38 results on '"P. Graff-Cailleaud"'
Search Results
2. Brachytherapy boost (BT-boost) or stereotactic body radiation therapy boost (SBRT-boost) for high-risk prostate cancer (HR-PCa)
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G. Mauriange-Turpin, T. Lizée, Stéphane Supiot, P. Trémolières, Jonathan Khalifa, P. Graff-Cailleaud, S. Krhili, E. Blais, and G. Peyraga
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Male ,Oncology ,medicine.medical_specialty ,Stereotactic body radiation therapy ,medicine.medical_treatment ,Brachytherapy ,Radiosurgery ,complex mixtures ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cumulative incidence ,Prospective Studies ,Retrospective Studies ,Clinical Trials as Topic ,business.industry ,Prostatic Neoplasms ,Cancer ,Androgen Antagonists ,Retrospective cohort study ,Gold standard (test) ,medicine.disease ,Combined Modality Therapy ,Radiation therapy ,030220 oncology & carcinogenesis ,Radiation Dose Hypofractionation ,Dose Fractionation, Radiation ,business - Abstract
Systematic review for the treatment of high-risk prostate cancer (HR-PCa, D'Amico classification risk system) with external body radiation therapy (EBRT)+brachytherapy-boost (BT-boost) or with EBRT+stereotactic body RT-boost (SBRT-boost). In March 2020, 391 English citations on PubMed matched with search terms "high risk prostate cancer boost". Respectively 9 and 48 prospective and retrospective studies were on BT-boost and 7 retrospective studies were on SBRT-boost. Two SBRT-boost trials were prospective. Only one study (ASCENDE-RT) directly compared the gold standard treatment [dose-escalation (DE)-EBRT+androgen deprivation treatment (ADT)] versus EBRT+ADT+BT-boost. Biochemical control rates at 9 years were 83% in the experimental arm versus 63% in the standard arm. Cumulative incidence of late grade 3 urinary toxicity in the experimental arm and in the standard arm was respectively 18% and 5%. Two recent studies with HR-PCa (National Cancer Database) demonstrated better overall survival with BT-boost (low dose rate LDR or high dose rate HDR) compared with DE-EBRT. These recent findings demonstrate the superiority of EBRT+BT-boost+ADT versus DE-EBRT+ADT for HR-PCa. It seems that EBRT+BT-boost+ADT could now be considered as a gold standard treatment for HR-PCa. HDR or LDR are options. SBRT-boost represents an attractive alternative, but the absence of randomised trials does not allow us to conclude for HR-PCa. Prospective randomised international phase III trials or meta-analyses could improve the level of evidence of SBRT-boost for HR-PCa. more...
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- 2021
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Catalog
3. [Challenges and limits of therapeutic de-escalation for papillomavirus-related oropharyngeal cancer]
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A, Modesto, P, Graff Cailleaud, P, Blanchard, P, Boisselier, and Y, Pointreau
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Oropharyngeal Neoplasms ,Papillomavirus Infections ,Humans ,Prognosis ,Papillomaviridae ,Neoplasm Staging - Abstract
The incidence of HPV-related oropharyngeal cancers has been increasing in Western countries for several decades. If they are individualized within the latest TNM classification, the current standards of management do not authorize the management of these patients to be singled out. However, their distinct oncogenesis and their excellent prognosis compared to other patients has allowed the development of several clinical trials based on the question of therapeutic de-escalation. This review of the literature aims to take stock of the elements provided by clinical research in recent years. more...
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- 2022
4. Chemotherapy and radiotherapy in locally advanced head and neck cancer: an individual patient data network meta-analysis
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Brian O'Sullivan, Everett E. Vokes, J. Bernier, J. Vermorken, Jean-Jacques Mazeron, J.W. Lee, J. Simes, Carlo Fallai, P. Olmi, Cai Grau, K.H. Cho, B. Lacas, J.J. Cruz Hernandez, P. Graff-Cailleaud, Branislav Jeremic, J. Overgaard, Giuseppe Sanguineti, J.H. Hay, Voichita Bar-Ad, B. Gery, H. Quon, W. Dobrowsky, B. Maciejewski, M. Nankivell, Catherine Fortpied, Y. Belkacemi, Z. Szutkowski, V. Budach, David J. Adelstein, Maria Grazia Ghi, Allan Hackshaw, A. Trotti, Vincent Grégoire, Jens Overgaard, P. Blanchard, David I. Rosenthal, B. O'Sullivan, B.G. Haffty, Ju-Whei Lee, E. Moyal, M. Alfonsi, O. Choussy, S. Kumar, Barbara Burtness, M. Cheugoua-Zanetsie, C.M.P. Viegas, V. Tseroni, E. Lartigau, H. Bartelink, Björn Zackrisson, Jean-Pierre Pignon, S. Staar, J. Waldron, J.S. Wu, A. Lopes, M.G. Ghi, Sarbani Ghosh Laskar, Lisa Licitra, K.D Wernecke, C. Grau, Y.G. Tao, J. Agarwal, Yoann Pointreau, Maurice Cheugoua-Zanetsie, M. Lotayef, G. Calais, Claire Petit, J. Moon, J.A. Langendijk, C.A. Kristensen, W. Budach, Mahesh K.B. Parmar, Mahesh K. B. Parmar, Athanassios Argiris, Benjamin Lacas, C. Sire, S. Spencer, Beth M. Beadle, C. Petit, John Simes, Michael Poulsen, Arlene A. Forastiere, Q.T. Le, Adam S. Garden, L.P. Zhong, J.J. Mazeron, H. van Tinteren, Å. Bratland, Jean Pierre Pignon, Yi Li, Jeffrey S Tobias, S.H. Moon, P. Strojan, J. Bourhis, S. Temam, A. Bacigalupo, Pedro A. Torres-Saavedra, E.E. Vokes, C.M.L. Driessen, Stéphane Temam, M.M Dominello, E. Chamorey, J. Widder, Ricardo Hitt, C. van Herpen, Séverine Racadot, M. Julieron, H. Yamazaki, Rafał Suwiński, Z. Takácsi-Nagy, A. Hansen, K. Skladowski, D. Chaukar, P. Lee, S. Hayoz, F. Lewin, Marshall R. Posner, Atul Sharma, S. Mehta, M.G. Poulsen, S. Ghosh Laskar, R. Suwinski, B. Campbell, Wojciech Michalski, Jimmy J. Caudell, Jørgen Johansen, C. Simon, C. Fortpied, R. Orecchia, Volker Budach, George Shenouda, V. Torri, Shaleen Kumar, E Haddad, P. Rovea, P. Torres-Saavedra, Juan Jesús Cruz Hernández, Lai-Ping Zhong, Quynh-Thu Le, B. Zaktonik, J.W. Denham, A. Aupérin, B. Zackrisson, Gregory T. Wolf, J.C. Horiot, C. Stromberger, Jean Bourhis, S. Chabaud, Michel Lapeyre, Eric Lartigau, S.J. Wong, George Fountzilas, P. Nilsson, David M. Brizel, M.R. Posner, L. Tripcony, René-Jean Bensadoun, C. Jones, M.G. Ruo Redda, Pierre Blanchard, D. Thomson, A. Hackshaw, B. Jeremic, G. Sanguineti, Pirus Ghadjar, A. Auperin, P. Garaud, Damage and Repair in Cancer Development and Cancer Treatment (DARE), and Guided Treatment in Optimal Selected Cancer Patients (GUTS) more...
