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Bourbonne V, Lévy A, Khalifa J, Antoni D, Blais E, Darréon J, Le Péchoux C, Lerouge D, Giraud P, Marguerit A, Pourel N, Riet FG, Thureau S. Radiotherapy in the management of lung oligometastases. Cancer Radiother 2024; 28:36-48. [PMID: 38228422 DOI: 10.1016/j.canrad.2023.06.030] [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: 02/26/2023] [Revised: 06/07/2023] [Accepted: 06/29/2023] [Indexed: 01/18/2024]
Abstract
In recent years, the development of both medical imaging and new systemic agents (targeted therapy and immunotherapy) have revolutionized the field of oncology, leading to a new entity: oligometastatic disease. Adding local treatment of oligometastases to systemic treatment could lead to prolonged survival with no significant impact on quality of life. Given the high prevalence of lung oligometastases and the new systemic agents coming with increased pulmonary toxicity, this article provides a comprehensive review of the current state-of-art for radiotherapy of lung oligometastases. After reviewing pretreatment workup, the authors define several radiotherapy regimen based on the localization and size of the oligometastases. A comment on the synergistic combination of medical treatment and radiotherapy is also made, projecting on future steps in this specific clinical setting.
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Affiliation(s)
- V Bourbonne
- Radiation Oncology Department, CHU de Brest, Brest, France; LaTim, Inserm, UMR 1101, université de Bretagne occidentale, Brest, France
| | - A Lévy
- Department of Radiation Oncology, Centre international des cancers thoraciques (CICT), Gustave-Roussy, 94805 Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - J Khalifa
- Department of Radiation Oncology, institut Claudius-Regaud, institut universitaire du cancer Toulouse-Oncopôle, Toulouse, France
| | - D Antoni
- Department of Radiation Oncology, Institut de cancérologie Strasbourg Europe, Strasbourg, France
| | - E Blais
- Department of Radiation Oncology, polyclinique Marzet, Pau, France
| | - J Darréon
- Department of Radiation Oncology, institut Paoli-Calmettes, Marseille, France
| | - C Le Péchoux
- Department of Radiation Oncology, Centre international des cancers thoraciques (CICT), Gustave-Roussy, 94805 Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - D Lerouge
- Department of Radiation Oncology, centre François-Baclesse, Caen, France
| | - P Giraud
- Department of Radiation Oncology, hôpital européen Georges-Pompidou, Paris, France; Université Paris Cité, Paris, France
| | - A Marguerit
- Department of Radiation Oncology, Institut de cancérologie de Montpellier, Montpellier, France
| | - N Pourel
- Department of Radiation Oncology, institut Sainte-Catherine, Avignon, France
| | - F-G Riet
- Department of Radiation Oncology, centre hospitalier privé Saint-Grégoire, 35760 Saint-Grégoire, France
| | - S Thureau
- Radiotherapy Department, centre Henri-Becquerel, Rouen, France; QuantIF-Litis EA4108, université de Rouen, Rouen, France.
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2
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Khalifa J, Lévy A, Sauvage LM, Thureau S, Darréon J, Le Péchoux C, Lerouge D, Pourel N, Antoni D, Blais E, Martin É, Marguerit A, Giraud P, Riet FG. Radiotherapy in the management of synchronous metastatic lung cancer. Cancer Radiother 2024; 28:22-35. [PMID: 37574329 DOI: 10.1016/j.canrad.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/02/2023] [Indexed: 08/15/2023]
Abstract
Metastatic lung cancer classically portends a poor prognosis. The management of metastatic lung cancer has dramatically changed with the emergence of immune checkpoint inhibitors, targeted therapy and due to a better understanding of the oligometastatic process. In metastatic lung cancers, radiation therapy which was only used with palliative intent for decades, represents today a promising way to treat primary and oligometastatic sites with a curative intent. Herein we present through a literature review the role of radiotherapy in the management of synchronous metastatic lung cancers.
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Affiliation(s)
- J Khalifa
- Department of Radiation Oncology, institut Claudius-Regaud/IUCT-Oncopole, Toulouse, France; U1037, Inserm, CRCT, Toulouse, France.
| | - A Lévy
- Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Gustave-Roussy, 94805 Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; Université Paris-Saclay, Molecular Radiotherapy and Therapeutic Innovation lab, Inserm U1030, 94805 Villejuif, France
| | - L-M Sauvage
- Department of Radiation Oncology, institut Curie, Paris, France
| | - S Thureau
- Department of Radiation Oncology, centre Henri-Becquerel, Rouen, France; QuantIf-Litis EA4108, université de Rouen, Rouen, France
| | - J Darréon
- Department of Radiation Oncology, institut Paoli-Calmettes, Marseille, France
| | - C Le Péchoux
- Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Gustave-Roussy, 94805 Villejuif, France
| | - D Lerouge
- Department of Radiation Oncology, centre François-Baclesse, Caen, France
| | - N Pourel
- Department of Radiation Oncology, institut Sainte-Catherine, Avignon, France
| | - D Antoni
- Department of Radiation Oncology, institut de cancérologie Strasbourg Europe, Strasbourg, France
| | - E Blais
- Department of Radiation Oncology, polyclinique Marzet, Pau, France
| | - É Martin
- Department of Radiation Oncology, centre Georges-François-Leclerc, Dijon, France
| | - A Marguerit
- Department of Radiation Oncology, institut de cancérologie de Montpellier, Montpellier, France
| | - P Giraud
- Department of Radiation Oncology, hôpital européen Georges-Pompidou, Paris, France; Université Paris Cité, Paris, France
| | - F-G Riet
- Department of Radiation Oncology, centre hospitalier privé Saint-Grégoire, Saint-Grégoire, France
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Belkacemi Y, Debbi K, Besnard C, Grellier N, Fonteneau G, Colson-Durand L, Lerouge D, Durdux C, Campana F, Pons P, Flandin I, Pasquier D, de Crevoisier R, Wachter T, Thureau S, Noël G, Conzague-Casabianca L, Petit A, Supiot S, Azria D. [The morbidity and mortality review meetings in radiotherapy departments: Procedure, implementation and prospects of the "Proust" French national project]. Cancer Radiother 2023; 27:474-479. [PMID: 37507286 DOI: 10.1016/j.canrad.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023]
Abstract
Radiation-induced acute and late toxicity depends on several parameters. The type, severity and duration of morbidity are mainly related to irradiated volume, total dose and its fractionation and the intrinsic radiosensitivity of the patients. The follow-up of these toxicities is essential. However, unlike many specialties, morbidity and mortality reviews procedures are not developed as part of quality governance programs in radiation therapy departments for the monitoring of toxicity which sometimes hinder the patients' quality of life. One French survey published within the framework of the project entitled Prospective Registration of Morbidity and Mortality, Individual Radiosensitivity and Radiation Technique (Proust), conclude that there was a lack of knowledge of morbidity and mortality reviews and considerable confusion between these reviews and other quality processes without perspective for the local morbidity and mortality reviews development in a large number of the participated centers. In this article, we will discuss the procedure of the "ideal morbidity and mortality reviews" and its implementation through a monocentric experience started in 2015. Thus, the Proust project is a unique opportunity to implement and standardize a national morbidity and mortality reviews implementation in radiation therapy departments by involving the French regions.
