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Mula-Hussain L, Lum K, Alaslani O, Bebedjian R, Grimard L, Sinclair J, Dos Santos MP. Perimesencephalic subarachnoid hemorrhage as a rare delayed complication of radiation therapy in a patient with parotid basaloid squamous cell carcinoma. J Med Imaging Radiat Sci 2024:S1939-8654(24)00017-1. [PMID: 38418293 DOI: 10.1016/j.jmir.2024.02.006] [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: 09/30/2023] [Revised: 01/08/2024] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
In this case report, we address a rare entity of parotid cancer: basaloid squamous cell carcinoma, which was surgically unresectable and had thus far only been treated with radiation therapy. Following twenty years of continuous remission, our patient presented with an acute perimesencephalic subarachnoid hemorrhage. The cause of the acute perimesencephalic subarachnoid hemorrhage was a delayed complication of radiation therapy.
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Affiliation(s)
- Layth Mula-Hussain
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Keanu Lum
- Department of Radiology, Radiation Oncology and Medical Physics, Section of Diagnostic and Interventional Neuroradiology, The Ottawa Hospital; Ottawa, ON, Canada
| | - Ohoud Alaslani
- Department of Radiology, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Razmik Bebedjian
- Department of Medicine, Neurology Division, The Ottawa Hospital; University of Ottawa; Ottawa, ON, Canada
| | - Laval Grimard
- Department of Radiology, Radiation Oncology and Medical Physics, The Ottawa Hospital; Ottawa, ON, Canada
| | - John Sinclair
- Department of Surgery, Neurosurgery Division, The Ottawa Hospital; University of Ottawa; Ottawa, ON, Canada
| | - Marlise P Dos Santos
- Department of Radiology, Radiation Oncology and Physics, Section of Diagnostic and Interventional Neuroradiology, The Ottawa Hospital; Associate Professor of Radiology, University of Ottawa; Clinician Investigator, Neurosciences Program, Ottawa Hospital Research Institute; Scientist, Brain and Mind Research Institute; Ottawa ON, Canada.
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Whelan TJ, Smith S, Nielsen TO, Parpia S, Fyles AW, Bane A, Liu FF, Grimard L, Stevens C, Bowen J, Provencher S, Rakovitch E, Theberge V, Mulligan AM, Akra MA, Voduc KD, Hijal T, Dayes IS, Pond GR, Levine MN. LUMINA: A prospective trial omitting radiotherapy (RT) following breast conserving surgery (BCS) in T 1N 0 luminal A breast cancer (BC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.17_suppl.lba501] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA501 Background: Adjuvant breast RT is usually prescribed following BCS to reduce the risk of local recurrence (LR). However, this treatment is inconvenient, costly, and associated with acute and late toxicity. Traditional clinical pathological factors (CPFs) alone are limited in their ability to identify women with a low enough risk of LR to omit RT. Molecular defined intrinsic subtypes of BC provide additional prognostic information with luminal A having the lowest risk of recurrence. A retrospective analysis of a previous trial suggested that women >60 years with luminal A grade 1-2 T1N0 BC treated by BCS and endocrine therapy alone had a low rate of LR ( JCO 2015; 33:2035). The utility of identifying luminal A subtype combined with CPFs has not been prospectively evaluated for its ability to guide RT decision-making. Methods: A prospective multicenter cohort study was performed. Eligibility criteria were: women ≥ 55 years; having undergone BCS for grade 1-2 T1N0 BC; ≥ 1mm margins of excision; luminal A subtype (defined as: ER ≥ 1%, PR>20%, HER2 negative and Ki67 ≤ 13.25%); and treated with adjuvant endocrine therapy. ER, PR and HER2 were performed locally as per ASCO guidelines. Patients meeting clinical eligibility with ER ≥ 1%, PR>20%, HER2 negative BC were registered and had Ki67 immunohistochemistry performed centrally in one of three Canadian laboratories using International Ki67 Working Group methods. Proficiency testing between laboratories was performed yearly. Patients with Ki67 ≤ 13.25% were enrolled in the trial and were assigned to not receive RT. The primary outcome was LR defined as time from enrollment to any invasive or non-invasive cancer in the ipsilateral breast. Assuming a 5-year LR rate of 3.5%, 500 patients were required to show that the upper bound of a two sided 90% (one-sided 95%) confidence interval (CI) was <5%. Patients were followed every six months for the first two years and then yearly. The probability of LR was estimated using the cumulative incidence function with death as a competing risk. Secondary outcomes were contralateral BC; relapse free survival (RFS) based on any recurrence; disease free survival (DFS) based on any recurrence, second cancer or death; and overall survival (OS). Results: From August 2013 to July 2017, 501 of 727 registered patients from 26 centers had a Ki67 ≤ 13.25% and were enrolled. Median follow-up was 5 years. Median age was 67 and 442 (88%) patients were <75 years. Median tumor size was 1.1 cm. The 5-year rate of LR satisfied our pre-specified boundary (see Table). Conclusions: Women ≥ 55 years with grade 1-2 T1N0 luminal A BC following BCS treated with endocrine therapy alone had very low rates of LR at 5 years and are candidates for omission of RT. Clinical trial information: NCT01791829. [Table: see text]
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Affiliation(s)
| | | | - Torsten O. Nielsen
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, BC, Canada
| | - Sameer Parpia
- Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada
| | - Anthony W. Fyles
- Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, ON, Canada
| | - Anita Bane
- Toronto General Hospital - UHN, Toronto, ON, Canada
| | - Fei-Fei Liu
- Princess Margaret Cancer Centre - UHN, Toronto, ON, Canada
| | | | | | - Julie Bowen
- Northeast Cancer Centre/Health Sciences North, Sudbury, ON, Canada
| | - Sawyna Provencher
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | | | | | | | - Mohamed A. Akra
- CancerCare Manitoba/University of Manitoba, Winnipeg, MB, Canada
| | | | - Tarek Hijal
- McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Mark Norman Levine
- Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada
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Arnaout A, Varela NP, Allarakhia M, Grimard L, Hey A, Lau J, Thain L, Eisen A. Baseline staging imaging for distant metastasis in women with stages I, II, and III breast cancer. ACTA ACUST UNITED AC 2020; 27:e123-e145. [PMID: 32489262 DOI: 10.3747/co.27.6147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background In Ontario, there is no clearly defined standard of care for staging for distant metastasis in women with newly diagnosed and biopsy-confirmed breast cancer whose clinical presentation is suggestive of early-stage disease. This guideline addresses baseline imaging investigations for women with newly diagnosed primary breast cancer who are otherwise asymptomatic for distant metastasis. Methods The medline and embase databases were systematically searched for evidence from January 2000 to April 2019, and the best available evidence was used to draft recommendations relevant to the use of baseline imaging investigation in women with newly diagnosed primary breast cancer who are otherwise asymptomatic. Final approval of this practice guideline was obtained from both the Staging in Early Stage Breast Cancer Advisory Committee and the Report Approval Panel of the Program in Evidence-Based Care. Recommendations These recommendations apply to all women with newly diagnosed primary breast cancer (originating in the breast) who have no symptoms of distant metastasis Staging tests using conventional anatomic imaging [chest radiography, liver ultrasonography, chest-abdomen-pelvis computed tomography (ct)] or metabolic imaging modalities [integrated positron-emission tomography (pet)/ct, integrated pet/magnetic resonance imaging (mri), bone scintigraphy] should not be routinely ordered for women newly diagnosed with clinical stage i or stage ii breast cancer who have no symptoms of distant metastasis, regardless of biomarker status. In women newly diagnosed with stage iii breast cancer, baseline staging tests using either anatomic imaging (chest radiography, liver ultrasonography, chest-abdomen-pelvis ct) or metabolic imaging modalities (pet/ct, pet/mri, bone scintigraphy) should be considered regardless of whether the patient is symptomatic for distant metastasis and regardless of biomarker profile.
