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Latorzeff I, Camps-Maléa A, Supiot S, de Crevoisier R, Farcy-Jacquet MP, Hannoun-Lévi JM, Riou O, Pommier P, Artignan X, Chapet O, Créhange G, Marchesi V, Pasquier D, Sargos P. Indication and perspectives of radiation therapy in the setting of de-novo metastatic prostate cancer. Cancer Radiother 2024; 28:49-55. [PMID: 37827959 DOI: 10.1016/j.canrad.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 10/14/2023]
Abstract
Prostate cancer is the most common cancer and the third leading cause of cancer mortality in men. Each year, approximately 10% of prostate cancers are diagnosed metastatic at initial presentation. The standard treatment option for de-novo metastatic prostate cancer is androgen deprivation therapy with novel hormonal agent or with chemotherapy. Recently, PEACE-1 trial highlighted the benefit of triplet therapy resulting in the combination of androgen deprivation therapy combined with docetaxel and abiraterone. Radiotherapy can be proposed in a curative intent or to treat local symptomatic disease. Nowadays, radiotherapy of the primary disease is only recommended for de novo low-burden/low-volume metastatic prostate cancer, as defined in the CHAARTED criteria. However, studies on stereotactic radiotherapy on oligometastases have shown that this therapeutic approach is feasible and well tolerated. Prospective research currently focuses on the benefit of intensification by combining treatment of the metastatic sites and the primary all together. The contribution of metabolic imaging to better define the target volumes and specify the oligometastatic character allows a better selection of patients. This article aims to define indications of radiotherapy and perspectives of this therapeutic option for de-novo metastatic prostate cancer.
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Affiliation(s)
- I Latorzeff
- Department of Radiation Oncology, clinique Pasteur, Toulouse, France.
| | - A Camps-Maléa
- Department of Radiation Oncology, hôpital Bretonneau, CHU de Tours, Tours, France
| | - S Supiot
- Department of Radiation Oncology, institut de cancérologie de l'Ouest centre René-Gauducheau, Saint-Herblain, France; CNRS, Nantes, France; Université de Nantes, Nantes, France
| | - R de Crevoisier
- Department of Radiation Oncology, centre Eugène-Marquis, Rennes, France
| | - M-P Farcy-Jacquet
- Fédération universitaire d'oncologie radiothérapie, institut de cancérologie du Gard, CHU de Nîmes, Nîmes, France
| | - J-M Hannoun-Lévi
- Department of Radiation Oncology, centre Antoine-Lacassagne, Nice, France
| | - O Riou
- Department of Radiation Oncology, institut du cancer de Montpellier, Montpellier, France; Fédération universitaire d'oncologie radiothérapie de Méditerranée Occitanie, université de Montpellier, Montpellier, France; U1194, Inserm, Montpellier, France; IRCM, Montpellier, France
| | - P Pommier
- Department of Radiation Oncology, institut de cancérologie de l'Ouest, Angers, France
| | - X Artignan
- Department of Radiation Oncology, centre hospitalier privé Saint-Grégoire, Rennes, France
| | - O Chapet
- Department of Radiation Oncology, centre hospitalier Lyon Sud, Pierre-Bénite, France
| | - G Créhange
- Department of Radiation Oncology, institut Curie, Saint-Cloud, France
| | - V Marchesi
- Department of Medical Physics, centre Alexis-Vautrin, Vandœuvre-lès-Nancy, France
| | - D Pasquier
- Academic Department of Radiation Oncology, centre Oscar-Lambret, Lille, France; UMR 9189 - CRIStAL, université de Lille, CNRS, école Centrale Lille, 59000 Lille, France
| | - P Sargos
- Department of Radiotherapy, institut Bergonié, Bordeaux, France
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Sargos P, Le Guevelou J, Khalifa J, Albiges L, Azria D, de Crevoisier R, Supiot S, Créhange G, Roubaud G, Chapet O, Pasquier D, Blanchard P, Latorzeff I. The role of radiation therapy for de novo metastatic bladder and renal cancers. Cancer Radiother 2024; 28:56-65. [PMID: 37286452 DOI: 10.1016/j.canrad.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/21/2023] [Indexed: 06/09/2023]
Abstract
Metastatic bladder and renal cancers account respectively for 2.1% and 1.8% of cancer deaths worldwide. The advent of immune checkpoint inhibitors has revolutionized the management of metastatic disease, by demonstrating considerable improvements in overall survival. However, despite initial sensitivity to immune checkpoint inhibitors for most patients, both bladder and renal cancer are associated with short progression-free survival and overall survival, raising the need for further strategies to improve their efficacy. Combining systemic therapies with local approaches is a longstanding concept in urological oncology, in clinical settings including both oligometastatic and polymetastatic disease. Radiation therapy has been increasingly studied with either cytoreductive, consolidative, ablative or immune boosting purposes, but the long-term impact of this strategy remains unclear. This review intends to address the impact of radiation therapy with either curative or palliative intent, for synchronous de novo metastatic bladder and renal cancers.
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Affiliation(s)
- P Sargos
- Department of Radiation Oncology, institut Bergonié, Bordeaux, France.
| | - J Le Guevelou
- Faculty of Medicine, Geneva, Switzerland; Department of Radiation Oncology, centre Eugène-Marquis, Rennes, France
| | - J Khalifa
- Department of Radiation Oncology, institut Claudius-Regaud, Institut universitaire du cancer de Toulouse - Oncopole, Toulouse, France
| | - L Albiges
- Department of Cancer Medicine, institut Gustave-Roussy, Villejuif, France
| | - D Azria
- Department of Radiation Oncology, Institut du cancer de Montpellier (ICM), IRCM U1194 Inserm, université de Montpellier, Montpellier, France
| | - R de Crevoisier
- Department of Radiation Oncology, centre Eugène-Marquis, Rennes, France
| | - S Supiot
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest, Saint-Herblain, France; CRCINA CNRS, Nantes, France; Inserm, Nantes, France; Université de Nantes et d'Angers, Nantes, France
| | - G Créhange
- Department of Radiation Oncology, institut Curie, Saint-Cloud, France
| | - G Roubaud
- Department of Medical Oncology, institut Bergonié, Bordeaux, France
| | - O Chapet
- Department of Oncology Department, centre hospitalier Lyon Sud, Pierre-Bénite, France
| | - D Pasquier
- Department of Radiation Oncology, centre Oscar-Lambret, Lille, France; Cristal UMR 9189, université de Lille, Lille, France
| | - P Blanchard
- Department of Radiation Oncology, Gustave-Roussy Cancer Campus, université Paris-Saclay, Oncostat U1018 Inserm, Villejuif, France
| | - I Latorzeff
- Department of Radiation Oncology, clinique Pasteur, Toulouse, France
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Haaser T, Lahmi L, Osman D, Gesbert C, Cheval V, Constantinides Y, de Crevoisier R, Dejean C, Escande A, Ghannam Y, Lorchel F, Thureau S, Lagrange JL, Durdux C, Huguet F. [Ethical stakes of information in radiation oncology: Thinking the risk and building the therapeutic alliance]. Cancer Radiother 2023; 27:480-486. [PMID: 37573195 DOI: 10.1016/j.canrad.2023.06.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 08/14/2023]
Abstract
Informing patients before receiving radiation therapy is a fundamental ethical imperative. As a condition of the possibility of autonomy, information allows people to make health decisions concerning themselves, which is required by French law. This information includes in particular the potential risks due to radiation therapy. It is therefore necessary to think about what risk is, and how to define and assess it, in order to finally communicate it. The practice of informing people involves many ethical issues relating to the very content of the information, the form in which it is transmitted or even the intention that leads the health professional to say (or not to say) the risk. The transmission of information also questions the way to build a relationship of trust with the patients and how to integrate their own representations about these treatments. Between the risks of paternalism or even defensive medicine, this practice is at the heart of our professional practice.
