Pub Date : 2024-11-01DOI: 10.1016/j.canrad.2024.07.012
Manou Rakotosamimanana , Jean-Michel Hannoun-Lévi , Sofia Rivera
Approximately 10 to 15% of patients with breast cancer will have a local recurrence after initial conservative treatment or mastectomy. Total mastectomy has historically been the standard treatment for local recurrence. However, the question of reirradiation may arise as part of a second conservative treatment in conjunction with segmentectomy or in the case of chest wall recurrence to improve local control. Different modalities are available: brachytherapy, external beam radiotherapy with or without hyperthermia. Although the carcinologic results are encouraging, this complex situation requires rigorous patient selection and technical requirements to achieve the best local control and limit toxicity events. This article presents a review of the literature on the different indications and techniques for reirradiation of ipsilateral recurrent breast cancer, with the aim of providing decision support in clinical practice.
{"title":"Réirradiation des récidives de carcinomes mammaires","authors":"Manou Rakotosamimanana , Jean-Michel Hannoun-Lévi , Sofia Rivera","doi":"10.1016/j.canrad.2024.07.012","DOIUrl":"10.1016/j.canrad.2024.07.012","url":null,"abstract":"<div><div>Approximately 10 to 15% of patients with breast cancer will have a local recurrence after initial conservative treatment or mastectomy. Total mastectomy has historically been the standard treatment for local recurrence. However, the question of reirradiation may arise as part of a second conservative treatment in conjunction with segmentectomy or in the case of chest wall recurrence to improve local control. Different modalities are available: brachytherapy, external beam radiotherapy with or without hyperthermia. Although the carcinologic results are encouraging, this complex situation requires rigorous patient selection and technical requirements to achieve the best local control and limit toxicity events. This article presents a review of the literature on the different indications and techniques for reirradiation of ipsilateral recurrent breast cancer, with the aim of providing decision support in clinical practice.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"28 6","pages":"Pages 586-590"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The evolution of radiation therapy techniques goes hand in hand with the evolution of the profession of radiation therapist. In the particular context of online adaptive radiotherapy based on cone beam computed tomography images, delegation of certain tasks from the physician to the radiation therapist is possible within the framework of a cooperation protocol. This delegation requires prior theoretical and practical training. It enriches the practice of radiation therapists by allowing them to acquire new skills and greater autonomy. It foreshadows access for radiation therapists to advanced practice.
{"title":"Delineation of target volume by radiation therapists during online adaptive radiation therapy: What authorization?","authors":"Tiffanie Trouillet, Silouane Poli-Flament, Florence Huguet","doi":"10.1016/j.canrad.2024.07.016","DOIUrl":"10.1016/j.canrad.2024.07.016","url":null,"abstract":"<div><div>The evolution of radiation therapy techniques goes hand in hand with the evolution of the profession of radiation therapist. In the particular context of online adaptive radiotherapy based on cone beam computed tomography images, delegation of certain tasks from the physician to the radiation therapist is possible within the framework of a cooperation protocol. This delegation requires prior theoretical and practical training. It enriches the practice of radiation therapists by allowing them to acquire new skills and greater autonomy. It foreshadows access for radiation therapists to advanced practice.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"28 6","pages":"Pages 565-567"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.canrad.2024.07.008
Juliette Jacques , Mario Terlizzi
In this narrative review, we will explore the different options for salvage re-irradiation for locally recurrent prostate cancer. Brachytherapy (BT) and stereotactic body radiation therapy (SBRT) appear to be successful options. We detailed doses, volumes, oncological outcomes, and toxicity events to identify the best salvage strategy. Salvage reirradiation can only be proposed in certain cases, depending on the patient and the clinical scenario. Specific imaging and tests are needed to safely deliver this treatment.
