Françoise Mornex - Academia.edu (original) (raw)
Papers by Françoise Mornex
European Journal of Cancer Supplements, 2007
Cancer/Radiothérapie, 2010
Cancer/Radiothérapie, 2009
La radiothérapie stéréotaxique permet de délivrer précisément une dose de réirradiation dans le v... more La radiothérapie stéréotaxique permet de délivrer précisément une dose de réirradiation dans le volume cible, en épargnant les tissus sains. Nous rapportons ici les résultats de la radiothérapie stéréotaxique par CyberKnife ® , avec ou sans du cétuximab, en traitement de rattrapage. Patients et méthodes. hommes et 16 femmes, d'âge médian 59 ans ont été réirradiés par CyberKnife ® pour une récidive inopérable en territoire irradié (tumeur ≤ 65 mm). Trente-trois patients ont reç u en concomitance du cétuximab pour un carcinome épidermoïde. Soixante-douze pourcent des carcinomes en récidive étaient épidermoïdes, 14 % glandulaires. Les doses de radiothérapie antérieurement délivrées allaient de 18 à 75 Gy avec une médiane de 58 Gy. Le volume tumoral macroscopique (GTV) a été déterminé sur IRM, scanographie ou TEP. Le volume cible anatomoclinique (CTV) est égal au volume tumoral macroscopique + 5 mm et le volume cible prévisionnel (PTV) est le volume cible anatomoclinique + 1 mm. La dose prescrite était de 36 Gy en 6 fractions de 6 Gy sur 11 à 12 jours sur l'isodose 95 % couvrant 95 % du volume cible prévisionnel.
International Journal of Radiation Oncology*Biology*Physics, 2007
Purpose/Objective(s): Survival rates of advanced esophageal cancer patients treated by radiothera... more Purpose/Objective(s): Survival rates of advanced esophageal cancer patients treated by radiotherapy have increased by using concurrent chemotherapy. However, standard-dose chemotherapy leads to a relatively high incidence of hematological toxicity and therefore, patients can receive chemotherapy only once or twice during the radiation course. On the other hand, reduced-dose chemotherapy can be given throughout the radiation course and can sensitize the response of tumors to radiation. In 1992, we began protocol treatment using low-dose protracted infusion of 5-FU combined with conventional radiotherapy. Thereafter, the successful local control rate using this treatment encouraged us to add cisplatin to the regimen. The aim of this study was to evaluate the long-term results of this protocol treatment. Materials/Methods: From 1992 to 2002, a total of 64 advanced esophageal cancer patients were registered in our protocol study. The eligibility criteria were as follows: age \80; ECOG performance status: 0, 1, 2, or 3; no distant metastasis (except for supraclavicular lymph nodes); no previous treatment; no other active malignancy. In these patients, 53 (83%) were not surgical candidates because of unresectable disease (42 patients) or other medical problems (11 patients). Radiotherapy was performed by standard fractionation using a 10-MV x-ray. Total radiation doses ranged from 60 to 76.6 Gy (median dose: 70 Gy; one patient who died of fistula formation at 25.2 Gy was excluded). Thirty patients received a daily continuous infusion of 5-FU (median dose: 300 mg/m 2 ) concurrently with radiotherapy (5-FU group), and the remaining 34 received a daily continuous infusion of 5-FU (median dose: 250 mg/m 2 ) and a daily continuous or a daily 1-hour bolus infusion of cisplatin (median dose: 3 mg/m 2 ) (FP group). Twenty-eight patients (93%) in the 5-FU group and 32 (94%) in the FP group received chemotherapy for more than 3 weeks. Results: A complete response and partial response were obtained in 22 and 30 patients, respectively, and the response rate was 81%. The local progression-free rates at 1-, 2-, and 5-years were 54, 49, and 49%, respectively. The overall survival rates at 1-, 2-, and 5-years were 55, 27, and 12%, respectively. There was no significant difference in the survival rate or local progression-free rate between the 5-FU group and FP group. The acute hematological toxicity level was acceptable. However, in 13 patients, treatment-related death occurred: 5 in the 5-FU group and 8 in the FP group. Five patients died of acute non-hematological toxicity of chemoradiotherapy: 1 necrotizing enterocolitis, 1 radiation pneumonitis, 2 bacterial pneumonia, and 1 general collapse. Five patients died of late toxicity: 1 radiation pleuritis, 2 congestive heart failure, and 2 acute myocardial infarction. In addition, 3 other patients died of mediastinitis because of esophageal perforation after placement of metallic stent for benign or malignant esophageal stenosis. Conclusions: Given the large population of patients in this study with unresectable disease or other medical problems, our treatment seemed to provide comparable efficacy and less hematological toxicity than standard-dose chemoradiotherapy. A low-dose protracted infusion of 5-FU alone showed equivalent efficacy to 5-FU combined with cisplatin when administered with radiotherapy.