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Male ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Network Meta-Analysis ,Head and Neck Neoplasms/mortality ,chemotherapy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,head and neck cancer, radiotherapy, chemotherapy, radiochemotherapy ,030212 general & internal medicine ,radiotherapy ,business.industry ,Head and neck cancer ,Hazard ratio ,Dose fractionation ,Induction chemotherapy ,Cancer ,Chemoradiotherapy ,medicine.disease ,Radiation therapy ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Concomitant ,Female ,head and neck cancer ,radiochemotherapy ,Dose Fractionation, Radiation ,business ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] - Abstract
Contains fulltext : 235407.pdf (Publisher’s version ) (Closed access) BACKGROUND: Randomised, controlled trials and meta-analyses have shown the survival benefit of concomitant chemoradiotherapy or hyperfractionated radiotherapy in the treatment of locally advanced head and neck cancer. However, the relative efficacy of these treatments is unknown. We aimed to determine whether one treatment was superior to the other. METHODS: We did a frequentist network meta-analysis based on individual patient data of meta-analyses evaluating the role of chemotherapy (Meta-Analysis of Chemotherapy in Head and Neck Cancer [MACH-NC]) and of altered fractionation radiotherapy (Meta-Analysis of Radiotherapy in Carcinomas of Head and Neck [MARCH]). Randomised, controlled trials that enrolled patients with non-metastatic head and neck squamous cell cancer between Jan 1, 1980, and Dec 31, 2016, were included. We used a two-step random-effects approach, and the log-rank test, stratified by trial to compare treatments, with locoregional therapy as the reference. Overall survival was the primary endpoint. The global Cochran Q statistic was used to assess homogeneity and consistency and P score to rank treatments (higher scores indicate more effective therapies). FINDINGS: 115 randomised, controlled trials, which enrolled patients between Jan 1, 1980, and April 30, 2012, yielded 154 comparisons (28 978 patients with 19 253 deaths and 20 579 progression events). Treatments were grouped into 16 modalities, for which 35 types of direct comparisons were available. Median follow-up based on all trials was 6·6 years (IQR 5·0-9·4). Hyperfractionated radiotherapy with concomitant chemotherapy (HFCRT) was ranked as the best treatment for overall survival (P score 97%; hazard ratio 0·63 [95% CI 0·51-0·77] compared with locoregional therapy). The hazard ratio of HFCRT compared with locoregional therapy with concomitant chemoradiotherapy with platinum-based chemotherapy (CLRT(P)) was 0·82 (95% CI 0·66-1·01) for overall survival. The superiority of HFCRT was robust to sensitivity analyses. Three other modalities of treatment had a better P score, but not a significantly better HR, for overall survival than CLRT(P) (P score 78%): induction chemotherapy with taxane, cisplatin, and fluorouracil followed by locoregional therapy (IC(TaxPF)-LRT; 89%), accelerated radiotherapy with concomitant chemotherapy (82%), and IC(TaxPF) followed by CLRT (80%). INTERPRETATION: The results of this network meta-analysis suggest that further intensifying chemoradiotherapy, using HFCRT or IC(TaxPF)-CLRT, could improve outcomes over chemoradiotherapy for the treatment of locally advanced head and neck cancer. FUNDINGS: French Institut National du Cancer, French Ligue Nationale Contre le Cancer, and Fondation ARC. more...
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- 2021
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5. Traitement du cancer de la prostate localisé à l’apex par curiethérapie ou ultrasons focalisés
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G. Fiard, S. Crouzet, P. Graff-Cailleaud, Service d'urologie [CHU Grenoble], Centre Hospitalier Universitaire [Grenoble] (CHU), Service de radiothérapie / curiethérapie, Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER-Université de Lille-UNICANCER, and Université Lille Nord de France (COMUE)-UNICANCER-Université Lille Nord de France (COMUE)-UNICANCER more...
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03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Urology ,[SDV]Life Sciences [q-bio] ,030218 nuclear medicine & medical imaging - Abstract
Resume Nous rapportons le cas d’un patient de 64 ans presentant un cancer de la prostate de bon pronostic localise au niveau de l’apex, visible en IRM, pour lequel la possibilite d’un traitement par curietherapie exclusive ou ultrasons focalisee est discutee. Les indications, resultats et limites des deux techniques sont presentes. more...
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- 2020
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6. [Concurrent chemoradiotherapy for head neck cancers. Should organs at risk dose constraints be revisited ?]
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P. Graff-Cailleaud, Julian Biau, Michel Lapeyre, J. Miroir, S. Racadot, L. Brun, B. Gleyzolle, J. Moreau, Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), UNICANCER, Centre Léon Bérard [Lyon], Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), and CCSD, Accord Elsevier more...
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Larynx ,medicine.medical_specialty ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Urology ,03 medical and health sciences ,0302 clinical medicine ,Mucositis ,medicine ,Chemotherapy ,Radiology, Nuclear Medicine and imaging ,Head and neck cancer ,MESH: Radiotherapy Dosage ,Radiothérapie ,MESH: Chemoradiotherapy ,MESH: Humans ,MESH: Organs at Risk ,Radiotherapy ,business.industry ,medicine.disease ,3. Good health ,Parotid gland ,Organes à risque ,Radiation therapy ,MESH: Head and Neck Neoplasms ,[SDV] Life Sciences [q-bio] ,Organs at risk ,medicine.anatomical_structure ,Oncology ,Dose ,030220 oncology & carcinogenesis ,Concomitant ,Cancers des VADS ,Toxicity ,business ,Chimiothérapie - Abstract
International audience; Concurrent chemoradiotherapy improves the outcome of locally advanced head and neck cancers and the current reference chemotherapy is cisplatin. These results are obtained at the cost of increased toxicities. To limit the risk of toxicity, organ at riskdose constraints have been established starting with 2D radiotherapy, then 3D radiotherapy and intensity-modulated radiotherapy. Regarding grade ≥3 acute toxicities, the scientific literature attests that concurrent chemoradiotherapy significantly increases risks of mucositis and dysphagia. Constraints applied to the oral mucosa volume excluding the planning target volume, the pharyngeal constrictor muscles and the larynx limit this adverse impact. Regarding late toxicity, concurrent chemoradiotherapy increases significantly the risk of postoperative neck fibrosis and hearing loss. However, for some organs at risk, concurrent chemotherapy appears to increase late radiation induced effect, even though the results are less marked (brachial plexus, mandible, pharyngeal constrictor muscles, parotid gland). This additional adverse impact of concomitant chemotherapy may be notable only when organs at risk receive less than their usual dose thresholds and this would be vanished when those thresholds are exceeded as seems to be the situation for the parotid glands. Until the availability of more robust data, it seems appropriate to apply the principle of delivering dose to organs at risk as low as reasonably achievable. more...
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- 2020
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7. Curiethérapie de la prostate : évolutions des indications et des techniques
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Pierre Blanchard, P Graff-Cailleaud, and Alberto Bossi
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medicine.medical_specialty ,business.industry ,Prostatectomy ,medicine.medical_treatment ,Brachytherapy ,medicine.disease ,High-Dose Rate Brachytherapy ,030218 nuclear medicine & medical imaging ,Late toxicity ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Radiology, Nuclear Medicine and imaging ,External beam radiotherapy ,Radiology ,business ,Radiation treatment planning ,Prostate brachytherapy - Abstract
Prostate brachytherapy has been for a long time one of the standard treatments for low risk prostate cancer, with high rates of biochemical control and low levels of urinary and sexual late toxicity compared to other available techniques, namely external beam radiotherapy and radical prostatectomy. The aim of this article is to review the recent innovations of prostate brachytherapy, which suggest a bright future for the technique. We will discuss the extension of indications of permanent implant brachytherapy to favorable intermediate-risk patients, the use of novel isotopes such as Palladium 103 and Cesium 131, and the benefit of brachytherapy as a boost following external beam radiotherapy for intermediate and high-risk patients. We will also discuss the rise of high dose rate brachytherapy, as a boost or monotherapy, the increasing use of MRI for patient selection and treatment planning, as well as the development of brachytherapy as a means of focal therapy. more...
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- 2018
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8. Validation interne au GORTEC du consensus international de délinéation des CTV-P pour les cancers des VADS (méthode de consensus formalisé) : résultats des phases de cotation
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Yungan Tao, P. Boisselier, Yoann Pointreau, Jean Bourhis, M. Alfonsi, Michel Lapeyre, Julian Biau, Laurent Martin, Florence Huguet, P. Graff-Cailleaud, Séverine Racadot, Pierre Blanchard, Joël Castelli, X. Sun, Christian Sire, and Juliette Thariat more...
