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Perrier L, Balusson F, Morelle M, Castelli J, Thariat J, Benezery K, Hasbini A, Gery B, Berger A, Liem X, Guihard S, Chapet S, Thureau S, Auberdiac P, Pommier P, Ruffier A, Devillers A, Oger E, Campillo-Gimenez B, de Crevoisier R. Cost-effectiveness of weekly adaptive radiotherapy versus standard IMRT in head and neck cancer alongside the ARTIX trial. Radiother Oncol 2024; 193:110116. [PMID: 38316193 DOI: 10.1016/j.radonc.2024.110116] [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: 09/15/2023] [Revised: 01/21/2024] [Accepted: 01/28/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND AND PURPOSE We performed a cost-effectiveness analysis (CEA) comparing an adaptive radiotherapy (ART) strategy, based on weekly replanning, aiming to correct the parotid gland overdose during treatment and expecting therefore to decrease xerostomia, when compared to a standard IMRT. MATERIALS AND METHODS We conducted the ARTIX trial, a randomized, parallel-group, multicentric study comparing a systematic weekly replanning ART to a standard IMRT. The primary endpoint was the frequency of xerostomia at 12 months, measured by stimulating salivary flow with paraffin. The CEA was designed alongside the ARTIX trial which was linked to the French national health data system (SNDS). For each patient, healthcare consumptions and costs were provided by the SNDS. The reference case analysis was based on the primary endpoint of the trial. Sensitivity and scenario analyses were performed. RESULTS Of the 129 patients randomly assigned between 2013 and 2018, only 2 records were not linked to the SNDS, which provides a linkage proportion of 98.4%. All of the other 127 records were linked with good to very good robustness. On the intent-to-treat population at 12 months, mean total costs per patient were €41,564 (SD 23,624) and €33,063 (SD 16,886) for ART and standard IMRT arms, respectively (p = 0.033). Incremental cost effectiveness ratio (ICER) was €162,444 per xerostomia avoided. At 24 months, ICER was €194,521 per xerostomia avoided. For both progression-free and overall survival, ART was dominated by standard IMRT. CONCLUSION The ART strategy was deemed to be not cost-effective compared with standard IMRT for patients with locally advanced oropharyngeal cancer.
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Affiliation(s)
- Lionel Perrier
- Univ Lyon, Leon Berard Cancer Center, GATE UMR 5824, 28 Prom. Léa et Napoléon Bullukian F-69008, Lyon, France; Human and Social Science Department, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian F-69008, Lyon, France.
| | - Frédéric Balusson
- Pharmacovigilance and Pharmacoepidemiology, CHU Rennes, Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Magali Morelle
- Univ Lyon, Leon Berard Cancer Center, GATE UMR 5824, 28 Prom. Léa et Napoléon Bullukian F-69008, Lyon, France
| | - Joël Castelli
- Department of Radiotherapy, Centre Eugene Marquis, Avenue Bataille Flandres Dunkerques F35000, Rennes, France
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, Laboratoire de Physique Corpusculaire, IN2P3/ENISAEN-CNRS, Normandie Université, Caen, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Avenue de Valombrose F06000, Nice, France
| | - Ali Hasbini
- Radiotherapy, Clinique Pasteur-Lanroze, 32 Rue Auguste Kervern F29200, Brest, France
| | - Bernard Gery
- Department of Radiation Oncology, Centre François Baclesse, Laboratoire de Physique Corpusculaire, IN2P3/ENISAEN-CNRS, Normandie Université, Caen, France
| | - Antoine Berger
- Department of Radiotherapy, CHU Poitiers, 2 Rue de la Milétrie F86000, Poitiers, France
| | - Xavier Liem
- Academic Department of Radiation Oncology and Brachytherapy, Oscar Lambret Center, Lille, France
| | - Sébastien Guihard
- Department of Radiotherapy, ICANS, 17 rue Albert Calmette F67033, Strasbourg, France
| | - Sophie Chapet
- Department of Radiotherapy, Centre Jean-Bernard, institut inter-régional de cancérologie (ILC), CCS, 64, rue de Degré F-72000, Le Mans, France
| | - Sébastien Thureau
- Department of Radiotherapy, Centre Henri Becquerel, 1 Rue d'Amiens F76038, Rouen, France; Quantif LITIS EA 4108, University of Rouen, 22, Boulevard Gambetta F-76183, Rouen Cedex 1, France
| | - Pierre Auberdiac
- Radiotherapy, Clinique Claude Bernard, 1 rue du Père Colombier F81000, Albi, France
| | - Pascal Pommier
- Department of Radiotherapy, ICO-Angers, 15, rue André Boquel 49055, Angers cedex 02, France
| | - Amandine Ruffier
- Department of Radiotherapy, Centre Jean-Bernard, institut inter-régional de cancérologie (ILC), CCS, 64, rue de Degré F-72000, Le Mans, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre Eugene Marquis, Avenue Bataille Flandres Dunkerques F35000, Rennes, France
| | - Emmanuel Oger
- Pharmacovigilance and Pharmacoepidemiology, CHU Rennes, Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Boris Campillo-Gimenez
- Department of Clinical Research, Centre Eugene Marquis, Avenue Bataille Flandres Dunkerques F35000, Rennes, France; Inserm, LTSI-UMR 1099, University of Rennes, F-35000, Rennes, France
| | - Renaud de Crevoisier
- Department of Radiotherapy, Centre Eugene Marquis, Avenue Bataille Flandres Dunkerques F35000, Rennes, France
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Bailleux C, Zwarthoed C, Evesque L, Baron D, Scouarnec C, Benezery K, Chardin D, Jaraudias C, Chateau Y, Gal J, François E. Prognostic impact of post-treatment FDG PET/CT in anal canal cancer: A prospective study. Radiother Oncol 2023; 188:109905. [PMID: 37678620 DOI: 10.1016/j.radonc.2023.109905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/12/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND AND PURPOSE The aim of our prospective study was to assess the prognostic value of 18F-FDG PET/CT performed two months post treatment for anal canal neoplasm. POPULATION AND METHODS Consecutive patients with histologically proved anal cancer, with 18F-FDG PET/CT pre and two months post treatment were included. Patients were not previously treated for this neoplasm and then received radiotherapy ± chemotherapy. Clinical and pathologic data were collected and for 18F-FDG PET/CT visual and quantitative analysis (standardized uptake value, metabolic volume) were performed; response was classified according to EORTC and PERCIST criteria. The results were assessed for disease free survival and local recurrence free survival using the log-Rank test RESULTS: From December 2014 to September 2019, 94 consecutive patients were screened and 78 were included in this study. Median follow-up was 51 months. Two months post treatment, 37 patients (47.4%) had a complete radiological response according to both EORTC and PERCIST criteria, 66 patients (84.6%) had a clinical complete response. For disease free survival, the prognostic value of complete response was statistically significant (p=0.02) with 18F-FDG PET/CT and with clinical examination (p<0.001). For local recurrence free survival, the prognostic value with 18F-FDG PET/CT was lower (p=0.04) than clinical examination (p < 0.007). CONCLUSION While clinical examination remains the gold standard for post treatment evaluation in anal cancer, 18F-FDG PET/CT has a statistically significant prognostic value. These two assessments could be combined to improve early evaluation.
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Affiliation(s)
- Caroline Bailleux
- Centre Antoine Lacassagne, Department of Medical Oncology, 33 avenue de Valombrose 06189 Nice, France
| | - Colette Zwarthoed
- Centre Antoine Lacassagne, Department of Nuclear Medicine, 33 avenue de Valombrose 06189 Nice, France
| | - Ludovic Evesque
- Centre Antoine Lacassagne, Department of Medical Oncology, 33 avenue de Valombrose 06189 Nice, France
| | - David Baron
- Centre Antoine Lacassagne, Department of Radiation Oncology, 33 avenue de Valombrose 06189 Nice, France
| | - Cyrielle Scouarnec
- Centre Antoine Lacassagne, Department of Radiation Oncology, 33 avenue de Valombrose 06189 Nice, France
| | - Karen Benezery
- Centre Antoine Lacassagne, Department of Radiation Oncology, 33 avenue de Valombrose 06189 Nice, France
| | - David Chardin
- Centre Antoine Lacassagne, Department of Nuclear Medicine, 33 avenue de Valombrose 06189 Nice, France
| | - Claire Jaraudias
- Centre Antoine Lacassagne, Department of Medical Oncology, 33 avenue de Valombrose 06189 Nice, France
| | - Yann Chateau
- Centre Antoine Lacassagne, Department of Medical Statistic, 33 avenue de Valombrose 06189 Nice, France
| | - Jocelyn Gal
- Centre Antoine Lacassagne, Department of Medical Statistic, 33 avenue de Valombrose 06189 Nice, France
| | - Eric François
- Centre Antoine Lacassagne, Department of Medical Oncology, 33 avenue de Valombrose 06189 Nice, France.
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Castelli J, Thariat J, Benezery K, Hasbini A, Gery B, Berger A, Liem X, Guihard S, Chapet S, Thureau S, Auberdiac P, Pommier P, Ruffier A, Perrier L, Devillers A, Campillo-Gimenez B, de Crevoisier R. Weekly Adaptive Radiotherapy vs Standard Intensity-Modulated Radiotherapy for Improving Salivary Function in Patients With Head and Neck Cancer: A Phase 3 Randomized Clinical Trial. JAMA Oncol 2023; 9:1056-1064. [PMID: 37261806 PMCID: PMC10236337 DOI: 10.1001/jamaoncol.2023.1352] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 09/24/2022] [Accepted: 03/08/2023] [Indexed: 06/02/2023]
Abstract
Importance Xerostomia is a major toxic effect associated with intensity-modulated radiotherapy (IMRT) for oropharyngeal cancers. Objective To assess whether adaptive radiotherapy (ART) improves salivary function compared with IMRT in patients with head and neck cancer. Design, Setting, and Participants This phase 3 randomized clinical trial was conducted in 11 French centers. Patients aged 18 to 75 years with stage III-IVB squamous cell oropharyngeal cancer treated with chemoradiotherapy were enrolled between July 5, 2013, and October 1, 2018. Data were analyzed from November 2021 to May 2022. Interventions The patients were randomly assigned (1:1) to receive standard IMRT (without replanning) or ART (systematic weekly replanning). Main Outcomes and Measures The primary end point was the frequency of xerostomia, measured by stimulating salivary flow with paraffin. Secondary end points included salivary gland excretory function measured using technetium-99m pertechnetate scintigraphy, patient-reported outcomes (Eisbruch xerostomia-specific questionnaire and the MD Anderson Symptom Inventory for Head and Neck Cancer questionnaire), early and late toxic effects, disease control, and overall and cancer-specific survival. Results A total of 132 patients were randomized, and after 1 exclusion in the ART arm, 131 were analyzed: 66 in the ART arm (mean [SD] age at inclusion, 60 [8] years; 57 [86.4%] male) and 65 in the standard IMRT arm (mean [SD] age at inclusion, 60 [8] years; 57 [87.7%] male). The median follow-up was 26.4 months (IQR, 1.2-31.3 months). The mean (SD) salivary flow (paraffin) at 12 months was 630 (450) mg/min in the ART arm and 584 (464) mg/min in the standard arm (P = .64). The mean (SD) excretory function of the parotid gland at 12 months, measured by scintigraphy, improved in the ART arm (48% [17%]) compared with the standard arm (41% [17%]) (P = .02). The 2-year-overall survival was 76.9% (95% CI, 64.7%-85.4%) in both arms. Conclusions and Relevance This randomized clinical trial did not demonstrate a benefit of ART in decreasing xerostomia compared with standard IMRT. No significant differences were found in secondary end points except for parotid gland excretory function, as assessed by scintigraphy, or in survival rates. Trial Registration ClinicalTrials.gov Identifier: NCT01874587.
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Affiliation(s)
- Joël Castelli
- University of Rennes, CLCC Eugène Marquis, Inserm, LTSI–UMR 1099, Rennes, France
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, Laboratoire de Physique Corpusculaire, Normandie Universite, Caen, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
| | - Ali Hasbini
- Radiotherapy, Clinique Pasteur-Lanroze, Brest, France
| | - Bernard Gery
- Department of Radiation Oncology, Centre François Baclesse, Laboratoire de Physique Corpusculaire, Normandie Universite, Caen, France
| | - Antoine Berger
- Department of Radiotherapy, CHU Poitiers, Poitiers, France
| | - Xavier Liem
- Academic Department of Radiation Oncology and Brachytherapy, Oscar Lambret Center, Lille, France
| | - Sébastien Guihard
- Department of Radiotherapy, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Sophie Chapet
- Department of Radiotherapy, CHU Tours, Tours, France
| | | | | | - Pascal Pommier
- Department of Radiotherapy, Centre Léon Bérard, Lyon, France
| | | | - Lionel Perrier
- University Lyon, Léon Bérard Cancer Centre, Lyon, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
| | | | - Renaud de Crevoisier
- University of Rennes, CLCC Eugène Marquis, Inserm, LTSI–UMR 1099, Rennes, France
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Culié D, Schiappa R, Pace-Loscos T, Guelfucci B, Vergez S, Garrel R, Fakhry N, Dassonville O, Poissonnet G, Lallemant B, Sudaka A, Saada-Bouzid E, Benezery K, Temam S, Gorphe P, Chamorey E, Bozec A. Enteral Nutrition during Radiotherapy for Oropharyngeal Cancers: Prevalence and Prognostic Factors Based on HPV Status (A GETTEC Study). J Clin Med 2023; 12:jcm12093169. [PMID: 37176609 PMCID: PMC10179627 DOI: 10.3390/jcm12093169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Nutritional support during radiotherapy is crucial to tolerating and completing oropharyngeal squamous cell carcinoma (OPSCC) treatment. The impact of HPV status on nutritional support is debated. The objective was to evaluate the rate of Reactive Feeding Tube (RFT) use and determine its prognostic factors during definitive radiotherapy for OPSCC. All OPSCC patients treated from 2009 to 2014 were included in this multicentric retrospective study. The impact of tumor p16 status on the risk of RFT was assessed through multivariate analyses. Among the 543 patients, 103 patients required an RFT (19.0%). The use of RFT differed between centers (5% to 32.4%). In multivariate analysis, only tongue base involvement and concurrent chemotherapy were significantly associated with RFT (OR = 2.18 and 3.7, respectively). Tongue base involvement and concomitant chemotherapy were prognostic factors for RFT. HPV status was not a prognostic factor for enteral nutrition during radiotherapy for OPSCC.
