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Belkacemi Y, Gabelle-Flandin I, Deley MCL, Petit A, Guilbert P, Geffrelot J, Carrie C, Rivin Del Campo E, Hanzen C, Brunaud CC, Lecouillard I, Magne N, Tallet AR, Leduc N, Belgadi B, Auzac G, Lacornerie T, Lemonnier J, Bourgier C, Lartigau E. Early Results of the French Multicenter, Randomized SHARE Trial Comparing Whole Breast Irradiation vs. Accelerated Partial Breast Irradiation in Postmenopausal Women with Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S46. [PMID: 37784505 DOI: 10.1016/j.ijrobp.2023.06.324] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The aim is to report toxicity and cosmetic outcomes at 3 and up to 9 years of follow-up of post-menopausal patients randomized to receive either standard whole breast irradiation (WBI), including hypofractionated options, versus accelerated partial breast irradiation (APBI). MATERIALS/METHODS From December 2010 to July 2015, 1006 patients were enrolled in 34 French centers. Among the whole population, 28 patients who did not meet the final selection criteria or withdrew consent were excluded leading to a modified intention to treat analysis dataset of 978 patients (WBI: n = 488; APBI: n = 490). Median age (65y) and tumor stage pT1 (99%) rates were similar in both arms. Patients had conservative surgery with clip placement in the tumor bed. Clear margins (> 2mm) were observed in 99% of the patients. In both arms, 96-97% of the patients had negative sentinel lymph node biopsy. The median time interval between surgery and radiotherapy was 57d in WBI vs 62d in APBI. WBI schedules consisted of 50 Gy in 25 fr+16 Gy (n = 212) or 40 Gy in 15 fr (n = 156) or 42.5 Gy in 16 fr (n = 120). APBI arm consisted of 38.5 Gy or 40 Gy in 10 fr, 2 fr/day. Overall, 94 patients from the APBI arm finally received standard WBI. For statistical considerations, SHARE trial, sponsored by UNICANCER (NCT01247233) is a non-inferiority randomized controlled trial comparing APBI versus WBI in terms of local control as primary objective. Secondary endpoints were severe toxicity (NCI-CTCAE v4 grade ≥ 2), and cosmetic results. For both outcomes, we estimated the cumulative incidences (CI) using Kalbfleish and Prentice method, considering disease relapse, secondary cancer or death as competing events. Treatment effect (APBI vs WBI) was estimated by cause-specific Hazard Ratios (cs-HR) from Cox models. RESULTS Median follow-up was 5.8y (range, 0.13-9.5). The number of deaths was 27, and the number of local relapses was 8. Among the 978 patients, 582 and 396 had finally WBI and APBI, respectively. The rates of post-operative hematoma, edema and infection were low: 8-9%, 2%, 3-2%, respectively. When considering any type of severe toxicity, we observed a significant reduction rate in APBI compared to WBI: cs-HR = 0.73 (95% confidence interval: 0.61-0.88); p = 0.001, and 3-year CI of severe toxicity at 45% in WBI vs 36% in APBI arm. The difference was also in favor of APBI when considering breast skin toxicity alone: cs-HR = 0.55 (0.44-0.70), p<0.001 and 3-year CI at 36% in WBI vs 21% in APBI arm. Conversely, for breast other toxicities, WBI was found less toxic than APBI with a 3-year CI of 8% vs 15%, respectively. When considering cosmetic results, we observed no significant difference between the two arms in both evaluations by physicians and patients. CONCLUSION Historically SHARE is the first APBI trial that included hypofractionated schedules in the standard arm. We report increased risk of severe toxicity and skin breast toxicity in standard arm as compared with APBI arm without any difference in terms of cosmetic results. Longer follow-up is needed.
