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Mauclet C, Dupont MV, Roelandt K, Regnier M, Delos M, Pirard L, Vander Borght T, Dahlqvist C, Froidure A, Rondelet B, Vanderick J, Remouchamps V, Duplaquet F, Ocak S. Treatment and Prognosis of Patients with Lung Cancer and Combined Interstitial Lung Disease. Cancers (Basel) 2023; 15:3876. [PMID: 37568692 PMCID: PMC10417812 DOI: 10.3390/cancers15153876] [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: 05/27/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) is associated with a higher lung cancer (LC) risk and may impact cancer's clinical characteristics, treatment strategies, and outcomes. This impact's extent is unclear, particularly in Caucasians. METHODS In this retrospective observational study, we reviewed the files of all LC patients diagnosed in a 38-month period. Expert radiologists reviewed the computed tomography scans performed at diagnosis. Patients with LC and ILD (n = 29, 7%) were compared to those without ILD (n = 363, 93%) for population and cancer characteristics, treatments, and clinical outcomes. RESULTS Patients with LC and ILD were older (73 ± 8 vs. 65 ± 11 years; p < 0.001). There was no significant difference in LC histology, localization, stage, or treatment modalities. The respiratory complication rate after cancer treatment was significantly higher in the ILD group (39% vs. 6%; p < 0.01). Overall survival rates were similar at 12 (52% vs. 59%; p = 0.48) and 24 months (41% vs. 45%; p = 0.64) but poorer in the ILD group at 36 months, although not statistically significant (9% vs. 39%; p = 0.06). The ILD group had a higher probability of death (hazard ratio (HR) = 1.49 [0.96;2.27]), but this was not statistically significant (p = 0.06). In a Cox regression model, patients with ILD treated surgically had a significantly higher mortality risk (HR = 2.37 [1.1;5.09]; p = 0.03). CONCLUSIONS Patients with combined LC and ILD have worse clinical outcomes even when similar treatment modalities are offered.
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Affiliation(s)
- Charlotte Mauclet
- Division of Pulmonology, Clinique Saint-Luc Bouge, Rue Saint-Luc, 8, 5004 Namur, Belgium
| | - Michaël V. Dupont
- Division of Radiology, CHU UCL Namur (Godinne Site), Université Catholique de Louvain (UCLouvain), Avenue G. Thérasse, 1, 5530 Yvoir, Belgium; (M.V.D.); (K.R.)
| | - Kerwin Roelandt
- Division of Radiology, CHU UCL Namur (Godinne Site), Université Catholique de Louvain (UCLouvain), Avenue G. Thérasse, 1, 5530 Yvoir, Belgium; (M.V.D.); (K.R.)
| | - Maxime Regnier
- Scientific Support Unit, CHU UCL Namur (Godinne Site), Université Catholique de Louvain (UCLouvain), Avenue G. Thérasse, 1, 5530 Yvoir, Belgium;
| | - Monique Delos
- Division of Pathology, CHU UCL Namur (Godinne Site), Université Catholique de Louvain (UCLouvain), Avenue G. Thérasse, 1, 5530 Yvoir, Belgium;
| | - Lionel Pirard
- Division of Pulmonology, CHU UCL Namur (Godinne Site), Université Catholique de Louvain (UCLouvain), Avenue G. Thérasse, 1, 5530 Yvoir, Belgium; (L.P.); (C.D.); (F.D.); (S.O.)
| | - Thierry Vander Borght
- Division of Nuclear Medicine, CHU UCL Namur (Godinne Site), Université Catholique de Louvain (UCLouvain), Avenue G. Thérasse, 1, 5530 Yvoir, Belgium;
| | - Caroline Dahlqvist
- Division of Pulmonology, CHU UCL Namur (Godinne Site), Université Catholique de Louvain (UCLouvain), Avenue G. Thérasse, 1, 5530 Yvoir, Belgium; (L.P.); (C.D.); (F.D.); (S.O.)
| | - Antoine Froidure
- Division of Pulmonology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10, 1200 Bruxelles, Belgium;
- Pole of Pulmonology, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 55/B1.55.02, 1200 Bruxelles, Belgium
| | - Benoît Rondelet
- Division of Thoracic Surgery, CHU UCL Namur (Godinne Site), Université Catholique de Louvain (UCLouvain), Avenue G. Thérasse, 1, 5530 Yvoir, Belgium;
| | - Jean Vanderick
- Division of Radiation Therapy, CHU UCL Namur (Sainte-Elisabeth Site), Université Catholique de Louvain (UCLouvain), Place Louise Godin, 15, 5000 Namur, Belgium; (J.V.); (V.R.)
| | - Vincent Remouchamps
- Division of Radiation Therapy, CHU UCL Namur (Sainte-Elisabeth Site), Université Catholique de Louvain (UCLouvain), Place Louise Godin, 15, 5000 Namur, Belgium; (J.V.); (V.R.)
| | - Fabrice Duplaquet
- Division of Pulmonology, CHU UCL Namur (Godinne Site), Université Catholique de Louvain (UCLouvain), Avenue G. Thérasse, 1, 5530 Yvoir, Belgium; (L.P.); (C.D.); (F.D.); (S.O.)
| | - Sebahat Ocak
- Division of Pulmonology, CHU UCL Namur (Godinne Site), Université Catholique de Louvain (UCLouvain), Avenue G. Thérasse, 1, 5530 Yvoir, Belgium; (L.P.); (C.D.); (F.D.); (S.O.)
- Pole of Pulmonology, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 55/B1.55.02, 1200 Bruxelles, Belgium
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Pierrard J, Deheneffe S, Longton E, Henry S, Van Houtte P, Remouchamps V. Radiation therapy-induced left vocal cord paralysis following lung stereotactic body radiation therapy: A case report and review of the literature. Cancer Radiother 2023; 27:69-74. [PMID: 35872055 DOI: 10.1016/j.canrad.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 02/06/2023]
Abstract
We report the case of a 50-year old women with an oncological history of metastatic breast carcinoma who underwent lung stereotactic body radiation therapy (SBRT) of 60Gy in 8 fractions for a left upper lobe metastatic lesion. Seven months later, she complains about hoarseness and weakness of voice. Tumoral relapse and other frequent etiologies were excluded. The diagnosis of radiation induced left recurrent laryngeal nerve paralysis causing left vocal cord paralysis (VCP) was made. The symptomatology did not improve till the disease progression and death of the patient 29 months after SBRT. VCP after lung SBRT is a rare adverse event that has not yet been well described in the medical literature.
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Affiliation(s)
- J Pierrard
- Department of Radiotherapy, CHU UCL Namur, Site Ste Elisabeth, Namur, Belgium.
| | - S Deheneffe
- Department of Radiotherapy, CHU UCL Namur, Site Ste Elisabeth, Namur, Belgium
| | - E Longton
- Department of Radiotherapy, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - S Henry
- Department of Medical Oncology, CHU UCL Namur, Site Ste Elisabeth, Namur, Belgium
| | - P Van Houtte
- Department of Radiotherapy, Institut Jules-Bordet, Université Libre Bruxelles, Brussels, Belgium
| | - V Remouchamps
- Department of Radiotherapy, CHU UCL Namur, Site Ste Elisabeth, Namur, Belgium
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Vaandering A, Jansen N, Weltens C, Moretti L, Stellamans K, Vanhoutte F, Scalliet P, Remouchamps V, Lievens Y. Radiotherapy-specific quality indicators at national level: How to make it happen. Radiother Oncol 2023; 178:109433. [PMID: 36464181 DOI: 10.1016/j.radonc.2022.11.022] [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: 08/12/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE /OBJECTIVE To promote best practice and quality of care, the Belgian College of Physicians for Radiotherapy Centers established a set of radiotherapy specific quality indicators for benchmarking on a national level. This paper describes the development, the collected QIs, the observed trends and the departments' evaluation of this initiative. MATERIAL AND METHODS The Donabedian approach was used, focussing on structural, process and outcome QIs. The criteria for QI selection were availability, required for low-threshold regular collection, and applicability to guidelines and good practice. The QIs were collected yearly and individualized reports were sent out to all RT departments. In 2021, a national survey was held to evaluate the ease of data collection and submission, and the perceived importance and validity of the collected QIs. RESULTS 18 structural QI and 37 process and outcome parameters (n = 25 patients/pathology/department) were collected. The participation rate amounted to 95 % overall. The analysis gave a national overview of RT activity, resources, clinical practice and reported acute toxicities. The individualized reports allowed departments to benchmark their performance. The 2021 survey indicated that the QIs were overall easy to collect, relevant and reliable. The collection of acute recorded toxicities was deemed a weak point due to inter-observer variabilities and lack of follow-up time. CONCLUSION QI collection on a national level is a valuable process in steering quality improvement initiatives. The feasibility and relevance was demonstrated with a high level of participation. The national initiative will continue to evolve as a quality monitoring and improvement tool.
