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Boydev C.,University of Valenciennes and Hainaut‑Cambresis | Boydev C.,Ecole Polytechnique Federale de Lausanne | Pasquier D.,Departement University Of Radiotherapie | Derraz F.,University of Valenciennes and Hainaut‑Cambresis | And 4 more authors.
Journal of Physics: Conference Series | Year: 2014

We evaluated automatic three-dimensional intensity-based rigid registration (RR) methods for prostate localization on CBCT scans and studied the impact of rectum distension on registration quality. 106 CBCT scans of 9 prostate patients were used. Each one was registered to the planning computed tomography (CT) scan using different methods: (a) global registration, (b) pelvis bony structure registration, (c) bony registration refined by a local prostate registration using the CT clinical target volume (CTV) expanded with 1, 3, 5, 8, 10, 12, 15 or 20-mm margin. Automatic CBCT contours were generated after propagation of the manual CT contours. To evaluate results, a radiation oncologist was asked to manually delineate the CTV on the CBCT scans (gold standard). The Dice similarity coefficients between propagated and manual CBCT contours were calculated. © Published under licence by IOP Publishing Ltd.


PubMed | Departement University Of Radiotherapie, Institute Of Cancerologie Of Louest, University of Strasbourg, Service de radiotherapie and 2 more.
Type: | Journal: Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique | Year: 2016

Radiotherapy for brain metastases has become more multifaceted. Indeed, with the improvement of the patients life expectancy, side effects must be undeniably avoided and the retreatments or multiple treatments are common. The cognitive side effects should be warned and the most modern techniques of radiation therapy are used regularly to reach this goal. The new classifications of patients with brain metastases help guiding treatment more appropriately. Stereotactic radiotherapy has supplanted whole brain radiation therapy both for patients with metastases in place and for those who underwent surgery. Hippocampus protection is possible with intensity-modulated radiotherapy. Its relevance in terms of cognitive functioning should be more clearly demonstrated but the requirement, for using it, is increasingly strong. While addressing patients in palliative phase, the treatment of brain metastases is one of the localisations where technical thinking is the most challenging.


PubMed | Center Oscar Lambret, Institute Of Cancerologie Of Louest and Departement University Of Radiotherapie
Type: | Journal: Radiation oncology (London, England) | Year: 2015

The aim of current study was to investigate the way dose is prescribed to lung lesions during SBRT using advanced dose calculation algorithms that take into account electron transport (type B algorithms). As type A algorithms do not take into account secondary electron transport, they overestimate the dose to lung lesions. Type B algorithms are more accurate but still no consensus is reached regarding dose prescription. The positive clinical results obtained using type A algorithms should be used as a starting point.In current work a dose-calculation experiment is performed, presenting different prescription methods. Three cases with three different sizes of peripheral lung lesions were planned using three different treatment platforms. For each individual case 60 Gy to the PTV was prescribed using a type A algorithm and the dose distribution was recalculated using a type B algorithm in order to evaluate the impact of the secondary electron transport. Secondly, for each case a type B algorithm was used to prescribe 48 Gy to the PTV, and the resulting doses to the GTV were analyzed. Finally, prescriptions based on specific GTV dose volumes were evaluated.When using a type A algorithm to prescribe the same dose to the PTV, the differences regarding median GTV doses among platforms and cases were always less than 10% of the prescription dose. The prescription to the PTV based on type B algorithms, leads to a more important variability of the median GTV dose among cases and among platforms, (respectively 24%, and 28%). However, when 54 Gy was prescribed as median GTV dose, using a type B algorithm, the variability observed was minimal.Normalizing the prescription dose to the median GTV dose for lung lesions avoids variability among different cases and treatment platforms of SBRT when type B algorithms are used to calculate the dose. The combination of using a type A algorithm to optimize a homogeneous dose in the PTV and using a type B algorithm to prescribe the median GTV dose provides a very robust method for treating lung lesions.


Antoni D.,Departement University Of Radiotherapie | Antoni D.,University of Strasbourg | Mornex F.,University of Lyon | Mornex F.,University Claude Bernard Lyon 1
Current Opinion in Oncology | Year: 2016

Purpose of review The treatment of locally advanced nonsmall cell lung cancer (NSCLC) is becoming a significant challenge because of a growing proportion of patients with unresectable or potentially eligible for surgery after a multimodality treatment, stage II to III disease. Despite a multimodality approach consisting in concurrent chemoradiotherapy, the prognosis remains poor. Recent findings Different strategies, including induction and consolidation chemotherapy, chemotherapy regimens, fractionation and radiation doses have been evaluated in phase II and III trials, as well as new therapeutic approaches such as immunotherapy. For patients with resectable stage III disease the optimal strategy remains unclear. The American Society for Radiation and Clinical Oncology and the European Society for Medical Oncology published recent guidelines in 2015. Summary Concurrent chemoradiotherapy improves overall survival compared with sequential chemotherapy followed by radiation. Adding induction or consolidation chemotherapy to chemoradiotherapy does not appear to improve the outcome. Chemotherapy based on cisplatin combined with radiation is recommended in stage III NSCLC. The standard dose and fractionation of radiotherapy are 60Gy, one daily fraction of 2Gy over 6 weeks. Targeted therapies and immunotherapy may improve the management of locally advanced NSCLC in the future. © Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.