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Affiliation(s)
- Y Belkacemi
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Équipe i-Biot, unité 955, Inserm, IMRB, université Paris-Est Créteil, Créteil, France.
| | - K Debbi
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Équipe i-Biot, unité 955, Inserm, IMRB, université Paris-Est Créteil, Créteil, France
| | - C Besnard
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - N Grellier
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - G Fonteneau
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - L Colson-Durand
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Service d'oncologie-radiothérapie, Institut oncologique Paris-Nord, Sarcelles, France
| | - D Lerouge
- Service d'oncologie-radiothérapie, centre François-Baclesse, Caen, France
| | - C Durdux
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, AP-HP, université Paris-Cité, Paris, France
| | - F Campana
- Service d'oncologie-radiothérapie, institut Hartmann, Levallois-Perret, France
| | - P Pons
- Service d'oncologie-radiothérapie, institut Hartmann, Levallois-Perret, France
| | - I Flandin
- Service d'oncologie-radiothérapie, centre hospitalier universitaire de Grenoble, Grenoble, France
| | - D Pasquier
- Département universitaire d'oncologie-radiothérapie, centre Oscar-Lambret, UMR 9189, université de Lille, Centre de recherche en informatique, signal et automatique de Lille (Cristal), Lille, France
| | - R de Crevoisier
- Service d'oncologie-radiothérapie, centre Eugène-Marquis, Rennes, France
| | - T Wachter
- Service d'oncologie-radiothérapie, centre hospitalier général d'Orléans, Orléans, France
| | - S Thureau
- Service d'oncologie-radiothérapie, centre Henri-Becquerel, QuantIF Litis unit EA 4108, université de Rouen, Rouen, France
| | - G Noël
- Service d'oncologie-radiothérapie, institut de cancérologie Strasbourg Europe (ICANS), université de Strasbourg, Strasbourg, France
| | | | - A Petit
- Service d'oncologie-radiothérapie, institut Bergonié, Bordeaux, France
| | - S Supiot
- Service d'oncologie-radiothérapie, institut de cancérologie de l'Ouest, centre René-Gauducheau, université de Nantes, Nantes, France
| | - D Azria
- Service d'oncologie-radiothérapie, Institut du cancer de Montpellier (ICM), université de Montpellier, Institut de recherche sur le cancer de Montpellier (IRCM), unit 1194, Inserm, Montpellier, France
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Trédaniel J, Barlési F, Le Péchoux C, Lerouge D, Pichon É, Le Moulec S, Moreau L, Friard S, Westeel V, Petit L, Carré O, Guichard F, Raffy O, Villa J, Prévost A, Langlais A, Morin F, Wislez M, Giraud P, Zalcman G, Mornex F. Final results of the IFCT-0803 study, a phase II study of cetuximab, pemetrexed, cisplatin, and concurrent radiotherapy in patients with locally advanced, unresectable, stage III, non-squamous, non-small-cell lung cancer. Cancer Radiother 2022; 26:670-677. [PMID: 35260342 DOI: 10.1016/j.canrad.2021.12.005] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/24/2021] [Accepted: 12/12/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Roughly 20% of patients with non-small-cell lung cancer exhibit locally advanced, unresectable, stage III disease. Concurrent platinum-based chemoradiotherapy is the backbone treatment, which is followed by maintenance immunotherapy, yet with poor long-term prognosis. This phase II trial (IFCT-0803) sought to evaluate whether adding cetuximab to cisplatin and pemetrexed chemoradiotherapy would improve its efficacy in these patients. MATERIALS AND METHODS Eligible patients received weekly cetuximab (loading dose 400mg/m2 day 1; subsequent weekly 250mg/m2 doses until two weeks postradiotherapy). Chemotherapy comprised cisplatin (75mg/m2) and pemetrexed (500mg/m2), both delivered on day 1 of a 21-day cycle of maximally four. Irradiation with maximally 66Gy started on day 22. Disease control rate at week 16 was the primary endpoint. RESULTS One hundred and six patients were included (99 eligible patients). Compliance exceeded 95% for day 1 of chemotherapy cycles 1 to 4, with 76% patients receiving the 12 planned cetuximab doses. Maximal grade 3 toxicity occurred in 63% patients, and maximal grade 4 in 9.6%. The primary endpoint involving the first 95 eligible patients comprised two (2.1%) complete responses, 57 (60.0%) partial responses, and 27 (28.4%) stable diseases. This 90.5% disease control rate (95% confidence interval [95% CI]: 84.6%-96.4%) was achieved at week 16. After median 63.0-month follow-up, one-year and two-year survival rates were 75.8% and 59.5%. Median overall survival was 35.8months (95% CI: 23.5-NR), and median progression-free survival 14.4months (95% CI: 11.2-18.8), with one-year and two-year progression-free survival rates of 57.6% and 34.3%. CONCLUSION These survival rates compare favourably with published data, thus justifying further development of cetuximab-based induction chemoradiotherapy.
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Affiliation(s)
- J Trédaniel
- Department of pneumology, hôpital Saint-Joseph, 75014 Paris, France.
| | - F Barlési
- Multidisciplinary oncology and therapeutic innovations department, centre hospitalier universitaire de Marseille, 13000 Marseille, France
| | - C Le Péchoux
- Department of radiation oncology, Gustave-Roussy, 94805 Villejuif, France
| | - D Lerouge
- Department of radiation oncology, centre François-Baclesse, 14000 Caen, France
| | - É Pichon
- Department of pneumology, centre hospitalier universitaire de Tours, 37000 Tours, France
| | - S Le Moulec
- Department of pneumology, institut Bergonié, 33000 Bordeaux, France
| | - L Moreau
- Department of pneumology, hôpital Louis-Pasteur, 68024 Colmar, France
| | - S Friard
- Department of pneumology, hôpital Foch, 92150 Suresnes, France
| | - V Westeel
- Department of pneumology, centre hospitalier universitaire de Besançon, 25000 Besançon, France
| | - L Petit
- Department of pneumology, centre hospitalier Alpes Léman, 74130 Contamine-sur-Arve, France
| | - O Carré
- Department of pneumology, clinique de l'Europe, 80090 Amiens, France
| | - F Guichard
- Department of oncology, polyclinique, 33000 Bordeaux, France
| | - O Raffy
- Department of pneumology, hôpital de Chartres, 28000 Chartres, France
| | - J Villa
- Department of pneumology, centre hospitalier universitaire de Grenoble, 38000 Grenoble, France
| | - A Prévost
- Department of pneumology, centre de lutte contre le cancer Jean-Godinot, 51100 Reims, France
| | - A Langlais
- Intergroupe francophone de cancérologie thoracique, 75000 Paris, France
| | - F Morin
- Intergroupe francophone de cancérologie thoracique, 75000 Paris, France
| | - M Wislez
- Department of pneumology, hôpital Cochin, 75014 Paris, France
| | - P Giraud
- Department of radiation Oncology, hôpital européen Georges-Pompidou, 75015 Paris, France
| | - G Zalcman
- Department of pneumology, centre hospitalier universitaire de Caen, 14000 Caen, France
| | - F Mornex
- Department of radiation oncology, centre hospitalier universitaire de Lyon, 69000 Lyon, France
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Abstract
Herein are presented the recommendations from the Société française de radiothérapie oncologique regarding indications and modalities of lung cancer radiotherapy. The recommendations for delineation of the target volumes and organs at risk are detailed.
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Affiliation(s)
- J Khalifa
- Département de radiothérapie, Institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France.
| | - D Lerouge
- Département de radiothérapie, centre François-Baclesse, 3, avenue du General-Harris, 14076 Caen, France
| | - C Le Péchoux
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - N Pourel
- Département de radiothérapie, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS80005, 84918 Avignon cedex 9, France
| | - J Darréon
- Service de physique médicale, institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - F Mornex
- Service de radiothérapie, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - P Giraud
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, Paris, France; Université de Paris, 85, boulevard Saint-Germain, 75006 Paris, France
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Deshayes S, Leite Ferreira D, Madelaine J, Oulkhouir Y, Campbell K, Fouquet H, Teulier S, Magnier R, Heyndrickx M, Lerouge D, Bergot E, Justet A. [D-CBP study: Evaluation of lung cancer management times]. Rev Mal Respir 2021; 38:894-903. [PMID: 34756617 DOI: 10.1016/j.rmr.2021.09.002] [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: 02/26/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Lung cancer is the leading cause of cancer-related death. Delays may have an impact on patient survival. The objective of this study was to evaluate the diagnostic and therapeutic management times for patients admitted for lung cancer treatment in the Respiratory Department of CHU de Caen Normandie. MATERIALS AND METHODS This is a retrospective, single-center and observational study, conducted on all patients treated for lung cancer from June 2017 to January 2018 in our department of pneumology in the Caen Normandie CHU. The main median times were investigated were: Global Time (abnormal imaging-treatment), Diagnosis time (abnormal imaging-diagnosis) and Treatment Time (diagnosis-treatment). RESULTS One hundred and twenty-seven (127) patients were included. Median global time was 55.5 days [31,25; 393], median diagnosis time was 22 days [13; 49], and median treatment time was 24.5 days [12,25; 45]. DISCUSSION Our treatment times are consistent with those previously published. Areas for improvement are being developed in accordance with the 2014-2019 cancer plan, in particularly the creation in our institution of a specific care pathway for patients with lung cancer.