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Affiliation(s)
- Aude Vaandering
- UCL Cliniques Universitaires St Luc, Department of radiation oncology, Brussels, Belgium; Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
| | - Nicolas Jansen
- University Hospital of Liège, Department of radiation oncology, Liège, Belgium
| | - Caroline Weltens
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium
| | - Luigi Moretti
- Institut Jules Bordet, Department of radiation oncology, Brussels, Belgium
| | - Karin Stellamans
- AZ Groeninge, Department of radiation oncology, Kortrijk, Belgium
| | - Frederik Vanhoutte
- Ghent University Hospital and Ghent University, Department of radiation oncology, Ghent, Belgium
| | - Pierre Scalliet
- Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Vincent Remouchamps
- CHU-UCL Namur - site Saint Elisabeth, Department of radiation oncology, Namur, Belgium
| | - Yolande Lievens
- Ghent University Hospital and Ghent University, Department of radiation oncology, Ghent, Belgium
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Lievens Y, Boesmans L, Engels H, Geets X, Jansen N, Janssens S, Lambrecht M, Remouchamps V, Roosens S, Stellamans K, Verellen D, Weltens C, Weytjens R, Van Damme N. OC-0505 Coverage with evidence development: generating real-life evidence on SBRT in Belgium. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02605-6] [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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Lievens Y, Lambrecht M, Boesmans L, Engels H, Geets X, Janssens S, Moretti L, Remouchamps V, Roosens S, Van Damme N. OC-0752 SBRT for lung cancer and lung metastases: prospective national registration project in Belgium. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02658-5] [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: 10/18/2022]
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Benkhaled S, Koshariuk O, Van Esch A, Remouchamps V. Characteristics and dosimetric impact of intrafraction motion during peripheral lung cancer stereotactic radiotherapy: is a second midpoint cone beam computed tomography of added value? Rep Pract Oncol Radiother 2022; 27:490-499. [PMID: 36186683 PMCID: PMC9518766 DOI: 10.5603/rpor.a2022.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background In our department, during lung stereotactic body radiation therapy (SBRT), all patients receive an intra-fractional midpoint cone beam computed tomography (CBCT). This study aimed to quantify the benefit of adding a second midpoint CBCT over a course of peripheral lung SBRT. Materials and methods Six-hundred-sixty-four CBCTs from 166 patients were retrospectively analyzed. Treatments were based on the internal target volume (ITV) approach. An isotropic 0.5 cm margin was used to create the planning target volume (PTV) around the ITV. The prescribed dose was 48 Gy in 4 fractions to the PTV. Patients were divided into two groups: patients for whom the 3D-intra-fractional-variation (IFV) was < 0.5 cm (105 patients, low risk group) and patients with at least one 3D-IFV ≥ 0.5 cm (61 patients, high-risk group). Plans simulating the dosimetric impact of the IFV were created as follows: the original 2 arcs (ARC ) were copied into a new plan consisting of 4 times ARC 1 and 4 times ARC 2. The delivery of ARC 1 was always assumed to have occurred with the isocenter initially coordinated, whereas the positions of ARC 2 were modified for each arc by the measured the 3D-IFV. Results For the PTV, we obtained: D99% (Gy) = 45.2 vs. 48.2 Gy (p < 0.0001); Dmean = 53 vs. 54 Gy (p < .0001) for the reconstructed vs. planned dose values, respectively. For the ITV, the changes are less pronounced: D99% (Gy) = 52.2 vs. 53.6 Gy (p = 0.0007); Dmean = 56 vs. 56.8 Gy (p = 0.0144). The V48 Gy(%)-ITV coverage did not statistically change between the delivered vs. planned dose (p = 0.1803). Regarding the organs at risk for both groups, dose-volume-histograms were near-identical. Conclusion We demonstrated that a single CBCT is sufficient and reliable to manage the IFV during peripheral lung SBRT.
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Charlier F, Descamps T, Lievens Y, Geets X, Remouchamps V, Lambrecht M, Moretti L. ProCaLung - Peer review in stage III, mediastinal node-positive, non-small-cell lung cancer: How to benchmark clinical practice of nodal target volume definition and delineation in Belgium ☆. Radiother Oncol 2021; 167:57-64. [PMID: 34890738 DOI: 10.1016/j.radonc.2021.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE The Quality Assurance project for stage III non-small cell lung cancer radiotherapy ProCaLung performed a multicentric two-step exercise evaluating mediastinal nodal Target Volume Definition and Delineation (TVD) variability and the opportunity for standardization. The TVD variability before and after providing detailed guidelines and the value of qualitative contour reviewing before applying quantitative measures were investigated. MATERIALS AND METHODS The case of a patient with stage III NSCLC and involved mediastinal lymph nodes was used as a basis for this study. Twenty-two radiation oncologists from nineteen centers in Belgium and Luxembourg participated in at least one of two phases of the project (before and after introduction of ProCaLung contouring guidelines). The resulting thirty-three mediastinal nodal GTV and CTV contours were then evaluated using a qualitative-before-quantitative (QBQ) approach. First, a qualitative analysis was performed, evaluating adherence to most recent guidelines. From this, a list of observed deviations was created and these were used to evaluate contour conformity. The second analysis was quantitative, using overlap and surface distance measures to compare contours within qualitative groups and between phases. A 'most robust' reference volume for these analyses was created using the STAPLE-algorithm and an averaging method. RESULTS Five GTV and seven CTV qualitative groups were identified. Second step contours were more often in higher-conformity groups (p = 0.012 for GTV and p = 0.024 for CTV). Median Residual Mean Square Distances improved from 2.34 mm to 1.36 mm for GTV (p = 0.01) and from 4.53 mm to 1.58 mm for CTV (p < 0.0001). Median Dice coefficients increased from 0.81 to 0.84 for GTV (p = 0.07) and from 0.82 to 0.89 for CTV (p ≤ 0.001). Using HC-contours only to generate references translated in more robust quantitative evaluations. CONCLUSION Variability of mediastinal nodal TVD was reduced after providing the ProCaLung consensus guidelines. A qualitative review was essential for providing meaningful quantitative measures.
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Affiliation(s)
- Florian Charlier
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Descamps
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Xavier Geets
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Vincent Remouchamps
- Radiation Oncology Department, CHU UCL Namur - site Sainte Elisabeth, Namur, Belgium
| | - Maarten Lambrecht
- Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - Luigi Moretti
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
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Stouthandel MEJ, Kayser F, Vakaet V, Khoury R, Deseyne P, Monten C, Schoepen M, Remouchamps V, De Caluwé A, Janoray G, De Neve W, Mazy S, Veldeman L, Van Hoof T. Delineation guidelines for the lymphatic target volumes in 'prone crawl' radiotherapy treatment position for breast cancer patients. Sci Rep 2021; 11:22529. [PMID: 34795352 PMCID: PMC8602302 DOI: 10.1038/s41598-021-01841-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/01/2021] [Indexed: 12/15/2022] Open
Abstract
Our recently developed prone crawl position (PCP) for radiotherapy of breast cancer patients with lymphatic involvement showed promising preliminary data and it is being optimized for clinical use. An important aspect in this process is making new, position specific delineation guidelines to ensure delineation (for treatment planning) is uniform across different centers. The existing ESTRO and PROCAB guidelines for supine position (SP) were adapted for PCP. Nine volunteers were MRI scanned in both SP and PCP. Lymph node regions were delineated in SP using the existing ESTRO and PROCAB guidelines and were then translated to PCP, based on the observed changes in reference structure position. Nine PCP patient CT scans were used to verify if the new reference structures were consistently identified and easily applicable on different patient CT scans. Based on these data, a team of specialists in anatomy, CT- and MRI radiology and radiation oncology postulated the final guidelines. By taking the ESTRO and PROCAB guidelines for SP into account and by using a relatively big number of datasets, these new PCP specific guidelines incorporate anatomical variability between patients. The guidelines are easily and consistently applicable, even for people with limited previous experience with delineations in PCP.