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Affiliation(s)
- Y Belkacemi
- APHP. Radiation Oncology Department and Henri Mondor Breast Center. Henri Mondor University Hospital. University of Paris East Creteil (UPEC). INSERM U955 (i-Biot), IMRB, Créteil, France, Creteil, France
| | - I Gabelle-Flandin
- Hopital Michallon - Centre hospitalier universitaire de Grenoble, Grenoble, France
| | | | - A Petit
- Institut Bergonié, Bordeaux, France
| | | | | | - C Carrie
- Centre Leon Berard, Lyon, France
| | | | - C Hanzen
- Centre Henri Becquerel, Rouen, France
| | - C Charra Brunaud
- Institut de cancerologie de Lorraine Alexis Vautrin, Nancy, France
| | | | - N Magne
- Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | | | - N Leduc
- Centre Catalan d'oncologie, Perpignan, France
| | - B Belgadi
- Centre Hospitalier de Montelimar, Montelimar, France
| | - G Auzac
- Gustave Roussy, Villejuif, France
| | | | | | - C Bourgier
- Institut du cancer de Montpellier, Montpellier, France
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Le Bras A, Belkacemi Y, Bourgier C, Gabelle-Flandin I, Petit A, Guilbert P, Geffrelot J, Racadot S, Rivin Del Campo E, Hanzen C, Charra Brunaud C, Auzac G, Lacornerie T, Lemonnier J, Lartigau E, Durand-Zaleski I. Economic evaluation and budget-impact of accelerated partial breast irradiation (APBI) versus standard or hypofractionated whole breast irradiation (WBI) in postmenopausal women with early-stage breast cancer. Results from the French SHARE randomized trial. Radiother Oncol 2023; 187:109818. [PMID: 37480995 DOI: 10.1016/j.radonc.2023.109818] [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: 04/19/2023] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE This economic evaluation reports the incremental cost-utility ratio and national budget impact in France of accelerated partial breast irradiation (APBI) vs standard or hypofractionated whole breast irradiation (WBI) in breast cancer patients at low risk of local recurrence. MATERIALS AND METHODS We compared 490 women randomized to the APBI (ten fractions delivered twice daily over one week) with 488 women in the WBI arm (one fraction per day delivered five days per week over three or six weeks). We took the perspective of the French national health insurance with a three-year time horizon. The outcome was quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio was estimated and uncertainty was explored by probabilistic bootstrapping. Transportation and sick leave costs were added in a sensitivity analysis and a national budget impact analysis based on the incidence of breast cancer estimates in France performed. RESULTS At three years, the average cost per patient was €2,549 (±1,954) in the APBI arm and €4,468 (±1,586) in the WBI arm (p-value < 0.001), radiotherapy was the main driver of the difference between the two arms. No significant difference was found in QALYs. For an average of 60,000 new cases of breast cancer diagnosed annually in France, 28,000 would be eligible for treatment with APBI. A 100% uptake of APBI would result in a yearly30 million€ cost saving. CONCLUSION APBI for the treatment of postmenopausal women with early-stage breast cancer is cost saving, with no difference in outcome measured by QALYs.
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Affiliation(s)
- Alicia Le Bras
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Clinical Research Unit Eco Ile de France, 75004, Paris, France.
| | - Yazid Belkacemi
- Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor University Hospital, Radiation Oncology Department and Henri Mondor Breast Center and INSERM Unit 955, Immunoregulation and Biotherapy (I-Biot) Team, The Mondor Institute for Biomedical Research (IMRB), Creteil, France.
| | - Celine Bourgier
- Institut de cancérologie Gustave-Roussy, Département de radiothérapie, 114 rue Édouard-Vaillant, Villejuif, France
| | - Isabelle Gabelle-Flandin
- Centre Hospitalier Universitaire Grenoble Alpes, Clinique Universitaire de Cancérologie-Radiothérapie, 38000, Grenoble, France
| | - Adeline Petit
- Institut Bergonié, Department of Radiotherapy, 229 Cours de L'Argonne, 33076, Bordeaux, France
| | | | - Julien Geffrelot
- Centre François Baclesse, Department of Radiation Oncology, Caen, France
| | | | - Eleonor Rivin Del Campo
- Assistance Publique-Hôpitaux de Paris (AP-HP), Tenon University Hospital, Department of Radiation Oncology, Paris 75020, France
| | - Chantal Hanzen
- Centre Henri Becquerel, UNICANCER, Department of Oncology, Rouen, France
| | - Claire Charra Brunaud
- Institut de Cancérologie de Lorraine, Department of Radiotherapy and Brachytherapy, Vandoeuvre-Lès-Nancy, France
| | - Guillaume Auzac
- Institut d'Oncologie Thoracique (IOT), Department of Radiation Oncology, Gustave Roussy, F-94805, Villejuif, France
| | - Thomas Lacornerie
- Centre Oscar Lambret, Department of Medical Physics, 59020, Lille, France
| | | | - Eric Lartigau
- Centres Oscar Lambret et Université de Lille, Lille, France.
| | - Isabelle Durand-Zaleski
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Clinical Research Unit Eco Ile de France, CRESS-UMR1153, 75004, Paris, France.
