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Basse C, Khalifa J, Thillays F, Le Pechoux C, Maury JM, Bonte PE, Coutte A, Pourel N, Bourbonne V, Pradier O, Belliere A, Le Tinier F, Deberne M, Tanguy R, Denis F, Padovani L, Zaccariotto A, Molina T, Chalabreysse L, Brioude G, Delatour B, Faivre JC, Cao K, Giraud P, Riet FG, Thureau S, Antoni D, Massabeau C, Keller A, Bonnet E, Lerouge D, Martin E, Girard N, Botticella A. Recommendations for Post-Operative Radiotherapy after complete resection of Thymoma - a French DELPHI consensus initiative. J Thorac Oncol 2024:S1556-0864(24)00161-8. [PMID: 38608932 DOI: 10.1016/j.jtho.2024.04.003] [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: 10/22/2023] [Revised: 03/29/2024] [Accepted: 04/06/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Thymomas are rare intrathoracic malignancies that can relapse after surgery. Whether or not Post-Operative Radiotherapy (PORT) should be delivered after surgery remains a major issue. RADIORYTHMIC is an ongoing, multicenter, randomized phase 3 trial addressing this question in patients with completely R0 resected Masaoka-Koga stage IIb/III thymoma. Experts in the field met to develop recommendations for PORT. METHODS A scientific committee from the RYTHMIC network identified key issues regarding the modalities of PORT in completely resected thymoma. A DELPHI-method was used to question 24 national experts, with 115 questions regarding: 1/ Imaging techniques, 2/ Clinical Target Volume (CTV) and margins, 3/ Dose constraints to Organs At Risk, 4/ Dose and fractionation, 5/ Follow-up and records. Consensus was defined when opinions reached ≥ 80% agreement. RESULTS We established the following recommendations: pre-operative contrast-enhanced CT-scan is recommended (94% agreement); optimization of radiation delivery includes either a 4D-CT based planning (82% agreement), a breath-holding inspiration breath-hold-based planning, or daily control CT-imaging (81% agreement); imaging fusion based on cardiovascular structures of pre-operative and planning CT-scan is recommended (82% agreement); right coronary and left anterior descending coronary arteries should be delineated as cardiac substructures (88% agreement); rotational RCMI/VMAT is recommended (88% agreement); total dose is 50Gy (81% agreement) with 1.8-2Gy per fraction (94% agreement); cardiac evaluation, and follow-up for patients with history of cardiovascular disease is recommended (88% agreement) with EKG and evaluation of LVEF at 5 years and 10 years. CONCLUSION This is the first consensus for PORT in thymoma. Implementation will help to harmonize practices.
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Affiliation(s)
- Clémence Basse
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France; Paris Saclay Campus, Versailles Saint Quentin University, Versailles, France
| | - Jonathan Khalifa
- Department of Radiotherapy, Institut Claudius Rigaud, Institut Universitaire du Cancer de Toulouse Oncopole, France
| | - François Thillays
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest Centre René Gauducheau, Nantes, France
| | - Cécile Le Pechoux
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Jean-Michel Maury
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; IVPC UMR754 INRA, Univ Lyon, Université Claude Bernard Lyon 1, EPHE, Lyon, France
| | | | | | - Nicolas Pourel
- Radiation department, Institut Sainte Catherine, Avignon, France
| | - Vincent Bourbonne
- Department of Radiotherapy, University Hospital of Brest, Brest, France
| | - Olivier Pradier
- Department of Radiotherapy, University Hospital of Brest, Brest, France
| | - Aurélie Belliere
- Department of Radiotherapy, Centre Jean Perrin, Clermont-Ferrand, France
| | | | - Mélanie Deberne
- Department of Radiotherapy, Hospices Civils Lyonnais, Lyon, France
| | - Ronan Tanguy
- Department of Radiotherapy, Hospices Civils Lyonnais, Lyon, France
| | - Fabrice Denis
- Department of Radiotherapy, Centre de Cancérologie de la Sarthe, ELSAN, Le Mans, France
| | - Laetitia Padovani
- Department of Radiotherapy, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Audrey Zaccariotto
- Department of Radiotherapy, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Thierry Molina
- Pathology Department, Necker Enfants Malades Hospital, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Lara Chalabreysse
- Department of Pathology, Groupement Hospitalier Est, Bron Cedex Lyon, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, Disease of the Oesophagus and Lung Transplantations, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Bertrand Delatour
- Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, 2 rue Henri le Guilloux, 35000 Rennes, France
| | | | - Kim Cao
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France
| | - Philippe Giraud
- Paris City University, Department of Radiation Oncology, Hopital Européen Georges Pompidou, Paris, France
| | | | | | - Delphine Antoni
- Department of Radiotherapy, ICANS, Institut de Cancérologie de Strasbourg, France
| | - Carole Massabeau
- Department of Radiotherapy, Institut Claudius Rigaud, Toulouse, France
| | - Audrey Keller
- Department of Radiotherapy, Institut Claudius Rigaud, Toulouse, France
| | | | | | - Etienne Martin
- Department of Radiotherapy, Centre Georges-François-Leclerc, Dijon, France
| | - Nicolas Girard
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France; Paris Saclay Campus, Versailles Saint Quentin University, Versailles, France.
| | - Angela Botticella
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
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Bourbonne V, Lévy A, Khalifa J, Antoni D, Blais E, Darréon J, Le Péchoux C, Lerouge D, Giraud P, Marguerit A, Pourel N, Riet FG, Thureau S. Radiotherapy in the management of lung oligometastases. Cancer Radiother 2024; 28:36-48. [PMID: 38228422 DOI: 10.1016/j.canrad.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/07/2023] [Accepted: 06/29/2023] [Indexed: 01/18/2024]
Abstract
In recent years, the development of both medical imaging and new systemic agents (targeted therapy and immunotherapy) have revolutionized the field of oncology, leading to a new entity: oligometastatic disease. Adding local treatment of oligometastases to systemic treatment could lead to prolonged survival with no significant impact on quality of life. Given the high prevalence of lung oligometastases and the new systemic agents coming with increased pulmonary toxicity, this article provides a comprehensive review of the current state-of-art for radiotherapy of lung oligometastases. After reviewing pretreatment workup, the authors define several radiotherapy regimen based on the localization and size of the oligometastases. A comment on the synergistic combination of medical treatment and radiotherapy is also made, projecting on future steps in this specific clinical setting.
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Affiliation(s)
- V Bourbonne
- Radiation Oncology Department, CHU de Brest, Brest, France; LaTim, Inserm, UMR 1101, université de Bretagne occidentale, Brest, France
| | - A Lévy
- Department of Radiation Oncology, Centre international des cancers thoraciques (CICT), Gustave-Roussy, 94805 Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - J Khalifa
- Department of Radiation Oncology, institut Claudius-Regaud, institut universitaire du cancer Toulouse-Oncopôle, Toulouse, France
| | - D Antoni
- Department of Radiation Oncology, Institut de cancérologie Strasbourg Europe, Strasbourg, France
| | - E Blais
- Department of Radiation Oncology, polyclinique Marzet, Pau, France
| | - J Darréon
- Department of Radiation Oncology, institut Paoli-Calmettes, Marseille, France
| | - C Le Péchoux
- Department of Radiation Oncology, Centre international des cancers thoraciques (CICT), Gustave-Roussy, 94805 Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - D Lerouge
- Department of Radiation Oncology, centre François-Baclesse, Caen, France
| | - P Giraud
- Department of Radiation Oncology, hôpital européen Georges-Pompidou, Paris, France; Université Paris Cité, Paris, France
| | - A Marguerit
- Department of Radiation Oncology, Institut de cancérologie de Montpellier, Montpellier, France
| | - N Pourel
- Department of Radiation Oncology, institut Sainte-Catherine, Avignon, France
| | - F-G Riet
- Department of Radiation Oncology, centre hospitalier privé Saint-Grégoire, 35760 Saint-Grégoire, France
| | - S Thureau
- Radiotherapy Department, centre Henri-Becquerel, Rouen, France; QuantIF-Litis EA4108, université de Rouen, Rouen, France.