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Oncology ,Philosophy ,Radiology, Nuclear Medicine and imaging ,Humanities - Abstract
Introduction et but de l’etude Le consensus international de delineation des volumes cible anatomocliniques tumoraux des carcinomes epidermoides des voies aerodigestives superieures a propose l’application de marges d’expansion geometriques autour du volume tumoral macroscopique (5 + 5 mm avec adaptation par localisation) selon le concept du Danish Head and Neck Cancer Group (DAHANCA). Il offre l’avantage d’une standardisation des pratiques mais la methodologie d’obtention de ce consensus fait defaut. Ce changement de pratique a pousse le Groupe d’oncologie radiotherapie tete et cou (Gortec) a la mise en place d’une demarche de validation interne. Materiel et methodes La methode utilisee etait celle du consensus formalise de la Haute autorite de sante (HAS) qui permet de formaliser le degre d’accord et fonder des recommandations par deux phases de cotations iteratives suivies d’une etape de lecture de propositions definitives. Les cotations variaient de 1 a 9. Les propositions etaient jugees appropriees si la mediane des cotations etait superieure ou egale a 7 (extremes : 5-9), inappropriees si elle etait inferieure ou egale a 3,5 (extremes : 1-5) ; incertaines pour les autres valeurs. La cotation sur le degre d’accord selon Lee et al. etait utilisee en complement (≥ 85 % : haut, 75-84 % : modere ; Resultats et analyse statistique Le chapitre « General description of the procedure for the primary tumour (CTV-P) delineation » comportait 13 propositions. Neuf etaient cotees appropriees et quatre incertaines avec des degres d’accord moderes a hauts (77 a 92 %). Le chapitre « Guidelines for the delineation of the primary tumour CTV site by site » precisant la delineation organe par organe selon le stade T comportait 32 propositions. Elles etaient toutes jugees incertaines avec des degres d’accord faibles (47-69 %). Seules les propositions sur les T1 (volumes cible anatomocliniques P1 et P2) avaient un degre d’accord modere (84,5 %). Le chapitre « Discussion : Limit of validity and A word of caution » comportait quatre propositions. Deux etaient jugees appropriees et deux incertaines avec des degres d’accord hauts (92 a 100 %). Les huit items sur les choix proposes par le Gortec etaient appropries pour cinq, incertains pour deux et inapproprie pour un. La proposition d’appliquer strictement le concept geometrique etait jugee inappropriee avec 0 % d’accord. La proposition de s’orienter vers une approche « geoanatomique » consistant a debuter la delineation du volume cible anatomoclinique P2 selon le concept geometrique puis d’etendre cette delineation selon le concept anatomique des voies d’extension tumorale, etait jugee appropriee avec un haut degre d’accord (100 %). Conclusion Les resultats des phases de cotation s’orientent vers une validation interne par le Gortec du consensus complete par une approche « geoanatomique » pour la delineation du volume cible anatomoclinique P2. Les resultats de la derniere etape de lecture devraient etre disponibles le jour du congres. more...
- Published
- 2020
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9. [Indications and outlooks of radiohormonal therapy of high-risk prostate cancers]
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I, Latorzeff, P, Sargos, G, Créhange, Y, Belkacémi, D, Azria, A, Hasbini, T, Dubergé, A, Toledano, P, Graff-Cailleaud, O, Chapet, C, Hennequin, R, de Crevoisier, S, Supiot, and D, Pasquier
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Male ,Antineoplastic Agents, Hormonal ,Brachytherapy ,Humans ,Prostatic Neoplasms ,Androgen Antagonists ,Radiotherapy Dosage ,Chemoradiotherapy ,Neoplasm Grading ,Prostate-Specific Antigen ,Prognosis ,Randomized Controlled Trials as Topic - Abstract
Prostate cancer is a sensitive adenocarcinoma, in more than 80% of cases, to chemical castration, due to its hormone dependence. Locally advanced and/or high-risk cancer is defined based on clinical stage, initial prostate specific antigen serum concentration value or high Gleason score. Hormone therapy associated with radiation therapy is the standard of management and improves local control, reduces the risk of distant metastasis and improves specific and overall survival. Duration of hormone therapy, dose level of radiation therapy alone or associated with brachytherapy are controversial data in the literature. The therapeutic choice, multidisciplinary, depends on the age and comorbidity of the patient, the prognostic criteria of the pathology and the urinary function of the patient. Current research focuses on optimizing local and distant control of these aggressive forms and incorporates neoadjuvant or adjuvant chemotherapy and also new hormone therapies. more...
- Published
- 2019
10. Managing Discordant Findings Between Multiparametric Magnetic Resonance Imaging and Transrectal Magnetic Resonance Imaging–directed Prostate Biopsy—The Key Role of Magnetic Resonance Imaging–directed Transperineal Biopsy
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Bajeot, Anne-Sophie, Covin, Bertrand, Meyrignac, Oliver, Pericart, Sarah, Aziza, Richard, Portalez, Daniel, Graff-Cailleaud, Pierre, Ploussard, Guillaume, Roumiguié, Mathieu, and Malavaud, Bernard
- Abstract
Discordant findings between multiparametric magnetic resonance imaging (mpMRI) and transrectal image-guided biopsies of the prostate (TRUS-P) may result in inadequate risk stratification of localized prostate cancer. more...
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- 2022
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11. [Prostate brachytherapy: New techniques, new indications]
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P, Blanchard, P, Graff-Cailleaud, and A, Bossi
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Male ,Brachytherapy ,Humans ,Prostatic Neoplasms ,Radiotherapy Dosage - Abstract
Prostate brachytherapy has been for a long time one of the standard treatments for low risk prostate cancer, with high rates of biochemical control and low levels of urinary and sexual late toxicity compared to other available techniques, namely external beam radiotherapy and radical prostatectomy. The aim of this article is to review the recent innovations of prostate brachytherapy, which suggest a bright future for the technique. We will discuss the extension of indications of permanent implant brachytherapy to favorable intermediate-risk patients, the use of novel isotopes such as Palladium 103 and Cesium 131, and the benefit of brachytherapy as a boost following external beam radiotherapy for intermediate and high-risk patients. We will also discuss the rise of high dose rate brachytherapy, as a boost or monotherapy, the increasing use of MRI for patient selection and treatment planning, as well as the development of brachytherapy as a means of focal therapy. more...
- Published
- 2017
12. Traitement du cancer de la prostate localisé à l'apex par curiethérapie ou ultrasons focalisés.
- Author
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Fiard, G., Graff-Cailleaud, P., and Crouzet, S.
- Abstract
Nous rapportons le cas d'un patient de 64 ans présentant un cancer de la prostate de bon pronostic localisé au niveau de l'apex, visible en IRM, pour lequel la possibilité d'un traitement par curiethérapie exclusive ou ultrasons focalisée est discutée. Les indications, résultats et limites des deux techniques sont présentés. We describe the case of a 64-year-old patient presenting with low-risk localized prostate cancer of the apex, visible on MRI. We discuss the possibility of treating with brachytherapy of focused ultrasound. Indications, results and limitations of both techniques are presented. [ABSTRACT FROM AUTHOR] more...
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- 2020
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13. PO-0812: Dosimetric impact of using Acuros algorithm for stereotactic lung and spine treatments
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Laure Vieillevigne, A. Tournier, J.M. Bachaud, C. Massabeau, T. Younes, R. Ferrand, and P. Graff Cailleaud
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medicine.medical_specialty ,Lung ,business.industry ,Hematology ,030218 nuclear medicine & medical imaging ,Spine (zoology) ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Nuclear medicine - Published
- 2017
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14. P13. Spine SBRT: Benefit of Magnetic Resonance Imaging acquisition in treatment position and first results of Volumetric Modulated Arc Therapy dose plan
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J.M. Bachaud, P. Graff-Cailleaud, C. Massabeau, R. Aziza, Y. Sekkal, N. Morel, A. Tournier, L. Parent, and S. Ken
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medicine.diagnostic_test ,business.industry ,Biophysics ,Planning target volume ,General Physics and Astronomy ,Gross Target Volume ,Magnetic resonance imaging ,General Medicine ,Volumetric modulated arc therapy ,Position (vector) ,Coronal plane ,medicine ,Radiology, Nuclear Medicine and imaging ,business ,Nuclear medicine ,Stereotactic body radiotherapy ,Biomedical engineering ,Volume (compression) - Abstract
Purpose In stereotactic body radiotherapy (SBRT), high-gradient dose is delivered and target volumes have to be delineated precisely in order to avoid irradiation of healthy tissue. Magnetic Resonance Imaging (MRI) acquisition in treatment position allows same spine curvature reproduction and shows to be useful to delineate organs at risk such as spinal cord. The aim of this study is to report the benefit of setting out an imaging protocol optimized for SBRT planning and to present a Volumetric Modulated Arc Therapy (VMAT) methodology to treat spine metastasis. Material and methods Patient immobilization and positioning was first set up at the GE Healthcare Planning CT scan with dedicated thermo-plastic nets, supports and cushions. An MR compatible table was designed by Orfit Industries and approved for testing by Siemens Healthcare. The same patient’s immobilization devices were used at the MR scan to perform optimized imaging series to reproduce treatment position. At the 1.5T Siemens Aera MR scan, head and body ex coils were used and imaging sequences were optimized to account for the table and immobilization devices. Coronal 3D Turbo Spin Echo T2-weighted and T1-weighted (3D TSE T2-w and 3D T1-w TSE) had the same acquisition matrix size and field-of-view with 1.00 mm slice thickness, resulting in isotropic voxel size of 1.00 mm3. TR/TE were 1100 ms/132 ms (T2-w) and 400 ms/18 ms (T1-w), respectively. Gross Target Volume (GTV) was contoured as the visible lesion on CT scan or hyper-signal on MR images. Clinical Target Volume was delineated upon GTV location according to [1]. The Planning Target Volume was defined as CTV + 2 mm. An optimized PTV was created: PTV2 = [PTV { (medullary canal + (spinal cord + 3 mm))]. VMAT dose plans were performed with AAA algorithm (Eclipse v11), 6MV fields and 1 mm calculation grid. The prescription was 3 * 9 Gy on the median volume of the PTV2. We compared different methods to decrease the dose outside the PTV2 (NTO function (Normal Tissue Objective) vs; NTO automatic vs. rings). A second study was performed to compare different configurations: 2 coplanar 360° arcs (collimators 15°/345° or 100°/80°) and 4 coplanar 360° arcs (collimators 15°/345/100°/80°). Results There was no problem of registration on the spine curvature between CT and MR images thanks to the table and immobilization devices (Fig. 1A). Examples of MR/Planning CT registration with benefit for target volume and organs at risk delineation are illustrated on Fig. 1B. Different geometries of PTV were considered, when spinous process was involved, 4 arcs are needed to better conform the PTV and respect the dose to the spinal cord. Dose plans reach good coverage of PTV2 (95% PTV received 96.8% of the prescribed dose), maximum dose for PTV2 was 105%. For the spinal cord +2 mm, max dose was 19.85 Gy, V11.1 Gy = 0.64 cc and V18Gy Conclusion Optimized imaging protocol in RT treatment position allows high precision registration with planning CT scan for a better delineation of target volume and organs at risk. All dose planning simulations fulfilled [1] , [2] , [3] the international recommendations. Download : Download high-res image (342KB) Download : Download full-size image more...
