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Tao Y, Biau J, Sun XS, Sire C, Martin L, Alfonsi M, Prevost JB, Modesto A, Lafond C, Tourani JM, Miroir J, Kaminsky MC, Coutte A, Liem X, Chautard E, Vauleon E, Drouet F, Ruffier A, Ramee JF, Waksi G, Péchery A, Wanneveich M, Guigay J, Aupérin A, Bourhis J. Pembrolizumab versus cetuximab concurrent with radiotherapy in patients with locally advanced squamous cell carcinoma of head and neck unfit for cisplatin (GORTEC 2015-01 PembroRad): a multicenter, randomized, phase II trial. Ann Oncol 2023; 34:101-110. [PMID: 36522816 DOI: 10.1016/j.annonc.2022.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [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: 06/28/2022] [Revised: 10/01/2022] [Accepted: 10/13/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To evaluate potential synergistic effect of pembrolizumab with radiotherapy (RT) compared with a standard-of-care (SOC) cetuximab-RT in patients with locally advanced-squamous cell carcinoma of head and neck (LA-SCCHN). PATIENTS AND METHODS Patients with nonoperated stage III-IV SCC of oral cavity, oropharynx, hypopharynx, and larynx and unfit for receiving high-dose cisplatin were enrolled. Patients received once-daily RT up to 69.96 Gy in 33 fractions with weekly cetuximab (cetuximab-RT arm) or 200 mg Q3W pembrolizumab during RT (pembrolizumab-RT arm). The primary endpoint was locoregional control (LRC) rate 15 months after RT. To detect a difference between arms of 60%-80% in 15-month LRC, inclusion of 66 patients per arm was required to achieve a power of at least 0.85 at two-sided significance level of 0.20. RESULTS Between May 2016 and October 2017, 133 patients were randomized to cetuximab-RT (n = 66) and pembrolizumab-RT (n = 67). Two patients (one in each arm) were not included in the analysis (a consent withdrawal and a progression before treatment start). The median age was 65 years (interquartile range 60-70 years), 92% were smokers, 60% were oropharynx (46% of oropharynx with p16+) and 75% were stage IV. Median follow-up was 25 months in both arms. The 15-month LRC rate was 59% with cetuximab-RT and 60% with pembrolizumab-RT ]odds ratio 1.05, 95% confidence interval (CI) 0.43-2.59; P = 0.91]. There was no significant difference between arms for progression-free survival (hazard ratio 0.85, 95% CI 0.55-1.32; P = 0.47) and for overall survival (hazard ratio 0.83, 95% CI 0.49-1.40; P = 0.49). Toxicity was lower in the pembrolizumab-RT arm than in the cetuximab-RT arm: 74% versus 92% patients with at least one grade ≥3 adverse events (P = 0.006), mainly due to mucositis, radiodermatitis, and rash. CONCLUSION Compared with the SOC cetuximab-RT, pembrolizumab concomitant with RT did not improve the tumor control and survival but appeared less toxic in unfit patients with LA-SCCHN.
