503 results on '"Pierre Blanchard"'
Search Results
2. Particle beam therapy for nasopharyngeal cancer: A systematic review and meta-analysis
- Author
-
Wai Tong Ng, Barton But, Charlene H.L. Wong, Cheuk-Wai Choi, Melvin L.K. Chua, Pierre Blanchard, and Anne W.M. Lee
- Subjects
Nasopharyngeal cancer ,Particle beam therapy ,Proton beam therapy ,Carbon ion beam therapy ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background/purpose: A systematic review and meta-analysis were performed to better understand the benefits of particle beam therapy for nasopharyngeal cancer (NPC) treatment. The survival outcomes and toxicity of primary and recurrent NPC patients treated with proton or carbon ion beam therapy were investigated. Method: PubMed, Scopus, and Embase were searched between 1 January 2007 to 3 November 2021. The inclusion and exclusion criteria included studies with either primary or recurrent NPC patients, sample size of ≥10 patients, and proton or carbon ion beam therapy as interventions. Twenty-six eligible studies with a total of 1502 patients were included. We used a random-effect meta-analysis to examine the impact of particle beam therapy on primary NPC patients and qualitatively described the results among recurrent patients. The primary outcome was overall survival (OS), while secondary outcomes included progression-free survival (PFS), local control (LC) and toxicity. Results: The pooled OS at 1-year, 2-year and 3-year and 5-year for primary NPC patients who received particle beam therapy were 96 % (95 % confidence interval (CI) = 92 %-98 %), 93 % (95 % CI = 83 %-97 %), 90 % (95 % CI = 73 %-97 %) and 73 % (95 % CI = 52 %-87 %) respectively. The pooled 1-year and 2-year PFS, and LC for these patients were above 90 %. For locally recurrent NPC patients, the 1-year OS rate ranged from 65 % to 92 %, while the 1-year LC rate ranged from 80 % to 88 %. Both proton and carbon ion beam therapy were generally safe among primary and recurrent patients, with ≥G3 late toxicity rates of 20 % or less. Approximately a 5 % mortality rate was reported among recurrent patients. Conclusions: This systematic review and meta-analysis demonstrated particle beam therapy has great potential in treating NPC, yielding excellent survival outcomes with low toxicity. However, further investigations are needed to assess the long-term outcomes and cost-effectiveness of this newer form of radiotherapy.
- Published
- 2022
- Full Text
- View/download PDF
3. 2011–2021 rising prevalence of HPV infection among oropharyngeal carcinoma in France
- Author
-
Philippe Gorphe, Pierre Blanchard, Gabriel C. T. E. Garcia, Marion Classe, Caroline Even, Stéphane Temam, and Ingrid Breuskin
- Subjects
Oropharyngeal neoplasms ,Papillomavirus infections ,Aging ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background The objective of our study was to investigate changes over the past decade in patient age and the prevalence of HPV in the population of patients with oropharyngeal carcinoma (OPC) treated at our center. Methods We performed a retrospective cohort study of patients treated at our cancer center for OPC between 2011 and 2021. Tissue biopsies were assessed for HPV status based on p16 staining for all patients. Results There were 1,365 treated patients. The proportion of p16-positive patients increased from 43% in 2011 to 57.3% in 2021 (p = 0.01). The sex ratio was 3.6 M/1F for p16-positive and 3.7 M/1F for p16-negative patients (p = 0.94). The mean age increased from 60.2 y in 2011 to 63.6 y in 2021. The mean ages were 61.9 y for p16-positive and 61.7 y for p16-negative patients (p = 0.71), but there was a broader age distribution for the p16-positive patients (p = 0.03). The proportion of patients older than 70 y increased from 11% in 2011 to 28.2% in 2021, and this aging was similar between p16-positive (30.7% in 2021) and p16-negative (26.3% in 2021) patients. The 2-year and 5-year OS rates were 73.7% and 56.5% for the entire cohort. p16-positive patients had 2-year and 5-year OS rates of 86.8% and 77.4%, respectively, whereas p16-negative patients had 2-year and 5-year OS rates of 63.9% and 40.5%. Conclusions Assessment of the change over the past decade in the population of patients with OPC at our center showed that HPV-positive OPC now appear to have overtaken HPV-negative cases in France, with 57.3% in 2021, and showed significant aging, with almost thirty percent of patients now older than 70 years. Those combined changes emphasize some of the challenges to be addressed in future OPC management.