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Affiliation(s)
- Michael E J Stouthandel
- Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy park, entrance 98, 9000, Ghent, Belgium.
| | - Françoise Kayser
- Department of Radiology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Vincent Vakaet
- Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy park, entrance 98, 9000, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, Radiotherapy park, entrance 98, 9000, Ghent, Belgium
| | - Ralph Khoury
- Department of Radiology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Pieter Deseyne
- Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy park, entrance 98, 9000, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, Radiotherapy park, entrance 98, 9000, Ghent, Belgium
| | - Chris Monten
- Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy park, entrance 98, 9000, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, Radiotherapy park, entrance 98, 9000, Ghent, Belgium
| | - Max Schoepen
- Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy park, entrance 98, 9000, Ghent, Belgium
| | - Vincent Remouchamps
- Department of Radiotherapy, CHU UCL Namur, site Ste Elisabeth, Place Louise Godin 15, 5000, Namur, Belgium
| | - Alex De Caluwé
- Department of Radiation Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Guillaume Janoray
- Department of Radiation Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Wilfried De Neve
- Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy park, entrance 98, 9000, Ghent, Belgium
| | - Stephane Mazy
- Department of Radiology, CHU-UCL Namur, site Ste Elisabeth, Place Louise Godin 15, 5000, Namur, Belgium
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy park, entrance 98, 9000, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, Radiotherapy park, entrance 98, 9000, Ghent, Belgium
| | - Tom Van Hoof
- Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy park, entrance 98, 9000, Ghent, Belgium
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Dubaere E, Goffaux M, Wanet M, Bihin B, Gheldof C, Demoulin AS, Bolly A, Bustin F, Duplaquet F, Baugnee PE, Gustin M, Hers V, Maisin F, Marchand E, Ocak S, Pirard L, Vancutsem O, Van Neck E, Vandermoten G, Zaharia L, Remouchamps V. Long term outcome after 48 Gy stereotactic ablative body radiotherapy for peripheral stage I non-small cell lung cancer. BMC Cancer 2019; 19:639. [PMID: 31253136 PMCID: PMC6599378 DOI: 10.1186/s12885-019-5863-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/20/2019] [Indexed: 12/25/2022] Open
Abstract
Background To evaluate the outcome of patients treated with stereotactic ablative body radiotherapy (SABR) with curative intent for stage I non-small cell lung cancer (NSCLC) with regard to local, regional and distant tumor control, disease-free survival (DFS), overall survival (OS) and toxicity. Methods Data of 300 patients treated with SABR for NSCLC cancer for the period of November 2007 to June 2016 were retrospectively analyzed. Of which, 189 patients had single primary lung lesion and were included in the study. The prescribed dose for the tumor was 48 Gy, given in 12 Gy × 4 fractions for all patients. In 2010, an improved protocol was established in advanced technology for the planning CT, dose calculation and imaging. Cumulative incidence function (CIF) of local, regional, distant or any recurrences were computed using competing risk analysis with death as a competing event. Survivals (DFS and OS) were estimated using the Kaplan-Meier method and Cox proportional regression was used for comparisons. Toxicities were graded according to the common terminology criteria for adverse events version 4.0 (CTCAE v.4). Results Diagnosis was histologically confirmed in 42% of the patients (N = 80). At 1, 2 and 4 years, the cumulative incidence function (CIF) of local relapses were 8% [4–13%], 15% [10–21%] and 18% [12–25%], the CIF of regional relapses were 4% [2–8%], 10% [6–16%] and 12% [8–19%], the CIF of distant relapses were 9% [5–14%], 15% [11–22%] and 20% [15–28%] and the CIF of any relapses were 14% [10–20%], 28% [22–36%], 34% [27–43%], respectively. After 1, 2 and 4 years, the OS rates were 83% [95% CI: 78–89%] (N = 128), 65% [95% CI: 57–73%] (N = 78) and 37% [95% CI: 29–47%] (N = 53), respectively. The median survival time was 37 months. The DFS after 1, 2 and 4 years reached 75% [95% CI: 68–81%] (N = 114), 49% [95% CI: 42–58%] (N = 60) and 31% [95% CI: 24–41%] (N = 41), respectively. No grade 4 or 5 toxicity was observed. Conclusions We observed a long-term local control and survival after SABR for peripheral stage I NSCLC in this large series of patients with the expected low toxicity.
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Affiliation(s)
- Emilie Dubaere
- Department of Radiotherapy, CHU UCL Namur, Site Ste Elisabeth, Place Louise Godin 15, 5000, Namur, Belgium
| | | | - Marie Wanet
- Department of Radiotherapy, CHU UCL Namur, Site Ste Elisabeth, Place Louise Godin 15, 5000, Namur, Belgium
| | - Benoit Bihin
- NARILIS, Namur, Belgium.,CHU UCL Namur, Site Godinne, Yvoir, Belgium
| | - Céline Gheldof
- Department of Radiotherapy, CHU UCL Namur, Site Ste Elisabeth, Place Louise Godin 15, 5000, Namur, Belgium
| | | | - Antoine Bolly
- Department of Radiotherapy, CHU UCL Namur, Site Ste Elisabeth, Place Louise Godin 15, 5000, Namur, Belgium
| | | | | | | | | | | | - Fabienne Maisin
- Department of Radiotherapy, CHU UCL Namur, Site Ste Elisabeth, Place Louise Godin 15, 5000, Namur, Belgium
| | - Eric Marchand
- NARILIS, Namur, Belgium.,CHU UCL Namur, Site Godinne, Yvoir, Belgium
| | - Sebahat Ocak
- CHU UCL Namur, Site Godinne, Yvoir, Belgium.,Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL et Dermatologie (PNEU), Université Catholique de Louvain (UCL), Brussels, Belgium
| | | | | | | | | | | | - Vincent Remouchamps
- Department of Radiotherapy, CHU UCL Namur, Site Ste Elisabeth, Place Louise Godin 15, 5000, Namur, Belgium. .,NARILIS, Namur, Belgium.
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Mauclet C, Duplaquet F, Pirard L, Rondelet B, Dupont M, Pop-Stanciu C, Vander Borght T, Remmelink M, D’Haene N, Lambin S, Wanet M, Remouchamps V, Ocak S. Complete tumor response of a locally advanced lung large-cell neuroendocrine carcinoma after palliative thoracic radiotherapy and immunotherapy with nivolumab. Lung Cancer 2019; 128:53-56. [DOI: 10.1016/j.lungcan.2018.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/28/2018] [Accepted: 12/04/2018] [Indexed: 11/25/2022]
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Édeline V, Remouchamps V, Isnardi V, Vander Borght T. Multimodality imaging using PET/CT (18F)-fluorodeoxyglucose for radiotherapy field delineation of localized Hodgkin lymphoma. Cancer Radiother 2018; 22:384-392. [DOI: 10.1016/j.canrad.2018.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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Vrieling C, van Werkhoven E, Maingon P, Poortmans P, Weltens C, Fourquet A, Schinagl D, Oei B, Rodenhuis CC, Horiot JC, Struikmans H, Van Limbergen E, Kirova Y, Elkhuizen P, Bongartz R, Miralbell R, Morgan DAL, Dubois JB, Remouchamps V, Mirimanoff RO, Hart G, Collette S, Collette L, Bartelink H. Prognostic Factors for Local Control in Breast Cancer After Long-term Follow-up in the EORTC Boost vs No Boost Trial: A Randomized Clinical Trial. JAMA Oncol 2017; 3:42-48. [PMID: 27607734 DOI: 10.1001/jamaoncol.2016.3031] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Prognostic factors of ipsilateral breast tumor recurrence (IBTR) may change over time following breast-conserving therapy. Objective The EORTC "boost no boost" trial showed that young age and high-grade invasive carcinoma were the most important risk factors for IBTR. This study reanalyses pathological prognostic factors related to IBTR using long-term follow-up. Design, Setting, and Participants Participants included 5569 early-stage breast cancer patients, treated with breast-conserving surgery (BCS) and whole-breast irradiation (WBI), who were randomized between no boost and a 16-Gy boost in the EORTC phase III "boost no boost" trial (1989-1996). A total of 1616 patients with a microscopically complete resection (according to local pathologists), included in the central pathology review, have been analyzed in this study. Median follow-up was 18.2 years. Interventions No further treatment or 16-Gy boost, after BCS and 50-Gy WBI. Main Outcomes and Measures Time to ipsilateral breast tumor recurrence (IBTR) as first event. Results The 20-year cumulative incidence of IBTR in 1616 patients (160 events observed) was 15% (95% CI, 12%-17%). Young age (P < .001) and presence of ductal carcinoma in situ (DCIS) (HR, 2.15; 95% CI, 1.36-3.38; P = .001) were associated with an increased risk of IBTR in multivariable analysis. The cumulative incidence of IBTR at 20 years was 34% (95% CI, 25%-41%), 14% (95% CI, 10%-18%), and 11% (95% CI, 8%-15%), in patients 40 years or younger, 41 to 50 years and 50 years or older, respectively (P < .001). This incidence was 18% (95% CI, 14%-22%) and 9% (95% CI, 6%-12%) for tumors with and without DCIS (P < .001). High-grade tumors relapsed more frequently early during follow-up but the relative effect of age and presence of DCIS seemed stable over time. The boost reduced the 20-year IBTR incidence from 31% (95% CI, 22%-39%) to 15% (95% CI, 8%-21%) (HR, 0.37; 95% CI, 0.22-0.62; P < .001) in high-risk patients (≤50 years with DCIS present). Conclusions and Relevance The association of high-grade invasive tumor with IBTR diminished during follow-up, while the effect of DCIS adjacent to invasive tumor seemed to remain stable. Therefore, patients with high-grade invasive tumors should be monitored closely, especially in the first 5 years, while additional DCIS is an indication for longer follow-up, emphasizing the importance of long-term trial follow-up to estimate absolute effects accurately. Trial Registration clinicaltrials.gov Identifier: NCT02295033.