{"title":"Salvage reirradiation for locally recurrent prostate cancer: A narrative review","authors":"Juliette Jacques , Mario Terlizzi","doi":"10.1016/j.canrad.2024.07.008","DOIUrl":"10.1016/j.canrad.2024.07.008","url":null,"abstract":"<div><div>In this narrative review, we will explore the different options for salvage re-irradiation for locally recurrent prostate cancer. Brachytherapy (BT) and stereotactic body radiation therapy (SBRT) appear to be successful options. We detailed doses, volumes, oncological outcomes, and toxicity events to identify the best salvage strategy. Salvage reirradiation can only be proposed in certain cases, depending on the patient and the clinical scenario. Specific imaging and tests are needed to safely deliver this treatment.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"28 6","pages":"Pages 576-579"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.canrad.2024.07.006
Julian Biau , Florent Guillemin , Angeline Ginzac , Julie Villa , Gilles Truc , Delphine Antoni , Clara Le Fèvre , François Thillays
Traditionally, postoperative whole-brain radiation therapy (WBRT) has been used for resected brain metastases, reducing local and intracerebral relapses. However, WBRT is associated with cognitive deterioration. Postoperative stereotactic radiotherapy (SRT) has emerged due to its neurocognitive preservation benefits. Despite its advantages, postoperative SRT has several drawbacks, including difficulties in target volume delineation, increased risk of radionecrosis (RN) and leptomeningeal disease (LMD), and prolonged treatment duration. Preoperative SRT has been proposed as a potential alternative, offering promising results in retrospective studies. Retrospective studies have suggested that preoperative SRT could achieve high local control rates with fewer LMD and RN rates compared to postoperative SRT. However, preoperative SRT is primarily based on retrospective data, and no phase 2/3 trials have been published to date. Ongoing clinical trials are expected to provide further insights into the efficacy and safety of preoperative SRT, addressing key questions regarding fractionation, dose, and timing relative to surgery.
{"title":"Preoperative stereotactic radiotherapy for the management of brain metastases","authors":"Julian Biau , Florent Guillemin , Angeline Ginzac , Julie Villa , Gilles Truc , Delphine Antoni , Clara Le Fèvre , François Thillays","doi":"10.1016/j.canrad.2024.07.006","DOIUrl":"10.1016/j.canrad.2024.07.006","url":null,"abstract":"<div><div>Traditionally, postoperative whole-brain radiation therapy (WBRT) has been used for resected brain metastases, reducing local and intracerebral relapses. However, WBRT is associated with cognitive deterioration. Postoperative stereotactic radiotherapy (SRT) has emerged due to its neurocognitive preservation benefits. Despite its advantages, postoperative SRT has several drawbacks, including difficulties in target volume delineation, increased risk of radionecrosis (RN) and leptomeningeal disease (LMD), and prolonged treatment duration. Preoperative SRT has been proposed as a potential alternative, offering promising results in retrospective studies. Retrospective studies have suggested that preoperative SRT could achieve high local control rates with fewer LMD and RN rates compared to postoperative SRT. However, preoperative SRT is primarily based on retrospective data, and no phase 2/3 trials have been published to date. Ongoing clinical trials are expected to provide further insights into the efficacy and safety of preoperative SRT, addressing key questions regarding fractionation, dose, and timing relative to surgery.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"28 6","pages":"Pages 534-537"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Herein, we provide a non-exhaustive selection of the main clinical trials presented in 2023–2024 related to radiation-oncology used in the treatment of urological cancers including prostate cancer (radiotherapy of localized prostate cancer, post-prostatectomy irradiation, reirradiation, biochemical recurrence following local treatment, radiotherapy for metastatic cancer), muscle invasive bladder cancer and primary kidney cancer.
{"title":"Essais qui changent les pratiques : cancers urologiques","authors":"Pierre Graff , Pascal Pommier , Mathieu Minsat , Gilles Créhange","doi":"10.1016/j.canrad.2024.07.010","DOIUrl":"10.1016/j.canrad.2024.07.010","url":null,"abstract":"<div><div>Herein, we provide a non-exhaustive selection of the main clinical trials presented in 2023–2024 related to radiation-oncology used in the treatment of urological cancers including prostate cancer (radiotherapy of localized prostate cancer, post-prostatectomy irradiation, reirradiation, biochemical recurrence following local treatment, radiotherapy for metastatic cancer), muscle invasive bladder cancer and primary kidney cancer.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"28 6","pages":"Pages 513-518"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.canrad.2024.09.003
Charlotte Robert , Philippe Meyer , Brigitte Séroussi , Thomas Leroy , Jean-Emmanuel Bibault
The integration of artificial intelligence, particularly deep learning algorithms, into radiotherapy represents a transformative shift in the field, enhancing accuracy, efficiency, and personalized care. This paper explores the multifaceted impact of artificial intelligence on radiotherapy, the evolution of the roles of radiation oncologists and medical physicists, and the associated practical challenges. The adoption of artificial intelligence promises to revolutionize the profession by automating repetitive tasks, improving diagnostic precision, and enabling adaptive radiotherapy. However, it also introduces significant risks, such as automation bias, verification failures, and the potential erosion of clinical skills. Ethical considerations, such as maintaining patient autonomy and addressing biases in artificial intelligence systems, are critical to ensuring the responsible use of artificial intelligence. Continuous training and development of robust quality assurance programs are required to mitigate these risks and maximize the benefits of artificial intelligence in radiotherapy.
