Vandœuvre-lès-Nancy, France
Vandœuvre-lès-Nancy, France

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Mandonnet E.,Hopital Lariboisiere | Fontaine D.,Hopital Pasteur | Taillandier L.,Nancy University Hospital Center | Bernier V.,Radiotherapy Center | And 3 more authors.
Neurosurgical Review | Year: 2010

Grade II gliomas grow slowly and linearly (at rates about 4 mm/year) before undergoing anaplastic transformation. In order to analyze how surgery may affect radiological grade II glioma kinetics, we restrospectively reviewed our national database searching for patients operated on for a supratentorial grade II glioma between 1997 and 2007. We selected patients with at least two postoperative MRI with a minimal delay of 6 months. For each patient, postoperative residues were segmented on successive MRIs. Velocities of diameter expansion were estimated by linear regression of mean diameter evolution for each patient. Fifty-four patients fulfilled inclusion criteria. Median postoperative follow-up was 1.6 years with, on average, 3.4 MRI examinations per patient. Postoperative growth rates of mean diameter were normally distributed, around a mean value of 4.3 mm/year (SD∈=∈3.2 mm/year). Statistical analysis showed no difference between this distribution and the distribution of preoperative growth rates in a previous series of 143 grade II gliomas. For a subset of 23 patients, delay between first MRI and surgery made it possible to estimate also preoperative growth rates. Intrapatient comparison revealed that growth rates were grossly unchanged for 80% of cases. In summary, inter- and intrapatient comparison of pre- and postoperative growth rates proves that surgery does not change grade II glioma dynamics, thus, acting as a cytoreduction. © 2009 Springer-Verlag.


Sharma V.,University of Witwatersrand | Gaye P.M.,Cheikh Anta Diop University | Wahab S.A.,Ain Shams University | Ndlovu N.,Radiotherapy Center | And 6 more authors.
Diseases of the Esophagus | Year: 2010

While numerous surveys of pattern of practices of palliative radiotherapy (RT) in advanced esophageal cancers have been published in developed countries, there is no such survey in African countries. During and after a regional training course by the International Atomic Energy Agency (IAEA) in palliative cancer care, a questionnaire was distributed to African RT centers to gather information about infrastructure and human resources available, and the pattern of practice of palliative RT for esophageal cancers. Twenty-four of the 35 centers (60%) completed the questionnaire. Twenty out of 23 (87%) centers treat patients with esophageal cancer presenting with dysphagia using external beam RT (16 centers external beam RT alone and 4 centers also use brachytherapy as a boost). Twelve (60%) centers prescribe RT doses of 30 Gy in 10 fractions and 2 centers 20 Gy in 5 fractions. Eighteen centers (78%) have low dose rate (LDR) brachytherapy, and 9 (39%) centers have high dose rate (HDR) brachytherapy. One center only used HDR brachytherapy alone to a dose of 16 Gy in 2 fractions over 8 days. RT remains a major component of treatment of patients with esophageal cancers in African countries. Still, there is a great variety among centers in both indications for RT and its characteristics for a treatment indication. © 2009 Copyright the Authors, Journal compilation © 2010, Wiley Periodicals, Inc. and the International Society for Diseases of the Esopha.


Custidiano E.R.,FaCENA | Valenzuela M.R.,FaCENA | Dumont J.L.,Elekta CMS Software | McDonnell J.,Santa Fe Institute | And 2 more authors.
Nuclear Instruments and Methods in Physics Research, Section B: Beam Interactions with Materials and Atoms | Year: 2011

Monte Carlo simulations were used to study the changes in the incident spectrum when a poly-energetic photon beam passes through a static brass compensator. The simulated photon beam spectrum was evaluated by comparing it against the incident spectra. We also discriminated the changes in the transmitted spectrum produced by each of the microscopic processes. (i.e. Rayleigh scattering, photoelectric effect, Compton scattering, and pair production). The results show that the relevant process in the energy range considered is the Compton Effect, as expected for composite materials of intermediate atomic number and energy range considered. © 2011 Elsevier B.V. All rights reserved.


Lorin L.,Center Leclerc | Lorin L.,University of Burgundy | Bertaut A.,Center Leclerc | Bertaut A.,University of Burgundy | And 8 more authors.
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2015