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To NH, Gabelle-Flandin I, Luong TMH, Loganadane G, Ouidir N, Boukhobza C, Grellier N, Verry C, Thiolat A, Cohen JL, Radosevic-Robin N, Belkacemi Y. Pathologic Response to Neoadjuvant Sequential Chemoradiation Therapy in Locally Advanced Breast Cancer: Preliminary, Translational Results from the French Neo-APBI-01 Trial. Cancers (Basel) 2023; 15:cancers15072030. [PMID: 37046691 PMCID: PMC10092968 DOI: 10.3390/cancers15072030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Radiation therapy (RT), a novel approach to boost the anticancer immune response, has been progressively evaluated in the neoadjuvant setting in breast cancer (BC). Purpose: We aimed to evaluate immunity-related indicators of response to neoadjuvant chemoradiation therapy (NACRT) in BC for better treatment personalization. Patients and Methods: We analyzed data of the first 42 patients included in the randomized phase 2 Neo-APBI-01 trial comparing standard neoadjuvant chemotherapy (NACT) and NACRT regimen in locally advanced triple-negative (TN) and luminal B (LB) subtype BC. Clinicopathological parameters, blood counts and the derived parameters, total tumor-infiltrating lymphocytes (TILs) and their subpopulation, as well as TP53 mutation status, were assessed as predictors of response. Results: Twenty-one patients were equally assigned to each group. The pathologic complete response (pCR) was 33% and 38% in the NACT and NACRT groups, respectively, with a dose-response effect. Only one LB tumor reached pCR after NACRT. Numerous parameters associated with response were identified, which differed according to the assigned treatment. In the NACRT group, baseline hemoglobin of ≥13 g/dL and body mass index of <26 were strongly associated with pCR. Higher baseline neutrophils-to-lymphocytes ratio, total TILs, and T-effector cell counts were favorable for pCR. Conclusion: This preliminary analysis identified LB and low-TIL tumors as poor responders to the NACRT protocol, which delivered RT after several cycles of chemotherapy. These findings will allow for amending the selection of patients for the trial and help better design future trials of NACRT in BC.
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Belkacemi Y, Gabelle-Flandin I, Deley MCL, Petit A, Guilbert P, Geffrelot J, Carrie C, Campo ERD, Hanzen C, Charra-Brunaud C, Lecouillard I, Magne N, Tallet A, Leduc N, Belgadi B, Fourneret P, Coutte A, Capelo E, Darloy F, Ramirez MG, Dudouet P, Clavere P, Suchaud JP, Auzac G, Lacornerie T, Lemonnier J, Bourgier C, Lartigau E. Abstract PD3-05: Early results of the French multicenter, randomized SHARE trial comparing whole breast irradiation versus accelerated partial breast irradiation in postmenopausal women with early-stage breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd3-05] [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: 03/06/2023]
Abstract
Abstract
Purpose: The aim of current analyses is to report toxicity and cosmetic outcomes at 3 and up to 9 years of follow-up of post-menopausal patients randomized to receive either standard external beam whole breast radiotherapy (WBI), including hypofractionated options, versus accelerated partial breast irradiation (APBI). Methods and materials: From December 2010 to July 2015, 1006 patients were enrolled in 34 French centers (503 in each arm). Among the whole population, 28 patients who did not meet the final selection criteria or withdrew consent were excluded leading to a modified intention to treat analysis dataset of 978 patients (WBI: n=488; APBI: n=490). Median age (65y) and tumor stage pT1 (99%) rates were similar in both arms. Patients had conservative surgery with clip placement in the tumor bed. Clear margins (> 2mm) were observed in 99% of the patients. In both arms, 96-97% of the patients had negative sentinel lymph node biopsy (SLNB; median number: 4 in WBI arm and 5 in APBI), luminal BC. Ductal histology was observed 82%. Only 2% and 1% of patients had grade III and pN(i+) disease. The median time interval between surgery and radiotherapy was 57d in WBI vs 62d in APBI. WBI schedules consisted of: 50Gy in 25fr + 16Gy boost (n=212) or 40Gy in 15fr (n=156) or 42.5Gy in 16fr (n=120), while APBI arm consisted of 38.5Gy or 40Gy in 10fr. Overall, 94 patients from the APBI arm finally received standard WBI. For statistical considerations, SHARE trial, sponsored by UNICANCER (NCT01247233) is a non-inferiority randomized controlled trial comparing APBI versus WBI in terms of local control as primary objective. Secondary endpoints were severe toxicity (NCI-CTCAE v4 grade ≥ 2), and cosmetic results, evaluated by doctors and by patients, over the entire follow-up. For both outcomes, we estimated the cumulative incidences (CI) using Kalbfleish and Prentice method, considering disease relapse, secondary cancer or death as competing events. Treatment effect (APBI vs WBI) was estimated by cause-specific Hazard Ratios (cs-HR) from Cox models adjusted on stratification factors. Results: Median follow-up was 5.8y (range, 0.13-9.5). The number of deaths was 27, and the number of local relapses was 8. Among the 978 patients, 582 and 396 had finally WBI and APBI, respectively. The rates of post-operative hematoma, edema and infection were low: 8-9%, 2%, 3-2%, respectively. When considering any type of severe toxicity, we observed a significant reduction rate in APBI compared to WBI: cs-HR=0.73 (95% confidence interval: 0.61-0.88); p=0.001, and 3-year cumulative incidence (CI) of severe toxicity at 45% (41-49) in WBI vs 36% (32-40) in APBI arm. The difference was also in favor of APBI when considering breast skin toxicity alone: cs-HR=0.55 (0.44-0.70), p< 0.001 and 3-year CI at 36% (32-40) in WBI vs 21% (18-25) in APBI arm. Conversely, for breast other toxicities, WBI was found less toxic than APBI: cs-HR= 2.10 (1.51-2.91), p< 0.001, and 3-year CI at 8% (5-10) vs 15% (12-19), respectively. When considering cosmetic results according to the investigator, we observed no significant difference between the two arms: cs-HR=1.04 (0.81-1.33), p=0.26 and 3-year probability of remaining with good to excellent cosmetic results at 77% (73-81) in WBI arm and 78% (74-81) in APBI arm. Findings were similar when considering results according to the patient: cs-HR=1.07 (0.85-1.37), p=0.23, and 3-year probability at 74% (70-78) and 75% (70-79), respectively. Conclusions Historically SHARE is the first APBI trial that included hypofractionated schedules in the standard arm. We reported increased risk of severe toxicity and skin breast toxicity in standard arm as compared with APBI arm without any difference in terms of cosmetic results. Longer follow-up is needed.
Citation Format: Yazid Belkacemi, Isabelle Gabelle-Flandin, Marie-Cécile Le Deley, Adeline Petit, Philippe Guilbert, Julien Geffrelot, Christian Carrie, Eleonor Rivin Del Campo, Chantal Hanzen, Claire Charra-Brunaud, Isabelle Lecouillard, Nicolas Magne, Agnès Tallet, Nicolas Leduc, Blaha Belgadi, Philippe Fourneret, Alexandre Coutte, Esther Capelo, Franck Darloy, Muriel Garcia Ramirez, Philippe Dudouet, Pierre Clavere, Jean-Philippe Suchaud, Guillaume Auzac, Thomas Lacornerie, Jérôme Lemonnier, Céline Bourgier, Eric Lartigau. Early results of the French multicenter, randomized SHARE trial comparing whole breast irradiation versus accelerated partial breast irradiation in postmenopausal women with early-stage breast cancer. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD3-05.
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Bras AL, Belkacemi Y, Bourgier C, Gabelle-Flandin I, Petit A, Guilbert P, Geffrelot J, Carrie C, CAMPO ERIVINDEL, Hanzen C, charra-brunaud C, Auzac G, Lacornerie T, Lemonnier J, Lartigau E, Durand-Zaleski I. Abstract P1-10-13: Economic comparison of standard external beam whole breast (WBI) versus accelerated partial breast irradiation (ABPI) in postmenopausal women with early-stage breast cancer. Results from the French SHARE randomized trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p1-10-13] [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: 03/06/2023]
Abstract
Abstract
Purpose: The economic evaluation reports the incremental cost utility ratio and budget impact of APBI vs standard external beam WBI for the treatment of post-menopausal women with early stage breast cancer.
