Pierre-Yves Bondiau - Academia.edu (original) (raw)
Papers by Pierre-Yves Bondiau
Onkologie, 2009
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms, and metastatic disease is... more Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms, and metastatic disease is present at diagnosis in about 50%. Most common metastatic sites are the liver, the lungs, and the peritoneum. Bony metastases are uncommon and of unknown prognosis. A 57-year-old man presented with diplopia due to a clival metastastic lesion from an asymptomatic rectal stromal tumor. This patient also had liver and vertebral metastases. Treatment with imatinib, a tyrosine kinase inhibitor, led to a partial response of the primary tumor and hepatic metastasis, but the patient developed aggressive bone metastases that proved refractory to 3 different tyrosine kinase inhibitors. Different drug distribution or different mutation patterns of key prognostic receptors (e.g. cKIT receptor) in bone and soft tissues may explain the unusually aggressive pattern of these bony metastases of a GIST. Pharmacodynamic and molecular investigations are warranted to check these hypotheses.
Leukemia & Lymphoma, 2008
Multicenter, retrospective study of standard-dose RIT in eight heavily pre-treated patients with ... more Multicenter, retrospective study of standard-dose RIT in eight heavily pre-treated patients with CD20-positive follicular lymphoma who had relapsed after previous autologous bone marrow transplantation (ABMT). Patients underwent nine courses of (90)Y-ibritumomab tiuxetan (0.3 or 0.4 mCi/kg body weight). Responses included five CR, two PR, one SD and one PD. Median DFS was 12 months with median follow-up of 17 months and 1-year OS was 83% (7/8 patients). Grade 4 thrombocytopenia occurred in 7/9 treatments, with no episodes of bleeding, and only two patients received a platelet transfusion. One patient, who had 20% bone marrow involvement at the time of relapse diagnosis, presented with Grade 4 thrombocytopenia and Grade 4 neutropenia and died of septic shock 6 months after RIT. One other case of Grade 4 neutropenia, without a serious infectious syndrome, was observed. Standard-dose RIT seems feasible and potentially effective after ABMT in correctly selected patients with follicular lymphoma.
Translational lung cancer research, 2016
The equivalent uniform dose (EUD) radiobiological model can be applied for lung cancer treatment ... more The equivalent uniform dose (EUD) radiobiological model can be applied for lung cancer treatment plans to estimate the tumor control probability (TCP) and the normal tissue complication probability (NTCP) using different dose calculation models. Then, based on the different calculated doses, the quality adjusted life years (QALY) score can be assessed versus the uncomplicated tumor control probability (UTCP) concept in order to predict the overall outcome of the different treatment plans. Nine lung cancer cases were included in this study. For the each patient, two treatments plans were generated. The doses were calculated respectively from pencil beam model, as pencil beam convolution (PBC) turning on 1D density correction with Modified Batho's (MB) method, and point kernel model as anisotropic analytical algorithm (AAA) using exactly the same prescribed dose, normalized to 100% at isocentre point inside the target and beam arrangements. The radiotherapy outcomes and QALY were ...
BMC Cancer
Background Proton beam therapy (PBT) is a new-emerging cancer treatment in China but its treatmen... more Background Proton beam therapy (PBT) is a new-emerging cancer treatment in China but its treatment costs are high and not yet covered by Chinese public medical insurance. The advanced form of PBT, intensity-modulated proton radiation therapy (IMPT), has been confirmed to reduce normal tissue complication probability (NTCP) as compared to conventional intensity-modulated photon-radiation therapy (IMRT) in patients with oropharyngeal cancer (OPC). Herein, we evaluated the cost-effectiveness and applicability of IMPT versus IMRT for OPC patients in China, aiming at guiding the proper use of PBT. Methods A 7-state Markov model was designed for analysis. Base-case evaluation was performed on a 56-year-old (median age of OPC in China) patient under the assumption that IMPT could provide a 25% NTCP-reduction in long-term symptomatic dysphagia and xerostomia. Model robustness was examined using probabilistic sensitivity analysis, cohort analysis, and tornado diagram. One-way sensitivity ana...
BMC Cancer, 2020
Background Cost-effectiveness is a pivotal consideration for clinical decision making of high-tec... more Background Cost-effectiveness is a pivotal consideration for clinical decision making of high-tech cancer treatment in developing countries. Intensity-modulated proton radiation therapy (IMPT, the advanced form of proton beam therapy) has been found to improve the prognosis of the patients with paranasal sinus and nasal cavity cancers compared with intensity-modulated photon-radiation therapy (IMRT). However, the cost-effectiveness of IMPT has not yet been fully evaluated. This study aimed at evaluating the cost-effectiveness of IMPT versus IMRT for treatment decision making of paranasal sinus and nasal cavity cancers in Chinese settings. Methods A 3-state Markov model was designed for cost-effectiveness analysis. A base case evaluation was performed on a patient of 47-year-old (median age of patients with paranasal sinus and nasal cavity cancers in China). Model robustness was examined by probabilistic sensitivity analysis, Markov cohort analysis and Tornado diagram. Cost-effective...