Objectives The new French cancer plan provides the implementation of organized screening. To make an assessment of the situation, we aim to describe clinical, tumor and survival characteristics of patients with invasive cervical cancer. Study design Data on women suffering from invasive cervical cancer and diagnosed from 1998 to 2010 were provided by the Cote d'Or breast cancer registry. Survival was described using the Kaplan-Meier method and prognostic factors of survival were estimated in a Cox proportional hazard model. Results On the whole, 1019 cancers have been collected including 311 (30.5%) invasive ones. The peak incidence was between 40 and 49 years, with an average age of 52 years (SD = 16.4). Cancers were mostly squamous cell carcinoma (80.1%) and diagnosed at a localized stage (53.7%). Only 49% (71/145) of our population were up to date on their Pap smear follow up with lower rates in deprived women. The 5-year survival rate was 62% (15% for women with FIGO stage IV and 91% for women with FIGO stage I) with a median survival of 12.3 years [95% CI: 6.6-NR]. Multivariate analysis showed that risk of death was the highest for group age 50-59 (OR = 4.93; 95% CI: [1.55-15.70]) compared to women aged less than 40, advanced stage (OR = 3.12; 95% CI [1.82-5.35]), and non accurate follow up (OR = 2.81; 95% CI [1.32-5.97]). After cancer diagnosis, no impact of the deprivation index on survival was found. Conclusion This study confirms the poor outcome of advanced invasive cervical cancer and the importance of early detection of cervical cancer. Preventive communication should be even more developed and the implementation of a screening program may go through the provision of improved screening tools. © 2015 Elsevier Ireland Ltd. All rights reserved.


PubMed | CHU Dijon, Pathology Center, Radiotherapy Center, University of Burgundy and Center Leclerc
Type: | Journal: European journal of obstetrics, gynecology, and reproductive biology | Year: 2015

The new French cancer plan provides the implementation of organized screening. To make an assessment of the situation, we aim to describe clinical, tumor and survival characteristics of patients with invasive cervical cancer.Data on women suffering from invasive cervical cancer and diagnosed from 1998 to 2010 were provided by the Cote dOr breast cancer registry. Survival was described using the Kaplan-Meier method and prognostic factors of survival were estimated in a Cox proportional hazard model.On the whole, 1019 cancers have been collected including 311 (30.5%) invasive ones. The peak incidence was between 40 and 49 years, with an average age of 52 years (SD=16.4). Cancers were mostly squamous cell carcinoma (80.1%) and diagnosed at a localized stage (53.7%). Only 49% (71/145) of our population were up to date on their Pap smear follow up with lower rates in deprived women. The 5-year survival rate was 62% (15% for women with FIGO stage IV and 91% for women with FIGO stage I) with a median survival of 12.3 years [95% CI: 6.6-NR]. Multivariate analysis showed that risk of death was the highest for group age 50-59 (OR=4.93; 95% CI: [1.55-15.70]) compared to women aged less than 40, advanced stage (OR=3.12; 95% CI [1.82-5.35]), and non accurate follow up (OR=2.81; 95% CI [1.32-5.97]). After cancer diagnosis, no impact of the deprivation index on survival was found.This study confirms the poor outcome of advanced invasive cervical cancer and the importance of early detection of cervical cancer. Preventive communication should be even more developed and the implementation of a screening program may go through the provision of improved screening tools.


Pergolizzi S.,Messina University | Maranzano E.,S Maria Hospital | De Angelis V.,S Mariadella Misericordia Hospital | Lupattelli M.,University of Perugia | And 18 more authors.
Digestive and Liver Disease | Year: 2013

Aims: To determine the incidence of cancer treatment-induced diarrhoea in patients submitted to irradiation. Methods: Forty-five Italian radiation oncology departments took part in this prospective observational study and a total of 1020 patients were enrolled. The accrual lasted three consecutive weeks; evaluation was based on diary cards filled in daily by patients during radiotherapy and one week after cessation. Diary cards recorded both the onset and intensity of diarrhoea. Results: A total of 1004 patients were eligible for this analysis. 147/1004 (14.6%) patients had diarrhoea. The median minimum number of daily events was 1 (range 1-7) with a median maximum events of 3 (range 1-23). 82/147 patients (56.2%) had a drug prescription for diarrhoea. In the evaluation of the onset of diarrhoea, in multivariate analysis, we found the following factors to be statistically significant predictors of an increased likelihood of diarrhoea: primitive tumour site, therapeutic purpose and field size. Conclusions: Patients with abdominal-pelvic cancer, treated with curative purpose and using large field sizes are at high risk of cancer treatment-induced diarrhoea. Diarrhoea was also observed in patients treated at other sites. In this population group there is the need for more stringent monitoring during the delivery of radiation therapy. © 2013 Editrice Gastroenterologica Italiana S.r.l.