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Affiliation(s)
- T Haaser
- Service d'oncologie radiothérapie, hôpital Haut Lévêque, centre hospitalier universitaire de Bordeaux, avenue Magellan, 33600 Pessac, France; Centre éthique et recherche en santé de Bordeaux, centre hospitalier universitaire de Bordeaux, Bordeaux, France; EA 4574 sciences, philosophie, humanités, universités de Bordeaux et Bordeaux Montaigne, Pessac, France.
| | - L Lahmi
- Service d'oncologie radiothérapie, institut Curie, Paris, France
| | - D Osman
- Service de médecine intensive-réanimation, hôpital de Bicêtre, AP-HP, DMU Correve, université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France
| | - C Gesbert
- Direction de la qualité, des services aux patients et des parcours, centre hospitalier de Versailles, Versailles, France
| | - V Cheval
- Service universitaire d'oncologie radiothérapie, centre Oscar-Lambret, faculté de médecine Henri-Warembourg, laboratoire CRIStAL, UMR9189, université de Lille, Lille, France
| | - Y Constantinides
- Espace éthique Île-de-France, Paris université Sorbonne Nouvelle, Paris, France
| | - R de Crevoisier
- Service d'oncologie radiothérapie, centre Eugène-Marquis, Rennes, France
| | - C Dejean
- Service d'oncologie radiothérapie, unité de physique médicale, centre Antoine-Lacassagne, Nice, France
| | - A Escande
- Service universitaire d'oncologie radiothérapie, centre Oscar-Lambret, faculté de médecine Henri-Warembourg, laboratoire CRIStAL, UMR9189, université de Lille, Lille, France
| | - Y Ghannam
- Service d'oncologie radiothérapie, hôpital Tenon, centre de recherche Saint-Antoine UMR_S 938, institut universitaire de cancérologie, AP-HP, Sorbonne université, Paris, France
| | - F Lorchel
- Service d'oncologie radiothérapie, centre hospitalier universitaire Lyon-Sud, Lyon, France; Centre d'oncologie radiothérapie et oncologie de Mâcon (Orlam), Mâcon, France
| | - S Thureau
- Service d'oncologie radiothérapie, Quantis Litis EA 4108, centre Henri-Becquerel, Rouen, France
| | - J L Lagrange
- Université Paris-Est Créteil Val-de-Marne, Paris, France
| | - C Durdux
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Paris, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, centre de recherche Saint-Antoine UMR_S 938, institut universitaire de cancérologie, AP-HP, Sorbonne université, Paris, France
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Abancourt L, Le Guévelou J, Taillez A, Vu A, de Crevoisier R, Supiot S, Hennequin C, Chapet O, Blanchard P, Mirabel X, Lartigau É, Pasquier D. [Stereotactic body radiation therapy for primary kidney cancer]. Cancer Radiother 2023; 27:568-572. [PMID: 37543493 DOI: 10.1016/j.canrad.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 08/07/2023]
Abstract
The incidence of primary renal cancer is increasing, particularly in elderly patients who may have comorbidities and/or a surgical contraindications. Stereotactic body radiotherapy has primarily been evaluated retrospectively to date. The most commonly used dose schedules are 40Gy in five fractions, 42Gy in three fractions, and 26Gy in one fraction. The results in terms of local control and toxicity are very encouraging. The advantages of stereotactic body radiotherapy compared to thermal ablative treatments are its non-invasive nature, absence of general anesthesia, ability to treat larger lesions, and those close to the renal hilum. Prospective evaluations are still necessary.
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Affiliation(s)
- L Abancourt
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - J Le Guévelou
- Radiotherapy department, centre régional de lutte contre le cancer Eugène-Marquis, 35042 Rennes, France
| | - A Taillez
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - A Vu
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - R de Crevoisier
- Radiotherapy department, centre régional de lutte contre le cancer Eugène-Marquis, 35042 Rennes, France
| | - S Supiot
- Institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, université de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - O Chapet
- Département of de radiothérapie oncologie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université de Lyon, 69000 Lyon, France
| | - P Blanchard
- Département de radiothérapie oncologique, Gustave-Roussy cancer campus, université Paris-Saclay, Oncostat U1018, Inserm, Villejuif, France
| | - X Mirabel
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - É Lartigau
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France; Univ. Lille & CNRS CRIStAL UMR 9189, Lille, France
| | - D Pasquier
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France; Univ. Lille & CNRS CRIStAL UMR 9189, Lille, France.
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Sosa-Marrero C, Acosta O, Pasquier D, Thariat J, Delpon G, Fiorino C, Rancatti T, Malard O, Foray N, de Crevoisier R. Voxel-wise analysis: A powerful tool to predict radio-induced toxicity and potentially perform personalised planning in radiotherapy. Cancer Radiother 2023; 27:638-642. [PMID: 37517974 DOI: 10.1016/j.canrad.2023.06.024] [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: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023]
Abstract
Dose - volume histograms have been historically used to study the relationship between the planned radiation dose and healthy tissue damage. However, this approach considers neither spatial information nor heterogenous radiosensitivity within organs at risk, depending on the tissue. Recently, voxel-wise analyses have emerged in the literature as powerful tools to fully exploit three-dimensional information from the planned dose distribution. They allow to identify anatomical subregions of one or several organs in which the irradiation dose is associated with a given toxicity. These methods rely on an accurate anatomical alignment, usually obtained by means of a non-rigid registration. Once the different anatomies are spatially normalised, correlations between the three-dimensional dose and a given toxicity can be explored voxel-wise. Parametric or non-parametric statistical tests can be performed on every voxel to identify the voxels in which the dose is significantly different between patients presenting or not toxicity. Several anatomical subregions associated with genitourinary, gastrointestinal, cardiac, pulmonary or haematological toxicity have already been identified in the literature for prostate, head and neck or thorax irradiation. Voxel-wise analysis appears therefore first particularly interesting to increase toxicity prediction capability by identifying specific subregions in the organs at risk whose irradiation is highly predictive of specific toxicity. The second interest is potentially to decrease the radio-induced toxicity by limiting the dose in the predictive subregions, while not decreasing the dose in the target volume. Limitations of the approach have been pointed out.
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Affiliation(s)
- C Sosa-Marrero
- Université de Rennes, CLCC Eugène-Marquis, Inserm, LTSI - UMR 1099, 35000 Rennes, France
| | - O Acosta
- Université de Rennes, CLCC Eugène-Marquis, Inserm, LTSI - UMR 1099, 35000 Rennes, France
| | - D Pasquier
- Radiotherapy Department, centre Oscar-Lambret, 59000 Lille, France; Université de Lille, CNRS, école centrale de Lille, Cristal UMR 9189, Lille, France
| | - J Thariat
- Department of Radiation Oncology, centre François-Baclesse, 14000 Caen, France
| | - G Delpon
- Medical physics department, institut de cancérologie de l'Ouest, IMT Atlantique, Nantes université, CNRS/IN2P3, Subatech, Nantes, France
| | - C Fiorino
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 690, 20132 Milan, Italy
| | - T Rancatti
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - O Malard
- Service de chirurgie oto-rhinolaryngologique (ORL) et chirurgie cervicofaciale, Hôtel-Dieu, CHU de Nantes, Nantes, France
| | - N Foray
- Centre Léon-Bérard, Inserm U1296 "Radiation: Defense/Health/Environment", 69008 Lyon, France
| | - R de Crevoisier
- Université de Rennes, CLCC Eugène-Marquis, Inserm, LTSI - UMR 1099, 35000 Rennes, France; Département de radiothérapie, centre Eugène-Marquis, 35000 Rennes, France.
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Belkacemi Y, Debbi K, Besnard C, Grellier N, Fonteneau G, Colson-Durand L, Lerouge D, Durdux C, Campana F, Pons P, Flandin I, Pasquier D, de Crevoisier R, Wachter T, Thureau S, Noël G, Conzague-Casabianca L, Petit A, Supiot S, Azria D. [The morbidity and mortality review meetings in radiotherapy departments: Procedure, implementation and prospects of the "Proust" French national project]. Cancer Radiother 2023; 27:474-479. [PMID: 37507286 DOI: 10.1016/j.canrad.2023.06.018] [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: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023]
Abstract
Radiation-induced acute and late toxicity depends on several parameters. The type, severity and duration of morbidity are mainly related to irradiated volume, total dose and its fractionation and the intrinsic radiosensitivity of the patients. The follow-up of these toxicities is essential. However, unlike many specialties, morbidity and mortality reviews procedures are not developed as part of quality governance programs in radiation therapy departments for the monitoring of toxicity which sometimes hinder the patients' quality of life. One French survey published within the framework of the project entitled Prospective Registration of Morbidity and Mortality, Individual Radiosensitivity and Radiation Technique (Proust), conclude that there was a lack of knowledge of morbidity and mortality reviews and considerable confusion between these reviews and other quality processes without perspective for the local morbidity and mortality reviews development in a large number of the participated centers. In this article, we will discuss the procedure of the "ideal morbidity and mortality reviews" and its implementation through a monocentric experience started in 2015. Thus, the Proust project is a unique opportunity to implement and standardize a national morbidity and mortality reviews implementation in radiation therapy departments by involving the French regions.
