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Wang Q, Gupta V, Cao A, Singhal A, Gary T, Adunyah SE. A Case Study of Enhancing the Data Science Capacity of an RCMI Program at a Historically Black Medical College. Int J Environ Res Public Health 2023; 20:4775. [PMID: 36981686 PMCID: PMC10048727 DOI: 10.3390/ijerph20064775] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 05/07/2023]
Abstract
As data grows exponentially across diverse fields, the ability to effectively leverage big data has become increasingly crucial. In the field of data science, however, minority groups, including African Americans, are significantly underrepresented. With the strategic role of minority-serving institutions to enhance diversity in the data science workforce and apply data science to health disparities, the National Institute for Minority Health Disparities (NIMHD) provided funding in September 2021 to six Research Centers in Minority Institutions (RCMI) to improve their data science capacity and foster collaborations with data scientists. Meharry Medical College (MMC), a historically Black College/University (HBCU), was among the six awardees. This paper summarizes the NIMHD-funded efforts at MMC, which include offering mini-grants to collaborative research groups, surveys to understand the needs of the community to guide project implementation, and data science training to enhance the data analytics skills of the RCMI investigators, staff, medical residents, and graduate students. This study is innovative as it addressed the urgent need to enhance the data science capacity of the RCMI program at MMC, build a diverse data science workforce, and develop collaborations between the RCMI and MMC's newly established School of Applied Computational Science. This paper presents the progress of this NIMHD-funded project, which clearly shows its positive impact on the local community.
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Affiliation(s)
- Qingguo Wang
- Department of Computer Science & Data Science, School of Applied Computational Sciences, Meharry Medical College, Nashville, TN 37208, USA
| | - Vibhuti Gupta
- Department of Computer Science & Data Science, School of Applied Computational Sciences, Meharry Medical College, Nashville, TN 37208, USA
| | - Aize Cao
- Department of Biomedical Data Science, School of Applied Computational Sciences, Meharry Medical College, Nashville, TN 37208, USA
| | - Ashutosh Singhal
- Department of Biomedical Data Science, School of Applied Computational Sciences, Meharry Medical College, Nashville, TN 37208, USA
| | - Todd Gary
- Department of Biomedical Data Science, School of Applied Computational Sciences, Meharry Medical College, Nashville, TN 37208, USA
| | - Samuel E. Adunyah
- Department of Biochemistry, Cancer Biology, Neurosciences and Pharmacology, Meharry Medical College, Nashville, TN 37208, USA
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Césaire M, Rambeau A, Cherifi F, Géry B, Johnson A, Nacher M, Thariat J. Effect of lymphoid volume irradiation on radiation-induced lymphopenia in head and neck cancers. Cancer Radiother 2023:S1278-3218(23)00006-9. [PMID: 36759240 DOI: 10.1016/j.canrad.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 02/10/2023]
Abstract
PURPOSE Radiotherapy induces significant and prolonged lymphopenia in head and neck cancer patients with poorer outcomes and reduced survival. Irradiated volumes may be correlated with lymphopenia with a potential impact on immunotherapy efficacy. We assessed associations between volumes treated with radiotherapy and the nadir of the lymphocyte count in patients with head and neck cancer. MATERIALS AND METHODS We conducted a monocentric retrospective study in patients with head and neck cancer treated with radiation. Univariate analysis used regression analysis to model nadir lymphocyte count and radiotherapy volumes; multivariate analysis then modelled factors associated with nadir lymphocyte count. RESULTS Of the 77 included patients, 97% presented lymphopenia during radiotherapy with an average nadir of 431 cells/mm3 at a median of 40 days after the beginning of treatment. The volume of high-risk radiotherapy and gross tumour volume were correlated with nadir lymphocyte count with a Spearman coefficient of -0.267 (P=0.019) and -0.387 (P=0.001), respectively. After multivariate linear regression, high-risk radiotherapy was significantly associated with nadir lymphocyte count with a regression coefficient of -0.32 (per cubic centimetre) [95% CI=-0.60; -0.03] (P=0.028). CONCLUSION High-risk radiotherapy was significantly associated with nadir lymphocyte count in patients with head and neck cancer treated with radiation. Sparing lymphoid volumes from irradiation by elective nodal irradiation or proton therapy may limit lymphopenia and needs to be investigated in combination with immunotherapy.
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Pointreau Y, Moreau J, Vendrely V, Schipman B. [Impact of IMRT for neoadjuvant rectal cancer?]. Cancer Radiother 2022; 26:865-70. [PMID: 36064531 DOI: 10.1016/j.canrad.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022]
Abstract
The standard management of locally advanced rectal tumors as cT3-T4 and/or N0/N1 is based on preoperative treatment combining radiotherapy of 45 to 50Gy and chemotherapy based on 5-fluorouracil. Intensity-modulated radiotherapy has already shown its interest compared to conformal radiotherapy in other locations, like in pelvic cancer. The role of intensity-modulated radiotherapy in the pre/postoperative treatment of rectal cancers is not a standard of care. Published studies showed its feasibility with the objective of less toxicity with equivalent efficacy.
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Delhiat AC, Combet-Curt V, Vendrely V. [Anal cancer: Focus on current treatment and future perspective]. Cancer Radiother 2022; 26:871-874. [PMID: 36008262 DOI: 10.1016/j.canrad.2022.06.029] [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: 06/02/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 10/15/2022]
Abstract
Anal cancer is considered a rare tumor, accounting for 6 % of digestive cancers and about 2000 new cases per year in France. It is mostly diagnosed at a localized stage. For many years, the standard of care for patients with localized disease is an association with radiotherapy and chemotherapy including Mitomycin C and 5-Fluorouracil. There weren't any major changes in the therapeutic management of these tumors despite several phase III studies. However, there is an improvement in patient prognostic. This can be explained by imaging progress, using magnetic resonance imaging and positron emission tomography-computed tomography, permitting better staging and evaluation of disease. Moreover, irradiation modalities changed because of the development of Intensity Modulated Radiotherapy. Actual research focuses on a more personalized strategy according to tumoral stages. Patients with early-stage tumors are potentially over-treated with a risk of chronic digestive toxicities. Several studies are interested in irradiation de-escalation for these patients. On the other hand, treatment results for patients with advanced tumoral stages are disappointing. It seems relevant to propose a therapeutic intensification for these patients, such as dose escalation, association with new therapies like immunotherapy or induction chemotherapy using taxans given promising results at the metastatic stage.
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Affiliation(s)
- A C Delhiat
- Service d'oncologie-radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, Bordeaux, France
| | - V Combet-Curt
- Service d'oncologie-radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, Bordeaux, France
| | - V Vendrely
- Service d'oncologie-radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, Bordeaux, France; U1312-BRIC, eq BioGO, Inserm, université de Bordeaux, 33000 Bordeaux, France.
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Gao Q, Liu ZY, Cheng Y, Di XK, Zhang YM, Sun XC, Xia XJ, Ge XL. Prognostic factors for 495 nonoperative esophageal squamous cancer patients receiving IMRT plus chemotherapy: A retrospective analysis. Cancer Radiother 2022; 26:1002-1007. [PMID: 35933288 DOI: 10.1016/j.canrad.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/16/2022] [Accepted: 01/28/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Chemoradiotherapy is regarded as a standard scheme for inoperable and unresectable esophageal cancers. Our aims were to explore the prognostic factors relevant to esophageal squamous cell carcinoma (ESCC) following intensity-modulated radiation therapy (IMRT) plus chemotherapy. MATERIAL AND METHODS Totally 495 ESCC patients undergoing IMRT combined with chemotherapy in our hospital between 2011 and 2020 were retrospectively analyzed. Potential clinical prognosis-related factors were assessed by uni- and multivariate analyses. RESULTS The median overall survival (OS) and progression-free survival (PFS) of the ESCC patients were 2.25 and 1.24years, respectively. Uni- and multivariate analyses demonstrated the relevant independent prognostic factors of OS and PFS were gender, T stage, N stage, clinical stage, and tumor location (P<0.05), but not chemotherapy or radiotherapy dose. We further compared the 5-year OS rates among different T stages, N stages, clinical stages, genders, and tumor locations. The survival rate at the higher clinical stage was significantly lower (P<0.001). The 5-year OS in the upper thorax of the tumor was 46.0% and exceeded other tumor locations (P<0.05). The 5-year OS was 56.1% among females and 33.3% among males (P=0.001). CONCLUSIONS For ESCC patients receiving IMRT combined with chemotherapy, their long-term curative effects are influenced by T stages, N stages, clinical stages, genders, and tumor locations. ESCC patients who are females, or have upper thoracic tumor, or are at early clinical stage own better prognosis.
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Affiliation(s)
- Q Gao
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, 300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China
| | - Z-Y Liu
- Department of Radiation Oncology, Nanjing Jiangning Hospital and the Affiliated Jiangning Hospital of Nanjing Medical University, 168, Gushan Road, Jiangning District, Nanjing, Jiangsu, China
| | - Y Cheng
- Department of Radiation Oncology, The Second Hospital of Nanjing, 1-1, Zhongfu Road, Gulou District, Nanjing, Jiangsu, China
| | - X-K Di
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, 300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China
| | - Y-M Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, 300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China
| | - X-C Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, 300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China.
| | - X-J Xia
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, 300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China.
| | - X-L Ge
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, 300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China.
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Abstract
Dose constraints are essential for performing dosimetry, especially for intensity modulation and for radiotherapy under stereotaxic conditions. We present the update of the recommendations of the French society of oncological radiotherapy for the use of these doses in classical current practice but also for reirradiation.