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Affiliation(s)
- A Arnaout
- Department of Surgery, The Ottawa Hospital and The University of Ottawa, Ottawa, ON
| | - N P Varela
- Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), and Department of Oncology, McMaster University, Hamilton, ON
| | - M Allarakhia
- Patient Representative, The Ottawa Hospital, Ottawa, ON
| | - L Grimard
- Department of Radiation Medicine, The Ottawa Hospital, Ottawa, ON
| | - A Hey
- Regional Primary Care, Northeast Cancer Centre, Sudbury, ON
| | - J Lau
- Department of Radiology, The University of Ottawa, Ottawa, ON
| | - L Thain
- Ontario Health (Cancer Care Ontario) Regional Imaging, Southlake Regional Health Centre, Newmarket, and Mackenzie Health, Richmond Hill, ON
| | - A Eisen
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON
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Rakovitch E, Koch A, Grimard L, Soliman H, Stevens C, Perera F, Kong I, Senthelal S, Anthes M, Wiebe E, Cao J, Goldberg M, Smith S, Spadafora L, Parpia S, Whelan T. Abstract P6-16-01: Refined local recurrence risk estimates based on a multigene expression assay combined with clinicopathological features significantly impacts radiotherapy recommendation in patients with low/intermediate risk DCIS treated with breast-conserving surgery. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p6-16-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Guidelines recommend that breast radiation (RT) can be omitted for patients with a low risk of local recurrence (LR) after breast-conserving surgery (BCS) for DCIS. The inability to identify women at low risk of LR (<10%) at 10 years after BCS has hampered efforts to de-escalate therapy for DCIS. The Oncotype DX Breast DCIS Score® (DS), a 12-gene expression assay, predicts LR risk after BCS. The revised DS report adds information from the DS with clinicopathological features (CPF) (age, tumor size, year) (BCRT 2018;169;358-690) to provide refined estimates of LR risk and can better identify patients with low 10-year LR risk (<10%) after BCS. We evaluated the impact of refined LR risk estimates on its ability to change radiation oncologists’ recommendations for RT in women with low/moderate risk DCIS treated with BCS.
Methods: Prospective cohort study of women with low/moderate risk pure DCIS treated with BCS. Cases with age <45 yrs, margins <1mm, tumor >2.5cm, multifocality, or prior breast cancer were excluded. Baseline CPFs, the DS and risk of LR were collected. Pre-assay, the radiation oncologist provided an estimate of 10-year LR risk without RT and a preliminary recommendation for RT. Post-assay, final recommendations were recorded. The primary outcome was change in treatment recommendation by the radiation oncologist. Target sample size was 220 to provide data on 200 evaluable patients with adequate precision.
Results: 217 patients were evaluable: mean age, 63 years and mean tumor size, 1.1 cm. Nuclear grade was low in 26 (12%), intermediate in 116 (53%), and high in 75 (35%) of patients. Mean DS = 32; 140 (64%) low (<39), 32 (15%) intermediate (39-54), 45 (21%) high risk DS (≥5). The assay lead to a change in treatment recommendation in 35.2% (76/216) (95% CI: 29.1-41.8) of cases. The proportion of cases recommended to receive RT decreased from 79% (N=171) pre-assay to 50% post-assay (p<.001). This was due to a significant increase in the proportion of cases (46%) with a predicted low risk of LR (<10%) post-assay and recommendations to omit RT for those with low LR risk. Pre-assay, physician estimates of 10-yr LR risks after BCS based on CPFs alone were <10% in 13 (6%) cases, 10-15% in 76 (35%) cases and >15% in 128 (59%) cases. Post-assay, estimated 10-yr LR risk after BCS was <10% in 101 (46%) patients (83% recommended no RT), 10-15% in 67 (31%) (RT recommended in 66%) and >15% in 49 (22%) (RT recommended in 98%).
Conclusion: The use of the DCIS Score combined with CPFs identifies more women with an estimated low (<10%) 10-yr LR risk after BCS leading to a significant change in treatment recommendations with a decrease in recommendations for RT following BCS compared to CPFs alone.
Table 1.Post-assay 10-yr LR risk<10%10-15%>15%(N=101)(N= 67)(N=49)Pre-assay estimated 10-yr LR risk• <10% (N=13)922• 10-15% (N=76)50188• >15% (N=128)424739RT recommended• Yes17 (17%)44 (66%)48 (98%)• No83 (83%)23 (34%)1 (2%)
Citation Format: Eileen Rakovitch, Anne Koch, Laval Grimard, Hany Soliman, Christiaan Stevens, Francisco Perera, Iwa Kong, Senti Senthelal, Margaret Anthes, Ericka Wiebe, Jeffrey Cao, Mira Goldberg, Sally Smith, Luciana Spadafora, Sameer Parpia, Timothy Whelan. Refined local recurrence risk estimates based on a multigene expression assay combined with clinicopathological features significantly impacts radiotherapy recommendation in patients with low/intermediate risk DCIS treated with breast-conserving surgery [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-16-01.
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Affiliation(s)
- Eileen Rakovitch
- 1Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Anne Koch
- 2Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Laval Grimard
- 3The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Hany Soliman
- 1Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Francisco Perera
- 5London Regional Cancer Centre, University of Western Ontario, London, ON, Canada
| | - Iwa Kong
- 6Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Margaret Anthes
- 8Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Ericka Wiebe
- 9Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey Cao
- 10Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Mira Goldberg
- 6Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Sally Smith
- 11BC Cancer Agency, University of British Columbia, Victoria, BC, Canada
| | - Luciana Spadafora
- 6Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Sameer Parpia
- 6Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Timothy Whelan
- 6Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
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Goldberg M, Parpia S, Rakovitch E, Grimard L, Bowen J, Lukka H, Perera F, Fyles T, Whelan T. Long-Term Outcomes of Microinvasive Breast Cancer in the Canadian Hypofractionation Trial. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Jesse N Aronowitz
- Department of Radiation Oncology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Laval Grimard
- Department of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
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Goel R, Jain C, Xu Y, Al-Thaqfi S, Grimard L. 2324 Anal Cancer (AC): Chemotherapy treatment trends over time from 1989 to 2010 at the Ottawa Hospital Cancer Centre, Ottawa, Canada. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31240-0] [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: 10/22/2022]
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Affiliation(s)
- B Pierquin
- Centre Hospitalo-Universitaire Henri-Mondor, Créteil, France
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Affiliation(s)
- B Pierquin
- Centre Hospitalo-Universitaire Henri-Mondor, Créteil, France
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Caudrelier JM, Meng J, Esche B, Grimard L, Ruddy T, Amjadi K. IMRT sparing of normal tissues in locoregional treatment of breast cancer. Radiat Oncol 2014; 9:161. [PMID: 25052720 PMCID: PMC4223821 DOI: 10.1186/1748-717x-9-161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 07/12/2014] [Indexed: 12/25/2022] Open
Abstract
Purpose This clinical study was designed to prospectively evaluate the acute and moderately-late cardiac and lung toxicities of intensity modulated radiation therapy delivered by helical tomotherapy (IMRT-HT) for locoregional breast radiation treatment including the internal mammary nodes (IMN). Material/methods 30 patients with stage III breast cancers have been accrued in this study. All patients received adjuvant chemotherapy. Target volumes were defined as follows: the PTV included breast/chest wall, axillary level II, III, infra/supraclavicular, IM nodes CTVs plus 3 mm margins. The heart with subunits and the lungs were defined as critical organs. Dose to PTV was 50 Gy in 25 fractions. Acute toxicities were assessed every week and 2 weeks post treatment using the CTCAE v3.0.scale. The moderately-late toxicities were assessed clinically plus by cardiac myoview perfusion tests scheduled at baseline, 3 and 12-month follow-up, as well a CT chest at the 6 month follow-up. The data analysis is descriptive. Results All participants completed the 5-week course of radiation without interruption. Skin erythema was modest and mainly grade 1–2 between the 3rd and the 5th week of radiation treatment. Only 4/30 patients experienced grade 3 skin reactions, mostly seen 2 weeks post radiation. Only 5 patients demonstrated grade 1 or 2 dyspnea, but 3 of them already had symptoms pre-radiation treatment. With a median follow-up of 58 (24–76) months, there have been infrequent moderately-late side effects. Most were grade 1 and were sometimes present at the baseline assessment. Cardiac myoview tests done at baseline and 1-year follow-up for 15 out of 18 left sided breast cancers did not show any abnormalities related to radiation. The 6-month follow-up chest CT-scans done for 25 out of 30 patients showed minimal anterior lung fibrosis for 7 patients and were completely normal for the other 18. No locoregional recurrence has been recorded and the 5-year survival is 78% (95% CI: 70-97%). Conclusion IMRT-HT for locoregional breast radiation is very well tolerated with minimal acute or moderately-late side effects. Cardiac and respiratory tests did not show any strong evidence of significant treatment related abnormalities. Trial registration clinicaltrials.gov: http://NCT00508352.
