- Department of Radiology, Gustave Roussy University Hospital, Villejuif, France
| | - A Rehalia-Blanchard
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest-En-Jarez, France
| | - P Clavère
- Department of Radiotherapy, Limoges University Hospital, Limoges, France
| | - F Parker
- Department of Neurosurgery, Kremlin Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - J Pallud
- Department of Neurosurgey, Sainte-Anne University Hospital, Paris, France
| | - F Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
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Schernberg A, Blanchard P, Chargari C, Ou D, Levy A, Gorphe P, Breuskin I, Atallah S, Caula A, Escande A, Janot F, Nguyen F, Temam S, Deutsch E, Tao Y. Leukocytosis, prognosis biomarker in locally advanced head and neck cancer patients after chemoradiotherapy. Clin Transl Radiat Oncol 2018; 12:8-15. [PMID: 30073209 PMCID: PMC6068078 DOI: 10.1016/j.ctro.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 05/18/2018] [Revised: 06/14/2018] [Accepted: 07/04/2018] [Indexed: 12/30/2022] Open
Abstract
Objective To study the prognostic value of leukocyte increase in a retrospective cohort of locally advanced head and neck squamous cell carcinoma (HNSCC) patients receiving definitive concurrent cisplatin and radiation. Materials and methods Clinical records of consecutive previously untreated locally advanced HNSCC patients treated in our Institution between March 2006 and October 2012 by concurrent cisplatin (100 mg/m2, every 3 weeks) and radiation (70 Gy in 7 weeks) were collected. The prognostic value of pretreatment leukocyte increase was examined, with focus on patterns of relapse and survival. Leukocytosis and neutrophilia were defined as a leukocyte count or a neutrophils count exceeding 10 and 7.5 G/L, respectively. Results We identified 193 patients, all treated with concurrent cisplatin-based chemoradiotherapy. Respectively 24% and 20% patients displayed baseline leukocytosis or neutrophilia. Mean leukocyte count were significantly more elevated in current smokers, patients with performance status (PS) >0, T4 and less in HPV + tumor. The 5-year actuarial overall survival (OS) and progression-free survival (PFS) were 56% and 51% respectively. In univariate analysis, both leukocytosis and neutrophilia were strongly associated with worse OS and PFS (p < 0.001). In multivariate analysis, N classification, HPV/p16, smoking status and leukocytosis were associated with worse OS and PFS. Patients with <3 cycles of cisplatin had worse survival. Conclusion In locally advanced HNSCC treated with concurrent cisplatin and radiation, baseline leukocytosis predicts OS and PFS. In addition with HPV status, this independent biomarker could help identifying patients with high risk of tumor relapse.
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Affiliation(s)
- Antoine Schernberg
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Pierre Blanchard
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Cyrus Chargari
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.,INSERM1030, Gustave Roussy Cancer Campus, Villejuif France.,French Military Health Services Academy, Ecole du Val-de-Grâce, Paris, France.,Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France
| | - Dan Ou
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Antonin Levy
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.,INSERM1030, Gustave Roussy Cancer Campus, Villejuif France
| | - Philippe Gorphe
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Ingrid Breuskin
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Sarah Atallah
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Alexandre Caula
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Alexandre Escande
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - François Janot
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - France Nguyen
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Stéphane Temam
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Eric Deutsch
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.,INSERM1030, Gustave Roussy Cancer Campus, Villejuif France.,Université Paris Sud, Université Paris Saclay, Faculté de médecine du Kremlin-Bicetre, Le Kremlin-Bicetre, France
| | - Yungan Tao
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.,INSERM1030, Gustave Roussy Cancer Campus, Villejuif France
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Schernberg A, Bockel S, Annede P, Fumagalli I, Escande A, Mignot F, Kissel M, Morice P, Bentivegna E, Gouy S, Deutsch E, Haie-Meder C, Chargari C. Tumor Shrinkage During Chemoradiation in Locally Advanced Cervical Cancer Patients: Prognostic Significance, and Impact for Image-Guided Adaptive Brachytherapy. Int J Radiat Oncol Biol Phys 2018; 102:362-372. [PMID: 29920324 DOI: 10.1016/j.ijrobp.2018.06.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/30/2018] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To study the prognostic value of gross tumor volume (GTV) shrinkage and its dosimetric implication in a large cohort of patients with cervical cancer receiving definitive chemoradiotherapy plus image guided adaptive brachytherapy. METHODS AND MATERIALS Clinical records of consecutive patients treated in our institution between February 2004 and November 2015 by concurrent chemoradiotherapy (45 Gy in 25 fractions ± lymph node boosts) followed by a magnetic resonance imaging-guided adaptive pulse-dose rate brachytherapy were included. The prognostic value of GTV and its evolution after chemoradiotherapy were examined first on initial staging magnetic resonance imaging and then at time of brachytherapy. All measures and measurement cutoffs were selected using time-dependent area under the curve for 3-year progression-free survival (PFS). RESULTS GTV evolution between diagnosis and the time of brachytherapy was assessed in 247 patients. After chemoradiotherapy, complete response was observed in 75 patients (28%). Optimal cutoffs were GTV = 55 cm3 at diagnosis, GTV = 7.5 cm3 at brachytherapy, and GTV reduction ≥90%. All patients with volume above or reduction below these cutoffs had significant reduced overall survival, PFS, local control, and distant metastasis control (P < .001). Patients with anemia at diagnosis had a lower tumor volume response rate (P < .001). In multivariate analysis, incorporating the International Federation of Gynecology and Obstetrics stage, N+ stage, anemia, and dosimetric parameters for image guided adaptive brachytherapy, GTV optimal volume reduction after chemoradiotherapy was independently associated with improved overall survival, PFS, local control, and distant metastasis control (P < .001). CONCLUSIONS These results could provide a rationale for dose de-escalation studies in brachytherapy for patients displaying optimal GTV volumetric reduction after chemoradiotherapy and may reinforce the need for dose escalation in poorly responding patients.