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- 2016
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15. Traitement médical ou chirurgical des cancers de l’oropharynx : place du statut p16 dans la décision thérapeutique ?
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Amélie Lusque, S. Vergez, Jean Pierre Delord, A. Modesto, E. Uro-Costes, P. Graff-Cailleaud, Anne Laprie, T. Galissier, Michel Rives, and J. Sarini
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Oncology ,Radiology, Nuclear Medicine and imaging - Abstract
Objectif de l’etude Une approche medicale par (chimio)radiotherapie ou chirurgicale (chirurgie avec ou sans radiotherapie adjuvante) represente deux alternatives therapeutiques curatives des cancers oropharynges. Le choix de l’une ou de l’autre option reste controverse. La surexpression de p16 represente un facteur pronostique majeur pour ces patients, mais sa valeur predictive n’est pas connue. Nous rapportons les resultats en termes de controle tumoral et de toxicite stratifies sur le statut p16 d’une cohorte de patients traites par radio(chimio)therapie ou (radio)chirurgie. Materiel et methode il s’agit d’une etude retrospective incluant l’ensemble des patients pris en charge a visee curative pour un carcinome epidermoide oropharynge entre 2009 et 2013 dans notre institution. Les toxicites tardives ont ete gradees selon la Common Terminology Criteria for Adverse Events (CTCAE) v4.3 apres un delai minimal de 6 mois de la fin de tout traitement en l’absence de recidive locoregionale. Une relecture centralisee du statut p16 en immunohistochimie a ete effectuee. Resultats Parmi les 183 patients inclus, il y avait chez 89 (49 %) une surexpression de p16. Apres un suivi median de 4,7 ans, la probabilite de survie sans maladie a 3 ans variait selon les strategies therapeutiques, 66 % apres (chimio)radiotherapie et 33 % apres (radio)chirurgie (p = 0,002) en l’absence de surexpression de p16 et 83 % contre 82 % en presence (p = 0,48) pour les patients p16+. En presence d’une surexpression de p16, le taux de dysphagie tardive severe (de grade 3 ou plus) etait significativement plus important apres le traitement chirurgical qu’apres le traitement medical : 35 % contre 4 % (p = 0,004). Conclusion Notre etude met en evidence des taux de survie significativement variables apres traitement chirurgical ou medical en fonction du statut p16 des patients. Cette donnee aisement accessible dans la pratique clinique peut s’averer utile a la decision therapeutique. La valeur predictive du statut p16 devra etre validee par des donnees prospectives. more...
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- 2017
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16. Setting up for prostate focal brachytherapy at the Institut Universitaire du Cancer of Toulouse: Aspects of multi-modal registration and dosimetric feasibility
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D. Portalez, R. Aziza, C. Popotte, Régis Ferrand, M. Delannes, P. Graff-Cailleaud, B. Malayaud, T. Brun, S. Ken, and J.M. Bachaud
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Brachytherapy ,Biophysics ,General Physics and Astronomy ,Cancer ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Prostate ,Medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,business - Published
- 2015
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17. Estimation de la dose fœtale par mesure de dose lors d'une irradiation d'une tumeur de la parotide
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Alain Noel, P. Graff-Cailleaud, Didier Peiffert, and Vincent Marchesi
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Oncology ,Radiology, Nuclear Medicine and imaging - Published
- 2006
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18. Dosimetric comparison between conformal radiation therapy and intensity modulated radiation therapy for high-dose prostate radiation. A paradoxical increased dose to the anterior rectal wall
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Christian Marchal, Marc A. Bollet, Vincent Marchesi, Didier Peiffert, Pierre Aletti, Valérie Bernier, Pierre Bey, P. Graff-Cailleaud, and V. Beckendorf
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Cancer Research ,medicine.medical_specialty ,Radiation ,business.industry ,Conformal radiation therapy ,Intensity-modulated radiation therapy ,medicine.anatomical_structure ,Oncology ,Rectal wall ,Prostate ,medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,business ,Nuclear medicine - Published
- 2003
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19. Classification des discordances radio-anatomopathologiques des biopsies transrectales guidées par l’IRM
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Bajeot, A., Covin, B., Thoulouzan, M., Doumerc, N., Graff-Cailleaud, P., Aziza, R., Meyrignac, O., Soulié, M., Sarah, S., Roumiguié, M., and Malavaud, B.
- Abstract
L’AFU recommande la réalisation de biopsies guidées par l’IRM afin d’améliorer l’évaluation pré-thérapeutique de l’agressivité tumorale. Cela suppose que la chaîne associant l’imagerie, aux biopsies soit de parfaite qualité malgré la multiplicité des intervenants, interrogeant toute discordance. Nous confrontons systématiquement biopsies et imagerie et rapportons ici la proportion de discordance des biopsies ciblées par voie transrectale selon l’une ou l’autre de trois définitions prédéfinies. more...
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- 2020
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20. GETUG-AFU 17 : étude de phase III randomisée comparant la radiothérapie adjuvante à la radiothérapie de rattrapage précoce, combinées à l’hormonothérapie courte, pour les patients présentant un cancer de la prostate traité par prostatectomie radicale
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Sargos, P., Chabaud, S., Latorzeff, I., Magné, N., Benyoucef, A., Supiot, S., Pasquier, D., Abdiche, S., Gilliot, O., Graff-Cailleaud, P., Silva, M., Bergerot, P., Baumann, P., Belkacemi, Y., Azria, D., Brihou, M., Soulié, M., and Richaud, P. more...
- Abstract
La radiothérapie adjuvante (aRT) réduit le risque de rechute biochimique chez les patients atteints d’un cancer de la prostate traités par une prostatectomie radicale (RP). L’étude GETUG-AFU 17 ;a comparé l’efficacité et la toxicité de l’aRT par rapport à la radiothérapie de rattrapage précoce (sRT), associée à un traitement hormonal. more...
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- 2020
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21. P13. Spine SBRT: Benefit of Magnetic Resonance Imaging acquisition in treatment position and first results of Volumetric Modulated Arc Therapy dose plan.
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Tournier, A., Parent, L., Graff-Cailleaud, P., Massabeau, C., Bachaud, J.M., Aziza, R., Sekkal, Y., Morel, N., and Ken, S.