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Affiliation(s)
- Y Tao
- Gustave-Roussy Institute, Villejuif, France
| | - J Biau
- Centre Jean Perrin, Clermont Ferrand, France
| | - X S Sun
- Hôpital Nord Franche-Comté, Montbéliard and CHU Besançon, Montbéliard, France
| | - C Sire
- Centre Hospitalier de Bretagne Sud, Lorient, France
| | - L Martin
- Clinique des Ormeaux, Le Havre, France
| | - M Alfonsi
- Clinique Sainte Catherine, Avignon, France
| | | | - A Modesto
- Institut Claudius Regaud, Toulouse, France
| | - C Lafond
- Clinique Victor Hugo-Centre Jean Bernard, Le Mans, France
| | - J M Tourani
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - J Miroir
- Centre Jean Perrin, Clermont Ferrand, France
| | - M C Kaminsky
- Institut de Cancérologie de Lorraine, Nancy, France
| | - A Coutte
- Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - X Liem
- Centre Oscar Lambret, Lille, France
| | - E Chautard
- Centre Jean Perrin, Clermont Ferrand, France
| | - E Vauleon
- Centre Eugène Marquis, Rennes, France
| | - F Drouet
- Clinique Mutualiste de l'estuaire, Saint-Nazaire, France
| | - A Ruffier
- Gustave-Roussy Institute, Villejuif, France; Clinique Victor Hugo-Centre Jean Bernard, Le Mans, France
| | - J F Ramee
- Centre Hospitalier Départemental de Vendée, La Roche sur Yon, France
| | | | | | | | - J Guigay
- Centre Antoine Lacassagne, FHU OncoAge, University Côte d'Azur, Nice, France
| | - A Aupérin
- Unit of Biostatistics and Epidemiology, Gustave Roussy, Oncostat 1018 INSERM, labeled Ligue Contre le Cancer, Université Paris-Saclay, Villejuif, France
| | - J Bourhis
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Bourhis J, Tao Y, Sun X, Sire C, Martin L, Liem X, Coutte A, Pointreau Y, Thariat J, Miroir J, Rolland F, Kaminsky MC, Borel C, Maillard A, Sinigaglia L, Guigay J, Saada-Bouzid E, Even C, Aupérin A. LBA35 Avelumab-cetuximab-radiotherapy versus standards of care in patients with locally advanced squamous cell carcinoma of head and neck (LA-SCCHN): Randomized phase III GORTEC-REACH trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2112] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mione C, Martin F, Miroir J, Moreau J, Saroul N, Pham Dang N, Bellini R, Lapeyre M, Biau J. Impact of the method chosen for the analysis of recurrences after radiotherapy for head and neck cancers: volume-based, point-based and combined methods. Cancer Radiother 2021; 25:502-506. [PMID: 33762149 DOI: 10.1016/j.canrad.2020.05.021] [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: 04/23/2020] [Accepted: 05/21/2020] [Indexed: 11/25/2022]
Abstract
Intensity modulated radiation therapy for head and neck is a complex technique. Inappropriate delineation and/or dose distribution can lead to recurrences. Analysis of these recurrences should lead to improve clinical practice. For several years, different methods of analysis have been described. The purpose of this review is to describe these different methods and to discuss their advantages and limitations. The first published methods used a volume-based approach studying the entire volume of recurrence according to initial target volumes, or dose distribution. The main limitation of these methods was that the volume of recurrence studied was dependent on the delay in diagnosis of that recurrence. Subsequently, other methods used point-based approaches, conceptualizing recurrence either as a spherical expansion from a core of radioresistant cells (center of mass of recurrence volume) or using a more clinical approach, taking into account tumor expansion pathways. More recently, more precise combined methods have been described, combining the different approaches. The choice of method is decisive for conclusions on the origin of recurrence.
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Affiliation(s)
- C Mione
- Department of Radiotherapy, Jean-Perrin Centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - F Martin
- Department of Radiotherapy, Jean-Perrin Centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - J Miroir
- Department of Radiotherapy, Jean-Perrin Centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - J Moreau
- Department of Radiotherapy, Jean-Perrin Centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - N Saroul
- Department of ENT Surgery, Centre Hospitalier Universitaire Hôpital Gabriel Montpied, 58, rue Montalembert, 63003 Clermont Ferrand, France
| | - N Pham Dang
- Department of Maxillo-Facial Surgery, Centre Hospitalier Universitaire Hôpital Estaing, 63003 Clermont-Ferrand, France
| | - R Bellini
- Department of Radiology, Centre Jean Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - M Lapeyre
- Department of Radiotherapy, Jean-Perrin Centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - J Biau
- Department of Radiotherapy, Jean-Perrin Centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France.
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Guillemin F, Miroir J, Piram L, Bellini R, Saroul N, Pham Dang N, Boisselier P, Bourhis J, Calugaru V, Coutte A, Graff P, Pointreau Y, Racadot S, Sun XS, Thariat J, Biau J, Lapeyre M. [Proposal for the delineation of postoperative primary clinical target volumes in ethmoid cancers]. Cancer Radiother 2021; 25:200-205. [PMID: 33546996 DOI: 10.1016/j.canrad.2020.04.015] [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: 11/12/2019] [Revised: 03/20/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022]
Abstract
It is proposed to delineate the anatomo-clinical target volumes of primary tumor (CTV-P) in ethmoid cancers treated with post-operative radiotherapy. This concept is based on the use of radioanatomy and the natural history of cancer. It is supported by the repositioning of the planning scanner with preoperative imaging for the replacement of the initial GTV and the creation of margins around it extended to the microscopic risk zones according to the anatomical concept. This article does not discuss the indications of external radiotherapy but specifies the volumes to be delineated if radiotherapy is considered.