International Journal of Radiation Oncology Biology Physics, 2005
Purpose: This retrospective 12-year study evaluated the prognostic value of initial and postopera... more Purpose: This retrospective 12-year study evaluated the prognostic value of initial and postoperative staging of rectal tumors. Methods and Materials: Between 1985 and 1996, 297 patients were treated with preoperative radiotherapy (39 Gy in 13 fractions) and surgery for Stage T2-T4N0-N1M0 rectal adenocarcinoma. Pretreatment staging included a clinical examination and endorectal ultrasonography (EUS) since 1988. Clinical staging was performed by
Seminars in Radiation Oncology, 1998
Endocavitary radiation therapy (Endo RT) is performed mainly with a contact x-ray tube. Interstit... more Endocavitary radiation therapy (Endo RT) is performed mainly with a contact x-ray tube. Interstitial brachytherapy is a supplementary method to boost the tumor bed. Only strictly selected patients can be treated for cure by Endo RT. More than 1,000 patients have been treated in Europe and North America since 1950. In T1 NO adenocarcinoma, the primary local control rate is close to 90%. The overall 5-year survival is between 60% and 90% depending on patient selection. Careful follow-up is necessary because the majority of local failures can be salvaged, usually by radical surgery. The main advantages of Endo RT are a fully ambulatory and simple treatment that can be applied even in frail or elderly inoperable patients, a low risk of complications, and an inexpensive treatment. Results show it is possible to perform curative treatment in patients with more advanced rectal carcinoma. With the combination of external-beam radiation therapy and Endo RT in stage T2-3 N0-1 tumors, the primary local control rate is around 70%, and the incidence of severe radiation toxicity is less than 5%. Overall 5-year survival is between 50% and 70%. Endo RT can also be used as an adjuvant treatment after local excision, in the treatment of villous adenomas, and for palliation of advanced inoperable tumors.
Cancer, 1984
The authors developed an original procedure of endocurietherapy of high bile duct carcinoma. An i... more The authors developed an original procedure of endocurietherapy of high bile duct carcinoma. An iridium 192 wire is inserted into either a percutaneous transhepatic catheter or a surgically implanted external diversion catheter. The delivered dose varies between 10 and 60 Gy at 1 cm from the wire. Four of the seven patients analyzed also received external irradiation. There were no systemic or local complications. All patients experienced symptomatic relief and four are alive with no evidence of disease. This well-tolerated procedure permits symptomatic palliation without excessive side effects for the patient. In some cases, a curative effect can be expected.
International Journal of Radiation OncologyBiologyPhysics
To evaluate whether the tumor response after an initial course of irradiation predicts for colost... more To evaluate whether the tumor response after an initial course of irradiation predicts for colostomy-free survival and overall survival in patients with anal canal cancer. Between 1980 and 1998, 252 patients were treated by pelvic external-beam radiotherapy (EBRT) followed by a brachytherapy boost in 218 or EBRT in 34. EBRT was combined with chemotherapy in 168 patients. An evaluation of tumor regression, before the boost, was available for 221 patients. They were divided into four groups according to the tumor response: <70%, 70-80%, >80% but <100%, and 100%. The median follow-up time was 58 months. The overall survival rate was 72.6% +/- 3.1% and 57.3% +/- 4.2% at 5 and 10 years, respectively. The disease-free survival rate was 60.0% +/- 3.3% and 49.4% +/- 3.9% at 5 and 10 years, respectively. The colostomy-free survival rate was 61% at 5 years and 47% at 10 years. Two groups could be differentiated according to the percentage of tumor regression before the boost: >80%...
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2011
Medical therapies for hepatocellular carcinoma are limited. Standard antimitotic chemotherapies a... more Medical therapies for hepatocellular carcinoma are limited. Standard antimitotic chemotherapies and hormonotherapies are inefficient. Only sorafenib, an antiangiogenic agent inhibiting the VEGF and PDGF receptors as well as MAP kinase pathway, has shown a significant benefit on patient survival. However, its indication is restricted to patients with multifocal hepatocellular carcinoma not responding to transarterial hepatic chemoembolization or patients with hepatocellular carcinoma invading the venous portal tract or spreading to lymph nodes or as distant visceral metastasis.