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Purpose In stereotactic body radiotherapy (SBRT), high-gradient dose is delivered and target volumes have to be delineated precisely in order to avoid irradiation of healthy tissue. Magnetic Resonance Imaging (MRI) acquisition in treatment position allows same spine curvature reproduction and shows to be useful to delineate organs at risk such as spinal cord. The aim of this study is to report the benefit of setting out an imaging protocol optimized for SBRT planning and to present a Volumetric Modulated Arc Therapy (VMAT) methodology to treat spine metastasis. Material and methods Patient immobilization and positioning was first set up at the GE Healthcare Planning CT scan with dedicated thermo-plastic nets, supports and cushions. An MR compatible table was designed by Orfit Industries and approved for testing by Siemens Healthcare. The same patient’s immobilization devices were used at the MR scan to perform optimized imaging series to reproduce treatment position. At the 1.5T Siemens Aera MR scan, head and body ex coils were used and imaging sequences were optimized to account for the table and immobilization devices. Coronal 3D Turbo Spin Echo T2-weighted and T1-weighted (3D TSE T2-w and 3D T1-w TSE) had the same acquisition matrix size and field-of-view with 1.00 mm slice thickness, resulting in isotropic voxel size of 1.00 mm 3 . TR/TE were 1100 ms/132 ms (T2-w) and 400 ms/18 ms (T1-w), respectively. Gross Target Volume (GTV) was contoured as the visible lesion on CT scan or hyper-signal on MR images. Clinical Target Volume was delineated upon GTV location according to [1]. The Planning Target Volume was defined as CTV + 2 mm. An optimized PTV was created: PTV2 = [PTV { (medullary canal + (spinal cord + 3 mm))]. VMAT dose plans were performed with AAA algorithm (Eclipse v11), 6MV fields and 1 mm calculation grid. The prescription was 3 * 9 Gy on the median volume of the PTV2. We compared different methods to decrease the dose outside the PTV2 (NTO function (Normal Tissue Objective) vs; NTO automatic vs. rings). A second study was performed to compare different configurations: 2 coplanar 360° arcs (collimators 15°/345° or 100°/80°) and 4 coplanar 360° arcs (collimators 15°/345/100°/80°). Results There was no problem of registration on the spine curvature between CT and MR images thanks to the table and immobilization devices (Fig. 1A). Examples of MR/Planning CT registration with benefit for target volume and organs at risk delineation are illustrated on Fig. 1B. Different geometries of PTV were considered, when spinous process was involved, 4 arcs are needed to better conform the PTV and respect the dose to the spinal cord. Dose plans reach good coverage of PTV2 (95% PTV received 96.8% of the prescribed dose), maximum dose for PTV2 was 105%. For the spinal cord +2 mm, max dose was 19.85 Gy, V11.1 Gy = 0.64 cc and V18Gy <0.01 cc. Conclusion Optimized imaging protocol in RT treatment position allows high precision registration with planning CT scan for a better delineation of target volume and organs at risk. All dose planning simulations fulfilled [1–3] the international recommendations. [ABSTRACT FROM AUTHOR] more...
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- 2016
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22. SUN-LB280: Double Blind Multicenter Phase III Gortec Trial Evaluating the Efficacy of Oral Immune Modulating Formulae Therapy During Adjuvant Chemoradiotherapy in Head and Neck Squamous Cell Carcinoma (HNSCC).
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Senesse, P.F., Graff-Cailleaud, P., Sire, C., Gallocher, O., Lavau-Denes, S., Garcia-Ramirez, M., Alfonsi, M., Cupissol, D., Kaminsky, M.-C., Fiore, S., Flori, N., de Forges, H., Garrel, R., Janiszewski, C., Thézénas, S., and Boisselier, P. more...
- Published
- 2016
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23. 36 - Setting up for prostate focal brachytherapy at the Institut Universitaire du Cancer of Toulouse: Aspects of multi-modal registration and dosimetric feasibility.
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Popotte, C., Ken, S., Bachaud, J.M., Graff-Cailleaud, P., Malayaud, B., Delannes, M., Portalez, D., Aziza, R., Ferrand, R., and Brun, T.
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- 2015
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24. Consolidative Radiotherapy for Metastatic Urothelial Bladder Cancer Patients with No Progression and with No More than Five Residual Metastatic Lesions Following First-Line Systemic Therapy: A Retrospective Analysis.
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Aboudaram A, Chaltiel L, Pouessel D, Graff-Cailleaud P, Benziane-Ouaritini N, Sargos P, Schick U, Créhange G, Cohen-Jonathan Moyal E, Chevreau C, and Khalifa J
- Abstract
Local consolidative radiotherapy in the treatment of metastatic malignancies has shown promising results in several types of tumors. The objective of this study was to assess consolidative radiotherapy to the bladder and to residual metastases in metastatic urothelial bladder cancer with no progression following first-line systemic therapy., Materials/methods: Patients who received first-line therapy for the treatment of metastatic urothelial bladder cancer (mUBC) and who were progression-free following treatment with no more than five residual metastases were retrospectively identified through the database of four Comprehensive Cancer Centers, between January 2005 and December 2018. Among them, patients who received subsequent definitive radiotherapy (of EQD2Gy > 45Gy) to the bladder and residual metastases were included in the consolidative group (irradiated (IR) group), and the other patients were included in the observation group (NIR group). Progression-free survival (PFS) and overall survival (OS) were determined from the start of the first-line chemotherapy using the Kaplan-Meier method. To prevent immortal time bias, a Cox model with time-dependent covariates and 6-month landmark analyses were performed to examine OS and PFS., Results: A total of 91 patients with at least stable disease following first-line therapy and with no more than five residual metastases were analyzed: 51 in the IR group and 40 in the NIR group. Metachronous metastatic disease was more frequent in the NIR group (19% vs. 5%, p = 0.02); the median number of metastases in the IR group vs. in the NIR group was 2 (1-9) vs. 3 (1-5) ( p = 0.04) at metastatic presentation, and 1 (0-5) vs. 2 (0-5) ( p = 0.18) after completion of chemotherapy (residual lesions), respectively. Two grade 3 toxicities (3.9%) and no grade 4 toxicity were reported in the IR group related to radiotherapy. With a median follow up of 85.9 months (95% IC (36.7; 101.6)), median OS and PFS were 21.7 months (95% IC (17.1; 29.7)) and 11.1 months (95% IC (9.9; 14.1)) for the whole cohort, respectively. In multivariable analysis, consolidative radiotherapy conferred a benefit in both PFS (HR = 0.49, p = 0.007) and OS (HR = 0.47, p = 0.015) in the whole population; in the landmark analysis at 6 months, radiotherapy was associated with improved OS (HR = 0.48, p = 0.026), with a trend for PFS (HR = 0.57, p = 0.082)., Conclusion: Consolidative radiotherapy for mUBC patients who have not progressed after first-line therapy and with limited residual disease seems to confer both OS and PFS benefits. The role of consolidative radiotherapy in the context of avelumab maintenance should be addressed prospectively. more...
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- 2023
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25. [Challenges and limits of therapeutic de-escalation for papillomavirus-related oropharyngeal cancer].
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Modesto A, Graff Cailleaud P, Blanchard P, Boisselier P, and Pointreau Y
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- Humans, Neoplasm Staging, Papillomaviridae, Prognosis, Oropharyngeal Neoplasms pathology, Oropharyngeal Neoplasms therapy, Papillomavirus Infections complications
- Abstract
The incidence of HPV-related oropharyngeal cancers has been increasing in Western countries for several decades. If they are individualized within the latest TNM classification, the current standards of management do not authorize the management of these patients to be singled out. However, their distinct oncogenesis and their excellent prognosis compared to other patients has allowed the development of several clinical trials based on the question of therapeutic de-escalation. This review of the literature aims to take stock of the elements provided by clinical research in recent years., (Copyright © 2022. Published by Elsevier Masson SAS.) more...
- Published
- 2022
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26. Highly hypofractionated schedules for localized prostate cancer: Recommendations of the GETUG radiation oncology group.
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Lapierre A, Hennequin C, Beneux A, Belhomme S, Benziane Ouaritini N, Biston MC, Crehange G, de Crevoisier R, Dumas JL, Fawzi M, Lisbona A, Pasquier D, Pelissier S, Graff-Cailleaud P, Pommier P, Sargos P, Simon JM, Supiot S, Tantot F, and Chapet O more...
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- Humans, Male, Prospective Studies, Retrospective Studies, Prostatic Neoplasms radiotherapy, Prostatic Neoplasms surgery, Radiosurgery methods
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Stereotactic body radiotherapy (SBRT) has become treatment option for localized prostate cancer but the evidence base remains incomplete. Several clinical studies, both prospective and retrospective, have been published. However, treatment techniques, target volumes and dose constraints lack consistency between studies. Based on the current available literature, the French Genito-Urinary Group (GETUG) suggests that., (Copyright © 2022 Elsevier B.V. All rights reserved.) more...
- Published
- 2022
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27. Radiotherapy for oral cavity cancers.