{"title":"Artificial intelligence and radiotherapy: Evolution or revolution?","authors":"Charlotte Robert , Philippe Meyer , Brigitte Séroussi , Thomas Leroy , Jean-Emmanuel Bibault","doi":"10.1016/j.canrad.2024.09.003","DOIUrl":"10.1016/j.canrad.2024.09.003","url":null,"abstract":"<div><div>The integration of artificial intelligence, particularly deep learning algorithms, into radiotherapy represents a transformative shift in the field, enhancing accuracy, efficiency, and personalized care. This paper explores the multifaceted impact of artificial intelligence on radiotherapy, the evolution of the roles of radiation oncologists and medical physicists, and the associated practical challenges. The adoption of artificial intelligence promises to revolutionize the profession by automating repetitive tasks, improving diagnostic precision, and enabling adaptive radiotherapy. However, it also introduces significant risks, such as automation bias, verification failures, and the potential erosion of clinical skills. Ethical considerations, such as maintaining patient autonomy and addressing biases in artificial intelligence systems, are critical to ensuring the responsible use of artificial intelligence. Continuous training and development of robust quality assurance programs are required to mitigate these risks and maximize the benefits of artificial intelligence in radiotherapy.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"28 6","pages":"Pages 503-509"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.canrad.2024.09.006
Guillaume Camprodon , Alexandra Gabro , Zineb El Ayachi , Supriya Chopra , Remi Nout , Philippe Maingon , Cyrus Chargari
Among most tailored approaches in radiation oncology, the development of brachytherapy for the treatment of cervical cancer patients has benefited from various technological innovations. The development of 3D image-guided treatments was the first step for treatment personalization. This breakthrough preceded practice homogenization and validation of predictive dose and volume parameters and prognostic factors. We review some of the most significant strategies that emerged from the ongoing research in order to increase personalization in uterovaginal brachytherapy. A better stratification based on patients and tumors characteristics may lead to better discriminate candidates for intensification or de-escalation strategies, in order to still improve patient outcome while minimizing the risk of treatment-related side effects.
{"title":"Personalized strategies for brachytherapy of cervix cancer","authors":"Guillaume Camprodon , Alexandra Gabro , Zineb El Ayachi , Supriya Chopra , Remi Nout , Philippe Maingon , Cyrus Chargari","doi":"10.1016/j.canrad.2024.09.006","DOIUrl":"10.1016/j.canrad.2024.09.006","url":null,"abstract":"<div><div>Among most tailored approaches in radiation oncology, the development of brachytherapy for the treatment of cervical cancer patients has benefited from various technological innovations. The development of 3D image-guided treatments was the first step for treatment personalization. This breakthrough preceded practice homogenization and validation of predictive dose and volume parameters and prognostic factors. We review some of the most significant strategies that emerged from the ongoing research in order to increase personalization in uterovaginal brachytherapy. A better stratification based on patients and tumors characteristics may lead to better discriminate candidates for intensification or de-escalation strategies, in order to still improve patient outcome while minimizing the risk of treatment-related side effects.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"28 6","pages":"Pages 610-617"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.canrad.2024.07.009
Emma Agnoux , William Gehin , Anaïs Stefani , Vincent Marchesi , Nicolas Martz , Jean-Christophe Faivre
Patients with bone metastasis are prevalent among those receiving palliative radiotherapy (RT), with approximately 20 % requiring reirradiation (reirradiation). The goal of bone reirradiation may be local control (oligoreoccurrence or oligoprogression of a previously treated lesion or in a previous treatment field) or symptomatic (threatening or painful progression). Published data on bone reirradiation indicate almost two-thirds of overall pain response. The primary organ at risk (especially for spine treatment) is the spinal cord. The risk of radiation myelitis is < 1 % for cumulative doses of < 50 Gy. Intensity-modulated RT (IMRT) and stereotactic RT (SRT) appear to be safer than three-dimensional RT (3DRT), although randomized trials comparing these techniques in reirradiation are lacking. Reirradiation requires multidisciplinary assessment. Alternative treatments for bone metastases (surgery, interventional radiology, etc.) must be considered. Patients should have a performance status ≤ 2, with at least a 1-month interval between treatments. The planning process involves reviewing previous RT plans, cautious dose adjustments, and precise target delineation and dose distribution to minimize toxicity. Cumulative dosimetry, patient consent, and vigilant post-treatment monitoring and dose reporting are crucial.