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Affiliation(s)
- S Deshayes
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - D Leite Ferreira
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - J Madelaine
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - Y Oulkhouir
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - K Campbell
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - H Fouquet
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - S Teulier
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - R Magnier
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France
| | - M Heyndrickx
- Service de Chirurgie Thoracique, CHU de Caen, 14000 Caen, France
| | - D Lerouge
- Service de Radiothérapie, Centre de Lutte contre le Cancer François Baclesse, 14000 Caen, France
| | - E Bergot
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France; ISTCT, UMR6030-CNRS-CEA-Université de Caen, 14000 Caen, France
| | - A Justet
- Service de Pneumologie et d'Oncologie Thoracique, CHU de Caen, 14000 Caen, France; ISTCT, UMR6030-CNRS-CEA-Université de Caen, 14000 Caen, France.
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Moukasse Y, Pourel N, Lerouge D, Faivre-Finn C, Ramella S, Edwards J, Van Schil P, Rami-Porta R, Thomas P, Bardet A, Le Pechoux C. PH-0280: Quality of surgery and RT in stage IIIN2 NSCLC: Insights from the Lung Adjuvant Radiotherapy trial. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00304-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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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Lerouge D, Latorzeff I, Mirabel X, Dohan A, Mordant P, Barry De Longchamps N, Giraud P. [Erratum to "Stereotaxic radiotherapy of primary extracranial tumors" [Cancer Radiother. 24 (2020) DOI:10.1016/j.canrad.2020.06.020]]. Cancer Radiother 2020; 24:898. [PMID: 33004297 DOI: 10.1016/j.canrad.2020.08.043] [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: 11/17/2022]
Affiliation(s)
- D Lerouge
- Service d'oncologie radiothérapie, université de Paris, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - I Latorzeff
- Département de radiothérapie, centre François-Baclesse, avenue du Général-Harris, 14076 Caen, France
| | - X Mirabel
- Département de radiothérapie-oncologie, clinique Pasteur, bâtiment Atrium, 1, rue de la Petite-Vitesse, 31300 Toulouse, France
| | - A Dohan
- Département de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - P Mordant
- Unité de radiologie abdominopelvienne et interventionnelle, service de radiologie A, université de Paris, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - N Barry De Longchamps
- Unité Inserm U1152, service de chirurgie vasculaire, thoracique, et de transplantation pulmonaire, université de Paris, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France
| | - P Giraud
- Équipe 4, Inserm U1151, service d'urologie, Institut Necker-Enfants-malades, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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9
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Giraud P, Lerouge D, Latorzeff I, Mirabel X, Dohan A, Mordant P, Barry de Longchamps N. [Stereotaxic radiotherapy of primary extracranial tumors]. Cancer Radiother 2020; 24:513-522. [PMID: 32830055 DOI: 10.1016/j.canrad.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 12/25/2022]
Abstract
Stereotactic radiotherapy is a fundamental change from the conventional fractionated radiotherapy and represents a new therapeutic indication. Stereotactic radiotherapy is now a standard of care for inoperable patients or patients who refuse surgery. The results are encouraging with local control and survival rates very high in selected populations. The rate of late toxicity remains acceptable. Good tolerability makes it appropriate even for elderly and frail patients. In these fragile patients or in certain specific clinical situations, different surgical, radiotherapy or interventional radiology attitudes can be discussed on a case-by-case basis. These situations are considered in this article for the pulmonary, hepatic and prostatic localizations.
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Affiliation(s)
- P Giraud
- Service d'oncologie radiothérapie, université de Paris, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
| | - D Lerouge
- Département de radiothérapie, centre François-Baclesse, avenue du Général-Harris, 14076 Caen, France
| | - I Latorzeff
- Département de radiothérapie-oncologie, bâtiment Atrium, clinique Pasteur, 1, rue de la Petite-Vitesse, 31300 Toulouse, France
| | - X Mirabel
- Département de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - A Dohan
- Service de radiologie A, université de Paris, unité de radiologie abdominopelvienne et interventionnelle, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - P Mordant
- Service de chirurgie vasculaire, thoracique, et de transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, unité Inserm U1152, université de Paris, 46, rue Henri-Huchard, 75018 Paris, France
| | - N Barry de Longchamps
- Service d'urologie, Inserm U1151 - équipe 4/Institut Necker Enfants Malades, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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10
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Llacer-Moscardo C, Terlizzi M, Bonvalot S, Le Loarer F, Carrère S, Tetrau R, D'ascoli A, Lerouge D, Le Péchoux C, Thariat J. Pre- or postoperative radiotherapy for soft tissue sarcomas. Cancer Radiother 2020; 24:501-512. [PMID: 32807685 DOI: 10.1016/j.canrad.2020.05.007] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 11/17/2022]
Abstract
Sarcomas are rare tumours arising from mesenchymal tissue. A multimodal management in an expert centre combining surgery and radiotherapy is the current standard of care for localized soft-tissue sarcomas of the extremities, to enable limb-sparing strategies. The delivery of pre- radiotherapy or postoperative radiotherapy offers similar local control and survival rates but the toxicity profile is quite different: preoperative radiotherapy increases the risk of wound complications and postoperative radiotherapy affects long-term functional outcomes. While postoperative radiotherapy has long been the rule, especially in Europe, technical improvements with image-guided- and intensity-modulated radiotherapy associated with a better management of postoperative wounds has tended to change practices with more frequent preoperative radiotherapy. More recently the possibilities of a hypofractionated regimen or potentiation by nanoparticles to increase the therapeutic index plead in favour of a preoperative delivery of radiotherapy. The aim of this paper is to report pros and cons of pre- and post-operative radiotherapy for soft-tissue sarcomas.
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Affiliation(s)
- C Llacer-Moscardo
- Radiation Oncology Department, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France.
| | - M Terlizzi
- Radiation Oncology Department, hôpital Haut-Lévêque, CHU de Bordeaux, 1, avenue Magellan, 33600 Pessac, France
| | - S Bonvalot
- Department of Surgical Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - F Le Loarer
- Department of Pathology, institut Bergonié, 229, cours de l'Argonne, CS 61283, 33076 Bordeaux cedex, France
| | - S Carrère
- Department of Surgical Oncology, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - R Tetrau
- Radiology Department, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - A D'ascoli
- Department of Orthopaedics and Sports Surgery, hôpital Pasteur 2, Institut universitaire locomoteur et sports (IULS), 30, voie Romaine, 06000 Nice, France
| | - D Lerouge
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue General-Harris, 14000 Caen, France
| | - C Le Péchoux
- Radiation Oncology Department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - J Thariat
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue General-Harris, 14000 Caen, France
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11
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Loiseau C, Barraux V, Berejny P, Batalla A, Austins H, Ollivier C, Piantino A, Nicolas C, Stefan D, Kao W, Silva M, Lerouge D. 34 Custom applicators made by 3D printer in brachytherapy: Experience of the F. Baclesse centre (Caen- France). Phys Med 2019. [DOI: 10.1016/j.ejmp.2019.09.115] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Kissel M, Martel-Lafay I, Lequesne J, Faivre JC, Le Péchoux C, Stefan D, Barraux V, Loiseau C, Grellard JM, Danhier S, Lerouge D, Chouaid C, Gervais R, Thariat J. Irradiation stéréotaxique des oligométastases, oligorécurrences, oligopersistances et oligoprogressions extracérébrales de cancer bronchique. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Kissel M, Silva M, Lequesne J, Grellard JM, Loiseau C, Barraux V, Lerouge D, Lecornu M, Lesaunier F, Haie-Méder C, Chargari C, Thariat J. Impact sur le contrôle local et complications des implantations sous-optimales en curiethérapie utérovaginale. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.093] [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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14