BMC Cancer, 2019
Background: In stage III non-small cell lung cancer (NSCLC) treated with concomitant chemoradioth... more Background: In stage III non-small cell lung cancer (NSCLC) treated with concomitant chemoradiotherapy, there is a high rate of relapse. Some of these relapses are only local and can be treated by stereotactic ablative radiation therapy (SABR). Previous studies reporting outcome after SABR reirradiation of the thorax consisted of a heterogeneous population of various lung cancer stages or even different types of cancer. The purpose of study is to evaluate toxicity and outcome of this strategy in locally relapsed stage III NSCLC only. Methods: From February 2007 to November 2015, 46 Stage III NSCLC patients treated with SABR, for lung recurrence following conventionally fractionated radiation therapy (CFRT), were retrospectively analyzed. Results: Median follow-up was 47.3 months (1-76.9). The 2 and 4-year progression-free survival (PFS), and overall survival (OS) were of 25.5%/8.6 and 48.9%/30.8%, respectively. Highest presenting toxicity in patients (grade 1 through 5) was: 13 (28.3%), 7 (15.2%), 1 (2.2%), 0 and 2 (4.4%), with deaths due to hemoptysis (n = 1) and alveolitis (n = 1). Although the Biological Effective Dose (at Planning Tumor Volume isocenter) was lower for central tumors treated for an in-field relapse (n = 21, 116 Gy versus 168 Gy, p = 0.005), they had no significant difference in OS than the remaining cohort, but with a higher rate of grade 2-5 toxicities (OR = 0.22, [0.06-0.8], p = 0.02). Conclusion: Reirradiation with SABR for local relapse in patients previously treated for stage III NSCLC, is feasible and associated with good outcome. This is also true for central tumors treated for an in-field relapse, but should be radiated with caution to mitigate toxicity.
Http Www Theses Fr, 2004
Le cancer est un problème majeur de santé publique. Les traitements peuvent être à visée systémiq... more Le cancer est un problème majeur de santé publique. Les traitements peuvent être à visée systémique ou loco-régionale, dans ce dernier cas l'imagerie médicale joue un rôle important en permettant de préciser la localisation de la tumeur. L'objectif de la radiothérapie est de délivrer une dose curatrice de radiation au volume cible tout en épargnant les organes à risques (OAR) avoisinants. La détermination de la localisation précise de ce volume cible ainsi que des OAR permet de définir la position et la puissance des faisceaux d'irradiation. Après le rappel des principes de la radiothérapie et du traitement des cancers, nous précisons les enjeux cliniques des tumeurs oculaires, cérébrales et prostatiques. Nous effectuerons une mise au point sur le recalage d'images, les différentes techniques sont passées en revue dans le but d'être didactique vis-à-vis de la communauté médicale. Les résultats du recalage sont présentés dans le cadre de la planification de la radiothérapie cérébrale et prostatique afin de préciser les types de recalage applicable en oncologie et plus particulièrement à la radiothérapie. Ensuite, nous présentons les perspectives de ce type d'application selon différentes régions anatomiques. Les applications de la segmentation automatiques et l'évaluation des résultats dans le cadre des tumeur de l'encéphale sont décrits après avoir passé en revue les différentes méthodes de segmentation utilisables selon les localisations anatomiques. Nous verrons une application originale : la simulation numérique de la croissance tumorale virtuelle et la comparaison avec la croissance réelle d'une tumeur cérébrale présentée par un patient. Enfin, nous exposerons les futurs développements possibles des outils de traitement de l'image en radiothérapie ainsi que les pistes des recherche à explorer en oncologie.
Survey about LTFU care and specific questions about second cancers. (DOCX 13 kb)
Abstract. In cancer treatment, understanding the aggressiveness of the tumor is essential in ther... more Abstract. In cancer treatment, understanding the aggressiveness of the tumor is essential in therapy planning and patient follow-up. In this article, we present a novel method for quantifying the speed of invasion of gliomas in white and grey matter from time series of magnetic resonance (MR) images. The proposed approach is based on mathematical tumor growth models using the reaction-diffusion formalism. The quantification process is formulated by an inverse problem and solved using anisotropic fast marching method yielding an efficient algorithm. It is tested on a few images to get a first proof of concept with promising new results. 1
The Oncologist
Background The randomized controlled trial (RCT) is the gold standard to objectively assess the e... more Background The randomized controlled trial (RCT) is the gold standard to objectively assess the effect of treatments. To help improve the quality of RCTs, experts established a list of recommendations, the CONsolidated Standards of Reporting Trials (CONSORT) Statement. In this study, we evaluated the implementation of the CONSORT Statement in the field of high-grade gliomas in adult patients and looked for criteria associated with higher quality of RCTs. Materials and Methods We searched all high-grade gliomas RCTs published in PubMed between January 1990 and December 2016. The quality of these RCTs was assessed by completing a modified CONSORT Score (CS). Results Ninety-six published RCTs were identified. The median CS was 19.5 on a scale of 0–33. Items were not equally reported. Items regarding the method of randomization or the blinding were reported in less than 25% of RCTs. However, the CS has constantly improved over the years. Before the implementation of the CONSORT Statemen...