PubMed | University of Strasbourg, Departement University Of Radiotherapie and Service de radiotherapie
Type: | Journal: Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique | Year: 2016

Gliomas are the most frequent primary brain tumours. Treating these tumours is difficult because of the proximity of organs at risk, infiltrating nature, and radioresistance. Clinical prognostic factors such as age, Karnofsky performance status, tumour location, and treatments such as surgery, radiation therapy, and chemotherapy have long been recognized in the management of patients with gliomas. Molecular biomarkers are increasingly evolving as additional factors that facilitate diagnosis and therapeutic decision-making. These practice guidelines aim at helping in choosing the best treatment, in particular radiation therapy.


Leroy T.,Departement University Of Radiotherapie | Leroy T.,Lille University of Science and Technology | Gabelle Flandin I.,Grenoble University Hospital Center | Habold D.,Center Hospitalier Of Chambery | And 2 more authors.
Cancer/Radiotherapie | Year: 2012

The aim of this study was to evaluate the impact of radiation therapy on sexual life. The analysis was based on a Pubmed literature review. The keywords used for this research were "sexual, radiation, oncology, and cancer" After a brief reminder on the anatomy and physiology, we explained the main complications of radiation oncology and their impact on sexual life. Preventive measures and therapeutic possibilities were discussed. Radiation therapy entails local, systematic and psychological after-effects. For women, vaginal stenosis and dyspareunia represent the most frequent side effects. For men, radiation therapy leads to erectile disorders for 25 to 75% of the patients. These complications have an echo often mattering on the patient quality of life of and on their sexual life post-treatment reconstruction. The knowledge of the indications and the various techniques of irradiation allow reducing its potential sexual morbidity. The information and the education of patients are essential, although often neglected. In conclusion, radiation therapy impacts in variable degrees on the sexual life of the patients. Currently, there are not enough preventive and therapeutic means. Patient information and the early screening of the sexual complications are at stake in the support of patients in the reconstruction of their sexual life. © 2012 Société française de radiothérapie oncologique (SFRO).


Vautravers-Dewas C.,Charles de Gaulle University - Lille 3 | Vautravers-Dewas C.,Departement University Of Radiotherapie | Dewas S.,Charles de Gaulle University - Lille 3 | Bonodeau F.,Center Oscar Lambret | And 5 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: To evaluate the outcome, tolerance, and toxicity of stereotactic body radiotherapy, using image-guided robotic radiation delivery, for the treatment of patients with unresectable liver metastases. Methods and Material: Patients were treated with real-time respiratory tracking between July 2007 and April 2009. Their records were retrospectively reviewed. Metastases from colorectal carcinoma and other primaries were not necessarily confined to liver. Toxicity was evaluated using National Cancer Institute Common Criteria for Adverse Events version 3.0. Results: Forty-two patients with 62 metastases were treated with two dose levels of 40 Gy in four Dose per Fraction (23) and 45 Gy in three Dose per Fraction (13). Median follow-up was 14.3 months (range, 3-23 months). Actuarial local control for 1 and 2 years was 90% and 86%, respectively. At last follow-up, 41 (66%) complete responses and eight (13%) partial responses were observed. Five lesions were stable. Nine lesions (13%) were locally progressed. Overall survival was 94% at 1 year and 48% at 2 years. The most common toxicity was Grade 1 or 2 nausea. One patient experienced Grade 3 epidermitis. The dose level did not significantly contribute to the outcome, toxicity, or survival. Conclusion: Image-guided robotic stereotactic body radiation therapy is feasible, safe, and effective, with encouraging local control. It provides a strong alternative for patients who cannot undergo surgery. © 2011 Elsevier Inc.


