GCS ETOILE

Sainte-Foy-lès-Lyon, France

GCS ETOILE

Sainte-Foy-lès-Lyon, France

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Maucort-Boulch D.,University of Lyon | Maucort-Boulch D.,University Claude Bernard Lyon 1 | Maucort-Boulch D.,CNRS Biometry and Evolutionary Biology Laboratory | Baron M.-H.,hopital Jean Minjoz | And 9 more authors.
Cancer/Radiotherapie | Year: 2010

Purpose: The standard treatment of high-grade glioma is still unsatisfactory: the 2-year survival after radiotherapy being only 10-25%. A high linear energy transfer (LET) ionising radiotherapy has been used to overcome tumour radioresistance. An overview of the field is needed to justify future prospective controlled studies on carbon ion therapy. Materials and methods: A meta-analysis of clinical trials on neutron beam therapy and a literature review of clinical investigations on light ion use in high-grade glioma were carried out. Results: Four randomised controlled trials on neutron beam therapy were retained. The meta-analysis showed a non-significant 6% increase of two-year mortality (Relative risk [RR] = 1.06 [0.97-1.15]) in comparison with photon therapy. Two phase I/II trials on carbon and neon ion therapy reported for glioblastoma 10% and 31% two-year overall survivals and 13.9 and 19.0 months median survivals, respectively. Conclusion: This meta-analysis suggests that neutron beam therapy does not improve the survival of high-grade glioma patients while there is no definitive conclusion yet regarding carbon therapy. The ballistic accuracy and the improved biological efficacy of carbon ions renew the interest in prospective clinical trials on particle beam radiotherapy of glioma and let us expect favourable effects of dose escalation on patients' survival. © 2009 Société française de radiothérapie oncologique (SFRO).


Pommier P.,Center Leon Berard | Sunyach M.-P.,Center Leon Berard | Hu Y.,University of Lyon | Amsalem E.,CETAF | And 7 more authors.
Bulletin du Cancer | Year: 2010

The radiobiological properties of the hadrons (neutrons, protons, carbon ions) led to their therapeutic use in sarcomas, as a referent therapy or as an alternative to photon therapy. An extensive review of the literature has been conducted to assess the present indications and the perspectives for hadrontherapy. Compared to photons, neutrons are characterized by a higher biological efficiency that is on particular importance for these tumours usually considered as radio-resistant. Neutrons have been considered as a standard therapy for sarcoma' patients, contra-indicated for surgery or with a definitive R2 resection, but their indications and use have been restricted due to the occurrence of late severe toxicities related to their poor ballistic' properties. Thanks to their physical properties (Bragg Peak), protons are characterized by a higher conformity index compared to photons (and neutrons) with optimal organs at risk preservation that permits a dose escalation. Protontherapy is to date the standard of care for base of skull, spinal and paraspinal sarcomas. Carbon ions combined both advantages from protons and neutrons. Literature data permits to consider this radiation modality as a referent therapy for unresectable sarcomas. The ongoing diffusions of protons and carbon ions radiotherapy facilities will permit to offer these therapies to more patients and to conduct studies that are warranted to determine their indications and their results. ©John Libbey Eurotext.


Yoan J.,University of Lyon | Yoan J.,Jean Monnet University | Eric M.,University of Lyon | Eric M.,Jean Monnet University | Pascal P.,GCS ETOILE
IFAC Proceedings Volumes (IFAC-PapersOnline) | Year: 2011

In any cancer treatment, waiting times are critical, the faster the patient is treated the more effective the treatment is. Minimizing waiting times is especially difficult in the context of radiotherapy where material and human resources are usually scarce. Although healthcare scheduling is extensively documented, few studies have addressed the specific radiotherapy problem. In this paper we develop an original model of radiotherapy scheduling using an integer linear optimization of a non-block scheduling strategy. In order to outperform previous works, we have introduced the concept of treatment patterns over the entire patient treatment allowing realistic treatment protocols to take place. Results achieved show an improvement of radiotherapy treatment room utilization, a higher number of patients treated along with a decrease in patient waiting times. © 2011 IFAC.


Jacquemin Y.,LASPI | Marcon E.,LASPI | Pommier P.,GCS ETOILE
2010 IEEE Workshop on Health Care Management, WHCM 2010 | Year: 2010

In any cancer treatment, waiting times are critical, the faster you treat, the more effective the treatment is. Minimizing waiting times is especially difficult in the context of radiotherapy where material and human resources are usually scarce. Although healthcare scheduling is extensively documented, few studies have addressed the specific radiotherapy problem. In this paper we develop an integer linear optimization of a non-block scheduling strategy to improve existing models accuracy. After analyzing the weakness of the previous works, we suggest a new mathematical model, which better fits the reality. First we increase the planning horizon to ensure efficiency over several weeks then we take into account several new constraints such as critical human resources and protocol-dependant constraints while using near real-life data from the studied hospital. Results achieved show an improvement of radiotherapy treatment room utilization, a higher number of patients treated along with a decrease in patient waiting times.


Patin S.,GCS ETOILE | Pommier P.,Center Regional Of Lutte Contre Le Cancer Leon Berard | Yi H.,GCS ETOILE | Baron M.H.,Besancon University Hospital Center | And 2 more authors.
Journal of Cancer Epidemiology | Year: 2013

Context. Hadrontherapy is an innovative form of radiotherapy using beams of protons or carbon ions able to destroy some radio-resistant tumours. Because these tumours are highly specific amongst all cancerous tumours, it is impossible to determine the incidence of these diseases from surveillance registries. Goal. To assess, within the Rhône-Alpes region, the incidence of cancers being hadrontherapy indications. Method. Prospective, multicentre continuous data collection during 1 year, by practitioners participating to multidisciplinary tumor board. Tumours are inoperable, radio resistant, at primary stage of development, or locally recurrent, with low metastatic potential. Results. Study involved 27 healthcare centres, 52 groups of specialist practitioners. The estimated incidence of cancers eligible for hadrontherapy in the Rhône-Alpes region in 2010, that is, for 34 locations in all, is of 8.5/100 000 inhabitants. Appraisal of the low potential of metastatic progression is impeded, because these are rare diseases, whose outcome is unfamiliar to investigators. Conclusion. Future epidemiological studies will need to focus on prognosis and on the metastatic progression rate of these diseases. Indeed, there are few information available on this subject in the literature that could be used to improve preventive measures, medical care, and the surveillance of these rare cancers. © 2013 Stéphanie Patin et al.


Pommier P.,CRLCC Leon Berard | Hu Y.,CNRS Biometry and Evolutionary Biology Laboratory | Baron M.-H.,Besancon University Hospital Center | Chapet O.,Lyon University Hospital Center | And 2 more authors.
Bulletin du Cancer | Year: 2010

Carbon ion therapy is an innovative radiation therapy. It has been first proposed in the forties by Robert Wilson, however the first dedicated centres for human care have been build up only recently in Japan and Germany. The interest of carbon ion is twofold: 1) the very sharp targeting of the tumour with the so called spread out Bragg peak that delivers most of the beam energy in the tumour and nothing beyond it, sparing very efficiently the healthy tissues; 2) the higher relative biological efficiency compared to X rays or protons, able to kill radioresistant tumour cells. Both properties make carbon ions the elective therapy for non resectable radioresistant tumours loco-regionally threatening. The technical and clinical experience accumulated during the recent decades is summarized in this paper along with a detailed presentation of the elective indications. A short comparison between conventional radiotherapy and hadrontherapy is proposed for the indications which are considered as priority for carbon ions. ©John Libbey Eurotext.

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