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Affiliation(s)
- Y Belkacemi
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Équipe i-Biot, unité 955, Inserm, IMRB, université Paris-Est Créteil, Créteil, France.
| | - K Debbi
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Équipe i-Biot, unité 955, Inserm, IMRB, université Paris-Est Créteil, Créteil, France
| | - C Besnard
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - N Grellier
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - G Fonteneau
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - L Colson-Durand
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Service d'oncologie-radiothérapie, Institut oncologique Paris-Nord, Sarcelles, France
| | - D Lerouge
- Service d'oncologie-radiothérapie, centre François-Baclesse, Caen, France
| | - C Durdux
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, AP-HP, université Paris-Cité, Paris, France
| | - F Campana
- Service d'oncologie-radiothérapie, institut Hartmann, Levallois-Perret, France
| | - P Pons
- Service d'oncologie-radiothérapie, institut Hartmann, Levallois-Perret, France
| | - I Flandin
- Service d'oncologie-radiothérapie, centre hospitalier universitaire de Grenoble, Grenoble, France
| | - D Pasquier
- Département universitaire d'oncologie-radiothérapie, centre Oscar-Lambret, UMR 9189, université de Lille, Centre de recherche en informatique, signal et automatique de Lille (Cristal), Lille, France
| | - R de Crevoisier
- Service d'oncologie-radiothérapie, centre Eugène-Marquis, Rennes, France
| | - T Wachter
- Service d'oncologie-radiothérapie, centre hospitalier général d'Orléans, Orléans, France
| | - S Thureau
- Service d'oncologie-radiothérapie, centre Henri-Becquerel, QuantIF Litis unit EA 4108, université de Rouen, Rouen, France
| | - G Noël
- Service d'oncologie-radiothérapie, institut de cancérologie Strasbourg Europe (ICANS), université de Strasbourg, Strasbourg, France
| | | | - A Petit
- Service d'oncologie-radiothérapie, institut Bergonié, Bordeaux, France
| | - S Supiot
- Service d'oncologie-radiothérapie, institut de cancérologie de l'Ouest, centre René-Gauducheau, université de Nantes, Nantes, France
| | - D Azria
- Service d'oncologie-radiothérapie, Institut du cancer de Montpellier (ICM), université de Montpellier, Institut de recherche sur le cancer de Montpellier (IRCM), unit 1194, Inserm, Montpellier, France
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de Crevoisier R, Leseur J, Bouvet C, Huguet F, Lagrange JL, Haaser T, Pasquier D, Créhange G, Supiot S, Pommier P, Roy A, Berna A, Blanchard P, Marcucci L. Compréhension/acceptation de la radiothérapie : un dilemme éthique résolu par une éthique de la considération et de la sollicitude. Cancer Radiother 2023; 27:115-125. [PMID: 37011968 DOI: 10.1016/j.canrad.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 03/02/2023]
Abstract
PURPOSE Ethical questions are poorly investigated specifically in radiation oncology. The objective of the study was to identify and understand the main ethical issue in radiation oncology. MATERIALS AND METHODS A quantitative analysis was based on the answers to a questionnaire of 200 professionals from 22 radiation oncology departments. The questionnaire mainly aimed to characterize the main ethical issue. A monocentric qualitative analysis was based on semi-structured interviews focused on the main identified ethical issue, carried out with eight technologists, and 20 patients undergoing radiotherapy. RESULTS The main ethical issue was the understanding and/or acceptance of the treatment by the patients (71 %), which frequently arises (more than once a month) (52 %), and corresponds to an ethical tension between the principles of respect for autonomy and beneficence (the good as viewed by the patient) as defined by Beauchamp and Childress. The technologists, wish the patient to be fully involved in his treatment, with the even possibility of refusing it. However, excluding paternalism and autonomic relentlessness, the technologists have the feeling of acting for the good of the patients by treating them with radiation, even if the patients are not always aware of it, because they are within a situation of vulnerability. If the hierarchy of principles is a compromise alternative, this problem is finally well resolved by the effective implementation of an ethic of consideration and solicitude, restoring the patient capabilities, i.e. the maximum development of his potentialities in his situation of vulnerability. Beyond the legal dimension, patient information is crucial and must consider the specific temporality of the patient. CONCLUSION The main ethical issue in radiation oncology is the understanding and/or acceptance of the treatment involving the development of an ethic of consideration and solicitude.
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El Houat Y, Bouvier L, Baty M, Palard-Novello X, Pointreau Y, de Crevoisier R, Castelli J. Head and neck cancers volume reduction: should we reduce our prophylactic node radiation to spare the antitumor immune response? Cancer Radiother 2022; 26:916-920. [PMID: 36075834 DOI: 10.1016/j.canrad.2022.06.014] [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: 06/13/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/15/2022]
Abstract
Radiotherapy for locally advanced head and neck cancer classically include large prophylactic node volume. However, the use of these large volumes can be responsible for significant toxicity. Furthermore, the disappointing results of radioimmunotherapy combinations in head and neck tumors raise concerns about radiotherapy's potential negative impact on the immune response when large lymph node volumes are treated. Besides, in other tumor locations, such as lung cancers, the volumes of elective irradiation have been considerably reduced, with the same local control as before. This opinion piece reviews the current state of radiation volumes in head and neck cancers, the rationale for these volumes, the potential impact of radiotherapy on immune response, and the volume changes that would improve the efficacy of radioimmunotherapy combinations.
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Affiliation(s)
- Y El Houat
- Département de radiothérapie, centre Eugène-Marquis, 35000 Rennes, France
| | - L Bouvier
- Département de radiothérapie, centre Eugène-Marquis, 35000 Rennes, France
| | - M Baty
- Département de radiothérapie, centre Eugène-Marquis, 35000 Rennes, France
| | - X Palard-Novello
- Département de médecine nucléaire, centre Eugène-Marquis, 35000 Rennes, France
| | - Y Pointreau
- Institut inter-régional de cancérologie (ILC), centre Jean-Bernard, 9, rue Beauverger, 72000 Le Mans, France
| | - R de Crevoisier
- Département de radiothérapie, centre Eugène-Marquis, 35000 Rennes, France
| | - J Castelli
- Département de radiothérapie, centre Eugène-Marquis, 35000 Rennes, France.
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9
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Castelli J, Benezery K, Hasbini A, Gery B, Berger A, Liem X, Guihard S, Chapet S, Thureau S, Auberdiac P, Pommier P, Thariat J, Campillo B, de Crevoisier R. OC-0831 Results of ARTIX phase III study: adaptive radiotherapy versus standard IMRT in head and neck cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02695-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Nunes J, Fettem S, Tahri S, Macke L, Chourak H, Barateau A, Lafond C, de Crevoisier R, Bessieres I, Marage L, Acosta O. PO-1611 Evaluation of synthetic-CT generated from prostate MRI (0.35T) with a 2D+ Pix2Pix method. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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García-Elcano L, Mylona E, Acosta O, Lizée T, Gnep K, de Crevoisier R, Pascau J. OC-0770 Deep Learning-based segmentation of prostatic urethra on CT scans for treatment planning. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02676-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Nunes J, Macque L, Tahri S, Fettem S, Chourak H, Barateau A, Lafond C, de Crevoisier R, Acosta O, Bessieres I, Marage L. PO-1615 Evaluation of prostate synthetic CTs from 0.35T MR images using different deep training cohort sizes. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
We present the updated recommendations of the French society for oncological radiotherapy on image-guided radiotherapy (IGRT). The objective of the IGRT is to take into account the anatomical variations of the target volume occurring between or during the irradiation fractions, such as displacements and/or deformations, so that the delivered dose corresponds to the planned dose. This article presents the different IGRT devices, their use and quality control, and quantify the possible additional dose generated by each of them. The practical implementation of IGRT in various tumour locations is summarised, from the different "RecoRad™" guideline articles. Adaptive radiotherapy is then detailed, due to its complexity and its probable development in the next years. The place of radiation technologist in the practice of IGRT is then specified. Finally, a brief update is proposed on the delicate question of the additional dose linked to the in-room imaging, which must be estimated and documented at a minimum, as long as it is difficult to integrate it into the calculation of the dose distribution.