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Affiliation(s)
- F Guillemin
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - J Miroir
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - L Piram
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - R Bellini
- Département de radiodiagnostic, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - N Saroul
- Département de chirurgie ORL, centre hospitalier universitaire Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France
| | - N Pham Dang
- Département de chirurgie maxillofaciale, centre hospitalier universitaire Estaing, 63003 Clermont-Ferrand cedex 1, France
| | - P Boisselier
- Département de radiothérapie, Institut régional cancer de Montpellier, parc Euromédecine, 208 rue des Apothicaires, 34090 Montpellier, France
| | - J Bourhis
- Département de radiothérapie, Centre hospitalier universitaire vaudois, rue du Bugnon 46, 1005 Lausanne, Suisse
| | - V Calugaru
- Département de radiothérapie, institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - A Coutte
- Département de radiothérapie, CHU Amiens-Picardie, 30, avenue de la Croix-Jourdain, 80054 Amiens cedex 1, France
| | - P Graff
- Département de radiothérapie, Institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - Y Pointreau
- Département de radiothérapie, Institut inter-régional de cancérologie (ILC), centre Jean-Bernard, 9, rue Beauverger, 72000 Le Mans, France
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - X S Sun
- Département de radiothérapie, hôpital Nord Franche-Comté de Montbéliard, CHRU de Besançon, 1 rue Henri-Becquerel, 25200 Montbéliard, France
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France.
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Lapeyre M, Biau J, Miroir J, Moreau J, Gleyzolle B, Brun L, Racadot S, Graff-Cailleaud P. [Concurrent chemoradiotherapy for head neck cancers. Should organs at risk dose constraints be revisited ?]. Cancer Radiother 2020; 24:586-593. [PMID: 32861607 DOI: 10.1016/j.canrad.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 01/16/2023]
Abstract
Concurrent chemoradiotherapy improves the outcome of locally advanced head and neck cancers and the current reference chemotherapy is cisplatin. These results are obtained at the cost of increased toxicities. To limit the risk of toxicity, organ at riskdose constraints have been established starting with 2D radiotherapy, then 3D radiotherapy and intensity-modulated radiotherapy. Regarding grade ≥3 acute toxicities, the scientific literature attests that concurrent chemoradiotherapy significantly increases risks of mucositis and dysphagia. Constraints applied to the oral mucosa volume excluding the planning target volume, the pharyngeal constrictor muscles and the larynx limit this adverse impact. Regarding late toxicity, concurrent chemoradiotherapy increases significantly the risk of postoperative neck fibrosis and hearing loss. However, for some organs at risk, concurrent chemotherapy appears to increase late radiation induced effect, even though the results are less marked (brachial plexus, mandible, pharyngeal constrictor muscles, parotid gland). This additional adverse impact of concomitant chemotherapy may be notable only when organs at risk receive less than their usual dose thresholds and this would be vanished when those thresholds are exceeded as seems to be the situation for the parotid glands. Until the availability of more robust data, it seems appropriate to apply the principle of delivering dose to organs at risk as low as reasonably achievable.
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Affiliation(s)
- M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France.
