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Di Perri D, Jmil S, Lawson TM, Van Calster L, Whenham N, Renard L. Health-related quality of life and cognitive failures in patients with lower-grade gliomas treated with radiotherapy. Cancer Radiother 2023; 27:219-224. [PMID: 37080857 DOI: 10.1016/j.canrad.2022.10.004] [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: 07/25/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 04/22/2023]
Abstract
PURPOSE Patients with lower grade (grade 2 and 3) glioma (LGG) frequently experience prolonged clinical course after multimodal therapy (including surgery, radiotherapy (RT), and chemotherapy). There is therefore significant concern about the potential long-term impact of the disease and treatments on quality of life (QOL) and cognitive functioning. In this context, we evaluated health related QOL and cognitive failures in LGG patients previously treated in our RT department. PATIENTS AND METHODS Adult LGG patients previously treated with RT were prospectively included. Patients were evaluated based on standardized questionnaires [i.e., EORTC QLQ-C30, EORTC QLQ-BN20, and cognitive failures questionnaire (CFQ)]. RESULTS Forty-eight patients were included. Median time elapsed since the end of RT was 59.5 months (range: 4-297). Based on EORTC QLQ-C30 and QLQ-BN20, the most prevalent HRQOL issues were impaired cognitive functioning (50% of the patients), impaired emotional functioning (47.9%), financial difficulties (43.7%), fatigue (43.7%), future uncertainty (39.6%), and impaired physical functioning (35.4%). Based on the CFQ, 35.4% of the patients showed increased tendency to cognitive failures. CONCLUSION Patients with LGG frequently experience impairments in HRQOL and cognitive failures after treatment (including RT). Further efforts are therefore warranted to improve the QOL and cognitive outcome of these patients.
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Affiliation(s)
- D Di Perri
- Department of Radiation Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium.
| | - S Jmil
- Department of Radiation Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - T M Lawson
- Department of Neurosurgery, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - L Van Calster
- Department of Neurology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - N Whenham
- Department of Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - L Renard
- Department of Radiation Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Stavris C, Chiche L, Charpin C, Dukan P, Doncarli C, Drouet H, Delord M, Renard L, Allemand J, Caillères S, Talbi N, Halfon P, Retornaz F, Servettaz A. [Asthenia, weight loss in a 55 year-old woman]. Rev Med Interne 2022; 43:626-629. [PMID: 35908996 DOI: 10.1016/j.revmed.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 10/16/2022]
Affiliation(s)
- C Stavris
- Médecine interne, Hôpital européen Marseille, Marseille, France.
| | - L Chiche
- Médecine interne, Hôpital européen Marseille, Marseille, France
| | - C Charpin
- Rhumatologie, Hôpital européen Marseille, Marseille, France
| | - P Dukan
- Hépato-Gastro-Entérologie, Hôpital européen Marseille, Marseille, France
| | - C Doncarli
- Médecine interne, Hôpital européen Marseille, Marseille, France
| | - H Drouet
- Médecine interne, Hôpital européen Marseille, Marseille, France
| | - M Delord
- Médecine interne, Hôpital européen Marseille, Marseille, France
| | - L Renard
- Dermatologie, boulevard Chave, Marseille, France
| | - J Allemand
- Médecine interne, Hôpital européen Marseille, Marseille, France
| | - S Caillères
- Médecine interne, Hôpital européen Marseille, Marseille, France
| | - N Talbi
- Centre français des Porphyries, Hôpital Louis Mourier, Colombes, France
| | - P Halfon
- Médecine interne, Hôpital européen Marseille, Marseille, France
| | - F Retornaz
- Médecine interne, Hôpital européen Marseille, Marseille, France
| | - A Servettaz
- Service de médecine interne, maladies infectieuses, immunologie clinique, CHU de Reims, 45 rue Cognacq-Jay, 51092 Reims cedex, France
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Partoune E, Virzi M, Vander Veken L, Renard L, Maiter D. Occurrence of pituitary hormone deficits in relation to both pituitary and hypothalamic doses after radiotherapy for skull base meningioma. Clin Endocrinol (Oxf) 2021; 95:460-468. [PMID: 34028837 DOI: 10.1111/cen.14499] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/28/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022]
Abstract
CONTEXT Little accurate information is available regarding the risk of hypopituitarism after irradiation of skull base meningiomas. DESIGN Retrospective study in a single centre. PATIENTS 48 patients with a skull base meningioma and normal pituitary function at diagnosis, treated with radiotherapy (RXT) between 1998 and 2017 (median follow-up of 90 months). MEASUREMENTS The GH, TSH, LH/FSH and ACTH hormonal axes were evaluated yearly for the entire follow-up period. Mean doses delivered to the pituitary gland (PitD) and the hypothalamus (HypoD) were calculated, as well as the doses responsible for the development of deficits in 50% of patients after 5 years (TD50). RESULTS At least one hormone deficit was observed in 38% of irradiated patients and complete hypopituitarism in 13%. The GH (35%), TSH (32%) and LH/FSH axes (28%) were the most frequently affected, while ACTH secretion axis was less altered (13%). The risk of hypopituitarism was independently related to planning target volume (PTV) and to the PitD (threshold dose 45 Gy; TD50 between 50 and 54 Gy). In this series, the risk was less influenced by the HypoD, increasing steadily between doses of 15 and 70 Gy with no clear-cut dose threshold. CONCLUSIONS Over a median follow-up period of 7.5 years, hypopituitarism occurred in more than one third of patients irradiated for a skull base meningioma, and this prevalence was time- and dose-dependent. In this setting, the risk of developing hypopituitarism was mainly determined by the irradiated target volume and by the dose delivered to the pituitary gland.