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Moukasse Y, Pourel N, Lerouge D, Padovani L, Faivre-Finn C, Ramella S, Bardet A, Auzac G, Le Péchoux C. Contrôle qualité de la radiothérapie postopératoire des carcinomes bronchiques non à petites cellules de stade III avec envahissement N2 : une première étape importante dans l’étude multicentrique de phase III Lung Adjuvant Radiotherapy Trial (Lung ART-IFCT 0503). Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.013] [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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15
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Terlizzi M, Rapeaud E, Le Pechoux C, Salas S, Lerouge D, Sunyach M, Vogin G, Sole C, Zilli T, Myroslav L, Mampuya A, Calvo F, Attal J, De Bari B, Ozsahin M, Sargos P, Thariat J. Radiation Therapy in Extracranial Chondrosarcomas: A Multicenter French Sarcoma Group and Rare Cancer Network Study. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1105] [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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16
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Larsen F, Sargos P, Linacre V, Suarez F, Terlizzi M, Kirova Y, Van Houtte P, Lerouge D, Sole C. Radiation Therapy in Intrathoracic Sarcomas: A Rare Cancer Network Study. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.935] [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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17
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Lesueur P, Escande A, Thariat J, Lerouge D, Danhier S, Monnet I, Vauleon E, Cortot A, Chouaïd C, Gervais R. Clinical Outcomes of Patients with Lung Cancer Treated with Radiation Therapy Andanti-PD-1 Therapy: A Multicenter Retrospective Analysis From GFPC Group. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.136] [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: 10/28/2022]
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Lesueur P, Escande A, Thariat J, Monnet I, Vauléon E, Lerouge D, Danhier S, Do P, Cortot A, Dubos C, Chouaïd C, Gervais R. Tolérance et efficacité de la combinaison d’anti PD-1 et de radiothérapie chez les patients atteints de cancer bronchique non à petites cellules métastatiques : étude rétrospective multicentrique. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.021] [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: 10/28/2022]
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Le Pechoux C, Levy A, Mistry H, Martel-Lafay I, Bezjak A, Lerouge D, Padovani L, Taylor P, Faivre-Finn C. OA13.05 Prophylactic Cranial Irradiation (PCI) for Limited-Stage Small-Cell Lung Cancer: Results from the Phase 3 CONVERT Trial. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.309] [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: 10/28/2022]
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20
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Terlizzi M, Rapeaud E, Le Péchoux C, Salas S, Lerouge D, Sunyach MP, Vogin G, Solé C, Zilli T, Myroslav L, Mampuya A, Calvo F, Attal J, De Bari B, Ozsahin M, Sargos P, Thariat J. Radiothérapie des chondrosarcomes extracrâniens : étude multicentrique du Groupe sarcome français et du Rare Cancer Network. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Thureau S, Chaumet-Riffaud P, Modzelwski R, Hapdey S, Mahé M, Boisselier P, Beckendorf V, Salem N, Lerouge D, Dubray B, Vera P. Étude de phase II sur l’efficacité et la tolérance d’une augmentation de dose de radiothérapie des lésions hypoxiques définies par TEP-scanographie au fluoromisonidazole chez les patients suivis par un cancer bronchique non à petites cellules. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.115] [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: 10/21/2022]
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22
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Bibault JE, Arsène-Henry A, Durdux C, Mornex F, Hamza S, Trouette R, Thureau S, Faivre JC, Boisselier P, Lerouge D, Paragios N, Giraud P. Radiothérapie adaptative du carcinome bronchique non à petites cellules. Cancer Radiother 2015; 19:458-62. [DOI: 10.1016/j.canrad.2015.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 11/26/2022]
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23
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Barillot I, Peignaux K, Williaume D, Nickers P, Leblanc-Onfroy M, Lerouge D. Irradiation postopératoire conformationnelle avec modulation d’intensité des cancers de l’endomètre : résultats de l’essai multicentrique de phase II RTCMIENDOMETRE. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.07.012] [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: 10/27/2022]
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24
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Barillot I, Peignaux K, Williaume D, Nickers P, Leblanc-Onfroy M, Lerouge D. PO-0699 POST OPERATIVE IMRT IN ENDOMETRIAL CARCINOMAS: RESULTS OF THE PHASE II RTCMIENDOMETRE FRENCH MULTICENTRE TRIAL. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71032-0] [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: 11/29/2022]
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25
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Barillot I, Peignaux K, Castelain B, Leblanc-Onfroy M, Williaume D, Haie-Meder C, Lerouge D. 800 poster POST OPERATIVE INTENSITY MODULATION RADIOTHERAPY (IMRT) FOR ENDOMETRIAL CANCER: RESULTS OF THE QUALITY ASSURANCE PROGRAM “DUMMY RUN” OF THE PHASE 2 RTCMIENDOMETRE FRENCH MULTICENTRE TRIAL. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70922-7] [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: 10/18/2022]
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26
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Le Péchoux C, Laplanche A, Faivre-Finn C, Ciuleanu T, Wanders R, Lerouge D, Keus R, Hatton M, Videtic GM, Senan S, Wolfson A, Jones R, Arriagada R, Quoix E, Dunant A. Clinical neurological outcome and quality of life among patients with limited small-cell cancer treated with two different doses of prophylactic cranial irradiation in the intergroup phase III trial (PCI99-01, EORTC 22003-08004, RTOG 0212 and IFCT 99-01). Ann Oncol 2010; 22:1154-1163. [PMID: 21139020 DOI: 10.1093/annonc/mdq576] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We recently published the results of the PCI99 randomised trial comparing the effect of a prophylactic cranial irradiation (PCI) at 25 or 36 Gy on the incidence of brain metastases (BM) in 720 patients with limited small-cell lung cancer (SCLC). As concerns about neurotoxicity were a major issue surrounding PCI, we report here midterm and long-term repeated evaluation of neurocognitive functions and quality of life (QoL). PATIENTS AND METHODS At predetermined intervals, the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and brain module were used for self-reported patient data, whereas the EORTC-Radiation Therapy Oncology Group Late Effects Normal Tissue-Subjective, Objective, Management, Analytic scale was used for clinicians' assessment. For each scale, the unfavourable status was analysed with a logistic model including age, grade at baseline, time and PCI dose. RESULTS Over the 3 years studied, there was no significant difference between the two groups in any of the 17 selected items assessing QoL and neurological and cognitive functions. We observed in both groups a mild deterioration across time of communication deficit, weakness of legs, intellectual deficit and memory (all P < 0.005). CONCLUSION Patients should be informed of these potential adverse effects, as well as the benefit of PCI on survival and BM. PCI with a total dose of 25 Gy remains the standard of care in limited-stage SCLC.
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Affiliation(s)
| | - A Laplanche
- Biostatistics and Epidemiology Unit, Institut Gustave-Roussy, Villejuif, France
| | - C Faivre-Finn
- Department of Clinical Oncology, The Christie, Manchester, UK
| | - T Ciuleanu
- Medical Oncology Department, Institutul Oncologic I. Chiricuta, Cluj-Napoca, Romania
| | - R Wanders
- Radiation Oncology Department, MAASTRO Clinic, Maastricht, The Netherlands
| | - D Lerouge
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | - R Keus
- Radiation Oncology Department, Arnhem's Radiotherapeutisch Instituut, Arnhem, The Netherlands
| | - M Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - G M Videtic
- Radiation Oncology Department, Cleveland Clinic Foundation, Cleveland, USA
| | - S Senan
- Radiation Oncology Department, VU University Medical Centre, Amsterdam, The Netherlands
| | - A Wolfson
- Radiation Oncology Department, University of Miami School of Medicine, Miami, USA
| | - R Jones
- Department of Clinical Oncology, Beatson Oncology Centre, Glasgow, UK
| | - R Arriagada
- Radiation Oncology Department, Karolinska Institutet, Stockholm, Sweden
| | - E Quoix
- Department of Pneumology, Hôpital Lyautey, Strasbourg, France
| | - A Dunant
- Biostatistics and Epidemiology Unit, Institut Gustave-Roussy, Villejuif, France
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Courtecuisse AC, Loiseau C, Silva M, Lerouge D, Barraux V, lesaunier F. Évaluation de la faisabilité d’une escalade de dose par un boost de curiethérapie de débit pulsé associé à la radiothérapie externe dans le cancer de la prostate de risque intermédiaire. Cancer Radiother 2010. [DOI: 10.1016/j.canrad.2010.07.438] [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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28