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - J Miroir
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - J Moreau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - B Gleyzolle
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - L Brun
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P Graff-Cailleaud
- Département de radiothérapie, institut universitaire du cancer de Toulouse, 1, avenue Irene Joliot-Curie, 31100 Toulouse, France
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Bourhis J, Sun X, Pointreau Y, Sire C, Le Tourneau C, Coutte A, Kaminsky-Forrett MC, Alfonsi M, Boisselier P, Martin L, Delord JP, Clatot F, Miroir J, Rolland F, Crompton P, Brienza S, Szyldergemajn S, Even C, Tao Y. Double-blind randomized phase II results comparing concurrent high-dose cisplatin chemorradiation (CRT) plus debio 1143 or placebo in high-risk patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN): A GORTEC study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Biau J, Moreau J, Blanchard P, Thariat J, Miroir J, Lapeyre M. Réirradiations des carcinomes épidermoïdes des voies aérodigestives supérieures : indications et résultats. Cancer Radiother 2019; 23:559-564. [DOI: 10.1016/j.canrad.2019.07.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/08/2019] [Indexed: 01/12/2023]
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Piram L, Frédéric-Moreau T, Bellini R, Martin F, Miroir J, Saroul N, Pham Dang N, Biau J, Lapeyre M. Erratum à « Proposition de délinéation des volumes cibles tumoraux et sélection des aires ganglionnaires des cancers de la glande parotide » report [Cancer Radiother. 23 (2019) 255–263]. Cancer Radiother 2019; 23:470-471. [DOI: 10.1016/j.canrad.2019.06.001] [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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Piram L, Frédéric-Moreau T, Bellini R, Martin F, Miroir J, Saroul N, Pham Dang N, Biau J, Lapeyre M. Proposition de délinéation des volumes cibles tumoraux et sélection des aires ganglionnaires des cancers de la glande parotide. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Thariat J, Troussier I, Sun X, Salleron J, Petit C, Pflumio C, Arnaud B, Stephanie S, Castelli J, Miroir J, Krengli M, Giraud P, Khalifa J, Dore M, Blanchard N, Coutte A, Sumodhee S, Calugaru V, TAO Y, Dupin C, Pointreau Y, Patel S, rehalia-Blanchard A, Catteau L, Bensadoun R, Roth V, Christophe FJ. Uni or bilateral Irradiation in Cervical Lymph Node Metastases of Unknown Primary? Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1101] [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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Troussier I, Pflumio C, Sun X, Salleron J, Petit C, Caubet M, Beddock A, Calugaru V, Servagi Vernat S, Castelli J, Miroir J, Giraud P, Khalifa J, Doré M, Blanchard N, Coutte A, Dupin C, Sumodhee S, Rehailia-Blanchard A, Catteau L, Tao Y, Pointreau Y, Bensadoun RJ, Roth V, Faivre JC, Thariat J. Irradiation uni- ou bilatérale des métastases ganglionnaires cervicales de cancer primitif inconnu ? Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.038] [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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Piram L, Frédéric-Moreau T, Martin F, Miroir J, Saroul N, Pham-Dang N, Biau J, Lapeyre M. Radiothérapie des carcinomes épidermoïdes des voies aérodigestives supérieures non opérés : impact des contraintes de l’ICRU de couverture du volume tumoral primitif sur le contrôle local. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.047] [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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Biau J, Miroir J, Millardet C, Saroul N, Pham-Dang N, Racadot S, Huguet F, Kwiatkowski F, Pereira B, Bourhis J, Lapeyre M. [Description of the GORTEC 2017-03 study: Postoperative stereotactic radiotherapy for early stage oropharyngeal and oral cavity cancer with high risk margin (PHRC-K-16-164)]. Cancer Radiother 2017; 21:527-532. [PMID: 28865970 DOI: 10.1016/j.canrad.2017.07.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/16/2017] [Accepted: 07/19/2017] [Indexed: 12/20/2022]
Abstract
The GORTEC 2017-03-Stereo-postop study is a phase 2, multicentric, nationwide study, funded by the hospital clinical research program (PHRC). The sponsor is Centre Jean-Perrin in Clermont-Ferrand, in partnership with the GORTEC. The principal investigators are Dr J Biau and Dr M Lapeyre. The main objective is to study severe late toxicity of postoperative stereotactic radiotherapy (6×6Gy) for early stage oropharyngeal and oral cavity cancer with high risk margins. The secondary objectives include acute toxicity, efficacy, nutritional impact and quality of life. The population is adult patients, with pT1 or pT2 squamous cell carcinoma of the oropharynx or oral cavity (except lips), without indication of neck irradiation or concomitant chemotherapy, with at risk margin (R1, less than 5mm or uncertain). Ninety patients will be included over a 2-year period; this was calculated to limit the rate of 2-year severe toxicity at 5 to 15%, with a 2-year local control of at least 80 to 90%. If this study is considered as positive, stereotactic radiotherapy (6×6Gy) could become the third therapeutic option, with brachytherapy and normofractionated intensity-modulated radiotherapy (IMRT), for postoperative irradiation of oropharyngeal and oral cavity cancer with high risk margins.