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Affiliation(s)
- Eléonore Partoune
- Departments of Radiotherapy, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Maxime Virzi
- Departments of Radiotherapy, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Loïc Vander Veken
- Departments of Radiotherapy, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Laurette Renard
- Departments of Radiotherapy, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Dominique Maiter
- Endocrinology and Nutrition, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
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Abstract
Vestibular Evoked Myogenic Potentials (VEMP) are commonly recorded in patients experiencing vertigo or chronic instability. This test evaluates the patient's otolith function and is often combined with both Videonystagmography and Video Head Impulse Test. VEMP is a simple, reproducible test, in the absence of any pre-existing conductive hearing loss. Cervical VEMP explore both saccular function and the inferior vestibular nerve, whereas ocular VEMP assess utricular function and the superior vestibular nerve. In combination with previously described tests, VEMP allows characterization of vertigo and provides support for the diagnosis of superior semicircular canal dehiscence syndrome, Menière's disease, vestibular neuritis, vestibular schwannoma or idiopathic bilateral vestibulopathy. A good knowledge of these electrophysiological tests is essential in order to precisely assess the presence or absence of vestibular function impairment. We describe the test recording technique and the most common pitfalls in interpretation of the results. We then outline the results observed in various diseases impacting vestibular function.
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Affiliation(s)
- C Dorbeau
- Service d'ORL et Chirurgie Cervico-faciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - K Bourget
- Service d'ORL et Chirurgie Cervico-faciale, CHU de Nantes Hôtel-Dieu, 1, place Alexis Ricordeau, 44093 Nantes, France
| | - L Renard
- Service d'ORL et Chirurgie Cervico-faciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - C Calais
- Service d'ORL et Chirurgie Cervico-faciale, CHU de Nantes Hôtel-Dieu, 1, place Alexis Ricordeau, 44093 Nantes, France
| | - D Bakhos
- Service d'ORL et Chirurgie Cervico-faciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Inserm UI253, iBrain, Université de Tours, 10, boulevard Tonnellé, 37000 Tours, France.
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Piraux E, Caty G, Renard L, Vancraeynest D, Tombal B, Geets X, Reychler G. Effects of high-intensity interval training compared with resistance training in prostate cancer patients undergoing radiotherapy: a randomized controlled trial. Prostate Cancer Prostatic Dis 2020; 24:156-165. [PMID: 32719354 DOI: 10.1038/s41391-020-0259-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Exercise training has shown beneficial effects in the management of radiotherapy-related side effects in prostate cancer (PCa) patients undergoing radiation therapy (RT). However, the optimal modality of the exercise programs have not been yet determined. The aim of this randomized controlled trial was to investigate the effects of high-intensity interval training (HIIT) and resistance training (RES) compared to usual care (UC) on cancer-treatment-related fatigue (CTRF) (primary outcome), quality of life, depression, daytime sleepiness, insomnia, sleep quality, functional exercise capacity and executive function in PCa patients during RT. METHODS PCa patients undergoing RT with or without ADT were randomized in HIIT, RES or UC. Both exercise programs included three sessions per week during 5-8 weeks. HIIT consisted of 8-15 × 60 s intervals (≥85% maximal heart rate). RES was performed with 1-3 sets of 8-12 repetitions for each large muscle groups. The primary outcome was changed in CTRF measured with the Functional Assessment of Chronic Illness Therapy-Fatigue. RESULTS Seventy-two subjects (69.1 ± 8.2 years) completed the study. No exercise-related adverse events occurred. HIIT (p = 0.012) and RES (p = 0.039) training attenuated increases in CTRF compared to UC. Functional exercise capacity, evaluated by the 6-min walk test, increased after HIIT (p = 0 = 0.43) and RES (p = 0.041) compared to UC (+0.1%). No other secondary variables were different between groups. CONCLUSIONS Both intervention groups displayed beneficial effects on CTRF and functional exercise capacity in PCa patients undergoing RT. In addition, HIIT and RES are both safe with an excellent attendance rate to the exercise sessions.
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Affiliation(s)
- Elise Piraux
- Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium. .,Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium. .,Clinical Neuroscience, Institute of Neurosciences, Université catholique de Louvain, Brussels, Belgium.
| | - Gilles Caty
- Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Clinical Neuroscience, Institute of Neurosciences, Université catholique de Louvain, Brussels, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Laurette Renard
- Department of Radiation Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - David Vancraeynest
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Division of Cardiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Bertrand Tombal
- Service d'urologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Xavier Geets
- Department of Radiation Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Molecular Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Gregory Reychler
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Haute Ecole Léonard de Vinci, PARNASSE-ISEI, Brussels, Belgium.,Secteur de kinésithérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Dirix P, Strijbos M, Fransis K, Liefhooghe N, Van Bruwaene S, Uvin P, Ghysel C, Ost D, Engels B, Van den Begin R, Otte FX, Roumeguere T, Palumbo S, Neybuch Y, Fonteyne V, Renard L, Everaerts W, Tombal B, Ost P, Dirix L. A phase II randomized, open-label study comparing salvage radiotherapy in combination with 6 months of androgen-deprivation therapy with LHRH agonist or antagonist versus anti-androgen therapy with apalutamide in patients with biochemical progression after radical prostatectomy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz248.057] [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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Costa E, Lawson TM, Lelotte J, Fomekong E, Vaz RG, Renard L, Whenham N, Raftopoulos C. Long-term survival after glioblastoma resection: hope despite poor prognosis factors. J Neurosurg Sci 2019; 63:251-257. [DOI: 10.23736/s0390-5616.18.04180-2] [Citation(s) in RCA: 12] [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] [Indexed: 11/08/2022]
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Weber DC, Ares C, Villa S, Peerdeman SM, Renard L, Baumert BG, Lucas A, Veninga T, Pica A, Jefferies S, Ricardi U, Miralbell R, Stelmes JJ, Liu Y, Collette L, Collette S. Adjuvant postoperative high-dose radiotherapy for atypical and malignant meningioma: A phase-II parallel non-randomized and observation study (EORTC 22042-26042). Radiother Oncol 2018; 128:260-265. [PMID: 29960684 DOI: 10.1016/j.radonc.2018.06.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [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: 04/10/2018] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The therapeutic strategy for non-benign meningiomas is controversial. The objective of this study was to prospectively investigate the impact of high dose radiation therapy (RT) on the progression-free survival (PFS) rate at 3 years in WHO grade II and III meningioma patients. MATERIALS AND METHODS In this multi-cohorts non-randomized phase II and observational study, non-benign meningioma patients were treated according to their WHO grade and Simpson's grade. Patients with atypical meningioma (WHO grade II) and Simpson's grade 1-3 [Arm 1] entered the non-randomized phase II study designed to show a 3-year PFS > 70% (primary endpoint). All other patients entered the 3 observational cohorts: WHO grade II Simpson grade 4-5 [Arm 2] and Grade III Simpson grade 1-3 or 4-5 [Arm 3&4] in which few patients were expected. RESULTS Between 02/2008 and 06/2013, 78 patients were enrolled into the study. This report focuses on the 56 (median age, 54 years) eligible patients with WHO grade II Simpson's grade 1-3 meningioma who received RT (60 Gy). At a median follow up of 5.1 years, the estimated 3-year PFS is 88.7%, hence significantly greater than 70%. Eight (14.3%) treatment failures were observed. The 3-year overall survival was 98.2%. The rate of late signs and symptoms grade 3 or more was 14.3%. CONCLUSIONS These data show that 3-year PFS for WHO grade II meningioma patients undergoing a complete resection (Simpson I-III) is superior to 70% when treated with high-dose (60 Gy) RT.