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Kreps S, Barillot I, Peignaux K, Nickers P, Leblanc-Onfroy M, Williaume D, Haie-Meder C, Lerouge D. Irradiation avec modulation d’intensité (RCMI) postopératoire des cancers de l’endomètre : résultats de la procédure d’assurance de qualité « dummy run » de l’essai français multicentrique de phase 2 RTCMIENDOMETRE. Cancer Radiother 2010. [DOI: 10.1016/j.canrad.2010.07.479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Stuer JS, Casaer M, Lerouge D, Helderweirt J, Nijs N, Berghe G, Vanhorebeek I. Monitoring enteral nutrition efficacy in ICU patients: is there a place for the Brix value-derived fraction of enteral formula in gastric residual volume? Crit Care 2010. [PMCID: PMC2934031 DOI: 10.1186/cc8782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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30
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Lerouge D, Gervais R, Dansin E, Dujon C, Chouaid C, Riviere A, Precheur-Agulhon B, Piolat V, Zalcman G, Lartigau E. A fractionated schedule of oral vinorelbine (NVBo) with cisplatin (CDDP) concomitantly with radiotherapy (RT) after induction chemotherapy (CT) in locally advanced (LA) non-small cell lung cancer (NSCLC): Safety and efficacy results of a phase II trial. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7539] [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
7539 Background: NVB+CDDP as induction and concomitant regimen with RT is a recognized treatment in LA NSCLC (Vokes, J Clin Oncol. 2002). The oral formulation of NVB may simplify the administration and a new fractionated schedule may further improve the results during CT-RT. Methods: Non operable stage IIIA-IIIB NSCLC patients (pts) received an induction CT of 2 cycles of NVBiv 25 mg/m2 + CDDP 80 mg/m2 on D1 and NVBo 60mg/m2 on D8 every 3 weeks. Non progressive pts received 2 additional cycles of fixed dose NVBo of 20 mg on D1, D3 and D5, + CDDP 80 mg/m2 on D1 every 3 weeks, combined with a conformal RT at 66 Gy. Results: Between October 05 and May 08, 70 pts were enrolled (68 evaluable for the safety, 64 for response) : 28% stage IIIA, 72% IIIB; 44 % squamous, 30 % adenocarcinoma; 85% male; median age 61 years (range 41;73); median KPS 90%. After induction CT, OR was 42% (PR), Disease Control (DC) = 87%. 4 pts were down-staged and underwent surgery. After CT-RT completion, OR was 55% (CR = 7%), DC = 88%. Main Toxicities (G3–4, % of pts) were: neutropenia (19%), N/V (1%), radic pneumopathy (1%), anorexia (7%). Oesophagitis was recorded in 42% of pts with no G3–4 : G1 (26%), G2 (16%). Conclusions: This new schedule provides a disease control in 88% of pts with 55% OR. Given the optimal tolerance profile of this fractionated administration of NVBo+CDDP, 72% of pts could complete the planned treatment. Furthermore, NVBo taken at home at D3 and D5 reduces the organizational constraints linked to CT-RT. This new scheme offers a well tolerated and efficient therapeutic option in the treatment of non operable IIIA-IIIB NSCLC. Further follow-up is required in order to assess time to progression and survival. [Table: see text]
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Affiliation(s)
- D. Lerouge
- Francois Baclesse Cancer Centre, Caen, France; Oscar Lambret Cancer Centre, Lille, France; Centre Hospitalier A. Mignot, Versailles, France; Saint Antoine Hospital, Paris, France; Institut de Recherche Pierre Fabre, Boulogne, France; University Hospital of Caen, Caen, France
| | - R. Gervais
- Francois Baclesse Cancer Centre, Caen, France; Oscar Lambret Cancer Centre, Lille, France; Centre Hospitalier A. Mignot, Versailles, France; Saint Antoine Hospital, Paris, France; Institut de Recherche Pierre Fabre, Boulogne, France; University Hospital of Caen, Caen, France
| | - E. Dansin
- Francois Baclesse Cancer Centre, Caen, France; Oscar Lambret Cancer Centre, Lille, France; Centre Hospitalier A. Mignot, Versailles, France; Saint Antoine Hospital, Paris, France; Institut de Recherche Pierre Fabre, Boulogne, France; University Hospital of Caen, Caen, France
| | - C. Dujon
- Francois Baclesse Cancer Centre, Caen, France; Oscar Lambret Cancer Centre, Lille, France; Centre Hospitalier A. Mignot, Versailles, France; Saint Antoine Hospital, Paris, France; Institut de Recherche Pierre Fabre, Boulogne, France; University Hospital of Caen, Caen, France
| | - C. Chouaid
- Francois Baclesse Cancer Centre, Caen, France; Oscar Lambret Cancer Centre, Lille, France; Centre Hospitalier A. Mignot, Versailles, France; Saint Antoine Hospital, Paris, France; Institut de Recherche Pierre Fabre, Boulogne, France; University Hospital of Caen, Caen, France
| | - A. Riviere
- Francois Baclesse Cancer Centre, Caen, France; Oscar Lambret Cancer Centre, Lille, France; Centre Hospitalier A. Mignot, Versailles, France; Saint Antoine Hospital, Paris, France; Institut de Recherche Pierre Fabre, Boulogne, France; University Hospital of Caen, Caen, France
| | - B. Precheur-Agulhon
- Francois Baclesse Cancer Centre, Caen, France; Oscar Lambret Cancer Centre, Lille, France; Centre Hospitalier A. Mignot, Versailles, France; Saint Antoine Hospital, Paris, France; Institut de Recherche Pierre Fabre, Boulogne, France; University Hospital of Caen, Caen, France
| | - V. Piolat
- Francois Baclesse Cancer Centre, Caen, France; Oscar Lambret Cancer Centre, Lille, France; Centre Hospitalier A. Mignot, Versailles, France; Saint Antoine Hospital, Paris, France; Institut de Recherche Pierre Fabre, Boulogne, France; University Hospital of Caen, Caen, France
| | - G. Zalcman
- Francois Baclesse Cancer Centre, Caen, France; Oscar Lambret Cancer Centre, Lille, France; Centre Hospitalier A. Mignot, Versailles, France; Saint Antoine Hospital, Paris, France; Institut de Recherche Pierre Fabre, Boulogne, France; University Hospital of Caen, Caen, France
| | - E. Lartigau
- Francois Baclesse Cancer Centre, Caen, France; Oscar Lambret Cancer Centre, Lille, France; Centre Hospitalier A. Mignot, Versailles, France; Saint Antoine Hospital, Paris, France; Institut de Recherche Pierre Fabre, Boulogne, France; University Hospital of Caen, Caen, France
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Lerouge D, Lesaunier F, Degrendel AC, Silva M, Tranchant JF, Loiseau C, M'Vondo CM, Brune D. Curiethérapie descancers deverge: expérience ducentre François-Baclesse (Caen). Cancer Radiother 2007. [DOI: 10.1016/j.canrad.2007.09.137] [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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Aumont M, Mahe MA, Prevost B, Sunyach MP, Peiffert D, Maingon P, Thomas L, Begue M, Willaume D, Lerouge D, Campion L. Exclusive high dose rate brachytherapy (HDR-BT) for early stage non-small cell lung carcinoma: Results of a retrospective study in 226 patients. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7688] [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
7688 Objective: To evaluate efficacy and toxicity of HDR BT in non operable endobronchial carcinoma from a retrospective multicentric study. Patients and Methods: Criteria for selection: non small cell carcinoma accessible to fiberoptic bronchoscopy, no extrabronchial extension on CT, contraindication to surgery and external radiation therapy (ERT). Statistical analysis: survival curves calculated with the Kaplan-Meier method and compared with the Logrank test; Cox model to evaluate in uni and multivariate analysis the impact on survival and complications of these parameters: location of tumor: lobar or segmental vs main stem bronchus, previous ERT vs no, total dose:= 30 Gy vs less, dose per fraction:= 5 Gy vs more, number of catheter(s):1 vs = 2. Results: Between 1991 and 2006, 226 patients from 9 radiotherapy departments were included. Main characteristics of tumors: squamous-cell histology: 96%, stage Tis: 60, T1: 153, T2: 9, Tx 4; lobar or segmental location: 91%. 51 patients (22.5%) had received ERT for previous lung cancer(s). Characteristics of HDR BT were: total dose = 30 Gy: 70%, dose per fraction = 5 Gy: 66%, 1 catheter: 46%. Dose was prescribed at 1 cm from the radius. Mean follow-up was 30.4 months (9- 116). Histologic evaluation was performed at 3 months in 137 patients. 92% had a complete response. 128 patients were died: intercurrent disease 45, local failure 35, complications 13. Two and 5-year survival: overall: 57%, 29%; specific (death of lung cancer) 81%, 56%; local- relapse free (LRF) 68%, 50%. Toxicity included 1.3% pneumothorax, hemoptysis 6.6% (5% fatal), bronchitis 20%. In univariate analysis: overall, specific and LRF survival were better for lobar or segmental location vs main stem bronchus (p=0.0001), overall and specific survival were higher with no previous ERT (p=0.006). In multivariate analysis, lobar or segmental location was associated with improved overall (p=0.0001) and LRF (p=0.003) survival. LRF survival was better in patients treated with = 2 catheters (p=0.007). No factor influence frequency of complications. Conclusion: This large retrospective study confirmed that HDRBT is efficient and safe in medically inoperable patients particulary with lobar or segmental endobronchial carcinoma. No significant financial relationships to disclose.