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Affiliation(s)
- Jean-Michel Caudrelier
- Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, 501, Smyth Rd, Ottawa, ON K1H8L6, Canada.
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Moyana TN, Kendal WS, Chatterjee A, Jonker DJ, Maroun JA, Grimard L, Shabana W, Mimeault R, Hakim SW. Role of Fine-Needle Aspiration in the Surgical Management of Pancreatic Neuroendocrine Tumors: Utility and Limitations in Light of the New World Health Organization Classification. Arch Pathol Lab Med 2014; 138:896-902. [DOI: 10.5858/arpa.2013-0300-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Pancreatic neuroendocrine tumors (Panc-NETs) are rare and tend to get overshadowed by their more prevalent and aggressive ductal adenocarcinoma counterparts. The biological behavior of PancNETs is unpredictable, and thus management is controversial. However, the new World Health Organization classification has significantly contributed to the prognostic stratification of these patients. Concurrently, there have been advances in surgical techniques for benign or low-grade pancreatic tumors. These procedures include minimally invasive and parenchyma-sparing operations such as laparoscopy and enucleation.
Objective.—To report on the utility and limitations of fine-needle aspiration in the preoperative evaluation and management of PancNETs.
Design.—This was a retrospective review of our institutional tumor database from 2002 to 2012. There were 25 cases of PancNETs that were localized and staged by medical imaging and diagnosed by fine-needle aspiration.
Results.—Fourteen patients underwent laparotomy, with some requiring only limited surgery; 4 had laparoscopic resections; 4 were serially observed without surgical intervention; and another 3 were inoperable. After a mean follow-up of 37 months, more than half of the patients had no evidence of disease, including most of those who underwent minimally invasive surgery.
Conclusions.—Fine-needle aspiration is a useful diagnostic adjunct to medical imaging in the preoperative evaluation and management of PancNETs. However, there are limitations with regard to grading PancNETs using this technique.
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Affiliation(s)
- Terence N. Moyana
- From the Departments of Pathology & Laboratory Medicine (Drs Moyana and Hakim) and Radiological Sciences (Dr Shabana) and the Divisions of Radiation Oncology (Drs Kendal and Grimard), Gastroenterology (Dr Chatterjee), Medical Oncology (Drs Maroun and Jonker), and Hepatobiliary Surgery (Dr Mimeault), The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Wayne S. Kendal
- From the Departments of Pathology & Laboratory Medicine (Drs Moyana and Hakim) and Radiological Sciences (Dr Shabana) and the Divisions of Radiation Oncology (Drs Kendal and Grimard), Gastroenterology (Dr Chatterjee), Medical Oncology (Drs Maroun and Jonker), and Hepatobiliary Surgery (Dr Mimeault), The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Avijit Chatterjee
- From the Departments of Pathology & Laboratory Medicine (Drs Moyana and Hakim) and Radiological Sciences (Dr Shabana) and the Divisions of Radiation Oncology (Drs Kendal and Grimard), Gastroenterology (Dr Chatterjee), Medical Oncology (Drs Maroun and Jonker), and Hepatobiliary Surgery (Dr Mimeault), The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Derek J. Jonker
- From the Departments of Pathology & Laboratory Medicine (Drs Moyana and Hakim) and Radiological Sciences (Dr Shabana) and the Divisions of Radiation Oncology (Drs Kendal and Grimard), Gastroenterology (Dr Chatterjee), Medical Oncology (Drs Maroun and Jonker), and Hepatobiliary Surgery (Dr Mimeault), The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Jean A. Maroun
- From the Departments of Pathology & Laboratory Medicine (Drs Moyana and Hakim) and Radiological Sciences (Dr Shabana) and the Divisions of Radiation Oncology (Drs Kendal and Grimard), Gastroenterology (Dr Chatterjee), Medical Oncology (Drs Maroun and Jonker), and Hepatobiliary Surgery (Dr Mimeault), The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Laval Grimard
- From the Departments of Pathology & Laboratory Medicine (Drs Moyana and Hakim) and Radiological Sciences (Dr Shabana) and the Divisions of Radiation Oncology (Drs Kendal and Grimard), Gastroenterology (Dr Chatterjee), Medical Oncology (Drs Maroun and Jonker), and Hepatobiliary Surgery (Dr Mimeault), The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Wael Shabana
- From the Departments of Pathology & Laboratory Medicine (Drs Moyana and Hakim) and Radiological Sciences (Dr Shabana) and the Divisions of Radiation Oncology (Drs Kendal and Grimard), Gastroenterology (Dr Chatterjee), Medical Oncology (Drs Maroun and Jonker), and Hepatobiliary Surgery (Dr Mimeault), The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Richard Mimeault
- From the Departments of Pathology & Laboratory Medicine (Drs Moyana and Hakim) and Radiological Sciences (Dr Shabana) and the Divisions of Radiation Oncology (Drs Kendal and Grimard), Gastroenterology (Dr Chatterjee), Medical Oncology (Drs Maroun and Jonker), and Hepatobiliary Surgery (Dr Mimeault), The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Shaheed W. Hakim
- From the Departments of Pathology & Laboratory Medicine (Drs Moyana and Hakim) and Radiological Sciences (Dr Shabana) and the Divisions of Radiation Oncology (Drs Kendal and Grimard), Gastroenterology (Dr Chatterjee), Medical Oncology (Drs Maroun and Jonker), and Hepatobiliary Surgery (Dr Mimeault), The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
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Smith B, Hamilton S, Grimard L. The Emotional and Psychological Impact of Treating Paediatrics on Front-line Radiation Therapists. J Med Imaging Radiat Sci 2013. [DOI: 10.1016/j.jmir.2013.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Di Valentin T, Alam Y, Ali Alsharm A, Arif S, Aubin F, Biagi J, Booth CM, Bourque S, Burkes R, Champion P, Colwell B, Cripps C, Dallaire M, Dorreen M, Finn N, Frechette D, Gallinger S, Gapski J, Giacomantonio C, Gill S, Goel R, Goodwin R, Grimard L, Grothey A, Hammad N, Hedley D, Jhaveri K, Jonker D, Ko Y, L'espérance M, Maroun J, Ostic H, Perrin N, Rother M, St-Hilaire E, Tehfe M, Thirlwell M, Welch S, Yarom N, Asmis T. Eastern Canadian colorectal cancer consensus conference: application of new modalities of staging and treatment of gastrointestinal cancers. Curr Oncol 2012; 19:169-74. [PMID: 22670096 PMCID: PMC3364767 DOI: 10.3747/co.19.931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Ottawa, Ontario, October 22-23, 2010. Health care professionals involved in the care of patients with colorectal cancer participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancer, such as the use of epidermal growth factor inhibitors in metastatic colon cancer, the benefit of calcium and magnesium with oxaliplatin chemotherapy, the role of microsatellites in treatment decisions for stage II colon cancer, the staging and treatment of rectal cancer, and the management of colorectal and metastatic pancreatic cancers.
