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PubMed | Center Antoine Lacassagne, Institute Of Cancerologie Of La Loire Lucien Neuwirth, University of Paris Descartes and 3 Center dImagerie Nucleaire
Type: Journal Article | Journal: The British journal of radiology | Year: 2016

The aim of this study was to report the first cases of salvage radiotherapy (RT) using the intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) targeted on choline positron emission tomography (PET) uptake in a local recurrent prostate cancer, after a radical prostatectomy.Four patients received salvage irradiation for biochemical relapse that occurred after the initial radical prostatectomy. The relapse occurred from 10 months to 6 years with PSA levels ranging from 2.35 to 4.86ngml(-1). For each patient, an (18)F-choline PET-CT showed a focal choline uptake in prostatic fossa, with standardized uptake value calculated on the basis of predicted lean body mass (SUL) max of 3.3-6.8. No involved lymph node or distant metastases were diagnosed. IMRT doses were of 62.7Gy (1.9Gy/fraction, 33 fractions), with a SIB of 69.3Gy (2.1Gy/fraction, 33 fractions) to a PET-guided target volume.Acute toxicities were limited. We observed no gastrointestinal toxicity grade 2 and only one grade 2 genitourinary toxicity. At 1-month follow-up evaluation, no complication and a decrease in PSA level (6.8-43.8% of the pre-therapeutic level) were reported. After 4 months, a decrease in PSA level was obtained for all the patients, ranging from 30% to 70%. At a median follow-up of 15 months, PSA level was controlled for all the patients, but one of them experienced a distant lymph node recurrence.Salvage irradiation to the prostate bed with SIB guided by PET-CT is feasible, with biological efficacy and no major acute toxicity.IMRT with PET-oriented SIB for salvage treatment of prostate cancer is possible, without major acute toxicity.


PubMed | Clinique Claude Bernard, Center Antoine Lacassagne, Institute Of Cancerologie Of La Loire Lucien Neuwirth and Jean Monnet University
Type: Comparative Study | Journal: Medical dosimetry : official journal of the American Association of Medical Dosimetrists | Year: 2016

For patients with cervical cancer, intensity-modulated radiation therapy (IMRT) improves target coverage and allows dose escalation while reducing the radiation dose to organs at risk (OARs). In this study, we compared dosimetric parameters among 3-dimensional conformal radiotherapy (3D-CRT), step-and-shoot IMRT, and volumetric intensity-modulated arc radiotherapy (VMAT) in a series of patients with cervical cancer receiving definitive radiotherapy. Computed tomography (CT) scans of 10 patients with histologically proven cervical cancer treated with definitive radiation therapy (RT) from December 2008 to March 2010 at our department were selected for this study. The gross tumor volume (GTV) and clinical target volume (CTV) were delineated following the guidelines of the Gyn IMRT consortium that included cervix, uterus, parametrial tissues, and the pelvic nodes including presacral. The median age was 57 years (range: 30 to 85 years). All 10 patients had squamous cell carcinoma with Federation of Gynecology and Obstetrics (FIGO) stage IB-IIIB. All patients were treated by VMAT. OAR doses were significantly reduced for plans with intensity-modulated technique compared with 3D-CRT except for the dose to the vagina. Between the 2 intensity-modulated techniques, significant difference was observed for the mean dose to the small intestine, to the benefit of VMAT (p < 0.001). There was no improvement in terms of OARs sparing for VMAT although there was a tendency for a slightly decreased average dose to the rectum: - 0.65Gy but not significant (p = 0.07). The intensity modulation techniques have many advantages in terms of quality indexes, and particularly OAR sparing, compared with 3D-CRT. Following the ongoing technologic developments in modern radiotherapy, it is essential to evaluate the intensity-modulated techniques on prospective studies of a larger scale.


PubMed | Laboratoire Of Radiobiologie Cellulaire Et Moleculaire Of Lyon Sud, Hopitaux Universitaires Paris Val Of Seine, Institute Of Cancerologie Of La Loire Lucien Neuwirth and Jean Monnet University
Type: Journal Article | Journal: Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie | Year: 2016

The aim of this study was to appreciate the place and role of geriatric assessment in elderly patients with prostate cancer.We performed a retrospective analysis of prostate cancer patients who underwent geriatric assessment during the therapeutic management from 2008 to 2014. Patient, tumor, treatment characteristics and their associated toxicity as well as the parameters of geriatric assessment were studied. The occurrence of geriatric assessment within the 3months preceding a therapeutic decision was reviewed.Data of seventy-four patients were analyzed with a median follow-up of 15.6years. The average age at diagnosis was 74.3 and 80.6 at the geriatric assessment. At the time of the geriatric assessment 64patients had metastatic disease, 39 were in poor condition more than 50% of patients had walking ability disorders. Thirteen patients underwent radical surgery, 28 received radiotherapy, 30patients had chemotherapy and hormonotherapy was prescribed for 72patients. The geriatric assessment, requested on average 15years after diagnosis, was not carried out within the 3months preceding treatment decision for 55patients.The recourse to geriatric assessment is predominantly used to endorse a decision of supportive care for elderly patients with prostate cancer. An early intervention by a geriatrician consultant for the initial management and then at each therapeutic event is a sine qua non condition for efficient personalized therapeutic management suitable to every patient according to physiological age.4.