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Affiliation(s)
- M. Aumont
- Centre Rene Gauducheau, St. Herblain, France; Centre Oscar Lambret, Lille, France; Centre Leon Berard, Lyon, France; Centre Alexis Vautrin, Nancy, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonie, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre Eugene Marquis, Rennes, France; Centre Francois Baclesse, Caen, France
| | - M. A. Mahe
- Centre Rene Gauducheau, St. Herblain, France; Centre Oscar Lambret, Lille, France; Centre Leon Berard, Lyon, France; Centre Alexis Vautrin, Nancy, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonie, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre Eugene Marquis, Rennes, France; Centre Francois Baclesse, Caen, France
| | - B. Prevost
- Centre Rene Gauducheau, St. Herblain, France; Centre Oscar Lambret, Lille, France; Centre Leon Berard, Lyon, France; Centre Alexis Vautrin, Nancy, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonie, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre Eugene Marquis, Rennes, France; Centre Francois Baclesse, Caen, France
| | - M. P. Sunyach
- Centre Rene Gauducheau, St. Herblain, France; Centre Oscar Lambret, Lille, France; Centre Leon Berard, Lyon, France; Centre Alexis Vautrin, Nancy, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonie, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre Eugene Marquis, Rennes, France; Centre Francois Baclesse, Caen, France
| | - D. Peiffert
- Centre Rene Gauducheau, St. Herblain, France; Centre Oscar Lambret, Lille, France; Centre Leon Berard, Lyon, France; Centre Alexis Vautrin, Nancy, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonie, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre Eugene Marquis, Rennes, France; Centre Francois Baclesse, Caen, France
| | - P. Maingon
- Centre Rene Gauducheau, St. Herblain, France; Centre Oscar Lambret, Lille, France; Centre Leon Berard, Lyon, France; Centre Alexis Vautrin, Nancy, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonie, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre Eugene Marquis, Rennes, France; Centre Francois Baclesse, Caen, France
| | - L. Thomas
- Centre Rene Gauducheau, St. Herblain, France; Centre Oscar Lambret, Lille, France; Centre Leon Berard, Lyon, France; Centre Alexis Vautrin, Nancy, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonie, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre Eugene Marquis, Rennes, France; Centre Francois Baclesse, Caen, France
| | - M. Begue
- Centre Rene Gauducheau, St. Herblain, France; Centre Oscar Lambret, Lille, France; Centre Leon Berard, Lyon, France; Centre Alexis Vautrin, Nancy, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonie, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre Eugene Marquis, Rennes, France; Centre Francois Baclesse, Caen, France
| | - D. Willaume
- Centre Rene Gauducheau, St. Herblain, France; Centre Oscar Lambret, Lille, France; Centre Leon Berard, Lyon, France; Centre Alexis Vautrin, Nancy, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonie, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre Eugene Marquis, Rennes, France; Centre Francois Baclesse, Caen, France
| | - D. Lerouge
- Centre Rene Gauducheau, St. Herblain, France; Centre Oscar Lambret, Lille, France; Centre Leon Berard, Lyon, France; Centre Alexis Vautrin, Nancy, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonie, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre Eugene Marquis, Rennes, France; Centre Francois Baclesse, Caen, France
| | - L. Campion
- Centre Rene Gauducheau, St. Herblain, France; Centre Oscar Lambret, Lille, France; Centre Leon Berard, Lyon, France; Centre Alexis Vautrin, Nancy, France; Centre Georges-Francois Leclerc, Dijon, France; Institut Bergonie, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre Eugene Marquis, Rennes, France; Centre Francois Baclesse, Caen, France
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Hennequin C, Zalcman G, Porte H, Le Péchoux C, Lerouge D. [Role of radiotherapy in pleural mesothelioma]. Rev Mal Respir 2006; 23:11S71-5. [PMID: 17370382] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- C Hennequin
- Service de Radiothérapie, Hôpital Saint-Louis, Paris
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Deniaud-Alexandre E, Touboul E, Lerouge D, Grahek D, Petegnief Y, Gres B, El Balaa H, Kerrou K, Milleron B, Lebeau B, Talbot J. Impact of Computed Tomography and 18F-Deoxyglucose-Hybrid Positron Emission Tomography Image Fusion on Conformal Radiotherapy in Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Deniaud-Alexandre E, Touboul E, Lerouge D, Grahek D, Foulquier JN, Petegnief Y, Grès B, El Balaa H, Keraudy K, Kerrou K, Montravers F, Milleron B, Lebeau B, Talbot JN. Tomographie par émission de positons et détection en coïncidence (TEDC) et recalage d'images de simulation virtuelle par tomodensitométrie. Impact sur la planification de la radiothérapie conformationnelle des cancers bronchiques non à petites cellules. Cancer Radiother 2005; 9:304-15. [PMID: 16087377 DOI: 10.1016/j.canrad.2005.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 04/18/2005] [Revised: 06/22/2005] [Accepted: 07/01/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED To report a retrospective study concerning the impact of fused 18F-fluorodeoxy-D-glucose (FDG)-hybrid positron emission tomography (PET) and computed tomography (CT) images on three-dimensional conformal radiation therapy (3D-CRT) planning for patients with non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS One hundred and one patients consecutively treated for stages I-III NSCLC were studied. Each patient underwent CT and FDG-hybrid PET for simulation treatment in the same radiation treatment position. Images were coregistered using five fiducial markers. Target volume delineation was initially performed on the CT images and the corresponding FDG-PET data were subsequently used as an overlay to the CT data to define target volume. RESULTS FDG-PET identified previously undetected distant metastatic disease in 8 patients making them ineligible for curative CRT (one patient presented some positive uptakes corresponding to concomitant pulmonary tuberculosis). Another patient was ineligible for curative treatment because fused CT/PET images demonstrated excessively extensive intrathoracic disease. The gross tumor volume (GTV) was decreased by CT/PET image fusion in 21 patients (23%) and was increased in 24 patients (26%). The GTV reduction was > or = 25% in 7 patients because CT/PET image fusion reduced pulmonary GTV in 6 patients (3 patients with atelectasis) and mediastinal nodal GTV in 1 patient. The GTV increase was > or = 25% in 14 patients due to an increase of the pulmonary GTV in 11 patients (4 patients with atelectasis) and detection of occult mediastinal lymph node involvement in 3 patients. Among 81 patients receiving a total dose > or = 60 Gy at ICRU point, after CT/PET image fusion, the percentage of total lung volume receiving more than 20 Gy (VL20) increased in 15 cases and decreased in 22 cases. The percentage of total heart volume receiving more than 36 Gy increased in 8 patients and decreased in 14 patients. The spinal cord volume receiving at least 45 Gy (2 patients) decreased. After multivariate analysis, one single independent factor made significant effect of FDG/PET on the modification of the size of the GTV: tumor with atelectasis (P = 0.0001). Conclusion. - Our study confirms that integrated hybrid PET/CT in the treatment position and coregistered images have an impact on treatment planning and management of patients with NSCLC. FDG images using dedicated PET scanners with modern image fusion techniques and respiration-gated acquisition protocols could improve CT/PET image coregistration. However, prospective studies with histological correlation are necessary and the impact on treatment outcome remains to be demonstrated.