Methods and materials: We compared 488 women in the standard arm (1 fraction per day delivered 5 days per week over 3 or 6/6.5 weeks) to 490 women in the ABPI arm (ten fractions delivered twice per day over one week). We took the perspective of the healthcare system, a 3-year time horizon; the outcomes were quality adjusted life years (QALYs). QALYs were calculated from the EQ5D5L questionnaires at baseline, 3 months, 6 months, 12 months and yearly after irradiation; scores were converted into utilities using the French value set and QALYs computed with the area under the curve approach. Measures of within-trial use of hospital resources were based on routine hospital data via patient-level information. We used the itemized and DRG cost data from each individual patient. Transportation costs were added in a sensitivity analysis. A 2.5% discount rate was applied to costs and QALYs. An incremental analysis with differences in costs and QALYs was performed to calculate the cost utility ratio. Bootstrapping was used to quantify uncertainty on the joint distribution of costs and outcomes, and 1,000 paired estimates of mean differential costs and QALYs were reported on a cost-effectiveness plane. A budget impact analysis based on incidence of breast cancer estimates was added. All analyses followed the intent to treat principle.
Results: Cost and utilities were available for the entire population. Costs and QALY results are presented in table 1. The 2 925 € (95% IC, -3 364 €; - 2 452 €) significant difference in total costs favoring ABPI was driven by the difference in radiotherapy costs and partly by lower transportation costs. No significant difference was found in QALYs. Figure 1 shows the uncertainty of the joint distribution of costs and QALYs. All replication are in the lower half of the plane indicating that ABPI is cost saving with QALYs distributed on each side of the vertical axis indicating equal distribution of QALYs. would be eligible for treatment with ABPI. The uptake of ABPI for 16% of these women would result in a 16 million€ cost saving.
Conclusions: At three years, ABPI for the treatment of postmenopausal women with early-stage breast cancer was found to be cost saving, with no difference in outcome measured by QALYs.
Table 1.
Figure 1.
Citation Format: Alicia Le Bras, Yazid Belkacemi, céline Bourgier, Isabelle Gabelle-Flandin, Adeline Petit, Philippe Guilbert, Julien Geffrelot, Christian Carrie, Eleonor RIVIN DEL CAMPO, Chantal Hanzen, claire charra-brunaud, Guillaume Auzac, Thomas Lacornerie, Jérôme Lemonnier, Eric Lartigau, Isabelle Durand-Zaleski. Economic comparison of standard external beam whole breast (WBI) versus accelerated partial breast irradiation (ABPI) in postmenopausal women with early-stage breast cancer. Results from the French SHARE randomized trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-10-13.
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To NH, Kossai M, Ouidir N, Grellier N, Assaf E, Gabelle-Flandin I, Belkacemi Y, Radosevic-Robin N. Atypical responses to neoadjuvant chemotherapy combined with accelerated partial breast tumor-directed radiotherapy: two cases and considerations for future clinical trials. Rep Pract Oncol Radiother 2022; 27:1114-1118. [PMID: 36632297 PMCID: PMC9826652 DOI: 10.5603/rpor.a2022.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/04/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nhu Hanh To
- Department of Radiation Oncology and The Henri Mondor Breast Center, The Henri Mondor University Hospital, Creteil, France,University of Paris-Est Créteil (UPEC), Creteil, France,INSERM Unit 955, Immunoregulation and Biotherapy (I-Biot) Team, The Mondor Institute for Biomedical Research (IMRB), Creteil, France,Transatlantic Radiation Oncology Network (TRONE), Créteil, France
| | - Myriam Kossai
