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Le Scodan R, Ghannam Y, Kirova Y, Bourgier C, Richard Tallet A. Radiation therapy of the primary tumour and oligometastatic sites in patients with breast cancer with synchronous metastases: A literature review. Cancer Radiother 2024; 28:3-14. [PMID: 38065784 DOI: 10.1016/j.canrad.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 02/04/2024]
Abstract
De novo metastatic breast cancer represents 5 to 8% of all breast cancers (2500 new cases per year in France). Systemic treatment is the cornerstone of treatment, whereas radiation therapy usually has a palliative intent. Advances in systemic and local treatments (surgery and radiation therapy) have substantially improved overall survival. In the recent breast cancer statistics in the United States, the 5-year relative survival for patients diagnosed during 2012-2018 was 29% for stage IV (Breast Cancer Statistics). Thus, an increasing proportion of metastatic breast cancers present a prolonged complete response to systemic therapy, which raises the question of the impact of local treatment on patient survival. Radiation therapy has shown its value for early breast cancer, but its place in the local management of the primary tumour or oligometastatic sites for de novo metastatic breast cancer remains under debate. This article is a literature review assessing the role of radiation therapy directed to the primary tumour and oligometastatic sites of breast cancer in patients with synchronous metastases, in order to highlight clinicians in their therapeutic decision.
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Affiliation(s)
- R Le Scodan
- Institut de cancérologie et radiothérapie brétillien (ICRB), hôpitaux privés rennais, centre hospitalier privé Saint-Grégoire, Vivalto, Saint-Grégoire, France.
| | - Y Ghannam
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, Angers, France
| | - Y Kirova
- Département de radiothérapie, institut Curie, Paris, France
| | - C Bourgier
- Université de Montpellier, Montpellier, France; Institut de recherche en cancérologie de Montpellier (IRCM), Inserm U1194, Montpellier, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, institut régional du cancer Montpellier (ICM), Montpellier, France
| | - A Richard Tallet
- Département d'oncologie radiothérapie, institut Paoli-Calmettes, Marseille, France; Centre de recherche en cancérologie de Marseille (CRCM), Inserm UMR 1068, Marseille, France
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2
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Larnaudie A, Bourbonne V, Michalet M, Laune Q, Delaye M, Huguet F, Azria D, Varnier R, Ghannam Y. [Last year of residency for radiation oncologists in France: Overview and perspectives]. Cancer Radiother 2023; 27:718-724. [PMID: 37891037 DOI: 10.1016/j.canrad.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE The last year of the radiotherapy oncology internship in France has become a phase of empowerment, called "junior doctor", allowing interns to validate acts previously reserved only for senior doctors. This study focused on the responsibilities given to the first promotion of junior doctors in France and their feelings on this new status. MATERIAL AND METHODS A cross-sectional survey was carried out by the French associations of interns and young doctors in oncology, Aerio and SFjRO. A questionnaire was sent to the class referents of each city for transmission to the junior doctors of the year 2021-2022 from September 1st to November 30th, 2022. The questions concerned training, the modalities of this year and the feelings. Responses were analyzed anonymously using R. 4.3.1 software. RESULTS For radiation oncology, 33 responses were obtained from 21 cities. For most junior doctors, three to four localizations (51%) were performed with an average of five new patients per week. The contours were reviewed either systematically (51%) or only at the beginning (32%). Dosimetry was reported as never countersigned in 19%; 80% of junior doctors described having been the only radiation oncologist during multidisciplinary staff meetings. The two main areas of improvement were theoretical training (45%) and legal frameworks/contracts (42%). CONCLUSION These results relating to the first class of junior doctors showed an overall agreement with the recommendations of the Cnec. Feedback from interns was positive. The supervision of brachytherapy and dosimetry activities, the presence alone in multidisciplinary panel remained points of vigilance.