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Affiliation(s)
- G Noël
- Département de radiothérapie-oncologie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France.
| | - D Antoni
- Département de radiothérapie-oncologie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France
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Abstract
We present the update of the recommendations of the French society for radiation oncology on radiation therapy for the management of brain metastases. It has evolved in recent years and has become more complex. As the life expectancy of patients has increased and retreatments have become more frequent, side effects must be absolutely avoided. Cognitive side effects must in particular be prevented, and the most modern radiation therapy techniques must be used systematically. New prognostic classifications specific to the primary tumour of patients, advances in imaging and radiation therapy technology and new systemic therapeutic strategies, are making treatment more relevant. Stereotactic radiation therapy has supplanted whole-brain radiation therapy both for patients with metastases in place and for those who underwent surgery. Hippocampus protection is possible with intensity-modulated radiation therapy. Its relevance in terms of cognitive functioning should be more clearly demonstrated but the requirement for its use is constantly increasing. New targeted cancer treatment therapies based on the nature of the primitive have complicated the notion of the place and timing of radiation therapy and the discussion during multidisciplinary care meeting to indicate the best sequences is becoming a challenging issue as data on the interaction between treatments remain to be documented. In the end, although aimed at patients in the palliative phase, the management of brain metastases is one of the locations for which technical reflection is the most challenging and treatment become increasingly personalized.
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Affiliation(s)
- I Latorzeff
- Service de radiothérapie, groupe Oncorad Garonne, clinique Pasteur, l'« Atrium », 1, rue de la Petite-Vitesse, 31300 Toulouse, France; Centre régional de radiochirurgie stéréotaxique, CHU Rangueil, avenue Jean-Poulhès, 31052 Toulouse cedex, France.
| | - D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - S Josset
- Service de physique médicale, institut de cancérologie de l'Ouest, Unicancer, 44805 Saint-Herblain, France
| | - G Noël
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - A Tallet-Richard
- Département universitaire de radiothérapie, institut Paoli-Calmettes, Unicancer, 232, boulevard de Sainte-Marguerite, 13273 Marseille, France
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Huguet F, Rivin Del Campo E, Orthuon A, Mornex F, Bessières I, Guimas V, Vendrely V. Radiation therapy of pancreatic cancers. Cancer Radiother 2021; 26:259-265. [PMID: 34953706 DOI: 10.1016/j.canrad.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present the update of the recommendations of the French society of oncological radiotherapy on radiotherapy of pancreatic tumors. Currently, the use of radiation therapy for patients with pancreatic cancer is subject to discussion. In the adjuvant setting, the standard treatment is six months of chemotherapy with 5-fluorouracile, irinotecan and oxaliplatin. Chemoradiation may improve the survival of patients with incompletely resected tumours (R1). This remains to be confirmed by a prospective trial. Neoadjuvant chemoradiation is a promising treatment especially for patients with borderline resectable tumours. For patients with locally advanced tumours, there is no standard. An induction chemotherapy followed by chemoradiation for non progressive patients reduces the rate of local relapse. Whereas in the first trials of chemoradiation large fields were used, the treated volumes have been reduced to improve tolerance. Tumour movements induced by breathing should be taken in account. Intensity modulated radiation therapy allows a reduction of doses to the organs at risk. Whereas widely used, this technique has poor evidence-based recommendation. Stereotactic body radiation therapy is also being studied, as a neoadjuvant or exclusive treatment.
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Affiliation(s)
- F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, Sorbonne Université, 4, rue de la Chine, 75020 Paris, France.
| | - E Rivin Del Campo
- Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - A Orthuon
- Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - F Mornex
- Service de radiothérapie, centre hospitalier Lyon-Sud, hospices civils, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - I Bessières
- Département de physique médicale, centre Georges-François-Leclerc, 1, rue Professeur-Marion, 21000 Dijon, France
| | - V Guimas
- Service d'oncologie radiothérapie, institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - V Vendrely
- Service de radiothérapie, CHU de Bordeaux, 33604 Pessac cedex, France
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Larnaudie A, Marcy PY, Delaby N, Costes Martineau V, Troussier I, Bensadoun RJ, Vergez S, Servagi Vernat S, Thariat J. Radiotherapy of salivary gland tumours. Cancer Radiother 2021; 26:213-220. [PMID: 34953702 DOI: 10.1016/j.canrad.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Primary tumours of the salivary glands account for about 5 to 10% of tumours of the head and neck. These tumours represent a multitude of situations and histologies, where surgery is the mainstay of treatment and radiotherapy is frequently needed for malignant tumours (in case of stage T3-T4, nodal involvement, extraparotid invasion, positive or close resection margins, histological high-grade tumour, lymphovascular or perineural invasion, bone involvement postoperatively, or unresectable tumours). The diagnosis relies on anatomic and functional MRI and ultrasound-guided fine-needle aspiration for the diagnostic of benign or malignant tumors. In addition to patient characteristics, the determination of primary and nodal target volumes depends on tumor extensions and stage, histology and grade. Therefore, radiotherapy of salivary gland tumors requires a certain degree of personalization, which has been codified in the recommendations of the French multidisciplinary network of expertise for rare ENT cancers (Refcor) and may justify a specialised multidisciplinary discussion. Although radiotherapy is usually recommended for malignant tumours only, recurrent pleomorphic adenomas may sometimes require radiotherapy based on multidisciplinary discussion. An update of indications and recommendations for radiotherapy for salivary gland tumours in terms of techniques, doses, target volumes and dose constraints to organs at risk of the French society for radiotherapy and oncology (SFRO) was reported in this article.
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Affiliation(s)
- A Larnaudie
- Département de radiothérapie, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Service de radiothérapie, CHU de Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - P-Y Marcy
- Radiodiagnostic et radiologie interventionnelle, polyclinique Elsan, 332, avenue Frédéric-Mistral, 83190 Ollioules, France
| | - N Delaby
- Unité de physique médicale, centre Eugène-Marquis, 35000 Rennes cedex, France
| | - V Costes Martineau
- Service d'anatomie pathologique, CHU de Montpellier, 34000 Montpellier, France; Réseau d'expertise français sur les cancers ORL rares (Refcor), 94800 Villejuif, France
| | - I Troussier
- Service de radiothérapie, centre de haute énergie, 06000 Nice, France
| | - R-J Bensadoun
- Réseau d'expertise français sur les cancers ORL rares (Refcor), 94800 Villejuif, France; Service de radiothérapie, centre de haute énergie, 06000 Nice, France
| | - S Vergez
- Réseau d'expertise français sur les cancers ORL rares (Refcor), 94800 Villejuif, France; Service d'ORL et chirurgie cervicofaciale, CHU de Toulouse/oncopôle, 31000 Toulouse, France
| | - S Servagi Vernat
- Institut privé de radiothérapie, clinique Claude-Bernard, 97, rue Claude-Bernard, 57070 Metz, France
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Normandie université, 14000 Caen, France; Réseau d'expertise français sur les cancers ORL rares (Refcor), 94800 Villejuif, France; Groupe d'oncologie radiothérapie des cancers de la tête et du cou (Gortec), 37000 Tours, France.
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He DC, Zhu ZJ, Zhang XY, Zhang Y, Hong J, Shi TT, Han JH. Dosimetric analysis of postoperative radiotherapy for thymoma. Cancer Radiother 2021; 26:537-541. [PMID: 34728117 DOI: 10.1016/j.canrad.2021.07.037] [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: 05/24/2021] [Revised: 07/11/2021] [Accepted: 07/27/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the dosimetric differences between intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in the treatment of male and female thymoma. MATERIAL AND METHODS This single-institutional analysis included 20 patients with thymoma treated with RT between January 2017 and December 2020. Twenty patients were retrospectively planned for IMRT (IMRT1 with an average field angle of 216°, 288°, 0°, 72°,and 144°; IMRT2 with fan-shaped field angles of 280°, 320°, 0°, 40°, and 80°) and VMAT (VMAT1 with two arcs ranging form 280° to 80°,clockwise and then counterclockwise; VMAT2 with two 360° arcs). The plans for all investigated RT modalities were optimized for a prescriptional dose of 50Gy and fractional dose of 2.0Gy. Planning target volume (PTV) and organs-at-risk (OARs: heart, breasts, lungs, spinal cord, and esophagus) dosimetric parameters were compared. RESULTS All plans met the preparation aims for all the included metrics. There was little difference in the median values of PTV parameters (D2%, D98%, Dmean, homogeneity index[HI], and conformity index [CI]). The CI of the VMAT2 plan was the closest to 1 in both therapy groups. The monitor unit (MU) of IMRT2 and the estimated total delivery time of VMAT1 were the lowest in both therapy groups and were statistically significant. In the male group, the lung parameters (Dmean, V5Gy, V10Gy, and V20Gy) for VMAT1 were the lowest and showed statistical significance. In the female group, the lung parameters (Dmean, V5Gy, V10Gy, and V20Gy) and bilateral breast parameters (Dmean, V5Gy, V10Gy, and V20Gy) of IMRT2 were the lowest and showed statistical significance. CONCLUSIONS In male thymoma patients undergoing postoperative RT (PORT) treatment, the choice of fan-shaped VMAT may be a better option for protecting the lungs. For female thymoma patients receiving PORT, fan-shaped IMRT can better protect the lungs and breasts. The fan-shaped field performed better than the average and the full arc fields in PORT for thymoma.
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Affiliation(s)
- D-C He
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, No. 1 Huanghe Road West, Huaiyin District, Huai'an ,Jiangsu 223300,People's Republic of China
| | - Z-J Zhu
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, No. 1 Huanghe Road West, Huaiyin District, Huai'an ,Jiangsu 223300,People's Republic of China
| | - X-Y Zhang
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, No. 1 Huanghe Road West, Huaiyin District, Huai'an ,Jiangsu 223300,People's Republic of China
| | - Y Zhang
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, No. 1 Huanghe Road West, Huaiyin District, Huai'an ,Jiangsu 223300,People's Republic of China
| | - J Hong
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, No. 1 Huanghe Road West, Huaiyin District, Huai'an ,Jiangsu 223300,People's Republic of China
| | - T-T Shi
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, No. 1 Huanghe Road West, Huaiyin District, Huai'an ,Jiangsu 223300,People's Republic of China
| | - J-H Han
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, No. 1 Huanghe Road West, Huaiyin District, Huai'an ,Jiangsu 223300,People's Republic of China.
