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Sainte-Catherine, France

Giraud P.,University of Paris Descartes | Morelle M.,University Pierre and Marie Curie | Morelle M.,French National Center for Scientific Research | Pourel N.,Sainte Catherine Institute | And 7 more authors.
Cancer Investigation | Year: 2012

A comparative, nonrandomized, multicenter, and prospective analysis were performed between April 2004 and June 2008 in 20 French centers in order to compare clinical aspects of respiratory-gated conformal radiotherapy (RGRT) during breast cancer irradiation versus conventional conformal radiotherapy. The final results based on 233 evaluable patients at 48 months confirm the feasibility and good reproducibility of the RGRT systems. The main results demonstrated a marked reduction of dosimetric parameters predictive of lungs and cardiac toxicities in the RGRT group; especially the dose delivered to the heart during irradiation of the left breast; mostly observed with deep inspiration breath-hold techniques. © 2012 Informa Healthcare USA, Inc. Source

Nouhaud E.,The Surgical Center | Crehange G.,The Surgical Center | Cueff A.,Biostatistics and Epidemiological Unit | Quivrin M.,The Surgical Center | And 5 more authors.
BMC Research Notes | Year: 2013

Abstract. Background: To evaluate the feasibility and efficacy of Stereotactic body radiation therapy (SBRT) for primary liver lesions and liver metastases treated with linear accelerators with or without rotational Intensity Modulated RadioTherapy (IMRT). Methods. Patients with either hepatocellular carcinoma, cholangiocarcinoma or metastatic liver lesions who had one to three lesions treated with SBRT in a single institution were retrospectively reviewed. Tumor response was evaluated according to EASL criteria 3 months after SBRT completion using MRI and/or abdominal CT scan. Responses were categorised as: Stable Disease (SD), Partial Response (PR), Complete Response (CR), Local Progression or Distant Progression in cases of new intra-hepatic lesions out-of-field or extra-hepatic metastases. Local Control (LC), Progression Free Survival (PFS), Overall Survival (OS) and treatment-related toxicities are reported. Results: Between 2007 and 2012, 20 patients with a total of 24 lesions were treated with SBRT. Fourteen patients presented hepatocellular carcinoma (HCC), the others had either metastatic lesions from colorectal cancer (CRC) or cholangiocarcinoma. The median diameter of the lesions was 23 mm (5-98).The dose per fraction ranged from 6 to 20 Gy with a median total dose of 60 Gy (range: 36-60 Gy). The dose was prescribed to the 80% isodose line covering the PTV.The median follow-up was 24 months (15.7-29.7).The actuarial LC rate was 78% for patients with HCC and 83% for those with adenocarcinoma and cholangiocarcinoma. Median OS was 37 months and OS rates were 83% at 12 and 24 months for HCC and 100% for adenocarcinoma. PFS was 54% for HCC and 50% for other types of tumors at 24 months.Acute grade 3-4 toxicities occurred in 2 patients; a small proportion of the other patients experienced grade 1 or 2 toxicities. Conclusions: SBRT provides excellent local control with minimal side effects in selected patients. © 2013 Nouhaud et al.; licensee BioMed Central Ltd. Source

Phelip J.M.,Jean Monnet University | Mineur L.,Sainte Catherine Institute | De la Fouchardiere C.,Leon Berard Center | Chatelut E.,Institute Claudius Regaud | And 6 more authors.
Annals of Surgical Oncology | Year: 2016