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Grimard L, Stern H. PO-409 LOCAL EXCISION AND BRACHYTHERAPY FOR SPHINCTER PRESERVATION IN RECTAL CANCER: RESULTS ON A COHORT OF 70 PATIENTS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)72375-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Clark B, Brown R, Ploquin J, Kind A, Grimard L, Dunscombe P. WE-C-214-06: Patient Safety Improvement through Incident Learning in Radiation Treatment - Four Years Experience. Med Phys 2011. [DOI: 10.1118/1.3613337] [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: 11/07/2022] Open
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Clark BG, Brown RJ, Ploquin JL, Kind AL, Grimard L. The management of radiation treatment error through incident learning. Radiother Oncol 2010; 95:344-9. [DOI: 10.1016/j.radonc.2010.03.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 03/14/2010] [Accepted: 03/20/2010] [Indexed: 10/19/2022]
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Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, Shelley W, Grimard L, Bowen J, Lukka H, Perera F, Fyles A, Schneider K, Gulavita S, Freeman C. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 2010; 362:513-20. [PMID: 20147717 DOI: 10.1056/nejmoa0906260] [Citation(s) in RCA: 1171] [Impact Index Per Article: 83.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The optimal fractionation schedule for whole-breast irradiation after breast-conserving surgery is unknown. METHODS We conducted a study to determine whether a hypofractionated 3-week schedule of whole-breast irradiation is as effective as a 5-week schedule. Women with invasive breast cancer who had undergone breast-conserving surgery and in whom resection margins were clear and axillary lymph nodes were negative were randomly assigned to receive whole-breast irradiation either at a standard dose of 50.0 Gy in 25 fractions over a period of 35 days (the control group) or at a dose of 42.5 Gy in 16 fractions over a period of 22 days (the hypofractionated-radiation group). RESULTS The risk of local recurrence at 10 years was 6.7% among the 612 women assigned to standard irradiation as compared with 6.2% among the 622 women assigned to the hypofractionated regimen (absolute difference, 0.5 percentage points; 95% confidence interval [CI], -2.5 to 3.5). At 10 years, 71.3% of women in the control group as compared with 69.8% of the women in the hypofractionated-radiation group had a good or excellent cosmetic outcome (absolute difference, 1.5 percentage points; 95% CI, -6.9 to 9.8). CONCLUSIONS Ten years after treatment, accelerated, hypofractionated whole-breast irradiation was not inferior to standard radiation treatment in women who had undergone breast-conserving surgery for invasive breast cancer with clear surgical margins and negative axillary nodes. (ClinicalTrials.gov number, NCT00156052.)
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Affiliation(s)
- Timothy J Whelan
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada.
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Haddad A, El-Sayed S, Zohr R, Belec J, Eapen L, Esche B, Grimard L. A Prospective Trial of Helical Tomotherapy (HT) in Patients with Head and Neck Cancer (HNC): Results of Dosimetric Comparisons with Three-Dimensional Conformal Radiotherapy (3D-CRT). Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grimard L, Stern H, Spaans JN. Brachytherapy and local excision for sphincter preservation in T1 and T2 rectal cancer. Int J Radiat Oncol Biol Phys 2009; 74:803-9. [PMID: 19250765 DOI: 10.1016/j.ijrobp.2008.08.075] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 08/21/2008] [Accepted: 08/21/2008] [Indexed: 12/23/2022]
Abstract
PURPOSE To report long-term results of brachytherapy after local excision (LE) in the treatment of T1 and T2 rectal cancer at risk of recurrence due to residual subclinical disease. METHODS AND MATERIALS Between 1989 and 2007, 32 patients undergoing LE and brachytherapy were followed prospectively for a mean of 6.2 years. Estimates of local recurrence (LR), disease-specific survival (DSS), and overall survival (OS) were generated. Treatment-related toxicity and the effect of known prognostic factors were determined. RESULTS There were 8 LR (3 T1, 5 T2), of which 5 were salvaged surgically. Median time to the 8 LR was 14 months, and the 5-year rate of local control was 76%. Although there have been 9 deaths to date, only 5 were from disease. Five-year DSS and OS rates were 85% and 78%, respectively. There were 4 cases of Grade 2-3 radionecrosis and 1 case of mild stool incontinence. The sphincter was preserved in 27 of 32 patients. CONCLUSION Local excision and adjuvant brachytherapy for T1 and T2 rectal cancer is an appealing treatment alternative to immediate radical resection, particularly in the frail and elderly who are unable to undergo major surgery, as well as for patients wanting to avoid a permanent colostomy.
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Affiliation(s)
- Laval Grimard
- Division of Radiation Oncology, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada.
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Bjarnason GA, MacKenzie RG, Nabid A, Hodson ID, El-Sayed S, Grimard L, Brundage M, Wright J, Hay J, Ganguly P, Leong C, Wilson J, Jordan RC, Walker M, Tu D, Parulekar W. Comparison of Toxicity Associated With Early Morning Versus Late Afternoon Radiotherapy in Patients With Head-and-Neck Cancer: A Prospective Randomized Trial of the National Cancer Institute of Canada Clinical Trials Group (HN3). Int J Radiat Oncol Biol Phys 2009; 73:166-72. [DOI: 10.1016/j.ijrobp.2008.07.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 07/02/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
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21
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Crook J, Ma C, Esche B, Grimard L, Jezioranski J. POD-2.11: Brachytherapy for Squamous Carcinoma of the Penis: A Penile Conserving Option. Urology 2008. [DOI: 10.1016/j.urology.2008.08.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Whelan T, Pignol J, Julian J, Grimard L, Bowen J, Perera F, Schneider K, Shelley W, Fyles A, Levine M. Long-term Results of a Randomized Trial of Accelerated Hypofractionated Whole Breast Irradiation Following Breast Conserving Surgery in Women with Node-Negative Breast Cancer. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.829] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [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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Crook J, Ma C, Grimard L. Radiation therapy in the management of the primary penile tumor: an update. World J Urol 2008; 27:189-96. [PMID: 18636264 DOI: 10.1007/s00345-008-0309-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 07/01/2008] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Squamous carcinoma of the penis is rare but psychologically devastating and potentially fatal. Radiotherapy offers a penile-conserving treatment option without jeopardizing cure. We have used primary penile brachytherapy as the treatment of choice for T1, T2 and selected T3 patients since 1989 and present updated results for 67 patients. METHODS Mean age was 60 years (range 22-93). Stage was T1 in 56%, T2: 33%, T3: 8%, and Tx: 3%. Grade was moderate or poorly differentiated in 48%. In Toronto after-loading pulse dose rate (PDR) brachytherapy (n = 41) was used for all treatments while Ottawa used manually loaded Iridium(192) (n = 26). Two or three parallel planes of needles (median 6) were inserted using pre-drilled lucite templates for guidance and fixation; 60 Gy was delivered over 4-5 days. RESULTS Median follow-up is 4 years (range 0.2-16.2). At 10 years, actuarial overall survival is 59%, cause specific survival 83.6%. Nine men died of penile cancer and eight of other causes with no evidence of recurrence. Penectomy was required for eight local failures and two necroses, for an actuarial penile preservation rate at 5 years of 88% and 10 years of 67%. The soft tissue necrosis rate is 12% and the urethral stenosis rate 9%. Six of 11 regional failures were salvaged by lymph node dissection +/- external radiation. The other five all had concurrent distant failure and died of disease. CONCLUSIONS Brachytherapy is an effective treatment for T1, T2 and selected T3 SCC of the penis. Close follow-up is mandatory as local failures and many regional failures can be salvaged by surgery.
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Affiliation(s)
- Juanita Crook
- Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
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Clark BG, Brown R, Kind A, Wilkins D, Grimard L. Sci-Thurs PM: Delivery-05: One year of learning from incidents. Med Phys 2008; 35:3400. [PMID: 28512798 DOI: 10.1118/1.2965912] [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] [Indexed: 11/07/2022] Open
Abstract
The aim of this study is to quantify the effect of an incident learning system in radiation therapy. The system is designed to detect all occurrences of "an unwanted or unexpected change from a normal system behaviour that causes or has the potential to cause an adverse effect to persons or equipment". Our application to radiation therapy defines 5 incident types, four levels of severity and four work domains where errors discovered during routine quality assurance within each domain were not classified as incidents. During 2007, we recorded, corrected, investigated, determined root cause and learned from 657 incidents. The vast majority of these incidents were classified as potential minor clinical incidents having little or no impact on patient treatment. The value of the system lies in the application of the learning portion of the investigation. We demonstrated a dramatic reduction in the rate of more severe incidents by the implementation of several simple tools. Our results also show a reduction of incidents on accelerators treating essentially a single disease site. The only treatment unit treating with both image guidance and intensity modulation recorded the fewest incidents while the cobalt unit with the least technological assistance recorded three times the average treatment unit incidents with a higher severity. Additionally, although the rate of incidents at the point of treatment delivery was low, the impact of those incidents was substantially higher than that of incidents originating during treatment planning. This system has proven to be a powerful program management tool.