Journal of Adolescent and Young Adult Oncology
To describe fecundity in female survivors of childhood cancer and consider the correlation with q... more To describe fecundity in female survivors of childhood cancer and consider the correlation with quality of life (QOL). Of 1744 women treated for childhood cancer before the age of 15 years at one of eight French cancer treatment centers between 1948 and 1992, 1187 who were alive in 2005 were sent a self-administered questionnaire, including questions about health status, QOL (MOS SF-36), and fecundity. A standardized fecundity ratio (SFR) was calculated (SFR: observed/expected number of children) for each individual based on a national reference. Of the 972 individuals (82%) who responded, 53% had at least 1 child. The overall SFR, 0.65, was dependent upon the initial diagnosis, more decreased in Central Nervous System tumors (0.24; p < 10) than in Germ cell (0.46; p = 0.03) or Sympathetic Nervous System tumors (0.79; p = 0.02). The average QOL motor score was 72.5 ± 19.5, and the average mental score was 61.4 ± 16.7. After adjusting for age, pathology, and self-reported sequelae in the questionnaires, it was determined that SF-36 mental (p = 0.002) and motor (p < 0.0002) scores correlated positively with fecundity, and SF-36 scores correlated negatively with locomotor late effects (p < 0.0001), growth insufficiency (p = 0.002), and psychological disorders (p < 0.001). Gonadal insufficiency was correlated with neither motor nor mental scores. Women treated for childhood cancer demonstrated impaired fecundity that correlated with poor QOL, as registered by the SF-36. Patients should be warned of the risk of impaired fecundity early during the follow-up. If possible, preservation of fertility should be prioritized at initiation of therapy.
Radiation oncology (London, England), Jan 9, 2017
Optimal management of locally recurrent prostate cancer after definitive radiation therapy is sti... more Optimal management of locally recurrent prostate cancer after definitive radiation therapy is still challenging. With the development of highly accurate radiotherapy devices, prostate salvage re-irradiation might generate lower toxicity rates than classical salvage therapies. We retrospectively evaluated the toxicity and the feasibility of a prostate re-irradiation after definitive radiation therapy failure. Two modalities were investigated: high-dose-rate brachytherapy (HDRB) on whole prostate gland and focal stereotactic radiotherapy (SBRT) using CyberKnife® linac. Between 2011 and 2015, 28 patients with imaged and/or biopsy-proven intra-prostatic recurrence of cancer after definitive radiation therapy underwent a salvage re-irradiation using HDRB (n = 10) or focal SBRT (n = 18). The schedule of re-irradiation was 35 Gy in 5 fractions. Biological response (defined as post-salvage radiation PSA variation) and biochemical no-evidence of disease (bNED) were evaluated in the whole coh...
Radiotherapy and Oncology, 2016
To evaluate the feasibility and effectiveness of combining radiofrequency (RF), cementoplasty (CP... more To evaluate the feasibility and effectiveness of combining radiofrequency (RF), cementoplasty (CP) and Radiotherapy (RT) for pain treatment of bone metastasis (mts) in oligo-metastatic patients (pts). Material and Methods: From April 2015 to September 2015 twelve pts. (9 men, 3 women; median age 64 years) with 12 injuries to bones (vertebral column n = 9; femur, n = 1; sacrum, n = 2) were treated. Diagnosis of bone mts and then its treatment should be based on the combination of different elements: clinical evaluation, CT, MRI and nuclear medicine patterns. The mini-invasive treatment of oligometastatic pts aims pain relief that improving the quality of life; treat biomechanical stability of the spine; and an antineoplastic effect-cytoreductive. RF ablation was performed with the pts under sedation a CT-guidance, and was followed by cement injection. Pain relief was valuated with visual analogue scale (VAS) score. After 10 days on average, the patient was subjected to Stereotactic-RT or Volumetric Modulated Arc Therapy (VMAT) technique and a total dose of 20-30 Gy. Results: Technical success and pain relief was archived in all pts. Pain rating with the VAS decrease from a mean of 9 to a mean of 4, and after 3 month was detected a mayor decrease (2,5). We recorded an overall improvement in the quality of life measured with a suitable test There was no particular toxicity. At present no patient died for progression of disease.The evolution of the disease will be evaluated with the use of MRI. Conclusion: Our data showing the importance of a multidisciplinary approach oligo-metastatic patients. RF with CP and RT carried out by experts is effective for pain relief and functional recovery in patients with painful bone metastases and can significantly improve quality of life. EP-1438 Radiosurgery to the resection cavity of brain metastasis: Long term efficacity
Clinical Colorectal Cancer, 2016
Patients with metastatic colorectal cancer (CRC) may present with oligometastatic lung lesions fo... more Patients with metastatic colorectal cancer (CRC) may present with oligometastatic lung lesions for which stereotactic ablative radiotherapy (SABR) can be utilized. This study aims to report efficacy and prognostic factors associated with colorectal lung metastases treated with SABR. This is a retrospective study including patients who presented with lung oligometastasis from CRC treated with SABR from September 2007 to November 2014. We identified 53 oligometastatic patients with 87 lung lesions. The median prescription dose was 60 Gy in 3 fractions (median biological effective dose of 180 Gy). The median follow up was 33 months. The 1- and 2-year local control, metastasis-free survival, and overall survival were 79.8% and 78.2%, 29.2% and 16.2%, and 83.8% and 69.3%, respectively. On multivariate analysis, rectal primary site (P = .001) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 metastases (P = .02) were significantly associated with a lower local control rate. Rectal lesions were associated with higher radiation dose (169.3 Gy vs. 153.3 Gy; P = .01) and higher rate of KRAS mutations (73.3% vs. 40.4%; P = .02). KRAS mutation did not predict for local control, but predicted for a 1-year metastasis-free survival detriment (0% vs. 37.5%; P = .04), when compared with KRAS wild-type. On multivariate analysis, there is an overall survival detriment associated with gross tumor volume ≥ 3266 mm(3) (P = .03) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 metastases (P = .04). In CRC, oligometastatic lung lesions treated with SABR had a worse outcome in patients presenting with a rectal primary, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 metastases, or treated with a larger gross tumor volume. More aggressive treatment may be considered in this subset of patients to improve outcome.