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2011
Hepatocellular carcinoma is a poor prognosis tumour. The potential curative therapeutic options a... more Hepatocellular carcinoma is a poor prognosis tumour. The potential curative therapeutic options are orthotopic liver transplantation, surgical resection and radiofrequency ablation. Unfortunately, only a minority of patients (around 20%) are eligible for these techniques. Thus, patients can benefit from palliative options, such as transarterial chemoembolization (TACE) or sorafenib that bring only modest benefit on survival. Conformal radiotherapy allows delivering high dose radiation within a precise tumour volume while sparing the surrounding liver parenchyma. As employed in monotherapy, conformal radiotherapy is highly efficient for small size hepatocellular carcinoma (<5 cm). Above 5 cm, its efficacy is more limited but its association with TACE gives spectacular rates of complete responses. Controlled phase 2 or 3 trials are urgently warranted to define its indications in the therapeutic algorithm of hepatocellular carcinoma.
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2011
Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for re... more Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for resectable localized pancreatic adenocarcinoma. However, there is to date no completed phase III study to validate this approach and treatment effects evaluation still remains an active area of investigation. From the mature results of the SFRO-FFCD 9704 trial, we explored the antitumoral effect of a 5-fluoro-uracil and cisplatin-based preoperative chemoradiation regimen, with a special highlight on the histopathological response and performed a literature review. Treatment consisted of concurrent radiotherapy (50 Gy within five weeks) and chemotherapy with 5-fluoro-uracil (300 mg/m(2)/day, five days/week, weeks 1-5) and cisplatin (20mg/m(2)/day, days 1-5 and 29-33), followed by surgical resection of the pancreatic tumour in patients without progression. In all, 41 patients were enrolled, 26 patients (63%) underwent surgical resection with curative intent and 21 (80.7%) had R0 resection. A...
Cancer/Radiothérapie, 2008
Objectifs de l'étude. -Évaluer l'amplitude de mouvement et les variations de volume de la tumeur,... more Objectifs de l'étude. -Évaluer l'amplitude de mouvement et les variations de volume de la tumeur, du foie et des organes abdominaux induits par la respiration lors de l'irradiation d'un carcinome hépatocellulaire.
Digestive and Liver Disease, 2014
We performed a randomized, non-comparative phase II study evaluating docetaxel in combination wit... more We performed a randomized, non-comparative phase II study evaluating docetaxel in combination with either daily continuous (protracted IV) 5-fluorouracil or cisplatin administered weekly, concurrent to radiotherapy in the treatment of locally advanced pancreatic carcinoma. Results of the docetaxel plus cisplatin regimen are reported. Forty chemotherapy-naive patients with locally advanced pancreatic carcinoma were randomly assigned to receive 5-fluorouracil and docetaxel or docetaxel 20mg/m(2) and cisplatin 20mg/m(2)/week, plus concurrent radiotherapy for 6 weeks. The radiation dose to the primary tumour was 54Gy in 30 fractions. The trial&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s primary endpoint was the 6-month crude non-progression rate. 51 patients from 7 centres were included in the docetaxel-cisplatin treatment group. Six-month non-progression rate was 39% (95% confidence interval: 26-53). Median overall survival was 9.6 months (95% confidence interval: 2.4-60.7); 6 complete and 8 partial responses were obtained. Six patients survived more than 2 years after their inclusion in the trial. Grade ≥3 toxicity was reported in 63% of patients; no treatment-related death occurred. Severe toxicities were mainly anorexia (22%), vomiting (20%) and fatigue (24%). Despite inadequate efficacy according to the main end point, this regimen gave a satisfactory rate of objective response (27%) with tolerable toxicity.
Présenté à l'American Society of Therapeutic Radiology and Oncology, octobre 2005, Denver, Colora... more Présenté à l'American Society of Therapeutic Radiology and Oncology, octobre 2005, Denver, Colorado, USA
Purpose: Hepatocellular carcinoma (HCC) is a poor prognosis tumor, and only 20% of patients will ... more Purpose: Hepatocellular carcinoma (HCC) is a poor prognosis tumor, and only 20% of patients will benefit from curative therapies (surgery, liver transplantation, percutaneous ablation). Although conventional radiotherapy has been traditionally regarded as inefficient and toxic for cirrhotic patients, three-dimensional conformal radiotherapy (3DCRT) has provided promising preliminary data for the treatment of HCC. Methods and Materials: Prospective phase II trial including Child-Pugh A/B cirrhotic patients with small-size HCC (1 nodule <5 cm, or 2 nodules <3 cm) nonsuitable for curative treatments, to assess tolerance and efficacy of high-dose (66 Gy, 2 Gy/fraction) 3DCRT. Results: Twenty-seven patients were enrolled. Among the 25 assessable patients, tumor response was observed for 23 patients (92%), with complete response for 20 patients (80%), and partial response for 3 patients (12%). Stable disease was observed in 2 patients (8%). Grade 4 toxicities occurred in 2 of 11 (22%) Child-Pugh B patients only. Child-Pugh A patients tolerated treatment well, and 3/16 (19%) developed asymptomatic Grade 3 toxicities. Conclusion: High-dose 3DCRT is a noninvasive, well-tolerated modality that is highly suitable for the treatment of small HCCs in cirrhotic patients, with promising results. However, additional trials are needed to optimize this technique and formally compare it with the usual curative approaches.