{"title":"Reirradiation of bone metastasis: A narrative review of the literature","authors":"Emma Agnoux , William Gehin , Anaïs Stefani , Vincent Marchesi , Nicolas Martz , Jean-Christophe Faivre","doi":"10.1016/j.canrad.2024.07.009","DOIUrl":"10.1016/j.canrad.2024.07.009","url":null,"abstract":"<div><div>Patients with bone metastasis are prevalent among those receiving palliative radiotherapy (RT), with approximately 20 % requiring reirradiation (reirradiation). The goal of bone reirradiation may be local control (oligoreoccurrence or oligoprogression of a previously treated lesion or in a previous treatment field) or symptomatic (threatening or painful progression). Published data on bone reirradiation indicate almost two-thirds of overall pain response. The primary organ at risk (especially for spine treatment) is the spinal cord. The risk of radiation myelitis is<!--> <!--><<!--> <!-->1 % for cumulative doses of<!--> <!--><<!--> <!-->50<!--> <!-->Gy. Intensity-modulated RT (IMRT) and stereotactic RT (SRT) appear to be safer than three-dimensional RT (3DRT), although randomized trials comparing these techniques in reirradiation are lacking. Reirradiation requires multidisciplinary assessment. Alternative treatments for bone metastases (surgery, interventional radiology, etc.) must be considered. Patients should have a performance status<!--> <!-->≤<!--> <!-->2, with at least a 1-month interval between treatments. The planning process involves reviewing previous RT plans, cautious dose adjustments, and precise target delineation and dose distribution to minimize toxicity. Cumulative dosimetry, patient consent, and vigilant post-treatment monitoring and dose reporting are crucial.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"28 6","pages":"Pages 568-575"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The modalities of management by reirradiation for recurrence or a second localization of head and neck squamous cell carcinoma (HNSCC) in previously irradiated terrain is challenging due to the great heterogeneity of data in the literature, mainly retrospective data reporting non-negligible risks of serious late toxicity events. With the recent development of more precise and conformal radiotherapy techniques such as intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), stereotactic radiotherapy (SBRT), the benefit-to-risk ratio of reirradiation has evolved in recent years with encouraging results, but patient selection is crucial. The aim of this review is to discuss the role of HNSCC reirradiation in terms of patient selection and external photon radiotherapy techniques for definitive tumor reirradiation and postoperative reirradiation.
{"title":"Reirradiation of squamous cell carcinoma of the head and neck with external photons: A practical review of the literature","authors":"Élodie Queyrel , Arianne Lapierre , Yoann Pointreau , Michel Lapeyre , Julian Biau , Amandine Ruffier","doi":"10.1016/j.canrad.2024.07.011","DOIUrl":"10.1016/j.canrad.2024.07.011","url":null,"abstract":"<div><div>The modalities of management by reirradiation for recurrence or a second localization of head and neck squamous cell carcinoma (HNSCC) in previously irradiated terrain is challenging due to the great heterogeneity of data in the literature, mainly retrospective data reporting non-negligible risks of serious late toxicity events. With the recent development of more precise and conformal radiotherapy techniques such as intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), stereotactic radiotherapy (SBRT), the benefit-to-risk ratio of reirradiation has evolved in recent years with encouraging results, but patient selection is crucial. The aim of this review is to discuss the role of HNSCC reirradiation in terms of patient selection and external photon radiotherapy techniques for definitive tumor reirradiation and postoperative reirradiation.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"28 6","pages":"Pages 580-585"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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