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Affiliation(s)
- E Deniaud-Alexandre
- Service d'oncologie-radiothérapie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France
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Moureau-Zabotto L, Touboul E, Lerouge D, Deniaud-Alexandre E, Grahek D, Foulquier JN, Petenief Y, Grès B, El Balaa H, Kerrou K, Montravers F, Keraudy K, Tiret E, Gendre JP, Grange JD, Hourry S, Talbot JN. Tomographie par émission de positons et fusion d'images de simulation virtuelle par tomodensitométrie. Impact sur la planification de la radiothérapie conformationnelle des cancers de l'œsophage. Cancer Radiother 2005; 9:152-60. [PMID: 16023043 DOI: 10.1016/j.canrad.2005.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Revised: 03/18/2005] [Accepted: 04/01/2005] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the impact of fused (18)F-fluoro-deoxy-D-glucose (FDG)-hybrid positron emission tomography (PET) and computed tomography (CT) images on conformal radiation therapy (CRT) planning for patients with esophageal carcinoma. PATIENTS AND METHODS Thirty-four patients with esophageal carcinoma were referred for concomitant radiotherapy and chemotherapy with radical intent. Each patient underwent CT and FDG-hybrid PET for simulation treatment in the same radiation treatment position. PET-images were coregistered using five fiducial markers. Target delineation was initially performed on CT images and the corresponding PET data were subsequently used as an overlay to CT data to define the target volume. RESULTS FDG-PET identified previously undetected distant metastatic disease in 2 patients, making them ineligible for curative CRT. The Gross Tumor Volume (GTV) was decreased by CT and FDG image fusion in 12 patients (35%) and was increased in 7 patients (20.5%). The GTV reduction was >or=25% in 4 patients due to reduction of the length of the esophageal tumor. The GTV increase was >or=25% with FDG-PET in 2 patients due to the detection of occult mediastinal lymph node involvement in one patient and an increased length of the esophageal tumor in the other patient. Modifications of the GTV affected the planning treatment volume (PTV) in 18 patients. Modifications of delineation of GTV and displacement of the isocenter of PTV by FDG-PET also affected the percentage of total lung volume receiving more than 20 Gy (VL20) in 25 patients (74%), with a dose reduction in 12 patients and a dose increase in 13 patients. CONCLUSION In our study, CT and FDG-PET image fusion appeared to have an impact on treatment planning and management of patients with esophageal carcinoma related to modifications of GTV. The impact on treatment outcome remains to be demonstrated.
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Affiliation(s)
- L Moureau-Zabotto
- Service d'oncologie-radiothérapie, hôpital Tenon AP-HP, 4, rue de la Chine, 75020 Paris et CancerEst, université Paris-VI, GHU Est, France
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Touboul E, Deniaud-Alexandre E, Moureau-Zabotto L, Lerouge D. [The impact of integrating images of positron emission tomography with computed tomography simulation on radiation therapy planning]. Cancer Radiother 2004; 8 Suppl 1:S29-35. [PMID: 15679244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The coregistration of planning CT and 18F-fluoro-deoxy-2-glucose (FDG) positron emission tomography (PET) with patient in the same treatment position is the principally well-established tool for improving the target coverage defined and the target planning volume to treat the metabolic target volume. Most of the interest in the coresgistred CT/PET images on volume delineation has focused on conformal radiation therapy of non-small cell lung cancer. In spite of technical difficulties related to the target volume displacements, and the sensitivity and the specificity of FDG-PET images < 100%, the target volume delineation is significantly changed by the coregistration of FDG-PET images and planning CT by either reduction of the radiation volume (excluding atelectasis or mediastinal lymph node) or the increasing of mediastinal lymph node involvement. Image fusion technique reduces the interobserver variability in target volume delineation. Furthermore, after induction chemotherapy image fusion leads to improve the patient management by detecting locoregional progression disease or the presence of metastatic disease. Other anatomic tumor sites are going to investigate such as: head-and-neck cancer, gynecologic cancer, oesophageal cancer, anal cancer, Hodgkin's disease, and non-Hodgkin's lymphoma. The impact on treatment outcome remains to be demonstrated.
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Affiliation(s)
- E Touboul
- Service d'oncologie-radiothérapie, hôpital Tenon AP-HP, Cancerest, université Paris-VI, GHU-Est, 4, rue de la Chine, 75020 Paris, France.
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Lerouge D, Touboul E, Lefranc JP, Genestie C, Moureau-Zabotto L, Blondon J. [Locally advanced non inflammatory breast cancer treated by combined chemotherapy and preoperative irradiation: updated results in a series of 120 patients]. Cancer Radiother 2004; 8:155-67. [PMID: 15217583 DOI: 10.1016/j.canrad.2004.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 09/29/2003] [Revised: 01/07/2004] [Accepted: 01/16/2004] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate our updated data concerning survival and locoregional control in a study of locally advanced non inflammatory breast cancer after primary chemotherapy followed by external preoperative irradiation. PATIENTS AND METHODS Between 1982 and 1998, 120 patients (75 stage IIIA, 41 stage IIIB, and 4 stage IIIC according to AJCC staging system 2002) were consecutively treated by four courses of induction chemotherapy with anthracycline-containing combinations followed by preoperative irradiation (45 Gy to the breast and nodal areas) and a fifth course of chemotherapy. Three different locoregional approaches were proposed, depending on tumour characteristics and tumour response. After completion of local therapy, all patients received a sixth course of chemotherapy and a maintenance adjuvant chemotherapy regimen without anthracycline. The median follow-up from the beginning of treatment was 140 months. RESULTS Mastectomy and axillary dissection were performed in 49 patients (with residual tumour larger than 3 cm in diameter or located behind the nipple or with bifocal tumour), and conservative treatment in 71 patients (39 achieved clinical complete response or partial response >90% and received additional radiation boost to initial tumour bed; 32 had residual mass <or=3 cm in diameter and were treated by wide excision and axillary dissection followed by a boost to the excision site). Ten-year actuarial local failure rate was 13% after irradiation alone, 23% after wide excision and irradiation, and 4% after mastectomy (p =0.1). After multivariate analysis, possibility of breast-conserving therapy was related to initial tumour size (<6 vs. >or=6 cm in diameter, p =0.002). Ten-year overall metastatic disease-free survival rate was 61%. After multivariate analysis, metastatic disease-free survival rates were significantly influenced by clinical stage (stage IIIA-B vs. IIIC, p =0.0003), N-stage (N0 vs. N1-2a, and 3c, p =0.017), initial tumour size (<6 vs. >or=6 cm in diameter, p =0.008), and tumour response after induction chemotherapy and preoperative irradiation (clinically complete response + partial response vs. non-response, p =0.0015). In the non conservative breast treatment group, of the 32 patients with no change in clinical tumour size after induction chemotherapy, the 10-year metastatic disease-free survival rate was 59% with only one local relapse. Arm lymphedema was noted in 17% (14 of 81) following axillary dissection and in 2.5% (1 of 39) without axillary dissection. Cosmetic results were satisfactory in 70% of patients treated by irradiation alone and in 51.5% of patients after wide excision and irradiation. CONCLUSION Despite the poor prognosis of patients with locally advanced non inflammatory breast cancer resistant to primary anthracycline-based regimen, aggressive locoregional management using preoperative irradiation and mastectomy with axillary dissection offers a possibility of long term survival with low local failure rate for patients without extensive nodal disease. On the other hand, the rate of local failure seems to be high in patients with clinical partial tumour response following induction chemotherapy and breast-conserving treatment combining preoperative irradiation and large wide excision.