Circulation, 2015
Background— Cardiac disease (CD) is one of the major side effects of childhood cancer therapy, bu... more Background— Cardiac disease (CD) is one of the major side effects of childhood cancer therapy, but until now little has been known about the relationship between the heart radiation dose (HRD) received during childhood and the risk of CD. Methods and Results— The cohort comprised 3162 5-year survivors of childhood cancer. Chemotherapy information was collected and HRD was estimated. There were 347 CDs in 234 patients, 156 of them were rated grade ≥3. Cox and Poisson regression models were used. The cumulative incidence of any type of CD at 40 years of age was 11.0% (95% confidence interval [CI], 9.5–12.7) and 7·4% (95% CI, 6.2–8.9) when only the CDs of grade ≥3 were considered. In comparison with patients who received no anthracycline and either no radiotherapy or an HRD<0·1Gy, the risk was multiplied by 18·4 (95% CI, 7.1–48.0) in patients who had received anthracycline and no radiotherapy or a HRD <0.1Gy, by 60.4 (95% CI, 22.4–163.0) in those who had received no anthracycline...
The Journal of Clinical Endocrinology & Metabolism, 2015
Cancer/Radiothérapie, 2010
Cancer/Radiothérapie, 2003
Les métastases systémiques des cancers de l'ovaire sont fréquentes, mais elles atteignent raremen... more Les métastases systémiques des cancers de l'ovaire sont fréquentes, mais elles atteignent rarement le système nerveux. Nous présentons ici le cas d'une patiente traitée pour un cancer de l'ovaire par l'association d'une chirurgie et d'une chimiothérapie. Trois mois après la fin de la chimiothérapie, des métastases cérébrales ont été mises en évidence : elles ont été traitées par chirurgie itérative et irradiation panencéphalique. Comme la fréquence des métastases cérébrales solitaires des cancers de l'ovaire est plus importante que dans d'autres cancers, il est probable qu'elles se comportent légèrement différemment. L'analyse des données de la littérature montre une augmentation de l'incidence des métastases cérébrales depuis le milieu des années 1990. Les métastases cérébrales des cancers de l'ovaire peuvent survenir pendant ou après la chimiothérapie adjuvante et la meilleure stratégie afin de définir les déterminants de la survie n'est pas bien connue. Le traitement agressif par chirurgie, lorsqu'il est possible, associé à la radiothérapie, peut être proposé en présence d'une à trois métastases cérébrales. Le traitement multimodal, lorsqu'il est possible, permet d'augmenter la durée de survie et d'améliorer le performance status. Compte tenu de l'augmentation de l'incidence des métastases cérébrales des cancers de l'ovaire et de leur apparition possible pendant ou au décours d'une chimiothérapie, certains auteurs ont proposé un traitement prophylactique cérébral par irradiation chez les patientes qui reçoivent une chimiothérapie adjuvante.
Bulletin du cancer, 2010
Cyberknife (Accuray Inc. Sunnyvale, USA) stereotactic body radiation therapy (SBRT) involves the ... more Cyberknife (Accuray Inc. Sunnyvale, USA) stereotactic body radiation therapy (SBRT) involves the delivery of a small number of large doses of radiation to a target volume using continuously evolving advanced technology. It has emerged as a novel treatment modality for cancer and modified some concepts of cancer treatment. It is indicated in early-stage primary cancer, sometimes as an alternative to surgery. It is also indicated for patients with oligometastatic disease who have relatively long survival with the aim to optimize disease control with a good quality of life. Although there remain some uncertainties regarding the radiobiology of hypofractionation, local control and tolerance have been promising. Indications are increasing under strict quality assurance programs worldwide and prospective clinical evaluation.
Interactive cardiovascular and thoracic surgery, 2010
Radiotherapy is often the treatment used for inoperable early-stage lung cancer as well as pulmon... more Radiotherapy is often the treatment used for inoperable early-stage lung cancer as well as pulmonary metastases. In the last decade, efforts were done to increase local control with high-dose radiation without excessive collateral damage. Initially used for cranial lesions, stereotactic radiosurgery enlarged extracranial indications; the Cyberknife radiosurgery system needs metal (gold) markers for image guidance. For lung tumours, fiducials are inserted computed tomography (CT)-guided or bronchoscopy-guided. We describe four patients where fiducial placement was done during surgery.