More than 80% of patients who undergo a potentially curative resection for pancreatic cancer deve... more More than 80% of patients who undergo a potentially curative resection for pancreatic cancer develop local or distant recurrence. Neoadjuvant chemoradiotherapy might offer potential benefits regarding local and systemic control and survival. This multi-institutional Phase II trial explored the feasibility of preoperative chemoradiation in this situation. Treatment consisted of concurrent radiotherapy (50 Gy within 5 weeks), and chemotherapy with 5-fluorouracil (300 mg/m(2)/day, 5 days/week, 5 consecutive weeks) and cisplatin (20 mg/m(2)/day, Days 1-5 and 29-33), followed by surgical resection of the pancreatic tumor in patients without progression. A total of 41 patients were enrolled. Of these, 38 (93%) received &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =47 Gy; 30 patients (73%) received &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =75% of the prescribed doses of chemotherapy. Surgical resection was performed in 26 patients (63%). Because of local or metastatic progression, 5 patients (12%) did not undergo surgery and 10 underwent surgery without resection of the pancreatic tumor. Operative mortality was 2.8%. Among 40 evaluable patients, 27 were successfully treated (67.5%; 95% CI, 50.9-81.4%). Pancreatic cancer is chemo-radiosensitive. The proposed pre-operative scheme is feasible, does not prevent successful surgery, and must be tested on a Phase III setting. Yet, the large proportion of tumor progression during and after chemoradiation justifies the use of more efficient drugs such as Gemcitabine, and optimized radiotherapy including new techniques such as intensity-modulated radiation therapy.
Cancer/Radiothérapie, 1997
... Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (63). M Blichert-Toft, H ... more ... Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (63). M Blichert-Toft, H Brincker, JA Andersen, KW Andersen, CK Axelsson and HT Mouridsen et al., A danish randomized trial comparing breast-preserving therapy with mastectomy in mammary carcinoma. ...
Cancer/Radiothérapie, 2009
Reçu le 8 septembre 2008 ; reçu sous la forme révisée le 12 septembre 2008 ; accepté le 18 septem... more Reçu le 8 septembre 2008 ; reçu sous la forme révisée le 12 septembre 2008 ; accepté le 18 septembre 2008 Disponible sur Internet le 13 décembre 2008 Résumé Objectif de l'étude. -Évaluer l'impact dosimétrique du blocage respiratoire au cours d'une irradiation conformationnelle du carcinome hépatocellulaire (CHC) et déterminer la phase respiratoire optimale de traitement (expiration ou inspiration). Patients et méthodes. -Deux scanographies ont été réalisées en inspiration et en expiration chez 20 patients atteints de carcinome hépatocellulaire. Le volume tumoral macroscopique a été délinéé sur l'acquisition en inspiration bloquée (GTV insp ) et celle en expiration bloquée (GTV exp ). La fusion des deux volumes tumoraux macroscopiques a permis d'obtenir un volume tumoral macroscopique global (respiration libre). Le volume cible prévisionnel (PTV) était défini en rajoutant 1 cm autour de chaque volume tumoral macroscopique. Le foie, l'estomac, le duodénum, les deux reins, la moelle épinière et le coeur ont été délinéés. Trois plans dosimétriques ont été réalisés en expiration, inspiration et sur le volume cible prévisionnel global.
Cancer/Radiothérapie, 2009
Purpose. -Chemoradiotherapy is the standard treatment of inoperable and/or non-resectable IIIA/B ... more Purpose. -Chemoradiotherapy is the standard treatment of inoperable and/or non-resectable IIIA/B non-small-cell lung cancer (NSCLC). Aware of the necessity to increase local control in locally advanced NSCLC, we analyzed the feasibility of high-dose three-dimensional conformal radiation therapy (3D-CRT) in the treatment of localised NSCLC.
Cancer/Radiothérapie, 2007
76 Gy. Les histogrammes dose-volume des volumes cibles et des organes à risque et les volumes des... more 76 Gy. Les histogrammes dose-volume des volumes cibles et des organes à risque et les volumes des organes à risque ont été étudiés. Un suivi prospectif de la toxicité et de la qualité de vie est en cours.