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Ofili EO, Sarpong D, Yanagihara R, Tchounwou PB, Fernández-Repollet E, Malouhi M, Idris MY, Lawson K, Spring NH, Rivers BM. The Research Centers in Minority Institutions ( RCMI) Consortium: A Blueprint for Inclusive Excellence. Int J Environ Res Public Health 2021; 18. [PMID: 34202383 DOI: 10.3390/ijerph18136848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Abstract
The Research Centers in Minority Institutions, (RCMI) Program was established by Congress to address the health research and training needs of minority populations, by preparing future generations of scientists at these institutions, with a track record of producing minority scholars in medicine, science, and technology. The RCMI Consortium consists of the RCMI Specialized Centers and a Coordinating Center (CC). The RCMI-CC leverages the scientific expertise, technologies, and innovations of RCMI Centers to accelerate the delivery of solutions to address health disparities in communities that are most impacted. There is increasing recognition that the gap in representation of racial/ethnic groups and women is perpetuated by institutional cultures lacking inclusion and equity. The objective of this work is to provide a framework for inclusive excellence by developing a systematic evaluation process with common data elements that can track the inter-linked goals of workforce diversity and health equity. At its core, the RCMI Program embodies the trinity of diversity, equity, and inclusion. We propose a realist evaluation framework and a logic model that integrates the institutional context to develop common data metrics for inclusive excellence. The RCMI-CC will collaborate with NIH-funded institutions and research consortia to disseminate and scale this model.
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Hedges JR, Soliman KFA, Southerland WM, D’Amour G, Fernández-Repollet E, Khan SA, Kumar D, Shikuma CM, Rivers BM, Yates CC, Yanagihara R, Thompson WE, Bond VC, Harris-Hooker S, McClure SA, Ofili EO. Strengthening and Sustaining Inter-Institutional Research Collaborations and Partnerships. Int J Environ Res Public Health 2021; 18:2727. [PMID: 33800316 PMCID: PMC7967451 DOI: 10.3390/ijerph18052727] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/06/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Abstract
Inter-institutional collaborations and partnerships play fundamental roles in developing and diversifying the basic biomedical, behavioral, and clinical research enterprise at resource-limited, minority-serving institutions. In conjunction with the Research Centers in Minority Institutions (RCMI) Program National Conference in Bethesda, Maryland, in December 2019, a special workshop was convened to summarize current practices and to explore future strategies to strengthen and sustain inter-institutional collaborations and partnerships with research-intensive majority-serving institutions. Representative examples of current inter-institutional collaborations at RCMI grantee institutions are presented. Practical approaches used to leverage institutional resources through collaborations and partnerships within regional and national network programs are summarized. Challenges and opportunities related to such collaborations are provided.
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Grants
- U01GM132771 NIGMS NIH HHS
- U54 MD007582 NIMHD NIH HHS
- U13MD014961 NIMHD NIH HHS
- UL1 TR002378 NCATS NIH HHS
- G12 MD007590 NIMHD NIH HHS
- U54MD007579, U54MD007582, U54MD007585, U54MD007590, U54MD007595, U54MD007597,U54MD007600, U54MD007601, U54MD007602, and U54MD012392. NIMHD NIH HHS
- U54 MD007590 NIMHD NIH HHS
- U54MD007584, U54MD008149, U24MD015970, and R25MD007589. NIMHD NIH HHS
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Affiliation(s)
- Jerris R. Hedges
- Department of Medicine and Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
| | - Karam F. A. Soliman
- Department of Basic Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA;
| | - William M. Southerland
- Department of Biochemistry & Molecular Biology, College of Medicine, Howard University, Washington, DC 20059, USA;
| | - Gene D’Amour
- Office of the President, Xavier University of Louisiana, New Orleans, LA 70125, USA;
| | - Emma Fernández-Repollet
- Department of Pharmacology & Toxicology, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA;
| | - Shafiq A. Khan
- Department of Biological Sciences, Clark Atlanta University, Atlanta, GA 30314, USA;
| | - Deepak Kumar
- Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, Durham, NC 27707, USA;
| | - Cecilia M. Shikuma
- Department of Medicine and Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA;
| | - Brian M. Rivers
- Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Clayton C. Yates
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL 36088, USA;
| | - Richard Yanagihara
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA;
| | - Winston E. Thompson
- Department of Physiology and Obstetrics & Gynecology, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Vincent Craig Bond
- Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Sandra Harris-Hooker
- Department of Pathology & Anatomy, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Shelia A. McClure
- Office of Research Development, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Elizabeth O. Ofili
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA;
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13
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Yanagihara R, Berry MJ, Carson MJ, Chang SP, Corliss H, Cox MB, Haddad G, Hohmann C, Kelley ST, Lee ESY, Link BG, Noel RJ, Pickrel J, Porter JT, Quirk GJ, Samuel T, Stiles JK, Sy AU, Taira DA, Trepka MJ, Villalta F, Wiese TE. Building a Diverse Workforce and Thinkforce to Reduce Health Disparities. Int J Environ Res Public Health 2021; 18:1569. [PMID: 33562262 PMCID: PMC7915161 DOI: 10.3390/ijerph18041569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/20/2021] [Accepted: 02/03/2021] [Indexed: 02/03/2023]
Abstract
The Research Centers in Minority Institutions (RCMI) Program was congressionally mandated in 1985 to build research capacity at institutions that currently and historically recruit, train, and award doctorate degrees in the health professions and health-related sciences, primarily to individuals from underrepresented and minority populations. RCMI grantees share similar infrastructure needs and institutional goals. Of particular importance is the professional development of multidisciplinary teams of academic and community scholars (the "workforce") and the harnessing of the heterogeneity of thought (the "thinkforce") to reduce health disparities. The purpose of this report is to summarize the presentations and discussion at the RCMI Investigator Development Core (IDC) Workshop, held in conjunction with the RCMI Program National Conference in Bethesda, Maryland, in December 2019. The RCMI IDC Directors provided information about their professional development activities and Pilot Projects Programs and discussed barriers identified by new and early-stage investigators that limit effective career development, as well as potential solutions to overcome such obstacles. This report also proposes potential alignments of professional development activities, targeted goals and common metrics to track productivity and success.
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Affiliation(s)
- Richard Yanagihara
- University of Hawaii at Manoa, Honolulu, HI 96813, USA; (M.J.B.); (S.P.C.); (A.U.S.); (D.A.T.)
| | - Marla J. Berry
- University of Hawaii at Manoa, Honolulu, HI 96813, USA; (M.J.B.); (S.P.C.); (A.U.S.); (D.A.T.)
| | - Monica J. Carson
- University of California, Riverside, Riverside, CA 92521, USA; (M.J.C.); (B.G.L.)
| | - Sandra P. Chang
- University of Hawaii at Manoa, Honolulu, HI 96813, USA; (M.J.B.); (S.P.C.); (A.U.S.); (D.A.T.)
| | - Heather Corliss
- San Diego State University, San Diego, CA 92182, USA; (H.C.); (S.T.K.); (J.P.)
| | - Marc B. Cox
- University of Texas at El Paso, El Paso, TX 79968, USA;
| | | | | | - Scott T. Kelley
- San Diego State University, San Diego, CA 92182, USA; (H.C.); (S.T.K.); (J.P.)
| | - Eun Sook Yu Lee
- Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA;
| | - Bruce G. Link
- University of California, Riverside, Riverside, CA 92521, USA; (M.J.C.); (B.G.L.)
| | - Richard J. Noel
- Ponce Health Sciences University, Ponce, PR 00716, USA; (R.J.N.J.); (J.T.P.)
| | - Julie Pickrel
- San Diego State University, San Diego, CA 92182, USA; (H.C.); (S.T.K.); (J.P.)
| | - James T. Porter
- Ponce Health Sciences University, Ponce, PR 00716, USA; (R.J.N.J.); (J.T.P.)
| | - Gregory J. Quirk
- University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA;
| | | | | | - Angela U. Sy
- University of Hawaii at Manoa, Honolulu, HI 96813, USA; (M.J.B.); (S.P.C.); (A.U.S.); (D.A.T.)
| | - Deborah A. Taira
- University of Hawaii at Manoa, Honolulu, HI 96813, USA; (M.J.B.); (S.P.C.); (A.U.S.); (D.A.T.)
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14
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Bartolucci L, Adrien C, Goudjil F, Amessis M, El Amine W, Fourquet A, Mazal A, Kirova Y. Dosimetric comparison of four high performance techniques for irradiation of breast cancer patients. Cancer Radiother 2021; 25:254-258. [PMID: 33402289 DOI: 10.1016/j.canrad.2020.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE The use of IMRT for the treatment of breast cancer has been growing considerably in our institution since 2009. Alternatively, helical tomotherapy (HT) using a field width of 2.5 and 5cm (HT_FW_5), volumetric-modulated arc therapy (VMAT), or proton therapy with pencil-beam scanning (PT-PBS) have also been used to reduce treatment duration or optimize organ-at-risk (OAR) sparing. The purpose of this study was to compare the 4 treatment modalities available at our site. PATIENTS AND METHODS We studied 10 patients treated for breast cancer with lymph node involvement. The prescribed dose was 51.8Gy to the breast with a simultaneous integrated boost up to 63Gy, and 50.4Gy to lymph nodes in 28 fractions. The CTV was delineated according to ESTRO Guidelines. Dosimetric planning in routine clinical practice was performed using HT_FW_2.5. The approved clinical plan was compared to the 3 other plans. Dosimetric goals for PTV coverage were D95%≥95% and D2%≤107% of the prescribed dose. Mean and maximum doses to OAR were recorded. RESULTS HT_FW_5 and VMAT plans ensure equivalent or even better PTV coverage compared to the initial clinically approved plan but at the cost of poorer OAR sparing. PT_PBS plans showed that an excellent PTV coverage can be maintained with significantly lower doses to OAR. CONCLUSION HT_FW_5 and VMAT plans allow a significant reduction of treatment duration and can be a good alternative to HT_FW_2.5 for specific populations. HT_FW_2.5 could be chosen for patients at higher risk of side effects. In addition, PT_PBS should be considered in the near future as it has been shown to have a major potential benefit to lower the risk of side effects with the same level of PTV coverage.
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Affiliation(s)
- L Bartolucci
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - C Adrien
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - F Goudjil
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - M Amessis
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - W El Amine
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - A Fourquet
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - A Mazal
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - Y Kirova
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France.