Onkologie, 2009
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms, and metastatic disease is... more Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms, and metastatic disease is present at diagnosis in about 50%. Most common metastatic sites are the liver, the lungs, and the peritoneum. Bony metastases are uncommon and of unknown prognosis. A 57-year-old man presented with diplopia due to a clival metastastic lesion from an asymptomatic rectal stromal tumor. This patient also had liver and vertebral metastases. Treatment with imatinib, a tyrosine kinase inhibitor, led to a partial response of the primary tumor and hepatic metastasis, but the patient developed aggressive bone metastases that proved refractory to 3 different tyrosine kinase inhibitors. Different drug distribution or different mutation patterns of key prognostic receptors (e.g. cKIT receptor) in bone and soft tissues may explain the unusually aggressive pattern of these bony metastases of a GIST. Pharmacodynamic and molecular investigations are warranted to check these hypotheses.
Leukemia & Lymphoma, 2008
Multicenter, retrospective study of standard-dose RIT in eight heavily pre-treated patients with ... more Multicenter, retrospective study of standard-dose RIT in eight heavily pre-treated patients with CD20-positive follicular lymphoma who had relapsed after previous autologous bone marrow transplantation (ABMT). Patients underwent nine courses of (90)Y-ibritumomab tiuxetan (0.3 or 0.4 mCi/kg body weight). Responses included five CR, two PR, one SD and one PD. Median DFS was 12 months with median follow-up of 17 months and 1-year OS was 83% (7/8 patients). Grade 4 thrombocytopenia occurred in 7/9 treatments, with no episodes of bleeding, and only two patients received a platelet transfusion. One patient, who had 20% bone marrow involvement at the time of relapse diagnosis, presented with Grade 4 thrombocytopenia and Grade 4 neutropenia and died of septic shock 6 months after RIT. One other case of Grade 4 neutropenia, without a serious infectious syndrome, was observed. Standard-dose RIT seems feasible and potentially effective after ABMT in correctly selected patients with follicular lymphoma.
Translational lung cancer research, 2016
The equivalent uniform dose (EUD) radiobiological model can be applied for lung cancer treatment ... more The equivalent uniform dose (EUD) radiobiological model can be applied for lung cancer treatment plans to estimate the tumor control probability (TCP) and the normal tissue complication probability (NTCP) using different dose calculation models. Then, based on the different calculated doses, the quality adjusted life years (QALY) score can be assessed versus the uncomplicated tumor control probability (UTCP) concept in order to predict the overall outcome of the different treatment plans. Nine lung cancer cases were included in this study. For the each patient, two treatments plans were generated. The doses were calculated respectively from pencil beam model, as pencil beam convolution (PBC) turning on 1D density correction with Modified Batho's (MB) method, and point kernel model as anisotropic analytical algorithm (AAA) using exactly the same prescribed dose, normalized to 100% at isocentre point inside the target and beam arrangements. The radiotherapy outcomes and QALY were ...
BMC Cancer
Background Proton beam therapy (PBT) is a new-emerging cancer treatment in China but its treatmen... more Background Proton beam therapy (PBT) is a new-emerging cancer treatment in China but its treatment costs are high and not yet covered by Chinese public medical insurance. The advanced form of PBT, intensity-modulated proton radiation therapy (IMPT), has been confirmed to reduce normal tissue complication probability (NTCP) as compared to conventional intensity-modulated photon-radiation therapy (IMRT) in patients with oropharyngeal cancer (OPC). Herein, we evaluated the cost-effectiveness and applicability of IMPT versus IMRT for OPC patients in China, aiming at guiding the proper use of PBT. Methods A 7-state Markov model was designed for analysis. Base-case evaluation was performed on a 56-year-old (median age of OPC in China) patient under the assumption that IMPT could provide a 25% NTCP-reduction in long-term symptomatic dysphagia and xerostomia. Model robustness was examined using probabilistic sensitivity analysis, cohort analysis, and tornado diagram. One-way sensitivity ana...
BMC Cancer, 2020
Background Cost-effectiveness is a pivotal consideration for clinical decision making of high-tec... more Background Cost-effectiveness is a pivotal consideration for clinical decision making of high-tech cancer treatment in developing countries. Intensity-modulated proton radiation therapy (IMPT, the advanced form of proton beam therapy) has been found to improve the prognosis of the patients with paranasal sinus and nasal cavity cancers compared with intensity-modulated photon-radiation therapy (IMRT). However, the cost-effectiveness of IMPT has not yet been fully evaluated. This study aimed at evaluating the cost-effectiveness of IMPT versus IMRT for treatment decision making of paranasal sinus and nasal cavity cancers in Chinese settings. Methods A 3-state Markov model was designed for cost-effectiveness analysis. A base case evaluation was performed on a patient of 47-year-old (median age of patients with paranasal sinus and nasal cavity cancers in China). Model robustness was examined by probabilistic sensitivity analysis, Markov cohort analysis and Tornado diagram. Cost-effective...