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Lapeyre M, Racadot S, Renard S, Biau J, Moreira JF, Biston MC, Pointreau Y, Thariat J, and Graff-Cailleaud P
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- Dental Care, France, Humans, Immobilization, Mouth Neoplasms diagnostic imaging, Mouth Neoplasms pathology, Mouth Neoplasms surgery, Neck Dissection, Patient Positioning, Radiation Oncology, Radiotherapy Dosage, Brachytherapy methods, Mouth Neoplasms radiotherapy, Radiotherapy, Intensity-Modulated methods
- Abstract
Intensity modulated radiation therapy and brachytherapy are standard techniques of irradiation for the treatment of oral cavity cancers. These techniques are detailed in terms of indication, planning, delineation and selection of the volumes of interest, dosimetry and patients positioning control. This is an update of the guidelines of the French Society of Radiotherapy Correspondence., (Copyright © 2021 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.) more...
- Published
- 2022
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28. Recommendations for planning and delivery of radical radiotherapy for localized urothelial carcinoma of the bladder.
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Khalifa J, Supiot S, Pignot G, Hennequin C, Blanchard P, Pasquier D, Magné N, de Crevoisier R, Graff-Cailleaud P, Riou O, Cabaillé M, Azria D, Latorzeff I, Créhange G, Chapet O, Rouprêt M, Belhomme S, Mejean A, Culine S, and Sargos P more...
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- Humans, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted, Carcinoma, Transitional Cell, Radiotherapy, Image-Guided, Radiotherapy, Intensity-Modulated, Urinary Bladder Neoplasms diagnostic imaging, Urinary Bladder Neoplasms radiotherapy
- Abstract
Purpose: Curative radio-chemotherapy is recognized as a standard treatment option for muscle-invasive bladder cancer (MIBC). Nevertheless, the technical aspects for MIBC radiotherapy are heterogeneous with a lack of practical recommendations., Methods and Materials: In 2018, a workshop identified the need for two cooperative groups to develop consistent, evidence-based guidelines for irradiation technique in the delivery of curative radiotherapy. Two radiation oncologists performed a review of the literature addressing several topics relative to radical bladder radiotherapy: planning computed tomography acquisition, target volume delineation, radiation schedules (total dose and fractionation) and dose delivery (including radiotherapy techniques, image-guided radiotherapy (IGRT) and adaptive treatment modalities). Searches for original and review articles in the PubMed and Google Scholar databases were conducted from January 1990 until March 2020. During a meeting conducted in October 2020, results on 32 topics were presented and discussed with a working group involving 15 radiation oncologists, 3 urologists and one medical oncologist. We applied the American Urological Association guideline development's method to define a consensus strategy., Results: A consensus was obtained for all 34 except 4 items. The group did not obtain an agreement on CT enhancement added value for planning, PTV margins definition for empty bladder and full bladder protocols, and for pelvic lymph-nodes irradiation. High quality evidence was shown in 6 items; 8 items were considered as low quality of evidence., Conclusion: The current recommendations propose a homogenized modality of treatment both for routine clinical practice and for future clinical trials, following the best evidence to date, analyzed with a robust methodology. The XXX group formulates practical guidelines for the implementation of innovative techniques such as adaptive radiotherapy., (Copyright © 2021 Elsevier B.V. All rights reserved.) more...
- Published
- 2021
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29. Brachytherapy boost (BT-boost) or stereotactic body radiation therapy boost (SBRT-boost) for high-risk prostate cancer (HR-PCa).
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Peyraga G, Lizee T, Khalifa J, Blais E, Mauriange-Turpin G, Supiot S, Krhili S, Tremolieres P, and Graff-Cailleaud P
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- Androgen Antagonists therapeutic use, Brachytherapy adverse effects, Clinical Trials as Topic, Combined Modality Therapy methods, Dose Fractionation, Radiation, Humans, Male, Prospective Studies, Radiation Dose Hypofractionation, Radiosurgery adverse effects, Retrospective Studies, Brachytherapy methods, Prostatic Neoplasms radiotherapy, Radiosurgery methods
- Abstract
Systematic review for the treatment of high-risk prostate cancer (HR-PCa, D'Amico classification risk system) with external body radiation therapy (EBRT)+brachytherapy-boost (BT-boost) or with EBRT+stereotactic body RT-boost (SBRT-boost). In March 2020, 391 English citations on PubMed matched with search terms "high risk prostate cancer boost". Respectively 9 and 48 prospective and retrospective studies were on BT-boost and 7 retrospective studies were on SBRT-boost. Two SBRT-boost trials were prospective. Only one study (ASCENDE-RT) directly compared the gold standard treatment [dose-escalation (DE)-EBRT+androgen deprivation treatment (ADT)] versus EBRT+ADT+BT-boost. Biochemical control rates at 9 years were 83% in the experimental arm versus 63% in the standard arm. Cumulative incidence of late grade 3 urinary toxicity in the experimental arm and in the standard arm was respectively 18% and 5%. Two recent studies with HR-PCa (National Cancer Database) demonstrated better overall survival with BT-boost (low dose rate LDR or high dose rate HDR) compared with DE-EBRT. These recent findings demonstrate the superiority of EBRT+BT-boost+ADT versus DE-EBRT+ADT for HR-PCa. It seems that EBRT+BT-boost+ADT could now be considered as a gold standard treatment for HR-PCa. HDR or LDR are options. SBRT-boost represents an attractive alternative, but the absence of randomised trials does not allow us to conclude for HR-PCa. Prospective randomised international phase III trials or meta-analyses could improve the level of evidence of SBRT-boost for HR-PCa., (Copyright © 2020 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.) more...
- Published
- 2021
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30. Distinct Outcomes of Oropharyngeal Squamous Cell Carcinoma Patients after Distant Failure According to p16 Status: Implication in Therapeutic Options.
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Modesto A, Siegfried A, Lusque A, Vergez S, Sarini J, Brouchet L, Uro-Coste E, Graff-Cailleaud P, and Delord JP
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- Humans, Papillomaviridae, Squamous Cell Carcinoma of Head and Neck, Carcinoma, Squamous Cell therapy, Head and Neck Neoplasms, Oropharyngeal Neoplasms therapy
- Abstract
Introduction: Recent modifications in the epidemiology of oropharyngeal squamous cell carcinoma (OSCC) have led to the increase of Human papillomavirus (HPV) related metastatic head and neck cancer patients with high life expectancy even at advanced stage, low comorbidity and still restricted systemic therapy opportunities. In the recent era of ablative therapies' development, oligometastatic HPV OSCC patients are indubitably good candidates for intensified treatment. However, data related to outcomes after optimised management of metastatic sites are dramatically missing., Materials and Patients: In our cohort of 186 unselected consecutive OSCC patients treated with curative intent at our institution between 2009 and 2013, we analysed the incidence, treatment and outcomes of distant metastatic (DM) failure according to p16 status., Results: After a median follow-up of 4.2 years (95% CI: 3.8-4.4) from primary diagnosis of OSCC, 21/95 p16- patients (22.1%) vs. 8/91 (8.8%) p16+ patients presented DM failure with a median interval of 11 (range 0-46) and 28 months (range 0-71), respectively ( p = 0.10). Overall survival (OS) after DM failure was significantly higher in p16+ patients with a two-year OS rate of 75% and 15% for p16+ and p16-, respectively ( p = 0.002). In eight HPV-related metastatic patients, three underwent ablative lung metastasis treatment and are still complete responders four to five years later., Conclusion: This study highlights distinct outcomes of metastatic HPV-related OSCC patients emphasised by three long-term complete responders after lung ablative treatment. In patients with high life expectancy and limited tumour burden, the question of ablative treatment such as metastasectomy or stereotactic ablative radiotherapy (SBRT) should be addressed. more...
- Published
- 2021
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31. Laparoscopic closure of the pouch of Douglas by a peritoneal running suture. A minimally invasive and prosthetic-free technique to prevent excessive dose delivery to the small bowel during pelvic irradiation for prostate cancer.
- Author
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Loo M, Martinez-Gomez C, Khalifa J, Angeles MA, Chira C, Piram L, Martin E, Malavaud B, Ferron G, and Graff-Cailleaud P
- Abstract
Background and Purpose: Prostate radiotherapy relies on the delivery of high doses that can be obstructed when a small bowel loop descends in the pelvis. We present a laparoscopic minimally invasive prosthetic-free technique closing the Douglas' pouch with a peritoneal running suture to cordon off the bowel from the pelvis and hence allow optimal irradiation., Materials and Methods: Prostate cancer patients referred for radiotherapy and whose planning-CT revealed a bowel loop trapped in the pelvis were proposed the procedure, followed by a new planning-CT. This proof-of-concept study reports postoperative follow-up and dosimetric benefits., Results: The procedure was performed in ten patients (2016-2020) as a same-day surgery for nine. Median operative time was 34 min (range 22-50) and no relevant intraoperative complication occurred. The third patient of the series presented a small bowel hernia through the peritoneal suture at the 15th postoperative day requiring a laparotomic desincarceration without major consequences. Regarding the small bowel, median D1cc (dose to 1 cc) was 65.5 Gy and 55.5 Gy (p = 0.005) before and after procedure. Median V60 (volume receiving ≥60 Gy) was 10.2 cc and 0.0 cc (p = 0.005). In the immediate vicinity of the small bowel (5 mm), median D1cc was 68.3 Gy and 57.7 Gy (p = 0.005). Radiotherapy was safely delivered to all patients., Conclusion: Laparoscopic closure of the Douglas' pouch by a peritoneal suture is an efficient technique to cordon off inconvenient ectopic small bowel loops. It prevents excessive bowel irradiation and hence facilitates curative prostate radiotherapy. The technique could be applied to other pelvic malignancies., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Author(s).) more...