- Published
- 2022
- Full Text
- View/download PDF
4. Meta-analysis of chemotherapy in nasopharynx carcinoma (MAC-NPC): An update on 26 trials and 7080 patients
- Author
-
Pierre Blanchard, Anne W.M. Lee, Alexandra Carmel, Ng Wai Tong, Jun Ma, Anthony T.C. Chan, Ruey Long Hong, Ming-Yuan Chen, Lei Chen, Wen-Fei Li, Pei-Yu Huang, Dora L.W. Kwong, Sharon S.X. Poh, Roger Ngan, Hai-Qiang Mai, Camille Ollivier, George Fountzilas, Li Zhang, Jean Bourhis, Anne Aupérin, Benjamin Lacas, Jean-Pierre Pignon, Ellen Benhamou, Somvilai Chakrabandhu, Anthony TC Chan, Qiu-Yan Chen, Yong Chen, Richard J Chappell, Horace Choi, Daniel TT Chua, Melvin Lee Kiang Chua, Julian Higgins, Ming-Huang Hong, Ruey-Long Hong, Edwin Pun Hui, C.F. Hsiao, Michael Kam, Georgia Angeliki Koliou, Dora LW Kwong, Shu-Chuan Lai, Ka On Lam, Michael L LeBlanc, Anne WM Lee, Ho Fun Victor Lee, Wen Fei Li, Brigette Ma, Frankie Mo, James Moon, Wai Tong Ng, Brian O'Sullivan, Claire Petit, Jean Pierre Pignon, Sharon X. Poh, Gerta Rücker, Jonathan Sham, Yoke Lim Soong, Ying Sun, Terence Tan, Lin-Quan Tang, Yuk Tung, Joseph Wee, Xuang Wu, Tingting Xu, Yuan Zhang, and Guopei Zhu
- Subjects
Individual patient data ,Meta-analysis ,Randomized trials ,Chemotherapy ,Nasopharynx carcinoma ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Purpose: Chemotherapy, when added to radiotherapy, improves survival in locally advanced nasopharyngeal carcinoma (NPC). This article presents the second update of the Meta-Analysis of Chemotherapy in NPC. Methods: Published or unpublished randomized trials assessing radiotherapy (±a second chemotherapy timing) with/without chemotherapy in non-metastatic NPC patients were identified. Updated data were sought for studies included in the previous rounds of the meta-analysis. The primary endpoint was overall survival. All trials were analyzed following the intent-to-treat principle using a fixed-effects model. Treatments were classified in five subsets according to chemotherapy timing. The statistical analysis plan was pre-specified. Results: Eighteen new trials were identified. Individual patient data were available for seven. In total, the meta-analysis now included 26 trials and 7,080 patients. The addition of chemotherapy reduced the risk of death, with a hazard ratio (HR) of 0.79 (95% confidence interval (CI) [0.73; 0.85]), and an absolute survival increase at 5 and 10 years of 6.1% [+3.9; +8.3] and + 8.4% [+5.7; +11.1], respectively. The largest effect was observed for concomitant + adjuvant, induction (with concomitant in both arms) and concomitant chemotherapy, with respective HR [95%CI] of 0.68 [0.59; 0.79] (absolute survival increase at 5 years: 12.3% (7.0%;17.6%)), 0.73 [0.63; 0.86] (6.0% (2.5%;9.5%)) and 0.81 [0.70; 0.92] (5.2% (0.8%;9.6%)). The benefit of chemotherapy was also demonstrated by improvement in progression-free survival, cancer mortality, locoregional control and distant control. There was a significant interaction between patient age and chemotherapy effect. Conclusion: This updated meta-analysis confirms the benefit of concomitant chemotherapy and concomitant + adjuvant chemotherapy, and suggests that addition of induction or adjuvant chemotherapy to concomitant chemotherapy improves tumor control and survival. The benefit of chemotherapy decreases with increasing patient age.