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15
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Kuntz L, Noel G. [Pelvic irradiation and hematopoietic toxicity: A review of the literature]. Cancer Radiother 2020; 25:77-91. [PMID: 33358082 DOI: 10.1016/j.canrad.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/21/2020] [Accepted: 05/03/2020] [Indexed: 02/03/2023]
Abstract
Pelvic bone marrow is the site of nearly 50% of total hematopoiesis. Radiation therapy of pelvic lymph node areas, and cancers located near the bony structures of the pelvis, exposes to hematological toxicity in the range of 30 to 70%. This toxicity depends on many factors, including the presence or absence of concomitant chemotherapy and its type, the volume of irradiated bone, the received doses, or the initial hematopoietic reserve. Intensity modulated radiation therapy allows the optimisation of dose deposit on at risk organs while providing optimal coverage of target volumes. However, this suggests that dose constraints should be known precisely to limit the incidence of radiation side effects. This literature review focuses firstly on pelvic lymph node areas and bony volumes nearby, then on the effects of irradiation on bone marrow and the current dosimetric constraints resulting from it, and finally on hematological toxicities by carcinologic location and progress in reducing these toxicities.
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Affiliation(s)
- L Kuntz
- Département de radiothérapie, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - G Noel
- Département de radiothérapie, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France.
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16
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Brun L, Dupic G, Chassin V, Chautard E, Moreau J, Dedieu V, Khalil T, Verrelle P, Lapeyre M, Biau J. Hypofractionated stereotactic radiotherapy for large brain metastases: Optimizing the dosimetric parameters. Cancer Radiother 2020; 25:1-7. [PMID: 33257109 DOI: 10.1016/j.canrad.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Stereotactic radiotherapy plays a major role in the treatment of brain metastases (BM). We aimed to compare the dosimetric results of four plans for hypofractionated stereotactic radiotherapy (HFSRT) for large brain metastases. MATERIAL AND METHODS Ten patients treated with upfront NovalisTx® non-coplanar multiple dynamic conformal arcs (DCA) HFSRT for≥25mm diameter single BM were included. Three other volumetric modulated arc therapy (VMAT) treatment plans were evaluated: with coplanar arcs (Eclipse®, Varian, VMATcEclipse®), with coplanar and non-coplanar arcs (VMATncEclipse®), and with non-coplanar arcs (Elements Cranial SRS®, Brainlab, VMATncElements®). The marginal dose prescribed for the PTV was 23.1Gy (isodose 70%) in three fractions. The mean GTV was 27mm3. RESULTS Better conformity indices were found with all VMAT techniques compared to DCA (1.05 vs 1.28, P<0.05). Better gradient indices were found with VMATncElements® and DCA (2.43 vs 3.02, P<0.001). High-dose delivery in healthy brain was lower with all VMAT techniques compared to DCA (5.6 to 6.3 cc vs 9.4 cc, P<0.001). Low-dose delivery (V5Gy) was lower with VMATncEclipse® or VMATncElements® than with DCA (81 or 94 cc vs 110 cc, P=0.02). CONCLUSIONS NovalisTx® VMAT HFSRT for≥25mm diameter brain metastases provides the best dosimetric compromise in terms of target coverage, sparing of healthy brain tissue and low-dose delivery compared to DCA.
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Affiliation(s)
- L Brun
- Department of radiation oncology, Jean-Perrin center, 63011 Clermont-Ferrand, France
| | - G Dupic
- Department of radiation oncology, Jean-Perrin center, 63011 Clermont-Ferrand, France.
| | - V Chassin
- Department of medical physics, Jean-Perrin center, Clermont-Ferrand, France
| | - E Chautard
- Clermont Auvergne university, INSERM, U1240 IMoST, 63000 Clermont-Ferrand, France; Department of pathology, Clermont Auvergne university, Jean-Perrin center, 63011 Clermont-Ferrand, France
| | - J Moreau
- Department of radiation oncology, Jean-Perrin center, 63011 Clermont-Ferrand, France
| | - V Dedieu
- Department of medical physics, Jean-Perrin center, Clermont-Ferrand, France
| | - T Khalil
- Department of neurosurgery, Clermont-Ferrand hospital, 63003 Clermont-Ferrand, France
| | - P Verrelle
- Department of radiation oncology, Jean-Perrin center, 63011 Clermont-Ferrand, France
| | - M Lapeyre
- Department of radiation oncology, Jean-Perrin center, 63011 Clermont-Ferrand, France
| | - J Biau
- Department of radiation oncology, Jean-Perrin center, 63011 Clermont-Ferrand, France; Clermont Auvergne university, INSERM, U1240 IMoST, 63000 Clermont-Ferrand, France
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17
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Sy A, Hayes T, Laurila K, Noboa C, Langwerden RJ, Hospital MM, Andújar-Pérez DA, Stevenson L, Cunningham SMR, Rollins L, Madanat H, Penn T, Mehravaran S. Evaluating Research Centers in Minority Institutions: Framework, Metrics, Best Practices, and Challenges. Int J Environ Res Public Health 2020; 17:E8373. [PMID: 33198272 DOI: 10.3390/ijerph17228373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
The NIH-funded Research Centers in Minority Institutions (RCMI) program is currently funding 18 academic institutions to strengthen the research environment and contribution to health disparities research. The purpose of this multiphase mixed-methods study was to establish a uniform evaluation framework for demonstrating the collective success of this research consortium. Methods included discussions of aims and logic models at the RCMI Evaluators' Workshop, a literature review to inform an evaluation conceptual framework, and a case study survey to obtain evaluation-related information and metrics. Ten RCMIs participated in the workshop and 14 submitted responses to the survey. The resultant RCMI Evaluation Conceptual Model presents a practical ongoing approach to document RCMIs' impacts on health disparities. Survey results identified 37 common metrics under four primary categories. Evaluation challenges were issues related to limited human resources, data collection, decision-making, defining metrics, cost-sharing, and revenue-generation. There is a need for further collaborative efforts across RCMI sites to engage program leadership and community stakeholders in addressing the identified evaluation challenges and measurement. Program leadership should be engaged to apply the Evaluation Conceptual Framework and common metrics to allow for valid inter-institutional comparisons and consortium-wide evaluations. Stakeholders could ensure evaluation metrics are used to facilitate community impacts.
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18
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Benhmida S, Sun R, Gherga E, Hammoud Y, Rouvier J, Mauvais O, Bockel S, Louvrier A, Lebbad A, Bontemps P, Ortholan C, Bourhis J, Lestrade L, Sun XS. Split-course hypofractionated radiotherapy for aged and frail patients with head and neck cancers. A retrospective study of 75 cases. Cancer Radiother 2020; 24:812-819. [PMID: 33144061 DOI: 10.1016/j.canrad.2020.03.013] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the efficacy and the tolerance of a split course hypofractionated (SCH) radiotherapy (RT) protocol in head and neck cancer (HNC) for eldery and/or unfit patients (pts). PATIENTS AND METHODS Pts with HNC treated by SCH-RT in two institutions were included retrospectively. The main SCH RT regimen was two courses of 30 grays (Gy)/10 fractions separated by 2-4 weeks, without any systemic therapy. RESULTS Between February 2012 and January 2019, 75 consecutive patients were analyzed. The median age was 80 years (range: 45.7-98.2) and 53 (70.7%) were men. Sixty-one (81.3%) pts had stage III/IV disease and 54 (72%) had at least two comorbidities. All of them were treated with intensity-modulated radiotherapy. Median follow-up was 10.6 months (range: 3.1-58.3). Local control at 12 and 24 months was 72.8% IC95%[62-85.5] and 51.7% IC95%[38.1-70.1] respectively. Progression free survival (PFS) at 12 and 24 months were 47.7% IC95%[37.4-60.8] and 41% IC95%[15-36.4] respectively, with a median of 11.5 months IC95%[8.9-17]. OS at 12 and 24 months were 60.4% IC95%[50-73.1] and 41% IC95%[30.6-54.9] respectively, with a median of 19.3 months IC95%[11.9-25.8]. Acute and late grade 3 or higher toxicities occurred for 6 (8%) and 3 (4%) pts. CONCLUSION The present SCH-RT regimen seems effective, well-tolerated and could represent an alternative to palliative strategies for pts deemed unfit for standard exclusive RT.
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Affiliation(s)
- S Benhmida
- Department of radiotherapy, CHU de Besancon, 2, boulevard Fleming, 25030 Besançon, France; Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France.
| | - R Sun
- Department of radiotherapy, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - E Gherga
- Department of radiotherapy, CHU de Besancon, 2, boulevard Fleming, 25030 Besançon, France; Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France
| | - Y Hammoud
- Department of radiotherapy, CHU de Besancon, 2, boulevard Fleming, 25030 Besançon, France; Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France
| | - J Rouvier
- Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France
| | - O Mauvais
- Department of head and neck surgery, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France
| | - S Bockel
- Department of radiotherapy, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - A Louvrier
- Department of Maxillofacial Surgery and Stomatology, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France
| | - A Lebbad
- Department of head and neck surgery, Hôpital Nord Franche-Comté, 100, route de Moval, Trevenans, France
| | - P Bontemps
- Department of radiotherapy, CHU de Besancon, 2, boulevard Fleming, 25030 Besançon, France; Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France
| | - C Ortholan
- Department of radiotherapy, Centre hospitalier Princesse-Grace, 98000 Monaco, Monaco
| | - J Bourhis
- Centre Hospitalier Universitaire Vaudois, Service de Radio-oncologie, 1005 Lausanne, Switzerland
| | - L Lestrade
- Department of radiotherapy, CHU de Besancon, 2, boulevard Fleming, 25030 Besançon, France; Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France
| | - X S Sun
- Department of radiotherapy, CHU de Besancon, 2, boulevard Fleming, 25030 Besançon, France; Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France
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19
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Randrian V, Biau J, Benoît C, Pezet D, Lapeyre M, Moreau J. [Preoperative intensity-modulated radiotherapy of rectal cancers: Relevance and modalities]. Cancer Radiother 2020; 24:345-353. [PMID: 32360094 DOI: 10.1016/j.canrad.2019.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/27/2019] [Accepted: 11/06/2019] [Indexed: 12/18/2022]
Abstract
Preoperative radiotherapy boosted by chemotherapy is a recommended treatment in locally advanced rectal cancers. This treatment is delivered by three dimensional conformal irradiation, which is usually well tolerated but can induce potential toxicity such as rectitis, cystitis and hematologic adverse effects. Intensity-modulated radiotherapy, widely available nowadays, allows optimization of volume covering and sparing of organs at risk such as bladder and bone marrow. This review presents relevant clinical situations and requirements for a beneficial and safe preoperative irradiation of rectal cancers by intensity-modulated technique. This technique is compared to three-dimensional conformal radiotherapy.