- Published
- 2020
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32. Adjuvant radiotherapy versus early salvage radiotherapy plus short-term androgen deprivation therapy in men with localised prostate cancer after radical prostatectomy (GETUG-AFU 17): a randomised, phase 3 trial.
- Author
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Sargos P, Chabaud S, Latorzeff I, Magné N, Benyoucef A, Supiot S, Pasquier D, Abdiche MS, Gilliot O, Graff-Cailleaud P, Silva M, Bergerot P, Baumann P, Belkacemi Y, Azria D, Brihoum M, Soulié M, and Richaud P more...
- Subjects
- Adenocarcinoma drug therapy, Adenocarcinoma pathology, Adenocarcinoma surgery, Aged, Disease Progression, France, Humans, Male, Male Urogenital Diseases epidemiology, Male Urogenital Diseases etiology, Medical Overuse prevention & control, Middle Aged, Prostatic Neoplasms drug therapy, Prostatic Neoplasms pathology, Prostatic Neoplasms surgery, Radiotherapy, Adjuvant adverse effects, Survival Analysis, Treatment Outcome, Adenocarcinoma radiotherapy, Androgen Antagonists administration & dosage, Prostatectomy, Prostatic Neoplasms radiotherapy, Salvage Therapy adverse effects
- Abstract
Background: Adjuvant radiotherapy reduces the risk of biochemical progression in prostate cancer patients after radical prostatectomy. We aimed to compare adjuvant versus early salvage radiotherapy after radical prostatectomy, combined with short-term hormonal therapy, in terms of oncological outcomes and tolerance., Methods: GETUG-AFU 17 was a randomised, open-label, multicentre, phase 3 trial done at 46 French hospitals. Men aged at least 18 years who had an Eastern Cooperative Oncology Group performance status of 1 or less, localised adenocarcinoma of the prostate treated with radical prostatectomy, who had pathologically-staged pT3a, pT3b, or pT4a (with bladder neck invasion), pNx (without pelvic lymph nodes dissection), or pN0 (with negative lymph nodes dissection) disease, and who had positive surgical margins were eligible for inclusion in the study. Eligible patients were randomly assigned (1:1) to either immediate adjuvant radiotherapy or delayed salvage radiotherapy at the time of biochemical relapse. Random assignment, by minimisation, was done using web-based software and stratified by Gleason score, pT stage, and centre. All patients received 6 months of triptorelin (intramuscular injection every 3 months). The primary endpoint was event-free survival. Efficacy and safety analyses were done on the intention-to-treat population. The trial is registered with ClinicalTrials.gov, NCT00667069., Findings: Between March 7, 2008, and June 23, 2016, 424 patients were enrolled. We planned to enrol 718 patients, with 359 in each study group. However, on May 20, 2016, the independent data monitoring committee recommended early termination of enrolment because of unexpectedly low event rates. At database lock on Dec 19, 2019, the overall median follow-up time from random assignment was 75 months (IQR 50-100), 74 months (47-100) in the adjuvant radiotherapy group and 78 months (52-101) in the salvage radiotherapy group. In the salvage radiotherapy group, 115 (54%) of 212 patients initiated study treatment after biochemical relapse. 205 (97%) of 212 patients started treatment in the adjuvant group. 5-year event-free survival was 92% (95% CI 86-95) in the adjuvant radiotherapy group and 90% (85-94) in the salvage radiotherapy group (HR 0·81, 95% CI 0·48-1·36; log-rank p=0·42). Acute grade 3 or worse toxic effects occurred in six (3%) of 212 patients in the adjuvant radiotherapy group and in four (2%) of 212 patients in the salvage radiotherapy group. Late grade 2 or worse genitourinary toxicities were reported in 125 (59%) of 212 patients in the adjuvant radiotherapy group and 46 (22%) of 212 patients in the salvage radiotherapy group. Late genitourinary adverse events of grade 2 or worse were reported in 58 (27%) of 212 patients in the adjuvant radiotherapy group versus 14 (7%) of 212 patients in the salvage radiotherapy group (p<0·0001). Late erectile dysfunction was grade 2 or worse in 60 (28%) of 212 in the adjuvant radiotherapy group and 17 (8%) of 212 in the salvage radiotherapy group (p<0·0001)., Interpretation: Although our analysis lacked statistical power, we found no benefit for event-free survival in patients assigned to adjuvant radiotherapy compared with patients assigned to salvage radiotherapy. Adjuvant radiotherapy increased the risk of genitourinary toxicity and erectile dysfunction. A policy of early salvage radiotherapy could spare men from overtreatment with radiotherapy and the associated adverse events., Funding: French Health Ministry and Ipsen., (Copyright © 2020 Elsevier Ltd. All rights reserved.) more...
- Published
- 2020
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33. [Concurrent chemoradiotherapy for head neck cancers. Should organs at risk dose constraints be revisited ?]
- Author
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Lapeyre M, Biau J, Miroir J, Moreau J, Gleyzolle B, Brun L, Racadot S, and Graff-Cailleaud P
- Subjects
- Humans, Radiotherapy Dosage, Chemoradiotherapy adverse effects, Chemoradiotherapy methods, Head and Neck Neoplasms therapy, Organs at Risk radiation effects
- Abstract
Concurrent chemoradiotherapy improves the outcome of locally advanced head and neck cancers and the current reference chemotherapy is cisplatin. These results are obtained at the cost of increased toxicities. To limit the risk of toxicity, organ at riskdose constraints have been established starting with 2D radiotherapy, then 3D radiotherapy and intensity-modulated radiotherapy. Regarding grade ≥3 acute toxicities, the scientific literature attests that concurrent chemoradiotherapy significantly increases risks of mucositis and dysphagia. Constraints applied to the oral mucosa volume excluding the planning target volume, the pharyngeal constrictor muscles and the larynx limit this adverse impact. Regarding late toxicity, concurrent chemoradiotherapy increases significantly the risk of postoperative neck fibrosis and hearing loss. However, for some organs at risk, concurrent chemotherapy appears to increase late radiation induced effect, even though the results are less marked (brachial plexus, mandible, pharyngeal constrictor muscles, parotid gland). This additional adverse impact of concomitant chemotherapy may be notable only when organs at risk receive less than their usual dose thresholds and this would be vanished when those thresholds are exceeded as seems to be the situation for the parotid glands. Until the availability of more robust data, it seems appropriate to apply the principle of delivering dose to organs at risk as low as reasonably achievable., (Copyright © 2020 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.) more...
- Published
- 2020
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34. [Indications and outlooks of radiohormonal therapy of high-risk prostate cancers].
- Author
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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, and Pasquier D
- Subjects
- Androgen Antagonists therapeutic use, Brachytherapy, Humans, Male, Neoplasm Grading, Prognosis, Prostate-Specific Antigen blood, Prostatic Neoplasms blood, Prostatic Neoplasms complications, Prostatic Neoplasms pathology, Radiotherapy Dosage, Randomized Controlled Trials as Topic, Antineoplastic Agents, Hormonal therapeutic use, Chemoradiotherapy methods, Prostatic Neoplasms therapy
- Abstract
Prostate cancer is a sensitive adenocarcinoma, in more than 80% of cases, to chemical castration, due to its hormone dependence. Locally advanced and/or high-risk cancer is defined based on clinical stage, initial prostate specific antigen serum concentration value or high Gleason score. Hormone therapy associated with radiation therapy is the standard of management and improves local control, reduces the risk of distant metastasis and improves specific and overall survival. Duration of hormone therapy, dose level of radiation therapy alone or associated with brachytherapy are controversial data in the literature. The therapeutic choice, multidisciplinary, depends on the age and comorbidity of the patient, the prognostic criteria of the pathology and the urinary function of the patient. Current research focuses on optimizing local and distant control of these aggressive forms and incorporates neoadjuvant or adjuvant chemotherapy and also new hormone therapies., (Copyright © 2020 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.) more...