PubMed | French National Center for Scientific Research, University of Lyon and Institute Of Cancerologie Of La Loire Lucien Neuwirth
Type: | Journal: Frontiers in oncology | Year: 2017

[This corrects the article on p. 58 in vol. 6, PMID: 27014633.].


Mery B.,Institute Of Cancerologie Of La Loire Lucien Neuwirth | Guy J.-B.,Institute Of Cancerologie Of La Loire Lucien Neuwirth | Swalduz A.,Institute Of Cancerologie Of La Loire Lucien Neuwirth | Vallard A.,Institute Of Cancerologie Of La Loire Lucien Neuwirth | And 7 more authors.
Critical Reviews in Oncology/Hematology | Year: 2015

Lung cancer is a major public health concern worldwide. Progress in improving 5-year survival is lagging behind comparable survival rates in other common cancers. The majority of patients with locally advanced non-small cell lung cancer (NSCLC) are not suitable for surgical resection, hence the major role of radical radiotherapy. Advances in radiotherapy techniques allow targeted treatment of the disease, whilst minimizing the dose to organs at risk. Recent research into fractionation schedules, with hyperfractionated and accelerated radiotherapy regimens has been promising. Platinum-based chemotherapy has long been the standard of care for the initial treatment of advanced NSCLC. However, if radical radiotherapy remains the cornerstone of treatment for patients with unresectable advanced NSCLC either as single modality treatment or with concomitant chemotherapy, advances in understanding of tumor molecular biology and targeted drug development should bring targeted agents into the NSCLC management. The development of numerous therapeutic approaches has made the locally advanced NSCLC world change. An up-to-date overview of the current literature on updated chemotherapeutic agents, targeted therapy, immunotherapy, radiotherapy in stage III NSCLC is provided. © 2015 Elsevier Ireland Ltd. All rights reserved.


PubMed | Service danatomie et cytologie pathologique and Institute Of Cancerologie Of La Loire Lucien Neuwirth
Type: Review | Journal: Journal de gynecologie, obstetrique et biologie de la reproduction | Year: 2016

Rhabdomyosarcoma, most common soft tissue tumor in children, represent 8% of solid tumors in children. Conversely, in adults, this histology is very rare and no consensual recommendation is supported. If gynecological localization is one of the most frequent in children, it is a minority in adults. The management of this type of tumor is based on treatment multimodality combining surgery, chemotherapy, radiotherapy and brachytherapy. This pathological separate entity differs from other sarcomas by its greater sensitivity to chemotherapy and radiotherapy. The aim of this study is to conduct a general review of diagnostic and treatment of genital tract rhabdomyosarcoma in adults, and to report pathological characteristics of this type of tumor.


PubMed | University of Lyon, Institute Of Physique Nucleaire Of Lyon and Institute Of Cancerologie Of La Loire Lucien Neuwirth
Type: Journal Article | Journal: Oncotarget | Year: 2016

Cancer Stem Cells (CSCs) in Head and Neck Squamous Cell Carcinoma (HNSCC) have extremely aggressive profile (high migratory and invasive potential). These characteristics can explain their resistance to conventional treatment. Efficacy of photon and carbon ion irradiation with addition of cetuximab (5 nM) is studied on clonogenic death, migration and invasion of two HNSCC populations: SQ20B and SQ20B/CSCs. SQ20B express E-cadherin and overexpress EGFR while SQ20B/CSCs express N-cadherin and low EGFR. Cetuximab strongly inhibits SQ20B proliferation but has no effect on SQ20B/CSCs. 2 Gy photon irradiation enhances migration and invasiveness in both populations (p < 0.05), while cetuximab only stops SQ20B migration (p < 0.005). Carbon irradiation significantly inhibits invasion in both populations (p < 0.05), and the association with cetuximab significantly inhibits invasion in both populations (p < 0.005). These results highlight CSCs characteristics: EGFRLow, cetuximab-resistant, and highly migratory. Carbon ion irradiation appears to be a very promising therapeutic modality counteracting migration/invasion process in both parental cells and CSCs in contrast to photon irradiation.

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