BMC Cancer, 2019
Background: In stage III non-small cell lung cancer (NSCLC) treated with concomitant chemoradioth... more Background: In stage III non-small cell lung cancer (NSCLC) treated with concomitant chemoradiotherapy, there is a high rate of relapse. Some of these relapses are only local and can be treated by stereotactic ablative radiation therapy (SABR). Previous studies reporting outcome after SABR reirradiation of the thorax consisted of a heterogeneous population of various lung cancer stages or even different types of cancer. The purpose of study is to evaluate toxicity and outcome of this strategy in locally relapsed stage III NSCLC only. Methods: From February 2007 to November 2015, 46 Stage III NSCLC patients treated with SABR, for lung recurrence following conventionally fractionated radiation therapy (CFRT), were retrospectively analyzed. Results: Median follow-up was 47.3 months (1-76.9). The 2 and 4-year progression-free survival (PFS), and overall survival (OS) were of 25.5%/8.6 and 48.9%/30.8%, respectively. Highest presenting toxicity in patients (grade 1 through 5) was: 13 (28.3%), 7 (15.2%), 1 (2.2%), 0 and 2 (4.4%), with deaths due to hemoptysis (n = 1) and alveolitis (n = 1). Although the Biological Effective Dose (at Planning Tumor Volume isocenter) was lower for central tumors treated for an in-field relapse (n = 21, 116 Gy versus 168 Gy, p = 0.005), they had no significant difference in OS than the remaining cohort, but with a higher rate of grade 2-5 toxicities (OR = 0.22, [0.06-0.8], p = 0.02). Conclusion: Reirradiation with SABR for local relapse in patients previously treated for stage III NSCLC, is feasible and associated with good outcome. This is also true for central tumors treated for an in-field relapse, but should be radiated with caution to mitigate toxicity.
Http Www Theses Fr, 2004
Le cancer est un problème majeur de santé publique. Les traitements peuvent être à visée systémiq... more Le cancer est un problème majeur de santé publique. Les traitements peuvent être à visée systémique ou loco-régionale, dans ce dernier cas l'imagerie médicale joue un rôle important en permettant de préciser la localisation de la tumeur. L'objectif de la radiothérapie est de délivrer une dose curatrice de radiation au volume cible tout en épargnant les organes à risques (OAR) avoisinants. La détermination de la localisation précise de ce volume cible ainsi que des OAR permet de définir la position et la puissance des faisceaux d'irradiation. Après le rappel des principes de la radiothérapie et du traitement des cancers, nous précisons les enjeux cliniques des tumeurs oculaires, cérébrales et prostatiques. Nous effectuerons une mise au point sur le recalage d'images, les différentes techniques sont passées en revue dans le but d'être didactique vis-à-vis de la communauté médicale. Les résultats du recalage sont présentés dans le cadre de la planification de la radiothérapie cérébrale et prostatique afin de préciser les types de recalage applicable en oncologie et plus particulièrement à la radiothérapie. Ensuite, nous présentons les perspectives de ce type d'application selon différentes régions anatomiques. Les applications de la segmentation automatiques et l'évaluation des résultats dans le cadre des tumeur de l'encéphale sont décrits après avoir passé en revue les différentes méthodes de segmentation utilisables selon les localisations anatomiques. Nous verrons une application originale : la simulation numérique de la croissance tumorale virtuelle et la comparaison avec la croissance réelle d'une tumeur cérébrale présentée par un patient. Enfin, nous exposerons les futurs développements possibles des outils de traitement de l'image en radiothérapie ainsi que les pistes des recherche à explorer en oncologie.
Survey about LTFU care and specific questions about second cancers. (DOCX 13 kb)
Abstract. In cancer treatment, understanding the aggressiveness of the tumor is essential in ther... more Abstract. In cancer treatment, understanding the aggressiveness of the tumor is essential in therapy planning and patient follow-up. In this article, we present a novel method for quantifying the speed of invasion of gliomas in white and grey matter from time series of magnetic resonance (MR) images. The proposed approach is based on mathematical tumor growth models using the reaction-diffusion formalism. The quantification process is formulated by an inverse problem and solved using anisotropic fast marching method yielding an efficient algorithm. It is tested on a few images to get a first proof of concept with promising new results. 1
The Oncologist
Background The randomized controlled trial (RCT) is the gold standard to objectively assess the e... more Background The randomized controlled trial (RCT) is the gold standard to objectively assess the effect of treatments. To help improve the quality of RCTs, experts established a list of recommendations, the CONsolidated Standards of Reporting Trials (CONSORT) Statement. In this study, we evaluated the implementation of the CONSORT Statement in the field of high-grade gliomas in adult patients and looked for criteria associated with higher quality of RCTs. Materials and Methods We searched all high-grade gliomas RCTs published in PubMed between January 1990 and December 2016. The quality of these RCTs was assessed by completing a modified CONSORT Score (CS). Results Ninety-six published RCTs were identified. The median CS was 19.5 on a scale of 0–33. Items were not equally reported. Items regarding the method of randomization or the blinding were reported in less than 25% of RCTs. However, the CS has constantly improved over the years. Before the implementation of the CONSORT Statemen...