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Affiliation(s)
- V Randrian
- Département de médecine digestive et hépatobiliaire, CHU de l'hôpital Estaing, 63003 Clermont-Ferrand cedex 1, France
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - C Benoît
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - D Pezet
- Département de chirurgie digestive et hépatobiliaire, CHU de l'hôpital Estaing, 63003 Clermont-Ferrand cedex 1, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - J Moreau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France.
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20
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Hend D, Mnejja W, Fourati N, Kallel M, Siala W, Sahnoun T, Farhat L, Daoud J. [Adaptive radiotherapy for nasopharyngeal carcinomas: Where are we?]. Bull Cancer 2020; 107:565-73. [PMID: 32245602 DOI: 10.1016/j.bulcan.2019.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 11/21/2022]
Abstract
Modern high-precision radiotherapy techniques have recently incorporated the notion of anatomical variations of the patient during treatment and have tried to adapt the treatment planning to them. Adaptive radiotherapy for nasopharyngeal tumors is starting to prove its benefit nowadays. His interest is constantly being evaluated. The variations encountered during the treatment are both geometric and dosimetric. They are represented by a reduction in the macroscopic tumors volume, a change in its position and a consequent dosimetric impact. The changes also concern organs at risk with a reduction of glandular structure volumes, and a different position which increases their doses. Delivered doses to noble structures (brainstem and spinal cord) may also increase. However, difficulties are encountered in its realization. There is a problem to perfectly reproduce the patient position during the second acquisition, which impacts the fusion quality between the two CT scans. This generates an imprecision in the definition of the same treatment isocentre on the second scanner. Also, there is a difficulty in accumulated doses calculation. The indication of adaptive radiotherapy remains a subject of controversy. It should be proposed for a subgroup of patients who could benefit from this new strategy. We present here an update on the state of the art of adaptive radiotherapy for nasopharyngeal cancer.
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21
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Laurans M, Botticella A, Moukasse Y, Lévy A, Le Péchoux C. [Lung cancer and elective nodal irradiation: A solved issue?]. Cancer Radiother 2019; 23:701-7. [PMID: 31501024 DOI: 10.1016/j.canrad.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/27/2019] [Indexed: 12/25/2022]
Abstract
Lung cancer treatment is a heavy workload for radiation oncologist and that field showed many evolutions over the last two decades. The issue about target volume was raised when treatment delivery became more precise with the development of three-dimensional conformal radiotherapy. Initially based upon surgical series, numerous retrospective and prospective studies aimed to evaluate the risk of elective nodal failure of involved-field radiotherapy compared to standard large field elective nodal irradiation. In every setting, locally advanced non-small cell lung cancer, localized non-small cell lung cancer, localized small cell lung cancer, exclusive chemoradiation or postoperative radiotherapy, most of the studies showed no significant difference between involved-field radiotherapy or elective nodal irradiation with elective nodal failure rate under 5% at 2 years, provided staging had been done with modern imaging and diagnostic techniques (positron emission tomography scan, endoscopy, etc.). Moreover, if reducing irradiated volumes are safe regarding recurrences, involved-field radiotherapy allowed dose escalation while reducing acute and late oesophageal, cardiac and pulmonary toxicities. Consequently, major clinical trials involving radiotherapy initiated in the last two decades and international clinical guidelines recommended omission of elective nodal irradiation in favour of in-field radiotherapy.
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Peiffert D. [Anal channel cancer: customization of dose, volume and breaching]. Cancer Radiother 2019; 23:773-777. [PMID: 31471250 DOI: 10.1016/j.canrad.2019.07.138] [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: 07/04/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
The conservative treatment of squamous cell carcinoma of anal canal by irradiation is recommended as first indication. Despite its rarity, significant improvements were obtained by retrospective or prospective clinical studies these 20 past years, evaluating concomitant chemotherapy and IMRT. Nevertheless, the individualisation of the treatment, over dose distribution, has poor data available. Fractionation remains classic (1.8-2.0Gy/Fr), but the optimal dose level remains under discussion. The strategy concerning the volumes and doses for the prophylactic volumes remains under discussion. This paper will describe the data published, and the recommendations of working Groups, and the main options under evaluation. To conclude, today only the absence of gap is recommended, the benefit of a one-step schedule reducing the treatment time, then increasing local control and survival, but personalised schedules remain under investigation.
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Affiliation(s)
- D Peiffert
- Département de radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-les-Nancy, France.
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Bourdais R, Achkar S, Chauffert-Yvart L, Pasquier D, Sargos P, Blanchard P, Latorzeff I. [Prophylactic nodal radiotherapy in prostate cancer]. Cancer Radiother 2019; 23:688-695. [PMID: 31451356 DOI: 10.1016/j.canrad.2019.07.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 12/30/2022]
Abstract
The risk of lymph node invasion, in case of prostate cancer, increases with the clinical stage of the disease, the Gleason score of prostate biopsies and the value of PSA at diagnosis. Historically, beyond 15% risk of lymph node involvement, irradiation of the pelvic areas was performed with prostate radiotherapy (RT) to take into account the risk of occult lymph node metastasis in patients at risk, but the benefit of this therapeutic approach remains to be demonstrated. The data from surgical lymph node dissection seem to question the risk levels, the escalation of the dose on the prostate increases the survival without relapse, the contribution of image-guided radiotherapy, (IGRT) and modulation of intensity (IMRT), decreases the toxicity of pelvic RT. This article reviews the principles of prophylactic ganglion irradiation for prostate cancer and discusses its relevance, current uncertainties, and prospective trials.
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Affiliation(s)
- R Bourdais
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - S Achkar
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - L Chauffert-Yvart
- Service d'oncologie radiothérapie, GHU La Pitié-Salpêtrière-Charles-Foix, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - D Pasquier
- Département de radiothérapie, Centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex; Université de Lille et Centre de Recherche en Informatique Signal et Automatique de Lille CRISTAL UMR CNRS 9189, 59000 Lille, France.
| | - P Sargos
- Département de radiothérapie, Institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
| | - P Blanchard
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - I Latorzeff
- Département de radiothérapie-oncologie, Bât Atrium, Clinique Pasteur, 1, rue de la petite vitesse, 31300 Toulouse, France.
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Brahimi Y, Antoni D, Srour R, Wagner P, Proust F, Thiery A, Labani A, Noël G. [Skull base meningioma: Clinical and radiological efficacy based on a quantitative volumetric analysis]. Cancer Radiother 2019; 23:290-295. [PMID: 31128988 DOI: 10.1016/j.canrad.2018.11.005] [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: 05/19/2017] [Revised: 06/23/2018] [Accepted: 11/13/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To date, no correlation has been found between clinical and radiological efficacy after irradiation of skull base meningiomas. However, the evaluation of the radiological response was most often made by questionable methods that may have underestimated the radiological effectiveness of radiotherapy. The objective of this work is to verify this hypothesis by quantitative volumetric analysis. MATERIAL AND METHODS Data from 35 patients treated with either helical tomotherapy (45.7%) or fractionated stereotactic radiotherapy (54.3%) were retrospectively analysed. These were mainly women (94%) aged 59 (43-81) with lesions mainly of the cavernous sinus (60%). There was a median of 2 (1-4) symptoms and the main symptoms were visual impairment (39%), cranial nerve deficits (23.4%) and headaches (17.2%). RESULTS Median tumour volume decreased significantly (P<0.05) from 9.6mL (0.3-36.6) to 6.8mL (0.1-26.5) after median follow-up of 44 months (24-77). Sixty-three percent of patients had an improvement of at least one symptom. In univariate analysis, clinical efficacy (P<0.05), radiotherapy technique (P<0.05), tumor topography (P<0.05) and initial tumor volume (P<0.05) were predictive factors for radiological response. In multivariate analysis, only the inverse correlation between radiological response and initial tumor volume remained significant (ρ: -0.47 95% CI -3.2 to 5.7; P<0.05). CONCLUSION The quantitative volumetric monitoring demonstrates a major radiological efficiency of radiotherapy. However, no clear correlation between clinical and radiological efficacy was found.
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Affiliation(s)
- Y Brahimi
- University radiation oncology department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - D Antoni
- University radiation oncology department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratory of radiobiology, EA 3430, Federation of translational medicine, Strasbourg (FMTS), Strasbourg university, 67000 Strasbourg, France
| | - R Srour
- Neurosurgery department, hôpital Pasteur, 39, avenue de la Liberté, 68000 Colmar, France
| | - P Wagner
- Department of radiology, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - F Proust
- Neurosurgery department, CHU de Strasbourg, 1, rue Molière, 67000 Strasbourg, France
| | - A Thiery
- Epidemiology and biostatistics department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - A Labani
- Department of radiology, CHU de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - G Noël
- University radiation oncology department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratory of radiobiology, EA 3430, Federation of translational medicine, Strasbourg (FMTS), Strasbourg university, 67000 Strasbourg, France.
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Farhat L, Mnejja W, Fourati N, Daoud H, Sahnoun T, Ben Kridis W, Ghorbel A, Frikha M, Siala W, Daoud J. [Contribution and limits of intensity-modulated reirradiation of nasopharyngeal carcinomas]. Cancer Radiother 2019; 23:28-33. [PMID: 30563746 DOI: 10.1016/j.canrad.2018.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE We report in this study, the dosimetric and carcinologic results of intensity-modulated technique for the reirradiation of nasopharyngeal carcinomas. PATIENTS AND METHODS Eight patients reirradiated with intensity-modulation technique between January 2015 and December 2017 were included. We noted for each patient: the minimum, maximum and average doses, the dose received by 95% (D95%), 98% (D98%) and 2% (D2%) of the volume to be irradiated, the homogeneity and conformity indices and doses to the organs at risk. RESULTS Target volume coverage was satisfactory with a median of D95% greater than 57Gy (95% of the prescribed dose). The median maximum dose received by the spinal cord and brainstem were 8.2Gy and 18.25Gy, respectively. After a median follow-up of 14.5 months [1-29 months], five patients were in complete remission of their disease. Overall survival at 2 years was 66.7%. An increase in preexisting late toxicity after the first irradiation (now grade 2 or above) was found in four patients (50% of cases). CONCLUSION Intensity-modulation is an attractive technique for reirradiation of the nasopharynx. It allows a better conformity of the dose to the target and a reduction of the doses on the already irradiated critical organs. This offers good control of the disease with fewer severe late toxicities.