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Affiliation(s)
- R de Crevoisier
- Radiotherapy department, centre régional de lutte contre le cancer Eugène Marquis, 35042 Rennes, France.
| | - C Lafond
- Radiotherapy department, centre régional de lutte contre le cancer Eugène Marquis, 35042 Rennes, France
| | - A Mervoyer
- Radiotherapy department, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint Herblain, France; Medical physics department, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint Herblain, France
| | - C Hulot
- Radiotherapy department, centre régional de lutte contre le cancer Eugène Marquis, 35042 Rennes, France
| | - N Jaksic
- Radiotherapy department, centre régional de lutte contre le cancer Eugène Marquis, 35042 Rennes, France
| | - I Bessières
- Medical physics department, centre Georges-François Leclerc, rue du Professeur-Marion, 21000 Dijon, France
| | - G Delpon
- Radiotherapy department, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint Herblain, France; Medical physics department, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint Herblain, France
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14
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Delpon G, Lazaro D, de Crevoisier R. Gestion des doses liées à l’imagerie de positionnement en radiothérapie. Cancer Radiother 2021. [DOI: 10.1016/j.canrad.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Baty M, Pasquier D, Gnep K, Castelli J, Delaby N, Lacornerie T, de Crevoisier R. Quels choix de contraintes dosimétriques en situation de réirradiation stéréotaxique pour une récidive d’un cancer de prostate ? Cancer Radiother 2021. [DOI: 10.1016/j.canrad.2021.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Leseur J, Créhange G, Pasquier D, Supiot S, Pommier P, Latorzeff I, Blanchard P, Mahé M, Sargos P, Colliaux J, Huguet F, Haaser T, Clavère P, Peiffert D, Lartigau É, Giraud P, Noël G, Simon JM, Hasbini A, Chauveinc L, Hennequin C, Lagrange J, de Crevoisier R. Évaluation du questionnement éthique en radiothérapie. Cancer Radiother 2021. [DOI: 10.1016/j.canrad.2021.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Tahri S, Cadin C, Chourak H, Barateau A, Ribault S, Acosta O, Greer P, Dowling J, Lafond C, de Crevoisier R, Nunes JC. Calcul de dose à partir d’IRM en radiothérapie de la prostate par méthode d’apprentissage profond. Cancer Radiother 2021. [DOI: 10.1016/j.canrad.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Briens A, Neuzillet C, Huguet F, Rivin Del Campo E, Guimas V, Fallet E, Garcia Molina S, François E, Montagne L, Schick U, Lesueur P, Siphroudis L, Edeline J, Castelli J, de Crevoisier R, Lièvre A, Gnep K. PO-1263 Exclusive radiotherapy in early stage anal cancer - outcomes, patterns and predictors of relapse. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07714-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Duvergé L, Bondiau PY, Claude L, Supiot S, Vaugier L, Thillays F, Doyen J, Ricordel C, Léna H, Bellec J, Chajon E, de Crevoisier R, Castelli J. Discontinuous stereotactic body radiotherapy schedule increases overall survival in early-stage non-small cell lung cancer. Lung Cancer 2021; 157:100-108. [PMID: 34016489 DOI: 10.1016/j.lungcan.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/06/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The duration of stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) may affect patient outcomes. We aimed to determine the impact of a continuous versus discontinuous SBRT schedule on local control (LC) and overall survival (OS) in NSCLC patients. MATERIALS AND METHODS Consecutive NSCLC stage I patients (475) treated with SBRT in four centers were retrospectively analyzed. The delivered dose ranged from 48 to 75 Gy in 3-10 fractions. Based on the ratio between the treatment duration (TD) and number of fractions (n), patients were divided into two groups: continuous schedule (CS) (TD ≤ 1.6n; 239 patients) and discontinuous schedule (DS) (TD > 1.6n; 236 patients). LC and OS were compared using Cox regression analyses after propensity score matching (216 pairs). RESULTS The median follow-up period was 41 months. Multivariate analysis showed that the DS (hazard ratio (HR): 0.42; 95 % confidence interval (CI): 0.22-0.78) and number of fractions (HR: 1.24; 95 % CI: 1.07-1.43) were significantly associated with LC. The DS (HR: 0.67; 95 % CI: 0.51-0.89), age (HR: 1.02; 95 % CI: 1-1.03), WHO performance status (HR: 2.27; 95 % CI: 1.39-3.7), and T stage (HR: 1.4; 95 % CI: 1.03-1.87) were significantly associated with OS. The 3-year LC and OS were 92 % and 64 % and 81 % and 53 % for DS and CS treatments, respectively (p < 0.01). Cox analysis confirmed that the discontinuous SBRT schedule significantly increased LC and OS. CONCLUSION DS is associated with significantly improved LC and OS in early-stage NSCLC patients treated with SBRT.
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Affiliation(s)
- L Duvergé
- Radiation Oncology Department, Centre Eugène Marquis, Avenue Flandres Dunkerque, 35000 Rennes, France.
| | - P-Y Bondiau
- Radiation Oncology Department, Centre Antoine Lacassagne, 06000 Nice, France
| | - L Claude
- Radiation Oncology Department, Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - S Supiot
- Radiation Oncology Department, Institut de Cancérologie de l'Ouest- René Gauducheau, Bd J Monod, 44800 Nantes, St-Herblain, France
| | - L Vaugier
- Radiation Oncology Department, Institut de Cancérologie de l'Ouest- René Gauducheau, Bd J Monod, 44800 Nantes, St-Herblain, France
| | - F Thillays
- Radiation Oncology Department, Institut de Cancérologie de l'Ouest- René Gauducheau, Bd J Monod, 44800 Nantes, St-Herblain, France
| | - J Doyen
- Radiation Oncology Department, Centre Antoine Lacassagne, 06000 Nice, France
| | - C Ricordel
- Pneumology Department, Centre Hospitalier Universitaire de Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - H Léna
- Pneumology Department, Centre Hospitalier Universitaire de Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - J Bellec
- Radiation Oncology Department, Centre Eugène Marquis, Avenue Flandres Dunkerque, 35000 Rennes, France
| | - E Chajon
- Radiation Oncology Department, Centre Eugène Marquis, Avenue Flandres Dunkerque, 35000 Rennes, France
| | - R de Crevoisier
- Radiation Oncology Department, Centre Eugène Marquis, Avenue Flandres Dunkerque, 35000 Rennes, France
| | - J Castelli
- Radiation Oncology Department, Centre Eugène Marquis, Avenue Flandres Dunkerque, 35000 Rennes, France
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20
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Delpon G, Lazaro D, de Crevoisier R. [Management of image guidance doses delivered during radiotherapy]. Cancer Radiother 2021; 25:790-794. [PMID: 33390319 DOI: 10.1016/j.canrad.2020.05.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/29/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
Image-guided radiotherapy (IGRT) has become a standard irradiation technique to improve the clinical outcome of patients in terms of toxicity and local control due to better targeting of radiation during the irradiation fraction. Positioning imaging systems, whether embedded or not, such as kV for 2×2D acquisitions and especially kVCBCT for 3D acquisitions are however irradiating in a large volume including the target volume but also healthy tissue, with a theoretical risk of increased toxicity and second cancer. It therefore appears very important both to optimize the absorbed dose due to IGRT practice but also to report it, especially in case of kVCBCT. The AAPM report published in 2018 (« Image guidance doses delivered during radiotherapy: Quantification, management, and reduction ») proposes a management of image guidance doses delivered during radiotherapy. This report is the basis of this focus article that aims at giving orders of magnitude and proposing a management of image guidance doses delivered during radiotherapy in clinical practice. The dose delivered per kVCBCT is about 0.5 to 2 cGy at isocenter according to treatment site. As long as the calculation algorithms are not available in the treatment planning systems, it seems appropriate to use at least the published dose orders of magnitude. This estimate should ultimately allow the clinician to decide on the therapeutic strategy in the event of accumulation of positioning imaging sessions.