- Published
- 2022
- Full Text
- View/download PDF
5. Immune-related arthritis following pelvic radiation therapy in a patient with lung cancer receiving long-term immune checkpoint blocker treatment: Case report
- Author
-
Mihaela Aldea, Rakiba Belkhir, Emeline Colomba, Pierre Blanchard, Francois-Xavier Danlos, Angela Botticella, Mario Terlizzi, Eric Deutsch, Cecile Le Péchoux, David Planchard, Jean-Marie Michot, Benjamin Besse, and Antonin Levy
- Subjects
radiation therapy ,anti-PD(L)1 ,immunotherapy ,toxicity ,adverse (side) effects ,immunoradiotherapy ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Radiotherapy can trigger immune-related out-of-field “abscopal” response. We report a patient with advanced NSCLC (non-small cell lung cancer) receiving long-term anti-PD1 (programmed cell death protein 1) who have developed out-of-field immune-related arthritis following pelvic irradiation.
- Published
- 2022
- Full Text
- View/download PDF
6. NTCP Modeling of Late Effects for Head and Neck Cancer: A Systematic Review
- Author
-
Sonja Stieb, MD, Anna Lee, MD, MPH, Lisanne V. van Dijk, PhD, Steven Frank, MD, Clifton David Fuller, MD, PhD, and Pierre Blanchard, MD, PhD
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Nuclear and particle physics. Atomic energy. Radioactivity ,QC770-798 - Published
- 2021
- Full Text
- View/download PDF
7. Activity-Based Costing of Intensity-Modulated Proton versus Photon Therapy for Oropharyngeal Cancer
- Author
-
Nikhil G. Thaker, MD, David Boyce-Fappiano, MD, Matthew S. Ning, MD, Dario Pasalic, MD, Alexis Guzman, MBA, Grace Smith, MD, PhD, MPH, Emma B. Holliday, MD, James Incalcaterra, PhD, Adam S. Garden, MD, Simona F. Shaitelman, MD, G. Brandon Gunn, MD, C. David Fuller, MD, PhD, Pierre Blanchard, MD, Thomas W. Feeley, MD, Robert S. Kaplan, PhD, and Steven J. Frank, MD
- Subjects
proton radiation therapy ,impt ,oropharyngeal carcinoma ,imrt ,tdabc ,time-driven activity-based costing ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Nuclear and particle physics. Atomic energy. Radioactivity ,QC770-798 - Abstract
Purpose: In value-based health care delivery, radiation oncologists need to compare empiric costs of care delivery with advanced technologies, such as intensity-modulated proton therapy (IMPT) and intensity-modulated radiation therapy (IMRT). We used time-driven activity-based costing (TDABC) to compare the costs of delivering IMPT and IMRT in a case-matched pilot study of patients with newly diagnosed oropharyngeal (OPC) cancer. Materials and Methods: We used clinicopathologic factors to match 25 patients with OPC who received IMPT in 2011-12 with 25 patients with OPC treated with IMRT in 2000-09. Process maps were created for each multidisciplinary clinical activity (including chemo-therapy and ancillary services) from initial consultation through 1 month of follow-up. Resource costs and times were determined for each activity. Each patient-specific activity was linked with a process map and TDABC over the full cycle of care. All calculated costs were normalized to the lowest-cost IMRT patient. Results: TDABC costs for IMRT were 1.00 to 3.33 times that of the lowest-cost IMRT patient (mean ± SD: 1.65 ± 0.56), while costs for IMPT were 1.88 to 4.32 times that of the lowest-cost IMRT patient (2.58 ± 0.39) (P < .05). Although single-fraction costs were 2.79 times higher for IMPT than for IMRT (owing to higher equipment costs), average full cycle cost of IMPT was 1.53 times higher than IMRT, suggesting that the initial cost increase is partly mitigated by reductions in costs for other, non-RT supportive health care services. Conclusions: In this matched sample, although IMPT was on average more costly than IMRT primarily owing to higher equipment costs, a subset of IMRT patients had similar costs to IMPT patients, owing to greater use of supportive care resources. Multidimensional patient outcomes and TDABC provide vital methodology for defining the value of radiation therapy modalities.