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Affiliation(s)
- A Larnaudie
- Service de radiothérapie, centre François-Baclesse, avenue du Général-Harris, 14000 Caen, France; Société française des jeunes radiothérapeutes oncologues (SFJRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France.
| | - V Bourbonne
- Société française des jeunes radiothérapeutes oncologues (SFJRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Service de radiothérapie, centre hospitalier universitaire de Brest, 2, avenue Foch, 29200 Brest, France
| | - M Michalet
- Service de radiothérapie, institut de cancérologie, Montpellier, parc Euromédecine, 208, avenue des Apothicaires, 34090 Montpellier, France
| | - Q Laune
- Service de radiothérapie, centre hospitalier universitaire de Brest, 2, avenue Foch, 29200 Brest, France; Association d'enseignement et de recherche des internes en oncologie (Aerio), 149, avenue du Maine, 75014 Paris, France
| | - M Delaye
- Association d'enseignement et de recherche des internes en oncologie (Aerio), 149, avenue du Maine, 75014 Paris, France; Service d'oncologie médicale, institut Curie, 35, rue Daily, 92210 Saint-Cloud, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, 75020 Paris, France; Collège national des enseignants en cancérologie (Cnec), Paris, France
| | - D Azria
- Service de radiothérapie, institut de cancérologie, Montpellier, parc Euromédecine, 208, avenue des Apothicaires, 34090 Montpellier, France; Société française de radiothérapie oncologique (SFRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France
| | - R Varnier
- Research on Healthcare Performance (Reshape), Inserm, U1290, université Claude-Bernard, Lyon, France; Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Y Ghannam
- Société française des jeunes radiothérapeutes oncologues (SFJRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Service de radiothérapie, institut de cancérologie de l'Ouest, 15, rue André-Boquel, 49100 Angers, France
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3
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Allali S, Carton M, Sarrade T, Everhard S, Rivera S, Ghannam Y, Peignaux K, Guilbert P, Chara-Brunaud C, Blanchecotte J, Pasquier D, Racadot S, Bourgier C, Cottu P, Kirova Y. CANTO: Skin Toxicities Evaluation of a Multicenter Large Prospective Cohort of Irradiated Patients for Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e163. [PMID: 37784763 DOI: 10.1016/j.ijrobp.2023.06.995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Skin damage is a common toxicity during oncology management. Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients treated for an early breast cancer (BC). MATERIALS/METHODS CANTO (NCT01993498) is a prospective, multicentric, clinical cohort study of 11 400 patients with stage I-III BC, treated in 26 French cancer centers. In this study, we will evaluate the 8561 patients during their overall management for a BC. We are focus on specifical skin toxicities: Erythema, fibrosis, telangiectasia and skin color (CTCAE v4.0). These toxicities were assessed at 3-6 (M0), 12 (M12), 36 (M36), 60 (M60) months. RESULTS The prevalence of toxicities of interest varied over time, so at M0, 30.4% of patients had erythema while 17.7% of patients had fibrosis. At M12, M36 and M60, the prevalence of erythema decreased from 5.5 % to 2.5 % then to 2 %, respectively, while fibrosis remained stable at about 19 %. The prevalence of telangiectasia increased from 0.8 % to 7 % from M0 to M60. While the modification of skin color was 51.1 % at M0, and 10.6 % at M60. After adjustments, at M0, there was a statistically significant association between the onset of cutaneous erythema and obesity, the presence of axillary dissection, the type of surgery the age of the patient as well as the tumor phenotype RH+/HER2+ [OR: 0.79 [0.67; 0.93]]. Concerning fibrosis, a statistically significant association was found, at M12, with the age of the patient, obesity, tumor grade, Charlson score, type of surgery and mitotic index. Obesity and the age of the patient represent at M12 and M36 a risk significantly associated with the onset of telangiectasia. Concerning the modification of skin color at M12, we find a link between the age of the patient, obesity, tobacco consumption, tumor grade, Charlson score, type of surgery, and alcohol consumption [OR: 0.69 [0.51; 0.91]]. CONCLUSION In this study we identified several risk factors for acute and late skin toxicity. The knowledge of its predictive factors allows a personalized management of the patient by adapting our treatments and our monitoring according to these different factors.