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Affiliation(s)
- G Delpon
- Service de physique médicale, institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44805 Nantes Saint-Herblain, France.
| | - D Lazaro
- Laboratoire modélisation et simulation des systèmes, CEA-LIST, Saclay, France
| | - R de Crevoisier
- Service de radiothérapie, Centre Eugène Marquis, Rennes, France
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21
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Bellec J, Simon A, Benali K, Jaksic N, Caille P, Lederlin M, Lafond C, de Crevoisier R, Martins R. Cardiac stereotactic body radiation therapy for refractory ventricular tachycardia: Impact of cardiac and respiratory movement on the target volume definition. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Bellec J, Simon A, Jaksic N, Caille P, Léderlin M, Lafond C, Martins R, de Crevoisier R. Radiothérapie ablative des tachycardies ventriculaires : impact des mouvements cardiaques et respiratoires sur la définition du volume cible. Cancer Radiother 2020. [DOI: 10.1016/j.canrad.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Thureau S, Briens A, Decazes P, Castelli J, Barateau A, Garcia R, Thariat J, de Crevoisier R. PET and MRI guided adaptive radiotherapy: Rational, feasibility and benefit. Cancer Radiother 2020; 24:635-644. [PMID: 32859466 DOI: 10.1016/j.canrad.2020.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
Adaptive radiotherapy (ART) corresponds to various replanning strategies aiming to correct for anatomical variations occurring during the course of radiotherapy. The goal of the article was to report the rational, feasibility and benefit of using PET and/or MRI to guide this ART strategy in various tumor localizations. The anatomical modifications defined by scanner taking into account tumour mobility and volume variation are not always sufficient to optimise treatment. The contribution of functional imaging by PET or the precision of soft tissue by MRI makes it possible to consider optimized ART. Today, the most important data for both PET and MRI are for lung, head and neck, cervical and prostate cancers. PET and MRI guided ART appears feasible and safe, however in a very limited clinical experience. Phase I/II studies should be therefore performed, before proposing cost-effectiveness comparisons in randomized trials and before using the approach in routine practice.
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Affiliation(s)
- S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, QuantIF EA 4108, université de Rouen, 76000 Rouen, France.
| | - A Briens
- Département de radiothérapie, centre Eugène-Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France
| | - P Decazes
- Département de médecine nucléaire, center Henri-Becquerel, QuantIF EA 4108, université de Rouen, Rouen, France
| | - J Castelli
- Département de radiothérapie, centre Eugène Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
| | - A Barateau
- Département de radiothérapie, centre Eugène Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
| | - R Garcia
- Service de physique médicale, institut Sainte-Catherine, 84918 Avignon, France
| | - J Thariat
- Department of radiation oncology, centre François-Baclesse, 14000 Caen, France; Laboratoire de physique corpusculaire IN2P3/ENSICAEN-UMR6534-Unicaen-Normandie université, 14000 Caen, France; ARCHADE Research Community, 14000 Caen, France
| | - R de Crevoisier
- Département de radiothérapie, centre Eugène-Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
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24
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Latorzeff I, Sargos P, Créhange G, Belkacémi Y, Azria D, Hasbini A, Dubergé T, Toledano A, Graff-Cailleaud P, Chapet O, Hennequin C, de Crevoisier R, Supiot S, Pasquier D. Indications et perspectives de l’hormonoradiothérapie des cancers de prostate à haut risque. Cancer Radiother 2020. [DOI: 10.1016/j.canrad.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Largent A, Barateau A, Nunes J, Lafond C, Greer P, Dowling J, Baxter J, Saint-Jalmes H, Acosta O, de Crevoisier R. 45 A comparison of pseudo-CT generation methods for prostate MRI-based dose planning: deep learning, patch-based, atlas-based and bulk-density methods. Phys Med 2019. [DOI: 10.1016/j.ejmp.2019.09.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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26
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Sosa Marrero C, Acosta O, Castro M, Hernández A, Rioux-Leclercq N, Castelli J, Paris F, de Crevoisier R. Modélisation/simulation de prolifération tumorale et de réponse à la radiothérapie. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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27
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Dissaux G, Visvikis D, Pradier O, Chajon É, Barillot I, Duverge L, Masson I, Abgral R, Santiago Ribeiro MJ, Devillers A, Pallardy A, Fleury V, Mahé MA, de Crevoisier R, Hatt M, Schick U. Prédiction de la récidive locale par l’analyse de texture dérivée de l’imagerie tomographique par émission de positon (TEP/TDM) des cancers pulmonaires non à petites cellules localisés traités par irradiation stéréotaxique. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Acosta O, Mylona E, Lafond C, Créhange G, Supiot S, Castelli J, de Crevoisier R. Identification de sous-régions rectale et urétrovésicales hautement prédictives de toxicité en cas d’irradiation prostatique. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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29
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Beaumont J, Acosta O, Devillers A, Palard-Novello X, Chajon E, de Crevoisier R, Castelli J. Voxel-based identification of local recurrence sub-regions from pre-treatment PET/CT for locally advanced head and neck cancers. EJNMMI Res 2019; 9:90. [PMID: 31535233 PMCID: PMC6751236 DOI: 10.1186/s13550-019-0556-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022] Open
Abstract
Background Overall, 40% of patients with a locally advanced head and neck cancer (LAHNC) treated by chemoradiotherapy (CRT) present local recurrence within 2 years after the treatment. The aims of this study were to characterize voxel-wise the sub-regions where tumor recurrence appear and to predict their location from pre-treatment 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) images. Materials and methods Twenty-six patients with local failure after treatment were included in this study. Local recurrence volume was identified by co-registering pre-treatment and recurrent PET/CT images using a customized rigid registration algorithm. A large set of voxel-wise features were extracted from pre-treatment PET to train a random forest model allowing to predict local recurrence at the voxel level. Results Out of 26 expert-assessed registrations, 15 provided enough accuracy to identify recurrence volumes and were included for further analysis. Recurrence volume represented on average 23% of the initial tumor volume. The MTV with a threshold of 50% of SUVmax plus a 3D margin of 10 mm covered on average 89.8% of the recurrence and 96.9% of the initial tumor. SUV and MTV alone were not sufficient to identify the area of recurrence. Using a random forest model, 15 parameters, combining radiomics and spatial location, were identified, allowing to predict the recurrence sub-regions with a median area under the receiver operating curve of 0.71 (range 0.14–0.91). Conclusion As opposed to regional comparisons which do not bring enough evidence for accurate prediction of recurrence volume, a voxel-wise analysis of FDG-uptake features suggested a potential to predict recurrence with enough accuracy to consider tailoring CRT by dose escalation within likely radioresistant regions.
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Affiliation(s)
- J Beaumont
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France
| | - O Acosta
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France
| | - A Devillers
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France.,Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France
| | - X Palard-Novello
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France.,Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France
| | - E Chajon
- Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France
| | - R de Crevoisier
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France.,Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France
| | - J Castelli
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, 35000, Rennes, France. .,Department of Radiotherapy, Centre Eugene Marquis, avenue de la Bataille Flandre Dunkerque, 35000, Rennes, France.
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Baty M, Créhange G, Pasquier D, Palard X, Deleuze A, Gnep K, Key S, Beuzit L, Castelli J, de Crevoisier R. Salvage reirradiation for local prostate cancer recurrence after radiation therapy. For who? When? How? Cancer Radiother 2019; 23:541-558. [PMID: 31421999 DOI: 10.1016/j.canrad.2019.07.125] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 06/19/2019] [Accepted: 07/03/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Literature review reporting results of salvage brachytherapy and stereotactic body radiotherapy for prostate recurrence only after radiotherapy for prostate cancer. MATERIALS AND METHODS A total of 38 studies (including at least 15 patients per study) were analysed: 19 using low-dose-rate brachytherapy, nine high-dose-rate brachytherapy and ten stereotactic body radiotherapy. Only five studies were prospective. The median numbers of patients were 30 for low-dose-rate brachytherapy, 34 for high-dose-rate brachytherapy, and 30 for stereotactic body radiotherapy. The median follow-up were 47months for low-dose-rate brachytherapy, 36months for high-dose-rate brachytherapy and 21months for stereotactic body radiotherapy. RESULTS Late genitourinary toxicity rates ranged, for grade 2: from 4 to 42% for low-dose-rate brachytherapy, from 7 to 54% for high-dose-rate brachytherapy and from 3 to 20% for stereotactic body radiotherapy, and for grade 3 or above: from 0 to 24% for low-dose-rate brachytherapy, from 0 to 13% for high-dose-rate brachytherapy and from 0 to 3% for grade 3 or above (except 12% in one study) for stereotactic body radiotherapy. Late gastrointestinal toxicity rates ranged, for grade 2: from 0 to 6% for low-dose-rate brachytherapy, from 0 to 14% for high-dose-rate brachytherapy and from 0 to 11% for stereotactic body radiotherapy, and for grade 3 or above: from 0 to 6% for low-dose-rate brachytherapy, and from 0 to 1% for high-dose-rate brachytherapy and stereotactic body radiotherapy. The 5-year biochemical disease-free survival rates ranged from 20 to 77% for low-dose-rate brachytherapy and from 51 to 68% for high-dose-rate brachytherapy. The 2- and 3-year disease-free survival rates ranged from 40 to 82% for stereotactic body radiotherapy. Prognostic factors of biochemical recurrence have been identified. CONCLUSION Despite a lack of prospective data, salvage reirradiation for prostate cancer recurrence can be proposed to highly selected patients and tumours. Prospective comparative studies are needed.