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Affiliation(s)
- Dorian Culié
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Renaud Schiappa
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Tanguy Pace-Loscos
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, 83100 Toulon, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, 31100 Toulouse, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, 34295 Montpellier, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance-Hospitals of Marseille, 13005 Marseille, France
| | - Olivier Dassonville
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
| | - Gilles Poissonnet
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, 30900 Nîmes, France
| | - Anne Sudaka
- Antoine Lacassagne Centre, Department of Pathology, Côte d'Azur University, 06000 Nice, France
| | - Esma Saada-Bouzid
- Antoine Lacassagne Centre, Department of Medical Oncology, Côte d'Azur University, 06000 Nice, France
| | - Karen Benezery
- Antoine Lacassagne Centre, Department of Radiotherapy, Côte d'Azur University, 06000 Nice, France
| | - Stephane Temam
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, 94805 Villejuif, France
| | - Phillipe Gorphe
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, 94805 Villejuif, France
| | - Emmanuel Chamorey
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Alexandre Bozec
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
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Jaraudias C, Saint LMA, Schiappa R, Baron D, Marie L, Benezery K, Scouarnec C, François É, Evesque L. Failure of Initial Curative Treatment for Non-Metastatic Anal Squamous Cell Carcinoma: From Prognostic Factors Analysis to Stratified Treatment. Clin Colorectal Cancer 2022; 21:362-370. [PMID: 35934635 DOI: 10.1016/j.clcc.2022.07.001] [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: 10/24/2021] [Revised: 03/14/2022] [Accepted: 07/03/2022] [Indexed: 01/26/2023]
Abstract
In squamous cell anal canal neoplasms, persistent disease or recurrence after initial chemoradiotherapy are not the rule, yet their occurrence deserves to be analyzed to better identify prognostics factors. The aim of our study was to describe the patterns of failures of the initial treatment, their subsequent evolution and to identify prognostic factors in these relapsed patients. All patients with non-metastatic anal squamous cell carcinoma initially treated with curative intent at the Centre Antoine Lacassagne between 1999 and 2019, and who presented persistent disease or recurrence were analyzed. The median follow-up was 44 months. Univariate and multivariate analyses were performed to identify prognostic factors. From our database of 528 patients, 77 patients were eligible: 25 with persistent disease and 52 with recurrence after complete response. The median overall survival was 39 months (95% CI: 25.5-52.3 months) from the date of treatment failure. In univariate analysis, prognostic factors were gender, initial lymph node status, type of failure, response to treatment's failure. In multivariate analysis, only female gender remained statistically significant (HR 0.43- P=0.016). 32% of patients with persistent disease had metastatic status. 17.3% and 5.8% of recurrences respectively occurred after three and five years of follow-up. Systematic imaging could be performed after initial treatment because of distant lesions in one third of patients with persistent disease. The follow-up should not be interrupted before five years, given the significant frequency of late recurrences. In multivariate analysis, only female gender was statistically significant. Stratified treatment based on prognostic factors could be envisaged, the details of which remain to be defined.
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Affiliation(s)
- Claire Jaraudias
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue Valombrose 06100 Nice, France.
| | | | - Renaud Schiappa
- Department of Epidemiology, Biostatistics and Health Data, Centre Antoine Lacassagne, 33 Avenue Valombrose 06100 Nice, France
| | - David Baron
- Department of Radiotherapy, Centre Antoine Lacassagne, 33 Avenue Valombrose 06100 Nice, France
| | - Léa Marie
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue Valombrose 06100 Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, 33 Avenue Valombrose 06100 Nice, France
| | - Cyrielle Scouarnec
- Department of Radiotherapy, Centre Antoine Lacassagne, 33 Avenue Valombrose 06100 Nice, France
| | - Éric François
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue Valombrose 06100 Nice, France
| | - Ludovic Evesque
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue Valombrose 06100 Nice, France
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Li G, Xia YF, Huang YX, Okat D, Qiu B, Doyen J, Bondiau PY, Benezery K, Gao J, Qian CN. Better preservation of erectile function in localized prostate cancer patients with modern proton therapy: Is it cost-effective? Prostate 2022; 82:1438-1446. [PMID: 35915875 DOI: 10.1002/pros.24417] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/18/2022] [Accepted: 07/11/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) has gradually been recognized as favorable curative treatment for localized prostate cancer (PC). However, the high rate of erectile dysfunction (ED) after traditional photon-based SBRT remains an ongoing challenge that greatly impacts the quality of life of PC survivors. Modern proton therapy allows higher conformal SBRT delivery and has the potential to reduce ED occurrence but its cost-effectiveness remains uninvestigated. METHODS A Markov decision model was designed to evaluate the cost-effectiveness of proton SBRT versus photon SBRT in reducing irradiation-related ED. Base-case evaluation was performed on a 66-year-old (median age of PC) localized PC patient with normal pretreatment erectile function. Further, stratified analyses were performed for different age groups (50, 55, 60, 65, 70, and 75 years) and threshold analyses were conducted to estimate cost-effective scenarios. A Chinese societal willingness-to-pay (WTP) threshold (37,653 US dollars [$])/quality-adjusted life-year [QALY]) was adopted. RESULTS For the base case, protons provided an additional 0.152 QALY at an additional cost of $7233.4, and the incremental cost-effectiveness ratio was $47,456.5/QALY. Protons was cost-effective for patients ≤62-year-old at the WTP of China (≤66-year-old at a WTP of $50,000/QALY; ≤73-year-old at a WTP of $100,000/QALY). For patients at median age, once the current proton cost ($18,000) was reduced to ≤$16,505.7 or the patient had a life expectancy ≥88 years, protons were cost-effective at the WTP of China. CONCLUSIONS Upon assumption-based modeling, the results of current study support the use of proton SBRT in younger localized PC patients who are previously potent, for better preservation of erectile function. The findings await further validation using data from future comparative clinical trials.
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Affiliation(s)
- Guo Li
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Radiation Oncology, Guangzhou Concord Cancer Center, Guangzhou, Guangdong, China
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yi-Xiang Huang
- Department of Health Management, Public Health Institute of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Deniz Okat
- Department of Finance, Hong Kong University of Science and Technology, Kowloon, Hong Kong, China
| | - Bo Qiu
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jerome Doyen
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
- Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Pierre-Yves Bondiau
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
- Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Karen Benezery
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
- Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Jin Gao
- Division of Life Sciences and Medicine, Department of Radiation Oncology, The First Affiliated Hospital of University of Science and Technology of China, University of Science and Technology of China, Hefei, Anhui, China
| | - Chao-Nan Qian
- Department of Radiation Oncology, Guangzhou Concord Cancer Center, Guangzhou, Guangdong, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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Li G, Xia YF, Huang YX, Okat D, Qiu B, Doyen J, Bondiau PY, Benezery K, Gao J, Qian CN. Cost-effectiveness of using protons for breast irradiation aiming at minimizing cardiotoxicity: A risk-stratification analysis. Front Med (Lausanne) 2022; 9:938927. [PMID: 36091675 PMCID: PMC9452743 DOI: 10.3389/fmed.2022.938927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background Incidental exposure of the heart to ionizing irradiation is associated with an increased risk of ischemic heart disease and subsequent fatality in patients with breast cancer after radiotherapy. Proton beam therapy can limit the heart dose in breast irradiation to a negligible level. However, compared with conventional photon modality, proton breast irradiation is more expensive. In this study, we performed cost-effectiveness analyses to identify the type of patients who would be more suitable for protons. Methods A Markov decision model was designed to evaluate the cost-effectiveness of protons vs. photons in reducing the risk of irradiation-related ischemic heart disease. A baseline evaluation was performed on a 50-year-old woman patient without the preexisting cardiac risk factor. Furthermore, risk-stratification analyses for photon mean heart dose and preexisting cardiac risk were conducted on 40-, 50-, and 60-year-old women patients under different proton cost and willingness-to-pay (WTP) settings. Results Using the baseline settings, the incremental effectiveness (protons vs. photons) increased from 0.043 quality-adjusted life-year (QALY) to 0.964 QALY when preexisting cardiac risk increased to 10 times its baseline level. At a proton cost of 50,000 US dollars ($), protons could be cost-effective for ≤ 60-year-old patients with diabetes and ≤50-year-old patients with grade II–III hypertension at the WTP of China ($37,653/QALY); for ≤ 60-year-old patients with diabetes and ≤ 50-year-old patients with grade II–III hypertension or ≥ 2 major cardiac risk factors at a WTP of $50,000/QALY; and for ≤ 60-year-old patients with diabetes, grade II–III hypertension or ≥ 2 major cardiac risk factors and ≤ 50-year-old patients with total cholesterol ≥ 240 mg/dL at a WTP of $100,000/QALY. Conclusion Patients' preexisting cardiac risk status was a key factor affecting the cardiac benefits gained from protons and should therefore be a major consideration for the clinical decision of using protons; cost-effective scenarios of protons exist in those patients with high risk of developing cardiac diseases.
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Affiliation(s)
- Guo Li
- Department of Radiation Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
- Department of Radiation Oncology, Guangzhou Concord Cancer Center, Guangzhou, China
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yi-Xiang Huang
- Department of Health Management, Public Health Institute of Sun Yat-sen University, Guangzhou, China
| | - Deniz Okat
- Department of Finance, Hong Kong University of Science and Technology, Kowloon, Hong Kong SAR, China
| | - Bo Qiu
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jerome Doyen
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
- Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Pierre-Yves Bondiau
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
- Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Karen Benezery
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
- Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Jin Gao
- Division of Life Sciences and Medicine, Department of Radiation Oncology, The First Affiliated Hospital of University of Science and Technology of China, University of Science and Technology of China, Hefei, China
| | - Chao-Nan Qian
- Department of Radiation Oncology, Guangzhou Concord Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- *Correspondence: Chao-Nan Qian ;
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8
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Castelli J, Benezery K, Hasbini A, Gery B, Berger A, Liem X, Guihard S, Chapet S, Thureau S, Auberdiac P, Pommier P, Thariat J, Campillo B, de Crevoisier R. OC-0831 Results of ARTIX phase III study: adaptive radiotherapy versus standard IMRT in head and neck cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02695-0] [Citation(s) in RCA: 1] [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: 11/28/2022]
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9
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Debbi K, Loganadane G, To NH, Kinj R, Husain ZA, Chapet S, Nguyen NP, Barillot I, Benezery K, Belkacemi Y, Calais G. Curative intent Stereotactic Ablative Radiation Therapy (SABR) for treatment of lung oligometastases from head and neck squamous cell carcinoma (HNSCC): a multi-institutional retrospective study. Br J Radiol 2022; 95:20210033. [PMID: 35143326 PMCID: PMC10993965 DOI: 10.1259/bjr.20210033] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The aim of this retrospective study was to assess outcomes of SABR for metachronous isolated lung oligometastases from HNSCC. METHODS For patients who developed isolated, 1 or 2 lungs lesions (<5cm) consistent with metastases from HNSCC, the indication of SABR was validated in a multidisciplinary tumor board. All patients were monitored by CT or PET CT after SABR (Stereotactic Ablative Body Radiation) for HNSCC. RESULTS Between November 2007 and February 2018, 52 patients were treated with SABR for metachronous lung metastases. The median time from the treatment of the primary HNSCC to the development of lung metastases was 18 months (3-93). The cohort's median age was 65.5 years old (50-83). The vast majority (94.2%) received 60 Gy in three fractions. Forty-one patients (78.5%) presented a solitary lung metastasis, while 11 patients (21.5%) had two lung metastases. With a median follow-up of 45.3 months, crude local and metastatic control rates were 74 and 38%, respectively. 1 year and 2 year Overall Survival (OS) were 85.8 and 65.9%, respectively. The median OS was 46.8 months. About one-fourth of patients were retreated by SABR for distant pulmonary recurrence. The treatment was well tolerated with only one patient who reported ≥ grade 3 toxicity (1.9%). CONCLUSION In selected metastatic HNSCC patients, early detection and treatment of lung metastases with SABR is effective and safe. Prospective studies are required to validate this potential shift. ADVANCES IN KNOWLEDGE Patients with oligometastases and controlled primary HNSCC seem to benefit from metastasis directed therapies.