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Khalifa J, Lévy A, Sauvage LM, Thureau S, Darréon J, Le Péchoux C, Lerouge D, Pourel N, Antoni D, Blais E, Martin É, Marguerit A, Giraud P, Riet FG. Radiotherapy in the management of synchronous metastatic lung cancer. Cancer Radiother 2024; 28:22-35. [PMID: 37574329 DOI: 10.1016/j.canrad.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/02/2023] [Indexed: 08/15/2023]
Abstract
Metastatic lung cancer classically portends a poor prognosis. The management of metastatic lung cancer has dramatically changed with the emergence of immune checkpoint inhibitors, targeted therapy and due to a better understanding of the oligometastatic process. In metastatic lung cancers, radiation therapy which was only used with palliative intent for decades, represents today a promising way to treat primary and oligometastatic sites with a curative intent. Herein we present through a literature review the role of radiotherapy in the management of synchronous metastatic lung cancers.
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Affiliation(s)
- J Khalifa
- Department of Radiation Oncology, institut Claudius-Regaud/IUCT-Oncopole, Toulouse, France; U1037, Inserm, CRCT, Toulouse, France.
| | - A Lévy
- Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Gustave-Roussy, 94805 Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; Université Paris-Saclay, Molecular Radiotherapy and Therapeutic Innovation lab, Inserm U1030, 94805 Villejuif, France
| | - L-M Sauvage
- Department of Radiation Oncology, institut Curie, Paris, France
| | - S Thureau
- Department of Radiation Oncology, centre Henri-Becquerel, Rouen, France; QuantIf-Litis EA4108, université de Rouen, Rouen, France
| | - J Darréon
- Department of Radiation Oncology, institut Paoli-Calmettes, Marseille, France
| | - C Le Péchoux
- Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Gustave-Roussy, 94805 Villejuif, France
| | - D Lerouge
- Department of Radiation Oncology, centre François-Baclesse, Caen, France
| | - N Pourel
- Department of Radiation Oncology, institut Sainte-Catherine, Avignon, France
| | - D Antoni
- Department of Radiation Oncology, institut de cancérologie Strasbourg Europe, Strasbourg, France
| | - E Blais
- Department of Radiation Oncology, polyclinique Marzet, Pau, France
| | - É Martin
- Department of Radiation Oncology, centre Georges-François-Leclerc, Dijon, France
| | - A Marguerit
- Department of Radiation Oncology, institut de cancérologie de Montpellier, Montpellier, France
| | - P Giraud
- Department of Radiation Oncology, hôpital européen Georges-Pompidou, Paris, France; Université Paris Cité, Paris, France
| | - F-G Riet
- Department of Radiation Oncology, centre hospitalier privé Saint-Grégoire, Saint-Grégoire, France
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Calderon B, Vazquez L, Belkacemi M, Pourel N. Stereotactic radiotherapy for brain metastases: predictive factors of radionecrosis. Eur J Med Res 2023; 28:233. [PMID: 37443046 DOI: 10.1186/s40001-023-01178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE Stereotactic radiotherapy (SRT) is a highly effective approach and represents the current standard of treatment for patients with limited number of brain metastasis (BM). SRT is generally well tolerated but can sometimes lead to radionecrosis (RN). The aim of this study was to identify predictive factors of radionecrosis related to SRT for brain metastasis. METHODS This retrospective observational cohort study included patients who underwent SRT in the Institut Sainte Catherine between January 1st, 2017 and December 31st, 2020 for the treatment of brain metastasis from any cancer. Individual data and particularly signs of radionecrosis (clinical, imaging, anatomopathological) were collected from electronic medical records. Radionecrosis was defined as the occurrence on MRI of contrast-enhancing necrotic lesions, surrounded by edema, occurring at least 6 months after SRT and localized within fields of irradiation. RESULTS 123 patients were included; median age was 66 years. 17 patients (11.8%) developed radionecrosis after a median follow up of 418.5 days [63;1498]. Predictive factors of radionecrosis in multivariate analysis were age under 66 years with a sensitivity of 77% and a specificity of 56%. No other factor as the presence of comorbidities, the number of irradiated metastases, the PTV volume or the volume of irradiated healthy brain were predictive of radionecrosis. CONCLUSION Age at treatment initiation and tumor location seems to be correlated with radionecrosis in patients with brain metastasis treated with SRT. These elements could be useful to adapted radiation therapy.
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Affiliation(s)
- Benoît Calderon
- Institut Sainte Catherine, 250 Chemin Des Baigne-Pieds, 84000, Avignon, France
| | - Léa Vazquez
- Institut Sainte Catherine, 250 Chemin Des Baigne-Pieds, 84000, Avignon, France.
| | | | - Nicolas Pourel
- Institut Sainte Catherine, 250 Chemin Des Baigne-Pieds, 84000, Avignon, France
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Le Pechoux C, Pourel N, Barlesi F, Lerouge D, Antoni D, Lamezec B, Nestle U, Boisselier P, Dansin E, Paumier A, Peignaux K, Thillays F, Zalcman G, Madelaine J, Pichon E, Larrouy A, Lavole A, Argo-Leignel D, Derollez M, Faivre-Finn C, Hatton MQ, Riesterer O, Bouvier-Morel E, Dunant A, Edwards JG, Thomas PA, Mercier O, Bardet A. Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART): an open-label, randomised, phase 3 trial. Lancet Oncol 2022; 23:104-114. [PMID: 34919827 DOI: 10.1016/s1470-2045(21)00606-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND In patients with non-small-cell lung cancer (NSCLC), the use of postoperative radiotherapy (PORT) has been controversial since 1998, because of one meta-analysis showing a deleterious effect on survival in patients with pN0 and pN1, but with an unclear effect in patients with pN2 NSCLC. Because many changes have occurred in the management of patients with NSCLC, the role of three-dimensional (3D) conformal PORT warrants further investigation in patients with stage IIIAN2 NSCLC. The aim of this study was to establish whether PORT should be part of their standard treatment. METHODS Lung ART is an open-label, randomised, phase 3, superiority trial comparing mediastinal PORT to no PORT in patients with NSCLC with complete resection, nodal exploration, and cytologically or histologically proven N2 involvement. Previous neoadjuvant or adjuvant chemotherapy was allowed. Patients aged 18 years or older, with an WHO performance status of 0-2, were recruited from 64 hospitals and cancer centres in five countries (France, UK, Germany, Switzerland, and Belgium). Patients were randomly assigned (1:1) to either the PORT or no PORT (control) groups via a web randomisation system, and minimisation factors were the institution, administration of chemotherapy, number of mediastinal lymph node stations involved, histology, and use of pre-treatment PET scan. Patients received PORT at a dose of 54 Gy in 27 or 30 daily fractions, on five consecutive days a week. Three dimensional conformal radiotherapy was mandatory, and intensity-modulated radiotherapy was permitted in centres with expertise. The primary endpoint was disease-free survival, analysed by intention to treat at 3 years; patients from the PORT group who did not receive radiotherapy and patients from the control group with no follow-up were excluded from the safety analyses. This trial is now closed. This trial is registered with ClinicalTrials.gov number, NCT00410683. FINDINGS Between Aug 7, 2007, and July 17, 2018, 501 patients, predominantly staged with 18F-fluorodeoxyglucose (18F-FDG) PET (456 [91%]; 232 (92%) in the PORT group and 224 (90%) in the control group), were enrolled and randomly assigned to receive PORT (252 patients) or no PORT (249 patients). At the cutoff date of May 31, 2019, median follow-up was 4·8 years (IQR 2·9-7·0). 3-year disease-free survival was 47% (95% CI 40-54) with PORT versus 44% (37-51) without PORT, and the median disease-free survival was 30·5 months (95% CI 24-49) in the PORT group and 22·8 months (17-37) in the control group (hazard ratio 0·86; 95% CI 0·68-1·08; p=0·18). The most common grade 3-4 adverse events were pneumonitis (13 [5%] of 241 patients in the PORT group vs one [<1%] of 246 in the control group), lymphopenia (nine [4%] vs 0), and fatigue (six [3%] vs one [<1%]). Late-grade 3-4 cardiopulmonary toxicity was reported in 26 patients (11%) in the PORT group versus 12 (5%) in the control group. Two patients died from pneumonitis, partly related to radiotherapy and infection, and one patient died due to chemotherapy toxicity (sepsis) that was deemed to be treatment-related, all of whom were in the PORT group. INTERPRETATION Lung ART evaluated 3D conformal PORT after complete resection in patients who predominantly had been staged using (18F-FDG PET-CT and received neoadjuvant or adjuvant chemotherapy. 3-year disease-free survival was higher than expected in both groups, but PORT was not associated with an increased disease-free survival compared with no PORT. Conformal PORT cannot be recommended as the standard of care in patients with stage IIIAN2 NSCLC. FUNDING French National Cancer Institute, Programme Hospitalier de Recherche Clinique from the French Health Ministry, Gustave Roussy, Cancer Research UK, Swiss State Secretary for Education, Research, and Innovation, Swiss Cancer Research Foundation, Swiss Cancer League.