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Affiliation(s)
- D Lerouge
- Service d'oncologie-radiothérapie, hôpital Tenon AP-HP, 4, rue de la Chine, 75020 Paris, France
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Lerouge D, Touboul E, Lefranc JP, Uzan S, Jannet D, Moureau-Zabotto L, Genestie C, Antoine M, Jamali M. Association concomitante préopératoire de radiothérapie et de chimiothérapie dans les cancers du col utérin opérables de stades IB2, IIA et IIB proximal de gros volume. Cancer Radiother 2004; 8:168-77. [PMID: 15217584 DOI: 10.1016/j.canrad.2004.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2003] [Revised: 02/11/2004] [Accepted: 02/14/2004] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate preliminary results in terms of toxicity, local tumour control, and survival after preoperative concomitant chemoradiation for operable bulky cervical carcinomas. PATIENTS AND METHODS Between December 1991 and October 2001, 42 patients (pts) with bulky cervical carcinomas stage IB2 (11 pts), IIA (15 pts), and IIB (16 pts) with 1/3 proximal parametrial invasion. Median age was 45 years (range: 24-75 years) and clinical median cervical tumour size was 5 cm (range: 4.1-8 cm). A clinical pelvic lymph node involvement has been observed in 10 pts. All patients underwent preoperative external beam pelvic radiation therapy (EBPRT) and concomitant chemotherapy during the first and the fourth radiation weeks combining 5-fluorouracil and cisplatin. The pelvic dose was 40.50 Gy over 4.5 weeks. EBPRT was followed by low-dose-rate uterovaginal brachytherapy with a total dose of 20 Gy in 17 pts. After a rest period of 5-6 weeks, all pts underwent class II modified radical hysterectomy with bilateral lymphadenectomy. Para-aortic lymphadenectomy was performed in eight pts without pathologic para-aortic lymph node involvement. Twenty-one of 25 pts who had not received preoperative uterovaginal brachytherapy underwent postoperative low-dose-rate vaginal brachytherapy of 20 Gy. The median follow-up was 31 months (range: 3-123 months). RESULTS Pathologic residual tumour or lymph node involvement was observed in 23 pts. Among the 22 pts with pathologic residual cervical tumour (<0.5 cm: nine pts; >or=0.5 to <or=1 cm: three pts; >1 cm: 10 pts), seven underwent preoperative EBRT followed by uterovaginal brachytherapy vs. 15 treated with preoperative EBRT alone (P = 0.23). Four pts had pathologic lymph node involvement, three pts had vaginal residual tumour, and four pts had pathologic parametrial invasion. The 2- and 5-year overall survival rates were 85% and 74%, respectively. The 2- and 5-year disease-free survival (DFS) rates were 80% and 71%, respectively. After multivariate analysis, the pathologic residual cervical tumour size was the single independent factor decreasing the probability of DFS (P = 0.0054). The 5-year local control rate and metastatic failure rate were 90% and 83.5%, respectively. Haematological effects were moderate. However, six pts had grade 3 acute intestinal toxicity. Four severe late complications requiring surgical intervention were observed (one small bowel complication, three ureteral complications). CONCLUSION Primary concomitant chemoradiation followed surgery for bulky operable stage I-II cervical carcinomas can be employed with acceptable toxicity. However, systematic preoperative uterovaginal brachytherapy should increase local tumour control.
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Affiliation(s)
- D Lerouge
- Service d'oncologie-radiothérapie, hôpital Tenon, AP-HP, 75020 Paris cedex 20, France
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Deniaud-Alexandre E, Lauratet B, Lefranc JP, Genestié C, Lerouge D, Moureau-Zabotto L, Touboul E. Rechute locale isolée après traitement conservateur pour un carcinome mammaire de stade I ou II, à propos de 57 patientes. Cancer Radiother 2004; 8:95-107. [PMID: 15063877 DOI: 10.1016/j.canrad.2004.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2003] [Revised: 01/19/2004] [Accepted: 01/29/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE - To identify predicting factors of local control and survival after isolate local failure by statistical analysis of the data after breast-conserving treatment for early breast cancer. METHODS AND PATIENTS - In time of local failure, mean age was 54.7 years old, mean tumor size was 19.3 mm and recurrence was more often infiltrating ductal carcinoma (88%). Local recurrence was unifocal in 44 cases and localised outside of the site of the primary tumorectomy in 35 cases. Local failure treatment was a radical mastectomy or parietectomy (53 patients). Hormonotherapy was delivered in 36 patients and chemotherapy was delivered in 26 patients. Mean follow-up was 62 months. RESULTS - Fifteen patients developed second local recurrence in a mean time of 36 months. Five years local control rate was 68% after the first local failure. Surgery treatment (non-conservative surgery vs. conservative surgery) was the only factor which influenced local control. Six patients developed homolateral axillary and/or supraclavicular node recurrence. Twelve patients underwent metastasis in a mean time of 36 months after the first local recurrence. Five years metastasis free survival rate was 80%. Peritumoral vascular invasion in time of the first local failure increased metastasis risk and node recurrence. Second local failure did not alter metastasis free survival. CONCLUSION - Peritumoral vascular invasion in time of the first local failure decreased node and metastasis free survival. Surgery should be radical, but the place of chemotherapy and hormonotherapy was not definite.
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MESH Headings
- Adult
- Age Factors
- Aged
- Breast/pathology
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Chemotherapy, Adjuvant
- Chi-Square Distribution
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Lymphatic Metastasis
- Mastectomy, Radical
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Metastasis
- Neoplasm Recurrence, Local
- Prognosis
- Radiotherapy Dosage
- Recurrence
- Risk Factors
- Survival Analysis
- Time Factors
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Affiliation(s)
- E Deniaud-Alexandre
- Service d'oncologie-radiothérapie, hôpital Tenon AP-HP, 4, rue de la Chine, 75020 Paris, France.
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41
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Touboul E, Moureau-Zabotto L, Lerouge D, Pène F, Deniaud-Alexandre E, Tiret E, Sezeur A, Houry S, Gallot D, Parc R, Schlienger M, Laugier A. [Radiotherapy of carcinomas of the anal canal. Tenon Hospital experience]. Cancer Radiother 2003; 7 Suppl 1:91s-99s. [PMID: 15124550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Since 1980, curative-intent radiation therapy of epidermoid carcinoma of the anal canal is the standard first line treatment. The combined concomitant chemotherapy and radiation therapy is presently established for locally advanced tumors more than 4 cm in length and/or with nodal involvement. We report the Tenon hospital experience since 1972 concerning the long term results after radiation therapy, the modifications of the radiation technique, and the evolution of treatment strategy.
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MESH Headings
- Aged
- Anal Canal/pathology
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/therapeutic use
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Anus Neoplasms/drug therapy
- Anus Neoplasms/mortality
- Anus Neoplasms/pathology
- Anus Neoplasms/radiotherapy
- Anus Neoplasms/surgery
- Brachytherapy
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/radiotherapy
- Carcinoma, Transitional Cell/surgery
- Cisplatin/administration & dosage
- Cisplatin/therapeutic use
- Combined Modality Therapy
- Female
- Fluorouracil/administration & dosage
- Fluorouracil/therapeutic use
- Follow-Up Studies
- Humans
- Iridium Radioisotopes
- Male
- Middle Aged
- Neoplasm Metastasis
- Neoplasm Recurrence, Local
- Particle Accelerators
- Radiotherapy Dosage
- Retrospective Studies
- Time Factors
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Affiliation(s)
- E Touboul
- Service d'oncologie-radiothérapie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
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Douillard JY, Lerouge D, Monnier A, Bennouna J, Haller AM, Sun XS, Assouline D, Grau B, Rivière A. Combined paclitaxel and gemcitabine as first-line treatment in metastatic non-small cell lung cancer: a multicentre phase II study. Br J Cancer 2001; 84:1179-84. [PMID: 11336467 PMCID: PMC2363882 DOI: 10.1054/bjoc.2001.1784] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The efficacy and toxicity of combined paclitaxel and gemcitabine was evaluated in 54 chemotherapy-naive patients with metastatic non-small cell lung cancer (NSCLC). Gemcitabine i.v. 1000 mg/m(2)was administered on days 1 and 8 and paclitaxel 200 mg/m(2)as a continuous 3-hour infusion on day 1. Treatment was repeated every 21 days. Patients had a median age of 53 years. ECOG performance status was 0 or 1 in 48 patients. 41 patients (75.9%) had initial stage IV disease; histology was mainly adenocarcinoma (46.3%). 2 patients (4.3%) achieved a complete response and 15 (31.9%) achieved a partial response giving an overall response rate of 36.2% (95% CI: 22.4-49.9%); 19 patients (40.4%) had stable disease and 10 (21.3%) had progressive disease. The median survival time was 51 weeks (95% CI: 46.5-59.3), with a 1-year survival probability of 0.48 (95% CI: 0.34-0.63). Grade 3/4 neutropenia and febrile neutropenia occurred in 15.2% and 2.2% of courses, respectively. Grade 3/4 thrombocytopenia was rare (1.8% of courses). Peripheral neurotoxicity developed in 25 patients (47.2%), mostly grade 1/2. Arthalgia/myalgia was observed in 30 patients (56.6%), generally grade 1 or 2. Grade 3 abnormal levels of serum glutamate pyruvate transaminase (SGPT) and serum glutamate oxaloacetate transaminase (SGOT) occurred in 5 patients (9.4%) and 1 patient (1.9%), respectively. Combined paclitaxel and gemcitabine is an active and well-tolerated regimen for the treatment of advanced NSCLC, and warrants further investigation in comparative, randomized trials.
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Affiliation(s)
- J Y Douillard
- Centre René Gauducheau, Saint-Herblain, 44805, France
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Douillard J, Lerouge D, Monnier A, Sun X, Haller M, Assouline D, Grau B. Phase II study with Taxol® (paclitaxel) and Gemzar® (gemcitabine) in metastatic non-small cell lung cancer (NSCLC). Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80147-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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