Maranzano E.,S Maria Hospital | De Angelis V.,Hospice | Pergolizzi S.,S Vincenzo Hospital | Lupattelli M.,University of Perugia | And 16 more authors.
Radiotherapy and Oncology | Year: 2010

Purpose: A prospective observational multicentre trial was carried out to assess the incidence, pattern, and prognostic factors of radiation-induced emesis (RIE), and to evaluate the use of antiemetic drugs in patients treated with radiotherapy or concomitant radio-chemotherapy. The application in clinical practice of the Multinational Association of Supportive Care in Cancer guidelines was also studied. Materials and methods: Forty-five Italian radiation oncology centres took part in this trial. The accrual lasted for 3 consecutive weeks and only patients starting radiotherapy or concomitant radio-chemotherapy in this period were enrolled. Evaluation was based on diary card filled in daily by patients during treatment and one week after stopping it. Diary card recorded the intensity of nausea/vomiting and prophylactic/symptomatic antiemetic drug prescriptions. Results: A total of 1020 patients entered into the trial, and 1004 were evaluable. Vomiting and nausea occurred in 11.0% and 27.1% of patients, respectively, and 27.9% patients had both vomiting and nausea. In multifactorial analysis, the only statistically significant patient-related risk factors were concomitant chemotherapy and previous experience of vomiting induced by chemotherapy. Moreover, two radiotherapy-related factors were significant risk factors for RIE, the irradiated site (upper abdomen) and field size (>400 cm2). An antiemetic drug was given only to a minority (17%) of patients receiving RT, and the prescriptions were prophylactic in 12.4% and symptomatic in 4.6%. Different compounds and a wide range of doses and schedules were used. Conclusions: These data were similar to those registered in our previous observational trial, and the radiation oncologists' attitude in underestimating RIE and under prescribing antiemetics was confirmed. © 2009 Elsevier Ireland Ltd. All rights reserved.


Niewald M.,Saarland University | Seegenschmiedt M.H.,Radiotherapy Center | Micke O.,Franziskus Hospital | Graeber S.,Saarland University | And 6 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: To conduct a randomized trial of radiation therapy for painful heel spur, comparing a standard dose with a very low dose. Methods and Materials: Sixty-six patients were randomized to receive radiation therapy either with a total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy twice weekly (standard dose) or with a total dose of 0.6 Gy applied in 6 fractions of 0.1 Gy twice weekly (low dose). In all patients lateral opposing 4-to 6-MV photon beams were used. The results were measured using a visual analogue scale, the Calcaneodynia score, and the SF12 health survey. The fundamental phase of the study ended after 3 months, and the follow-up was continued up to 1 year. Patients with insufficient pain relief after 3 months were offered reirradiation with the standard dosage at any time afterward. Results: Of 66 patients, 4 were excluded because of withdrawal of consent or screening failures. After 3 months the results in the standard arm were highly significantly superior compared with those in the low-dose arm (visual analogue scale, PZ.001; Calcaneodynia score, PZ.027; SF12, PZ.045). The accrual of patients was stopped at this point. Further evaluation after 12 months' follow-up showed the following results: (1) highly significant fewer patients were re-irradiated in the standard arm compared with the low-dose arm (P<.001); (2) the results of patients in the low-dose arm who were reirradiated were identical to those in the standard arm not reirradiated (reirradiation as a salvage therapy if the lower dose was ineffective); (3) patients experiencing a favorable result after 3 months showed this even after 12 months, and some results even improved further between 3 and 12 months. Conclusions: This study confirms the superior analgesic effect of radiation therapy with 6-Gy doses on painful heel spur even for a longer time period of at least 1 year. © 2012 Elsevier Inc.


Lettmaier S.,Friedrich - Alexander - University, Erlangen - Nuremberg | Kreppner S.,Friedrich - Alexander - University, Erlangen - Nuremberg | Lotter M.,Friedrich - Alexander - University, Erlangen - Nuremberg | Walser M.,Radiotherapy Center | And 3 more authors.
Radiotherapy and Oncology | Year: 2011

Background and purpose: Accelerated partial breast irradiation by means of multicatheter brachytherapy shows great promise in the modern treatment of early breast cancer combining high efficacy in preventing tumour recurrence with low levels of toxicity. The present work attempts a dosimetric comparison between this treatment modality and conventional whole breast external beam radiotherapy by looking at differences in risk organ exposure to radiation. Patients and methods: The planning CT data sets of 16 consecutive patients with left-sided breast cancer who received external beam radiotherapy to the whole breast followed by a boost to the tumour bed using multicatheter interstitial brachytherapy after breast conserving surgery were used to create two independent physical treatment plans - one for an external radiotherapy, one for sole partial breast brachytherapy in each case assuming a total reference dose of 50 Gy for each patient. Dose-volume parameters D 0.1cc, D 0.5cc, D 1cc, D 2cc, D 5cc, D 10cc, D 25cc, D 50cc, V 100, V 90, V 50, V 10, V 5 for the ipsilateral lung, the heart and the adjacent skin were calculated and compared between the two treatment modalities. Results: All organs at risk showed a substantially lower radiation exposure in the brachytherapy plan. This was most pronounced for the heart with values differing by a factor of four. Although somewhat less marked this was also true for the ipsilateral lung and the adjacent skin with exposure ratios of three and two, respectively. Conclusions: With the use of multicatheter interstitial brachytherapy substantial reductions in the radiation exposure of risk organs can be achieved in comparison to whole breast external beam radiotherapy. These are likely to translate into profound clinical benefits. © 2011 Elsevier Ireland Ltd. All rights reserved.

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