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Affiliation(s)
- M Baty
- Department of radiotherapy, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - G Créhange
- Department of radiotherapy, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - D Pasquier
- Department of radiation oncology, centre Oscar-Lambret, 3, avenue Frédéric-Combemale, 59020 Lille, France
| | - X Palard
- Department of nuclear medicine, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - A Deleuze
- Department of oncology, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - K Gnep
- Department of radiotherapy, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - S Key
- Department of radiotherapy, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - L Beuzit
- Department of radiology, CHU de Rennes, 35000 Rennes, France
| | - J Castelli
- Department of radiotherapy, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; LTSI, Inserm U1099, 35042 Rennes, France; Université Rennes 1, 35042 Rennes, France
| | - R de Crevoisier
- Department of radiotherapy, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; LTSI, Inserm U1099, 35042 Rennes, France; Université Rennes 1, 35042 Rennes, France.
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Rigaud B, Klopp A, Vedam S, Venkatesan A, Taku N, Simon A, Haigron P, de Crevoisier R, Brock KK, Cazoulat G. Deformable image registration for dose mapping between external beam radiotherapy and brachytherapy images of cervical cancer. Phys Med Biol 2019; 64:115023. [PMID: 30913542 DOI: 10.1088/1361-6560/ab1378] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For locally advanced cervical cancer (LACC), anatomy correspondence with and without BT applicator needs to be quantified to merge the delivered doses of external beam radiation therapy (EBRT) and brachytherapy (BT). This study proposed and evaluated different deformable image registration (DIR) methods for this application. Twenty patients who underwent EBRT and BT for LACC were retrospectively analyzed. Each patient had a pre-BT CT at EBRT boost (without applicator) and a CT and MRI at BT (with applicator). The evaluated DIR methods were the diffeomorphic Demons, commercial intensity and hybrid methods, and three different biomechanical models. The biomechanical models considered different boundary conditions (BCs). The impact of the BT devices insertion on the anatomy was quantified. DIR method performances were quantified using geometric criteria between the original and deformed contours. The BT dose was deformed toward the pre-CT BT by each DIR method. The impact of boundary conditions to drive the biomechanical model was evaluated based on the deformation vector field and dose differences. The GEC-ESTRO guideline dose indices were reported. Large organ displacements, deformations, and volume variations were observed between the pre-BT and BT anatomies. Rigid registration and intensity-based DIR resulted in poor geometric accuracy with mean Dice similarity coefficient (DSC) inferior to 0.57, 0.63, 0.42, 0.32, and 0.43 for the rectum, bladder, vagina, cervix and uterus, respectively. Biomechanical models provided a mean DSC of 0.96 for all the organs. By considering the cervix-uterus as one single structure, biomechanical models provided a mean DSC of 0.88 and 0.94 for the cervix and uterus, respectively. The deformed doses were represented for each DIR method. Caution should be used when performing DIR for this application as standard techniques may have unacceptable results. The biomechanical model with the cervix-uterus as one structure provided the most realistic deformations to propagate the BT dose toward the EBRT boost anatomy.
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Affiliation(s)
- B Rigaud
- Univ Rennes, CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, F-35000 Rennes, France. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America. Author to whom any correspondence should be addressed
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Scher N, Janoray G, Riet FG, Le Bayon AG, Debbi K, Lévy S, Louisot P, Garaud P, Chajon E, Barillot I, Salamé É, de Crevoisier R, Chapet S, Calais G. [Stereotactic body radiation therapy for hepatocellular carcinoma: Results from a retrospective multicentre study]. Cancer Radiother 2019; 23:104-115. [PMID: 30952560 DOI: 10.1016/j.canrad.2018.07.138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/24/2018] [Accepted: 07/29/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this paper was to describe local control, overall survival, progression-free survival and toxicity of CyberKnife®-based stereotactic body radiation therapy of hepatocellular carcinoma. MATERIAL AND METHODS Records of all the patients treated for hepatocellular carcinoma at the Eugene-Marquis cancer centre, Rennes and the Bretonneau hospital, Tours (France), between November 2010 and December 2016, were reviewed. Radiation therapy was performed as a salvage treatment, while awaiting liver transplantation or if no other treatment was possible. RESULTS One hundred and thirty-six patients were consecutively included in the study. The median follow-up was 13months. Median total dose prescribed, fractionation and overall treatment time were respectively 45Gy, three fractions and 5 days. Overall survival, progression-free survival and local control rates at 1year and 2years were 79.8 % and 63.5 %, 61.3 % and 39.4 %; 94.5 % and 91 %. Two grade 3 acute toxicity events and two grade 4 late toxicity events corresponding to a duodenal ulcer have been reported. Seven patients underwent classic radiation-induced hepatitis and 13 patients showed non-classical radiation-induced hepatitis. Barcelona Clinic Liver Cancer stage, World Health Organisation grade and planning target volume were correlated with overall survival in univariate Cox analysis. CONCLUSION Stereotactic body radiation therapy is effective and well-tolerated for inoperable hepatocellular carcinoma or as a bridge to liver transplantation. Toxicity is mainly related to cirrhotic background and requires a selection of patients and strict dose constraints.
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Affiliation(s)
- N Scher
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
| | - G Janoray
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - F-G Riet
- Département de radiothérapie, centre de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - A-G Le Bayon
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - K Debbi
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - S Lévy
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - P Louisot
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - P Garaud
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - E Chajon
- Département de radiothérapie, centre de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - I Barillot
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - É Salamé
- Département de chirurgie digestive, oncologique et transplantation hépatique, CHRU de Tours, 37044 Chambray-lès-Tours, France
| | - R de Crevoisier
- Département de radiothérapie, centre de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - S Chapet
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - G Calais
- Centre Henry-S.-Kaplan, clinique d'oncologie radiothérapie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
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Bibault JE, Denis F, Roué A, Gibon D, Fumagalli I, Hennequin C, Barillot I, Quéro L, Paumier A, Mahé MA, Servagi Vernat S, Créhange G, Lapeyre M, Blanchard P, Pointreau Y, Lafond C, Huguet F, Mornex F, Latorzeff I, de Crevoisier R, Martin V, Kreps S, Durdux C, Antoni D, Noël G, Giraud P. [Siriade 2.0: An e-learning platform for radiation oncology contouring]. Cancer Radiother 2018; 22:773-777. [PMID: 30360973 DOI: 10.1016/j.canrad.2018.02.003] [Citation(s) in RCA: 2] [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: 11/17/2017] [Revised: 01/23/2018] [Accepted: 02/08/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE In 2008, the French national society of radiation oncology (SFRO) and the association for radiation oncology continued education (AFCOR) created Siriade, an e-learning website dedicated to contouring. MATERIAL AND METHODS Between 2015 and 2017, this platform was updated using the latest digital online tools available. Two main sections were needed: a theoretical part and another section of online workshops. RESULTS Teaching courses are available as online commented videos, available on demand. The practical section of the website is an online contouring workshop that automatically generates a report quantifying the quality of the user's delineation compared with the experts'. CONCLUSION Siriade 2.0 is an innovating digital tool for radiation oncology initial and continuous education.