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Affiliation(s)
- B G Clark
- Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - R Brown
- Radiation Therapy, The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - A Kind
- Radiation Therapy, The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - D Wilkins
- Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - L Grimard
- Radiation Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON
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Harvey J, Grimard L, Esche B, Lamothe A, Spaans J. Brachytherapy for T1-T2 tonsillar carcinoma: Long-term results on 38 patients. Brachytherapy 2008. [DOI: 10.1016/j.brachy.2008.02.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grimard L, Lamothe A, Esche B, Spaans JN. Brachytherapy in the retreatment of patients with new primary head and neck cancer. J Otolaryngol 2007; 36:327-335. [PMID: 18076842] [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: 05/25/2023]
Abstract
OBJECTIVE Re-treatment for cure of the Head and Neck (H&N) region is therapeutically challenging. In this review we explore the long-term results of Ir(192) low-dose-rate (LDR) brachytherapy in the select subgroup of patients treated for a new H&N malignancy. METHODS & MATERIAL Thirteen patients received brachytherapy between 1987-2004 for a new primary H&N cancer, six of whom had been retreated previously. Brachytherapy was given as a monotherapy in eight patients and delivered adjuvantly in five patients. Three of the thirteen patients had advanced disease at the time of diagnosis. MAIN OUTCOME MEASURES In addition to the known prognostic factors of stage and site, intent of brachytherapy and prior re-treatment status were assessed for their influence on local control (LC) and overall survival (OS). RESULTS Local control differed by disease stage of the new primary tumor. With a median follow-up of 50 months, mean progression-free survival was 50.2 months [95%CI = 30.1-70.4] and the 2-year rate of LC was 58%. Adjuvant brachytherapy following surgery resulted in poor LC and OS due to advanced disease at diagnosis. Prior retreatment did not appear to affect LC or OS. OS at 2 and 5 years was 69% and 38%, respectively. There were no cases of grade III toxicity. CONCLUSIONS LDR Brachytherapy for a new primary H&N cancer is a well-tolerated retreatment alternative that results in good local control. Our results suggest that the best chance for long-term survival remains in the routine follow-up and early diagnosis of the new H&N malignancy.
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Affiliation(s)
- Laval Grimard
- Department of Radiation Oncology, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada
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Grimard L, Stern H. 2169. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Clark B, Montgomery L, Fox G, Carty K, MacPherson M, Malone S, MacRae R, Gerig L, Grimard L. 188 Implementation and workflow for a clinical tomotherapy unit. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80929-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grimard L, Stern H. 147 Brachytherapy for rectal cancer and sphincter preservation. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80888-1] [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: 11/25/2022]
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Abstract
OBJECTIVES Cerebral vascular disease has been reported as a long-term complication of cranial radiotherapy. The purpose of this study was to examine the frequency and risk factors associated with development of cerebral vascular disease in children after cranial radiation. MATERIALS AND METHODS A retrospective chart review of all cancer patients treated between 1985 and 2003 who were under the age of 18 years at the time of initial radiotherapy was performed. Variables examined include diagnosis and site of malignancy, age at the time of radiotherapy, sex, total radiation dosage, number of fractions, duration, and whether the patient had proven cerebral vascular event. RESULTS Two hundred and forty-four patients met the study criteria. One hundred and 13 cases involved tumors of the central nervous system. The remaining patients had systemic neoplastic disease. Post radiation cerebral vascular disease occurred in 11 (5%) patients, and all but one patient had a tumor involving the central nervous system (mainly in the posterior fossa and supratentorial midline). CONCLUSION There is an increased risk of cerebral vascular disease after radiation therapy in childhood, especially in children who received high dose radiation at the posterior fossa and supratentorial axial region.
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Affiliation(s)
- Daniel L Keene
- Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.
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Grimard L, Esche B, Lamothe A, Cygler J, Spaans J. Interstitial low-dose-rate brachytherapy in the treatment of recurrent head and neck malignancies. Head Neck 2006; 28:888-95. [PMID: 16721742 DOI: 10.1002/hed.20422] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [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: 11/10/2022] Open
Abstract
BACKGROUND Recurrent head and neck malignancies are therapeutically challenging. Brachytherapy is a retreatment alternative to external-beam radiation therapy (EBRT). METHODS Patients receiving brachytherapy during 1987-2004 for recurrent head and neck cancer were identified. Tumor and treatment characteristics and toxicities were recorded. Progression-free survival (PFS) and overall survival (OS) estimates were generated. The influence of prognostic factors was determined. RESULTS Eighty-two patients were analyzable. Analysis was limited to patients who had brachytherapy for a first recurrence (n = 45). Brachytherapy (> or = 55 Gy) was a monotherapy in 22 of 45 patients. As part of their salvage brachytherapy treatments, 14 patients also underwent surgery; 3 patients also underwent EBRT; and 6 patients underwent surgery, EBRT, and brachytherapy. Retreatment morbidity included acute toxicity (n = 7) and late toxicity (n = 18). Median PFS was 15 months, and locoregional control rates at 1 and 2 years were 50% and 37%, respectively. Time to progression differed by site of the primary tumor (p = .10). Median OS was 16 months, and OS at 2 and 5 years was 33% and 11%, respectively. CONCLUSIONS Brachytherapy for recurrent head and neck cancer has an acceptable toxicity profile and is viable alternative to EBRT. Further optimization of the best sites and doses for neck brachytherapy is required.
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Affiliation(s)
- Laval Grimard
- Department of Radiation Oncology, Ottawa Hospital Regional Cancer Centre, 503 Smyth Road, Ottawa, Ontario, Canada K1H 1C4.
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Cheung A, Grimard L, Lamothe A, Esche B, Cygler J, Gallant V. 189 Brachytherapy for squamous cell carcinoma of the nasal vestibule. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)80350-0] [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: 10/23/2022]
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Crook JM, Jezioranski J, Grimard L, Esche B, Pond G. Penile brachytherapy: results for 49 patients. Int J Radiat Oncol Biol Phys 2005; 62:460-7. [PMID: 15890588 DOI: 10.1016/j.ijrobp.2004.10.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [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: 08/12/2004] [Accepted: 10/18/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To report results for 49 men with squamous cell carcinoma (SCC) of the penis treated with primary penile interstitial brachytherapy at one of two institutions: the Ottawa Regional Cancer Center, Ottawa, and the Princess Margaret Hospital, Toronto, Ontario, Canada. METHODS AND MATERIALS From September 1989 to September 2003, 49 men (mean age, 58 years; range, 22-93 years) had brachytherapy for penile SCC. Fifty-one percent of tumors were T1, 33% T2, and 8% T3; 4% were in situ and 4% Tx. Grade was well differentiated in 31%, moderate in 45%, and poor in 2%; grade was unspecified for 20%. One tumor was verrucous. All tumors in Toronto had pulsed dose rate (PDR) brachytherapy (n = 23), whereas those in Ottawa had either Iridium wire (n = 22) or seeds (n = 4). Four patients had a single plane implant with a plastic tube technique, and all others had a volume implant with predrilled acrylic templates and two or three parallel planes of needles (median, six needles). Mean needle spacing was 13.5 mm (range, 10-18 mm), mean dose rate was 65 cGy/h (range, 33-160 cGy/h), and mean duration was 98.8 h (range, 36-188 h). Dose rates for PDR brachytherapy were 50-61.2 cGy/h, with no correction in total dose, which was 60 Gy in all cases. RESULTS Median follow-up was 33.4 months (range, 4-140 months). At 5 years, actuarial overall survival was 78.3% and cause-specific survival 90.0%. Four men died of penile cancer, and 6 died of other causes with no evidence of recurrence. The cumulative incidence rate for never having experienced any type of failure at 5 years was 64.4% and for local failure was 85.3%. All 5 patients with local failure were successfully salvaged by surgery; 2 other men required penectomy for necrosis. The soft tissue necrosis rate was 16% and the urethral stenosis rate 12%. Of 8 men with regional failure, 5 were salvaged by lymph node dissection with or without external radiation. All 4 men with distant failure died of disease. Of 49 men, 42 had an intact and tumor-free penis at last follow-up or death. The actuarial penile preservation rate at 5 years was 86.5%. CONCLUSIONS Brachytherapy is an effective treatment for T1, T2, and selected T3 SCC of the penis. Close follow-up is mandatory because local failures and many regional failures can be salvaged by surgery.