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Affiliation(s)
- Cecile Le Pechoux
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France.
| | - Nicolas Pourel
- Radiation Oncology, Institut Sainte Catherine, Avignon, France
| | - Fabrice Barlesi
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; Aix-Marseille University, Centre National de la Recherche Scientifique, Institut National des Sciences et de la Recherche Médicale, Centre de Recherche en Cancérologie de Marseille, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | | | - Delphine Antoni
- Department of Radiation Oncology, Centre Paul Strauss, Strasbourg, France
| | - Bruno Lamezec
- Radiation Oncology, Centre Armoricain de Radiothérapie, d'Imagerie médicale et d'Oncologie, St Brieuc, France
| | - Ursula Nestle
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany; Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Pierre Boisselier
- Department of Radiation Oncology, Centre Val d'Aurelle, Montpellier, France
| | - Eric Dansin
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Amaury Paumier
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest Centre Paul Papin, Angers, France
| | - Karine Peignaux
- Department of Radiation Oncology, Centre Georges-Francois Leclerc, Dijon, France
| | - François Thillays
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest Centre René Gauducheau, Nantes, France
| | - Gerard Zalcman
- Department of Pneumology, Centre Hospitalier Universitaire de Caen, Caen, France; Department of Thoracic Oncology, Université de Paris, Centre d'Investigation Clinique-1425-Bichat-Claude Bernard Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Jeannick Madelaine
- Department of Pneumology, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Eric Pichon
- Department of Pneumology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Anne Larrouy
- Radiation Oncology, Centre Specialisé Cancerologie Paris Nord, Sarcelles, France
| | - Armelle Lavole
- Department of Thoracic Oncology, Tenon University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | | | - Marc Derollez
- Pneumology, Polyclinique du Val de Sambre, Maubeuge, France
| | - Corinne Faivre-Finn
- University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Matthew Q Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich and Centre for Radiation Oncology, Cantonal Hospitals Aarau and Baden, Aarau, Switzerland
| | - Emilie Bouvier-Morel
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - Ariane Dunant
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - John G Edwards
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Pascal Alexandre Thomas
- Department of Thoracic Surgery, Hôpital Nord, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Institut d'Oncologie Thoracique, Marie-Lannelongue Hospital, Paris-Saclay University, Le Plessis Robinson, France
| | - Aurelie Bardet
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France; Oncostat Unité Mixte de Recherche 1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
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Abstract
Herein are presented the recommendations from the Société française de radiothérapie oncologique regarding indications and modalities of lung cancer radiotherapy. The recommendations for delineation of the target volumes and organs at risk are detailed.
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Affiliation(s)
- J Khalifa
- Département de radiothérapie, Institut universitaire du cancer de Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France.
| | - D Lerouge
- Département de radiothérapie, centre François-Baclesse, 3, avenue du General-Harris, 14076 Caen, France
| | - C Le Péchoux
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - N Pourel
- Département de radiothérapie, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS80005, 84918 Avignon cedex 9, France
| | - J Darréon
- Service de physique médicale, institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - F Mornex
- Service de radiothérapie, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - P Giraud
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, Paris, France; Université de Paris, 85, boulevard Saint-Germain, 75006 Paris, France
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Pourel N, Meyrieux C, Lisbona A. Quality/risk management system in radiotherapy: Changes afoot. Cancer Radiother 2021; 26:14-19. [PMID: 34953695 DOI: 10.1016/j.canrad.2021.10.004] [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] [Indexed: 10/19/2022]
Abstract
The French sanitary and regulatory context in which radiotherapy centres are comprised is evolving. Risk and quality management systems are currently adapting to these evolutions. The French nuclear safety agency (ASN) decision of July 1st 2008 on quality assurance obligations in radiotherapy has reached 10 years of age, and the French high authority of health (HAS) certification system 20 years now. Mandatory tools needed for the improvement of quality and safety in healthcare are now well known. From now on, the focus of healthcare policies is oriented towards evaluation of efficiency of these new organisations designed following ASN and HAS nationwide guidelines.
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Affiliation(s)
- N Pourel
- Pôle radiothérapie, Institut du cancer Avignon-Provence, 250, chemin de Baigne-Pieds, 84000 Avignon, France.
| | - C Meyrieux
- Département Qualité, Institut du cancer Avignon-Provence, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - A Lisbona
- Département de physique médicale, Institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
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8
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Borras JM, Corral J, Aggarwal A, Audisio R, Espinas JA, Figueras J, Naredi P, Panteli D, Pourel N, Prades J, Lievens Y. Innovation, value and reimbursement in radiation and complex surgical oncology: Time to rethink. Eur J Surg Oncol 2021; 48:967-977. [PMID: 34479744 DOI: 10.1016/j.ejso.2021.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Complex surgery and radiotherapy are the central pillars of loco-regional oncology treatment. This paper describes the reimbursement schemes used in radiation and complex surgical oncology, reports on literature and policy reviews. MATERIAL AND METHODS A systematic review of the literature of the reimbursement models has been carried out separately for radiotherapy and complex cancer surgery based on PRISMA guidelines. Using searches of PubMed and grey literature, we identified articles from scientific journals and reports published since 2000 on provider payment or reimbursement systems currently used in radiation oncology and complex cancer surgery, also including policy models. RESULTS Most European health systems reimburse radiotherapy using a budget-based, fee-for-service or fraction-based system; while few reimburse services according to an episode-based model. Also, the reimbursement models for cancer surgery are mostly restricted to differences embedded in the DRG system and adjustments applied to the fees, based on the complexity of each surgical procedure. There is an enormous variability in reimbursement across countries, resulting in different incentives and different amounts paid for the same therapeutic strategy. CONCLUSION A reimbursement policy, based on the episode of care as the basic payment unit, is advocated for. Innovation should be tackled in a two-tier approach: one defining the common criteria for reimbursement of proven evidence-based interventions; another for financing emerging innovation with uncertain definitive value. Relevant clinical and economic data, also collected real-life, should support reimbursement systems that mirror the actual cost of evidence-based practice.
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Affiliation(s)
- Josep M Borras
- University of Barcelona, Spain; Catalonian Cancer Plan, Department of Health, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Julieta Corral
- Catalonian Cancer Plan, Department of Health, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Ajay Aggarwal
- Guy's and St. Thomas' Hospital NHS Trust, United Kingdom
| | - Riccardo Audisio
- Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Josep Alfons Espinas
- Catalonian Cancer Plan, Department of Health, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Josep Figueras
- European Observatory on Health Systems and Policies, Belgium
| | - Peter Naredi
- Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Germany
| | | | - Joan Prades
- Catalonian Cancer Plan, Department of Health, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital & Ghent University, Belgium
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9
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Gomes F, Faivre-Finn C, Mistry H, Bezjak A, Pourel N, Fournel P, Van Meerbeeck J, Blackhall F. Safety of G-CSF with concurrent chemo-radiotherapy in limited-stage small cell lung cancer - Secondary analysis of the randomised phase 3 CONVERT trial. Lung Cancer 2021; 153:165-170. [PMID: 33545577 DOI: 10.1016/j.lungcan.2021.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The use of granulocyte colony-stimulating factors (G-CSF) during concurrent chemo-radiotherapy (cCTRT) for small cell lung cancer is not recommended by the American Society of Clinical Oncology due to safety concerns. This secondary analysis explored the safety and the role of prophylactic G-CSF (proG-CSF) in the delivery of cCTRT. MATERIAL AND METHODS Secondary analysis of 487 patients treated as per protocol on the phase 3 CONVERT trial which randomized patients between once-daily RT or twice-daily. RESULTS 180 of 487 eligible patients (37 %) received proG-CSF, 60 (33 %) as primary prophylaxis and 120 (67 %) as secondary prophylaxis following myelotoxic events. The regimen incidence of febrile neutropenia (FN) was 22 %. Its incidence in the proG-CSF group reduced significantly when proG-CSF was administered (22 % vs 10 %; OR 0.4; 95 %CI 0.2-0.7; p = 0.002). The rate of blood transfusion was higher in the proG-CSF group (51 % vs 31 %; OR 2.4; 95 %CI 1.6-3.5; p < 0.001). The incidence of severe thrombocytopenia was also higher is this group (28 % vs 15 %; OR 2.2; 95 %CI 1.4-3.5; p = 0.001). But this was significantly higher in those on secondary vs primary prophylaxis (34 % vs 15 %; OR 2.9; 95 %CI 1.3-7.4 p = 0.009) No differences observed in RT-related toxicity, treatment-related mortality or any survival outcomes. The optimal dose intensity (85 % or higher) of cisplatin was achieved in more patients within the proG-CSF group (75 % vs 67 %; OR 1.5; 95 %CI 0.9-2.3; p = 0.056). CONCLUSION There was no evidence that G-CSF directly caused myelotoxicity, instead most patients started G-CSF due to higher myelotoxicity risk. G-CSF maintained the planned dose intensity and there was no detrimental effect on survival. G-CSF may be considered as a supportive measure in this setting.