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Affiliation(s)
- J-E Bibault
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Paris Sorbonne Cité, 20, rue Leblanc, 75015 Paris, France
| | - F Denis
- Service de radiothérapie, centre Jean-Bernard, 9, rue Beauverger, 72000 Le Mans, France
| | - A Roué
- Institut national des sciences et techniques nucléaires, centre CEA de Saclay, D36, 91191 Gif-sur-Yvette, France
| | - D Gibon
- Aquilab, parc Eurasanté, biocentre Fleming, 250, rue Salvador-Allende, 59120 Loos, France
| | - I Fumagalli
- Service d'oncologie radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefau, 75010 Paris, France
| | - C Hennequin
- Service d'oncologie radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefau, 75010 Paris, France
| | - I Barillot
- Service d'oncologie radiothérapie, centre universitaire de cancérologie Henry-S.-Kaplan, 2, boulevard Tonnellé, 37044 Tours, France; Université François-Rabelais, 2, boulevard Tonnellé, 37044 Tours, France
| | - L Quéro
- Service d'oncologie radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefau, 75010 Paris, France
| | - A Paumier
- Service d'oncologie radiothérapie, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Professeur-Jacques-Monod, 44805 Saint-Herblain, France
| | - M-A Mahé
- Service d'oncologie radiothérapie, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Professeur-Jacques-Monod, 44805 Saint-Herblain, France
| | - S Servagi Vernat
- Service d'oncologie radiothérapie, institut Jean-Godinot, 1, rue Koenig, 51100 Reims, France
| | - G Créhange
- Service d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - M Lapeyre
- Service d'oncologie radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - P Blanchard
- Service d'oncologie radiothérapie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Y Pointreau
- Service de radiothérapie, centre Jean-Bernard, 9, rue Beauverger, 72000 Le Mans, France
| | - C Lafond
- Service de radiothérapie, centre Jean-Bernard, 9, rue Beauverger, 72000 Le Mans, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, Hôpitaux universitaires de l'Est parisien, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie, 4, rue de la Chine, 75020 Paris, France
| | - F Mornex
- Service d'oncologie radiothérapie, CHU Lyon Sud, 65, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - I Latorzeff
- Service d'oncologie radiothérapie, clinique Pasteur, 1, rue de la Petite-Vitesse, 31300 Toulouse, France
| | - R de Crevoisier
- Service d'oncologie radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandre-Dunkerque, 35700 Rennes, France
| | - V Martin
- Service d'oncologie radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefau, 75010 Paris, France
| | - S Kreps
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Paris Sorbonne Cité, 20, rue Leblanc, 75015 Paris, France
| | - C Durdux
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Paris Sorbonne Cité, 20, rue Leblanc, 75015 Paris, France
| | - D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg, France
| | - G Noël
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg, France
| | - P Giraud
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Paris Sorbonne Cité, 20, rue Leblanc, 75015 Paris, France.
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Sargos P, Créhange G, Hennequin C, Latorzeff I, de Crevoisier R, Roubaud G, Supiot S. Radiothérapie du cancer de la prostate localisé chez le sujet âgé : l’hypofractionnement modéré est-il le traitement de référence ? Cancer Radiother 2018; 22:631-634. [DOI: 10.1016/j.canrad.2018.07.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 12/11/2022]
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Scher N, Chapet S, Riet FG, Janoray G, Debbi K, Lévy S, Chajon E, Barillot I, de Crevoisier R, Calais G. Radiothérapie en conditions stéréotaxiques du carcinome hépatocellulaire : étude rétrospective multicentrique. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Castelli J, Simon A, Lafond C, Perichon N, Rigaud B, Chajon E, De Bari B, Ozsahin M, Bourhis J, de Crevoisier R. Adaptive radiotherapy for head and neck cancer. Acta Oncol 2018; 57:1284-1292. [PMID: 30289291 DOI: 10.1080/0284186x.2018.1505053] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Large anatomical variations can be observed during the treatment course intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC), leading to potential dose variations. Adaptive radiotherapy (ART) uses one or several replanning sessions to correct these variations and thus optimize the delivered dose distribution to the daily anatomy of the patient. This review, which is focused on ART in the HNC, aims to identify the various strategies of ART and to estimate the dosimetric and clinical benefits of these strategies. MATERIAL AND METHODS We performed an electronic search of articles published in PubMed/MEDLINE and Science Direct from January 2005 to December 2016. Among a total of 134 articles assessed for eligibility, 29 articles were ultimately retained for the review. Eighteen studies evaluated dosimetric variations without ART, and 11 studies reported the benefits of ART. RESULTS Eight in silico studies tested a number of replanning sessions, ranging from 1 to 6, aiming primarily to reduce the dose to the parotid glands. The optimal timing for replanning appears to be early during the first two weeks of treatment. Compared to standard IMRT, ART decreases the mean dose to the parotid gland from 0.6 to 6 Gy and the maximum dose to the spinal cord from 0.1 to 4 Gy while improving target coverage and homogeneity in most studies. Only five studies reported the clinical results of ART, and three of those studies included a non-randomized comparison with standard IMRT. These studies suggest a benefit of ART in regard to decreasing xerostomia, increasing quality of life, and increasing local control. Patients with the largest early anatomical and dose variations are the best candidates for ART. CONCLUSION ART may decrease toxicity and improve local control for locally advanced HNC. However, randomized trials are necessary to demonstrate the benefit of ART before using the technique in routine practice.
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Affiliation(s)
- J. Castelli
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
| | - A. Simon
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
| | - C. Lafond
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
| | - N. Perichon
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - B. Rigaud
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
| | - E. Chajon
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - B. De Bari
- Radiotherapy Department, CHU Jean-Minjoz, Besançon, France
| | - M. Ozsahin
- Radiotherapy Department, Lausanne University Hospital, Lausanne, Switzerland
| | - J. Bourhis
- Radiotherapy Department, Lausanne University Hospital, Lausanne, Switzerland
| | - R. de Crevoisier
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
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Bouvet C, Bertin K, Lafond C, Williaume D, de Crevoisier R, Leroy E. [Organization and risk management in stereotaxic body radiotherapy at the treatment station]. Cancer Radiother 2018; 22:532-536. [PMID: 30181030 DOI: 10.1016/j.canrad.2018.07.132] [Citation(s) in RCA: 2] [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: 07/10/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
The development of stereotaxic body radiotherapy in the last decade has forced the radiotherapy departments to redouble their efforts in the fields of quality and risk management. For this purpose, increasingly complex and rigorous controls of high performance machines as well as a solid team training must be put in place. Extreme hypofractionation requires both increased vigilance at the treatment desk and well-defined and known procedures. The in place organizations contribute to the control of the risks related to the stereotaxic body radiotherapy machines. The medical presence at the beginning of the treatment fractions has been specified as mandatory in a regulatory way since January 2017. This not only ensures security, but also transmits information to the radiation therapy technicians. At the Eugène-Marquis center, the skills of the technicians for stereotaxic body radiotherapy on two dedicated machines (Cyberknife® and Versa HD® Novalis® type) have been upgraded. An accreditation is formalized after a training period and re-evaluated annually. The communication inside and outside the radiotherapy field plays also an important role in maintaining a high level of exchange and sharing of essential information. The means implemented at the Eugène-Marquis center increase the risk control of SBRT, by paying attention to the management of skills at the treatment station.