Journal of Adolescent and Young Adult Oncology
To describe fecundity in female survivors of childhood cancer and consider the correlation with q... more To describe fecundity in female survivors of childhood cancer and consider the correlation with quality of life (QOL). Of 1744 women treated for childhood cancer before the age of 15 years at one of eight French cancer treatment centers between 1948 and 1992, 1187 who were alive in 2005 were sent a self-administered questionnaire, including questions about health status, QOL (MOS SF-36), and fecundity. A standardized fecundity ratio (SFR) was calculated (SFR: observed/expected number of children) for each individual based on a national reference. Of the 972 individuals (82%) who responded, 53% had at least 1 child. The overall SFR, 0.65, was dependent upon the initial diagnosis, more decreased in Central Nervous System tumors (0.24; p < 10) than in Germ cell (0.46; p = 0.03) or Sympathetic Nervous System tumors (0.79; p = 0.02). The average QOL motor score was 72.5 ± 19.5, and the average mental score was 61.4 ± 16.7. After adjusting for age, pathology, and self-reported sequelae in the questionnaires, it was determined that SF-36 mental (p = 0.002) and motor (p < 0.0002) scores correlated positively with fecundity, and SF-36 scores correlated negatively with locomotor late effects (p < 0.0001), growth insufficiency (p = 0.002), and psychological disorders (p < 0.001). Gonadal insufficiency was correlated with neither motor nor mental scores. Women treated for childhood cancer demonstrated impaired fecundity that correlated with poor QOL, as registered by the SF-36. Patients should be warned of the risk of impaired fecundity early during the follow-up. If possible, preservation of fertility should be prioritized at initiation of therapy.
Radiation oncology (London, England), Jan 9, 2017
Optimal management of locally recurrent prostate cancer after definitive radiation therapy is sti... more Optimal management of locally recurrent prostate cancer after definitive radiation therapy is still challenging. With the development of highly accurate radiotherapy devices, prostate salvage re-irradiation might generate lower toxicity rates than classical salvage therapies. We retrospectively evaluated the toxicity and the feasibility of a prostate re-irradiation after definitive radiation therapy failure. Two modalities were investigated: high-dose-rate brachytherapy (HDRB) on whole prostate gland and focal stereotactic radiotherapy (SBRT) using CyberKnife® linac. Between 2011 and 2015, 28 patients with imaged and/or biopsy-proven intra-prostatic recurrence of cancer after definitive radiation therapy underwent a salvage re-irradiation using HDRB (n = 10) or focal SBRT (n = 18). The schedule of re-irradiation was 35 Gy in 5 fractions. Biological response (defined as post-salvage radiation PSA variation) and biochemical no-evidence of disease (bNED) were evaluated in the whole coh...
Radiotherapy and Oncology, 2016
To evaluate the feasibility and effectiveness of combining radiofrequency (RF), cementoplasty (CP... more To evaluate the feasibility and effectiveness of combining radiofrequency (RF), cementoplasty (CP) and Radiotherapy (RT) for pain treatment of bone metastasis (mts) in oligo-metastatic patients (pts). Material and Methods: From April 2015 to September 2015 twelve pts. (9 men, 3 women; median age 64 years) with 12 injuries to bones (vertebral column n = 9; femur, n = 1; sacrum, n = 2) were treated. Diagnosis of bone mts and then its treatment should be based on the combination of different elements: clinical evaluation, CT, MRI and nuclear medicine patterns. The mini-invasive treatment of oligometastatic pts aims pain relief that improving the quality of life; treat biomechanical stability of the spine; and an antineoplastic effect-cytoreductive. RF ablation was performed with the pts under sedation a CT-guidance, and was followed by cement injection. Pain relief was valuated with visual analogue scale (VAS) score. After 10 days on average, the patient was subjected to Stereotactic-RT or Volumetric Modulated Arc Therapy (VMAT) technique and a total dose of 20-30 Gy. Results: Technical success and pain relief was archived in all pts. Pain rating with the VAS decrease from a mean of 9 to a mean of 4, and after 3 month was detected a mayor decrease (2,5). We recorded an overall improvement in the quality of life measured with a suitable test There was no particular toxicity. At present no patient died for progression of disease.The evolution of the disease will be evaluated with the use of MRI. Conclusion: Our data showing the importance of a multidisciplinary approach oligo-metastatic patients. RF with CP and RT carried out by experts is effective for pain relief and functional recovery in patients with painful bone metastases and can significantly improve quality of life. EP-1438 Radiosurgery to the resection cavity of brain metastasis: Long term efficacity
Clinical Colorectal Cancer, 2016
Patients with metastatic colorectal cancer (CRC) may present with oligometastatic lung lesions fo... more Patients with metastatic colorectal cancer (CRC) may present with oligometastatic lung lesions for which stereotactic ablative radiotherapy (SABR) can be utilized. This study aims to report efficacy and prognostic factors associated with colorectal lung metastases treated with SABR. This is a retrospective study including patients who presented with lung oligometastasis from CRC treated with SABR from September 2007 to November 2014. We identified 53 oligometastatic patients with 87 lung lesions. The median prescription dose was 60 Gy in 3 fractions (median biological effective dose of 180 Gy). The median follow up was 33 months. The 1- and 2-year local control, metastasis-free survival, and overall survival were 79.8% and 78.2%, 29.2% and 16.2%, and 83.8% and 69.3%, respectively. On multivariate analysis, rectal primary site (P = .001) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 metastases (P = .02) were significantly associated with a lower local control rate. Rectal lesions were associated with higher radiation dose (169.3 Gy vs. 153.3 Gy; P = .01) and higher rate of KRAS mutations (73.3% vs. 40.4%; P = .02). KRAS mutation did not predict for local control, but predicted for a 1-year metastasis-free survival detriment (0% vs. 37.5%; P = .04), when compared with KRAS wild-type. On multivariate analysis, there is an overall survival detriment associated with gross tumor volume ≥ 3266 mm(3) (P = .03) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 metastases (P = .04). In CRC, oligometastatic lung lesions treated with SABR had a worse outcome in patients presenting with a rectal primary, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 metastases, or treated with a larger gross tumor volume. More aggressive treatment may be considered in this subset of patients to improve outcome.