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Affiliation(s)
- Fabio Gomes
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, UK; Department of Radiotherapy-related Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Hitesh Mistry
- Division of Cancer Sciences/Pharmacy, University of Manchester, Manchester, UK
| | - Andrea Bezjak
- Canadian Cancer Trials Group, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | | | - Pierre Fournel
- Department of Medical Oncology, Institut de Cancerologie de la Loire, St. Priest En Jarez, France
| | - Jan Van Meerbeeck
- ERN/Lung, Department of Pulmonology & Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Fiona Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
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10
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Moukasse Y, Pourel N, Lerouge D, Faivre-Finn C, Ramella S, Edwards J, Van Schil P, Rami-Porta R, Thomas P, Bardet A, Le Pechoux C. PH-0280: Quality of surgery and RT in stage IIIN2 NSCLC: Insights from the Lung Adjuvant Radiotherapy trial. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00304-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Lamy PJ, van der Leest P, Lozano N, Becht C, Duboeuf F, Groen HJM, Hilgers W, Pourel N, Rifaela N, Schuuring E, Alix-Panabières C. Mass Spectrometry as a Highly Sensitive Method for Specific Circulating Tumor DNA Analysis in NSCLC: A Comparison Study. Cancers (Basel) 2020; 12:cancers12103002. [PMID: 33081150 PMCID: PMC7602843 DOI: 10.3390/cancers12103002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/12/2022] Open
Abstract
Simple Summary We compared the UltraSEEK™ Lung Panel on the MassARRAY® System (Agena Bioscience) with the FDA-approved Cobas® EGFR Mutation Test v2 for the detection of EGFR mutations in liquid biopsies of NSCLC patients, accompanied with preanalytical sample assessment using the novel Liquid IQ® Panel. For the detection of relevant predictive mutations using the UltraSEEK™ Lung Panel, an input of over 10 ng showed 100% concordance with Cobas® EGFR Mutation Test v2 and detection of all tissue confirmed mutations. In case of lower ccfDNA input, the risk of missing clinically relevant mutations should be considered. The use of a preanalytical ccfDNA quality control assay such as the Liquid IQ® Panel is recommended to confidently interpret results, avoiding bias induced by non-specific genomic DNA and low input of specific tumoral ccfDNA fragments. Abstract Plasma-based tumor mutational profiling is arising as a reliable approach to detect primary and therapy-induced resistance mutations required for accurate treatment decision making. Here, we compared the FDA-approved Cobas® EGFR Mutation Test v2 with the UltraSEEK™ Lung Panel on the MassARRAY® System on detection of EGFR mutations, accompanied with preanalytical sample assessment using the novel Liquid IQ® Panel. 137 cancer patient-derived cell-free plasma samples were analyzed with the Cobas® and UltraSEEK™ tests. Liquid IQ® analysis was initially validated (n = 84) and used to determine ccfDNA input for all samples. Subsequently, Liquid IQ® results were applied to harmonize ccfDNA input for the Cobas® and UltraSEEK™ tests for 63 NSCLC patients. The overall concordance between the Cobas® and UltraSEEK™ tests was 86%. The Cobas® test detected more EGFR exon19 deletions and L858R mutations, while the UltraSEEK™ test detected more T790M mutations. A 100% concordance in both the clinical (n = 137) and harmonized (n = 63) cohorts was observed when >10 ng of ccfDNA was used as determined by the Liquid IQ® Panel. The Cobas® and UltraSEEK™ tests showed similar sensitivity in EGFR mutation detection, particularly when ccfDNA input was sufficient. It is recommended to preanalytically determine the ccfDNA concentration accurately to ensure sufficient input for reliable interpretation and treatment decision making.
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Affiliation(s)
- Pierre-Jean Lamy
- Biopathologie et Génétique des Cancers, Institute d’Analyse Médicale Imagenome, Inovie, 6 Rue Fontenille, 34000 Montpellier, France;
- Correspondence: ; Tel.: +33-430-053-100
| | - Paul van der Leest
- Department of Pathology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (P.v.d.L.); (N.R.); (E.S.)
| | - Nicolas Lozano
- Biopathologie et Génétique des Cancers, Institute d’Analyse Médicale Imagenome, Inovie, 6 Rue Fontenille, 34000 Montpellier, France;
| | - Catherine Becht
- Oncologie Médicale, Clinique Clémenville, 25 rue Clémenville, 34000 Montpellier, France; (C.B.); (F.D.)
| | - Frédérique Duboeuf
- Oncologie Médicale, Clinique Clémenville, 25 rue Clémenville, 34000 Montpellier, France; (C.B.); (F.D.)
| | - Harry J. M. Groen
- Department of Pulmonary Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Werner Hilgers
- Oncologie Médicale, Institute Sainte Catherine, 250 Chemin de Baigne Pieds, 84918 Avignon, France; (W.H.); (N.P.)
| | - Nicolas Pourel
- Oncologie Médicale, Institute Sainte Catherine, 250 Chemin de Baigne Pieds, 84918 Avignon, France; (W.H.); (N.P.)
| | - Naomi Rifaela
- Department of Pathology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (P.v.d.L.); (N.R.); (E.S.)
| | - Ed Schuuring
- Department of Pathology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (P.v.d.L.); (N.R.); (E.S.)