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Affiliation(s)
- S Allali
- Institut Curie Paris, Paris, France
| | | | - T Sarrade
- Gustave Roussy, Cancer Campus, Villejuif, France
| | | | - S Rivera
- Gustave Roussy, Cancer Campus, Villejuif, France
| | - Y Ghannam
- Gustave Roussy, Cancer Campus, Villejuif, France
| | - K Peignaux
- Centre Georges-François Leclerc, Dijon, France
| | | | - C Chara-Brunaud
- Institut de cancérologie de Lorraine, Vandoeuvre les Nancy, France
| | - J Blanchecotte
- Institut de Cancérologie de L'ouest - Paul Papin, Angers, France
| | | | | | - C Bourgier
- Institut du Cancer de Montpellier, Montpellier, France
| | - P Cottu
- Institut Curie, Paris, 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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5
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Guihard S, Piot M, Issoufaly I, Giraud P, Bruand M, Faivre JC, Eugène R, Liem X, Pasquier D, Lamrani-Ghaouti A, Ghannam Y, Ruffier A, Guilbert P, Larnaudie A, Thariat J, Rivera S, Clavier JB. [Real world data in radiotherapy: A data farming project by Unitrad]. Cancer Radiother 2023; 27:455-459. [PMID: 37517975 DOI: 10.1016/j.canrad.2023.06.016] [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: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 08/01/2023]
Abstract
The aim of the data farming project by the Unitrad group is to produce and use large quantities of structured real-life data throughout radiotherapy treatment. Starting in 2016, target real world data were selected at expert consensus conferences and regularly updated, then captured in MOSAIQ© as the patient was treated. For each partner institution, the data was then stored in a relational database, then extracted and used by researchers to create real world knowledge. This production was carried out in a multicentre, coordinated fashion. When necessary, the raw data was shared according to the research projects, in compliance with regulations. Feedack was provided at each stage, enabling the system to evolve flexibly and rapidly, using the "agile" method. This work, which is constantly evolving, has led to the creation of health data warehouses focused on data of interest in radiotherapy, and the publication of numerous academic studies. It forms part of the wider context of the exploitation of real-life data in cancerology. Unitrad data farming is a collaborative project for creating knowledge from real-life radiotherapy data, based on an active network of clinicians and researchers.
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Affiliation(s)
- S Guihard
- Radiothérapie, institut de cancérologie de Strasbourg (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France.
| | - M Piot
- Laboratoire List3N, école doctorale SPI de l'université de technologie de Troyes, 12, rue Marie-Curie, 10300 Troyes, France
| | - I Issoufaly
- Radiothérapie, Gustave-Roussy, Villejuif, France
| | - P Giraud
- Inserm, UMR 1138, équipe« Science de l'information au service de la médecine », 15, rue de l'École-de-Médecine, 75006 Paris, France; Radiothérapie, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - M Bruand
- Radiothérapie, Institut de cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - J-C Faivre
- Radiothérapie, Institut de cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - R Eugène
- Oncology Informatics Consultant, Elekta SAS, Boulogne-Billancourt, France
| | - X Liem
- Radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - D Pasquier
- Radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | | | - Y Ghannam
- Radiothérapie, Gustave-Roussy, Villejuif, France
| | - A Ruffier
- Radiothérapie, institut interrégional de cancérologie, centre Jean-Bernard, clinique Victor-Hugo, Le Mans, France
| | - P Guilbert
- Radiothérapie, institut Godinot, 1, rue du Général-Koenig, 51100 Reims, France
| | - A Larnaudie
- Radiothérapie, centre François-Baclesse, 14000 Caen, France
| | - J Thariat
- Radiothérapie, centre François-Baclesse, 14000 Caen, France
| | - S Rivera
- Radiothérapie, Gustave-Roussy, Villejuif, France
| | - J-B Clavier
- Radiothérapie, institut de cancérologie de Strasbourg (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France
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6
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Legouté F, Lesueur P, El Kabbaj O, Ghannam Y, Michalet M, Monpetit E, Azria D, Giraud P, Calais G, Pointreau Y, Ollivier L. [French careers in oncology radiotherapy: Crossing views]. Cancer Radiother 2023; 27:75-79. [PMID: 36008260 DOI: 10.1016/j.canrad.2022.07.016] [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: 05/07/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 02/06/2023]
Abstract
The French Society of Young Radiation Oncologists (SFjRO), the National Union of Radiation Oncologists (SNRO) and the French Society of Oncological Radiotherapy (SFRO) aim to reconcile career opportunities and demographic needs in oncology. In 2021, 932 radiation oncologists (RO) are in regular activity in France, this represents an increase of more than 20% in ten years. Physician distribution is changing in public hospitals, cancer centers and private clinics. Currently one third of ROs works in each sector. In addition, fifteen percent of ROs have a mixed activity. In 2021, 180 young RO (trainees and residents) were questioned by SFjRO board about their training, internship, coaching and career guidance. An interactive communication was organized during the 32nd SFRO Meeting in 2021. It was an opportunity to bring the results of this study. More than 70% RO interviewed answered to the survey, for 55% among them, career choice was difficult. In order to help young ROs in their professional approach, three RO made an oral presentation during this session, about radiotherapy in public hospitals, private centers or with a mixed practice. The aim of this article is to summarize the highlights of the last SFjRO/SFRO session: expectations of young RO, career prospects and trends.