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Affiliation(s)
- Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland; Radiation Oncology Department, University Hospital of Zürich, Switzerland.
| | - Carmen Ares
- Radiation Oncology Department, Geneva University Hospital, Switzerland; Department of Radiation-Oncology, MAASTRO Clinic, & GROW School for Oncology, Maastricht University Medical Centre, The Netherlands
| | - Salvador Villa
- Department of Radiation Oncology, Catalan Institut of Oncology, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain
| | - Saskia M Peerdeman
- Department of Neurosurgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Laurette Renard
- Department of Radiation Oncology, University Hospital St Luc, Brussels, Belgium
| | - Brigitta G Baumert
- Department of Radiation-Oncology, MAASTRO Clinic, & GROW School for Oncology, Maastricht University Medical Centre, The Netherlands; Department of Radiation Oncology, Paracelsus Clinic Osnabrück and Univeristy of Münster, Germany
| | - Anna Lucas
- Department of Radiation Oncology, Institut Català d'Oncologia - L'Hospitalet, Barcelona, Spain
| | | | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland
| | - Sarah Jefferies
- Oncology Department, Addenbrookes Hospital, Cambridge, United Kingdom
| | | | - Raymond Miralbell
- Radiation Oncology Department, Geneva University Hospital, Switzerland
| | | | - Yan Liu
- EORTC Headquarters, Brussels, Belgium
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Eekers DB, In 't Ven L, Roelofs E, Postma A, Alapetite C, Burnet NG, Calugaru V, Compter I, Coremans IEM, Høyer M, Lambrecht M, Nyström PW, Méndez Romero A, Paulsen F, Perpar A, de Ruysscher D, Renard L, Timmermann B, Vitek P, Weber DC, van der Weide HL, Whitfield GA, Wiggenraad R, Troost EGC. The EPTN consensus-based atlas for CT- and MR-based contouring in neuro-oncology. Radiother Oncol 2018; 128:37-43. [PMID: 29548560 DOI: 10.1016/j.radonc.2017.12.013] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [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: 09/17/2017] [Revised: 12/01/2017] [Accepted: 12/19/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To create a digital, online atlas for organs at risk (OAR) delineation in neuro-oncology based on high-quality computed tomography (CT) and magnetic resonance (MR) imaging. METHODS CT and 3 Tesla (3T) MR images (slice thickness 1 mm with intravenous contrast agent) were obtained from the same patient and subsequently fused. In addition, a 7T MR without intravenous contrast agent was obtained from a healthy volunteer. Based on discussion between experienced radiation oncologists, the clinically relevant organs at risk (OARs) to be included in the atlas for neuro-oncology were determined, excluding typical head and neck OARs previously published. The draft atlas was delineated by a senior radiation oncologist, 2 residents in radiation oncology, and a senior neuro-radiologist incorporating relevant available literature. The proposed atlas was then critically reviewed and discussed by European radiation oncologists until consensus was reached. RESULTS The online atlas includes one CT-scan at two different window settings and one MR scan (3T) showing the OARs in axial, coronal and sagittal view. This manuscript presents the three-dimensional descriptions of the fifteen consensus OARs for neuro-oncology. Among these is a new OAR relevant for neuro-cognition, the posterior cerebellum (illustrated on 7T MR images). CONCLUSION In order to decrease inter- and intra-observer variability in delineating OARs relevant for neuro-oncology and thus derive consistent dosimetric data, we propose this atlas to be used in photon and particle therapy. The atlas is available online at www.cancerdata.org and will be updated whenever required.
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Affiliation(s)
- Daniëlle Bp Eekers
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands; Proton Therapy Department South-East Netherlands (ZON-PTC), Maastricht, The Netherlands.