| | - Catherine Alix-Panabières
- Laboratoire de Cellules Rares Circulantes, University Medical Center of Montpellier, 641, Avenue du Doyen Gaston GIRAUD, 34093 Montpellier, France;
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12
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Moukasse Y, Pourel N, Lerouge D, Padovani L, Faivre-Finn C, Ramella S, Bardet A, Auzac G, Le Péchoux C. Contrôle qualité de la radiothérapie postopératoire des carcinomes bronchiques non à petites cellules de stade III avec envahissement N2 : une première étape importante dans l’étude multicentrique de phase III Lung Adjuvant Radiotherapy Trial (Lung ART-IFCT 0503). Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Adebahr S, Liu Y, Colette S, Faivre-Finn C, Ahmad S, Ahmed M, Belderbos J, Andratschke N, Franks K, Geets X, Guckenberger M, Konopa K, Lambrecht M, Lewitzki V, Lievens Y, Pourel N, De Ruysscher D, Dziadziuszko R, Fortpied C, McDonald F, Peulen H, Grosu A, Hurkmans C, Le Pechoux C, Nestle U. OC-0061 EORTC 22113-8113 Lungtech trial on SBRT of central lung tumors. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30481-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Denis F, Basch EM, Lethrosne C, Pourel N, Molinier O, Pointreau Y, Domont J, Bourgeois HP, Senellart H, Bennouna J, Urban T, Septans AL, Balavoine M, Solal-Celigny P, Dueck AC, Letellier C. Randomized trial comparing a web-mediated follow-up via patient-reported outcomes (PRO) vs. routine surveillance in lung cancer patients: Final results. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.6500] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fabrice Denis
- Institut Inter-regional de Cancérologie Jean Bernard, Le Mans, France
| | - Ethan M. Basch
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | - Yoann Pointreau
- Centre Hospitalier et Régional Universitaire, Henry S. Kaplan Center, Clinique d’Oncologie et de Radiothérapie, Tours, France
| | - Julien Domont
- Institut Inter-regional de Cancérologie Jean Bernard, Le Mans, France
| | | | | | - Jaafar Bennouna
- Centre Hospitalier Universitaire Nantes, Digestive Oncology, Nantes, France
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Le Caer H, Pourel N, Berard H, Auliac JB, Monnet I, Descourt R, Vergnenegre A, Martel Lafay I, Greillier L, Chouaid C, Locher C. Impact of a comprehensive geriatric assessment to manage elderly patients with locally advanced non-small-cell lung cancers: An open phase II study using concurrent cisplatin - oral vinorelbine and radiotherapy (GFPC 08-06). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e20513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hervé Le Caer
- Centre Hospitalier de Saint Brieuc, Saint-Brieuc, France
| | | | - Henri Berard
- Hopital D'instruction Des Armes Sainte-Anne, Toulon, France
| | | | | | | | | | | | - Laurent Greillier
- Assistance Publique – Hôpitaux de Marseille, Aix Marseille University, Marseille, France
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Locher C, Pourel N, Le Caer H, Berard H, Auliac J, Monnet I, Descourt R, Vergnenegre A, Martel Lafay I, Greillier L, Chouaid C. Utilisation d’une évaluation gériatrique standardisée pour sélectionner les patients âgés ayant un cancer du poumon non à petites cellules localement avancé éligibles à un traitement de radio-chimiothérapie concomitante par cisplatine et navelbine orale (Essai GFPC 08-06, RACCOSA). Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.036] [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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17
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Blais E, Pichon B, Mampuya A, Antoine M, Lagarde P, Kantor G, Breton-Callu C, Lefebvre C, Gerard M, Aamarcha A, Ozsahin M, Bourhis J, Maingon P, Troussier I, Pourel N. Doses aux organes à risque en radiothérapie conformationnelle et en radiothérapie stéréotaxique : les poumons. Cancer Radiother 2017; 21:584-596. [DOI: 10.1016/j.canrad.2017.07.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/21/2017] [Accepted: 07/23/2017] [Indexed: 12/25/2022]
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18
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Denis F, Lethrosne C, Pourel N, Molinier O, Pointreau Y, Domont J, Bourgeois H, Senellart H, Trémolières P, Lizée T, Bennouna J, Urban T, El Khouri C, Charron A, Septans AL, Balavoine M, Landry S, Solal-Céligny P, Letellier C. Randomized Trial Comparing a Web-Mediated Follow-up With Routine Surveillance in Lung Cancer Patients. J Natl Cancer Inst 2017; 109:3573360. [PMID: 28423407 DOI: 10.1093/jnci/djx029] [Citation(s) in RCA: 274] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 02/07/2017] [Indexed: 11/13/2022] Open
Abstract
Background The use of web-based monitoring for lung cancer patients is growing in interest because of promising recent results suggesting improvement in cancer and resource utilization outcomes. It remains an open question whether the overall survival (OS) in these patients could be improved by using a web-mediated follow-up rather than classical scheduled follow-up and imaging. Methods Advanced-stage lung cancer patients without evidence of disease progression after or during initial treatment were randomly assigned in a multicenter phase III trial to compare a web-mediated follow-up algorithm (experimental arm), based on weekly self-scored patient symptoms, with routine follow-up with CT scans scheduled every three to six months according to the disease stage (control arm). In the experimental arm, an alert email was automatically sent to the oncologist when self-scored symptoms matched predefined criteria. The primary outcome was OS. Results From June 2014 to January 2016, 133 patients were enrolled and 121 were retained in the intent-to-treat analysis; 12 deemed ineligible after random assignment were not subsequently followed. Most of the patients (95.1%) had stage III or IV disease. The median follow-up was nine months. The median OS was 19.0 months (95% confidence interval [CI] = 12.5 to noncalculable) in the experimental and 12.0 months (95% CI = 8.6 to 16.4) in the control arm (one-sided P = .001) (hazard ratio = 0.32, 95% CI = 0.15 to 0.67, one-sided P = .002). The performance status at first detected relapse was 0 to 1 for 75.9% of the patients in the experimental arm and for 32.5% of those in the control arm (two-sided P < .001). Optimal treatment was initiated in 72.4% of the patients in the experimental arm and in 32.5% of those in the control arm (two-sided P < .001). Conclusions A web-mediated follow-up algorithm based on self-reported symptoms improved OS due to early relapse detection and better performance status at relapse.
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Affiliation(s)
- Fabrice Denis
- Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France.,CORIA UMR 6614-Normandie Université, CNRS Université et INSA de Rouen, Campus Universitaire du Madrillet, Saint-Etienne du Rouvray, France
| | - Claire Lethrosne
- Service de pneumologie, Centre Hospitalier, Le Coudray, Chartres, France
| | | | | | - Yoann Pointreau
- Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France
| | - Julien Domont
- Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France
| | - Hugues Bourgeois
- Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France
| | - Hélène Senellart
- Institut de Cancérologie de l'Ouest René Gauducheau, St Herblain, France
| | | | - Thibaut Lizée
- Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest René Gauducheau, St Herblain, France
| | - Thierry Urban
- Service de pneumologie, Centre Hospitalier Universitaire, Angers, France
| | | | - Alexandre Charron
- Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France
| | | | | | - Sébastien Landry
- Institut Inter-régional de Cancérologie Jean Bernard, Le Mans, France
| | | | - Christophe Letellier
- CORIA UMR 6614-Normandie Université, CNRS Université et INSA de Rouen, Campus Universitaire du Madrillet, Saint-Etienne du Rouvray, France
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Abstract
Radiotherapy for small cell lung carcinoma has known significant improvements over the past 10 years especially through routine use of PET-CT in the initial work-up and contouring before treatment. Prophylactic cranial irradiation remains a standard of care for locally advanced disease and is a subject of controversy for metastatic disease. A new indication for thoracic radiotherapy may soon arise for metastatic disease, still confirmation studies are ongoing.
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Affiliation(s)
- N Pourel
- Département de radiothérapie, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS80005, 84918 Avignon cedex 9, France.
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Abstract
Quality and safety management have been implemented for many years in healthcare structures (hospitals treating cancer, private radiotherapy centres). Their structure and formalization have improved progressively over time. These recommendations aim at describing the link between quality and safety management through its organization scheme based on quality-safety policy, process approach, document management and quality measurement. Dedicated tools, such as experience feedback, a priori risk mapping, to-do-lists and check-lists are shown as examples and recommended as routine practice.
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Affiliation(s)
- N Pourel
- Pôle de radiothérapie, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS80005, 84918 Avignon cedex 9, France.
| | - C Meyrieux
- Pôle de radiothérapie, département qualité, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS80005, 84918 Avignon cedex 9, France
| | - B Perrin
- Unité de radioprotection et physique médicale, pôle d'oncologie, centre hospitalier Pasteur, 39, avenue de la Liberté, 68024 Colmar cedex, France
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21
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Denis F, Lethrosne C, Pourel N, Molinier O, Pointreau Y, Domont J, Bourgeois HP, Senellart H, Tremolieres P, Lizee T, Bennouna J, Urban T, El Kouri C, Charron A, Septans AL, Balavoine M, Rolley C, Landry S, Solal-Celigny P, Letellier C. Overall survival in patients with lung cancer using a web-application-guided follow-up compared to standard modalities: Results of phase III randomized trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.18_suppl.lba9006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA9006 Background: We developed a web-application for an early detection of symptomatic relapse, complications and early supportive care in high-risk lung cancer patients between visits. A dynamical analysis of the weekly self-reported symptoms automatically triggered physician visit. Methods: We performed a national multi-institutional phase 3 prospective randomized study to compare web-application follow-up (experimental arm) for which patient’s self-scored symptoms that were weekly sent (between planned visits) to the oncologist and a clinical routine assessment with a CT-scan (every 3-6 months or at investigator’s discretion - standard arm). High risk lung cancer patients without progression and with a 0-2 performance status (PS) after an initial treatment were included. Maintenance chemotherapy or TKI therapy were allowed. In the experimental arm, an email alert was sent to the oncologist when some predefined clinical criteria were fulfilled: an imaging was then quickly prescribed. Early supportive cares were provided if adequate. The primary endpoint was to detect an improvement of 12% in 9 months survival in favor of the experimental arm (α = 5%, β = 20%, unilateral test). The boundary for declaring superiority with respect to overall survival at the pre-planned interim analysis was a p-value of less than 0.006. The PS at relapse, the quality of life (QOL) and cost-effectiveness were also investigated. Results: 121 patients were included in the intent-to-test survival analysis (90% were stage III/IV, median age: 65 y): 60 (61) in the experimental (standard) arms with equivalent baseline characteristics. Median follow-up was 9 months. Median overall survival in months was 19 (11.8), p=0.0014 (n = 121; HR = 0.33; 95 % CI, 0.16-0.67) and the PS at the first relapse was 0-1 for 81.5% (35.3%) of the patients (p<0.001) in the experimental (standard) arm. Conclusions: This trial shows a significant survival improvement using Web-application-guided follow-up that allowed better PS at relapse, earlier supportive care and reduction of routine imaging. QOL and cost analysis results will be presented during the meeting. Clinical trial information: NCT02361099.