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Affiliation(s)
- Conny Vrieling
- Department of Radiation Oncology, Clinique des Grangettes, Geneva, Switzerland
| | - Erik van Werkhoven
- Department of Biometrics, the Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Philippe Maingon
- Department of Radiation Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Philip Poortmans
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, Netherlands
| | - Caroline Weltens
- Department of Radiation Oncology, University Hospitals of Leuven, Leuven, Belgium
| | - Alain Fourquet
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Dominic Schinagl
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, Netherlands
| | - Bing Oei
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, Netherlands
| | - Carla C Rodenhuis
- Department of Radiation Oncology, Medical Center Utrecht, Utrecht, Netherlands
| | - Jean-Claude Horiot
- Department of Radiation Oncology, Clinique de Genolier, Genolier, Switzerland
| | - Henk Struikmans
- Department of Radiation Oncology, Medical Center Utrecht, Utrecht, Netherlands
| | - Erik Van Limbergen
- Department of Radiation Oncology, University Hospitals of Leuven, Leuven, Belgium
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Paula Elkhuizen
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Rudolf Bongartz
- Department of Radiation Oncology, Universitaetsklinikum Köln, Köln, Germany
| | - Raymond Miralbell
- Division of Radiation Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - David A L Morgan
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Vincent Remouchamps
- Department of Radiotherapy, Clinique et Maternité Sainte Elisabeth, Namur, Belgium
| | | | - Guus Hart
- Department of Biometrics, the Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Harry Bartelink
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, Netherlands
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Mazeron R, Gonzague-Casabianca L, Peignaux K, Remouchamps V, Chira C, Moisan P, Lazarovici J, Edeline V. PV-0278: Volume concepts in routine radiotherapy for localized Hodgkin lymphoma: results of a national survey. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31527-4] [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: 11/29/2022]
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Offersen BV, Boersma LJ, Kirkove C, Hol S, Aznar MC, Sola AB, Kirova YM, Pignol JP, Remouchamps V, Verhoeven K, Weltens C, Arenas M, Gabrys D, Kopek N, Krause M, Lundstedt D, Marinko T, Montero A, Yarnold J, Poortmans P. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer, version 1.1. Radiother Oncol 2016; 118:205-8. [DOI: 10.1016/j.radonc.2015.12.027] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 12/05/2015] [Indexed: 10/22/2022]
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Mazeron R, Gonzague-Casabianca L, Peignaux K, Isnardi V, Remouchamps V, Van der Borght T, Chira C, Berriolo-Riedinger A, Lazarovici J, Edeline V. Techniques de radiothérapie des lymphomes de Hodgkin localisés de l’adulte : résultats d’une enquête nationale. Cancer Radiother 2015. [DOI: 10.1016/j.canrad.2015.07.139] [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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Meattini I, Boersma L, Livi L, Kirkove C, Gabryś D, Somaiah N, Remouchamps V, Elkhuizen PHM, Kirova Y, Rivera S. In Regard to Vaidya et al. Int J Radiat Oncol Biol Phys 2015; 92:960-961. [PMID: 26194670 DOI: 10.1016/j.ijrobp.2015.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/15/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Icro Meattini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Liesbeth Boersma
- Department of Radiation Oncology (MAASTRO Clinic), University Hospital Maastricht, The Netherlands
| | - Lorenzo Livi
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Carine Kirkove
- Department of Radiation Oncology, Catholic University of Louvain, Brussels, Belgium
| | - Dorota Gabryś
- Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice, Poland
| | - Navita Somaiah
- Division of Radiotherapy and Imaging, Institute of Cancer Research and The Royal Marsden, London, UK
| | | | - Paula H M Elkhuizen
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Sofia Rivera
- Department of Radiation Oncology, Gustave Roussy, France
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Verhoeven K, Hortobagyi E, Kirkove C, Remouchamps V, Weltens C. PO-0778: Delineation of the regional nodal areas in breast radiotherapy: What are the most problematic regions? Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40770-4] [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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Mulliez T, Veldeman L, Vercauteren T, De Gersem W, Speleers B, Van Greveling A, Berwouts D, Remouchamps V, Van den Broecke R, De Neve W. Reproducibility of deep inspiration breath hold for prone left-sided whole breast irradiation. Radiat Oncol 2015; 10:9. [PMID: 25572707 PMCID: PMC4311491 DOI: 10.1186/s13014-014-0313-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 12/17/2014] [Indexed: 11/10/2022] Open
Abstract
Background Investigating reproducibility and instability of deep inspiration breath hold (DIBH) in the prone position to reduce heart dose for left-sided whole breast irradiation. Methods Thirty patients were included and underwent 2 prone DIBH CT-scans during simulation. Overlap indices were calculated for the ipsilateral breast, heart and lungs to evaluate the anatomical reproducibility of the DIBH maneuver. The breathing motion of 21 patients treated with prone DIBH were registered using magnetic probes. These breathing curves were investigated to gain data on intra-fraction reproducibility and instability of the different DIBH cycles during treatment. Results Overlap index was 0.98 for the ipsilateral breast and 0.96 for heart and both lungs between the 2 prone DIBH-scans. The magnetic sensors reported population amplitudes of 2.8 ± 1.3 mm for shallow breathing and 11.7 ± 4.7 mm for DIBH, an intra-fraction standard deviation of 1.0 ± 0.4 mm for DIBH, an intra-breath hold instability of 1.0 ± 0.6 mm and a treatment time of 300 ± 69 s. Conclusion Prone DIBH can be accurately clinically implemented with acceptable reproducibility and instability.
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Affiliation(s)
- Thomas Mulliez
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Radiotherapy, Clinique et Maternité Sainte-Elisabeth, Place Louise Godin 16, 5000, Namur, Belgium.
| | - Liv Veldeman
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Tom Vercauteren
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Werner De Gersem
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Bruno Speleers
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Annick Van Greveling
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Dieter Berwouts
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Vincent Remouchamps
- Department of Radiotherapy, Clinique et Maternité Sainte-Elisabeth, Place Louise Godin 16, 5000, Namur, Belgium.
| | - Rudy Van den Broecke
- Department of Gynaecology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Wilfried De Neve
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
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Offersen BV, Boersma LJ, Kirkove C, Hol S, Aznar MC, Biete Sola A, Kirova YM, Pignol JP, Remouchamps V, Verhoeven K, Weltens C, Arenas M, Gabrys D, Kopek N, Krause M, Lundstedt D, Marinko T, Montero A, Yarnold J, Poortmans P. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol 2015; 114:3-10. [PMID: 25630428 DOI: 10.1016/j.radonc.2014.11.030] [Citation(s) in RCA: 386] [Impact Index Per Article: 42.9] [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: 11/15/2014] [Revised: 11/15/2014] [Accepted: 11/15/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. MATERIAL AND METHODS During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions. RESULTS Borders of the CTV encompassing a 5mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer. CONCLUSION The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency.