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Affiliation(s)
- Antoine Schernberg
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France; INSERM U1030, Gustave Roussy Cancer Campus, Villejuif, France
| | - Sophie Bockel
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Pierre Annede
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Ingrid Fumagalli
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Alexandre Escande
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Fabien Mignot
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Manon Kissel
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Philippe Morice
- Faculté de médecine PARIS Sud, Université Paris Sud, Université Paris-Saclay, France; Department of Surgery, Gustave Roussy, Villejuif, France
| | | | - Sebastien Gouy
- Department of Surgery, Gustave Roussy, Villejuif, France
| | - Eric Deutsch
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France; INSERM U1030, Gustave Roussy Cancer Campus, Villejuif, France; Department of Surgery, Gustave Roussy, Villejuif, France
| | - Christine Haie-Meder
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Cyrus Chargari
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France; INSERM U1030, Gustave Roussy Cancer Campus, Villejuif, France; Department of Surgery, Gustave Roussy, Villejuif, France; French Military Health Services Academy, Ecole du Val-de-Grâce, Paris, France; Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France.
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Schernberg A, Nivet A, Dhermain F, Ammari S, Escande A, Pallud J, Louvel G, Deutsch E. Neutrophilia as a biomarker for overall survival in newly diagnosed high-grade glioma patients undergoing chemoradiation. Clin Transl Radiat Oncol 2018; 10:47-52. [PMID: 29928705 PMCID: PMC6008628 DOI: 10.1016/j.ctro.2018.04.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 02/05/2018] [Revised: 04/08/2018] [Accepted: 04/11/2018] [Indexed: 12/22/2022] Open
Abstract
Inflammation has been associated with poor outcome in various cancer histologies. In high-grade gliomas treated with concurrent temozolomide and radiation, pretreatment neutrophilia may be a significant prognosis factor for overall survival. In addition with previously available markers, this independent cost-effective biomarker could help identifying patients with worsened prognosis.
Objective To study the prognostic value of neutrophil disorders in a retrospective cohort of high-grade glioma patients receiving definitive concurrent temozolomide and radiation. Materials and methods Clinical records of consecutive patients treated in our Institution between January 2005 and December 2010 with concurrent temozolomide (75 mg/m2 daily) and radiation were collected. The prognostic value of pretreatment neutrophilia on survival, defined as a neutrophil count exceeding 7 G/L, was examined. Results We identified 164 patients, all treated with concurrent temozolomide-based chemoradiotherapy. Initial surgery was achieved in most (75%), with resection > 90% in 55 patients (34%). Total 151 patients (92%) had glioblastoma, and 13 patients (8%) had WHO grade III glioma. Eighty-two patients (50%) displayed pretreatment neutrophilia. Neutrophilia was not associated with concurrent or adjuvant temodal discontinuation (p > 0.3). The 2-year actuarial overall survival was 45%. Steroid consumption, i.e. 60 mg or more of daily prednisolone, increased pretreatment neutrophil count (p = 0.005). In univariate analysis, neutrophilia was associated with worse overall survival (p = 0.019), as well as age ≥ 65 years (p = 0.009), surgical resection < 90% (p = 0.003) and prednisolone consumption ≥ 60 mg/day (p = 0.016). In multivariate analysis, neutrophilia (p = 0.013), age ≥ 65 (p = 0.001), and surgical tumor resection < 90% (p = 0.010) independently decreased overall survival, while, steroid consumption was not (p = 0.088). Conclusion In high-grade gliomas treated with concurrent temozolomide and radiation, pretreatment neutrophilia may be a significant prognosis factor for overall survival. In addition with previously available markers, this independent cost-effective biomarker could help identifying patients with worsened prognosis.
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Affiliation(s)
- Antoine Schernberg
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.,INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France
| | - Alexandre Nivet
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Frédéric Dhermain
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Samy Ammari
- Radiology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Alexandre Escande
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Johan Pallud
- Neurosurgery Department, Sainte-Anne Hospital, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France
| | - Guillaume Louvel
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Eric Deutsch
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.,INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France.,Université Paris Sud, Université Paris Saclay, Faculté de médecine du Kremlin-Bicetre, Le Kremlin-Bicetre, France
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Seban R, Robert C, Dercle L, Yeh R, Reuze S, Schernberg A, Lumbroso J, Schlumberger M, Haie-Meder C, Chargari C, Deutsch E. OC-0394: Pretreatment bone marrow SUVmax in locally advanced cervical cancer: a novel prognostic biomarker? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30704-7] [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: 11/26/2022]
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Saleh K, Michot J, Schernberg A, Danu A, Lazarovici J, Ghez D, Girinsky T, Khalife-Saleh N, Mazeron R, Ribrag V, Boros A. EP-1249: Repeated low-dose radiation therapy in indolent Non-Hodgkin Lymphoma patients. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31559-7] [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: 11/30/2022]
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Limkin E, Reuzé S, Sun R, Schernberg A, Alexis A, Dirand A, Deutsch E, Ferté C, Robert C. EP-1993: Evaluation of the pertinence of CT-based radiomics shape features with 3D printed phantoms. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32302-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Reuzé S, Chargari C, Schernberg A, Seban R, Alexis A, Bockel S, Berthelot K, Escande A, Dercle L, Haie-Meder C, Deutsch E, Robert C. PO-0807: Diversity of PET imaging biomarkers predicting cervical cancer treatment outcome: where do we stand? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31117-4] [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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