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Affiliation(s)
- Fabrice Denis
- Institut Inter-regional de Cancérologie Jean Bernard, Le Mans, France
| | | | | | | | | | - Julien Domont
- Institut Inter-regional de Cancérologie Jean Bernard, Le Mans, France
| | | | - Helene Senellart
- Institut De Cancérologie De l'Ouest, Site René Gauducheau, Nantes, France
| | | | - Thibaut Lizee
- Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest – site René Gauducheau, Saint Herblain, France
| | | | | | - Alexandre Charron
- Institut Inter-regional de Cancérologie Jean Bernard, Le Mans, France
| | | | | | - Cyrielle Rolley
- Institut Inter-regional de Cancérologie Jean Bernard, Le Mans, France
| | - Sebastien Landry
- Institut Inter-regional de Cancérologie Jean Bernard, Le Mans, France
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Denis F, Lethrosne C, Pourel N, Molinier O, Pointreau Y, Domont J, Bourgeois HP, Senellart H, Tremolieres P, Lizee T, Bennouna J, Urban T, El Kouri C, Charron A, Septans AL, Balavoine M, Rolley C, Landry S, Solal-Celigny P, Letellier C. Overall survival in patients with lung cancer using a web-application-guided follow-up compared to standard modalities: Results of phase III randomized trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.lba9006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fabrice Denis
- Institut Inter-regional de Cancérologie Jean Bernard, Le Mans, France
| | | | | | | | | | - Julien Domont
- Institut Inter-regional de Cancérologie Jean Bernard, Le Mans, France
| | | | - Helene Senellart
- Institut De Cancérologie De l'Ouest, Site René Gauducheau, Nantes, France
| | | | - Thibaut Lizee
- Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest - site René Gauducheau, Saint Herblain, France
| | | | | | - Alexandre Charron
- Institut Inter-regional de Cancérologie Jean Bernard, Le Mans, France
| | | | | | - Cyrielle Rolley
- Institut Inter-regional de Cancérologie Jean Bernard, Le Mans, France
| | - Sebastien Landry
- Institut Inter-regional de Cancérologie Jean Bernard, Le Mans, France
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Denis F, Trémolières P, Lethrosne C, Pourel N, Sennelart H, Molinier O, El Khouri C, Solal-Céligny P, Urban T, Letellier C. Application clinique de la théorie du chaos en oncologie : résultats intermédiaires de l’essai randomisé multicentrique de phase 3 « Sentinel » de surveillance post-thérapeutique de patients suivis pour un cancer bronchique par web-application. Cancer Radiother 2015. [DOI: 10.1016/j.canrad.2015.07.074] [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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Le Péchoux C, Dunant A, Faivre-Finn C, Thomas PA, Pourel N, Lerouge D, Edwards J, Van Schil P, Rami-Porta R, Dansin E, Nestle U, Fadel E, Zalcman G. Postoperative Radiotherapy for Pathologic N2 Non-Small-Cell Lung Cancer Treated With Adjuvant Chemotherapy: Need for Randomized Evidence. J Clin Oncol 2015; 33:2930-1. [PMID: 26215941 DOI: 10.1200/jco.2015.62.1458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024] Open
Affiliation(s)
| | - Ariane Dunant
- Gustave-Roussy, Paris Sud University, Villejuif, France
| | | | | | | | | | - John Edwards
- Northern General Hospital, Sheffield, United Kingdom
| | | | | | | | - Ursula Nestle
- Freiburg University Medical Center, Freiburg im Breisgau, Germany
| | - Elie Fadel
- Centre Chirurgical Marie Lannelongue, Paris Sud University, Paris, France
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Pourel N, Meyrieux C, Arnaud A, Garcia R. EP-1317: Risk analysis based on FMEA methodology allows to deter the risk of human error in the field of SBRT. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41309-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: 11/28/2022]
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Abstract
Patient information duties are a basic task of radiation oncologists in their daily practice. This article is essentially a factsheet on legal obligations, the value of written informed consent and information documents that ought to be given to patient.
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Affiliation(s)
- N Pourel
- Service de radiothérapie, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, 84000 Avignon, France.
| | - B Py
- Faculté de droit de Nancy, université de Lorraine, 13, place Carnot, 54000 Nancy, France
| | - D Safran
- Service d'anesthésie-réanimation, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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Jouin A, Pourel N. Marges dans le cancer pulmonaire : volume cible interne/volume cible anatomoclinique. Cancer Radiother 2013; 17:428-33. [DOI: 10.1016/j.canrad.2013.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/25/2013] [Indexed: 10/26/2022]
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Meyrieux C, Garcia R, Pourel N, Mège A, Bodez V. [FMEA applied to the radiotherapy patient care process]. Cancer Radiother 2012; 16:613-8. [PMID: 23092808 DOI: 10.1016/j.canrad.2012.07.188] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 07/13/2012] [Accepted: 07/17/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Failure modes and effects analysis (FMEA), is a risk analysis method used at the Radiotherapy Department of Institute Sainte-Catherine as part of a strategy seeking to continuously improve the quality and security of treatments. PATIENTS AND METHODS The method comprises several steps: definition of main processes; for each of them, description for every step of prescription, treatment preparation, treatment application; identification of the possible risks, their consequences, their origins; research of existing safety elements which may avoid these risks; grading of risks to assign a criticality score resulting in a numerical organisation of the risks. Finally, the impact of proposed corrective actions was then estimated by a new grading round. RESULTS For each process studied, a detailed map of the risks was obtained, facilitating the identification of priority actions to be undertaken. For example, we obtain five steps in patient treatment planning with an unacceptable level of risk, 62 a level of moderate risk and 31 an acceptable level of risk. CONCLUSION The FMEA method, used in the industrial domain and applied here to health care, is an effective tool for the management of risks in patient care. However, the time and training requirements necessary to implement this method should not be underestimated.
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Affiliation(s)
- C Meyrieux
- Secteur qualité - gestion des risques, institut Sainte-Catherine, Avignon cedex, France.
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Poudenx M, Bondiau PY, Chamorey E, Venissac N, Otto J, Pourel N, Castelnau O, Tessier E, De Surmont Salasc B, Berdah JF, Pop D, Michel C, Mouroux J. Cisplatin-docetaxel induction plus concurrent 3-D conformal radiotherapy and weekly chemotherapy for locally advanced non-small cell lung cancer patients: a phase II trial. Oncology 2012; 83:321-8. [PMID: 22986621 DOI: 10.1159/000342081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 07/23/2012] [Indexed: 02/03/2023]
Abstract
Concurrent chemoradiotherapy (CHRT) is the standard of care for unresectable locally advanced stage III non-small cell lung cancer. However, the optimal combination remains unclear. The aim of this study was to evaluate the efficacy of 2 induction chemotherapy cycles (days 1 and 22) with docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2) followed by concurrent chemotherapy (weekly docetaxel-cisplatin, 20 mg/m(2)) and 3-D conformal radiotherapy for 6 weeks (66 Gy/5 fractions per week/2 Gy per fraction). The primary endpoint was the response rate. Secondary objectives were toxicity, time to progression, and overall survival. Forty-four patients were included and 40 were eligible. The mean age was 60.5 years (range 40.7-72.1), and 75% had stage IIIB disease. Six patients underwent complete R0 resection including 2 pathologic complete responses after a planned intermediate evaluation. Thirty-three patients completed CHRT. The objective response rate was 65% (95% CI 50.2-79.8). Grade 3-4 hematologic and digestive toxicities were observed mainly during the induction phase. Grade 3 esophagitis (5%) was experienced during CHRT. With a median follow-up of 38.7 months, the median progression-free survival was 28.3 months (95% CI 11.0-35.0) and the median survival rate was 31.4 months. Cisplatin-docetaxel induction followed by concurrent 3-D conformal radiotherapy and weekly chemotherapy is a feasible protocol associated with a promising response rate and acceptable toxicity.