| | - Lieke In 't Ven
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands
| | - Erik Roelofs
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands; The-D Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, The Netherlands
| | - Alida Postma
- Department of Radiology and Nuclear Medicine MUMC+, Maastricht, The Netherlands
| | - Claire Alapetite
- Institut Curie, Radiation Oncology Department, Paris & Proton Center, Orsay, France
| | - Neil G Burnet
- University of Cambridge Department of Oncology, Addenbrooke's Hospital, United Kingdom
| | - Valentin Calugaru
- Institute Curie, Paris, France; Institute Curie, Centre de Protonthérapie d'Orsay, Orsay, France
| | - Inge Compter
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands
| | - Ida E M Coremans
- Leiden University Medical Centre, Department of Radiotherapy, The Netherlands; Holland Proton Therapy Centre, Delft, The Netherlands
| | - Morton Høyer
- Danish Center for Particle Therapy, Aarhus, Denmark
| | - Maarten Lambrecht
- Department of Radiotherapy-Oncology, Leuven Kanker Instituut, UZ Gasthuisberg, Belgium
| | - Petra Witt Nyström
- The Skandion Clinic, Uppsala, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Alejandra Méndez Romero
- Holland Proton Therapy Centre, Delft, The Netherlands; Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Frank Paulsen
- Department of Radiation Oncology, Eberhard-Carls-Universität Tübingen, Germany
| | - Ana Perpar
- EBG MedAustron GmbH, Wiener Neustadt, Austria
| | - Dirk de Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands; Department of Radiotherapy-Oncology, Leuven Kanker Instituut, UZ Gasthuisberg, Belgium
| | - Laurette Renard
- Service de Radiothérapie Oncologique Cliniques universitaires St Luc, Brussels, Belgium
| | - Beate Timmermann
- Clinic for Particle Therapy, University Hospital Essen, West German Cancer Center (WTZ), Germany; West German Proton Therapy Center Essen (WPE), Germany; German Cancer Consortium (DKTK), partnersite Essen, Essen, Germany
| | - Pavel Vitek
- Proton Therapy Center Czech, Prague, Czech Republic
| | - Damien C Weber
- Paul Scherrer Institut med. Center for Proton Therapy, Switzerland
| | - Hiske L van der Weide
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Gillian A Whitfield
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom; The Children's Brain Tumour Research Network, University of Manchester, Royal Manchester Children's Hospital, United Kingdom
| | - Ruud Wiggenraad
- Holland Proton Therapy Centre, Delft, The Netherlands; Haaglanden Medisch Centrum, Department of Radiotherapy, Leidschendam, The Netherlands
| | - Esther G C Troost
- Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany; German Cancer Consortium (DKTK), partnersite Dresden, Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT), partnersite Dresden, Dresden, Germany
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Bolla M, Maingon P, Carrie C, Villa S, Kitsios P, Poortmans PM, Sundar S, van der Steen-Banasik EM, Armstrong J, Bosset JF, Herrera FG, Pieters B, Slot A, Bahl A, Ben-Yosef R, Boehmer D, Scrase C, Renard L, Shash E, Coens C, van den Bergh AC, Collette L. Short Androgen Suppression and Radiation Dose Escalation for Intermediate- and High-Risk Localized Prostate Cancer: Results of EORTC Trial 22991. J Clin Oncol 2016; 34:1748-56. [DOI: 10.1200/jco.2015.64.8055] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose Up to 30% of patients who undergo radiation for intermediate- or high-risk localized prostate cancer relapse biochemically within 5 years. We assessed if biochemical disease-free survival (DFS) is improved by adding 6 months of androgen suppression (AS; two injections of every-3-months depot of luteinizing hormone–releasing hormone agonist) to primary radiotherapy (RT) for intermediate- or high-risk localized prostate cancer. Patients and Methods A total of 819 patients staged: (1) cT1b-c, with prostate-specific antigen (PSA) ≥ 10 ng/mL or Gleason ≥ 7, or (2) cT2a (International Union Against Cancer TNM 1997), with no involvement of pelvic lymph nodes and no clinical evidence of metastatic spread, with PSA ≤ 50 ng/mL, were centrally randomized 1:1 to either RT or RT plus AS started on day 1 of RT. Centers opted for one dose (70, 74, or 78 Gy). Biochemical DFS, the primary end point, was defined from entry until PSA relapse (Phoenix criteria) and clinical relapse by imaging or death of any cause. The trial had 80% power to detect hazard ratio (HR), 0.714 by intent-to-treat analysis stratified by dose of RT at the two-sided α = 5%. Results The median patient age was 70 years. Among patients, 74.8% were intermediate risk and 24.8% were high risk. In the RT arm, 407 of 409 patients received RT; in the RT plus AS arm, 403 patients received RT plus AS and three patients received RT only. At 7.2 years median follow-up, RT plus AS significantly improved biochemical DFS (HR, 0.52; 95% CI, 0.41 to 0.66; P < .001, with 319 events), as well as clinical progression-free survival (205 events, HR, 0.63; 95% CI, 0.48 to 0.84; P = .001). In exploratory analysis, no statistically significant interaction between treatment effect and dose of RT could be evidenced (heterogeneity P = .79 and P = .66, for biochemical DFS and progression-free survival, respectively). Overall survival data are not mature yet. Conclusion Six months of concomitant and adjuvant AS improves biochemical and clinical DFS of intermediate- and high-risk cT1b-c to cT2a (with no involvement of pelvic lymph nodes and no clinical evidence of metastatic spread) prostatic carcinoma, treated by radiation.