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Affiliation(s)
- F Legouté
- Service de radiothérapie, centre hospitalier départemental Vendée, boulevard Stéphane-Moreau, 85000 La Roche-sur-Yon, France.
| | - P Lesueur
- Département de radiothérapie, centre François-Baclesse, Caen, France; Département de radiothérapie, centre Guillaume-le-Conquérant, Le-Havre, France
| | - O El Kabbaj
- Centre Saint-Yves-radiothérapie, 11, rue du Docteur-Audic, 56000 Vannes, France
| | - Y Ghannam
- Société française des jeunes radiothérapeutes oncologues (SFjRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Département de radiothérapie, Institut de cancérologie de l'ouest, 15, rue André-Boquel, 49100 Angers, France
| | - M Michalet
- Société française des jeunes radiothérapeutes oncologues (SFjRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Service d'oncologie radiothérapie, Institut du cancer de Montpellier, Montpellier, France
| | - E Monpetit
- Centre Saint-Yves-radiothérapie, 11, rue du Docteur-Audic, 56000 Vannes, France; Syndicat national des radiothérapeutes oncologues (SNRO), centre Saint-Yves radiothérapie, 11, rue du Docteur-Audic, 56000 Vannes, France
| | - D Azria
- Service d'oncologie radiothérapie, Institut du cancer de Montpellier, Montpellier, France; Société française de radiothérapie oncologique (SFRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France
| | - P Giraud
- Société française de radiothérapie oncologique (SFRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - G Calais
- Service de radiothérapie, centre régional universitaire de cancérologie Henry-S.-Kaplan, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - Y Pointreau
- Service de radiothérapie, centre régional universitaire de cancérologie Henry-S.-Kaplan, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Centre Jean-Bernard, clinique Victor-Hugo, (Institut interrégional de cancérologie), 9, rue Beauverger, 72000 Le Mans, France
| | - L Ollivier
- Société française des jeunes radiothérapeutes oncologues (SFjRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Département de radiothérapie, Institut de cancérologie de l'ouest, boulevard Professeur-Jacques-Monod, 44800 Saint-Herblain, France
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7
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Zhou Y, Larnaudie A, Ghannam Y, Ollivier L, Gounane Y, Laville A, Coutte A, Huertas A, Maroun P, Chargari C, Bockel S. Interactions of radiation therapy with common and innovative systemic treatments: Antidiabetic treatments, antihypertensives, lipid-lowering medications, immunosuppressive medications and other radiosensitizing methods. Cancer Radiother 2022; 26:979-986. [PMID: 36028416 DOI: 10.1016/j.canrad.2022.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
The invention and approval of innovative anticancer therapies in the last decade have revolutionized oncology treatment. Radiotherapy is one of the three traditional pillars in oncology treatment with surgery and systemic therapies. Some standard-of-care combinations of chemoradiotherapy widened the therapeutic window of radiation, while some other chemotherapies such as gemcitabine caused unacceptable toxicities when combined with radiation in lung cancers. Fast-paced progress are specially focused on immunotherapies, targeted-therapies, anti-angiogenic treatment, DNA repair inhibitors, hormonotherapy and cell cycle inhibitors. New anticancer therapeutic arsenals provided new possibilities of combined oncological treatments. The interactions of the radiotherapy with other systemic treatments, such as non-anticancer immunomodulatory/immunosuppressive medications are sometimes overlooked even though they could offer a real therapeutic benefit. In this review, we summarize the new opportunities and the risks of historical and novel combined therapies with radiation: non-anticancer immunomodulatory/immunosuppressive drugs, systemic reoxygenation, new therapies such as nanoparticles and SMAC mimetics. Key biological mechanisms, pre-clinical and available clinical data will be provided to demonstrate the promising opportunities in the years to come.