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Affiliation(s)
- J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France.
| | - J Miroir
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - C Millardet
- Département de physique médicale, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - N Saroul
- Département d'ORL-CCF, CHU Gabriel-Montpied, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - N Pham-Dang
- Département de chirurgie maxillo-faciale, CHU Estaing, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - F Huguet
- Département de radiothérapie, hôpital Tenon-AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Kwiatkowski
- Département de recherche clinique, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - B Pereira
- Département de biostatistiques, DRCI, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - J Bourhis
- Département de radiothérapie, CHUV, 1011 Lausanne, Suisse
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
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Miroir J, Biau J, Saroul N, Millardet C, Lapeyre M. PD-032: Pharyngeal constrictor muscle dose correlated with dysphagia after radiotherapy in head and neck. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30181-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Piram L, Frédéric-Moreau T, Miroir J, Saroul N, Pham Dang N, Berger L, Biau J, Lapeyre M. Étude prospective évaluant l’impact de la couverture du volume cible prévisionnel à haut risque par l’isodose 95 % sur les taux de contrôle local et de survie globale dans les cancers des voies aérodigestives supérieures pris en charge par radiothérapie conformationnelle avec modulation d’intensité. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.013] [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: 10/21/2022]
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Frédéric-Moreau T, Piram L, Miroir J, Saroul N, Benhaim C, Millardet C, Lapeyre M, Biau J. Radiothérapie par modulation d’intensité des cancers des fosses nasales et paranasales : amélioration des résultats par comparaison à la radiothérapie tridimensionnelle. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.010] [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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Miroir J, Biau J, Saroul N, Pham Dang N, Millardet C, Kwiatkowski F, Lapeyre M. Dysphagie tardive après radiothérapie conformationnelle avec modulation d’intensité des cancers des voies aérodigestives supérieures : la dose moyenne aux muscles constricteurs du pharynx est un facteur indépendant. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.07.046] [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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Miroir J, Biau J, Lapeyre M. Facteurs pronostiques de dysphagie après irradiation conformationnelle avec modulation d’intensité des cancers des voies aérodigestives supérieures avec irradiation bilatérale du cou. Cancer Radiother 2015. [DOI: 10.1016/j.canrad.2015.07.064] [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: 11/17/2022]
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Biau J, Chautard E, Miroir J, Lapeyre M. [Radioresistance parameters in head and neck cancers and methods to radiosensitize]. Cancer Radiother 2015; 19:337-46; quiz 360-1, 363. [PMID: 26119219 DOI: 10.1016/j.canrad.2015.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/06/2015] [Accepted: 02/12/2015] [Indexed: 12/24/2022]
Abstract
Head and neck cancers have been widely studied concerning their sensitivity to radiation therapy. Several parameters affect tumour response to radiation therapy. Some parameters are linked to the tumour. Large or invasive tumours, localization, such as oral cavity or adenopathy, are factors of radioresistance. Others parameters are linked to the patients themselves. Tobacco intoxication during radiotherapy and a low hemoglobin level contribute to radioresistance. More recently, a positive human papilloma virus (HPV) status has been reported to positively affect radiosensitivity. Finally, other parameters are related to tumour biology. Hypoxia, intrinsic radiosensitivity of tumour cells, tumour differentiation and repopulation (provided by Ki-67 index or EGFR level) are components of radiosensitivity. Currently, concurrent chemoradiotherapy is one of the gold standard treatments to overcome clinical outcome of locally advanced head and neck cancer. This combination increases locoregional control and survival. Taxane-based induction chemotherapy can also be an alternative. Another validated approach is the association of radiotherapy with cetuximab (EGFR targeting) but only one randomized study has been published. Fractionation modifications, especially hyperfractionation, have given positive results on both tumour control and survival. Strategies targeting hypoxia improve locoregional control but have less clinical impact.