- Department of Pathology, Centre Jean Perrin, Clermont-Ferrand, France,University Clermont Auvergne, INSERM Unit 1240 (IMoST), Radiopharmaceuticals & Biomarkers (RoBust) Team, Clermont-Ferrand, France
| | - Nabila Ouidir
- Department of Pathology, The Henri Mondor University Hospital, AP-HP, Creteil, France
| | - Noemie Grellier
- Department of Radiation Oncology and The Henri Mondor Breast Center, The Henri Mondor University Hospital, Creteil, France
| | - Elias Assaf
- Department of Medical Oncology, The Henri Mondor University Hospital, Creteil, France
| | - Isabelle Gabelle-Flandin
- University Clinic of Cancerology-Radiotherapy, The Grenoble Alpes University Hospital Centre, La Tronche, France
| | - Yazid Belkacemi
- Department of Radiation Oncology and The Henri Mondor Breast Center, The Henri Mondor University Hospital, Creteil, France,University of Paris-Est Créteil (UPEC), Creteil, France,INSERM Unit 955, Immunoregulation and Biotherapy (I-Biot) Team, The Mondor Institute for Biomedical Research (IMRB), Creteil, France,Transatlantic Radiation Oncology Network (TRONE), Créteil, France,Association of Radiation Oncologists in the Mediterranean region (AROME), Creteil, France
| | - Nina Radosevic-Robin
- Department of Pathology, Centre Jean Perrin, Clermont-Ferrand, France,University Clermont Auvergne, INSERM Unit 1240 (IMoST), Radiopharmaceuticals & Biomarkers (RoBust) Team, Clermont-Ferrand, France,Association of Radiation Oncologists in the Mediterranean region (AROME), Creteil, France
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Kefs S, Giraud JY, Naud J, Henry I, Gabelle-Flandin I, Balosso J, Chaikh A, Verry C. Doses delivered by portal imaging quality assurance in routine practice of adjuvant breast radiotherapy worth to by monitored and compensated in some cases. Quant Imaging Med Surg 2021; 11:3481-3493. [PMID: 34341725 DOI: 10.21037/qims-19-1031] [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: 12/10/2019] [Accepted: 03/22/2021] [Indexed: 11/06/2022]
Abstract
Background Imaging, in radiotherapy, has become a routine tool for repositioning of the target volume at each session. The repositioning precision, currently infracentimetric, evolves along with the irradiation techniques. This retrospective study aimed to identify practices and doses resulting from the use of high energy planar imaging (portal imaging) in daily practice. Methods A retrospective survey of portal images (PIs) was carried out over 10 years for 2,403 patients and for three linacs (1 Elekta SLi, 2 Varian Clinac) for postoperative mammary irradiations. Images were taken using a standardized number of monitor units (MU) for all patients. Due to the variable sensitivities of the detectors and the possibility of adjustment of the detector-patient distance, the number of MU were 3; 2 and 1 respectively, for Elekta SLi®, Clinac 600® and Clinac 2100®. Then, a representative cumulated dose was calculated in simplified reference conditions (5 cm depth, beam of 10 cm × 10 cm, 6 MV), considering the total number of images taken during the whole treatment course. The consistency between the representative doses and the actual absorbed doses received by the patients was verified by simulating a series of typical cases with the treatment plan dose calculation system. Results The delivered doses differ significantly between the three linacs. The mean representative dose values by complete treatment were 0.695; 0.241 and 0.216 Gy, respectively, for SLi, Clinac 600 and Clinac 2100. However, 15 patients were exposed to a dose >2 Gy with a maximum dose of 5.05 Gy. The simulated doses were very similar to the representative doses. Conclusions A significant dose delivery was highlighted by this study. These representative doses are presently communicated weekly to the radiation oncologist for the radiation protection of their patients. Moreover, they should be taken into account in a possible study of long-term stochastic risks.