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Affiliation(s)
- C Bouvet
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France.
| | - K Bertin
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - C Lafond
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - D Williaume
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - R de Crevoisier
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - E Leroy
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
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Castelli J, Simon A, Rigaud B, Chajon E, Thariat J, Benezery K, Vauleon E, Jegoux F, Henry O, Lafond C, de Crevoisier R. Adaptive radiotherapy in head and neck cancer is required to avoid tumor underdose. Acta Oncol 2018; 57:1267-1270. [PMID: 29706107 DOI: 10.1080/0284186x.2018.1468086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- J. Castelli
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- Université de Rennes 1, LTSI, Campus de Beaulieu, Rennes, France
- INSERM, U1099, Campus de Beaulieu, Rennes, France
| | - A. Simon
- Université de Rennes 1, LTSI, Campus de Beaulieu, Rennes, France
- INSERM, U1099, Campus de Beaulieu, Rennes, France
| | - B. Rigaud
- Université de Rennes 1, LTSI, Campus de Beaulieu, Rennes, France
- INSERM, U1099, Campus de Beaulieu, Rennes, France
| | - E. Chajon
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - J. Thariat
- Radiotherapy Department, Centre François Baclesse, Caen, France
| | - K. Benezery
- Radiotherapy Department, Centre Antoine Lacassagne, Nice, France
| | - E. Vauleon
- Department of Oncology, Centre Eugene Marquis, Rennes, France
| | - F. Jegoux
- Head and Neck Department, CHU Rennes, Rennes, France
| | - O. Henry
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - C. Lafond
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- Université de Rennes 1, LTSI, Campus de Beaulieu, Rennes, France
- INSERM, U1099, Campus de Beaulieu, Rennes, France
| | - R. de Crevoisier
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- Université de Rennes 1, LTSI, Campus de Beaulieu, Rennes, France
- INSERM, U1099, Campus de Beaulieu, Rennes, France
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Barateau A, Céleste M, Lafond C, Henry O, Couespel S, Simon A, Acosta O, de Crevoisier R, Périchon N. Calcul de dose de radiothérapie à partir de tomographies coniques : état de l’art. Cancer Radiother 2018; 22:85-100. [PMID: 29276135 DOI: 10.1016/j.canrad.2017.07.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/06/2017] [Accepted: 07/07/2017] [Indexed: 01/26/2023]
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40
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Largent A, Nunes JC, Lafond C, Périchon N, Castelli J, Rolland Y, Acosta O, de Crevoisier R. Planification à partir d’imagerie par résonance magnétique en radiothérapie. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Duvergé L, Bondiau PY, Bellec J, Corrre R, Ricordel C, de Latour B, Doyen J, de Crevoisier R, Chajon E, Castelli J. Impact du schéma d’irradiation dans le cadre d’une irradiation en conditions stéréotaxiques des carcinomes bronchiques non à petites cellules de stade I. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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42
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Castelli J, Depeursinge A, Nditifei-Ndoh V, Devillers A, Dicente Y, Schaer R, Prior J, Bourhis J, Sire C, de Crevoisier R. Valeur de la tomographie par émission de positons au ( 18 F)-fluorodésoxyglucose pour prédire la récidive dans les cancers ORL non oropharyngé pris en charge par chimioradiothérapie. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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43
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Lizée T, Acosta O, Mylona E, Le Dain M, Lafond C, Riet FG, de Crevoisier R. Développement d’une méthode de segmentation automatique de l’urètre sur tomodensitométrie de planification permettant d’évaluer la dose urétrale en cas de radiothérapie prostatique. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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44
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Goupy F, Le Prisé É, Williaume D, Lafond C, Périchon N, Hervé C, Leproust B, de Crevoisier R. Radiothérapie des cancers de prostate avec atteinte des vésicules séminales (de stade T3b) : résultats cliniques. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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45
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Barateau A, Périchon N, Couespel S, Castelli J, Lafond C, Chajon E, Henry O, de Crevoisier R. Quantification de la dose cumulée délivrée aux parotides, avec ou sans replanification, à partir de tomographies coniques. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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Nassef M, Simon A, Duvergé L, Rigaud B, Lafond C, Haigron P, de Crevoisier R. Vers une radiothérapie adaptative guidée par la dose pour les cancers de prostate pour corriger les surdosages dans les organes à risque. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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47
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Barateau A, Perichon N, Couespel S, Castelli J, Lafond C, Chajon E, Henry O, de Crevoisier R. Peut-on calculer une distribution de dose à partir de tomographies coniques pour suivre la dose délivrée en cours de radiothérapie ORL ? Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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48
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Castelli J, Simon A, Rigaud B, Lafond C, Henry O, Chajon E, Jégoux F, Vauleon E, de Crevoisier R. Radiothérapie adaptive des cancers ORL : bénéfice sur la couverture du volume tumoral. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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49
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Duvergé L, Castelli J, Lizée T, de Crevoisier R, Azria D. [Doses to organs at risk for conformational and stereotactic radiotherapy: Bladder]. Cancer Radiother 2017; 21:597-603. [PMID: 28882511 DOI: 10.1016/j.canrad.2017.07.038] [Citation(s) in RCA: 2] [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: 07/04/2017] [Accepted: 07/13/2017] [Indexed: 11/16/2022]
Abstract
Bladder dose constraints in case of conformational radiotherapy/intensity-modulated radiotherapy and stereotactic radiotherapy are reported from the literature, in particular from the French radiotherapy society RECORAD recommendations, according to the treated pelvic tumor sites. The dose-volume effect on urinary toxicity is not clearly demonstrated, making difficult to establish absolute dose constraints for the bladder. In case of high-dose prostate cancer radiotherapy, the bladder dose constraints are: V60Gy<50% and maximum dose<80Gy for standard fractionation and V60Gy<5%, V48Gy<25% and V41Gy<50% for moderate hypofractionation (20 fractions of 3Gy). In case of prostate stereotactic radiotherapy (five fractions of 7.25Gy), the most frequent dose constraints in the literature are V37Gy<10cm3 and V18Gy<40%. In case of conformational radiotherapy of cervix cancer, postoperative endometrium, anal canal and rectum, the recommendations are V40Gy<40% and D2% lower than the prescribed dose.
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Affiliation(s)
- L Duvergé
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France.
| | - J Castelli
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - T Lizée
- Département de radiothérapie, institut de cancérologie de l'Ouest, site Paul-Papin, 2, rue Moll, 49100 Angers, France
| | - R de Crevoisier
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - D Azria
- Département de cancérologie radiothérapie, CRLC Val-d'Aurelle-Paul-Lamarque, 208, rue des Apothicaires, 34000 Montpellier, France
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Gnep K, Lizée T, Campillo-Gimenez B, Delpon G, Droupy S, Perrier L, de Crevoisier R. [Toxicity and quality of life comparison of iodine 125 brachytherapy and stereotactic radiotherapy for prostate cancers]. Cancer Radiother 2017; 21:478-490. [PMID: 28888746 DOI: 10.1016/j.canrad.2017.07.043] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022]
Abstract
Quality of life is a major issue for good prognostic prostate cancer, for which brachytherapy is one of the reference treatments. Stereotactic Body Radiotherapy (SBRT) is a recent alternative however not yet validated as a standard treatment. This review of the literature reports and compares the toxicities and the quality of life, either after exclusive brachytherapy with iodine 125 or after SBRT. The comparison is made with the limitations of the absence of randomized trial comparing the two treatment techniques. Acute toxicity appears to be lower after SBRT compared to brachytherapy (from 10 to 40 % versus 30 to 40 %, respectively). Conversely, acute and late gastrointestinal toxicity (from 0 to 21 % and from 0 to 10 % of grade 2, respectively) appears more frequent with SBRT. Late urinary toxicity seems identical between both techniques (from 20 to 30 % of grade 2), with a possible urinary flare syndrome. Both treatments have an impact on erectile dysfunction, although it is not possible to conclude that a technique is superior because of the limited data on SBRT. SBRT has better bowel and urinary (irritation or obstruction) quality of life scores than brachytherapy; while sexual and urinary incontinence remain the same. The absence of randomized trial comparing SBRT with brachytherapy for prostate cancers does not allow to conclude on the superiority of one technique over another, thus justifying a phase III medicoeconomic evaluation.
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Affiliation(s)
- K Gnep
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35042 Rennes, France.
| | - T Lizée
- Département de radiothérapie, centre régional de lutte contre le cancer Paul-Papin, institut de cancérologie de l'Ouest, 49100 Angers, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
| | - B Campillo-Gimenez
- Direction de la recherche clinique, centre régional de lutte contre le cancer Eugène-Marquis, 35042 Rennes, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
| | - G Delpon
- Département de radiothérapie, centre régional de lutte contre le cancer René-Gauducheau, institut de cancérologie de l'Ouest, 44805 Saint-Herblain, France
| | - S Droupy
- Département d'urologie, centre hospitalier universitaire de Nîmes, 30029 Nîmes, France
| | - L Perrier
- Centre Léon-Bérard, université Lyon, direction de la recherche clinique et de l'innovation GATE L-SE UMR 5824, 69008 Lyon, France
| | - R de Crevoisier
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35042 Rennes, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
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