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Peiffert D, Baumann AS, Serre AA, Vendrely V, Rouard N, Faivre JC, Vogin G. [Anal canal cancer: In the era of intensity-modulated radiotherapy, outstanding issues]. Cancer Radiother 2018; 22:509-514. [PMID: 30181029 DOI: 10.1016/j.canrad.2018.07.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/15/2018] [Indexed: 02/07/2023]
Abstract
Intensity-modulated radiotherapy makes possible to optimize the irradiation and spare normal tissues. The toxicity remains important with concomitant chemotherapy often associated. The improvement of MRI and PET-CT define more precisely the target volumes, which need a higher dose, but necessitates to respect the rules of contouring. The treatment is uniform whatever the stage but should be individualized based on clinical stage and tumor response. New paradigms concern biology, staging, volumes and doses, fractionation and combined treatments.
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Affiliation(s)
- D Peiffert
- Service de radiothérapie, institut de cancérologie de Lorraine centre Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France; EA 4360 Apemac, université de Lorraine, 9, avenue de la Forêt-de-Haye, 54500 Nancy, France.
| | - A S Baumann
- Service de radiothérapie, institut de cancérologie de Lorraine centre Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - A A Serre
- Service de radiothérapie, institut de cancérologie de Lorraine centre Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - V Vendrely
- Service de radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - N Rouard
- Hôpital Édouard-Hériot, 69000 Lyon, France
| | - J C Faivre
- Service de radiothérapie, institut de cancérologie de Lorraine centre Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - G Vogin
- Service de radiothérapie, institut de cancérologie de Lorraine centre Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
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Brahimi Y, Antoni D, Srour R, Proust F, Cebula H, Labani A, Noël G. [Base of the skull meningioma: Efficacy, clinical tolerance and radiological evaluation after radiotherapy]. Cancer Radiother 2018; 22:264-286. [PMID: 29773473 DOI: 10.1016/j.canrad.2017.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/15/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022]
Abstract
Skull base meningioma leads to functional disturbances, which can significantly alter the quality of life. The optimal management of these lesions, whose goals are neurological preservation and tumour local control, is not yet clearly established. It is widely recognized that the goal of a radical excision should be abandoned despite the advances in the field of microsurgery of skull base lesions. Although less morbid, partial tumour excision would be associated with increased risk of local tumour recurrence. Although discussed both exclusive and adjuvant have proven to be highly successful in terms of clinical improvement and local control. Various radiation techniques have demonstrated their efficacy in the management of this pathology. However, high rates of clinical improvement are in contrast with low rates of radiological improvement. The notion of clinical and radiological dissociation appeared. However, in most of these studies, the analysis of the radiological response could be subject of legitimate criticism. This work proposes to review the local control, the efficacy and the clinical tolerance and the radiological response of the various radiation techniques for the meningioma of the base of the skull and to demonstrate the interest of quantitative volumetric analyses in the follow-up of meningioma after radiotherapy.
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Affiliation(s)
- Y Brahimi
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratoire de radiobiologie, UMR 7178 institut pluridisciplinaire Hubert-Curien (IPHC), université de Strasbourg, 67000 Strasbourg, France; CNRS, IPHC UMR 7178, 67000 Strasbourg, France
| | - R Srour
- Service de neurochirurgie, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar cedex, France
| | - F Proust
- Service de neurochirurgie, hôpital universitaire de Strasbourg, 1, rue Molière, 67000 Strasbourg, France
| | - H Cebula
- Service de neurochirurgie, hôpital universitaire de Strasbourg, 1, rue Molière, 67000 Strasbourg, France
| | - A Labani
- Service de radiologie, hôpital universitaire de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - G Noël
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratoire de radiobiologie, UMR 7178 institut pluridisciplinaire Hubert-Curien (IPHC), université de Strasbourg, 67000 Strasbourg, France; CNRS, IPHC UMR 7178, 67000 Strasbourg, France.
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Troussier I, Klausner G, Blais E, Giraud P, Lahmi L, Pflumio C, Faivre JC, Geoffrois L, Babin E, Morinière S, Maingon P, Thariat J. [Advances in the management of cervical lymphadenopathies of unknown primary with intensity modulated radiotherapy: Doses and target volumes]. Cancer Radiother 2018; 22:438-446. [PMID: 29731331 DOI: 10.1016/j.canrad.2017.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
Abstract
The definition of nodal and/or mucosal target volumes for radiation therapy for lymphadenopathies of unknown primary is controversial. Target volumes may include all nodal areas bilaterraly and be pan-mucosal or unilateral, selective, including the sole oropharyngeal mucosa. This review presents current recommendations in light of changes in the TNM classification, Human papillomavirus status and therapeutic advances. We conducted a systematic review of the literature with the following keywords: lymphadenopathy; head and neck; unknown primary and radiation therapy. There are no direct comparative studies between unilateral or bilateral nodal irradiation or pan-mucosal and selective mucosal irradiation. Contralateral lymph node failure rates range from 0 to 6% after unilateral nodal irradiation and 0 and 31% after bilateral irradiation. Occurrence of a mucosal primary varies between 0 and 19.2%. Initial clinical presentation and Human papillomavirus status are critical to define mucosal target volumes. Intensity-modulated radiotherapy is recommended (rather than three-dimensional irradiation) to avoid toxicities. Systemic treatments have similar indications as for identified primary head and neck cancers. Failures do not appear superior in case of unilateral nodal irradiation but comparative studies are warranted due to major biases hampering direct comparisons. Human papillomavirus status should be incorporated into the therapeutic strategy and practice-changing TNM staging changes will need to be evaluated.
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Affiliation(s)
- I Troussier
- Radio-oncologie, hôpitaux universitaires de Genève, Avenue de la Roseraie 53 CH-1205 Genève
| | - G Klausner
- Radiothérapie, groupe hospitalier Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - E Blais
- Radiothérapie, groupe hospitalier Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Giraud
- Radiothérapie, groupe hospitalier Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - L Lahmi
- Radiothérapie, groupe hospitalier Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Pflumio
- Oncologie médicale, centre Alexis-Vautrin, 6, avenue de Bourgogne, 54511 Vandoeuvre-lès-Nancy cedex, France
| | - J-C Faivre
- Radiothérapie, centre Alexis-Vautrin, 6, avenue de Bourgogne, 54511 Vandoeuvre-lès-Nancy cedex, France
| | - L Geoffrois
- Oncologie médicale, centre Alexis-Vautrin, 6, avenue de Bourgogne, 54511 Vandoeuvre-lès-Nancy cedex, France
| | - E Babin
- Carcinologie cervicofaciale, CHRU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France
| | - S Morinière
- Carcinologie cervicofaciale, CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | - P Maingon
- Radiothérapie, groupe hospitalier Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Thariat
- Département de radiothérapie/Archade, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Université Unicaen, 14000 Caen, France.
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Cerda T, Martin É, Truc G, Créhange G, Maingon P. Safety and efficacy of intensity-modulated radiotherapy in the management of spermatic cord sarcoma. Cancer Radiother 2016; 21:16-20. [PMID: 28041814 DOI: 10.1016/j.canrad.2016.07.102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/04/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Spermatic cord sarcoma is a rare disease, which management remains controversial due to the lack of guidelines. The standard therapeutic approach is surgical: wide soft-tissue resection with radical inguinal orchidectomy, The diagnosis is made during the analysis of the specimen. The high rate of local recurrence indicates adjuvant radiotherapy of the tumor bed. The aim of this series is to determine the efficacy and safety of postoperative intensity-modulated radiotherapy for spermatic cord sarcomas. PATIENTS AND METHODS Our series included five consecutive cases of spermatic cord sarcoma treated between 2011 and 2014. The indications for radiotherapy were: R1 status after initial surgery, R1 status after wide en bloc resection and orchiectomy, high French federation of cancer centers (FNCLCC) grade, tumor size over 5cm, tumor resection during surgery. RESULTS Median age at diagnosis was 66years (range 46-84years). Median follow-up was 18months (range 6-28months). Four patients had repeat surgery after incomplete removal. All surgeries were orchidectomy with primary ligation of testicular vessels. One patient did not have an in sano margin after the second surgical procedure. The median tumor size was 60mm (range 30-150mm). No recurrence was observed during the follow-up. CONCLUSION No grade 4 toxicities were reported and the most frequent acute toxicity was dermatitis. No recurrence was reported after adjuvant intensity-modulated radiotherapy. The treatment is feasible and well tolerated and seems to provide encouraging results regarding locoregional control of the disease. Dynamic or rotational intensity-modulated radiotherapy is now recommended to decrease acute toxicities while improving the efficacy of this approach.
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Affiliation(s)
- T Cerda
- Department of Radiation Oncology, CHU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.
| | - É Martin
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - G Truc
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - G Créhange
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France; Medical Imaging group, laboratoire électronique, informatique et image (Le2I) UMR 6306, CNRS, allée Alain-Savary, 21000 Dijon, France; Le2I UMR 6306, Arts et Métiers, allée Alain-Savary, 21000 Dijon, France; Le2I UMR 6306, UFR Sciences et Techniques, université de Bourgogne-Franche-Comté, allée Alain-Savary, 21000 Dijon, France
| | - P Maingon
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
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Cabanne A, Schick U, Pradier O, Rivera S. [Establishing margins from CTV to PTV in breast cancer treatment]. Cancer Radiother 2016; 20:640-4. [PMID: 27614520 DOI: 10.1016/j.canrad.2016.07.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/24/2016] [Accepted: 07/28/2016] [Indexed: 12/25/2022]
Abstract
The benefit of postoperative radiotherapy for breast cancer both in terms of local control and overall survival is widely acknowledged. Today, technological advances in simulation imaging and positioning control enable the definition of new margins from CTV to PTV. Improvements in mathematical modeling of random and systematic errors impact the treatment plans. However, there is no universal absolute value to consistently determine the margins from CTV to PTV. It is down to each centre to assess and correct as much as possible uncertainties due to positioning and internal movements depending on techniques and methods used for the implementation of treatment and monitoring. IMRT and respiratory gating techniques for breast radiotherapy will be considered more systematically in the years to come.