European Journal of Cancer Supplements, 2007
Cancer/Radiothérapie, 2010
Cancer/Radiothérapie, 2009
La radiothérapie stéréotaxique permet de délivrer précisément une dose de réirradiation dans le v... more La radiothérapie stéréotaxique permet de délivrer précisément une dose de réirradiation dans le volume cible, en épargnant les tissus sains. Nous rapportons ici les résultats de la radiothérapie stéréotaxique par CyberKnife ® , avec ou sans du cétuximab, en traitement de rattrapage. Patients et méthodes. hommes et 16 femmes, d'âge médian 59 ans ont été réirradiés par CyberKnife ® pour une récidive inopérable en territoire irradié (tumeur ≤ 65 mm). Trente-trois patients ont reç u en concomitance du cétuximab pour un carcinome épidermoïde. Soixante-douze pourcent des carcinomes en récidive étaient épidermoïdes, 14 % glandulaires. Les doses de radiothérapie antérieurement délivrées allaient de 18 à 75 Gy avec une médiane de 58 Gy. Le volume tumoral macroscopique (GTV) a été déterminé sur IRM, scanographie ou TEP. Le volume cible anatomoclinique (CTV) est égal au volume tumoral macroscopique + 5 mm et le volume cible prévisionnel (PTV) est le volume cible anatomoclinique + 1 mm. La dose prescrite était de 36 Gy en 6 fractions de 6 Gy sur 11 à 12 jours sur l'isodose 95 % couvrant 95 % du volume cible prévisionnel.
International Journal of Radiation Oncology*Biology*Physics, 2007
Purpose/Objective(s): Survival rates of advanced esophageal cancer patients treated by radiothera... more Purpose/Objective(s): Survival rates of advanced esophageal cancer patients treated by radiotherapy have increased by using concurrent chemotherapy. However, standard-dose chemotherapy leads to a relatively high incidence of hematological toxicity and therefore, patients can receive chemotherapy only once or twice during the radiation course. On the other hand, reduced-dose chemotherapy can be given throughout the radiation course and can sensitize the response of tumors to radiation. In 1992, we began protocol treatment using low-dose protracted infusion of 5-FU combined with conventional radiotherapy. Thereafter, the successful local control rate using this treatment encouraged us to add cisplatin to the regimen. The aim of this study was to evaluate the long-term results of this protocol treatment. Materials/Methods: From 1992 to 2002, a total of 64 advanced esophageal cancer patients were registered in our protocol study. The eligibility criteria were as follows: age \80; ECOG performance status: 0, 1, 2, or 3; no distant metastasis (except for supraclavicular lymph nodes); no previous treatment; no other active malignancy. In these patients, 53 (83%) were not surgical candidates because of unresectable disease (42 patients) or other medical problems (11 patients). Radiotherapy was performed by standard fractionation using a 10-MV x-ray. Total radiation doses ranged from 60 to 76.6 Gy (median dose: 70 Gy; one patient who died of fistula formation at 25.2 Gy was excluded). Thirty patients received a daily continuous infusion of 5-FU (median dose: 300 mg/m 2 ) concurrently with radiotherapy (5-FU group), and the remaining 34 received a daily continuous infusion of 5-FU (median dose: 250 mg/m 2 ) and a daily continuous or a daily 1-hour bolus infusion of cisplatin (median dose: 3 mg/m 2 ) (FP group). Twenty-eight patients (93%) in the 5-FU group and 32 (94%) in the FP group received chemotherapy for more than 3 weeks. Results: A complete response and partial response were obtained in 22 and 30 patients, respectively, and the response rate was 81%. The local progression-free rates at 1-, 2-, and 5-years were 54, 49, and 49%, respectively. The overall survival rates at 1-, 2-, and 5-years were 55, 27, and 12%, respectively. There was no significant difference in the survival rate or local progression-free rate between the 5-FU group and FP group. The acute hematological toxicity level was acceptable. However, in 13 patients, treatment-related death occurred: 5 in the 5-FU group and 8 in the FP group. Five patients died of acute non-hematological toxicity of chemoradiotherapy: 1 necrotizing enterocolitis, 1 radiation pneumonitis, 2 bacterial pneumonia, and 1 general collapse. Five patients died of late toxicity: 1 radiation pleuritis, 2 congestive heart failure, and 2 acute myocardial infarction. In addition, 3 other patients died of mediastinitis because of esophageal perforation after placement of metallic stent for benign or malignant esophageal stenosis. Conclusions: Given the large population of patients in this study with unresectable disease or other medical problems, our treatment seemed to provide comparable efficacy and less hematological toxicity than standard-dose chemoradiotherapy. A low-dose protracted infusion of 5-FU alone showed equivalent efficacy to 5-FU combined with cisplatin when administered with radiotherapy.