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Affiliation(s)
- Kamel Debbi
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
- University François-Rabelais,
Tours, France
- Radiation Oncology Department, Henri Mondor University
Hospital, APHP, UPEC,
Créteil, France
| | | | - Nhu Hanh To
- Radiation Oncology Department, Henri Mondor University
Hospital, APHP, UPEC,
Créteil, France
| | - Remy Kinj
- Department of Radiation Oncology, Centre
Antoine-Lacassagne, Nice,
France
| | - Zain A Husain
- Department of Radiation Oncology, Odette Cancer Center,
Sunnybrook Health Sciences Centre, Toronto,
Ontario, Canada
| | - Sophie Chapet
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
| | - Nam P Nguyen
- Department of Radiation Oncology, Howard
University, Washington, DC,
USA
| | - Isabelle Barillot
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
- University François-Rabelais,
Tours, France
| | - Karen Benezery
- Department of Radiation Oncology, Centre
Antoine-Lacassagne, Nice,
France
| | - Yazid Belkacemi
- Radiation Oncology Department, Henri Mondor University
Hospital, APHP, UPEC,
Créteil, France
| | - Gilles Calais
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
- University François-Rabelais,
Tours, France
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10
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Li G, Xia YF, Huang YX, Okat D, Qiu B, Doyen J, Bondiau PY, Benezery K, Gao J, Qian CN. Intensity-modulated proton radiation therapy as a radical treatment modality for nasopharyngeal carcinoma in China: A cost-effectiveness analysis. Head Neck 2021; 44:431-442. [PMID: 34837286 DOI: 10.1002/hed.26941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/11/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Compared to conventional intensity-modulated photon radiation therapy (IMRT), intensity-modulated proton radiation therapy (IMPT) has potential to reduce irradiation-induced late toxicities while maintaining excellent tumor control in patients with nasopharyngeal carcinoma (NPC). However, the relevant cost-effectiveness remains controversial. METHODS A Markov decision tree analysis was performed under the assumption that IMPT offered normal tissue complication probability reduction (NTCP reduction) in long-term dysphagia, xerostomia, and hearing loss, compared to IMRT. Base-case evaluation was performed on T2N2M0 NPC of median age (43 years old). A Chinese societal willingness-to-pay threshold (33558 US dollars [$])/quality-adjusted life-year [QALY]) was adopted. RESULTS For patients at median age and having NTCP reduction of 10%, 20%, 30%, 40%, 50%, and 60%, their incremental cost-effectiveness ratios were $102684.0/QALY, $43161.2/QALY, $24134.7/QALY, $13991.6/QALY, $8259.8/QALY, and $4436.1/QALY, respectively; IMPT should provide an NTCP reduction of ≥24% to be considered cost-effective. CONCLUSIONS IMPT has potential to be cost-effective for average Chinese NPC patients and should be validated clinically.
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Affiliation(s)
- Guo Li
- Department of Radiation Oncology, Guangzhou Concord Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yi-Xiang Huang
- Department of Health Management, Public Health Institute of Sun Yat-sen University, Guangzhou, China
| | - Deniz Okat
- Department of Finance, Hong Kong University of Science and Technology, Hong Kong, China
| | - Bo Qiu
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jerome Doyen
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Pierre-Yves Bondiau
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Karen Benezery
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Jin Gao
- Division of Life Sciences and Medicine, Department of Radiation Oncology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Chao-Nan Qian
- Department of Radiation Oncology, Guangzhou Concord Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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11
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Crehange G, M'vondo C, Bertaut A, Pereira R, Rio E, Peiffert D, Gnep K, Benezery K, Ronchin P, Noel G, Mineur L, Drouillard A, Blanc J, Rouffiac M, Boustani J. Exclusive Chemoradiotherapy With or Without Radiation Dose Escalation in Esophageal Cancer: Multicenter Phase 2/3 Randomized Trial CONCORDE (PRODIGE-26). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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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12
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Milliet F, Bozec A, Schiappa R, Viotti J, Modesto A, Dassonville O, Poissonnet G, Guelfucci B, Bizeau A, Vergez S, Dupret-Bories A, Garrel R, Fakhry N, Santini L, Lallemant B, Chambon G, Sudaka A, Peyrade F, Saada-Bouzid E, Benezery K, Jourdan-Soulier F, Chapel F, Sophie Ramay A, Roger P, Galissier T, Coste V, Ben Lakdar A, Guerlain J, Temam S, Mirghani H, Gorphe P, Chamorey E, Culié D. Metachronous second primary neoplasia in oropharyngeal cancer patients: Impact of tumor HPV status. A GETTEC multicentric study. Oral Oncol 2021; 122:105503. [PMID: 34500315 DOI: 10.1016/j.oraloncology.2021.105503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/02/2021] [Accepted: 08/18/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Patients with oropharyngeal squamous cell carcinoma (OPSCC) display a significant risk to develop a metachronous second primary neoplasia (MSPN). HPV and non-HPV-related OPSCC are 2 distinct entities with biological, clinical and prognostic differences. The aims of our study were to analyze the impact of tumor HPV status and other relevant clinical factors, such as tobacco and/or alcohol (T/A) consumption, on the risk and distribution of MSPN in OPSCC patients and to assess the impact of MSPN on patient survival. MATERIAL AND METHODS All OPSCC patients treated from 2009 to 2014 were included in this multicentric retrospective study. P16 immunohistochemical expression was used as a surrogate maker of tumor HPV status. The impact of tumor p16 status on the risk of MSPN was assessed in uni- and multivariate analyses. Overall survival (OS) was determined by Kaplan-Meier analysis. RESULTS Among the 1291 patients included in this study, 138 (10.7%) displayed a MSPN which was preferentially located in the head and neck area (H&N), lung and esophagus. Multivariate analyses showed that p16- tumor status (p = 0.003), T/A consumption (p = 0.005) and soft palate tumor site (p = 0.009) were significantly associated with a higher risk of MSPN. We found no impact of p16 tumor status on the median time between index OPSCC diagnosis and MSPN development, but a higher proportion of MSPN arising outside the H&N, lung and esophagus was found in p16 + than in p16- patients. MSPN development had an unfavorable impact (p = 0.04) on OS only in the p16 + patient group. CONCLUSION P16 tumor status and T/A consumption were the main predictive factors of MSPN in OPSCC patients. This study provides crucial results with a view to tailoring global management and follow-up of OPSCC patients.
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Affiliation(s)
- Florent Milliet
- Department of Otorhinolaryngology, University Hospital of Nice, France
| | - Alexandre Bozec
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Julien Viotti
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Anouchka Modesto
- Department of Radiotherapy, Cancer University Institute of Toulouse, Toulouse, France
| | - Olivier Dassonville
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Gilles Poissonnet
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Alain Bizeau
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Agnes Dupret-Bories
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Laure Santini
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Guillaume Chambon
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Anne Sudaka
- Department of Pathology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Frederic Peyrade
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | | | | | - Anne Sophie Ramay
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Pascal Roger
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Thibault Galissier
- Department of Pathology, Cancer University Institute of Toulouse, Toulouse, France
| | - Valérie Coste
- Department of Pathology, University Hospital of Montpellier, Montpellier, France
| | - Aicha Ben Lakdar
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | - Joanne Guerlain
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Stephane Temam
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Haitham Mirghani
- Otolaryngology and Head and Neck Surgery Department, European Hospital Georges Pompidou, APHP, Paris, France
| | - Phillipe Gorphe
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Emmanuel Chamorey
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Dorian Culié
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France.
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13
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Li G, Xia YF, Huang YX, Okat D, Qiu B, Doyen J, Bondiau PY, Benezery K, Gao J, Qian CN. Optimizing oropharyngeal cancer management by using proton beam therapy: trends of cost-effectiveness. BMC Cancer 2021; 21:944. [PMID: 34419008 PMCID: PMC8380358 DOI: 10.1186/s12885-021-08638-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 07/28/2021] [Indexed: 02/01/2023] Open
Abstract
Background Proton beam therapy (PBT) is a new-emerging cancer treatment in China but its treatment costs are high and not yet covered by Chinese public medical insurance. The advanced form of PBT, intensity-modulated proton radiation therapy (IMPT), has been confirmed to reduce normal tissue complication probability (NTCP) as compared to conventional intensity-modulated photon-radiation therapy (IMRT) in patients with oropharyngeal cancer (OPC). Herein, we evaluated the cost-effectiveness and applicability of IMPT versus IMRT for OPC patients in China, aiming at guiding the proper use of PBT. Methods A 7-state Markov model was designed for analysis. Base-case evaluation was performed on a 56-year-old (median age of OPC in China) patient under the assumption that IMPT could provide a 25% NTCP-reduction in long-term symptomatic dysphagia and xerostomia. Model robustness was examined using probabilistic sensitivity analysis, cohort analysis, and tornado diagram. One-way sensitivity analyses were conducted to identify the cost-effective scenarios. IMPT was considered as cost-effective if the incremental cost-effectiveness ratio (ICER) was below the societal willingness-to-pay (WTP) threshold. Results Compared with IMRT, IMPT provided an extra 0.205 quality-adjusted life-year (QALY) at an additional cost of 34,926.6 US dollars ($), and had an ICER of $170,082.4/ QALY for the base case. At the current WTP of China ($33,558 / QALY) and a current IMPT treatment costs of $50,000, IMPT should provide a minimum NTCP-reduction of 47.5, 50.8, 55.6, 63.3 and 77.2% to be considered cost-effective for patient age levels of 10, 20, 30, 40 and 50-year-old, respectively. For patients at the median age level, reducing the current IMPT costs ($50,000) to a $30,000 level would make the minimum NTCP-reduction threshold for “cost-effective” decrease from 91.4 to 44.6%, at the current WTP of China (from 69.0 to 33.5%, at a WTP of $50,000 / QALY; and from 39.7 to 19.1%, at a WTP of $100,000 / QALY). Conclusions Cost-effective scenarios of PBT exist in Chinese OPC patients at the current WTP of China. Considering a potential upcoming increase in PBT use in China, such cost-effective scenarios may further expand if a decrease of proton treatment costs occurs or an increase of WTP level. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08638-2.
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Affiliation(s)
- Guo Li
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong, 510095, P. R. China
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Yi-Xiang Huang
- Department of Health Management, Public Health Institute of Sun Yat-sen University, Guangzhou, Guangdong, 510000, P. R. China
| | - Deniz Okat
- Department of Finance, Hong Kong University of Science and Technology, Kowloon, Hong Kong, P. R. China
| | - Bo Qiu
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Jerome Doyen
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06189, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06200, Nice, France
| | - Pierre-Yves Bondiau
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06189, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06200, Nice, France
| | - Karen Benezery
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06189, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06200, Nice, France
| | - Jin Gao
- Department of Radiation Oncology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230031, P. R. China
| | - Chao-Nan Qian
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Radiation Oncology, Guangzhou Concord Cancer Center, Guangzhou, Guangdong, 510045, P. R. China.