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Affiliation(s)
- Michel Bolla
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Philippe Maingon
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Christian Carrie
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Salvador Villa
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Petros Kitsios
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Philip M.P. Poortmans
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Santhanam Sundar
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Elzbieta M. van der Steen-Banasik
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - John Armstrong
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Jean-François Bosset
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Fernanda G. Herrera
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Bradley Pieters
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Annerie Slot
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Amit Bahl
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Rahamim Ben-Yosef
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Dirk Boehmer
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Christopher Scrase
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Laurette Renard
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Emad Shash
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Corneel Coens
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Alphonsus C.M. van den Bergh
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
| | - Laurence Collette
- Michel Bolla, Centre Hospitalier Universitaire de Grenoble, Grenoble; Philippe Maingon, Georges-Francois-Leclerc Centre, Dijon; Christian Carrie, Leon Bérard Center, Lyon; Jean-François Bosset, University Hospital of Besancon–Jean Minjoz Hospital, Besancon, France; Salvador Villa, University Hospital Germans Trias I Pujol, Barcelona, Spain; Petros Kitsios, Bank of Cyprus Oncology Centre, Nicosia, Cyprus; Philip M.P. Poortmans, Radboud University Medical Center Nijmegen, Nijmegen; Elzbieta M. van der
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11
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de Ville de Goyet M, Brichard B, Robert A, Renard L, Veyckemans F, Vanhoutte L, Moniotte S. Prospective cardiac MRI for the analysis of biventricular function in children undergoing cancer treatments. Pediatr Blood Cancer 2015; 62:867-74. [PMID: 25597617 DOI: 10.1002/pbc.25381] [Citation(s) in RCA: 23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 10/27/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cardiotoxicity is one of the most serious long-term complications in childhood cancer survivors. Measurement of the left ventricular ejection and shortening fraction remains the most common screening tool for cardiac systolic dysfunction. However, M-mode echocardiography can be viewed as a crude approach as refined strategies are now available. The aim of this prospective study was to determine the role of cardiac MRI in the detection of subclinical left or right ventricular dysfunction as well as the prevalence of myocardial scaring in patients undergoing cancer treatments. PROCEDURE Eighty-one children were enrolled in a pre-chemotherapy and then in a yearly protocol including a: (i) clinical evaluation; (ii) laboratory evaluation; (iii) electrocardiogram; (iv) echocardiogram; and (v) a cardiac magnetic resonance imaging (cMRI). RESULTS Early left ventricular systolic dysfunction was only detected in two patients. The entire cohort presented a significant increase of the left atrial volume as measured by cMRI. This finding correlated with the total cumulative dose of anthracyclines (r = 0.34; P < 0.05) and the mean left ventricular radiation dose (r = 0.86; P < 0.05). We also observed a mild increase of myocardial scaring, similarly correlated to the radiation dose (r = 0.85; P < 0.05). CONCLUSIONS Screening tools for late-onset cardiomyopathy secondary to cancer treatment are lacking. Our findings support the use of cMRI for the evaluation of the left atrial volume, as an early marker of diastolic dysfunction, and myocardial delayed enhancement, as a marker of myocardial fibrosis and scaring. Longer follow-up and larger studies are still needed to better define the role of cMRI in the evaluation of childhood cancer survivors.
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Affiliation(s)
- Maëlle de Ville de Goyet
- Department of Pediatric Hematology and Oncology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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12
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Hammouch F, Boterberg T, Clement P, Joosens E, Whenham N, Verschaeve V, Devriendt D, Renard L, Baurain J. 8744 POSTER Extended Use of Adjuvant TMZ in Newly Diagnosed GBM Patients is Safe – Results From the Safety Analysis of the PATSGO Trial. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72295-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: 11/25/2022]
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13
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Budiharto T, Perneel C, Haustermans K, Junius S, Tombal B, Scalliet P, Renard L, Lerut E, Vekemans K, Joniau S, Poppel HV. A multi-institutional analysis comparing adjuvant and salvage radiation therapy for high-risk prostate cancer patients with undetectable PSA after prostatectomy. Radiother Oncol 2010; 97:474-9. [DOI: 10.1016/j.radonc.2010.07.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 07/07/2010] [Accepted: 07/07/2010] [Indexed: 10/19/2022]
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14
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Baurain J, Boterberg T, Devriendt D, Hammouch F, Cosnard G, Whenham N, Clement PM, Mitine C, Renard L. Interim analysis of the randomized PATSGO trial evaluating the prolongation of adjuvant temozolomide in newly diagnosed glioblastoma patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Vaandering A, Lee JA, Renard L, Grégoire V. Evaluation of MVCT protocols for brain and head and neck tumor patients treated with helical tomotherapy. Radiother Oncol 2009; 93:50-6. [DOI: 10.1016/j.radonc.2009.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 05/04/2009] [Accepted: 05/10/2009] [Indexed: 10/20/2022]
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16
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Dandois V, Rommel D, Renard L, Jamart J, Cosnard G. Substitution of 11C-methionine PET by perfusion MRI during the follow-up of treated high-grade gliomas: preliminary results in clinical practice. J Neuroradiol 2009; 37:89-97. [PMID: 19570578 DOI: 10.1016/j.neurad.2009.04.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [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: 01/17/2009] [Revised: 03/29/2009] [Accepted: 04/02/2009] [Indexed: 11/17/2022]
Abstract
PURPOSE Our aim was to compare perfusion magnetic resonance imaging (MRI) and positron emission tomography (PET) using carbon-11 labelled methionine (MET) in gliomas and their value in differentiating tumour recurrence from necrosis. MATERIALS AND METHODS We retrospectively reviewed 28 patients with a high-grade glioma. A total of 33MR perfusions and MET-PET were ultimately analysable for comparison between the relative cerebral blood volume (rCBV) and MET-PET examinations. Intra- and interobserver reproducibility was assessed and diagnostic value of rCBV compared to MET-PET and histology was assessed by the area under the receiver operating characteristic (ROC) curve. RESULTS ROC curve analysis showed that rCBV had at least equal performances in differentiating tumour recurrence and necrosis than MET-PET. Cut-off value of rCBV for differentiating tumour from necrosis was 182% with a sensitivity of 81.5% and a specificity of 100%. CONCLUSION In clinical practice, perfusion MRI could replace MET-PET for differentiating necrosis from tumour recurrence.
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Affiliation(s)
- V Dandois
- Department of Medical Imaging, MRI Unit, cliniques universitaires Saint-Luc, université catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium.
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Maza A, Renard L, Monestier S, Grob JJ, Richard MA. [Fever with skin rash and polyarthralgia in a genetically black-skinned woman]. Med Trop (Mars) 2008; 68:297-299. [PMID: 18689326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Adult onset Still's disease (AOSD) is a systemic disorder characterized by intermittent fever, evanescent rash, polyarthralgia or arthritis, and neutrophilic leucocytoclasis. Appearance of skin rash during fever episodes is the characteristic feature. An atypical form of AOSD with a fixed pigmented skin rash was described in 1994. Prognosis of the atypical form is thought to be more severe than that of the classic form. The purpose of this report is to describe the first case of atypical AOSD in a genetically black-skinned woman. Treatment required administration of high-dose systemic corticosteroids.