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Affiliation(s)
- Sami Kefs
- Department of Cancerology-Radiotherapy, University Hospital Grenoble-Alpes, Grenoble, France.,INSERM SRMR Team (Synchrotron Radiation and Medical Research), ESRF, Grenoble, France
| | - Jean-Yves Giraud
- Department of Cancerology-Radiotherapy, University Hospital Grenoble-Alpes, Grenoble, France.,INSERM SRMR Team (Synchrotron Radiation and Medical Research), ESRF, Grenoble, France
| | - Julie Naud
- Department of Cancerology-Radiotherapy, University Hospital Grenoble-Alpes, Grenoble, France
| | - Isabelle Henry
- Department of Cancerology-Radiotherapy, University Hospital Grenoble-Alpes, Grenoble, France
| | | | - Jacques Balosso
- Department of Cancerology-Radiotherapy, University Hospital Grenoble-Alpes, Grenoble, France.,INSERM SRMR Team (Synchrotron Radiation and Medical Research), ESRF, Grenoble, France.,University Grenoble-Alpes, Grenoble, France
| | | | - Camille Verry
- Department of Cancerology-Radiotherapy, University Hospital Grenoble-Alpes, Grenoble, France.,INSERM SRMR Team (Synchrotron Radiation and Medical Research), ESRF, Grenoble, France
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Cleuziou JP, Desgranges C, Henry I, Jaumot M, Chartier P, Sihanath R, Carré M, Bulabois CE, Cahn JY, Pasteris C, Balosso J, Gabelle-Flandin I, Verry C, Giraud JY. Total body irradiation using helical tomotherapy: Set-up experience and in-vivo dosimetric evaluation. Cancer Radiother 2021; 25:213-221. [PMID: 33402290 DOI: 10.1016/j.canrad.2020.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Helical Tomotherapy (HT) appears as a valuable technique for total body irradiation (TBI) to create highly homogeneous and conformal dose distributions with more precise repositioning than conventional TBI techniques. The aim of this work is to describe the technique implementation, including treatment preparation, planning and dosimetric monitoring of TBI delivered in our institution from October 2016 to March 2019. MATERIAL AND METHOD Prior to patient care, irradiation protocol was set up using physical phantoms. Gafchromic films were used to assess dose distribution homogeneity and evaluate imprecise patient positioning impact. Sixteen patients' irradiations with a prescribed dose of 12Gy were delivered in 6 fractions of 2Gy over 3 days. Pre-treatment quality assurance (QA) was performed for the verification of dose distributions at selected positions. In addition, in-vivo dosimetry was carried out using optically stimulated luminescence dosimeters (OSLD). RESULTS Planning evaluation, as well as results of pre-treatment verifications, are presented. In-vivo dosimetry showed the strong consistency of OSLD measured doses. OSLD mean relative dose differences between measurement and calculation were respectively +0,96% and -2% for armpit and hands locations, suggesting better reliability for armpit OSLD positioning. Repercussion of both longitudinal and transversal positioning inaccuracies on phantoms is depicted up to 2cm shifts. CONCLUSION The full methodology to set up TBI protocol, as well as dosimetric evaluation and pre-treatment QA, were presented. Our investigations reveal strong correspondence between planned and delivered doses shedding light on the dose reliability of OSLD for HT based TBI in-vivo dosimetry.
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Affiliation(s)
- J-P Cleuziou
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - C Desgranges
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - I Henry
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - M Jaumot
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - P Chartier
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - R Sihanath
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - M Carré
- Service d'hématologie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - C E Bulabois
- Service d'hématologie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - J-Y Cahn
- Service d'hématologie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - C Pasteris
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - J Balosso
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - I Gabelle-Flandin
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - C Verry
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - J-Y Giraud
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France.
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Leroux A, Gabelle-Flandin I, Sihanath R, Chartier P, Meneu F, Giraud J. 24 State of the art for breast cancer treatment in radiotherapy. Comparison of mono/multi isocentric conformational and helical techniques. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.09.106] [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: 11/30/2022] Open
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Abstract
Breast cancer is a common diagnosis in women and thus women are at risk of radiation-induced heart disease, in particular during radiotherapy for left breast cancer and when the internal mammary chain is included. Rates of major cardiac events increase with younger age at the time of irradiation, diagnosis before 1990s, higher radiation doses, coexisting cardiovascular risk factors and adjuvant cardiotoxic chemotherapy. Radiation-induced heart disease comprises a spectrum of cardiac pathologies, including pericardial disease, cardiomyopathy, coronary artery disease and valvular disease. The cardiac injury can appear a long time after radiotherapy and can consist of complex lesions with poor prognosis. The disciplines of cardiology and oncology have increasingly recognized the benefits of collaborating in the care of cancer patients with cardiac disease, developing guidelines for the assessment and management of radiation-related cardiovascular disease. We could consider screening patients with previous chest radiation every 5 years with transthoracic echocardiography and functional imaging. However, prevention remains the primary goal, using cardiac sparing doses and avoidance techniques in radiotherapy to improve patient survival.