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14
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Crehange G, M’vondo C, Bertaut A, Pereira R, Rio E, Peiffert D, Gnep K, Benezery K, Ronchin P, Noel G, Mineur L, Drouillard A, Blanc J, Rouffiac M, Boustani J. OC-0336 Dose escalated chemoradiotherapy in esophageal cancer : randomized phase 2/3 CONCORDE trial. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Mirghani H, Even C, Larive A, Fayette J, Benezery K, Clatot F, Geoffrois L, Tao Y, Nguyen F, Fabiano E, Kreps S, Neidhardt EM, Garic F, Auperin A, Blanchard P. Interim analysis of IMMUNEBOOST-HPV: A multicenter, randomized, open label, phase II study evaluating the feasibility, and tolerance of neoadjuvant nivolumab in high-risk HPV driven oropharynx cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6037] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6037 Background: Among HPV-positive Oropharyngeal Cancer (OPC) patients (pts), some has a less favorable prognosis (T4, N2/N3, smokers >10 pack-year [p/y]). We assume that neoadjuvant immunotherapy might improve their oncological outcomes, so we tested nivolumab (N) prior to ChemoRadiaTion (CRT). Methods: The study population is restricted to HPV positive OPC pts (both p16+ & HPV-DNA+) with advanced disease (T4, N2/N3) or a smoking history >10 p/y. Pts were randomly allocated 1:2 to receive either cisplatin-based CRT (n=20) or 2 cycles of N 240 mg followed by CRT (n=41). The Primary Endpoint (PE) is the rate of pts who can receive Full Treatment in Due Time (FTDT), according to these criteria: a) 2 N infusions on day 1 and on day 14-16 b) CRT started between days 28-37 after the 1st N infusion c) No RT break ≥1 week d) RT dose received >95% of theoretical dose e) Cisplatin dose received ≥200 mg/m² To achieve FTDT, all criteria are required in the Experimental Arm (EA) while only criteria c), d), and e) are required in the Control Arm (CA). In the EA, the trial was designed in 2 steps, with FTDT rate of 88% considered as inacceptable versus an alternative of 98%, a type I error of 0.10, and a type 2 error of 0.08. As per protocol, patient accrual was temporarily suspended after inclusion of 19 pts in the EA (1st step) and results were reviewed by an Independent Data Monitoring Committee (IDMC). To resume pts’ inclusion, FTDT had to be achieved in 18 pts in the EA. Results: From 07/2019 to 09/2020, 30 pts were enrolled including 11 in the CA (demographics are summarized in table). 2 pts in the EA did not reach the PE. For the 1st patient, the cisplatin dose was <200 mg/m2 due to grade 1 hearing loss and grade 2 tinnitus (1st cycle: 100 mg/m2, 2nd cycle: 80 mg/m2, no 3rd cycle). For the 2nd patient, CRT began at D38 due to logistical issues (maintenance of RT devices). As this delay was unrelated to N or to patient's condition, the IDMC considered that the inclusions could resume for the 2nd step. 7 N-related Adverse Events (AE) were reported in 4 pts including 3 serious AE (ankylosing spondylitis flare-up, colitis, diabetic ketoacidosis). Conclusions: Neoadjuvant N before CRT seems feasible for the treatment of OPC pts. The trial has reopened to inclusion as recommended by the IDMC. Clinical trial information: NCT03838263. [Table: see text]
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Affiliation(s)
| | | | - Alicia Larive
- Biostatistics and Epidemiology, Gustave-Roussy Cancer Campus, Paris-Saclay and Paris-Sud Universities, Villejuif, France
| | | | | | - Florian Clatot
- INSERM U1245, IRON Group, Centre Henri Becquerel, University Hospital, University of Normandy, Rouen, France
| | | | - Yungan Tao
- Institut Gustave Roussy, Villejuif, France
| | | | | | - Sarah Kreps
- Hôpital Européen Georges Pompidou HEGP, Paris, France
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Carsuzaa F, Lapeyre M, Gregoire V, Maingon P, Beddok A, Marcy PY, Salleron J, Coutte A, Racadot S, Pointreau Y, Graff P, Beadle B, Benezery K, Biau J, Calugaru V, Castelli J, Chua M, Di Rito A, Dore M, Ghadjar P, Huguet F, Jardel P, Johansen J, Kimple R, Krengli M, Laskar S, Mcdowell L, Nichols A, Tribius S, Valduvieco I, Hu C, Liem X, Moya-Plana A, D'onofrio I, Parvathaneni U, Takiar V, Orlandi E, Psyrri A, Shenouda G, Sher D, Steuer C, Shan Sun X, Tao Y, Thomson D, Tsai MH, Vulquin N, Gorphe P, Mehanna H, Yom SS, Bourhis J, Thariat J. Recommendations for postoperative radiotherapy in head & neck squamous cell carcinoma in the presence of flaps: A GORTEC internationally-reviewed HNCIG-endorsed consensus. Radiother Oncol 2021; 160:140-147. [PMID: 33984351 DOI: 10.1016/j.radonc.2021.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Head and neck reconstructive surgery using a flap is increasingly common. Best practices and outcomes for postoperative radiotherapy (poRT) with flaps have not been specified. We aimed to provide consensus recommendations to assist clinical decision-making highlighting areas of uncertainty in the presence of flaps. MATERIAL AND METHODS Radiation, medical, and surgical oncologists were assembled from GORTEC and internationally with the Head and Neck Cancer International Group (HNCIG). The consensus-building approach covered 59 topics across four domains: (1) identification of postoperative tissue changes on imaging for flap delineation, (2) understanding of tumor relapse risks and target volume definitions, (3) functional radiation-induced deterioration, (4) feasibility of flap avoidance. RESULTS Across the 4 domains, international consensus (median score ≥ 7/9) was achieved only for functional deterioration (73.3%); other consensus rates were 55.6% for poRT avoidance of flap structures, 41.2% for flap definition and 11.1% for tumor spread patterns. Radiation-induced flap fibrosis or atrophy and their functional impact was well recognized while flap necrosis was not, suggesting dose-volume adaptation for the former. Flap avoidance was recommended to minimize bone flap osteoradionecrosis but not soft-tissue toxicity. The need for identification (CT planning, fiducials, accurate operative report) and targeting of the junction area at risk between native tissues and flap was well recognized. Experts variably considered flaps as prone to tumor dissemination or not. Discrepancies in rating of 11 items among international reviewing participants are shown. CONCLUSION International GORTEC and HNCIG-endorsed recommendations were generated for the management of flaps in head and neck radiotherapy. Considerable knowledge gaps hinder further consensus, in particular with respect to tumor spread patterns.
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Affiliation(s)
| | - Michel Lapeyre
- Department of Radiation Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | - Vincent Gregoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Philippe Maingon
- Department of Radiation Oncology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Arnaud Beddok
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Pierre-Yves Marcy
- Department of Radiology, Clinique du Cap d'Or, La Seyne-sur-mer, France
| | - Julia Salleron
- Department of Biostatistics, Institut de cancérologie de Lorraine, France
| | - Alexandre Coutte
- Department of Radiation Oncology, Amiens Picardie University Medical Center, Amiens, France
| | - Severine Racadot
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Yoann Pointreau
- Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France
| | - Pierre Graff
- Department or Radiation Oncology, Institut C. Regaud, Toulouse, France
| | - Beth Beadle
- Department of Radiation Oncology, Stanford University Medical Center, Stanford University Medical Center, USA
| | - Karen Benezery
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France
| | - Julian Biau
- Department of Radiation Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | | | - Joel Castelli
- Department of Radiation Oncology, Centre Eugène Marquis, Rennes, France
| | - Melvin Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore
| | - Alessia Di Rito
- Department of Radiation Oncology, OC Radioterapia Ospedale "Mons. A.R. Dimiccoli" di Barletta, Rome, Italy
| | - Melanie Dore
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest, St Herblain, France
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité, Berlin, Germany
| | - Florence Huguet
- Department of Radiation Oncology, Hospital de Tenon, Paris, France
| | - Pauline Jardel
- Department of Radiation Oncology, CHU de la Milétrie, Poitiers, France
| | - Jorgen Johansen
- Department of Radiation Oncology, Odense University Hospital, Denmark
| | - Randall Kimple
- Department of Medical Oncology, University of Wisconsin-Madison, WI, USA
| | - Marco Krengli
- Department of Translational Medicine University of Piemonte Orientale, Novara, Italy
| | | | - Lachlan Mcdowell
- Department of Radiation Oncology, Peter McCallum Cancer Center, Melbourne, Australia
| | - Anthony Nichols
- Department of Head and Neck surgery, London Health Sciences Center, Ontario, Canada
| | - Silke Tribius
- Department of Radiation Oncology, Hermann-Holthusen-Institute for Radiation Oncology, Asklepios Hospital St. Georg, Hamburg, Germany
| | | | - Chaosu Hu
- Department of Radiation Oncology, Fundan University, Shanghai, China
| | - Xavier Liem
- Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | | | - Ida D'onofrio
- Department of Radiation Oncology, Hospital Naples, Italy
| | | | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinaty, USA
| | - Ester Orlandi
- Department of Radiation Oncology, CNAO, Milan, Italy
| | - Amanda Psyrri
- Department of Medical Oncology, Attikon University Hospital, Athens, Greece
| | - George Shenouda
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Canada
| | - David Sher
- Department of Radiation Oncology, UT Southwestern, Dallas, USA
| | - Conor Steuer
- Department of Head and Neck Surgery, Winship Cancer Institute, Atlanta, USA
| | - Xu Shan Sun
- Department of Radiation Oncology, University hospital CHBM, Montbéliard, France
| | - Yungan Tao
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - David Thomson
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mu-Hung Tsai
- Department of Radiation Oncology, National Cheng Kung University Hospital, Tïnan, Taiwan
| | - Noemie Vulquin
- Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France
| | - Philippe Gorphe
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - Hisham Mehanna
- Department of Radiation Oncology, Institute for Global Innovation, Birmingham, UK
| | - Sue S Yom
- Department of Radiation Oncology, NRG Oncology Cancer Research Group, USA
| | - Jean Bourhis
- Department of Radiation Oncology, UNIL-CHUV, Lausanne, Switzerland
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François-Baclesse, Laboratoire de physique corpusculaire IN2P3/ENSICAEN - UMR6534. Normandie University, Caen, and GORTEC, France.
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Sumodhee S, Benezery K, Baron D, Natale R, Gautier M, Dejean C, Gérard J. PP-0165 Contact X-Ray Brachytherapy for eyelid carcinoma: Efficacy and toxicity in 69 patients. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06457-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bozec A, Boscagli M, Serris M, Chamorey E, Dassonville O, Poissonnet G, Culié D, Scheller B, Benezery K, Gal J. Long-term functional and quality of life outcomes in laryngectomized patients after successful voice restoration using tracheoesophageal prostheses. Surg Oncol 2021; 38:101580. [PMID: 33862577 DOI: 10.1016/j.suronc.2021.101580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/10/2021] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess long-term functional and quality of life (QoL) outcomes and their predictive factors in laryngectomized patients after successful voice restoration using tracheoesophageal prostheses (TEP). METHODS This cross-sectional study was conducted in alive and disease-free patients at least 1 year after total laryngectomy ± partial pharyngectomy. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) Core (QLQ-C30) and Head and Neck Cancer (QLQ-H&N35) QoL questionnaires, the Voice Handicap Index (VHI-10) questionnaire and the Hospital Anxiety and Depression Scale (HADS). The level of dysphagia was evaluated using the Dysphagia Handicap Index (DHI) and the Dysphagia Outcomes and Severity Scale (DOSS). Predictive factors of these clinical outcomes were determined in univariate and multivariate analysis. RESULTS A total of 48 patients were included in this study. Long-term QoL and functioning scales scores were all superior to 70%. Main persistent symptoms were fatigue, dyspnea, senses, speech and coughing problems. A DOSS score ≥6, indicating normal/subnormal swallowing function, and a VHI-10 score ≤20, representing light to medium voice disorders, were found in at least 75% of patients. An anxiodepressive disorder (HADS global score ≥ 15) was reported by 15 (31%) patients and represented the main predictor of QoL and voice outcomes. A strong correlation was found between VHI-10 and global QoL scores. CONCLUSIONS After successful voice restoration, laryngectomized patients achieved satisfactory QoL and functional outcomes. Psychological distress was the main determinant of long-term QoL and is therefore of critical importance in the multidisciplinary management of laryngectomized patients.
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Affiliation(s)
- Alexandre Bozec
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France.
| | - Maxime Boscagli
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Marilou Serris
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Emmanuel Chamorey
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Olivier Dassonville
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Gilles Poissonnet
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Dorian Culié
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Boris Scheller
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Jocelyn Gal
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
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Doyen J, Sunyach MP, Almairac F, Bourg V, Naghavi AO, Duhil de Bénazé G, Claren A, Padovani L, Benezery K, Noël G, Hannoun-Lévi JM, Guedea F, Giralt J, Vidal M, Baudin G, Opitz L, Claude L, Bondiau PY. Early Toxicities After High Dose Rate Proton Therapy in Cancer Treatments. Front Oncol 2021; 10:613089. [PMID: 33520724 PMCID: PMC7842185 DOI: 10.3389/fonc.2020.613089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/23/2020] [Indexed: 12/25/2022] Open
Abstract
Background The conventional dose rate of radiation therapy is 0.01–0.05 Gy per second. According to preclinical studies, an increased dose rate may offer similar anti-tumoral effect while dramatically improving normal tissue protection. This study aims at evaluating the early toxicities for patients irradiated with high dose rate pulsed proton therapy (PT). Materials and Methods A single institution retrospective chart review was performed for patients treated with high dose rate (10 Gy per second) pulsed proton therapy, from September 2016 to April 2020. This included both benign and malignant tumors with ≥3 months follow-up, evaluated for acute (≤2 months) and subacute (>2 months) toxicity after the completion of PT. Results There were 127 patients identified, with a median follow up of 14.8 months (3–42.9 months). The median age was 55 years (1.6–89). The cohort most commonly consisted of benign disease (55.1%), cranial targets (95.1%), and were treated with surgery prior to PT (56.7%). There was a median total PT dose of 56 Gy (30–74 Gy), dose per fraction of 2 Gy (1–3 Gy), and CTV size of 47.6 ml (5.6–2,106.1 ml). Maximum acute grade ≥2 toxicity were observed in 49 (38.6%) patients, of which 8 (6.3%) experienced grade 3 toxicity. No acute grade 4 or 5 toxicity was observed. Maximum subacute grade 2, 3, and 4 toxicity were discovered in 25 (19.7%), 12 (9.4%), and 1 (0.8%) patient(s), respectively. Conclusion In this cohort, utilizing high dose rate proton therapy (10 Gy per second) did not result in a major decrease in acute and subacute toxicity. Longer follow-up and comparative studies with conventional dose rate are required to evaluate whether this approach offers a toxicity benefit.