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Affiliation(s)
- J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France; EA7283 Cancer Resistance Exploring and Targeting (CREAT), Clermont université, université d'Auvergne, 49, boulevard François-Mitterrand, CS 60032, 63001 Clermont-Ferrand cedex 1, France; Équipe recombinaison, réparation et cancer, UMR 3347, CNRS, centre universitaire, 91405 Orsay cedex, France; Inserm U1021, centre universitaire, 91405 Orsay cedex, France; Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| | - E Chautard
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France; EA7283 Cancer Resistance Exploring and Targeting (CREAT), Clermont université, université d'Auvergne, 49, boulevard François-Mitterrand, CS 60032, 63001 Clermont-Ferrand cedex 1, France
| | - J Miroir
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
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Biau J, Miroir J, Loos G, Saroul N, Bonnin N, Berger L, Millardet C, Moreira J, Lapeyre M. Étude prospective de la radiothérapie conformationnelle avec modulation d’intensité par RapidArc® des cancers des fosses nasales et paranasales. Cancer Radiother 2014. [DOI: 10.1016/j.canrad.2014.07.119] [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: 11/27/2022]
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Miroir J, Biau J, Loos G, Saroul N, Berger L, Millardet C, Moreira J, Lapeyre M. Étude prospective de RCMI par RapidArc® des cancers des voies aérodigestives supérieures avec irradiation bilatérale du cou. Cancer Radiother 2014. [DOI: 10.1016/j.canrad.2014.07.122] [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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Lapeyre M, Miroir J, Biau J. Délinéation des adénopathies et aires ganglionnaires pour les cancers de la sphère ORL. Cancer Radiother 2014; 18:572-6. [DOI: 10.1016/j.canrad.2014.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/07/2014] [Indexed: 10/24/2022]
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Lapeyre M, Biau J, Miroir J, Servagi-Vernat S, Giraud P. Radiothérapie conformationnelle avec modulation d’intensité des cancers des voies aérodigestives supérieures : enjeux éthiques et méthodologiques. Cancer Radiother 2014; 18:365-8. [DOI: 10.1016/j.canrad.2014.06.005] [Citation(s) in RCA: 5] [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] [Received: 05/25/2014] [Revised: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 11/29/2022]
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Miroir J, Biau J, Moreira J, Chassin V, Nicolas S, Marc R, Michel L. Adénopathie cervicale en territoire irradié : comparaison dosimétrique entre curiethérapie périopératoire et RCMI postopératoire. Cancer Radiother 2013. [DOI: 10.1016/j.canrad.2013.07.094] [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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Loos G, Moreau J, Miroir J, Benhaïm C, Biau J, Caillé C, Bellière A, Lapeyre M. [Image-guided radiotherapy and partial delegation to radiotherapy technicians: Clermont-Ferrand experience]. Cancer Radiother 2013; 17:389-92. [PMID: 24011600 DOI: 10.1016/j.canrad.2013.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 05/15/2013] [Revised: 06/10/2013] [Accepted: 06/19/2013] [Indexed: 11/30/2022]
Abstract
The various image-guided radiotherapy techniques raise the question of how to achieve the control of patient positioning before irradiation session and sharing of tasks between radiation oncologists and radiotherapy technicians. We have put in place procedures and operating methods to make a partial delegation of tasks to radiotherapy technicians and secure the process in three situations: control by orthogonal kV imaging (kV-kV) of bony landmarks, control by kV-kV imaging of intraprostatic fiducial goldmarkers and control by cone beam CT (CBCT) imaging for prostate cancer. Significant medical overtime is required to control these three IGRT techniques. Because of their competence in imaging, these daily controls can be delegated to radiotherapy technicians. However, to secure the process, initial training and regular evaluation are essential. The analysis of the comparison of the use of kV/kV on bone structures allowed us to achieve a partial delegation of control to radiotherapy technicians. Controlling the positioning of the prostate through the use and automatic registration of fiducial goldmarkers allows better tracking of the prostate and can be easily delegated to radiotherapy technicians. The analysis of the use of daily cone beam CT for patients treated with intensity modulated irradiation is underway, and a comparison of practices between radiotherapy technicians and radiation oncologists is ongoing to know if a partial delegation of this control is possible.
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Affiliation(s)
- G Loos
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 1, France.
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Miroir J, Toledano I, Montalban A, Mom T, Russier M, Lapeyre M. Curiethérapie périopératoire des adénopathies cervicales en territoire irradié avec primitif contrôlé. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.07.099] [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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