- Published
- 2021
- Full Text
- View/download PDF
8. Methodologies to Increase the Level of Evidence of Real-life Proton Therapy in Head and Neck Tumors
- Author
-
Francesco Dionisi, MD, Lamberto Widesott, PhD, Van VulpenMarco, MD, Clifton David Fuller, MD, Rocco Frondizi, PhD, Marco Meneguzzo, Pierre Blanchard, MD, Maurizio Amichetti, MD, and Giuseppe Sanguineti, MD
- Subjects
proton therapy ,head and neck cancer ,randomized trials ,model-based approach ,registries ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Nuclear and particle physics. Atomic energy. Radioactivity ,QC770-798 - Abstract
This review aims to present and assess available and new methodologies to increase the clinical evidence of proton therapy data for patients with head and neck cancer. Despite the increasing number of scientific reports showing the feasibility and effectiveness of proton therapy in head and neck cancer, clinical evidence on the potential benefits of its use remains low for several reasons. In this article, the pros and cons of consolidated and new methodologies in this setting such as randomized clinical trials, the model-based approach, and the use of prospective multicentric registries will be detailed.
- Published
- 2021
- Full Text
- View/download PDF
9. Immune system and intestinal microbiota determine efficacy of androgen deprivation therapy against prostate cancer
- Author
-
Hang Phuong Pham, Douglas G McNeel, Laurence Zitvogel, Corentin Richard, Antoine Toubert, Guido Kroemer, Stéphane Culine, Karim Fizazi, Bertrand Routy, Lisa Derosa, Francesco Asnicar, Nicola Segata, Gladys Ferrere, Florent Ginhoux, Anne-Gaelle Goubet, Safae Terrisse, Kousuke Ueda, Andrew Maltez Thomas, Valentin Quiniou, Cassandra Thelemaque, Garett Dunsmore, Emmanuel Clave, Melissa Gamat-Huber, Satoru Yonekura, Conrad Rauber, Jean-Eudes Fahrner, Eugenie Pizzato, Pierre Ly, Marine Fidelle, Marine Mazzenga, Carolina Alves Costa Silva, Federica Armanini, Federica Pinto, Romain Daillère, Pierre Blanchard, Paule Opolon, and Aymeric Silvin
- Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background Prostate cancer (PC) responds to androgen deprivation therapy (ADT) usually in a transient fashion, progressing from hormone-sensitive PC (HSPC) to castration-resistant PC (CRPC). We investigated a mouse model of PC as well as specimens from PC patients to unravel an unsuspected contribution of thymus-derived T lymphocytes and the intestinal microbiota in the efficacy of ADT.Methods Preclinical experiments were performed in PC-bearing mice, immunocompetent or immunodeficient. In parallel, we prospectively included 65 HSPC and CRPC patients (Oncobiotic trial) to analyze their feces and blood specimens.Results In PC-bearing mice, ADT increased thymic cellularity and output. PC implanted in T lymphocyte-depleted or athymic mice responded less efficiently to ADT than in immunocompetent mice. Moreover, depletion of the intestinal microbiota by oral antibiotics reduced the efficacy of ADT. PC reduced the relative abundance of Akkermansia muciniphila in the gut, and this effect was reversed by ADT. Moreover, cohousing of PC-bearing mice with tumor-free mice or oral gavage with Akkermansia improved the efficacy of ADT. This appears to be applicable to PC patients because long-term ADT resulted in an increase of thymic output, as demonstrated by an increase in circulating recent thymic emigrant cells (sjTRECs). Moreover, as compared with HSPC controls, CRPC patients demonstrated a shift in their intestinal microbiota that significantly correlated with sjTRECs. While feces from healthy volunteers restored ADT efficacy, feces from PC patients failed to do so.Conclusions These findings suggest the potential clinical utility of reversing intestinal dysbiosis and repairing acquired immune defects in PC patients.