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Affiliation(s)
- Jérôme Doyen
- Université Côte d'Azur, Department of Radiation Oncology, Centre Antoine-Lacassagne, Fédération Claude Lalanne, Nice, France
| | | | - Fabien Almairac
- Department of Neurosurgery, Centre Hospitalier Universitaire, University Côte d'Azur, Nice, France
| | - Véronique Bourg
- Department of Neurology, Centre Hospitalier Universitaire, University Côte d'Azur, Nice, France
| | - Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Gwenaëlle Duhil de Bénazé
- Department of Pediatric Oncology, Centre Hospitalier Universitaire, University Côte d'Azur, Nice, France
| | - Audrey Claren
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Laetitia Padovani
- Oncology Radiotherapy Department, CRCM Inserm, UMR1068, CNRS UMR7258, AMU UM105, Genome Instability and Carcinogenesis, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Karen Benezery
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Georges Noël
- Department of Radiation Oncology, Institut de cancérologie Strasbourg Europe (Icans), Strasbourg, France
| | - Jean-Michel Hannoun-Lévi
- Université Côte d'Azur, Department of Radiation Oncology, Centre Antoine-Lacassagne, Fédération Claude Lalanne, Nice, France
| | - Ferran Guedea
- Radiation Oncology Department, Institut Català d'Oncologia (ICO) and University of Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Giralt
- Hospital Vall d'Hebron, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Marie Vidal
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Guillaume Baudin
- Department of Radiology, Centre Antoine-Lacassagne, Nice, France
| | - Lucas Opitz
- Department of Anesthesiology, Centre Antoine-Lacassagne, Nice, France
| | - Line Claude
- Department of Radiotherapy, Léon Bérard Cancer Center, Lyon, France
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Culié D, Schiappa R, Modesto A, Viotti J, Chamorey E, Dassonville O, Poissonnet G, Bizeau A, Vergez S, Dupret-Bories A, Fakhry N, Santini L, Lallemant B, Chambon G, Sudaka A, Peyrade F, Saada-Bouzid E, Benezery K, Jourdan-Soulier F, Chapel F, Ramay AS, Roger P, Galissier T, Coste V, Ben Lakdar A, Guerlain J, Mirghani H, Gorphe P, Guelfucci B, Garrel R, Temam S, Bozec A. Upfront surgery or definitive radiotherapy for p16+ oropharyngeal cancer. A GETTEC multicentric study. Eur J Surg Oncol 2021; 47:1389-1397. [PMID: 33390333 DOI: 10.1016/j.ejso.2020.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/25/2020] [Accepted: 12/15/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the impact of the initial therapeutic strategy on oncologic outcomes in patients with HPV-positive OPSCC. METHODS All p16-positive OPSCCs treated from 2009 to 2014 in 7 centers were retrospectively included and classified according to the therapeutic strategy: surgical strategy (surgery ± adjuvant radiotherapy and chemotherapy) vs. non-surgical strategy (definitive radiotherapy ± chemotherapy). Univariate, multivariate propensity score matching analyses were performed to compare overall (OS), disease-specific (DSS) and recurrence-free survival (RFS). RESULTS 382 patients were included (surgical group: 144; non-surgical group: 238). Five-year OS, DSS and RFS were 89.2, 96.8 and 83.9% in the surgical group and 84.2, 87.1 and 70.4% in the non-surgical group, respectively. These differences were statistically significant for DSS and RFS after multivariate analysis, but only for RFS after propensity score matching analysis. CONCLUSION In p16+ OPSCC patients, upfront surgery results in higher RFS than definitive radiotherapy ± chemotherapy but does not impact OS.
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Affiliation(s)
- Dorian Culié
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France.
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Anouchka Modesto
- Department of Radiotherapy, Cancer University Institute of Toulouse, Toulouse, France
| | - Julien Viotti
- Department of Statistics, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Emmanuel Chamorey
- Department of Statistics, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Olivier Dassonville
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Gilles Poissonnet
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Alain Bizeau
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Agnes Dupret-Bories
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Laure Santini
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Guillaume Chambon
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Anne Sudaka
- Department of Pathology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Frederic Peyrade
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | | | | | - Anne Sophie Ramay
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Pascal Roger
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Thibault Galissier
- Department of Pathology, Cancer University Institute of Toulouse, Toulouse, France
| | - Valérie Coste
- Department of Pathology, University Hospital of Montpellier, Montpellier, France
| | - Aicha Ben Lakdar
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | - Joanne Guerlain
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Haitham Mirghani
- Department of Otorhinolaryngology and Head and Neck Surgery, European Hospital Georges Pompidou, Paris, France
| | - Phillipe Gorphe
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Stephane Temam
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Alexandre Bozec
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
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Culié D, Lisan Q, Leroy C, Modesto A, Schiappa R, Chamorey E, Dassonville O, Poissonnet G, Guelfucci B, Bizeau A, Vergez S, Dupret-Bories A, Garrel R, Fakhry N, Santini L, Lallemant B, Chambon G, Sudaka A, Peyrade F, Saada-Bouzid E, Benezery K, Jourdan-Soulier F, Chapel F, Ramay AS, Roger P, Galissier T, Coste V, Lakdar AB, Temam S, Gorphe P, Guerlain J, Bozec A, Mirghani H. Oropharyngeal cancer: First relapse description and prognostic factor of salvage treatment according to p16 status, a GETTEC multicentric study. Eur J Cancer 2020; 143:168-177. [PMID: 33333482 DOI: 10.1016/j.ejca.2020.10.034] [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: 06/03/2020] [Revised: 10/21/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Although Human Papilloma Virus (HPV)-driven oropharyngeal cancer (OPC) prognosis is significantly better than that of other head and neck cancers, up to 25% of cases will recur within 5 years. Data on the pattern of disease recurrence and efficiency of salvage treatment are still sparse. MATERIAL AND METHOD Observational study of all recurrent OPCs diagnosed, following a curative intent treatment, in seven French centers from 2009 to 2014. p16 Immunohistochemistry was used to determine HPV status. Clinical characteristics, distribution of recurrence site, and treatment modalities were compared by HPV tumor status. Overall survival was examined using Kaplan-Meier and multivariate Cox regression modeling. RESULTS 350 recurrent OPC patients (246 p16-negative and 104 p16-positive patients). The site of recurrence was more frequently locoregional for p16-negative patients (65.4% versus 52.9% in p16-positive patients) and metastatic for p16-positive patients (47.1% versus 34.6% in p16-patients, p = 0.03). Time from diagnosis to recurrence did not differ between p16-positive and p16-negative patients (12 and 9.6 months, respectively, p-value = 0.2), as the main site of distant metastasis (all p-values ≥0.10). Overall and relapse-free survival following the first recurrence did not differ according to p16 status (p-values from log-rank 0.30 and 0.40, respectively). In multivariate analysis, prognosis factors for overall survival in p16-negative patients were distant metastasis (HR 2.11, 95% CI 1.30-3.43) and concurrent local and regional recurrences (HR 2.20, 95% CI 1.24-3.88). CONCLUSION With the exception of the initial site of recurrence, the pattern of disease relapse and the efficiency of salvage treatment are not different between p16-positive and negative OPCs.
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Affiliation(s)
- Dorian Culié
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France.
| | - Quentin Lisan
- Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France; INSERM UMR970, Department of Epidemiology, Paris, France
| | - Charlotte Leroy
- Department of Otorhinolaryngology, Lariboisière Hospital, Paris, France
| | - Anouchka Modesto
- Department of Radiotherapy, Cancer University Institute of Toulouse, Toulouse, France
| | - Renaud Schiappa
- Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France; INSERM UMR970, Department of Epidemiology, Paris, France
| | - Emmanuel Chamorey
- Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France; INSERM UMR970, Department of Epidemiology, Paris, France
| | - Olivier Dassonville
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Gilles Poissonnet
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Alain Bizeau
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Agnes Dupret-Bories
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Laure Santini
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Guillaume Chambon
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Anne Sudaka
- Department of Pathology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Frederic Peyrade
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | | | | | - Anne Sophie Ramay
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Pascal Roger
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Thibault Galissier
- Department of Pathology, Cancer University Institute of Toulouse, Toulouse, France
| | - Valérie Coste
- Department of Pathology, University Hospital of Montpellier, Montpellier, France
| | - Aicha B Lakdar
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | - Stephane Temam
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Phillipe Gorphe
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Joanne Guerlain
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Alexandre Bozec
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Haitham Mirghani
- Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France
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Kinj R, Doyen J, Hannoun-Lévi J, Baudin G, Fererro J, Francois E, Chand M, Borchiellini D, Evesque L, Benezery K, Bondiau P. PO-1084: Stereotactic pelvic reirradiation for locoregional cancer relapse. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01101-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Debbi K, Loganadane V G, Kinj R, Chapet S, Janoray G, Benezery K, Barillot I, Calais G. Stereotactic Ablative Radiation Therapy (CyberKnife) for Lung Oligometastases from Head and Neck Squamous Cell Carcinoma (HNSCC): Bi-Institutional Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Atallah V, Poissonnet G, Roxanne E, Chand M, Anne S, Pauline G, Renaud S, Dorian C, Alexandre B, Sicurani J, Natale R, Hannoun-Levi J, Benezery K. PO-0851: Impact of Adjuvant Radiation Therapy for Advanced Cutaneous Squamous Cell Carcinoma of Head and Neck. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00868-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Milliet F, Bozec A, Schiappa R, Viotti J, Modesto A, Dassonville O, Poissonnet G, Guelfucci B, Bizeau A, Vergez S, Dupret-Bories A, Garrel R, Fakhry N, Santini L, Lallemant B, Chambon G, Sudaka A, Peyrade F, Saada-Bouzid E, Benezery K, Jourdan-Soulier F, Chapel F, Sophie Ramay A, Roger P, Galissier T, Coste V, Ben Lakdar A, Guerlain J, Temam S, Mirghani H, Gorphe P, Chamorey E, Culié D. Synchronous primary neoplasia in patients with oropharyngeal cancer: Impact of tumor HPV status. A GETTEC multicentric study. Oral Oncol 2020; 112:105041. [PMID: 33129057 DOI: 10.1016/j.oraloncology.2020.105041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/28/2020] [Accepted: 10/04/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Patients with oropharyngeal squamous cell carcinoma (OPSCC) display a significant risk of synchronous primary neoplasia (SPN) which could impact their management. The aims of this study were to evaluate the risk and distribution of SPN in OPSCC patients according to their HPV (p16) status, the predictive factors of SPN and the impact of SPN on therapeutic strategy and oncologic outcomes. MATERIAL AND METHODS All OPSCC patients treated from 2009 to 2014 were included in this multicentric retrospective study. Univariate analyses were conducted using Chi-2 and Fisher exact tests. For multivariate analyses, all variables associated with a p ≤ 0.10 in univariate analysis were included in logistic regression models. RESULTS Among the 1291 patients included in this study, 75 (5.8%) displayed a SPN which was preferentially located in the upper aerodigestive tract, lung and esophagus. Comorbidity level (p = 0.03), alcohol (p = 0.005) and tobacco (p = 0.01) consumptions, and p16 tumor status (p < 0.0001) were significant predictors of SPN. In multivariate analysis, p16+ status was significantly associated with a lower risk of SPN (OR = 0.251, IC95% [0.133;0.474]). Patients with a SPN were more frequently referred for non-curative treatment (p = 0.02). In patients treated with curative intent, there was no impact of SPN on the therapeutic strategy (surgical vs. non-surgical treatment). We observed no overall survival differences between patients with or without SPN. CONCLUSION P16 tumor status is the main predictive factor of SPN in OPSCC patients. This study provides crucial results which should help adapt the initial work-up and the global management of OPSCC patients.
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Affiliation(s)
- Florent Milliet
- Department of Otorhinolaryngology, University Hospital of Nice, France
| | - Alexandre Bozec
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Julien Viotti
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Anouchka Modesto
- Department of Radiotherapy, Cancer University Institute of Toulouse, Toulouse, France
| | - Olivier Dassonville
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Gilles Poissonnet
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Alain Bizeau
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Agnes Dupret-Bories
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Laure Santini
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Guillaume Chambon
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Anne Sudaka
- Department of Pathology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Frederic Peyrade
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | | | | | - Anne Sophie Ramay
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Pascal Roger
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Thibault Galissier
- Department of Pathology, Cancer University Institute of Toulouse, Toulouse, France
| | - Valérie Coste
- Department of Pathology, University Hospital of Montpellier, Montpellier, France
| | - Aicha Ben Lakdar
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | - Joanne Guerlain
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Stephane Temam
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Haitham Mirghani
- Department of Head and Neck Surgery, European Georges Pompidou Hospital, APHP, Paris, France
| | - Phillipe Gorphe
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Emmanuel Chamorey
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Dorian Culié
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France.