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Affiliation(s)
- Juanita M Crook
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada.
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Cygler J, Berrang T, Esche B, Shokrani P, Lochrin C, Grimard L. SU-FF-T-287: Effect of Tissue Inhomogeneitis on MU Required to Deliver Prescribed Dose - Monte Carlo Study. Med Phys 2005. [DOI: 10.1118/1.1998016] [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: 11/07/2022] Open
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Cygler JE, Lochrin C, Daskalov GM, Howard M, Zohr R, Esche B, Eapen L, Grimard L, Caudrelier JM. Clinical use of a commercial Monte Carlo treatment planning system for electron beams. Phys Med Biol 2005; 50:1029-34. [PMID: 15798275 DOI: 10.1088/0031-9155/50/5/025] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [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: 11/11/2022]
Abstract
In 2002 we fully implemented clinically a commercial Monte Carlo based treatment planning system for electron beams. The software, developed by MDS Nordion (presently Nucletron), is based on Kawrakow's VMC++ algorithm. The Monte Carlo module is integrated with our Theraplan Plustrade mark treatment planning system. An extensive commissioning process preceded clinical implementation of this software. Using a single virtual 'machine' for each electron beam energy, we can now calculate very accurately the dose distributions and the number of MU for any arbitrary field shape and SSD. This new treatment planning capability has significantly impacted our clinical practice. Since we are more confident of the actual dose delivered to a patient, we now calculate accurate three-dimensional (3D) dose distributions for a greater variety of techniques and anatomical sites than we have in the past. We use the Monte Carlo module to calculate dose for head and neck, breast, chest wall and abdominal treatments with electron beams applied either solo or in conjunction with photons. In some cases patient treatment decisions have been changed, as compared to how such patients would have been treated in the past. In this paper, we present the planning procedure and some clinical examples.
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Affiliation(s)
- J E Cygler
- Ottawa Regional Cancer Centre, Ottawa, ON, K1H 1C4, Canada
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Malone S, Szanto J, Alsbeith G, Szumacher E, Souhami L, Gray R, Girard A, Raaphorst P, Grimard L. [Radiation sensitivity testing and late neurological complications following radiosurgery for AVM: the use of SF2 from fibroblasts as a predictive factor]. Cancer Radiother 2003; 7:225-30. [PMID: 12914855 DOI: 10.1016/s1278-3218(03)00024-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify SF2 as a prognostic factor of late complications from radiosurgery in patients treated for AVM. PATIENTS AND METHODS Five patients with AVM treated in three canadian institutions and who suffered clinically significant neurological sequelaes secondary to radiosurgery were identified. Their fibroblasts were cultured and their radiation sensitivity tested to determine the SF2 for each patient. RESULTS Patients who developed a neurological complication from radionecrosis, secondary to radiosurgery had an SF2 different than the two control patients with AVM and no complications and also from a group of five cancer patients without late radiation complications (P = 0.005). CONCLUSION Radiosurgery is an elective procedure. The identification of a subgroup of patients who are radiosensitive and at a higher risk of radiation induced complications can allow the treatment team to reduce the risk of such complications. SF2 as a new predictive factor should be incorporated in predictive models of risk from treatment of AVM by radiosurgery. This work needs to be confirmed in a larger cohort of patients.
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Affiliation(s)
- S Malone
- Département de radio-oncologie, centre de cancérologie d'Ottawa, 503 Smyth, Ottawa, K1H 1C4, Ontario, Canada.
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Browman GP, Mohide EA, Willan A, Hodson I, Wong G, Grimard L, MacKenzie RG, El-Sayed S, Dunn E, Farrell S. Association between smoking during radiotherapy and prognosis in head and neck cancer: a follow-up study. Head Neck 2002; 24:1031-7. [PMID: 12454940 DOI: 10.1002/hed.10168] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The study objective was to confirm a previous finding that patients with stage III/IV squamous head and neck cancer (SHNC) who smoke during radiotherapy (RT) experience reduced survival. METHODS An observational cohort study. Patients' smoking status was assessed weekly by questionnaire plus blood cotinine. Patients were assessed every 3 to 4 months for survival. Logistic regression and Cox proportional hazards analyses were used to detect the independent contribution of smoking on survival. RESULTS Of 148 patients, 113 smoked during RT. Blood cotinine and smoking questionnaire responses were highly correlated (Spearman R = .69; p < .0005). Abstainers and very light smokers experienced better survival than light, moderate, and heavy smokers (median, 42 vs 29 months; p = .07). Tumor and nodal status and years smoked were the most important prognostic factors. Smoking during RT was not an independent predictor of survival, but baseline smoking status was (p = .016). CONCLUSION Smoking status should be documented in all future trials of RT in SHNC to allow for pooled analyses with sufficient power to address this question.
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Abstract
The survival rate for childhood cancer, including brain tumors, is increasing. As a result, long-term sequelae of chemotherapy and radiotherapy are also increasing. The purpose of this study was to determine the frequency of endocrine complications of therapy for brain tumors in pediatric patients. Endocrinopathy was observed in 19 of 20 (95%) of patients with supratentorial midline tumors. Fifty-seven patients with nonmidline tumors (22 supratentorial, 35 posterior fossa) were followed for a mean of 4.6 +/- 2.4 years. Twenty-two endocrinopathies occurred in 16 patients treated as follows: one of 23 patients (0.4%) had surgery alone, zero of four (0%) had chemotherapy alone, eight of 18 (44%) had radiotherapy alone, and seven of 12 (58%) had both radiotherapy and chemotherapy. Endocrine disturbance was particularly common after craniospinal radiation (10 of 18 [55%]). Growth failure occurred in none of 23 patients who had surgery alone, in one of four patients who had chemotherapy (25%), in 11 of 18 patients who had radiotherapy (61%), in seven of 12 patients who received both radiotherapy and chemotherapy (58%), and in 12 of 18 patients who had craniospinal radiation (67%). In conclusion, endocrine and growth disturbances are uncommon with surgery alone, although they occurred in 53 and 60%, respectively, of patients treated with cranial irradiation for a brain tumor. This finding underscores the importance of routine endocrinology follow-up for all brain tumor patients receiving cranial irradiation. Literature review and endocrine surveillance recommendations are included.
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Affiliation(s)
- Sarah E Muirhead
- Division of Endocrinology, University of Ottawa, Ottawa, ON, Canada
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Whelan T, MacKenzie R, Julian J, Levine M, Shelley W, Grimard L, Lada B, Lukka H, Perera F, Fyles A, Laukkanen E, Gulavita S, Benk V, Szechtman B. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst 2002; 94:1143-50. [PMID: 12165639 DOI: 10.1093/jnci/94.15.1143] [Citation(s) in RCA: 444] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Breast irradiation after lumpectomy is an integral component of breast-conserving therapy that reduces the local recurrence of breast cancer. Because an optimal fractionation schedule (radiation dose given in a specified number of fractions or treatment sessions over a defined time) for breast irradiation has not been uniformly accepted, we examined whether a 22-day fractionation schedule was as effective as the more traditional 35-day schedule in reducing recurrence. METHODS Women with invasive breast cancer who were treated by lumpectomy and had pathologically clear resection margins and negative axillary lymph nodes were randomly assigned to receive whole breast irradiation of 42.5 Gy in 16 fractions over 22 days (short arm) or whole breast irradiation of 50 Gy in 25 fractions over 35 days (long arm). The primary outcome was local recurrence of invasive breast cancer in the treated breast. Secondary outcomes included cosmetic outcome, assessed with the European Organisation for Research and Treatment of Cancer (EORTC) Cosmetic Rating System. All statistical tests were two-sided. RESULTS From April 1993 through September 1996, 1234 women were randomly assigned to treatment, 622 to the short arm and 612 to the long arm. Median follow-up was 69 months. Five-year local recurrence-free survival was 97.2% in the short arm and 96.8% in the long arm (absolute difference = 0.4%, 95% confidence interval [CI] = -1.5% to 2.4%). No difference in disease-free or overall survival rates was detected between study arms. The percentage of patients with an excellent or good global cosmetic outcome at 3 years was 76.8% in the short arm and 77.0% in the long arm; the corresponding data at 5 years were 76.8% and 77.4%, respectively (absolute difference = -0.6%, 95% CI = -6.5% to 5.5%). CONCLUSION The more convenient 22-day fractionation schedule appears to be an acceptable alternative to the 35-day schedule.