- Published
- 2022
- Full Text
- View/download PDF
10. Radiation-Induced Hypothyroidism After Radical Intensity Modulated Radiation Therapy for Oropharyngeal Carcinoma
- Author
-
Mona Kamal, MD, PhD, Christopher Ryan Peeler, PhD, Pablo Yepes, PhD, Abdallah S.R. Mohamed, MD, MSc, Pierre Blanchard, MD, Steven Frank, MD, Lei Chen, PhD, Amit Jethanandani, MPH, Rohit Kuruvilla, MD, Benjamin Greiner, MD, Jared Harp, MD, Robin Granberry, BA, Vivek Mehta, MD, Crosby Rock, MD, Katherine Hutcheson, PhD, Carlos Cardenas, PhD, G.Brandon Gunn, MD, Clifton Fuller, MD, PhD, and Dragan Mirkovic, PhD
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Purpose: To evaluate 2 published normal tissue complication probability models for radiation-induced hypothyroidism (RHT) on a large cohort of oropharyngeal carcinoma (OPC) patients who were treated with intensity-modulated radiation therapy (IMRT). Methods and Materials: OPC patients treated with retrievable IMRT Digital Imaging and Communications in Medicine (DICOMs) data and available baseline and follow-up thyroid function tests were included. Mean dose (Dmean) to the thyroid gland (TG) and its volume were calculated. The study outcome was clinical HT at least 6 months after radiation therapy, which was defined as grade ≥2 HT per Common Terminology Criteria for Adverse Events grading system (symptomatic hypothyroidism that required thyroid replacement therapy). Regression analyses and Wilcoxon rank-sum test were used. Receiver operating characteristic curves and area under the curve for the fitted model were calculated. Results: In the study, 360 OPC patients were included. The median age was 58 years. Most tumors (51%) originated from the base of tongue. IMRT-split field was used in 95%, and median radiation therapy dose was 69.96 Gy. In the study, 233 patients (65%) developed clinical RHT that required thyroid replacement therapy. On multivariate analysis higher Dmean and smaller TG volume maintained the statistically significant association with the risk of clinical RHT (P
- Published
- 2020
- Full Text
- View/download PDF
11. The Role of CT in the Staging and Follow-Up of Testicular Tumors: Baseline, Recurrence and Pitfalls
- Author
-
Thibaut Pierre, Fatine Selhane, Elise Zareski, Camilo Garcia, Karim Fizazi, Yohann Loriot, Anna Patrikidou, Natacha Naoun, Alice Bernard-Tessier, Hervé Baumert, Cédric Lebacle, Pierre Blanchard, Laurence Rocher, and Corinne Balleyguier
- Subjects
testicular cancer (TC) ,germ cells tumors (GCT) ,seminomatous and nonseminomatous GCT ,computed tomography (CT) ,oncologic diagnostic imaging ,retroperitoneal masses ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Ultrasound imaging of the testis represents the standard-of-care initial imaging for the diagnosis of TGCT, whereas computed tomography (CT) plays an integral role in the initial accurate disease staging (organ-confined, regional lymph nodes, or sites of distant metastases), in monitoring the response to therapy in patients who initially present with non-confined disease, in planning surgical approaches for residual masses, in conducting follow-up surveillance and in determining the extent of recurrence in patients who relapse after treatment completion. CT imaging has also an important place in diagnosing complications of treatments. The aims of this article are to review these different roles of CT in primary TGCT and focus on different pitfalls that radiologists need to be aware of.