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Culié D, Viotti J, Modesto A, Schiappa R, Chamorey E, Dassonville O, Poissonnet G, Guelfucci B, Bizeau A, Vergez S, Dupret-Bories A, Garrel R, Fakhry N, Santini L, Lallemant B, Chambon G, Sudaka A, Peyrade F, Saada-Bouzid E, Benezery K, Jourdan-Soulier F, Chapel F, Ramay AS, Roger P, Galissier T, Coste V, Ben Lakdar A, Guerlain J, Temam S, Mirghani H, Gorphe P, Bozec A. Upfront surgery or definitive radiotherapy for patients with p16-negative oropharyngeal squamous cell carcinoma. A GETTEC multicentric study. Eur J Surg Oncol 2020; 47:367-374. [PMID: 33004271 DOI: 10.1016/j.ejso.2020.07.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/08/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Therapeutic management of oropharyngeal squamous cell carcinomas (OPSCC) is still debated. Since the role of HPV was demonstrated, few studies have focused on HPV-negative OPSCC. The aim of our study was to assess the impact of therapeutic strategy (surgical vs. non-surgical) on oncologic outcomes in patients with HPV-negative OPSCC. MATERIAL AND METHOD All p16-negative OPSCCs treated from 2009 to 2014 in 7 tertiary-care centers were included in this retrospective study and were classified according to the therapeutic strategy: surgical strategy (surgery ± adjuvant radiotherapy and chemotherapy) vs. non-surgical strategy (definitive radiotherapy ± chemotherapy). Patients not eligible for surgery (unresectable tumor, poor general-health status) were excluded. Univariate, multivariate and propensity score matching analyses were performed to compare overall (OS), disease-specific (DSS) and recurrence-free survival (RFS). RESULTS Four hundred seventy-four (474) patients were included in the study (surgical group: 196; non-surgical group: 278). Five-year OS, DSS and RFS were 76.5, 81.3 and 61.3%, respectively, in the surgical group and 49.9, 61.8 and 43.4%, respectively, in the non-surgical group. The favorable impact of primary surgical treatment on oncologic outcomes was statistically significant after multivariate analysis. This effect was more marked for locally-advanced than for early-stage tumors. Propensity score matching analysis confirmed the prognostic impact of primary surgical treatment for RFS. CONCLUSION Therapeutic strategy is an independent prognostic factor in patients with p16-negative OPSCC and primary surgical treatment is associated with improved OS, DSS and RFS. These results suggest that surgical strategy is a reliable option for advanced stage OPSCC.
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Affiliation(s)
- Dorian Culié
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France.
| | - Julien Viotti
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Anouchka Modesto
- Department of Radiotherapy, Cancer University Institute of Toulouse, Toulouse, France
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Emmanuel Chamorey
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Olivier Dassonville
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Gilles Poissonnet
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Alain Bizeau
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Agnes Dupret-Bories
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Laure Santini
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Guillaume Chambon
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Anne Sudaka
- Department of Pathology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Frederic Peyrade
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | | | | | - Anne Sophie Ramay
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Pascal Roger
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Thibault Galissier
- Department of Pathology, Cancer University Institute of Toulouse, Toulouse, France
| | - Valérie Coste
- Department of Pathology, University Hospital of Montpellier, Montpellier, France
| | - Aicha Ben Lakdar
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | - Joanne Guerlain
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Stephane Temam
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Haitham Mirghani
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Phillipe Gorphe
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Alexandre Bozec
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
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Benezery K, Montagne L, Evesque L, Schiappa R, Hannoun-Levi JM, Francois E, Thamphya B, Gerard JP. Clinical response assessment after contact X-Ray brachytherapy and chemoradiotherapy for organ preservation in rectal cancer T2-T3 M0: The time/dose factor influence. Clin Transl Radiat Oncol 2020; 24:92-98. [PMID: 32695890 PMCID: PMC7363626 DOI: 10.1016/j.ctro.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 12/27/2022] Open
Abstract
Treatment initiation of T2-T3 rectal cancers with Contact (CXB) provides a fast clinical complete response. In T2N0< 3 cm tumors, CXB first with chemoradiotherapy can achieve local control in more than 85%. The Phase III OPERA trial should bring robust data in favor of CXB as initial treatment of T2N0< 3 cm.
Introduction A neoadjuvant treatment aimed at rectal preservation should achieve a clinical complete response. This study comparing neoadjuvant treatment initiated with Contact X-ray (CXB) or External Beam radiotherapy (EBRT) is evaluating the influence of the time/dose parameter on clinical response during the first six months. Materials and methods This retrospective consecutive series included T2-3 rectal adenocarcinoma staged using digital examination (DRE), endoscopy, magnetic radiation imaging and/or endorectal ultrasound. All patients were treated with organ preservation intent. Treatment protocol combined CXB (80–110 Gy/3–4 fractions) and EBRT ± concurrent capecitabine. In tumor exceeding 3.5 cm treatment was often initiated using EBRT. Clinical response was assessed (DRE, proctoscopy ± imaging) at very close interval between 2 weeks and 6 months after treatment initiation. Results Between 2002 and 2017, 61 patients (T2: 31; T3: 30) M0 (median age: 76 years) were treated. Treatment was initiated in 40 patients (T2: 28, T3: 12) with contact X-ray and in 21 (T2: 4, T3: 17) with EBRT. Using contact X-ray or EBRT first treatment, clinical complete (or near complete) response at week 14(±1) was respectively 88% [95CI:74–96] and 33% [95CI:15–57]. In multivariate analysis the treatment chronology was the most significant factor influencing cCR (OR: 7.53). At 6 months, with contact X-ray first all patients were in clinical complete response and five with EBRT remained in partial response. With 61 months median follow-up time, the local recurrence rate was 10% [95% CI: 6–16] at 5 years. T3 and fungating tumors were at higher risk of local recurrence. Organ preservation with good function was achieved in 95% of cases. Conclusion This non randomized study tends to show that in early T2-3 tumors, a strategy using upfront contact therapy, which is reducing the overall treatment time, is an option allowing a more favorable outcome than EBRT first.
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Affiliation(s)
- Karen Benezery
- Department of Radiotherapy, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Lucile Montagne
- Department of Radiotherapy, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Ludovic Evesque
- Department of Medical Oncology, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Renaud Schiappa
- Department of Statistics, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Brice Thamphya
- Department of Statistics, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
| | - Jean-Pierre Gerard
- Department of Radiotherapy, Centre Antoine-LACASSAGNE - University Côte d'Azur, Nice, France
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Kinj R, Doyen J, Hannoun-Lévi JM, Naghavi AO, Chand ME, Baudin G, Ferrero JM, François E, Evesque L, Borchiellini D, Benezery K, Bondiau PY. Stereotactic Pelvic Reirradiation for Locoregional Cancer Relapse. Clin Oncol (R Coll Radiol) 2020; 33:e15-e21. [PMID: 32641243 DOI: 10.1016/j.clon.2020.06.009] [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: 04/09/2020] [Revised: 05/12/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
Abstract
AIMS Up to 40% of patients who have received radiation for a pelvic malignancy will develop locoregional recurrence in the previously irradiated volume. Stereotactic body radiotherapy (SBRT) has been used in the oligometastatic setting, and provides an ablative approach ideal for reirradiation. The purpose of this study was to evaluate the outcomes after SBRT reirradiation of extraosseous recurrences in the pelvis. MATERIALS AND METHODS This single institution retrospective study evaluated patients treated with SBRT reirradiation in the pelvis from January 2011 to February 2018. Patients with more than five oligometastatic lesions, >7 cm in size, and recurrence within the prostate were excluded. RESULTS In total, 30 patients were treated with SBRT with a median follow-up of 29.4 months. The primary tumour sites were most commonly rectum (30.8%) and prostate (30.8%). The median time interval between irradiation for the primary and SBRT reirradiation was 48 months (3-245). The typical reirradiation treatment was 35 Gy in five fractions, the median gross tumour volume size was 10.2 (0.3-110.5) ml and the most common target was the iliac nodes (40%). There were three (10%) acute grade 3 toxicities and no late grade 3 or more toxicities. At 12/24 months, local relapse-free survival, metastasis-free survival, progression-free survival and overall survival were 67.7%/50.7%, 67%/41.7%, 34.8%/14.9% and 83.2%/62.5%, respectively. On univariate analysis, improved local control was associated with low gross tumour volume (<10 ml) (P = 0.003) and prostate primary (P = 0.02), but was no longer significant on multivariate analysis. The proximity of organ at risk to the target did not significantly correlate with worse toxicity (P = 0.14) or tumour coverage (gross tumour volume: P = 0.8, planning target volume: P = 0.4). CONCLUSION SBRT pelvic reirradiation in oligometastatic patients is a safe and effective treatment modality. Careful consideration should be taken with larger tumour size, as it may be associated with worse oncological and toxicity outcome.
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Affiliation(s)
- R Kinj
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - J Doyen
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France; University of Côte d'Azur, Nice, France
| | - J M Hannoun-Lévi
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France; University of Côte d'Azur, Nice, France
| | - A O Naghavi
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - M E Chand
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France
| | - G Baudin
- Department of Radiology, Centre Antoine Lacassagne, Nice, France
| | - J M Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - E François
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - L Evesque
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - D Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - K Benezery
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France
| | - P Y Bondiau
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France
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Li G, Qiu B, Huang YX, Doyen J, Bondiau PY, Benezery K, Xia YF, Qian CN. Cost-effectiveness analysis of proton beam therapy for treatment decision making in paranasal sinus and nasal cavity cancers in China. BMC Cancer 2020; 20:599. [PMID: 32590957 PMCID: PMC7320568 DOI: 10.1186/s12885-020-07083-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/16/2020] [Indexed: 02/03/2023] Open
Abstract
Background Cost-effectiveness is a pivotal consideration for clinical decision making of high-tech cancer treatment in developing countries. Intensity-modulated proton radiation therapy (IMPT, the advanced form of proton beam therapy) has been found to improve the prognosis of the patients with paranasal sinus and nasal cavity cancers compared with intensity-modulated photon-radiation therapy (IMRT). However, the cost-effectiveness of IMPT has not yet been fully evaluated. This study aimed at evaluating the cost-effectiveness of IMPT versus IMRT for treatment decision making of paranasal sinus and nasal cavity cancers in Chinese settings. Methods A 3-state Markov model was designed for cost-effectiveness analysis. A base case evaluation was performed on a patient of 47-year-old (median age of patients with paranasal sinus and nasal cavity cancers in China). Model robustness was examined by probabilistic sensitivity analysis, Markov cohort analysis and Tornado diagram. Cost-effective scenarios of IMPT were further identified by one-way sensitivity analyses and stratified analyses were performed for different age levels. The outcome measure of the model was the incremental cost-effectiveness ratio (ICER). A strategy was defined as cost-effective if the ICER was below the societal willingness-to-pay (WTP) threshold of China (30,828 US dollars ($) / quality-adjusted life year (QALY)). Results IMPT was identified as being cost-effective for the base case at the WTP of China, providing an extra 1.65 QALYs at an additional cost of $38,928.7 compared with IMRT, and had an ICER of $23,611.2 / QALY. Of note, cost-effective scenarios of IMPT only existed in the following independent conditions: probability of IMPT eradicating cancer ≥0.867; probability of IMRT eradicating cancer ≤0.764; or cost of IMPT ≤ $52,163.9. Stratified analyses for different age levels demonstrated that IMPT was more cost-effective in younger patients than older patients, and was cost-effective only in patients ≤56-year-old. Conclusions Despite initially regarded as bearing high treatment cost, IMPT could still be cost-effective for patients with paranasal sinus and nasal cavity cancers in China. The tumor control superiority of IMPT over IMRT and the patient’s age should be the principal considerations for clinical decision of prescribing this new irradiation technique.
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Affiliation(s)
- Guo Li
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong, 510095, P. R. China
| | - Bo Qiu
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Yi-Xiang Huang
- Department of Health Management, Public Health Institute of Sun Yat-sen University, Guangzhou, Guangdong, 510000, P. R. China
| | - Jerome Doyen
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06189, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06200, Nice, France
| | - Pierre-Yves Bondiau
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06189, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06200, Nice, France
| | - Karen Benezery
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06189, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06200, Nice, France
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Chao-Nan Qian
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Radiation Oncology, Guangzhou Concord Cancer Center, Guangzhou, Guangdong, 510045, P. R. China.
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Gérard JP, Dejean C, Montagne L, Benezery K, Doyen J, Hannoun Levi JM. A brief history of contact X-ray brachytherapy 50 kVp. Cancer Radiother 2020; 24:222-225. [PMID: 32171676 DOI: 10.1016/j.canrad.2020.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 11/18/2022]
Abstract
Contact X ray brachytherapy 50 kVp was initiated in the 1930s with the Siemens unit and popularized with the Philips unit in the 1950s. A renaissance was seen in the early 2000s with the Intrabeam™ unit for breast IORT. Presently the Papillon™ systems thanks to its high dose rate (>10Gy/mn) can be used to treat breast (IORT), skin, eyelid and rectal cancers. Future developments are expected to consolidate the place of contact radiotherapy as a safe and efficient treatment for accessible early tumors.