International Journal of Radiation Oncology Biology Physics, 2005
Purpose: This retrospective 12-year study evaluated the prognostic value of initial and postopera... more Purpose: This retrospective 12-year study evaluated the prognostic value of initial and postoperative staging of rectal tumors. Methods and Materials: Between 1985 and 1996, 297 patients were treated with preoperative radiotherapy (39 Gy in 13 fractions) and surgery for Stage T2-T4N0-N1M0 rectal adenocarcinoma. Pretreatment staging included a clinical examination and endorectal ultrasonography (EUS) since 1988. Clinical staging was performed by
Seminars in Radiation Oncology, 1998
Endocavitary radiation therapy (Endo RT) is performed mainly with a contact x-ray tube. Interstit... more Endocavitary radiation therapy (Endo RT) is performed mainly with a contact x-ray tube. Interstitial brachytherapy is a supplementary method to boost the tumor bed. Only strictly selected patients can be treated for cure by Endo RT. More than 1,000 patients have been treated in Europe and North America since 1950. In T1 NO adenocarcinoma, the primary local control rate is close to 90%. The overall 5-year survival is between 60% and 90% depending on patient selection. Careful follow-up is necessary because the majority of local failures can be salvaged, usually by radical surgery. The main advantages of Endo RT are a fully ambulatory and simple treatment that can be applied even in frail or elderly inoperable patients, a low risk of complications, and an inexpensive treatment. Results show it is possible to perform curative treatment in patients with more advanced rectal carcinoma. With the combination of external-beam radiation therapy and Endo RT in stage T2-3 N0-1 tumors, the primary local control rate is around 70%, and the incidence of severe radiation toxicity is less than 5%. Overall 5-year survival is between 50% and 70%. Endo RT can also be used as an adjuvant treatment after local excision, in the treatment of villous adenomas, and for palliation of advanced inoperable tumors.
Cancer, 1984
The authors developed an original procedure of endocurietherapy of high bile duct carcinoma. An i... more The authors developed an original procedure of endocurietherapy of high bile duct carcinoma. An iridium 192 wire is inserted into either a percutaneous transhepatic catheter or a surgically implanted external diversion catheter. The delivered dose varies between 10 and 60 Gy at 1 cm from the wire. Four of the seven patients analyzed also received external irradiation. There were no systemic or local complications. All patients experienced symptomatic relief and four are alive with no evidence of disease. This well-tolerated procedure permits symptomatic palliation without excessive side effects for the patient. In some cases, a curative effect can be expected.
International Journal of Radiation OncologyBiologyPhysics
To evaluate whether the tumor response after an initial course of irradiation predicts for colost... more To evaluate whether the tumor response after an initial course of irradiation predicts for colostomy-free survival and overall survival in patients with anal canal cancer. Between 1980 and 1998, 252 patients were treated by pelvic external-beam radiotherapy (EBRT) followed by a brachytherapy boost in 218 or EBRT in 34. EBRT was combined with chemotherapy in 168 patients. An evaluation of tumor regression, before the boost, was available for 221 patients. They were divided into four groups according to the tumor response: <70%, 70-80%, >80% but <100%, and 100%. The median follow-up time was 58 months. The overall survival rate was 72.6% +/- 3.1% and 57.3% +/- 4.2% at 5 and 10 years, respectively. The disease-free survival rate was 60.0% +/- 3.3% and 49.4% +/- 3.9% at 5 and 10 years, respectively. The colostomy-free survival rate was 61% at 5 years and 47% at 10 years. Two groups could be differentiated according to the percentage of tumor regression before the boost: >80%...
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2011
Medical therapies for hepatocellular carcinoma are limited. Standard antimitotic chemotherapies a... more Medical therapies for hepatocellular carcinoma are limited. Standard antimitotic chemotherapies and hormonotherapies are inefficient. Only sorafenib, an antiangiogenic agent inhibiting the VEGF and PDGF receptors as well as MAP kinase pathway, has shown a significant benefit on patient survival. However, its indication is restricted to patients with multifocal hepatocellular carcinoma not responding to transarterial hepatic chemoembolization or patients with hepatocellular carcinoma invading the venous portal tract or spreading to lymph nodes or as distant visceral metastasis.