Background: The purpose of this study was to assess the efficacy and tolerance of induction chemotherapy combining LV5FU2 with increased doses of irinotecan adapted to UGT1A1 genotyping and cetuximab in untreated potentially resectable liver metastases of colorectal cancer. Methods: Twenty-six patients, PS 0-1, with class II hepatic metastases received chemotherapy combining irinotecan 260 mg/m2 on day 1 for UGT1A1 6/6 and 6/7 genotypes and 220 mg/m2 for UGT1A1 7/7 genotypes, with leucovorin on day 1, 5FU 400 mg/m2 bolus on day 1 and continuous 5FU infusion for 46 h, and cetuximab on day 1 (day 1 = day 14). Primary prevention with lenograstim (day 5–9) was given to UGT1A1 6/7 and 7/7 genotypes. The primary endpoint was the response rate (RECIST1.1), and the secondary endpoints were tolerance (NCI-CTC criteria) and R0 resection rate. Results: The average number of cycles per patient was 6 (±1.9). The UGT1A1 genotype was 6/6 in 34.6 %, 6/7 in 53.9 %, and 7/7 in 11.5 % of patients. At 6 cycles, 18 patients (69.2 %) presented a partial response, 5 patients (19.2 %) had stable disease, 2 patients (7.7 %) died independently of chemotherapy, and 1 patient (3.9 %) refused the treatment after 3 cycles. Four patients received 2 more cycles and the cumulative response rate at 8 cycles was 76.9 % (20/26). There was no progression. Among assessable patients (n = 23), the overall response rate was 82.6 % and 21 patients (80.7 %) had a metastasis resection. The most frequent grade 3–4 toxicities were neutropenia (31 %), diarrhea (20.8 %), and anorexia (16.4 %). There were no deaths due to toxicity. Conclusions: High-dose FOLFIRI combined with cetuximab yielded high response rates and enabled complete resection of class II hepatic metastases in most patients. It seemed to be well-tolerated among healthy selected patients thanks to irinotecan dose adaptation according to UGT1A1 pharmacogenomics status. This intensified chemotherapy regimen needs to be confirmed in a randomized, phase III study. © 2016, Society of Surgical Oncology. Source

Perrier L.,University of Lyon | Perrier L.,Leon Berard Cancer Center | Morelle M.,University of Lyon | Morelle M.,Leon Berard Cancer Center | And 14 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2016

Purpose This cost analysis aimed to prospectively assess differences in costs between TomoTherapy and volumetric modulated arc therapy (VMAT) in patients with head and neck cancer. Methods and Materials Economic data were gathered from a multicenter study. However, randomization was not possible due to the availability of equipment. Costs were calculated using the microcosting technique from the hospital's perspective (in 2013 euros), and the time horizon was radiation therapy. Only resources that entered the hospital production process and which were likely to vary between the strategies being compared were considered. Acute adverse events observed within the time horizon were also assessed. Results The cost analysis was based on a total of 173 patient treatments given between 2010 and 2012 in 14 French cancer centers: 73 patients were treated with TomoTherapy, 92 with VMAT RapidArc, and 8 with VMAT SmartArc. Estimated costs of SmartArc were removed from the comparison due to the small sample size. The mean ± SD cost per patient of the treatment planning phase was €314 (±€214) for TomoTherapy and €511 (±€590) for RapidArc. Mean costs ± SD per patient of irradiation reached €3144 (±€565) for TomoTherapy and €1350 (±€299) for RapidArc. The most sensitive parameter of irradiation was the annual operating time of accelerators. Ninety-five percent confidence intervals for the mean costs of irradiation were €3016 to €3272 for TomoTherapy and €1281 to €1408 for RapidArc. The number of acute adverse events during radiation therapy was not significantly different between strategies. Conclusions TomoTherapy appeared to be more expensive than RapidArc mainly due to the higher price of the accelerator, the higher costs of maintenance, and the longer duration of treatment sessions. Because strategies were not significantly different in clinical effect, RapidArc appeared to be the strategy to be recommended at this stage of knowledge. © 2016 Elsevier Inc. All rights reserved. Source

Hebbar M.,University Hospital | Chibaudel B.,GERCOR | Andre T.,Pitie Salpetriere Hospital | Louvet C.,Saint Antoine Hospital | And 9 more authors.
Journal of Chemotherapy | Year: 2013

Objectives: To evaluate the MIROX strategy (6 FOLFOX7 cycles followed by 6 FOLFIRI cycles) in patients with resected or resectable metastases from colorectal cancer. Methods: This trial compared the MIROX strategy to 12 cycles of simplified LV5FU2 (sLV5FU2). Chemotherapy was perioperative or adjuvant, at the investigator's decision, with stratification for this parameter. The primary objective was disease-free survival (DFS). The trial was interrupted in 2004, following the results of the adjuvant MOSAIC trial showing superiority of FOLFOX4 over LV5FU2. Results: Thirty-nine patients were included: 20 in MIROX arm and 19 in sLV5FU2 arm. Median DFS was higher in the MIROX arm (not reached versus 24.8 months, P = 0.044). MIROX regimen was well tolerated; 5/20 patients experienced a Grade 3 sensoryneuropathy. Conclusion: The MIROX strategy demonstrated promising efficacy, but this must be considered cautiously due to the small number of patients included. The pragmatic approach adopted for the treatment chronology is feasible. © 2013 Edizioni Scientifiche per l'Informazione su Farmaci e Terapia. Source

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