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Affiliation(s)
- J P Gérard
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France.
| | - C Dejean
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - L Montagne
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - K Benezery
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - J Doyen
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - J M Hannoun Levi
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
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Gérard JP, Benezery K, Barbet N, Montagne L, Hannoun-Levi JM, Francois E. Planned organ preservation for T2 T3 M0 rectal adenocarcinoma: A possible option using chemoradiotherapy (CRT) and contact X-ray brachytherapy (CXB). A French multicenter study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.016] [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: 11/12/2022] Open
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32
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Saint A, Evesque L, Falk AT, Cavaglione G, Montagne L, Benezery K, Francois E. Mitomycin and 5-fluorouracil for second-line treatment of metastatic squamous cell carcinomas of the anal canal. Cancer Med 2019; 8:6853-6859. [PMID: 31524335 PMCID: PMC6853831 DOI: 10.1002/cam4.2558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 12/27/2022] Open
Abstract
Background Metastatic squamous cell carcinomas (SCC) of the anal canal are rare and there is no international consensus on their second‐line management. 5‐Fluorouracil (5‐FU) and mitomycin in combination with radiotherapy is the standard for locally advanced forms but its efficacy in metastatic stage has never been evaluated. Patients and methods We report a retrospective analysis of patients treated with 5‐FU and mitomycin from 2000 to 2017 in our institution for a metastatic SCC of the anal canal after failure of platinum‐based regimen. The main outcome was progression‐free survival (PFS) and the secondary outcomes were overall survival (OS), response rate, and toxicity. Results Nineteen patients, 15 women and four men, with a median age of 57 years were identified (range, 40‐79 years). Patients received a median of three cycles (1‐7) of mitomycin 5‐FU. A dose reduction was necessary in six patients (31.6%), one patient had to discontinue treatment following toxicity and no death was due to treatment toxicity was reported. An objective response was observed in five patients (26.4%, 95% CI 6.6‐46.2) including one complete response, six patients (31.6%, 95% CI 10.7‐52.5) showed tumor stabilization. Median PFS and OS were 3 months [95% CI 1‐5] and 7 months [95% CI 2.2‐11.8]. Responder had a median duration of response of 4 months [95% CI 1.8‐6.1] and one patient had 23 months duration of response. No significant difference was noted for PFS and OS for patients previously treated with mitomycin and 5‐FU at a local stage. Conclusion Mitomycin and 5‐FU regimen provides tumor control with acceptable tolerance. It is an option for patients with metastatic SCC of the anal canal after failure of platinum‐based chemotherapy. [Correction added on 9 October 2019, after first online publication: '5‐FU' was inadvertently removed from the Results and Conclusion and has now been added to the text.]
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Affiliation(s)
- Angélique Saint
- Digestive Oncology, Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Ludovic Evesque
- Digestive Oncology, Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Alexander T Falk
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Gérard Cavaglione
- Digestive Oncology, Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Lucile Montagne
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Karen Benezery
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Eric Francois
- Digestive Oncology, Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
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Boustani J, Rivin Del Campo R, Blanc J, Peiffert D, Benezery K, Pereira R, Rio E, Le Prisé E, Créhange G, Huguet F. OC-0381 Benchmark case in the ongoing PRODIGE 26 trial : quality assurance of dose escalated radiatherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30801-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bozec A, Schultz P, Gal J, Chamorey E, Chateau Y, Dassonville O, Poissonnet G, Demard F, Peyrade F, Saada E, Benezery K, Leysalle A, Santini L, Messaoudi L, Fakhry N. Evolution and predictive factors of quality of life in patients undergoing oncologic surgery for head and neck cancer: A prospective multicentric study. Surg Oncol 2019; 28:236-242. [PMID: 30851907 DOI: 10.1016/j.suronc.2019.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/07/2019] [Accepted: 01/27/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purposes of this study were to assess the evolution of quality of life (QoL) in patients with head and neck squamous cell carcinoma (HNSCC) undergoing oncologic surgery and to determine the predictive factors of post-therapeutic QoL. METHODS All HNSCC patients who underwent primary surgery, between 2012 and 2014, were enrolled in this prospective multicentric study. Patients completed the EORTC QLQ-C30 and QLQ-H&N35 questionnaires before surgery and at 6 months after treatment. Predictive factors of post-therapeutic QoL scores were determined. RESULTS A total of 200 patients were included in this study. There was no significant deterioration of global QoL and no significant increase in general symptoms between the pre- and post-therapeutic periods, but a significant deterioration in role and social functioning, and an increase of most head and neck symptoms. Tumor stage, tumor site and treatment modalities (type of surgery, adjuvant therapy) were the main predictors of QoL scores. We found a negative correlation between satisfaction with the information received and global QoL score or several functioning scales. CONCLUSION HNSCC surgical treatment affects patients QoL mainly by increasing head and neck symptoms, which results in social and role functioning deterioration. These results are of great interest to improve multidisciplinary care of HNSCC patients.
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Affiliation(s)
| | - Philippe Schultz
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Strasbourg, France
| | - Jocelyn Gal
- Department of Statistics, Centre Antoine Lacassagne, Nice, France
| | | | - Yann Chateau
- Department of Statistics, Centre Antoine Lacassagne, Nice, France
| | | | | | | | - Frédéric Peyrade
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Esma Saada
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
| | - Axel Leysalle
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
| | - Laure Santini
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Marseille, France
| | - Lila Messaoudi
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Strasbourg, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Marseille, France
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Castelli J, Simon A, Rigaud B, Chajon E, Thariat J, Benezery K, Vauleon E, Jegoux F, Henry O, Lafond C, de Crevoisier R. Adaptive radiotherapy in head and neck cancer is required to avoid tumor underdose. Acta Oncol 2018; 57:1267-1270. [PMID: 29706107 DOI: 10.1080/0284186x.2018.1468086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- J. Castelli
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- Université de Rennes 1, LTSI, Campus de Beaulieu, Rennes, France
- INSERM, U1099, Campus de Beaulieu, Rennes, France
| | - A. Simon
- Université de Rennes 1, LTSI, Campus de Beaulieu, Rennes, France
- INSERM, U1099, Campus de Beaulieu, Rennes, France
| | - B. Rigaud
- Université de Rennes 1, LTSI, Campus de Beaulieu, Rennes, France
- INSERM, U1099, Campus de Beaulieu, Rennes, France
| | - E. Chajon
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - J. Thariat
- Radiotherapy Department, Centre François Baclesse, Caen, France
| | - K. Benezery
- Radiotherapy Department, Centre Antoine Lacassagne, Nice, France
| | - E. Vauleon
- Department of Oncology, Centre Eugene Marquis, Rennes, France
| | - F. Jegoux
- Head and Neck Department, CHU Rennes, Rennes, France
| | - O. Henry
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - C. Lafond
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- Université de Rennes 1, LTSI, Campus de Beaulieu, Rennes, France
- INSERM, U1099, Campus de Beaulieu, Rennes, France
| | - R. de Crevoisier
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- Université de Rennes 1, LTSI, Campus de Beaulieu, Rennes, France
- INSERM, U1099, Campus de Beaulieu, Rennes, France
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Culié D, Garrel R, Viotti J, Schiappa R, Chamorey E, Fakhry N, Lallemant B, Vergez S, Dupret-Bories A, Dassonville O, Poissonnet G, Santini J, Peyrade F, Benezery K, Sudaka A, Jourdan-Soulier F, Chapel F, Guelfucci B, Bozec A. Impact of HPV-associated p16-expression and other clinical factors on therapeutic decision-making in patients with oropharyngeal cancer: A GETTEC multicentric study. Eur J Surg Oncol 2018; 44:1908-1913. [PMID: 29871820 DOI: 10.1016/j.ejso.2018.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 03/07/2018] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To analyze the impact of tumor p16 status and other clinical factors on the therapeutic decision-making process in patients with oropharyngeal squamous cell carcinoma (OPSCC). METHODS We conducted a multicenter retrospective study (GETTEC collaborative study group) enrolling all OPSCC patients with a determined p16-status considered eligible for surgery between 2009 and 2014. The impact of p16-status and other clinical factors on the therapeutic decision was evaluated in multivariate analysis. RESULTS A total of 476 patients were enrolled in the study, including 244 cases (51%) of p16-positive OPSCC. Overall, 223 (47%) patients underwent primary surgery, and 184 (83%) of them received postoperative radiotherapy ± chemotherapy. More patients with p16-positive OPSCC tended to undergo non-surgical treatment than did patients with p16-negative OPSCC (p = 0.10). Multivariate analysis showed that 5 factors significantly influenced therapeutic management of the patients: T-stage ≥ 3 (towards a non-surgical strategy; p < 0.001), N-stage ≥ 2a (non-surgical strategy; p = 0.02), tumor involvement of the glosso-tonsillar sulcus (surgical strategy; p = 0.002), tumor extension to the oral cavity (surgical strategy; p < 0.009) and the center of care (p < 0.001). The rate of patients directed towards a surgical strategy varied between 9% and 74% depending on the center. CONCLUSION There was a non-significant trend to recommend patients with p16-positive OPSCC for non-surgical treatment. Center of care, tumor stage and tumor anatomical subsite and extensions were the main determinants of the treatment choice.
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Affiliation(s)
- Dorian Culié
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, France
| | - Julien Viotti
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Renaud Schiappa
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Emmanuel Chamorey
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Marseille, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, France
| | - Sébastien Vergez
- Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | | | - Olivier Dassonville
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Gilles Poissonnet
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - José Santini
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Frédéric Peyrade
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Anne Sudaka
- Department of Pathology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | | | | | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Alexandre Bozec
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France.
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Tardy MP, Di Mauro I, Ebran N, Refae S, Bozec A, Benezery K, Peyrade F, Guigay J, Sudaka-Bahadoran A, Badoual C, Pedeutour F, Saada-Bouzid E. Microsatellite instability associated with durable complete response to PD-L1 inhibitor in head and neck squamous cell carcinoma. Oral Oncol 2018; 80:104-107. [PMID: 29631799 DOI: 10.1016/j.oraloncology.2018.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Magalie P Tardy
- Department of Medical Oncology, Centre Antoine Lacassagne, Cancer Research Center, 33 avenue de Valombrose, 06189 Nice cedex 2, France
| | - Ilaria Di Mauro
- Laboratory of Solid Tumor Genetics, University Hospital of Nice-Côte d'Azur, 30 avenue de la Voie romaine, 06001 Nice, France; Institute for Research on Cancer and Aging (IRCAN), CNRS, UMR 7284/INSERM U1081, Nice, France
| | - Nathalie Ebran
- Oncopharmacology Unit, Centre Antoine Lacassagne, Cancer Research Center, 33 avenue de Valombrose, 06189 Nice cedex 2, France
| | - Sadal Refae
- Department of Medical Oncology, Centre Antoine Lacassagne, Cancer Research Center, 33 avenue de Valombrose, 06189 Nice cedex 2, France; Oncopharmacology Unit, Centre Antoine Lacassagne, Cancer Research Center, 33 avenue de Valombrose, 06189 Nice cedex 2, France
| | - Alexandre Bozec
- Institut universitaire de la face et du cou, 31 avenue de Valombrose, 06189 Nice cedex 2, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Cancer Research Center, 33 avenue de Valombrose, 06189 Nice cedex 2, France
| | - Frédéric Peyrade
- Department of Medical Oncology, Centre Antoine Lacassagne, Cancer Research Center, 33 avenue de Valombrose, 06189 Nice cedex 2, France
| | - Joel Guigay
- Department of Medical Oncology, Centre Antoine Lacassagne, Cancer Research Center, 33 avenue de Valombrose, 06189 Nice cedex 2, France
| | - Anne Sudaka-Bahadoran
- Department of Pathology, Centre Antoine Lacassagne, Cancer Research Center, 33 avenue de Valombrose, 06189 Nice cedex 2, France
| | - Cécile Badoual
- Department of Pathology, G. Pompidou European Hospital APHP-University Paris Descartes, Paris, France
| | - Florence Pedeutour
- Laboratory of Solid Tumor Genetics, University Hospital of Nice-Côte d'Azur, 30 avenue de la Voie romaine, 06001 Nice, France; Institute for Research on Cancer and Aging (IRCAN), CNRS, UMR 7284/INSERM U1081, Nice, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Cancer Research Center, 33 avenue de Valombrose, 06189 Nice cedex 2, France; Oncopharmacology Unit, Centre Antoine Lacassagne, Cancer Research Center, 33 avenue de Valombrose, 06189 Nice cedex 2, France.
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Bozec A, Demez P, Gal J, Chamorey E, Louis MY, Blanchard D, De Raucourt D, Merol JC, Brenet E, Dassonville O, Poissonnet G, Santini J, Peyrade F, Benezery K, Lesnik M, Berta E, Ransy P, Babin E. Long-term quality of life and psycho-social outcomes after oropharyngeal cancer surgery and radial forearm free-flap reconstruction: A GETTEC prospective multicentric study. Surg Oncol 2017; 27:23-30. [PMID: 29549900 DOI: 10.1016/j.suronc.2017.11.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/25/2017] [Accepted: 11/22/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess long-term quality of life (QoL) and psycho-social outcomes, and to determine their predictive factors after oropharyngeal cancer (OPC) surgery and radial forearm free-flap (RFFF) reconstruction. METHODS Patients who had undergone OPC surgery and RFFF reconstruction who were still alive and disease-free at least 1 year after surgery were enrolled in this prospective multicentric study. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) Core (QLQ-C30) and Head and Neck Cancer (QLQ-H&N35) QoL questionnaires, the Voice Handicap Index (VHI-10) questionnaire and the Hospital Anxiety and Depression Scale (HADS). The level of dysphagia was evaluated using the Dysphagia Handicap Index (DHI) and the Dysphagia Outcomes and Severity Scale (DOSS). Predictive factors of these clinical outcomes were determined in univariate and multivariate analysis. RESULTS A total of 58 patients were included in this study. Long-term QoL and functioning scales scores were well-preserved (all superior to 70%). Main persistent symptoms were fatigue, reduced sexuality and oral function-related disorders (swallowing, teeth, salivary and mouth-opening problems). HADS anxiety and depression scores were 7.2 and 5.4, respectively. Twenty-one (36%) patients presented an anxiodepressive disorder (HADS global score ≥ 15). Among the 21 patients who were still working before surgery, 11 (52%) had returned to work at the time of our study. The HADS global score (p < 0.001) was the main predictor of QoL, VHI-10 and DOSS scores. CONCLUSIONS Psychological distress is the main determinant of long-term QoL and is therefore of critical importance in the multidisciplinary management of OPC patients.