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Affiliation(s)
- M Poudenx
- Centre Antoine Lacassagne, Nice, France. michel.poudenx @ nice.unicancer.fr
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Wong Hee Kam S, Chastel D, Pourel N, Garcia R. Radiothérapie avec modulation d’intensité des tumeurs pulmonaires : développement d’une méthode d’arcthérapie en condition de blocage inspiratoire profond. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.07.130] [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]
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Greillier L, Martel-Lafay I, Arpin D, Pourel N, Chabaud S, Lamy R, Madroszyk A, Fournel P. A Randomised Phase II Study of Cetuximab (C) in Combination with Two Cisplatin-Based Concurrent Chemoradiotherapy Regimens in Patients (PTS) with Stage III Non-Small Cell Lung Cancer (NSCLC). Final Results of the GFPC 08-03 Trial. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33783-2] [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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Giraud P, Djadi-Prat J, Morvan E, Morelle M, Remmonay R, Pourel N, Durdux C, Carrie C, Mornex F, Le Péchoux C, Bachaud JM, Boisselier P, Beckendorf V, Dendale R, Daveau C, Garcia R. Intérêts dosimétriques et cliniques de la radiothérapie asservie à la respiration des cancers du poumon et du sein : résultats du Stic 2003. Cancer Radiother 2012; 16:272-81. [DOI: 10.1016/j.canrad.2012.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 03/07/2012] [Accepted: 03/12/2012] [Indexed: 12/25/2022]
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33
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Fournel P, Pourel N. Les cancers bronchiques. ONCOLOGIE 2012. [DOI: 10.1007/s10269-012-2166-5] [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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Giraud P, Djadi-Prat J, Morelle M, Pourel N, Durdux C, Carrie C, Daveau C, Carrère MO, the STIC study centers. Contribution of Respiratory Gating Techniques for Optimization of Breast Cancer Radiotherapy. Cancer Invest 2012; 30:323-30. [DOI: 10.3109/07357907.2012.657818] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Philippe Giraud
- Department of Radiation Oncology, European Georges-Pompidou Hospital,
Paris Descartes University, Paris, France,1
- Department of Radiation Oncology,2
| | | | - Magalie Morelle
- Curie Institute, Paris, France, CNRS UMR GATE 5824, Léon Bérard Center,
Lyon, France,4
| | - Nicolas Pourel
- Department of Radiation Oncology, Sainte Catherine Institute,
Avignon, France,5
| | - Catherine Durdux
- Department of Radiation Oncology, European Georges-Pompidou Hospital,
Paris Descartes University, Paris, France,1
| | - Christian Carrie
- Department of Radiation Oncology, Léon Bérard Center,
Lyon, France6
| | - Caroline Daveau
- Department of Radiation Oncology, European Georges-Pompidou Hospital,
Paris Descartes University, Paris, France,1
| | - Marie-Odile Carrère
- Curie Institute, Paris, France, CNRS UMR GATE 5824, Léon Bérard Center,
Lyon, France,4
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Daveau C, Djadi-Prat J, Durdux C, Dendale R, Pourel N, Caron J, Simon J, Nguyen T, Carrère M, Giraud P. Respiration-gated Radiotherapy in a Large Prospective Breast Cancer Study: Dosimetric and Clinical Benefits. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pourel N, Mege A, Garcia R, Meyrieux C, Combelles B, Chauvet B. Analyser la fiabilité des traitements en radiothérapie oncologique : « la revue de processus ». Cancer Radiother 2009. [DOI: 10.1016/j.canrad.2009.07.015] [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: 10/20/2022]
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37
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Bondiau PY, Venissac N, Otto J, Pourel N, Berdah JF, Castelno O, Teissier E, De Surmont B, Poudenx M. Chimioradiothérapie concomitante avec cisplatine et docétaxel après chimiothérapie d’induction pour les cancers pulmonaires non à petites cellules, étude de phase II. Cancer Radiother 2008. [DOI: 10.1016/j.canrad.2008.08.059] [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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38
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Poudenx M, Bondiau P, Venissac N, Otto J, Pourel N, Castelnau O, Berdah J, De Surmont Salasc B, Teissier E, Mouroux J. Induction with cisplatin (C) and docetaxel (D) plus concurrent three-dimensional (3D) conformal radiotherapy and weekly C and D for locally advanced non-small cell lung cancer (NSCLC) patients (pts): Phase II trial. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7585] [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: 11/20/2022] Open
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Pourel N, Hilgers W, Santelmo N, Naffaa N, Reboul F. Induction 3D-chemoradiation (CRT) yields a high rate of pathologic complete response in stage IIB(Pancoast)/III NSCLC operable patients (pts) without increasing perioperative mortality after (bi-)lobectomy: A review of 107 cases treated in a community- based center. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7704] [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: 11/20/2022] Open
Abstract
7704 Background: Optimal preoperative treatment for stage IIB/III NSCLC remains a subject of controversy. According to the results of INT0139 trial (Albain KS et al in Proc ASCO 2005, abstr #7014), induction CRT appears to be superior to chemotherapy alone (CT) in terms of pathologic complete response (or microscopic residual foci, pCR), but increases postoperative (postop) mortality after pneumonectomy. Methods: Pts were selected through a multidisciplinary committee according to functional and resecability criteria. Induction treatment comprised 45 Gy/25 fractions/5 weeks. RT delivered to the primary tumor and pathologic hilar and/or mediastinal nodes (CTV) with an extra-margin of 1 to 1.5 cm (PTV). A 3D 5-field technique was used for all patients with 8–25 MV photons. Concurrent CT regimen was Cisplatinum 20 mg/m2 and Etoposide 50 mg/m2 (PE), d1–5, d29–33. Surgery was performed 4 to 6 weeks after CRT completion in deemed resectable pts. Inoperable pts were referred for a 20 Gy boost ± 1 extra-cycle of PE. Results: From 1996 to 2005, 107 NSCLC pts received CRT (stage IIB-Pancoast 18, IIIA 58 and IIIB 31). One hundred pts received the whole 45 Gy+PEx2; 72 pts had a thoracotomy (pneumonectomy 21, lobectomy 45, bi-lobectomy 5, exploratory only 1). During the 3-month postop time, 5 pts (6.9%) died, 4 after pneumonectomy (R 3, L 1, 19%), 1 after lobectomy (2.2%); 34 pts had 1–3 significant complication(s) (mainly, arrhythmia 10, pneumonia 8 (lethal 1), prolonged air leak 7, fistula 4, empyema 4 (lethal 2), pulmonary embolism 3 (lethal 2)).A pCR was observed in 39.5% of 71 resected pts; mediastinal nodes were sterilized in 60.9% of 46 cN2 pts. Analysis of survival and predictive factors is ongoing. Conclusions: Surgery is feasible after induction chemo-RT, particularly (bi-)lobectomy, in stage IIB/III NSCLC pts but pneumonectomy carries an inacceptable risk of postop death (particularly, right pneumonectomy). CRT yields an encouraging pCR rate of 39.5%. No significant financial relationships to disclose.