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Affiliation(s)
- Timothy Whelan
- T. Whelan, M. Levine, McMaster University, and Cancer Care Ontario (CCO) Hamilton Regional Cancer Centre, Hamilton, Ontario, Canada.
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Abstract
PURPOSE Interstitial brachytherapy is an effective organ sparing treatment for localized penile squamous cell carcinoma. We report results in 30 patients. MATERIALS AND METHODS From September 1989 to November 2000, 30 men with penile squamous cell carcinoma were treated with primary brachytherapy. Tumor size was 2 to 3 cm. in 8 and greater than 3 cm. in 14 (maximum 5 cm.). Tumor was well differentiated in 11 patients, moderately in 10, poorly in 2 and unspecified in 6. Histology was verrucous in 1 patient. All implants complied with the Paris system of dosimetry, 26 of 30 with rigid steel needles held in a 3-dimensional array. The prescribed dose was 60 Gy. delivered at an average dose rate of 68 cGy. hourly for an implant duration of 93 hours. RESULTS Median followup was 34 months. There have been 4 local failures yielding an actuarial local failure-free rate of 85% at 2 years (standard error 8%) and 76% at 5 years (11%). Each local failure was salvaged with penectomy (partial in 2 cases). There have been 4 isolated regional failures, involving 1 to 3 nodes, 3 moderately and 1 poorly differentiated, salvaged with groin dissection. Two patients with moderately differentiated T1 squamous cell carcinoma who died of metastatic disease after inoperable regional and subsequent distant failure. No well differentiated tumors failed regionally or distantly. Three men died of other causes with no evidence of recurrence. Function and cosmesis after implantation have been generally good. Some telangiectasia and pigmentation changes were common. Two men complained of loss of potency, 3 required dilatation for meatal stenosis and 1 underwent partial penectomy for radiation necrosis. CONCLUSIONS Brachytherapy provides excellent local control of T1 to T2 penile squamous cell carcinoma, with only 1 of 30 patients requiring partial penectomy for radionecrosis. Despite excellent local control, 50% of moderately or poorly differentiated tumors recurred distantly or regionally. We recommend planned staging superficial inguinal node dissection 3 months after implantation for moderately and/or poorly differentiated tumors with clinically negative groins.
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Affiliation(s)
- Juanita Crook
- Department of Radiation Oncology, University Health Network, Princess Margaret Hospital, Toronto, Canada
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42
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Abstract
PURPOSE Interstitial brachytherapy is an effective organ sparing treatment for localized penile squamous cell carcinoma. We report results in 30 patients. MATERIALS AND METHODS From September 1989 to November 2000, 30 men with penile squamous cell carcinoma were treated with primary brachytherapy. Tumor size was 2 to 3 cm. in 8 and greater than 3 cm. in 14 (maximum 5 cm.). Tumor was well differentiated in 11 patients, moderately in 10, poorly in 2 and unspecified in 6. Histology was verrucous in 1 patient. All implants complied with the Paris system of dosimetry, 26 of 30 with rigid steel needles held in a 3-dimensional array. The prescribed dose was 60 Gy. delivered at an average dose rate of 68 cGy. hourly for an implant duration of 93 hours. RESULTS Median followup was 34 months. There have been 4 local failures yielding an actuarial local failure-free rate of 85% at 2 years (standard error 8%) and 76% at 5 years (11%). Each local failure was salvaged with penectomy (partial in 2 cases). There have been 4 isolated regional failures, involving 1 to 3 nodes, 3 moderately and 1 poorly differentiated, salvaged with groin dissection. Two patients with moderately differentiated T1 squamous cell carcinoma who died of metastatic disease after inoperable regional and subsequent distant failure. No well differentiated tumors failed regionally or distantly. Three men died of other causes with no evidence of recurrence. Function and cosmesis after implantation have been generally good. Some telangiectasia and pigmentation changes were common. Two men complained of loss of potency, 3 required dilatation for meatal stenosis and 1 underwent partial penectomy for radiation necrosis. CONCLUSIONS Brachytherapy provides excellent local control of T1 to T2 penile squamous cell carcinoma, with only 1 of 30 patients requiring partial penectomy for radionecrosis. Despite excellent local control, 50% of moderately or poorly differentiated tumors recurred distantly or regionally. We recommend planned staging superficial inguinal node dissection 3 months after implantation for moderately and/or poorly differentiated tumors with clinically negative groins.
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Affiliation(s)
- Juanita Crook
- Department of Radiation Oncology, University Health Network, Princess Margaret Hospital, Toronto, Canada
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43
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Abstract
A 2-year-old girl who had a stage 2, favorable-histology Wilms tumor diagnosed when she was age 10 months presented with multiple brain metastases at second recurrence. She had been treated with combined radiotherapy, surgery, and chemotherapy; at 2 months after treatment, recurrent disease developed in the central nervous system and she died. Brain metastases are rare in the natural history of Wilms tumor. Although it does not appear that cerebral metastases are a barrier to tumor eradication and long-term survival if treated with combined modality therapy, treatment should be individualized.
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Affiliation(s)
- Rob MacRae
- Ottawa Regional Cancer Center and the Children's Hospital of Eastern Ontario, Canada
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44
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Alsbeih G, Malone S, Grimard L, Raaphorst GP. [In vitro radiosensitivity of skin fibroblasts can identify a group of patients with complications in various health tissues after radiotherapy]. Cancer Radiother 1999; 3:318-24. [PMID: 10486543 DOI: 10.1016/s1278-3218(99)80074-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE A retrospective study of the in vitro radiosensitivity of skin fibroblasts derived from two groups of patients treated by definitive radiotherapy for a variety of tumors who either displayed or did not display severe complications. PATIENTS AND METHODS Seven radiotherapy patients were selected: three were treated for head and neck, prostate and non-Hodgkin lymphoma tumors, and did not develop any significant complications (control group); four patients were treated for bladder, thyroid, head and neck and anal canal tumors and developed serious acute and especially late reactions (hypersensitive group). Primary cell cultures of skin fibroblasts were established and their radiosensitivity studied by the clonogenic assay after exposing to single radiation doses ranging between 1 and 8 Gy. RESULTS The survival fraction at 2 Gy (SF2) ranged from 0.27 to 0.38, with a mean of 0.33 for the control group, and from 0.10 to 0.20 with a mean of 0.17 for the hypersensitive group. The Mann-Whitney non-parametric test showed that the difference between the two means was statistically significant (p = 0.03). CONCLUSION The data are in favor of a correlation between the radiosensitivity of patients' fibroblasts and the reactions of different normal tissues to radiotherapy. This association supports the use of the clonogenic survival, or a surrogate test, as a predictive assay. The multiplicity of normal tissues and organs implicated in this association suggests the existence of genetic factors that determine, at least in part, the radiosensitivity of target cells involved in the expression of normal tissues complications following radiotherapy.
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Affiliation(s)
- G Alsbeih
- Groupe de recherche sur le cancer, centre régional de cancérologie d'Ottawa, Ontario, Canada
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45
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Abstract
Numerous structures are included in the irradiated volume of patients presenting with head and neck cancer: skin, mucosa, bone, teeth, cartilage, muscles, salivary glands, etc. Curative intent treatment of such tumours requires aggressive approach which can lead to severe sequellae. These sequellae are in most cases dose-dependent and volume-dependent. However, an appropriate technique might decrease the severity of such sequellae. Details of these late changes are presented, including their pathophysiology, clinical syndromes, potential treatment, and prevention.