Refaat T.,Departement University Of Radiotherapie | Refaat T.,Northwestern University | Refaat T.,Alexandria University | Nickers P.,Departement University Of Radiotherapie | Lartigau E.,Departement University Of Radiotherapie
Brachytherapy | Year: 2014

Purpose: To report the treatment outcomes and treatment-induced adverse events (AEs) of concomitant chemoradiotherapy boosted with pulsed-dose-rate brachytherapy using volume-based two-dimensional planning in patients with cervical cancer. Patients and Methods: After obtaining the institutional review board approval, patients with FIGO Stages IB to IIIB cervical cancer, treated from January 2006 to December 2008 consecutively, were included. Volume-based planning was used and entailed defining an envelope around the tumor on a two-dimensional image and prescribing the dose to this envelope and reporting the dose of the isodose of 60Gy. Patients and tumor characteristics, dosimetric parameters, AEs and treatment outcomes, local control rate, distant metastases rate, progression-free survival, and overall survival are reported. Results: The study included 95 patients; the median age is 50 years. The median tumor size is 50. cc (range, 25-78. cc). Median brachytherapy dose delivered to the envelope is 20Gy (range, 15-35Gy), and median volume encompassed by 60Gy isodose curve is 137. cc (range, 26-365. cc). The 3-year overall survival, progression-free survival, local control rate, and distant metastases rate were 83.8%, 72.4%, 84.8%, and 15.4%, respectively. Gastrointestinal and genitourinary Grade 3 and 4 acute AEs were reported in 11.6% and 3.3% and chronic Grade 3 and 4 AEs were reported in 3.2% and 4.2% of all patients, respectively. Conclusions: Chemoradiotherapy followed by pulsed-dose-rate brachytherapy boost is effective and tolerable treatment modality for locally confined cervical cancer. © 2014 American Brachytherapy Society.


PubMed | Alexandria University and Departement University Of Radiotherapie
Type: Editorial | Journal: Brachytherapy | Year: 2014

To report the treatment outcomes and treatment-induced adverse events (AEs) of concomitant chemoradiotherapy boosted with pulsed-dose-rate brachytherapy using volume-based two-dimensional planning in patients with cervical cancer.After obtaining the institutional review board approval, patients with FIGO Stages IB to IIIB cervical cancer, treated from January 2006 to December 2008 consecutively, were included. Volume-based planning was used and entailed defining an envelope around the tumor on a two-dimensional image and prescribing the dose to this envelope and reporting the dose of the isodose of 60 Gy. Patients and tumor characteristics, dosimetric parameters, AEs and treatment outcomes, local control rate, distant metastases rate, progression-free survival, and overall survival are reported.The study included 95 patients; the median age is 50 years. The median tumor size is 50cc (range, 25-78cc). Median brachytherapy dose delivered to the envelope is 20 Gy (range, 15-35 Gy), and median volume encompassed by 60 Gy isodose curve is 137cc (range, 26-365cc). The 3-year overall survival, progression-free survival, local control rate, and distant metastases rate were 83.8%, 72.4%, 84.8%, and 15.4%, respectively. Gastrointestinal and genitourinary Grade 3 and 4 acute AEs were reported in 11.6% and 3.3% and chronic Grade 3 and 4 AEs were reported in 3.2% and 4.2% of all patients, respectively.Chemoradiotherapy followed by pulsed-dose-rate brachytherapy boost is effective and tolerable treatment modality for locally confined cervical cancer.


PubMed | Departement University Of Radiotherapie
Type: Comparative Study | Journal: International journal of radiation oncology, biology, physics | Year: 2013

To compare the dosimetric results of volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) in the treatment of high-risk prostate cancer with pelvic nodal radiation therapy.Plans were generated for 10 consecutive patients treated for high-risk prostate cancer with prophylactic whole pelvic radiation therapy (WPRT) using VMAT and HT. After WPRT, a sequential boost was delivered to the prostate. Plan quality was assessed according to the criteria of the International Commission on Radiation Units and Measurements 83 report: the near-minimal (D98%), near-maximal (D2%), and median (D50%) doses; the homogeneity index (HI); and the Dice similarity coefficient (DSC). Beam-on time, integral dose, and several organs at risk (OAR) dosimetric indexes were also compared.For WPRT, HT was able to provide a higher D98% than VMAT (44.3 0.3 Gy and 43.9 0.5 Gy, respectively; P=.032) and a lower D2% than VMAT (47.3 0.3 Gy and 49.1 0.7 Gy, respectively; P=.005), leading to a better HI. The DSC was better for WPRT with HT (0.89 0.009) than with VMAT (0.80 0.02; P=.002). The dosimetric indexes for the prostate boost did not differ significantly. VMAT provided better rectum wall sparing at higher doses (V70, V75, D2%). Conversely, HT provided better bladder wall sparing (V50, V60, V70), except at lower doses (V20). The beam-on times for WPRT and prostate boost were shorter with VMAT than with HT (3.1 0.1 vs 7.4 0.6 min, respectively; P=.002, and 1.5 0.05 vs 3.7 0.3 min, respectively; P=.002). The integral dose was slightly lower for VMAT.VMAT and HT provided very similar and highly conformal plans that complied well with OAR dose-volume constraints. Although some dosimetric differences were statistically significant, they remained small. HT provided a more homogeneous dose distribution, whereas VMAT enabled a shorter delivery time.

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