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Affiliation(s)
- Y Zhou
- Department of Radiation Oncology, CHU d'Amiens-Picardie, 80000 Amiens, France; Institut de radiothérapie du sud de l'Oise, 60100 Creil, France
| | - A Larnaudie
- Department of Radiation Oncology, centre hospitalier universitaire Dupuytren, 87000 Limoges, France
| | - Y Ghannam
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest centre Paul-Papin, 49100 Angers, France
| | - L Ollivier
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest centre René-Gauducheau, 44880 Nantes, France
| | - Y Gounane
- Department of Radiation Oncology, hôpital La Source, 45100 Orléans, France
| | - A Laville
- Department of Radiation Oncology, CHU d'Amiens-Picardie, 80000 Amiens, France
| | - A Coutte
- Department of Radiation Oncology, CHU d'Amiens-Picardie, 80000 Amiens, France
| | - A Huertas
- Institut de radiothérapie du sud de l'Oise, 60100 Creil, France
| | - P Maroun
- Institut de radiothérapie du sud de l'Oise, 60100 Creil, France
| | - C Chargari
- Department of Radiation Oncology, Gustave-Roussy, 94800 Villejuif, France
| | - S Bockel
- Department of Radiation Oncology, Gustave-Roussy, 94800 Villejuif, France.
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8
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Haaser T, Constantinides Y, Huguet F, De Crevoisier R, Dejean C, Escande A, Ghannam Y, Lahmi L, Le Tallec P, Lecouillard I, Lorchel F, Thureau S, Lagrange JL. [Ethical stakes in palliative care in radiation oncology]. Cancer Radiother 2021; 25:699-706. [PMID: 34400087 DOI: 10.1016/j.canrad.2021.07.004] [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: 07/13/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
In 2021, the Ethics Commission of the SFRO has chosen the issue of the practice of palliative care in radiotherapy oncology. Radiation oncology plays a central role in the care of patients with cancer in palliative phase. But behind the broad name of palliative radiotherapy, we actually find a large variety of situations involving diverse ethical issues. Radiation oncologists have the delicate task to take into account multiple factors throughout a complex decision-making process. While the question of the therapeutic indication and the technical choice allowing it to be implemented remains central, reflection cannot be limited to these decision-making and technical aspects alone. It is also a question of being able to create the conditions for a singularity focused care and to build an authentic care relationship, beyond technicity. It is through this daily ethical work, in close collaboration with patients, and under essential conditions of multidisciplinarity and multiprofessionalism, that our fundamental role as caregiver can be deployed.
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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.
| | - Y Constantinides
- Espace Éthique Ile de France, Paris Université Sorbonne Nouvelle, 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
| | - 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
| | - L Lahmi
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Centre de Recherche Saint-Antoine UMR_S 938, Institut Universitaire de Cancérologie, AP-HP, Sorbonne Université, Paris, France
| | - P Le Tallec
- Service d'Oncologie Radiothérapie, Quantis Litis EA 4108, Centre Henri Becquerel, Rouen, France
| | - I Lecouillard
- Service d'Oncologie Radiothérapie, Centre Eugène Marquis, Rennes, 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
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Ghannam Y, Bourgier C, Legouté F, Gonzalez-Moya A, Lizée T, Trémolières P, Hennequin C. [Treatment of primary disease with irradiation in case of de novo metastatic breast cancer]. Cancer Radiother 2020; 24:567-575. [PMID: 32814669 DOI: 10.1016/j.canrad.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 11/18/2022]
Abstract
Synchronous metastatic breast cancer accounts for 5 to 6% of all breast cancers in Western countries, which corresponds to nearly 2500 new cases per year in France. Irradiation of the primary tumour in cases of metastatic disease at diagnosis was historically reserved for palliative indications. However, progress in systemic treatments, a better understanding of the biological basis of metastatic dissemination, the genesis of the concept of oligometastatic disease and ablative treatments directed towards metastases are revolutionizing the management of patients with de novo stage IV breast cancer. Survival of these patients has improved markedly over the years, and several studies have investigated the carcinological benefit of local treatment of the breast tumour in patients with advanced diseases at diagnosis. This article provides an update on the role of irradiation of the primary tumour in breast cancer with synchronous metastases, and discusses its interest through published or ongoing trials.
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Affiliation(s)
- Y Ghannam
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France.
| | - C Bourgier
- Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier cedex 05, France; Institut de recherche en cancérologie de Montpellier IRCM, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Inserm, U1194, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - F Legouté
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - A Gonzalez-Moya
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - T Lizée
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - P Trémolières
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris, France
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