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Affiliation(s)
- A Cabanne
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29200 Brest, France.
| | - U Schick
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29200 Brest, France
| | - O Pradier
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29200 Brest, France
| | - S Rivera
- Service A de radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
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31
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Llacer-Moscardo C, Bourgier C, Morel A, Fenoglietto P, Carrère S, Firmin N, Azria D. [Radiotherapy for soft tissue sarcomas: Technical evolution and impact on clinical benefit]. Cancer Radiother 2016; 20:666-76. [PMID: 27614501 DOI: 10.1016/j.canrad.2016.07.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 12/21/2022]
Abstract
The standard treatment for extremity soft tissue sarcomas is based on the association of surgery and radiotherapy. This strategy allows local control improvement with the risk of increased toxicity. There is therefore a growing interest to identify those patients who will benefit from radiotherapy and those who will have the same local control with surgery alone. Furthermore, the development of toxicity has been correlated with the extension of the irradiated volume and the volume receiving high doses. Technological development as intensity modulated radiotherapy and image-guided radiotherapy allows limited irradiated volume improving the protection of the organs at risk leading to clinical benefit improvement. Moreover, efforts are being done to improve local control for the patients at high risk of local relapse. In this paper, we discuss all these mentioned aspects.
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Abstract
Indication, doses, and technique of radiotherapy for salivary glands carcinoma are presented, and the contribution of neutrons and carbon ions. The recommendations for delineation of the target volumes and organs at risk are detailed.
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Affiliation(s)
- S Servagi-Vernat
- Département de radiothérapie, institut Jean-Godinot, 1, rue Koenig, 51100 Reims, France.
| | - F Tochet
- Service d'oncologie radiothérapie, centre hospitalier universitaire, boulevard Fleming, Besançon, France
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Abstract
Currently, the use of radiation therapy for patients with pancreatic cancer is subject to discussion. In adjuvant setting, the standard treatment is 6 months of chemotherapy with gemcitabine and capecitabine. Chemoradiation (CRT) may improve the survival of patients with incompletely resected tumors (R1). This should be confirmed by a prospective trial. Neoadjuvant CRT is a promising treatment especially for patients with borderline resectable tumors. For patients with locally advanced tumors, there is no a standard. An induction chemotherapy followed by CRT for non-progressive patients reduces the rate of local relapse. Whereas in the first trials of CRT large fields were used, the treated volumes have been reduced to improve tolerance. Tumor movements induced by breathing should be taken in account. Intensity modulated radiation therapy allows a reduction of doses to the organs at risk. Whereas widely used, this technique is not recommended.
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Colliaux J, Kharchi L, Vincendeau S, Simon A, Perdrieux M, Le Prisé É, Bellisant É, Castelli J, de Crevoisier R. [Expected benefit of lymph node and seminal vesical dissection to decrease high-risk prostate cancer radiotherapy]. Cancer Radiother 2016; 20:347-56. [PMID: 27344535 DOI: 10.1016/j.canrad.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/07/2016] [Accepted: 04/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE In case of pelvic lymph node and seminal vesicle dissection followed by prostate cancer intensity-modulated radiotherapy, the objective of the study was to evaluate the dosimetric benefit of reducing the target volume. PATIENTS AND METHODS A total of 25 patients with high-risk prostate cancer had surgery first followed by intensity-modulated radiotherapy and androgen deprivation. Four treatment planning were simulated for each patient, based on two CT scans performed before and after surgery. The target volumes were: prostate-seminal vesicles-lymph nodes, prostate-lymph nodes, prostate-seminal vesicles and prostate only. The total dose was 46Gy in the seminal vesicles and lymph nodes, and 80Gy in the prostate. RESULTS Compared to prostate target volume only, the addition of seminal vesicles and lymph nodes multiplied by a factor of 1.6 and 6.5 the target volume, respectively. Decreasing the target volume from prostate-seminal vesicles-lymph nodes to prostate-seminal vesicles, to prostate only decreased the rectal wall mean dose from 49Gy to 42Gy, to 36Gy, and the risk of late rectal bleeding from 4.4% to 3.2%, to 2.4% (P<0.05), respectively. The bladder wall mean dose decreased from 51Gy to 40Gy, to 35Gy (P<0,05), respectively. Not irradiating the lymph nodes decreased the absolute risk of diarrhea by 11%. CONCLUSION Lymph node and seminal vesicle dissection before prostate cancer intensity-modulated radiotherapy allows decreasing moderately the risk of digestive toxicity.
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Affiliation(s)
- J Colliaux
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; Université de Rennes 1, centre investigation clinique, CHU Pontchaillou, 2, rue Henri-Le Guilloux, 35000 Rennes, France
| | - L Kharchi
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; Inserm, U1099, laboratoire de traitement du signal et de l'image, 263, avenue du Général-Leclerc, 35042 Rennes, France
| | - S Vincendeau
- Service d'urologie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - A Simon
- Inserm, U1099, laboratoire de traitement du signal et de l'image, 263, avenue du Général-Leclerc, 35042 Rennes, France
| | - M Perdrieux
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - É Le Prisé
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - É Bellisant
- Université de Rennes 1, centre investigation clinique, CHU Pontchaillou, 2, rue Henri-Le Guilloux, 35000 Rennes, France
| | - J Castelli
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; Université de Rennes 1, centre investigation clinique, CHU Pontchaillou, 2, rue Henri-Le Guilloux, 35000 Rennes, France
| | - R de Crevoisier
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; Inserm, U1099, laboratoire de traitement du signal et de l'image, 263, avenue du Général-Leclerc, 35042 Rennes, France; Université de Rennes 1, centre investigation clinique, CHU Pontchaillou, 2, rue Henri-Le Guilloux, 35000 Rennes, France.
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Park JW, Yea JW. Three-dimensional customized bolus for intensity-modulated radiotherapy in a patient with Kimura's disease involving the auricle. Cancer Radiother 2016; 20:205-9. [PMID: 27020714 DOI: 10.1016/j.canrad.2015.11.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 11/21/2022]
Abstract
In radiotherapy, a commercial bolus often does not provide a suitable fit over irregular surfaces. To address this issue, we fabricated a customized bolus using 3D printing technology. The aim of our study was to evaluate the application of this 3D-printed bolus in a clinical setting. The patient was a 45-year-old man with recurrent Kimura's disease involving the auricle, receiving radiotherapy in our oncology department. A customized bolus, 5mm in thickness, was fabricated based on reconstruction of computed tomography (CT) images. The bolus was printed on a Dimension 1200 series SST 3D printer. Repeat CT-based simulation indicated an acceptable fit of the 3D-printed bolus to the target region, with a maximum air gap of less than 5mm at the tragus. Most of the surface area of the target region was covered by the 95% isodose line. The plan with the 3D-printed bolus improved target coverage compared to that without a bolus. And the plan with the 3D-printed bolus yielded comparable results to those with the paraffin wax bolus. In conclusion, a customized bolus using a 3D printer was successfully applied to an irregular surface.
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Peiffert D. [Recommendations for the management of cancers of the anal canal]. Cancer Radiother 2015; 19:416-20. [PMID: 26337477 DOI: 10.1016/j.canrad.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/20/2015] [Revised: 06/01/2015] [Accepted: 06/01/2015] [Indexed: 12/22/2022]
Abstract
Anal canal carcinomas remain rare, but their management has improved recently. The PET-CT is now used as a standard at the first diagnosis and after relapses. The introduction of intensity-modulated irradiation techniques makes it possible to better conform the pelviperineal and inguinal volumes, improving the homogeneity of the irradiation while sparing some pelvic structures, thus reducing acute and late effects. Nevertheless, the conversion from 3D to intensity-modulated radiotherapy needs a specific and careful approach, mainly for the management of the perineal region, where relapses and complications occur. Last but not least, new chemotherapy associations are studied for metastatic disease.
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Affiliation(s)
- D Peiffert
- Département de radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, CS 30519, 54500 Vandœuvre-lès-Nancy, France.
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Supiot S, Clément-Colmou K, Paris F, Corre I, Chiavassa S, Delpon G. [Which rules apply to hypofractionated radiotherapy?]. Cancer Radiother 2015; 19:421-5. [PMID: 26321647 DOI: 10.1016/j.canrad.2015.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 12/22/2022]
Abstract
Hypofractionated radiotherapy is now more widely prescribed due to improved targeting techniques (intensity modulated radiotherapy, image-guided radiotherapy and stereotactic radiotherapy). Low dose hypofractionated radiotherapy is routinely administered mostly for palliative purposes. High or very high dose hypofractionated irradiation must be delivered according to very strict procedures since every minor deviation can lead to major changes in dose delivery to the tumor volume and organs at risk. Thus, each stage of the processing must be carefully monitored starting from the limitations and the choice of the hypofractionation technique, tumour contouring and dose constraints prescription, planning and finally dose calculation and patient positioning verification.