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Affiliation(s)
| | - Liesbeth J Boersma
- Department of Radiation Oncology, Maastricht University Medical Centre - GROW (MAASTRO), The Netherlands
| | - Carine Kirkove
- Department of Radiation Oncology, Catholic University of Louvain, Belgium
| | - Sandra Hol
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands
| | | | - Albert Biete Sola
- Department of Radiation Oncology, Hospital Clinic i Provincial, Barcelona, Spain
| | - Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Jean-Philippe Pignol
- Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vincent Remouchamps
- Department of Radiation Oncology, Clinique Sainte Elisabeth (AMPR), Namur, Belgium
| | - Karolien Verhoeven
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium
| | - Caroline Weltens
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium
| | - Meritxell Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan, Reus, Spain
| | - Dorota Gabrys
- Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice, Poland
| | - Neil Kopek
- Department of Oncology, Division of Radiation Oncology, McGill University, Montréal, Canada
| | - Mechthild Krause
- German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ) Heidelberg, Dept. of Radiation Oncology and OncoRay, University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Dan Lundstedt
- Department of Oncology, Sahlgrenska Universitetssjukhuset, Gothenborg, Sweden
| | - Tanja Marinko
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Angel Montero
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario Sanchinarro, Madrid, Spain
| | - John Yarnold
- Division of Radiotherapy and Imaging, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Philip Poortmans
- Department of Radiation Oncology, Radboud university medical centre, The Netherlands
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Bartelink H, Maingon P, Poortmans P, Weltens C, Fourquet A, Jager J, Schinagl D, Oei B, Rodenhuis C, Horiot JC, Struikmans H, Van Limbergen E, Kirova Y, Elkhuizen P, Bongartz R, Miralbell R, Morgan D, Dubois JB, Remouchamps V, Mirimanoff RO, Collette S, Collette L. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol 2014; 16:47-56. [PMID: 25500422 DOI: 10.1016/s1470-2045(14)71156-8] [Citation(s) in RCA: 410] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Since the introduction of breast-conserving treatment, various radiation doses after lumpectomy have been used. In a phase 3 randomised controlled trial, we investigated the effect of a radiation boost of 16 Gy on overall survival, local control, and fibrosis for patients with stage I and II breast cancer who underwent breast-conserving treatment compared with patients who received no boost. Here, we present the 20-year follow-up results. METHODS Patients with microscopically complete excision for invasive disease followed by whole-breast irradiation of 50 Gy in 5 weeks were centrally randomised (1:1) with a minimisation algorithm to receive 16 Gy boost or no boost, with minimisation for age, menopausal status, presence of extensive ductal carcinoma in situ, clinical tumour size, nodal status, and institution. Neither patients nor investigators were masked to treatment allocation. The primary endpoint was overall survival in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT02295033. FINDINGS Between May 24, 1989, and June 25, 1996, 2657 patients were randomly assigned to receive no radiation boost and 2661 patients randomly assigned to receive a radiation boost. Median follow-up was 17.2 years (IQR 13.0-19.0). 20-year overall survival was 59.7% (99% CI 56.3-63.0) in the boost group versus 61.1% (57.6-64.3) in the no boost group, hazard ratio (HR) 1.05 (99% CI 0.92-1.19, p=0.323). Ipsilateral breast tumour recurrence was the first treatment failure for 354 patients (13%) in the no boost group versus 237 patients (9%) in the boost group, HR 0.65 (99% CI 0.52-0.81, p<0.0001). The 20-year cumulative incidence of ipsilatelal breast tumour recurrence was 16.4% (99% CI 14.1-18.8) in the no boost group versus 12.0% (9.8-14.4) in the boost group. Mastectomies as first salvage treatment for ipsilateral breast tumour recurrence occurred in 279 (79%) of 354 patients in the no boost group versus 178 (75%) of 237 in the boost group. The cumulative incidence of severe fibrosis at 20 years was 1.8% (99% CI 1.1-2.5) in the no boost group versus 5.2% (99% CI 3.9-6.4) in the boost group (p<0.0001). INTERPRETATION A radiation boost after whole-breast irradiation has no effect on long-term overall survival, but can improve local control, with the largest absolute benefit in young patients, although it increases the risk of moderate to severe fibrosis. The extra radiation dose can be avoided in most patients older than age 60 years. FUNDING Fonds Cancer, Belgium.
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Affiliation(s)
- Harry Bartelink
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
| | - Philippe Maingon
- Department of Radiation Oncology, Centre Georges-Francois Leclerc, Dijon, France
| | - Philip Poortmans
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, Netherlands; Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Caroline Weltens
- Department of Radiation Oncology, KU Leuven, University Hospitals Leuven, Belgium
| | - Alain Fourquet
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Jos Jager
- Department of Radiation Oncology, Maastro Clinic, Maastricht, Netherlands
| | - Dominic Schinagl
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bing Oei
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, Netherlands
| | - Carla Rodenhuis
- Department of Radiation Oncology, Medical Center Utrecht, Utrecht, Netherlands
| | | | - Henk Struikmans
- Department of Radiation Oncology, Medical Center Utrecht, Utrecht, Netherlands
| | - Erik Van Limbergen
- Department of Radiation Oncology, KU Leuven, University Hospitals Leuven, Belgium
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Paula Elkhuizen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Rudolf Bongartz
- Department of Radiation Oncology, Universitaetsklinikum Köln, Köln, Germany
| | - Raymond Miralbell
- Division of Radiation Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - David Morgan
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Vincent Remouchamps
- Department of Radiotherapy, Clinique et Maternité Sainte Elisabeth, Namur, Belgium
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Mulliez T, Veldeman L, Speleers B, Mahjoubi K, Remouchamps V, Van Greveling A, Gilsoul M, Berwouts D, Lievens Y, Van den Broecke R, De Neve W. Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation. Radiother Oncol 2014; 114:79-84. [PMID: 25497557 DOI: 10.1016/j.radonc.2014.11.038] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [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: 05/29/2014] [Revised: 11/14/2014] [Accepted: 11/23/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Cardiac disease has been related to heart dose after left-sided breast radiotherapy. This trial evaluates the heart sparing ability and feasibility of deep inspiration breath hold (DIBH) in the prone position for left-sided whole breast irradiation (WBI). MATERIALS AND METHODS Twelve patients underwent CT-simulation in supine shallow breathing (SB), supine DIBH, prone SB and prone DIBH. A validation cohort of 38 patients received prone SB and prone DIBH CT-scans; the last 30 patients were accepted for prone DIBH treatment. WBI was planned with a prescription dose of 40.05 Gy. RESULTS DIBH was able to reduce (p<0.001) heart dose in both positions, with results for prone DIBH at least as favorable as for supine DIBH. Mean heart dose was lowered from 2.2 Gy for prone SB to 1.3 Gy for prone DIBH (p<0.001), while preserving the lung sparing ability of prone positioning. Moreover prone DIBH nearly consistently reduced mean heart dose to less then 2 Gy, regardless of breast volume. All patients were able to perform the simulation procedure, 28/30 patients were treated with prone DIBH. CONCLUSIONS This trial demonstrates the ability and feasibility of prone DIBH to acquire optimal heart and lung sparing for left-sided WBI.
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Affiliation(s)
- Thomas Mulliez
- Department of Radiotherapy, Ghent University Hospital, Belgium; Department of Radiotherapy, Clinique et Maternité Sainte-Elisabeth, Namur, Belgium.
| | - Liv Veldeman
- Department of Radiotherapy, Ghent University Hospital, Belgium
| | - Bruno Speleers
- Department of Radiotherapy, Ghent University Hospital, Belgium
| | - Khalil Mahjoubi
- Department of Radiotherapy, Clinique et Maternité Sainte-Elisabeth, Namur, Belgium
| | - Vincent Remouchamps
- Department of Radiotherapy, Clinique et Maternité Sainte-Elisabeth, Namur, Belgium
| | | | - Monique Gilsoul
- Department of Radiotherapy, Clinique et Maternité Sainte-Elisabeth, Namur, Belgium
| | - Dieter Berwouts
- Department of Radiotherapy, Ghent University Hospital, Belgium
| | - Yolande Lievens
- Department of Radiotherapy, Ghent University Hospital, Belgium
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Mulliez T, Speleers B, Mahjoubi K, Remouchamps V, Gilsoul M, Veldeman L, Van den Broecke R, De Neve W. Prone left-sided whole-breast irradiation: Significant heart dose reduction using end-inspiratory versus end-expiratory gating. Cancer Radiother 2014; 18:672-7. [DOI: 10.1016/j.canrad.2014.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 04/10/2014] [Accepted: 04/15/2014] [Indexed: 11/25/2022]
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De Langhe S, Mulliez T, Veldeman L, Remouchamps V, van Greveling A, Gilsoul M, De Schepper E, De Ruyck K, De Neve W, Thierens H. Factors modifying the risk for developing acute skin toxicity after whole-breast intensity modulated radiotherapy. BMC Cancer 2014; 14:711. [PMID: 25252713 PMCID: PMC4192342 DOI: 10.1186/1471-2407-14-711] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [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: 10/28/2013] [Accepted: 09/18/2014] [Indexed: 11/29/2022] Open
Abstract
Background After breast-conserving radiation therapy most patients experience acute skin toxicity to some degree. This may impair patients’ quality of life, cause pain and discomfort. In this study, we investigated treatment and patient-related factors, including genetic polymorphisms, that can modify the risk for severe radiation-induced skin toxicity in breast cancer patients. Methods We studied 377 patients treated at Ghent University Hospital and at ST.-Elisabeth Clinic and Maternity in Namur, with adjuvant intensity modulated radiotherapy (IMRT) after breast-conserving surgery for breast cancer. Women were treated in a prone or supine position with normofractionated (25 × 2 Gy) or hypofractionated (15 × 2.67 Gy) IMRT alone or in combination with other adjuvant therapies. Patient- and treatment-related factors and genetic markers in regulatory regions of radioresponsive genes and in LIG3, MLH1 and XRCC3 genes were considered as variables. Acute dermatitis was scored using the CTCAEv3.0 scoring system. Desquamation was scored separately on a 3-point scale (0-none, 1-dry, 2-moist). Results Two-hundred and twenty patients (58%) developed G2+ dermatitis whereas moist desquamation occurred in 56 patients (15%). Normofractionation (both p < 0.001), high body mass index (BMI) (p = 0.003 and p < 0.001), bra cup size ≥ D (p = 0.001 and p = 0.043) and concurrent hormone therapy (p = 0.001 and p = 0.037) were significantly associated with occurrence of acute dermatitis and moist desquamation, respectively. Additional factors associated with an increased risk of acute dermatitis were the genetic variation in MLH1 rs1800734 (p=0.008), smoking during RT (p = 0.010) and supine IMRT (p = 0.004). Patients receiving trastuzumab showed decreased risk of acute dermatitis (p < 0.001). Conclusions The normofractionation schedule, supine IMRT, concomitant hormone treatment and patient related factors (high BMI, large breast, smoking during treatment and the genetic variation in MLH1 rs1800734) were associated with increased acute skin toxicity in patients receiving radiation therapy after breast-conserving surgery. Trastuzumab seemed to be protective.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hubert Thierens
- Department of Basic Medical Sciences, Ghent University, Proeftuinstraat 86, 9000 Ghent, Belgium.