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2011
Hepatocellular carcinoma is a poor prognosis tumour. The potential curative therapeutic options a... more Hepatocellular carcinoma is a poor prognosis tumour. The potential curative therapeutic options are orthotopic liver transplantation, surgical resection and radiofrequency ablation. Unfortunately, only a minority of patients (around 20%) are eligible for these techniques. Thus, patients can benefit from palliative options, such as transarterial chemoembolization (TACE) or sorafenib that bring only modest benefit on survival. Conformal radiotherapy allows delivering high dose radiation within a precise tumour volume while sparing the surrounding liver parenchyma. As employed in monotherapy, conformal radiotherapy is highly efficient for small size hepatocellular carcinoma (<5 cm). Above 5 cm, its efficacy is more limited but its association with TACE gives spectacular rates of complete responses. Controlled phase 2 or 3 trials are urgently warranted to define its indications in the therapeutic algorithm of hepatocellular carcinoma.
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2011
Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for re... more Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for resectable localized pancreatic adenocarcinoma. However, there is to date no completed phase III study to validate this approach and treatment effects evaluation still remains an active area of investigation. From the mature results of the SFRO-FFCD 9704 trial, we explored the antitumoral effect of a 5-fluoro-uracil and cisplatin-based preoperative chemoradiation regimen, with a special highlight on the histopathological response and performed a literature review. Treatment consisted of concurrent radiotherapy (50 Gy within five weeks) and chemotherapy with 5-fluoro-uracil (300 mg/m(2)/day, five days/week, weeks 1-5) and cisplatin (20mg/m(2)/day, days 1-5 and 29-33), followed by surgical resection of the pancreatic tumour in patients without progression. In all, 41 patients were enrolled, 26 patients (63%) underwent surgical resection with curative intent and 21 (80.7%) had R0 resection. A...
Cancer/Radiothérapie, 2008
Objectifs de l'étude. -Évaluer l'amplitude de mouvement et les variations de volume de la tumeur,... more Objectifs de l'étude. -Évaluer l'amplitude de mouvement et les variations de volume de la tumeur, du foie et des organes abdominaux induits par la respiration lors de l'irradiation d'un carcinome hépatocellulaire.
Digestive and Liver Disease, 2014
We performed a randomized, non-comparative phase II study evaluating docetaxel in combination wit... more We performed a randomized, non-comparative phase II study evaluating docetaxel in combination with either daily continuous (protracted IV) 5-fluorouracil or cisplatin administered weekly, concurrent to radiotherapy in the treatment of locally advanced pancreatic carcinoma. Results of the docetaxel plus cisplatin regimen are reported. Forty chemotherapy-naive patients with locally advanced pancreatic carcinoma were randomly assigned to receive 5-fluorouracil and docetaxel or docetaxel 20mg/m(2) and cisplatin 20mg/m(2)/week, plus concurrent radiotherapy for 6 weeks. The radiation dose to the primary tumour was 54Gy in 30 fractions. The trial&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s primary endpoint was the 6-month crude non-progression rate. 51 patients from 7 centres were included in the docetaxel-cisplatin treatment group. Six-month non-progression rate was 39% (95% confidence interval: 26-53). Median overall survival was 9.6 months (95% confidence interval: 2.4-60.7); 6 complete and 8 partial responses were obtained. Six patients survived more than 2 years after their inclusion in the trial. Grade ≥3 toxicity was reported in 63% of patients; no treatment-related death occurred. Severe toxicities were mainly anorexia (22%), vomiting (20%) and fatigue (24%). Despite inadequate efficacy according to the main end point, this regimen gave a satisfactory rate of objective response (27%) with tolerable toxicity.
Présenté à l'American Society of Therapeutic Radiology and Oncology, octobre 2005, Denver, Colora... more Présenté à l'American Society of Therapeutic Radiology and Oncology, octobre 2005, Denver, Colorado, USA
Purpose: Hepatocellular carcinoma (HCC) is a poor prognosis tumor, and only 20% of patients will ... more Purpose: Hepatocellular carcinoma (HCC) is a poor prognosis tumor, and only 20% of patients will benefit from curative therapies (surgery, liver transplantation, percutaneous ablation). Although conventional radiotherapy has been traditionally regarded as inefficient and toxic for cirrhotic patients, three-dimensional conformal radiotherapy (3DCRT) has provided promising preliminary data for the treatment of HCC. Methods and Materials: Prospective phase II trial including Child-Pugh A/B cirrhotic patients with small-size HCC (1 nodule <5 cm, or 2 nodules <3 cm) nonsuitable for curative treatments, to assess tolerance and efficacy of high-dose (66 Gy, 2 Gy/fraction) 3DCRT. Results: Twenty-seven patients were enrolled. Among the 25 assessable patients, tumor response was observed for 23 patients (92%), with complete response for 20 patients (80%), and partial response for 3 patients (12%). Stable disease was observed in 2 patients (8%). Grade 4 toxicities occurred in 2 of 11 (22%) Child-Pugh B patients only. Child-Pugh A patients tolerated treatment well, and 3/16 (19%) developed asymptomatic Grade 3 toxicities. Conclusion: High-dose 3DCRT is a noninvasive, well-tolerated modality that is highly suitable for the treatment of small HCCs in cirrhotic patients, with promising results. However, additional trials are needed to optimize this technique and formally compare it with the usual curative approaches.