- Published
- 2020
- Full Text
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35. Short-term androgen deprivation therapy combined with radiotherapy as salvage treatment after radical prostatectomy for prostate cancer (GETUG-AFU 16): a 112-month follow-up of a phase 3, randomised trial.
- Author
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Carrie C, Magné N, Burban-Provost P, Sargos P, Latorzeff I, Lagrange JL, Supiot S, Belkacemi Y, Peiffert D, Allouache N, Dubray BM, Servagi-Vernat S, Suchaud JP, Crehange G, Guerif S, Brihoum M, Barbier N, Graff-Cailleaud P, Ruffion A, Dussart S, Ferlay C, and Chabaud S more...
- Subjects
- Adenocarcinoma pathology, Adenocarcinoma surgery, Aged, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Prostatic Neoplasms pathology, Prostatic Neoplasms surgery, Survival Rate, Adenocarcinoma therapy, Androgen Antagonists therapeutic use, Chemoradiotherapy mortality, Prostatectomy mortality, Prostatic Neoplasms therapy, Radiotherapy, Conformal mortality, Salvage Therapy
- Abstract
Background: Radiotherapy is the standard salvage treatment after radical prostatectomy. To date, the role of androgen deprivation therapy has not been formally shown. In this follow-up study, we aimed to update the results of the GETUG-AFU 16 trial, which assessed the efficacy of radiotherapy plus androgen suppression versus radiotherapy alone., Methods: GETUG-AFU 16 was an open-label, multicentre, phase 3, randomised, controlled trial that enrolled men (aged ≥18 years) with Eastern Cooperative Oncology Group performance status of 0 or 1, with histologically confirmed adenocarcinoma of the prostate (but no previous androgen suppression or pelvic radiotherapy), stage pT2, T3, or T4a (bladder neck involvement only) and pN0 or pNx according to the tumour, node, metastasis (TNM) staging system, whose prostate-specific antigen (PSA) concentration increased from 0·1 ng/mL to between 0·2 ng/mL and 2·0 ng/mL after radical prostatectomy, without evidence of clinical disease. Patients were assigned through central randomisation (1:1) to short-term androgen suppression (subcutaneous injection of 10·8 mg goserelin on the first day of irradiation and 3 months later) plus radiotherapy (3D conformal radiotherapy or intensity modulated radiotherapy of 66 Gy in 33 fractions, 5 days a week for 7 weeks) or radiotherapy alone. Randomisation was stratified using a permuted block method (block sizes of two and four) according to investigational site, radiotherapy modality, and prognosis. The primary endpoint was progression-free survival in the intention-to-treat population. This post-hoc one-shot data collection done 4 years after last data cutoff included patients who were alive at the time of the primary analysis and updated long-term patient status by including dates for first local progression, metastatic disease diagnosis, or death (if any of these had occurred) or the date of the last tumour evaluation or last PSA measurement. Survival at 120 months was reported. Late serious adverse effects were assessed. This trial is registered on ClinicalTrials.gov, NCT00423475., Findings: Between Oct 19, 2006, and March 30, 2010, 743 patients were randomly assigned, 374 to radiotherapy alone and 369 to radiotherapy plus goserelin. At the time of data cutoff (March 12, 2019), the median follow-up was 112 months (IQR 102-123). The 120-month progression-free survival was 64% (95% CI 58-69) for patients treated with radiotherapy plus goserelin and 49% (43-54) for patients treated with radiotherapy alone (hazard ratio 0·54, 0·43-0·68; stratified log-rank test p<0·0001). Two cases of secondary cancer occurred since the primary analysis, but were not considered to be treatment related. No treatment-related deaths occurred., Interpretation: The 120-month progression-free survival confirmed the results from the primary analysis. Salvage radiotherapy combined with short-term androgen suppression significantly reduced risk of biochemical or clinical progression and death compared with salvage radiotherapy alone. The results of the GETUG-AFU 16 trial confirm the efficacy of androgen suppression plus radiotherapy as salvage treatment in patients with increasing PSA concentration after radical prostatectomy for prostate cancer., Funding: The French Health ministry, AstraZeneca, la Ligue Contre le Cancer, and La Ligue de Haute-Savoie., (Copyright © 2019 Elsevier Ltd. All rights reserved.) more...
- Published
- 2019
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36. [Prostate brachytherapy: New techniques, new indications].
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Blanchard P, Graff-Cailleaud P, and Bossi A
- Subjects
- Humans, Male, Radiotherapy Dosage, Brachytherapy methods, Prostatic Neoplasms radiotherapy
- Abstract
Prostate brachytherapy has been for a long time one of the standard treatments for low risk prostate cancer, with high rates of biochemical control and low levels of urinary and sexual late toxicity compared to other available techniques, namely external beam radiotherapy and radical prostatectomy. The aim of this article is to review the recent innovations of prostate brachytherapy, which suggest a bright future for the technique. We will discuss the extension of indications of permanent implant brachytherapy to favorable intermediate-risk patients, the use of novel isotopes such as Palladium 103 and Cesium 131, and the benefit of brachytherapy as a boost following external beam radiotherapy for intermediate and high-risk patients. We will also discuss the rise of high dose rate brachytherapy, as a boost or monotherapy, the increasing use of MRI for patient selection and treatment planning, as well as the development of brachytherapy as a means of focal therapy., (Copyright © 2018 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.) more...
- Published
- 2018
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37. New approach of ultra-focal brachytherapy for low- and intermediate-risk prostate cancer with custom-linked I-125 seeds: A feasibility study of optimal dose coverage.
- Author
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Brun T, Bachaud JM, Graff-Cailleaud P, Malavaud B, Portalez D, Popotte C, Aziza R, Lusque A, Filleron T, and Ken S
- Subjects
- Feasibility Studies, Humans, Iodine Radioisotopes therapeutic use, Magnetic Resonance Imaging methods, Male, Phantoms, Imaging, Prostate diagnostic imaging, Prostate radiation effects, Radiometry methods, Radiotherapy Dosage, Tomography, X-Ray Computed methods, Treatment Outcome, Brachytherapy methods, Prostatic Neoplasms radiotherapy, Radiotherapy Planning, Computer-Assisted methods
- Abstract
Purpose: To present the feasibility study of optimal dose coverage in ultra-focal brachytherapy (UFB) with multiparametric MRI for low- and intermediate-risk prostate cancer., Methods and Materials: UFB provisional dose plans for small target volumes (<7 cc) were calculated on a prostate training phantom to optimize the seeds number and strength. Clinical UFB consisted in a contour-based nonrigid registration (MRI/Ultrasound) to implant a fiducial marker at the location of the tumor focus. Dosimetry was performed with iodine-125 seeds and a prescribed dose of 160 Gy. On CT scans acquired at 1 month, dose coverage of 152 Gy to the ultra-focal gross tumor volume was evaluated. Registrations between magnetic resonance and CT scans were assessed on the first 8 patients with three software solutions: VariSeed, 3D Slicer, and Mirada, and quantitative evaluations of the registrations were performed. Impact of these registrations on the initial dose matrix was performed., Results: Mean differences between simulated dose plans and extrapolated Bard nomogram for UFB volumes were 36.3% (26-56) for the total activity, 18.3% (10-30) for seed strength, and 22.5% (16-38) for number of seeds. Registration method implemented in Mirada performed significantly better than VariSeed and 3D Slicer (p = 0.0117 and p = 0.0357, respectively). For dose plan evaluation between Mirada and VariSeed, D
100 % (Gy) for ultra-focal gross tumor volume had a mean difference of 28.06 Gy, mean values being still above the objective of 152 Gy. D90 % for the prostate had a mean difference of 1.17 Gy. For urethra and rectum, dose limits were far below the recommendations., Conclusions: This UFB study confirmed the possibility to treat with optimal dose coverage target volumes smaller than 7 cc., (Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.) more...- Published
- 2018
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38. [Mediastinal lymph node and vertebral metastases 3 years after liver transplantation for cholangiocarcinoma: 2 unusual localizations].
- Author
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Peyrin-Biroulet L, Bronowicki JP, Cinqualbre J, Gendrault P, Graff-Cailleaud P, and Marchal C
- Subjects
- Humans, Male, Mediastinum, Middle Aged, Time Factors, Cholangiocarcinoma secondary, Cholangiocarcinoma surgery, Liver Neoplasms pathology, Liver Neoplasms surgery, Liver Transplantation, Lymphatic Metastasis, Spinal Neoplasms secondary
- Published
- 2005
- Full Text
- View/download PDF
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