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Affiliation(s)
- S Supiot
- Département de radiothérapie, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France; Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France.
| | - K Clément-Colmou
- Département de radiothérapie, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France; Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France
| | - F Paris
- Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France
| | - I Corre
- Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France
| | - S Chiavassa
- Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France; Département de radiophysique, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - G Delpon
- Centre de recherche en cancérologie Nantes-Angers, UMR Inserm 892, quai Moncousu, 44007 Nantes cedex 1, France; CNRS 6299, quai Moncousu, 44007 Nantes cedex 1, France; Département de radiophysique, institut de cancérologie de l'Ouest Nantes-Angers, boulevard Jacques-Monod, 44805 Saint-Herblain, France
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Fiorentino A, Mazzola R, Ricchetti F, Giaj Levra N, Fersino S, Naccarato S, Sicignano G, Ruggieri R, Di Paola G, Massocco A, Gori S, Alongi F. Intensity modulated radiation therapy with simultaneous integrated boost in early breast cancer irradiation. Report of feasibility and preliminary toxicity. Cancer Radiother 2015. [PMID: 26206732 DOI: 10.1016/j.canrad.2015.02.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the feasibility and tolerance in the use of adjuvant intensity modulated radiation therapy (IMRT) and simultaneous integrated boost in patients with a diagnosis of breast cancer after breast-conserving surgery. PATIENTS AND METHODS Between September 2011 to February 2013, 112 women with a diagnosis of early breast cancer (T1-2, N0-1, M0) were treated with IMRT and simultaneous integrated boost after breast-conserving surgery in our institution. A dose of 50Gy in 25 fractions was prescribed to the whole breast and an additional dose of radiation was prescribed on the tumour bed. A dose prescription of 60Gy in 25 fractions to the tumour bed was used in patients with negative margins after surgery, whereas if the margins were close (<1mm) or positive (without a new surgical resection) a dose of 64Gy was prescribed. All patients were followed with periodic clinical evaluation. Acute and late toxicity were scored using the EORTC/RTOG radiation morbidity score system. Both patient and physician recorded cosmetic outcome evaluation with a subjective judgment scale at the time of scheduled follow-up. RESULTS The median follow-up was 28 months (range 24-40 months). The acute skin grade toxicity during the treatment was grade 0 in 8 patients (7%), grade 1 in 80 (72%), grade 2 in 24 cases (21%). No grade 3 or higher acute skin toxicity was observed. At 12 months, skin toxicity was grade 0 in 78 patients (70%), grade 1 in 34 patients (30%). No toxicity grade 2 or higher was registered. At 24 months, skin toxicity was grade 0 in 79 patients (71%), grade 1 in 33 patients (29%). No case of grade 2 toxicity or higher was registered. The pretreatment variables correlated with skin grade 2 acute toxicity were adjuvant chemotherapy (P=0.01) and breast volume ≥700cm(3) (P=0.001). Patients with an acute skin toxicity grade 2 had a higher probability to develop late skin toxicity (P<0.0001). In the 98% of cases, patients were judged to have a good or excellent cosmetic outcome. The 2-year-overall survival and 2-year-local control were 100%. CONCLUSION These data support the feasibility and safety of IMRT with simultaneous integrated boost in patients with a diagnosis of early breast cancer following breast-conserving surgery with acceptable acute and late treatment-related toxicity. A longer follow-up is needed to define the efficacy on outcomes.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Esthetics
- Feasibility Studies
- Female
- Follow-Up Studies
- Humans
- Mastectomy, Segmental
- Middle Aged
- Radiodermatitis/etiology
- Radiotherapy Dosage
- Radiotherapy, Adjuvant
- Radiotherapy, Intensity-Modulated
- Severity of Illness Index
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Affiliation(s)
- A Fiorentino
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - R Mazzola
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy; Radiation oncology school, university of Palermo, Palermo, Italy.
| | - F Ricchetti
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - N Giaj Levra
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - S Fersino
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - S Naccarato
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - G Sicignano
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - R Ruggieri
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - G Di Paola
- Statistic science faculty, university of Palermo, Palermo, Italy
| | - A Massocco
- Breast surgery, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - S Gori
- Medical oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - F Alongi
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
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Yossi S, El Alouani C, Pointreau Y, Laccourreye L, Capitain O, Gustin P, Peyraga G, Septans AL, Jadaud É, Vinchon-Petit S, Cellier P, Autret D, Tuchais C. [Recurrence sites following definitive intensity-modulated conformational radiotherapy of squamous-cell carcinomas of the upper aerodigestive tract]. Cancer Radiother 2015; 19:73-81. [PMID: 25623256 DOI: 10.1016/j.canrad.2014.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 10/10/2014] [Accepted: 10/15/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The implementation of intensity-modulated radiotherapy (IMRT) in a centre requires regular critical review of medical practices and feedback to optimize the subsequent management of patients. PATIENTS AND METHODS We reviewed and determined through a retrospective single-centre study recurrence sites of 167 consecutive patients treated for head and neck squamous cell carcinoma excluding skin or sinuses. Patients had mostly stage III or IV locally advanced cancer (n=123). RESULTS Locoregional control rates at 1 and 2 years were respectively 87.9% (95% confidence interval [95%CI]: 81.6%-92.1%) and 77.6% (95%CI: 70.1%-83.5). Among 55 relapses, 20 patients (36.4%) had treatment failures. Patients treated with 70 Gy relapsed mainly in high risk volume (78%). Those treated with 66 Gy recurred regionally outside the irradiated volume (n=4) or in the irradiated high risk volume (n=3) or had isolated metastatic failure (n=3). Those irradiated with 50 Gy had regional relapse outside the irradiated volume (n=2) or isolated metastatic relapse (n=2). We noticed respectively 5.4%, 10.2% and 4.2% isolated metastatic, local, cervical lymph node relapse. CONCLUSION Our results are consistent with data from the literature. Corrective actions were performed to enhance our practices.
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Affiliation(s)
- S Yossi
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France.
| | - C El Alouani
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France; Département de radiothérapie, centre hospitalier universitaire de Marrakech, Marrakech, Maroc
| | - Y Pointreau
- Centre Jean-Bernard-clinique Victor-Hugo, 9, rue Beauverger, 72000 Le Mans, France
| | - L Laccourreye
- Service d'ORL et de chirurgie maxillofaciale, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49100 Angers, France
| | - O Capitain
- Département d'oncologie médicale, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - P Gustin
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - G Peyraga
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - A-L Septans
- Délégation à la recherche clinique et à l'innovation, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - É Jadaud
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - S Vinchon-Petit
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - P Cellier
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - D Autret
- Département de physique médicale, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - C Tuchais
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
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Espenel S, Trone JC, Vallard A, Guy JB, Moriceau G, Méry B, Langrand-Escure J, Rivoirard R, de Laroche G, Chargari C, Magné N. [Rare cancers and new radiotherapy techniques]. Bull Cancer 2015; 102:105-12. [PMID: 25609480 DOI: 10.1016/j.bulcan.2014.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 11/22/2022]
Abstract
Rare cancers represent about a quarter of all cancers diagnosed in Europe, and their incidence is increasing. Meanwhile, scientific advances provide techniques, which become more and more sophisticated in the domain of radiotherapy. Treatment options for radiotherapy rare cancers are increasing, but are not yet evaluated. The question of the appropriateness of treatment by modern radiotherapy techniques in rare cancers remains. There are a lot of cases reported in the literature for treating rare cancers by modern technology. These techniques are often used when anatomical and dosimetric constraints do not achieve optimal treatment by surgery or standard radiotherapy. In contrast, standard radiotherapy techniques also provide good results in terms of overall survival and tolerance. They are also less expensive and less complex in terms of dosimetry. The establishment of specialized centers in rare cancers seems essential to evaluate the appropriateness of the use of modern techniques in these cases. Currently, data from the literature does not provide an answer to this question.
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Falk AT, Fenoglietto P, Azria D, Bourgier C. [New external radiotherapy technologies for breast cancer]. Cancer Radiother 2014; 18:480-5. [PMID: 25182528 DOI: 10.1016/j.canrad.2014.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 06/24/2014] [Accepted: 06/26/2014] [Indexed: 10/24/2022]
Abstract
The purpose of new radiotherapy techniques is to better deliver dose conformation in the tumour volume while diminishing organs at risk exposition. Their development is soaring in the breast cancer field in the adjuvant setting with intensity-modulated radiation therapy but also in cerebral and extracerebral oligometastastic presentation. Their usage is still being debated for breast cancer care. The objective of this narrative review is to list and discuss clinical data at our disposal for these news technologies.
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Affiliation(s)
- A T Falk
- Département de radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France; Université de Nice Sophia-Antipolis, BP 2135, 06103 Nice cedex 2, France
| | - P Fenoglietto
- Département de radiothérapie oncologique, centre régional de lutte contre le cancer, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France
| | - D Azria
- Département de radiothérapie oncologique, centre régional de lutte contre le cancer, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France; Inserm U896, institut de recherche en cancérologie de Montpellier, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France; Université de Montpellier 1, CS 19044, 34967 Montpellier cedex 2, France
| | - C Bourgier
- Département de radiothérapie oncologique, centre régional de lutte contre le cancer, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France; Inserm U896, institut de recherche en cancérologie de Montpellier, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France; Université de Montpellier 1, CS 19044, 34967 Montpellier cedex 2, France.
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Barillot I. [What technique for what tumor? Ethical and methodological issues: cervical cancer]. Cancer Radiother 2014; 18:360-4. [PMID: 25179248 DOI: 10.1016/j.canrad.2014.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/07/2014] [Accepted: 05/15/2014] [Indexed: 11/30/2022]
Abstract
Cancers of the uterus are on the list of cancer sites for which the interest of the use of conformal radiotherapy with intensity modulation is being evaluated by the French Health Authority. In 2014, many consider that many challenges still lie ahead for the integration of this technique in routine management of cervical cancer on intact uterus. These challenges, are they really a barrier to diffusion of this technique for a tumor location where the radiation keeps an important role? The purpose of this review is to discuss, in terms of the risk-benefit balance, the prescription of intensity-modulated radiotherapy compared to non-modulated three-dimensional conformal radiotherapy.
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Affiliation(s)
- I Barillot
- Centre régional de cancérologie H.S.-Kaplan, clinique d'oncologie et radiothérapie, hôpital Bretonneau, CHU de Tours, 2, boulevard Tonnellé, 37000 Tours, France; Université François-Rabelais, 37000 Tours, France.
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Khadige M, Peiffert D, Supiot S. [What is the level of evidence of new techniques in prostate cancer radiotherapy?]. Cancer Radiother 2014; 18:501-8. [PMID: 25192625 DOI: 10.1016/j.canrad.2014.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 06/23/2014] [Accepted: 06/29/2014] [Indexed: 12/30/2022]
Abstract
Prostate cancer radiotherapy has evolved from the old 2D technique to conformal, and then to intensity-modulated radiation therapy (IMRT) and stereotactic radiotherapy. At the same time, image-guidance (IGRT) is routinely used. New techniques such as protontherapy or carbontherapy are being developed with the objective of increased efficacy, decreased treatment duration, toxicity or cost. This review summarizes the evidence-based medicine of new technologies in the treatment of prostate cancer.
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