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Veldeman L, De Langhe S, Remouchamps V, van Greveling A, Gilsoul M, Speleers B, De Neve W, van den Broecke R, Mulliez T. Hypofractionated Radiotherapy Reduces Acute Skin Toxicity in Small and Large Breasted Patients Receiving Whole-Breast Irradiation. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu327.40] [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: 11/13/2022] Open
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Mulliez T, Veldeman L, Speleers B, Mahjoubi K, Remouchamps V, Van Greveling A, Gilsoul M, Berwouts D, Lievens Y, De Neve W. EP-1584: The effect of moderate deep inspiration breath hold on heart dose for prone left-sided whole breast irradiation. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31702-3] [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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Bougas S, Ninane C, Palumbo S, Baudoux A, Bustin F, Duplaquet F, Maisin F, Ocak S, Vandermoten G, Remouchamps V. EP-1164: A retrospective study of lung stereotactic radiotherapy: 24,3 months of follow up. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31282-2] [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: 11/25/2022]
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Remouchamps V, Bougas S, Ninane C, Baudoux A, Bustin F, Duplaquet F, Maisin F, Ocak S, Palumbo S, Vandermoten G. PO-0772: Technology evolution improved clinical outcome after SBRT/SABR with 48 Gy in 4 fractions for stage I lung cancer. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30890-2] [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: 10/23/2022]
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Amel V, Guerenne F, Meurisse F, Wefers S, Daisne J, Remouchamps V. Entretien infirmier-manipulateur de pré-simulation en radiothérapie. Cancer Radiother 2013. [DOI: 10.1016/j.canrad.2013.07.024] [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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Huyskens DP, Maingon P, Vanuytsel L, Remouchamps V, Roques T, Dubray B, Haas B, Kunz P, Coradi T, Bühlman R, Reddick R, Esch AV, Salamon E. A qualitative and a quantitative analysis of an auto-segmentation module for prostate cancer. Radiother Oncol 2008; 90:337-45. [PMID: 18812252 DOI: 10.1016/j.radonc.2008.08.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 07/28/2008] [Accepted: 08/09/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE This work describes the clinical validation of an automatic segmentation algorithm in CT-based radiotherapy planning for prostate cancer patients. MATERIAL AND METHODS The validated auto-segmentation algorithm (Smart Segmentation, version 1.0.05) is a rule-based algorithm using anatomical reference points and organ-specific segmentation methods, developed by Varian Medical Systems (Varian Medical Systems iLab, Baden, Switzerland). For the qualitative analysis, 39 prostate patients are analysed by six clinicians. Clinicians are asked to rate the auto-segmented organs (prostate, bladder, rectum and femoral heads) and to indicate the number of slices to correct. For the quantitative analysis, seven radiation oncologists are asked to contour seven prostate patients. The individual clinician contour variations are compared to the automatic contours by means of surface and volume statistics, calculating the relative volume errors and both the volume and slice-by-slice degree of support, a statistical metric developed for the purposes of this validation. RESULTS The mean time needed for the automatic module to contour the four structures is about one minute on a standard computer. The qualitative evaluation using a score with four levels ("not acceptable", "acceptable", "good" and "excellent") shows that the mean score for the automatically contoured prostate is "good"; the bladder scores between "excellent" and "good"; the rectum scores between "acceptable" and "not acceptable". Using the concept of surface and volume degree of support, the degree of support given to the automatic module is comparable to the relative agreement among the clinicians for prostate and bladder. The slice-by-slice analysis of the surface degree of support pinpointed the areas of disagreement among the clinicians as well as between the clinicians and the automatic module. CONCLUSION The efficiency and the limits of the automatic module are investigated with both a qualitative and a quantitative analysis. In general, with efficient correction tools at hand, the use of this auto-segmentation module will lead to a time gain for the prostate and the bladder; with the present version of the algorithm, modelling of the rectum still needs improvement. For the quantitative validation, the concept of relative volume error and degree of support proved very useful.
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Boehmer D, Maingon P, Poortmans P, Baron MH, Miralbell R, Remouchamps V, Scrase C, Bossi A, Bolla M. Guidelines for primary radiotherapy of patients with prostate cancer. Radiother Oncol 2006; 79:259-69. [PMID: 16797094 DOI: 10.1016/j.radonc.2006.05.012] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [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: 02/07/2006] [Revised: 05/15/2006] [Accepted: 05/23/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSES The appropriate application of 3-D conformal radiotherapy, intensity modulated radiotherapy or image guided radiotherapy for patients undergoing radiotherapy for prostate cancer requires a standardisation of target delineation as well as clinical quality assurance procedures. PATIENTS AND METHODS Pathological and imaging studies provide valuable information on tumour extension. In addition, clinical investigations on patient positioning and immobilisation as well as treatment verification data offer an abundance of information. RESULTS Target volume definitions for different risk groups of prostate cancer patients based on pathological and imaging studies are provided. Available imaging modalities, patient positioning and treatment preparation studies as well as verification procedures are collected from literature studies. These studies are summarised and recommendations are given where appropriate. CONCLUSIONS On behalf of the European Organisation for Research and Treatment of Cancer (EORTC) Radiation Oncology Group this article presents a common set of recommendations for external beam radiotherapy of patients with prostate cancer.
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Affiliation(s)
- Dirk Boehmer
- Klinik f. Strahlentherapie, Universitätsmedizin Berlin, Charité Campus Mitte, Germany.
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Machiels JP, Duck L, Honhon B, Coster B, Coche JC, Scalliet P, Humblet Y, Aydin S, Kerger J, Remouchamps V, Canon JL, Van Maele P, Gilbeau L, Laurent S, Kirkove C, Octave-Prignot M, Baurain JF, Kartheuser A, Sempoux C. Phase II study of preoperative oxaliplatin, capecitabine and external beam radiotherapy in patients with rectal cancer: the RadiOxCape study. Ann Oncol 2005; 16:1898-905. [PMID: 16219623 DOI: 10.1093/annonc/mdi406] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [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: 12/27/2022] Open
Abstract
BACKGROUND Preoperative radiotherapy has been shown to decrease the local recurrence rate of patients with locally advanced rectal cancer. Capecitabine and oxaliplatin are both active anticancer agents in the treatment of patients with advanced colorectal cancer and have radiosensitizing properties. Therefore, these drugs would be expected to improve effectiveness of preoperative radiotherapy in terms of local control and prevention of distant metastases. PATIENTS AND METHODS Forty patients with rectal cancer (T3-T4 and/or N+) received radiotherapy (1.8 Gy, 5 days a week over 5 weeks, total dose 45 Gy, 3D conformational technique) in combination with intravenous oxaliplatin 50 mg/m2 once weekly for 5 weeks and oral capecitabine 825 mg/m2 twice daily on each day of radiation. Surgery was performed 6-8 weeks after completion of radiotherapy. The main end points were safety and efficacy as assessed by the pathological complete response (pCR). RESULTS The most frequent grade 3/4 adverse event was diarrhea, occurring in 30% of patients. pCR was found in five (14%) patients. According to Dworak's classification, good regression was found in six (18%) additional patients. CONCLUSIONS Combination of preoperative radiotherapy with capecitabine and oxaliplatin is feasible for downstaging rectal cancer.
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Affiliation(s)
- J-P Machiels
- Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université Catholique de Louvain, Brussels, Belgium.