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Affiliation(s)
- N. Pourel
- Institut Sainte-Catherine, Avignon Cedex 2, France; Centre Hospitalier H. Duffaud, Avignon, France
| | - W. Hilgers
- Institut Sainte-Catherine, Avignon Cedex 2, France; Centre Hospitalier H. Duffaud, Avignon, France
| | - N. Santelmo
- Institut Sainte-Catherine, Avignon Cedex 2, France; Centre Hospitalier H. Duffaud, Avignon, France
| | - N. Naffaa
- Institut Sainte-Catherine, Avignon Cedex 2, France; Centre Hospitalier H. Duffaud, Avignon, France
| | - F. Reboul
- Institut Sainte-Catherine, Avignon Cedex 2, France; Centre Hospitalier H. Duffaud, Avignon, France
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Garcia R, Bodez V, Vial L, Gaillot-Petit N, Chastel D, Licata R, Pourel N, Reboul F. Techniques innovantes en radiothérapie des cancers bronchiques. ONCOLOGIE 2005. [DOI: 10.1007/s10269-005-0263-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pourel N, Hilgers W, Garcia R, Reboul F. Chimio-radiothérapie dans les formes localement avancées inopérables: acquis et perspectives. ONCOLOGIE 2005. [DOI: 10.1007/s10269-005-0262-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
PURPOSE To collect data on the health-related quality of life (QOL) of long-term survivors and to determine to what extent QOL might be an appropriate end point in the comparison of treatment options in oropharyngeal carcinoma. METHODS AND MATERIALS All patients treated between 1992 and 1998, in two French comprehensive cancer centers, by brachytherapy (BT) +/- external beam radiotherapy (EBRT) or surgery plus RT, or exclusive EBRT for T1-T3 (International Union Against Cancer staging system) oropharynx squamous cell carcinoma, were included. QOL was measured once in disease-free patients at least 2 years after treatment initiation. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire and the specific H&N35 module were self-administered by all participating patients. Sociodemographic data were collected using a questionnaire specifically designed for the study. The association between the QOL scores of the various treatment-, disease-, and patient-related variables was performed through bivariate analysis and then by multivariate analysis. The mean QOL scores of the EORTC QLQ-C30 questionnaire were compared with the mean scores in the general population. RESULTS Of the 159 eligible patients, 113 agreed to participate (97 men and 16 women, median age 61 years, range 41-83). The initial treatment was EBRT plus BT in 49 patients, surgery plus RT in 27, and EBRT alone in 37. The median follow-up time was 62 months (range 24-110). Compared with the general population, the three scores indicating the most impaired QOL were emotional and social functioning and fatigue. The clinical significance of global QOL impairment was borderline. The physical functioning, role functioning, and pain scores did not significantly differ from those of the general population. In multivariate analysis, the initial treatment had no significant influence on any dimension of QOL, except global QOL and emotional functioning. Surprisingly, surgery plus RT, as the initial treatment, favorably influenced the emotional functioning score and EBRT plus BT negatively influenced the global QOL score. None of these treatment modalities influenced any symptom scales. Patient selection was, at least partially, responsible for these paradoxical results. CONCLUSION The results of this study bring original and useful data about the QOL of long-term survivors of oropharynx carcinoma. In these patients, the QOL was significantly impaired, particularly in its psychosocial dimensions. The level of symptoms and functioning (except global QOL and emotional) was similar whatever the initial treatment. These results suggest the importance of coping processes. In a trial comparing treatment options from a long-term perspective, survival remains the most relevant end point, and a QOL evaluation should be a secondary end point. More prospective studies on QOL in head-and-neck cancer patients are needed to determine new strategies for rehabilitation management.
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Affiliation(s)
- Nicolas Pourel
- Department of Radiation Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France.
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Lapeyre M, Charra-Brunaud C, Kaminsky M, Geoffrois L, Dolivet G, Toussaint B, Maire F, Pourel N, Simon M, Marchal C, Bey P. Prise en charge des mucites après radiothérapie des cancers des voies aérodigestives supérieures. Cancer Radiother 2001. [DOI: 10.1016/s1278-3218(01)80018-4] [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: 10/20/2022]
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Lapeyre M, Charra-Brunaud C, Kaminsky MC, Geoffrois L, Dolivet G, Toussaint B, Maire F, Pourel N, Simon M, Marchal C, Bey P. [Management of mucositis following radiotherapy for head and neck cancers]. Cancer Radiother 2001; 5 Suppl 1:121s-130s. [PMID: 11797271] [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: 02/23/2023]
Abstract
Acute mucositis is common after radiotherapy for head and neck cancers. During the past 3 decades, there was a gradual evolution in the treatment modalities for locally advanced carcinomas (concomitant radio-chemotherapy, accelerated radiotherapy). These new strategies are accompanied by an increase in early mucosal reactions. At the present time, there is no widely accepted prophylaxis or effective treatment. Many traditional remedies or new agents seem ineffective (Sucralfate, Chlorhexidine, GM-CSF, Silver nitrate, Prostaglandin, anti-oxidants, Benzydamine hydrochloride), while others seem promising (Povidone-iodine, nonabsorbable antibiotic lozenges and antifungals, local GM-CSF, Glutamide, Low-energy laser, corticosteroïds). Radioprotectors are controversial and should be only used in experimental protocols and not in routine practice. However, some recommendations can be proposed: general prevention and global care before cancer therapy should be systematic (oral hygiene, dental and periodontal treatment, advice to avoid the use of tobacco and alcohol); frequent oral rinsing with a bland mouthwash (Povidone-iodine or others) should be used at the start of treatment because there are significant modifications of the oral microflora increased by a disturbed salivary flow; these mouthwashes could be associated with nonabsorbable antibiotic lozenges or antifungal topicals (bicarbonates, Amphotéricine B); Systematic percutaneous fluoroscopic gastrostomy should be decided before any aggressive treatments (concomitant radio-chemotherapy, accelerated radiotherapy); pain should be controlled; finally, the radiation technique should be optimized (mucosal-sparing block, conformal radiotherapy and intensity-modulated radiation therapy).
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Affiliation(s)
- M Lapeyre
- Département de radiothérapie, centre Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-lès-Nancy.
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Pourel N, Auque J, Bracard S, Hoffstetter S, Luporsi E, Vignaud JM, Bey P. Efficacy of external fractionated radiation therapy in the treatment of meningiomas: a 20-year experience. Radiother Oncol 2001; 61:65-70. [PMID: 11578730 DOI: 10.1016/s0167-8140(01)00391-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [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: 11/26/2022]
Abstract
BACKGROUND This is a retrospective analysis of a series of meningiomas treated by radiotherapy. MATERIALS AND METHODS From 1978 to 1997, 45 patients with intracranial meningiomas were referred for external fractionated radiotherapy at Centre Alexis Vautrin. All patients were given 50-70Gy to the tumor bed (median: 56Gy), 1.8-2Gy per fraction. RESULTS Evaluation was performed in June 1999 using the Kaplan-Meyer actuarial method with a median follow-up of 30 months (range: 1-166), relapse-free survivals (RFSs) were 75% at 5 years and 67% at 8 years; overall survival (OS) was 74% at 5 and 8 years. For the 26 benign histologically documented lesions, RFSs were 95% at 5 years and 81% at 8 years; OS was 85% at 5 and 8 years. One major radiation-induced complication occurred in this series (decline of cognitive function). According to the indication of radiotherapy, we divided the series into four groups: postoperative irradiation after a first subtotal resection (11 patients), 5-year RFS was 90%; after first recurrence (+/-salvage surgery, 14 patients), 73%; after further recurrence (+/-salvage surgery, 11 patients), 67%; as exclusive treatment (nine patients), 80%. Atypical and malignant lesions (n=7) all relapsed before 24 months of follow-up, all patients but one died before 42 months. Age at the time of irradiation (> or =60 vs. <60 years) and radiotherapy dose (> or =60 vs. <60Gy) did not influence local control or OS. Atypical and malignant lesions (WHO grades II and III) meningiomas had a worse outcome than benign lesions (WHO grade I, P<0.01). CONCLUSIONS These results compare favorably with previously published data. External fractionated radiotherapy is well tolerated and effective. There is still a debate about the place of radiotherapy in the treatment of meningiomas: after subtotal resection, should radiotherapy be given postoperatively or at the time of progression? Should radiotherapy replace surgery when the risk of postoperative sequellae is high? Prospective randomized trials would be required to address these issues.
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Affiliation(s)
- N Pourel
- Radiotherapy Department, Centre Alexis Vautrin, Avenue de Bourgogne, 54511 Vandoeuvre-Lès-Nancy, Cedex, France
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Lapeyre M, Buchheit I, Aletti P, Noel A, Pourel N, Geoffrois L, Kaminski M, Mettayer Y, Marchal C, Bey P. Conformal boost radiotherapy for carcinomas of the naso-pharynx: local control and dose/volumes distribution. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pourel N, Conroy T, Lapeyre M, Hoffstetter S, Peiffert D. 82 Assessment of quality of life in long-term survivors treated by brachytherapy for oropharyngeal carcinoma. Radiother Oncol 2001. [DOI: 10.1016/s0167-8140(01)80088-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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