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Affiliation(s)
- J J Mazeron
- Centre des tumeurs, groupe hospitalier Pitié-Salpêtrière, Paris, France
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46
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Abstract
With the increasing survival time of many pediatric patients with malignancies, unexpected symptoms or signs require diligent search for rare complications or second cancers related to the disease or treatment. We recently encountered a patient with extensive glioblastoma multiforme who developed pancytopenia six months after completion of treatment with craniospinal radiation and chemotherapy with etoposide and cyclophosphamide. Bone marrow aspirate and biopsy confirmed bone marrow metastasis from the brain tumor. He showed good partial remission with chemotherapy with carmustine and cis-platinum as demonstrated by serial bone marrow aspirate for cytology and cytogenetics and enjoyed good quality of life for eight months. 14 other patients with astrocytic glioma, two of whom are children, are reported in the literature to have diffuse bone marrow metastasis. Therefore, in patients with malignant astrocytic tumor, bone marrow metastasis, though not common, should be considered when bone pain or cytopenias occur, especially when prolonged.
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Affiliation(s)
- E Hsu
- Pediatric Neuro-oncology Service, Children's Hospital of Eastern Ontario, Canada
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Eapen L, Stewart D, Grimard L, Crook J, Futter N, Aref I, Huan S, Rasuli P, Peterson R. [Treatment of cancer of the bladder in elderly patients with an intra-arterial chemotherapy and radiotherapy combination: 10-year experience]. Cancer Radiother 1998; 2 Suppl 1:73s-76s. [PMID: 9749083] [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: 02/08/2023]
Abstract
PURPOSE Analysis of the results obtained in elderly (75 years and older) included a phase II trial combining intra-arterial cisplatin and concurrent radiation into invasive bladder cancer. PATIENTS AND METHODS Thirty-five patients (28 males and 7 females) were accrued from 1985 to 1996. There were 1 Ta, 4 T2, 11 T3A, 12 T3B, 3 T4A, and 4 T4B patients. Nine had unilateral hydronephrosis and two bilateral hydronephrosis. There were 28 transurethral resections which were incomplete in 23 patients. Intra-arterial cisplatin was given as 2-4 hours infusion (60-90 mg/m2) split through both internal iliac arteries on day 1, 14, 21, and 42. Irradiation to the pelvis was started on day 14 and consisted of 40 Gy/20 fractions followed by a boost of 20 Gy/10 fractions to the tumor with margins of 2 cm. RESULTS Thirty (86%) completed fully the protocol. One patient died from sepsis secondary to the treatment. The tumor response was evaluable in 29 patients and complete response was observed for 27 of them. Five of these 27 patients had an isolated bladder relapse which was salvaged by cystectomy in two patients. There were 11 deaths from bladder cancer (31% of the patients): 9 from distant metastase, one from local failure, and one from treatment. CONCLUSION This combined modality yields excellent results with high complete response rate and good tolerance. This approach may therefore be particularly appropriate for the elderly.
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Affiliation(s)
- L Eapen
- Service de radio-oncologie, Centre de cancérologie d'Ottawa, Ontario, Canada
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Salhani D, Grimard L, Li A, Yang H, Older J. 91 HDR brachytherapy optimization using simulated annealing coupled with a gradient technique. Radiother Oncol 1996. [DOI: 10.1016/0167-8140(96)87891-1] [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: 10/18/2022]
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Brundage MD, Bezjak A, Dixon P, Grimard L, Larochelle M, Warde P, Warr D. The role of palliative thoracic radiotherapy in non-small cell lung cancer. Can J Oncol 1996; 6 Suppl 1:25-32. [PMID: 8853535] [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: 02/02/2023]
Abstract
Non-small cell lung cancer is the most common cause of cancer death in both males and females. Despite this high incidence and mortality, comparatively little research has addressed the palliative treatment of thoracic symptoms. Until recently, information regarding the indications and effectiveness of radiation in this setting was obtained from retrospective reviews of single institutional experiences. More recently, three major randomized trials from the UK Medical Research Council (1991, 1992, 1994) have addressed the use of external beam radiation in randomized comparisons of different dose and fractionation strategies for patients with non-small cell lung cancer and symptoms due to intra-thoracic tumor. These studies show that shorter fractionation schemes provide equivalent palliation and essentially equivalent survival in the patient groups studied. Moreover, they provide estimates of the probability of successful palliation of common symptoms, and estimates of the toxicity of each regimen. A panel of oncologists with expertise in radiation oncology, medical oncology and epidemiology discussed the above trial results and a literature review. The panel concluded that radiation was indicated in the palliation of hemoptysis, chest pain, dysphagia, and dyspnea, and that the results of the MRC studies provided reasonable estimations of the efficacy and toxicity of radiation in this setting. These studies show that symptoms are more often than not improved with palliative radiotherapy (symptom improvement rates ranged from about 50 to 85%) and that palliation lasted for a substantial portion of the patients' remaining survival. The panel could not reach uniform consensus on the appropriate fractionation for radiation given with palliative intent. The panel agreed that favourable patients with stage IIIB NSCLC should be offered combined modality therapy with the intent of prolonging survival, and that patient preferences regarding the risks and benefits of this therapy should be considered. Further study was recommended, namely, a randomized trial evaluating five fractions of radiation vs a single fraction, using patient-based evaluation of palliation. The panel also recommended phase II development of a combined chemotherapy and low-dose radiation protocol appropriate for future study.
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Affiliation(s)
- M D Brundage
- Department of Radiation Oncology, Kingston Regional Cancer Centre, Ontario
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Danjoux CE, Jenkin RD, McLaughlin J, Grimard L, Gaspar LE, Dar AR, Fisher B, Whitton AC, Kraus V, Springer CD. Childhood medulloblastoma in Ontario, 1977-1987: population-based results. Med Pediatr Oncol 1996; 26:1-9. [PMID: 7494506 DOI: 10.1002/(sici)1096-911x(199601)26:1<1::aid-mpo1>3.0.co;2-q] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A retrospective review was carried out to study children, not more than 16 years old, with a confirmed diagnosis of medulloblastoma, who were residents of the Province of Ontario at the time of diagnosis between 1977 and 1987 inclusive. The provincial tumour registry provided the population database. One hundred and eight children with medulloblastoma were identified of whom 72 (67%) were initially treated at University of Toronto Centres and 36 (33%) at other Health Science Centres, hospitals, and Regional Cancer Centres (RCC) in Ontario. The hospital/Cancer Centre records were reviewed. The 5-year relapse-free survival (RFS) for all patients treated in Ontario was 58% (SE = 5%). Those treated in Toronto had a 5-year RFS of 65% (SE = 6%) compared to 44% (SE = 8%) for those treated in other RCCs in the province (P = 0.02). Relapse-free survival for the RCCs ranged from 25 to 60%, with a trend for improved survival with increasing centre size. Univariate analysis of determinants of relapse-free survival for all 108 patients showed the following variables to be significant: T-stage (Tx + T1 + T2 vs. T3A + T3B) P = 0.0004, M-stage (M0 + Mx vs. M1-4) P = 0.0006, extent of resection (total vs. less than total) P = 0.002, radiotherapy (craniospinal irradiation and posterior fossa boost vs. other) P = 0.02, and treatment centre (Toronto centres vs. RCC) P = 0.02. Cases treated at centres outside metropolitan Toronto had a nearly two-fold (relative risk = 1.93; 95% confidence interval = 1.07, 3.47) greater risk of recurrence or death than those seen in Toronto. However, in multivariate analysis this difference was not quite significant (P = 0.07) after controlling for stage (T and M), extent of resection, meningitis, and gender. These data suggest that patients with medulloblastoma should be referred for treatment to large centres with major pediatric neurosurgical and oncology resources.
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Affiliation(s)
- C E Danjoux
- Toronto Sunnybrook RCC, Department of Radiation Oncology, University of Toronto, Canada
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