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Scalliet PGM, Remouchamps V, Curran D, Ledent G, Wambersie A, Richard F, van Cangh P. Retrospective analysis of results of p(65)+Be neutron therapy for treatment of prostate adenocarcinoma at the cyclotron of Louvain-la-Leuve. Part II: Side effects and their influence on quality of life measured with QLQ-C30 of EORTC. Int J Radiat Oncol Biol Phys 2004; 58:1549-61. [PMID: 15050336 DOI: 10.1016/j.ijrobp.2003.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 12/03/2002] [Revised: 07/18/2003] [Accepted: 09/03/2003] [Indexed: 11/12/2022]
Abstract
PURPOSE Between 1978 and 1998, 533 prostate adenocarcinoma patients were treated with mixed photon-neutron radiotherapy. We report on a retrospective series of patients for whom the side effects of the treatment and their impact on quality of life were assessed by a mailed questionnaire. METHODS AND MATERIALS The European Organization for Research and Treatment of Cancer quality-of-life core questionnaire and a prostate-specific questionnaire were used. Between 1990 and 1996, 308 consecutive patients were treated. Two protocols were used: pelvic fields (50 Gy equivalent photons, 2 Gy/fraction) followed by a prostate boost (66 Gy) or prostate alone. The neutron/photon ratio varied. The questionnaire was mailed to 262 patients presumed to be alive. RESULTS Of the 262 patients, 230 replied. Of the 230 patients, 73% had no trouble doing strenuous activities and 4% had trouble with taking a short walk. The overall physical condition and quality-of-life questions received a mean score of 5.2 and 5.3 on a 7-point scale, respectively. Twenty-two percent had bowel movements at least four times daily, and 6% did so six times or more. Retaining stool was a problem in 26%, and only 38% reported full continence; 17% urinated four times or more nightly. Urinary incontinence was scored as "quite a bit" or "very much" in 11% and 5%, respectively. Hematuria and dysuria (pain) were reported by 7% and 16%, respectively, mainly as moderate. Only 28% reported easy erections, but 75% judged the sexual change acceptable. A greater neutron/photon ratio was significantly associated with more bowel problems (p = 0.003). CONCLUSION Mixed photon-neutron therapy for prostate cancer was associated with significant patient-reported side effects. Their significant effect on patients' quality of life is described.
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Affiliation(s)
- Pierre G M Scalliet
- Department of Radiation Oncology, Hospital St. Luc, Université Caholique de Louvain, Brussels, Belgium.
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Vicini F, Sharpe M, Kestin L, Wong J, Remouchamps V, Martinez A. The use of intensity modulated radiation therapy in the treatment of breast cancer: evolving definition, misdirected criticism, and untoward effects. Int J Radiat Oncol Biol Phys 2004; 58:1642-4. [PMID: 15050355 DOI: 10.1016/j.ijrobp.2003.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vicini FA, Remouchamps V, Wallace M, Sharpe M, Fayad J, Tyburski L, Letts N, Kestin L, Edmundson G, Pettinga J, Goldstein NS, Wong J. Ongoing clinical experience utilizing 3D conformal external beam radiotherapy to deliver partial-breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 2004; 57:1247-53. [PMID: 14630258 DOI: 10.1016/s0360-3016(03)01573-6] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.1] [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: 10/26/2022]
Abstract
PURPOSE We present our ongoing clinical experience utilizing 3D conformal radiation therapy (3D-CRT) to deliver partial-breast irradiation (PBI) in patients with early-stage breast cancer treated with breast-conserving therapy. MATERIALS AND METHODS Thirty-one patients referred for postoperative radiation therapy after lumpectomy were treated with PBI using our previously reported 3D-CRT technique. Ninety-four percent of patients had surgical clips outlining the lumpectomy cavity (mean: 6 clips). The clinical target volume (CTV) consisted of the lumpectomy cavity plus a 10-mm margin in 9 patients and 15-mm margin in 22 (median: 15 mm). The planning target volume consisted of the CTV plus a 10-mm margin for breathing motion and treatment setup uncertainties. The prescribed dose (PD) was 34 or 38.5 Gy (6 patients and 25 patients, respectively) in 10 fractions b.i.d. separated by 6 h and delivered in 5 consecutive days. Patients were treated in the supine position with 3-5 beams (mean: 4) designed to irradiate the CTV with <10% inhomogeneity and a comparable or lower dose to the heart, lung, and contralateral breast compared with standard whole-breast tangents. The median follow-up duration is 10 months (range: 1-30 months). Four patients have been followed >2 years, 6 >1.5 years, and 5 >1 year. The remaining 16 patients have been followed <12 months. RESULTS No skin changes greater than Grade 1 erythema were noted during treatment. At the initial 4-8-week follow-up visit, 19 patients (61%) experienced Grade 1 toxicity and 3 patients (10%) Grade 2 toxicity. No Grade 3 toxicities were observed. The remaining 9 patients (29%) had no observable radiation effects. Cosmetic results were rated as good/excellent in all evaluable patients at 6 months (n = 3), 12 months (n = 5), 18 months (n = 6), and in the 4 evaluable patients at >2 years after treatment. The mean coverage of the CTV by the 100% isodose line (IDL) was 98% (range: 54-100%, median: 100%) and by the 95% IDL, 100% (range: 99-100%). The mean coverage of the planning target volume by the 95% IDL was 100% (range: 97-100%). The mean percentage of the breast receiving 100% of the PD was 23% (range: 14-39%). The mean percentage of the breast receiving 50% of the PD was 47% (range: 34-60%). CONCLUSIONS Utilizing 3D-CRT to deliver PBI is technically feasible, and acute toxicity to date has been minimal. Additional follow-up will be needed to assess the long-term effects of these larger fraction sizes on normal-tissue sequelae and the impact of this fractionation schedule on treatment efficacy.
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MESH Headings
- Aged
- Aged, 80 and over
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Combined Modality Therapy
- Female
- Humans
- Mastectomy, Segmental
- Middle Aged
- Prospective Studies
- Radiotherapy Dosage
- Radiotherapy Planning, Computer-Assisted
- Radiotherapy, Conformal/methods
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Affiliation(s)
- Frank A Vicini
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA
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Letts N, Remouchamps V, Martinez A, Vicini F, Wong J. Set-up inaccuracies in breast irradiation: a comparison of free breathing and Active Breathing Control (ABC) treatment using Electronic Portal Images (EPI). Int J Radiat Oncol Biol Phys 2003. [DOI: 10.1016/s0360-3016(03)01178-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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Baglan KL, Sharpe MB, Jaffray D, Frazier RC, Fayad J, Kestin LL, Remouchamps V, Martinez AA, Wong J, Vicini FA. Accelerated partial breast irradiation using 3D conformal radiation therapy (3D-CRT). Int J Radiat Oncol Biol Phys 2003; 55:302-11. [PMID: 12527042 DOI: 10.1016/s0360-3016(02)03811-7] [Citation(s) in RCA: 243] [Impact Index Per Article: 11.6] [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] [Indexed: 11/23/2022]
Abstract
PURPOSE We present a novel three-dimensional conformal radiation therapy (3D-CRT) technique to treat the lumpectomy cavity, plus a 1.5-cm margin, in patients with early-stage breast cancer and study its clinical feasibility. METHODS AND MATERIALS A 3D-CRT technique for partial-breast irradiation was developed using archived CT scans from 7 patients who underwent an active breathing control study. The clinical feasibility of this technique was then assessed in 9 patients who were prospectively enrolled on an Investigational Review Board-approved protocol of partial-breast irradiation. The prescribed dose was 34 Gy in 5 patients and 38.5 Gy in 4 patients, delivered in 10 fractions twice daily over 5 consecutive days. The impact of both breathing motion and patient setup uncertainty on clinical target volume (CTV) coverage was studied, and an appropriate CTV-to-PTV (planning target volume) margin was calculated. RESULTS By adding a CTV-to-PTV "breathing-only" margin of 5 mm, 98%-100% of the CTV remained covered by the 95% isodose surface at the extremes of normal inhalation and normal exhalation. The "total" CTV-to-PTV margin employed to accommodate organ motion and setup error (10 mm) was found to be sufficient to accommodate the observed uncertainty in the delivery precision. Patient tolerance was excellent, and acute toxicity was minimal. No skin changes were noted during treatment, and at the initial 4-8-week follow-up visit, only mild localized hyperpigmentation and/or erythema was observed. No instances of symptomatic radiation pneumonitis have occurred. CONCLUSIONS Accelerated partial-breast irradiation using 3D-CRT is technically feasible, and acute toxicity to date has been minimal. A CTV-to-PTV margin of 10 mm seems to provide coverage for most patients. However, more patients and additional studies will be needed to validate the accuracy of this margin, and longer follow-up will be needed to assess acute and chronic toxicity, tumor control, and cosmetic results.