More than 80% of patients who undergo a potentially curative resection for pancreatic cancer deve... more More than 80% of patients who undergo a potentially curative resection for pancreatic cancer develop local or distant recurrence. Neoadjuvant chemoradiotherapy might offer potential benefits regarding local and systemic control and survival. This multi-institutional Phase II trial explored the feasibility of preoperative chemoradiation in this situation. Treatment consisted of concurrent radiotherapy (50 Gy within 5 weeks), and chemotherapy with 5-fluorouracil (300 mg/m(2)/day, 5 days/week, 5 consecutive weeks) and cisplatin (20 mg/m(2)/day, Days 1-5 and 29-33), followed by surgical resection of the pancreatic tumor in patients without progression. A total of 41 patients were enrolled. Of these, 38 (93%) received &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =47 Gy; 30 patients (73%) received &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =75% of the prescribed doses of chemotherapy. Surgical resection was performed in 26 patients (63%). Because of local or metastatic progression, 5 patients (12%) did not undergo surgery and 10 underwent surgery without resection of the pancreatic tumor. Operative mortality was 2.8%. Among 40 evaluable patients, 27 were successfully treated (67.5%; 95% CI, 50.9-81.4%). Pancreatic cancer is chemo-radiosensitive. The proposed pre-operative scheme is feasible, does not prevent successful surgery, and must be tested on a Phase III setting. Yet, the large proportion of tumor progression during and after chemoradiation justifies the use of more efficient drugs such as Gemcitabine, and optimized radiotherapy including new techniques such as intensity-modulated radiation therapy.
Cancer/Radiothérapie, 1997
... Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (63). M Blichert-Toft, H ... more ... Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (63). M Blichert-Toft, H Brincker, JA Andersen, KW Andersen, CK Axelsson and HT Mouridsen et al., A danish randomized trial comparing breast-preserving therapy with mastectomy in mammary carcinoma. ...
Cancer/Radiothérapie, 2009
Reçu le 8 septembre 2008 ; reçu sous la forme révisée le 12 septembre 2008 ; accepté le 18 septem... more Reçu le 8 septembre 2008 ; reçu sous la forme révisée le 12 septembre 2008 ; accepté le 18 septembre 2008 Disponible sur Internet le 13 décembre 2008 Résumé Objectif de l'étude. -Évaluer l'impact dosimétrique du blocage respiratoire au cours d'une irradiation conformationnelle du carcinome hépatocellulaire (CHC) et déterminer la phase respiratoire optimale de traitement (expiration ou inspiration). Patients et méthodes. -Deux scanographies ont été réalisées en inspiration et en expiration chez 20 patients atteints de carcinome hépatocellulaire. Le volume tumoral macroscopique a été délinéé sur l'acquisition en inspiration bloquée (GTV insp ) et celle en expiration bloquée (GTV exp ). La fusion des deux volumes tumoraux macroscopiques a permis d'obtenir un volume tumoral macroscopique global (respiration libre). Le volume cible prévisionnel (PTV) était défini en rajoutant 1 cm autour de chaque volume tumoral macroscopique. Le foie, l'estomac, le duodénum, les deux reins, la moelle épinière et le coeur ont été délinéés. Trois plans dosimétriques ont été réalisés en expiration, inspiration et sur le volume cible prévisionnel global.
Cancer/Radiothérapie, 2009
Purpose. -Chemoradiotherapy is the standard treatment of inoperable and/or non-resectable IIIA/B ... more Purpose. -Chemoradiotherapy is the standard treatment of inoperable and/or non-resectable IIIA/B non-small-cell lung cancer (NSCLC). Aware of the necessity to increase local control in locally advanced NSCLC, we analyzed the feasibility of high-dose three-dimensional conformal radiation therapy (3D-CRT) in the treatment of localised NSCLC.
Cancer/Radiothérapie, 2007
76 Gy. Les histogrammes dose-volume des volumes cibles et des organes à risque et les volumes des... more 76 Gy. Les histogrammes dose-volume des volumes cibles et des organes à risque et les volumes des organes à risque ont été étudiés. Un suivi prospectif de la toxicité et de la qualité de vie est en cours.