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Affiliation(s)
- S Marlière
- Clinique universitaire de cardiologie, centre hospitalier universitaire de Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France.
| | - E Vautrin
- Clinique universitaire de cardiologie, centre hospitalier universitaire de Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France
| | - C Saunier
- Clinique universitaire de cardiologie, centre hospitalier universitaire de Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France
| | - A Chaikh
- Service de cancérologie-radiothérapie, centre hospitalier universitaire de Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France
| | - I Gabelle-Flandin
- Service de cancérologie-radiothérapie, centre hospitalier universitaire de Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France
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Fdhila M, Gabelle-Flandin I, Balosso J, Chaikh A. Quantitative evaluation of the impact of heterogeneity correction on left breast cancer radiotherapy performed with respiratory gating. Int J Cancer Ther Oncol 2016. [DOI: 10.14319/ijcto.41.7] [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: 11/05/2022] Open
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12
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Li Z, Sergent F, Bolla M, Zhou Y, Gabelle-Flandin I. Prognostic factors of second primary contralateral breast cancer in early-stage breast cancer. Oncol Lett 2014; 9:245-251. [PMID: 25435968 PMCID: PMC4246626 DOI: 10.3892/ol.2014.2623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/25/2013] [Accepted: 07/08/2014] [Indexed: 11/14/2022] Open
Abstract
The aim of the present study was to investigate the therapeutic outcome of early-stage breast cancer (pT1aN0M0) and to identify prognostic factors for secondary primary contralateral breast cancer (CBC). A total of 85 patients with mammary carcinomas were included. All patients had undergone breast surgery and adjuvant treatment between January 2001 and December 2008 at the Central Hospital of Grenoble University (Grenoble, France). The primary end-points were disease-free survival and secondary CBC, and the potential prognostic factors were investigated. During a median follow-up of 60 months, 10 of the 85 patients presented with secondary primary cancer, of which six suffered with CBC. No patient mortalities were reported. The rates of CBC were 2.35, 3.53 and 7.06% at one, two and five years, respectively. The cumulative univariate analysis showed that microinvasion and family history are potential risk factors for newly CBC. The current study also demonstrated that secondary CBC was more likely to occur in patients with microinvasion or a family history of hte dise. In addition, the systematic treatment of secondary CBC should include hormone therapy.
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Affiliation(s)
- Zheng Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital Affiliated to Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Fabrice Sergent
- Department of Gynecology, Central Hospital of Grenoble University, Grenoble 38043, France
| | - Michel Bolla
- Department of Radiation Oncology, Central Hospital of Grenoble University, Grenoble 38043, France
| | - Yunfeng Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital Affiliated to Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Isabelle Gabelle-Flandin
- Department of Radiation Oncology, Central Hospital of Grenoble University, Grenoble 38043, France
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Vallier S, Troccaz J, Gabelle-Flandin I, Payan Y. Biomechanical breast modelling to improve patient positioning during breast cancer radiotherapy. Comput Methods Biomech Biomed Engin 2013; 16 Suppl 1:278-9. [DOI: 10.1080/10255842.2013.815862] [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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Blampey C, Ronflette E, Lamarre V, Court J, Guillem P, Dompnier F, Balosso J, Gabelle-Flandin I. Développement et état des lieux du temps d’accompagnement soignant en radiothérapie au niveau d’une région française en 2010. Cancer Radiother 2011. [DOI: 10.1016/j.canrad.2011.07.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gabelle-Flandin I, Beneyton V, Dusserre A, Sihanath R, de Villèle C, Henry I, Vassal S, Tessier A, Balosso J, Giraud JY. Étude pilote de « boost intégré » avec fractionnement en quatre séances hebdomadaires dans la radiothérapie du sein. Cancer Radiother 2011. [DOI: 10.1016/j.canrad.2011.07.041] [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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16
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Beneyton V, Dusserre A, Sihanath R, Reboulet G, Gabelle-Flandin I, Pasteris C, Villa J, Tessier A, Balosso J, Giraud J. Technique d’association d’une RCMI et d’un faisceau cervico-susclaviculaire standard pour l’irradiation des cancers ORL. Cancer Radiother 2011. [DOI: 10.1016/j.canrad.2011.07.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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