Circulation, 2015
Background— Cardiac disease (CD) is one of the major side effects of childhood cancer therapy, bu... more Background— Cardiac disease (CD) is one of the major side effects of childhood cancer therapy, but until now little has been known about the relationship between the heart radiation dose (HRD) received during childhood and the risk of CD. Methods and Results— The cohort comprised 3162 5-year survivors of childhood cancer. Chemotherapy information was collected and HRD was estimated. There were 347 CDs in 234 patients, 156 of them were rated grade ≥3. Cox and Poisson regression models were used. The cumulative incidence of any type of CD at 40 years of age was 11.0% (95% confidence interval [CI], 9.5–12.7) and 7·4% (95% CI, 6.2–8.9) when only the CDs of grade ≥3 were considered. In comparison with patients who received no anthracycline and either no radiotherapy or an HRD<0·1Gy, the risk was multiplied by 18·4 (95% CI, 7.1–48.0) in patients who had received anthracycline and no radiotherapy or a HRD <0.1Gy, by 60.4 (95% CI, 22.4–163.0) in those who had received no anthracycline...
The Journal of Clinical Endocrinology & Metabolism, 2015
Cancer/Radiothérapie, 2010
Cancer/Radiothérapie, 2003
Les métastases systémiques des cancers de l'ovaire sont fréquentes, mais elles atteignent raremen... more Les métastases systémiques des cancers de l'ovaire sont fréquentes, mais elles atteignent rarement le système nerveux. Nous présentons ici le cas d'une patiente traitée pour un cancer de l'ovaire par l'association d'une chirurgie et d'une chimiothérapie. Trois mois après la fin de la chimiothérapie, des métastases cérébrales ont été mises en évidence : elles ont été traitées par chirurgie itérative et irradiation panencéphalique. Comme la fréquence des métastases cérébrales solitaires des cancers de l'ovaire est plus importante que dans d'autres cancers, il est probable qu'elles se comportent légèrement différemment. L'analyse des données de la littérature montre une augmentation de l'incidence des métastases cérébrales depuis le milieu des années 1990. Les métastases cérébrales des cancers de l'ovaire peuvent survenir pendant ou après la chimiothérapie adjuvante et la meilleure stratégie afin de définir les déterminants de la survie n'est pas bien connue. Le traitement agressif par chirurgie, lorsqu'il est possible, associé à la radiothérapie, peut être proposé en présence d'une à trois métastases cérébrales. Le traitement multimodal, lorsqu'il est possible, permet d'augmenter la durée de survie et d'améliorer le performance status. Compte tenu de l'augmentation de l'incidence des métastases cérébrales des cancers de l'ovaire et de leur apparition possible pendant ou au décours d'une chimiothérapie, certains auteurs ont proposé un traitement prophylactique cérébral par irradiation chez les patientes qui reçoivent une chimiothérapie adjuvante.
Bulletin du cancer, 2010
Cyberknife (Accuray Inc. Sunnyvale, USA) stereotactic body radiation therapy (SBRT) involves the ... more Cyberknife (Accuray Inc. Sunnyvale, USA) stereotactic body radiation therapy (SBRT) involves the delivery of a small number of large doses of radiation to a target volume using continuously evolving advanced technology. It has emerged as a novel treatment modality for cancer and modified some concepts of cancer treatment. It is indicated in early-stage primary cancer, sometimes as an alternative to surgery. It is also indicated for patients with oligometastatic disease who have relatively long survival with the aim to optimize disease control with a good quality of life. Although there remain some uncertainties regarding the radiobiology of hypofractionation, local control and tolerance have been promising. Indications are increasing under strict quality assurance programs worldwide and prospective clinical evaluation.
Interactive cardiovascular and thoracic surgery, 2010
Radiotherapy is often the treatment used for inoperable early-stage lung cancer as well as pulmon... more Radiotherapy is often the treatment used for inoperable early-stage lung cancer as well as pulmonary metastases. In the last decade, efforts were done to increase local control with high-dose radiation without excessive collateral damage. Initially used for cranial lesions, stereotactic radiosurgery enlarged extracranial indications; the Cyberknife radiosurgery system needs metal (gold) markers for image guidance. For lung tumours, fiducials are inserted computed tomography (CT)-guided or bronchoscopy-guided. We describe four patients where fiducial placement was done during surgery.