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Affiliation(s)
- A Maza
- Service de dermatologie, CHU Sainte Marguerite, Marseille.
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Chateau H, Renard L, Falala S, Valette JP, Audigié F, Pourcelot P, Ravary B, Pacquet L, Denoix JM, Crevier-Denoix N. A method for quantifying vertical displacements of the trunk and gait symmetry in horses trotting at high speed. Comput Methods Biomech Biomed Engin 2007. [DOI: 10.1080/10255840701479792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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De Hertogh O, Renard L, Octave-Prignot M, Fournier C, Vynckier S, Scalliet P. Utilisation d'un ballon rectal pour le traitement par irradiation conformationnelle du cancer localisé de la prostate: impact sur les mouvements d'organes et sur la variation de dose dans le volume cible et la paroi rectale. Cancer Radiother 2006. [DOI: 10.1016/j.canrad.2006.09.015] [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: 10/24/2022]
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De Potter P, Levecq L, Godfraind C, Renard L. Primary orbital melanoma treated with iodine-125 plaque radiotherapy. Am J Ophthalmol 2006; 142:864-6. [PMID: 17056373 DOI: 10.1016/j.ajo.2006.05.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 01/24/2006] [Revised: 05/16/2006] [Accepted: 05/18/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To report a case of primary orbital melanoma successfully managed by custom-designed iodine-125 plaque. DESIGN Case report. METHODS A 59-year-old man with no systemic or secondary melanocytic tumor was diagnosed with primary orbital melanoma after transconjunctival incisional biopsy. He was treated with unshielded iodine-125 plaque (90 Gy) that was sutured to the sclera. The radiation plan was calculated to safely target the initial tumor volume and any residual intrascleral or loose orbital melanoma cells that could have been disseminated to the surrounding orbital tissues during incisional biopsy. RESULTS After 66 months' follow-up, the patient was still alive with partial remission of his liver metastases. Routine orbital magnetic resonance imaging studies confirmed the lack of orbital recurrence. CONCLUSIONS Plaque radiotherapy appears to be a reasonable alternative to exenteration or external irradiation for orbital melanoma after biopsy confirmation.
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Affiliation(s)
- Patrick De Potter
- Ocular Oncology Unit, Cliniques Universitaires St-Luc, Brussels, Belgium.
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Robert J, Renard L, Grenet K, Galerne E, Dal Farra A, Aussant M, Jarlier V. Implementation of isolation precautions: role of a targeted information flyer. J Hosp Infect 2006; 62:163-5. [PMID: 16257085 DOI: 10.1016/j.jhin.2005.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 01/04/2005] [Accepted: 07/04/2005] [Indexed: 10/25/2022]
Abstract
Isolation precautions are advocated in most countries for patients harbouring multi-drug-resistant organisms. We evaluated the impact of a targeted information flyer on the implementation of isolation precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA). A flyer providing a quick reference to the steps to be implemented following detection of MRSA was sent systematically by the microbiologists with all results displaying MRSA. Infection control staff compared isolation precautions in two three-month periods: the first (control) period before implementation of the flyer and the second (intervention) period after implementation of the flyer. Compared with the control period, compliance with isolation precautions increased significantly in the intervention period. In intensive care units, there was a sign posted on the door for 31 of 38 (82%) patients in the control period, and 33 out of 34 (97%) in the intervention period (P=0.06). Use of gowns increased from 82% to 100% (P=0.01), use of dedicated materials increased from 84% to 100% (P=0.03), availability of alcohol hand rub increased from 82% to 94% (P=0.10), and the proportion of MRSA patients in private rooms increased from 71% to 91% of the cases (P=0.07). In conclusion, compliance with isolation precautions increased after attaching a flyer to all MRSA-positive bacteriological results.
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Affiliation(s)
- J Robert
- Service de Bactériologie-Hygiène, Equipe Opérationnelle d'Hygiène, Hôpital de la Pitié-Salpêtrière et Faculté de Médecine Pierre et Marie Curie, Paris, France.
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Cvilic S, Renard L, Prignot M, Vynckier S, Scalliet P. 892 Partial volume irradiation in 3D conformal radiotherapy for the treatment of prostate adenocarcinoma: a poor man's solution to rectum sparing. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90918-9] [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: 11/16/2022] Open
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Renard L, Godfraind C, Boon LM, Vikkula M. A novel mutation in the SDHD gene in a family with inherited paragangliomas--implications of genetic diagnosis for follow up and treatment. Head Neck 2003; 25:146-51. [PMID: 12509798 DOI: 10.1002/hed.10220] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Early detection of paragangliomas (PGs) has been linked to low morbidity after surgical resection. Recent identification of causative genes (SDHB, SDHC, and SDHD) has made it possible to detect individuals at high risk for tumors. METHODS We identified a three-generation family, with four individuals affected with PGs. Because pedigree analysis suggested maternal imprinting (the phenotype is present only if inherited through the paternal line), the SDHD gene (PGL1) was screened. RESULTS A novel mutation that causes skipping of exon 3 was identified. Ten of the seventeen tested individuals carried the mutation. All six clinically unaffected individuals inherited the mutation from their mother. Five of them are men, with a 50% risk for affected progeny. CONCLUSIONS To allow early treatment with low morbidity, genetic counseling is needed when familial paraganglioma is suspected. Asymptomatic carriers should be followed by cervical MRI. In addition, because pheochromocytomas may occur, catecholamine excretion can be performed. This screening should probably be proposed at 5 to 10 years of age.