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Affiliation(s)
- Alexandre Bozec
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France.
| | - Pierre Demez
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Liège, Belgium
| | - Jocelyn Gal
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Emmanuel Chamorey
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Marie-Yolande Louis
- Department of Maxillo-facial and Head and Neck Surgery, Centre François-Baclesse, Caen, France
| | - David Blanchard
- Department of Maxillo-facial and Head and Neck Surgery, Centre François-Baclesse, Caen, France
| | - Dominique De Raucourt
- Department of Maxillo-facial and Head and Neck Surgery, Centre François-Baclesse, Caen, France
| | - Jean-Claude Merol
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Reims, France
| | - Esteban Brenet
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Reims, France
| | - Olivier Dassonville
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Gilles Poissonnet
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - José Santini
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Frédéric Peyrade
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Maria Lesnik
- Department of Otorhinolaryngology and Head and Neck Surgery, Institut Curie, Paris, France
| | - Etienne Berta
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital of Annecy, France
| | - Pierre Ransy
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Liège, Belgium
| | - Emmanuel Babin
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Caen, France
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Kinj R, Bondiau PY, François E, Gérard JP, Naghavi AO, Leysalle A, Chamorey E, Evesque L, Padovani B, Ianessi A, Benezery K, Doyen J. Radiosensitivity of Colon and Rectal Lung Oligometastasis Treated With Stereotactic Ablative Radiotherapy. Clin Colorectal Cancer 2017; 16:e211-e220. [DOI: 10.1016/j.clcc.2016.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/02/2016] [Accepted: 08/18/2016] [Indexed: 12/31/2022]
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Crehange G, Bertaut A, Peiffert D, Le Prise E, Etienne PL, Rio E, Pereira R, Noel G, Benezery K, Bonnetain F, Seitz JF. Exclusive chemoradiotherapy with or without dose escalation in locally advanced esophageal carcinoma: The CONCORDE study (PRODIGE 26). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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
4037 Background: In esophageal cancer (EC), 20 to 45% of patients suffer from local failure after 50Gy concomitant chemoradiation (cCRT). Improvements in staging together with target definitions led us to test dose escalation in the modern era of new technologies. Methods: Patients were randomly assigned cCRT to 40Gy elective nodal irradiation with either a 10Gy boost (Arm A) or 26Gy boost (Arm B) combined with FOLFOX-4. The primary endpoint of this phase II was acute toxicity according to the NCIC-CTCAE (version 4.0). Quality of life according to the EORTC QLQ-C30 and OG25 was a secondary endpoint. All analyses were performed in intent-to-treat. Results: 160 patients were randomized between Jun 2011 and Feb 2016: 81 patients in arm A and 79 patients in arm B. The mean age at diagnosis was 61.9 (7.9) years and 62.1 (7.8) years, respectively. Seventy patients in each arm had squamous cell carcinoma (86.4% in arm A and 88.6% in arm B) and 59 patients (72.8%) and 58 patients (73.4%) had stage III disease in arms A and B, respectively. IMRT was performed in 57 (70.4%) and 55 (69.6%) patients in arms A and B. The rates of grade ≥3 (G3+) non-hematological toxicity were not significantly different between arms A and B (76.5% vs 86.0%, p = 0.12). The rates of G3+ hematological toxicity were not significantly different between arms A and B (82.7% vs 88.6%, p = 0.29). The rates of G3+ non-hematological toxicity were not significantly different between patients treated with 3DRT (83.3%) and IMRT (81.3%) (p = 0.77). The mean global health scores at baseline and 3 months were 63.9 (sd = 21.4) vs 69.6 (sd = 23.1) in arm A (p = 0.10) and 65.27 (sd = 19.54) vs 58.8 (sd = 19.9) in arm B (p = 0.16). The presence of dysphagia was neither significantly different between arm A (89.23%) and arm B (86.21%) (p = 0.61) at baseline nor at 3 months (77.78% vs 86.84%, p = 0.29). Odynophagia was present at baseline in 78.46% in arm A and 75.86% in arm B (p = 0.73) while the rates observed at 3 months were 68.18% and 73.68%, respectively (p = 0.59). Conclusions: Dose escalated cCRT in patients with EC is feasible with no increased acute toxicity and no deterioration of QOL. A phase III trial is on-going to conclusively address the issue of local control with cCRT. Clinical trial information: NCT01348217.
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Affiliation(s)
| | | | - Didier Peiffert
- Institut de Cancérologie de Lorraine, Département de Radiothérapie, Vandoeuvre-Les-Nancy, France
| | | | | | - Emmanuel Rio
- Institut de Cancerologie de l'Ouest, Nantes, France
| | | | | | | | | | - Jean Francois Seitz
- Aix-Marseille University, Assistance Publique Hopitaux de Marseille, Marseille, France
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Gérard J, Dejean C, Chand M, Lam Cham Kee D, Doyen J, Benezery K, Hannoun-Levi J. EP-1766: First experiences using the new Papillon + TM Contact X-Ray Brachytherapy 50KVp (CXB) unit. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32128-x] [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: 10/19/2022]
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Borchiellini D, Etienne-Grimaldi M, Bensadoun R, Benezery K, Dassonville O, Poissonnet G, Llorca L, Ebran N, Formento P, Château Y, Thariat J, Milano G. Candidate apoptotic and DNA repair gene approach confirms involvement of ERCC1, ERCC5, TP53 and MDM2 in radiation-induced toxicity in head and neck cancer. Oral Oncol 2017; 67:70-76. [DOI: 10.1016/j.oraloncology.2017.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/01/2017] [Accepted: 02/03/2017] [Indexed: 02/07/2023]
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Bozec A, Schultz P, Gal J, Chamorey E, Chateau Y, Dassonville O, Poissonnet G, Santini J, Peyrade F, Saada E, Guigay J, Benezery K, Leysalle A, Santini L, Giovanni A, Messaoudi L, Fakhry N. Evaluation of the information given to patients undergoing head and neck cancer surgery using the EORTC QLQ-INFO25 questionnaire: A prospective multicentric study. Eur J Cancer 2016; 67:73-82. [DOI: 10.1016/j.ejca.2016.08.005] [Citation(s) in RCA: 10] [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: 04/18/2016] [Revised: 07/15/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
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Falk AT, Hébert C, Tran A, Chand ME, Leysalle A, Thariat J, Dassonville O, Poissonnet G, Bozec A, Saada E, Peyrade F, Benezery K. Radiotherapy for elderly patients and cetuximab, a monocentric study. Eur Arch Otorhinolaryngol 2016; 274:1061-1065. [DOI: 10.1007/s00405-016-4336-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/04/2016] [Indexed: 12/16/2022]
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Doyen J, Bondiau PY, Benezery K, Thariat J, Vidal M, Gérard A, Hérault J, Carrie C, Hannoun-Lévi JM. [Indications and results for protontherapy in cancer treatments]. Cancer Radiother 2016; 20:513-8. [PMID: 27614508 DOI: 10.1016/j.canrad.2016.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 06/10/2016] [Indexed: 12/16/2022]
Abstract
Purpose was to summarize results for proton therapy in cancer treatment. A systematic review has been done by selecting studies on the website www.pubmed.com (Medline) and using the following keywords: proton therapy, radiation therapy, cancer, chordoma, chondrosarcoma, uveal melanoma, retinoblastoma, meningioma, glioma, neurinoma, pituitary adenoma, medulloblastoma, ependymoma, craniopharyngioma and nasal cavity. There are several retrospective studies reporting results for proton therapy in cancer treatments in the following indications: ocular tumors, nasal tumors, skull-based tumors, pediatric tumors. There is no prospective study except one phase II trial in medulloblastoma. The use of proton therapy for these indications is due to dosimetric advantages offering better tumor coverage and organ at risk sparing in comparison with photon therapy. Clinical results are historically at least as efficient as photon therapy with a better toxicity profile in pediatric tumors (cognitive and endocrine functions, radiation-induced cancer) and a better tumoral control in tumors of the nasal cavity. Clinical advantages of proton therapy counterbalance its cost especially in pediatric tumors. Proton therapy could be used in other types of cancer. Proton therapy showed good outcome in ocular, nasal tumors, pediatric, skull-based and paraspinal tumors. Because of some dosimetric advantages, proton therapy could be proposed for other indications in cancer treatments.
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Affiliation(s)
- J Doyen
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France.
| | - P-Y Bondiau
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
| | - K Benezery
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
| | - J Thariat
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
| | - M Vidal
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
| | - A Gérard
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
| | - J Hérault
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
| | - C Carrie
- Centre Léon-Bérard, radiation oncology, 28, rue Laennec, 69008 Lyon, France
| | - J-M Hannoun-Lévi
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
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Camuzard O, Dassonville O, Ettaiche M, Chamorey E, Poissonnet G, Berguiga R, Leysalle A, Benezery K, Peyrade F, Saada E, Hechema R, Sudaka A, Haudebourg J, Demard F, Santini J, Bozec A. Primary radical ablative surgery and fibula free-flap reconstruction for T4 oral cavity squamous cell carcinoma with mandibular invasion: oncologic and functional results and their predictive factors. Eur Arch Otorhinolaryngol 2016; 274:441-449. [DOI: 10.1007/s00405-016-4219-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/16/2016] [Indexed: 10/21/2022]
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Castelli J, Simon A, Rigaud B, Lafond C, Chajon E, Ospina JD, Haigron P, Laguerre B, Loubière AR, Benezery K, de Crevoisier R. A Nomogram to predict parotid gland overdose in head and neck IMRT. Radiat Oncol 2016; 11:79. [PMID: 27278960 PMCID: PMC4898383 DOI: 10.1186/s13014-016-0650-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022] Open
Abstract
Purposes To generate a nomogram to predict parotid gland (PG) overdose and to quantify the dosimetric benefit of weekly replanning based on its findings, in the context of intensity-modulated radiotherapy (IMRT) for locally-advanced head and neck carcinoma (LAHNC). Material and methods Twenty LAHNC patients treated with radical IMRT underwent weekly computed tomography (CT) scans during IMRT. The cumulated PG dose was estimated by elastic registration. Early predictors of PG overdose (cumulated minus planned doses) were identified, enabling a nomogram to be generated from a linear regression model. Its performance was evaluated using a leave-one-out method. The benefit of weekly replanning was then estimated for the nomogram-identified PG overdose patients. Results Clinical target volume 70 (CTV70) and the mean PG dose calculated from the planning and first weekly CTs were early predictors of PG overdose, enabling a nomogram to be generated. A mean PG overdose of 2.5Gy was calculated for 16 patients, 14 identified by the nomogram. All patients with PG overdoses >1.5Gy were identified. Compared to the cumulated delivered dose, weekly replanning of these 14 targeted patients enabled a 3.3Gy decrease in the mean PG dose. Conclusion Based on the planning and first week CTs, our nomogram allowed the identification of all patients with PG overdoses >2.5Gy to be identified, who then benefitted from a final 4Gy decrease in mean PG overdose by means of weekly replanning.
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Affiliation(s)
- J Castelli
- Centre Eugene Marquis, Radiotherapy, de la Bataille Flandre Dunkerque, F-35000, Rennes, France. .,Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France. .,INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France.
| | - A Simon
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.,INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France
| | - B Rigaud
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.,INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France
| | - C Lafond
- Centre Eugene Marquis, Radiotherapy, de la Bataille Flandre Dunkerque, F-35000, Rennes, France
| | - E Chajon
- Centre Eugene Marquis, Radiotherapy, de la Bataille Flandre Dunkerque, F-35000, Rennes, France
| | - J D Ospina
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.,INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France
| | - P Haigron
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.,INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France
| | - B Laguerre
- Centre Eugene Marquis, Medical oncology, Rennes, F-35000, France
| | | | - K Benezery
- Centre Antoine Lacassagne, Radiotherapy, Nice, F-06100, France
| | - R de Crevoisier
- Centre Eugene Marquis, Radiotherapy, de la Bataille Flandre Dunkerque, F-35000, Rennes, France.,Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.,INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France
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Falk A, Hébert C, Paquet M, Tran A, Peyrade F, Saada E, Reure J, Dassonville O, Poissonnet G, Bozec A, Thariat J, Leysalle A, Chand M, Benezery K. EP-1084: Elderly patients concomitant radiotherapy + cetuximab in locally advanced head and neck cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vidal M, Gautier M, Croce O, Gerard J, Benezery K. PO-0862: Comparison of Monte-Carlo computed 50 kV X-rays radiation therapy and EBRT for rectal cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32112-0] [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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50
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Bozec A, Benezery K, Ettaiche M, Chamorey E, Vandersteen C, Dassonville O, Poissonnet G, Riss JC, Hannoun-Lévi JM, Chand ME, Leysalle A, Saada E, Guigay J, Sudaka A, Demard F, Santini J, Peyrade F. Induction chemotherapy-based larynx preservation program for locally advanced hypopharyngeal cancer: oncologic and functional outcomes and prognostic factors. Eur Arch Otorhinolaryngol 2016; 273:3299-306. [DOI: 10.1007/s00405-016-3919-3] [Citation(s) in RCA: 10] [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: 07/16/2015] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
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