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MESH Headings
- Aged
- Aged, 80 and over
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Combined Modality Therapy
- Feasibility Studies
- Female
- Humans
- Mastectomy, Segmental
- Middle Aged
- Movement
- Neoplasm Recurrence, Local/prevention & control
- Prospective Studies
- Radiotherapy Planning, Computer-Assisted/methods
- Radiotherapy, Conformal/methods
- Respiration
- Tomography, X-Ray Computed
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Affiliation(s)
- Kathy L Baglan
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA
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Baglan K, Sharpe M, Jaffray D, Frazier R, Fayed J, Kestin L, Remouchamps V, Wong J, Martinez A, Vicini F. Accelerated partial breast irradiation using 3D-conformal radiation therapy (3D-CRT. Int J Radiat Oncol Biol Phys 2002. [DOI: 10.1016/s0360-3016(02)03334-5] [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: 10/27/2022]
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Claus F, De Gersem W, Vanhoutte I, Duthoy W, Remouchamps V, De Wagter C, De Neve W. Evaluation of a leaf position optimization tool for intensity modulated radiation therapy of head and neck cancer. Radiother Oncol 2001; 61:281-6. [PMID: 11730998 DOI: 10.1016/s0167-8140(01)00441-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Since 1996, patients are treated at Ghent University Hospital with a multi-segment technique using MultiLeaf Collimators. The segments were obtained by using the Beam's eye view projections of the planning target volume (PTV) and the organs at risk (OARs), after which the segments weights were optimized. To investigate if optimization of the leaf positions would further improve the intensity modulated radiation therapy (IMRT) plans, a tool optimizing leaf positions and segment weights simultaneously, was developed. This tool is called SOWAT, which is the acronym for segment outline and weight adapting tool. MATERIAL AND METHODS The tool evaluates the effects of changing the position of each collimating leaf of all segments on the value of the objective function. Only changes that improve the value of the objective function are retained. Between December 1999 and January 2001, 30 head and neck patients were treated with IMRT. Two patient groups were distinguished: pharyngeal and laryngeal tumors (n=17) and sinonasal tumors (n=13). A specific set of physical endpoints was evaluated for each group. Dose statistics of the treatment plans without and with SOWAT were analyzed. RESULTS When using SOWAT for the pharyngeal and laryngeal cases, the PTV dose homogeneity increased with a median of 11% (range 2-27%), while the maximum dose to the spinal cord was decreased for 14 of the 17 patients. In four plans where parotid function preservation was a goal, the parotid mean dose was lower than 26 Gy in one plan without SOWAT, and in four plans with SOWAT. For the sinonasal tumors, the PTV dose homogeneity increased with a median of 7% (range 1-14%). SOWAT lowered the mean dose to 53 of the 63 optic pathway structures (retina, optic nerve and optic chiasm). SOWAT leaves the number of segments unchanged and has little or no effect on the delivery time. CONCLUSIONS SOWAT is a powerful tool to perform the final optimization of IMRT plans, without increasing the complexity of the plan or the delivery time.
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Affiliation(s)
- F Claus
- Division of Radiotherapy, Ghent University Hospital (GUH), De Pintelaan 185, 9000 Ghent, Belgium
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Claus F, De Deene Y, Remouchamps V, De Wagter C, Van Vaerenbergh K, Schauvliege J, Van Duyse B, Speleers B, Duthoy W, De Neve W. An isocenter position verification device for electronic portal imaging: physical and dosimetrical characteristics. Cancer Radiother 2001; 5:759-65. [PMID: 11797297 DOI: 10.1016/s1278-3218(01)00137-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The physical and dosimetrical characteristics of a device, designed to visualize the isocenter position on electronic portal images, were examined. The device, to be mounted on the gantry head of the accelerator, containing five spheric lead markers, was designed in order to visualize the isocenter position on portal images. A quality control device was designed to check the reliability of this technique. The disturbance of the dose distribution by the markers was studied with gel dosimetry. The use of markers resulted in a precise and accurate method to visualize the isocenter on portal images. A maximum underdosage of 11%, due to attenuation by the markers, was observed. The use of markers to visualize the isocenter position on portal images, is a fast and reliable method when analyzing patient setup errors with online electronic portal imaging.
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Affiliation(s)
- F Claus
- Division of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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Claus F, De Gersem W, De Wagter C, Van Severen R, Vanhoutte I, Duthoy W, Remouchamps V, Van Duyse B, Vakaet L, Lemmerling M, Vermeersch H, De Neve W. An implementation strategy for IMRT of ethmoid sinus cancer with bilateral sparing of the optic pathways. Int J Radiat Oncol Biol Phys 2001; 51:318-31. [PMID: 11567805 DOI: 10.1016/s0360-3016(01)01627-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [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
PURPOSE To develop a protocol for the irradiation of ethmoid sinus cancer, with the aim of sparing binocular vision; of developing a strategy of intensity-modulated radiation therapy (IMRT) planning that produces dose distributions that (1) are consistent with the protocol prescriptions and (2) are deliverable by static segmental IMRT techniques within a 15-minute time slot; of fine tuning the implementation strategy to a class solution approach that is sufficiently automated and efficient, allowing routine clinical application; of reporting on the early clinical implementation involving 11 patients between February 1999 and July 2000. patients and methods: Eleven consecutive T1-4N0M0 ethmoid sinus cancer patients were enrolled in the study. For Patients 1-8, a first protocol was implemented, defining a planning target volume prescription dose of 60 to 66 Gy in 30-33 fractions and a maximum dose (Dmax) of 50 Gy to optic pathway structures and spinal cord and limit of 60 Gy to brainstem. For Patients 9-11, an adapted (now considered mature) protocol was implemented, defining a (planning target volume) prescription dose of 70 Gy in 35 fractions and a Dmax to optic pathway structures and brainstem of 60 Gy and to spinal cord of 50 Gy. RESULTS The class solution-directed strategy developed during this study reduced the protocol translation process from a few days to about 2 hours of planner time. The mature class solution involved the use of 7 beam incidences (20-37 segments), which could be delivered within a 15-minute time slot. Acute side effects were limited and mild. None of the patients developed dry eye syndrome or other visual disturbances. The follow-up period is too short for detection of retinopathy or optic nerve and chiasm toxicity. CONCLUSION Conventional radiotherapy of ethmoid sinus tumors is associated with serious morbidity, including blindness. We hypothesize that IMRT has the potential to save binocular vision. The dose to the optic pathway structures can be reduced selectively by IMRT. Further enrollment of patients and longer follow-up will show whether the level of reduction tested by the clinical protocol is sufficient to save binocular vision. An adaptive strategy of IMRT planning was too inefficient for routine clinical practice. A class solution-directed strategy improved efficiency by eliminating human trial and error during the IMRT planning process.
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Affiliation(s)
- F Claus
- Division of Radiotherapy, Ghent University Hospital, Ghent, Belgium
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Scalliet PG, Remouchamps V, Lhoas F, Van Glabbeke M, Curran D, Ledent T, Wambersie A, Richard F, Van Cangh P. A retrospective analysis of the results of p(65) + Be neutrontherapy for the treatment of prostate adenocarcinoma at the cyclotron of Louvain-la-Neuve. Part I: Survival and progression-free survival. Cancer Radiother 2001; 5:262-72. [PMID: 11446080 DOI: 10.1016/s1278-3218(01)00102-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To retrospectively evaluate survival, progression-free survival (PFS) and biological response in a series of patients irradiated with mixed neutron/photon beams for locally advanced prostate cancer in our institution. PATIENTS AND METHODS Three hundred and eight patients were treated between January 1990 and December 1996. Fifty-five of these were recruited for pT3 or pN1 tumors after radical prostatectomy. Neoadjuvant androgen deprivation was given in 106 patients. The treatment protocol consisted of a mixed photon/neutron irradiation in a two-to-three proportion, up to a total equivalent dose of 66 Gy (assuming a clinical RBE value of 2.8). Pre- and post-treatment PSA determinations were available in practically all cases. Study endpoints were overall survival (OAS) and progression-free survival (PFS). The Cox proportional hazard regression model was used to investigate the prognostic value of baseline characteristics on survival and progression-free survival were a progression was defined as local, regional, metastatic or biological progression. Mean age was 69 years (49-86); mean pretreatment PSA was 15 (0.5-330) in all patients and 14 (0.5-160) in those receiving neoadjuvant hormonotherapy; seven patients only had an initial PSA < or = 4 ng/mL; 15% were T1, 46% were T2, 28% were T3 or pT3 and 4% were T4 (7% unspecified); WHO grade of differentiation was I in 38%, II in 38% and III in 14% (5% unspecified). RESULTS The median follow-up was 2.8 years (0-7.8). Five-year overall survival (OAS) was 79% (95% CI: 71-87%) and 5-year progression-free survival (PFS) was 64% (95% CI: 54-74%) for the entire series. PFS in patients with an initial PSA > or = 20 ng/mL was the same. PFS could be predicted by two optimal Cox regression models, one including histological grade (p = 0.003) and initial PSA (p = 0.0009) as cofactors, the other including histological grade (p = 0.003) and T stage (p = 0.02). The main prognostic factors for overall survival were PSA and age. Biological responses with PSA < 1.5 ng/mL, < 1 ng/mL and < 0.5 ng/mL at any time after treatment were documented in 70%, 61% and 47% of the patients, respectively. CONCLUSION Five-year OAS was 79%, PFS was 64%, and biological response was 70% for prostate cancer patients treated with mixed photon/neutron beams as applied at Louvain-la-Neuve, which are good results as compared with the literature. The usual prognostic factors were confirmed.
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Affiliation(s)
- P G Scalliet
- Department of Radiation Oncology, University Hospital St. Luc, UCL, B-1200 Brussels, Belgium
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