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Affiliation(s)
- Laurette Renard
- Department of Radiation Oncology, Cliniques universitaires St Luc, Université catholique de Louvain, Brussels, Belgium
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Warscotte L, Duprez T, Lonneux M, Michaux L, Renard L, Sindic CJM, Lecouvet FE. Concurrent spinal cord and vertebral bone marrow radionecrosis 8 years after therapeutic irradiation. Neuroradiology 2002; 44:245-8. [PMID: 11942381 DOI: 10.1007/s002340100677] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Concurrent radionecrosis within the spinal cord and the bone marrow at the same thoracic level was observed 8 years after localized therapeutic irradiation in a patient who had undergone repeated cycles of radiotherapy, glucocorticoid treatment, and chemotherapy for a non-Hodgkin's lymphoma. Mechanisms combining radiotoxic potentialization by glucocorticoids/alkylating agents and delayed radiation-induced vasculitis involving the common arterial pathways to the spinal cord and to the vertebrae were speculated to have acted in a synergistic way.
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Affiliation(s)
- L Warscotte
- Department of Neurology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Gilbeau L, Octave-Prignot M, Loncol T, Renard L, Scalliet P, Grégoire V. Comparison of setup accuracy of three different thermoplastic masks for the treatment of brain and head and neck tumors. Radiother Oncol 2001; 58:155-62. [PMID: 11166866 DOI: 10.1016/s0167-8140(00)00280-2] [Citation(s) in RCA: 153] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Setup accuracy is an important factor influencing the definition of the planning target volume (PTV). The purpose of this study was to compare the setup accuracy of three different thermoplastic masks used for immobilization of patients with brain or head and neck tumors. MATERIALS AND METHODS Thirty patients with brain or head and neck tumors were consecutively assigned to one of three different thermoplastic masks (Posifix): head mask with three fixation points (3 FP, ten patients), head and shoulder mask with four fixation points (4 FP, ten patients), head and shoulder mask with five fixation points (5 FP, four fixations plus an additional one on the top of head, ten patients). Once a week, during the session with a 6 MV linac (Elekta), orthogonal (antero-posterior and lateral) portal images were acquired for three fictitious isocenters placed during the simulation at the level of the head, the neck and the shoulders. Portal images and digitized simulator films were compared using the PIPS pro software, and displacements in antero-posterior (A-P), cranio-caudal (C-C) and medio-lateral (M-L) directions were calculated. From these displacements, 2D or 3D errors were also calculated. RESULTS A total of 915 portal images were obtained, of which 98% could be analyzed. For the whole population, total displacements reached a standard deviation (SD) of 2.2 mm at the level of the head and the neck. Systematic and random displacements were in the same order of magnitude and reached a SD of 1.8 mm. Patient setup was slightly worse at the shoulder level with a total displacement of 2.8 mm (1 SD) for both the C-C and the M-L directions. There again, the systematic and the random components were in the same order of magnitude below 2.4 mm (+/-SD). For isocenters in the head and in the neck, there was no substantial difference in the setup deviation between the three masks. The setup reproducibility was found to be significantly worse (P=0.01) at the level of the shoulders with the 3 FP mask. For the 2D random error, 1 SD of 2.3 mm was observed compared to 0.8 and 1.2 mm for the 4 and 5 FP masks, respectively. Lastly, 90% of the 3D total deviations were below 4.5 mm for the head and the neck. In the shoulder region, 90% of the 2D total deviations were below 5.5 mm. CONCLUSION Thermoplastic masks provide an accurate patient immobilization. At the shoulder level, setup variations are reduced when 4 or 5 FP masks are used. These data could be used for the assessment of margins for the PTV.
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Affiliation(s)
- L Gilbeau
- Radiation Oncology Department, Université Catholique de Louvain, St-Luc University Hospital, 10 Ave. Hippocrate, B-1200 Brussels, Belgium
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Castel A, Boschi A, Renard L, De Potter P. Optic nerve sheath meningiomas: clinical features, functional prognosis and controversial treatment. Bull Soc Belge Ophtalmol 2000; 275:73-8. [PMID: 10853310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Optic nerve sheath meningiomas (ONSM) are rare benign neoplastic lesions arising from meningothelial cells of the meninges. As clinical features are highly variable, the diagnosis is often delayed. From 1995 to 1999, 6 patients were diagnosed with ONSM in our department. We compared our series with the literature data. Visual prognosis is usually poor. Despite a large literature, the treatment guidelines are still highly controversial.
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Affiliation(s)
- A Castel
- Dept. of Ophtalmology, Université Catholique de Louvain
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Snyers B, Renard L, Kirkove C, Wery V. [Radiotherapy treatment of subfoveal retinal neovascularization related to age]. Bull Soc Belge Ophtalmol 1998; 262:63-8. [PMID: 9376923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Thirty-three patients who underwent low dose of radiation therapy for subfoveal choroidal membranes were studied after a mean follow-up of 16 months. The evaluated parameters were the visual outcome and the choroidal neovascularization evolution. In this study, the efficacy of low-dose radiation delivered to the macular region as an alternative treatment in subfoveal membrane was limited.
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Affiliation(s)
- B Snyers
- Service d'Ophtalmologie, Cliniques Universitaires Saint-Luc, Bruxelles
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Renard L. [Possibilities of psychoanalytic treatment in child and adolescent psychiatry in France]. Prax Kinderpsychol Kinderpsychiatr 1997; 46:278-87. [PMID: 9206789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article describes the context of psychoanalytical approaches and their influence upon child and adolescent psychiatry in an historical and organisational perspective. It deals with some current advances and discussions with regard to technical aspects: indication, frame and process as well as extensions of technique, that will raise weaknesses in questions about training in psychotherapy.
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Affiliation(s)
- L Renard
- Department de Psychiatrie, Hôpital International de l'Université de Paris
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Chevrolet J, Bourdain J, Durand P, Guidet B, Mateo J, May T, Mercat A, Nordmann P, Renard L, Sauder P. Prévention des infections à bactéries multirésistantes en réanimation. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s1164-6756(97)80077-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Simultaneous pharmacokinetic-pharmacodynamic (PK/PD) modelling for spiramycin in staphylococcal infections of the mammary gland of cows was used to predict the efficacy of spiramycin. A differential equation derived from the Zhi model was fitted to an in vitro killing curve and post-antibiotic effect determination. A seven-compartment PK model, in which 4 compartments representing each quarter of the mammary gland which was considered to be the effect compartment, was included. The PD model linked to the PK model was able to describe the in vivo spiramycin effect against Staphylococcus aureus. The parameters calculated from in vitro data predicted a rapid decrease for the first 12-24 h, and regrowth within 72 h following the treatment, whereas in vivo the bacterial effect was much less after 24 h than that predicted by the in vitro data. PK/PD modelling permitted the simulation of various doses to optimize the efficacy of the antibiotic, taking into account such dynamic parameters as bacterial growth rate constant, bacterial killing rate constant and the Michaelis-Menten type saturation constant. An optimal dosage regimen of 20000 IU/kg per day for 3 days was predicted for the treatment of Staphylococcus aureus mastitis.
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Affiliation(s)
- L Renard
- Unité de Pharmacocinétique, CNEVA-Fougères, Centre National d'Etudes Vétérinaires et Alimentaires, France
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Renard L, Henry P, Sanders P, Laurentie M, Delmas JM. Determination of spiramycin and neospiramycin in plasma and milk of lactating cows by reversed-phase high-performance liquid chromatography. J Chromatogr B Biomed Appl 1994; 657:219-26. [PMID: 7952072 DOI: 10.1016/0378-4347(94)80091-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
After chloroform extraction, the rapid and sensitive determination of spiramycin and neospiramycin can be performed with AASP-diol clean-up cartridges prior to reversed-phase C18 high-performance liquid chromatography. The limits of quantification of spiramycin in plasma and milk are 0.023 and 0.013 microgram/ml, respectively, and those of neospiramycin, are 0.058 and 0.006 microgram/ml, respectively. Application of the method to the analysis of plasma and milk samples obtained from pharmacokinetic studies is described. Spiramycin has a terminal half-life of 14.27 h in plasma and 34.59 h in milk, while neospiramycin has a half-life of 25.62 h in plasma and 105.85 h in milk.
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Affiliation(s)
- L Renard
- Centre National d'Etudes Vétérinaires et Alimentaires, Laboratoire des Médicaments Vétérinaires, Fougères, France
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Amiot L, Drénou B, Lamy T, Renard L, Fauchet R. Quantitative expression of major histocompatibility complex (MHC) on human normal and leukemic myeloid cells. Hum Immunol 1994. [DOI: 10.1016/0198-8859(94)90225-9] [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: 10/27/2022]
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Renard L. [Depression in adolescence]. Soins Psychiatr 1993:4-13. [PMID: 8115863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Richard F, Renard L, Bonte J, van Dam J, Wambersie A. Neutron therapy of locally advanced uterine cervix carcinoma at Louvain-la-Neuve. Strahlenther Onkol 1990; 166:69-71. [PMID: 2405534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- F Richard
- UCL-Cliniques Universitaires St-Luc, Bruxelles, Belgium
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Richard F, Renard L, Wambersie A. Neutron therapy of soft tissue sarcoma at Louvain-la-Neuve (interim results 1987). Strahlenther Onkol 1989; 165:306-8. [PMID: 2711339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The results of fast neutron therapy of soft tissue sarcoma at the cyclotron of Louvain-la-Neuve are reviewed. 75 patients were analysed, the follow-up ranged from six to 102 months (mean: 30.7 months). 47 patients were treated after radical surgery. A local control rate of 91.5% (43/47) was achieved, and 70% of the patients are alive. 28 patients were irradiated with gross tumour present at the time of neutron therapy (recurrence, incomplete resection, inoperable): a local control was achieved in 5/28 cases (18%), and 68% of the patients are alive. A complication rate of 16% was recorded which was directly related to the treatment volume.
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Affiliation(s)
- F Richard
- Université Catholique de Louvain, Unité de Radiothérapie, Neutron- et Curiethérapie, Cliniques Universitaires St-Luc, Bruxelles, Belgium
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Renard L, Lageix P, Losson M. [Are adolescence and institutions opposed?]. Sante Ment Que 1988; 13:135-43. [PMID: 17093601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
After reviewing and putting into perspective the general situation of institutions, the authors concentrate on the institutional aspects of the normal process of adolescence; the room given to psychopathological mechanisms in the transactions of certain adolescents with the institutions ; the usefulness of institutional formalization in setting up therapeutic environments and activities.
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Renard L, Jeammet P. [Specificity and diversity of psychopathology in the adolescent. Apropos of symptoms and behaviors involving the body]. Ann Pediatr (Paris) 1986; 33:663-9. [PMID: 3800231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Richard F, Renard L, Wambersie A. Results of neutron therapy of locally advanced soft tissue sarcomas at Louvain-la-Neuve. Strahlentherapie 1985; 161:794-6. [PMID: 4082215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Between March 1978 and October 1983, 65 patients with locally advanced soft tissue sarcomas were treated at the cyclotron of Louvain-la-Neuve. 46 patients are analysed, 19 patients with intraabdominal or intrathoracic lesions are excluded. After "radical surgery" (no "gross tumour" present at the time of neutron therapy), a local control rate of 93% was achieved (25/27 patients) and the survival was 74%. In a second group of 19 patients with incompletely resected, or recurrent, or inoperable tumour, a local control was obtained in four cases (21%), and 13 patients were alive (69%). The follow-up ranged from three to 65 months (mean: 25,9 months). Ten severe complications were observed (22%); they were related to the field sizes, which reflected the local tumour extent.
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Servais JP, Lempereur J, Renard L, Leroy V. Examination by ESCA of the Constitution and Effects on Lacquer Adhesion of Passivation Films on Tinplate. ACTA ACUST UNITED AC 1979. [DOI: 10.1179/bcj.1979.14.3.126] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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