- Published
- 2022
- Full Text
- View/download PDF
12. Magnetic Resonance-based Response Assessment and Dose Adaptation in Human Papilloma Virus Positive Tumors of the Oropharynx treated with Radiotherapy (MR-ADAPTOR): An R-IDEAL stage 2a-2b/Bayesian phase II trial
- Author
-
Houda Bahig, Ying Yuan, Abdallah S.R. Mohamed, Kristy K. Brock, Sweet Ping Ng, Jihong Wang, Yao Ding, Kate Hutcheson, Molly McCulloch, Peter A. Balter, Stephen Y. Lai, Abrahim Al-Mamgani, Jan-Jakob Sonke, Uulke A. van der Heide, Christopher Nutting, X. Allen Li, Jared Robbins, Mussadiq Awan, Irene Karam, Katherine Newbold, Kevin Harrington, Uwe Oelfke, Shreerang Bhide, Marielle E.P. Philippens, Chris H.J. Terhaard, Andrew J. McPartlin, Pierre Blanchard, Adam S. Garden, David I. Rosenthal, Gary B. Gunn, Jack Phan, Guillaume Cazoulat, Michalis Aristophanous, Kelli K. McSpadden, John A. Garcia, Cornelis A.T. van den Berg, Cornelis P.J. Raaijmakers, Linda Kerkmeijer, Patricia Doornaert, Sanne Blinde, Steven J. Frank, and Clifton D. Fuller
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Current standard radiotherapy for oropharynx cancer (OPC) is associated with high rates of severe toxicities, shown to adversely impact patients’ quality of life. Given excellent outcomes of human papilloma virus (HPV)-associated OPC and long-term survival of these typically young patients, treatment de-intensification aimed at improving survivorship while maintaining excellent disease control is now a central concern. The recent implementation of magnetic resonance image – guided radiotherapy (MRgRT) systems allows for individual tumor response assessment during treatment and offers possibility of personalized dose-reduction. In this 2-stage Bayesian phase II study, we propose to examine weekly radiotherapy dose-adaptation based on magnetic resonance imaging (MRI) evaluated tumor response. Individual patient’s plan will be designed to optimize dose reduction to organs at risk and minimize locoregional failure probability based on serial MRI during RT. Our primary aim is to assess the non-inferiority of MRgRT dose adaptation for patients with low risk HPV-associated OPC compared to historical control, as measured by Bayesian posterior probability of locoregional control (LRC). Methods: Patients with T1-2 N0-2b (as per AJCC 7th Edition) HPV-positive OPC, with lymph node
- Published
- 2018
- Full Text
- View/download PDF
13. The Reality of Randomized Controlled Trials for Assessing the Benefit of Proton Therapy: Critically Examining the Intent-to-Treat Principle in the Presence of Insurance Denial
- Author
-
Mike Hernandez, MS, J. Jack Lee, PhD, Beow Y. Yeap, ScD, Rong Ye, MS, Robert L. Foote, MD, Paul Busse, MD, PhD, Samir H. Patel, MD, Roi Dagan, MD, James Snider, MD, Nasiruddin Mohammed, MD, MBA, Alexander Lin, MD, Pierre Blanchard, MD, PhD, Scott B. Cantor, PhD, Menna Y. Teferra, MS, Kate Hutcheson, PhD, Pablo Yepes, PhD, Radhe Mohan, PhD, Zhongxing Liao, MD, Thomas F. DeLaney, MD, and Steven J. Frank, MD
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Purpose: This study hypothesized that insurance denial would lead to bias and loss of statistical power when evaluating the results from an intent-to-treat (ITT), per-protocol, and as-treated analyses using a simulated randomized clinical trial comparing proton therapy to intensity modulated radiation therapy where patients incurred increasing rates of insurance denial. Methods and Materials: Simulations used a binary endpoint to assess differences between treatment arms after applying ITT, per-protocol, and as-treated analyses. Two scenarios were developed: 1 with clinical success independent of age and another assuming dependence on age. Insurance denial was assumed possible for patients
- Published
- 2021
- Full Text
- View/download PDF
14. A frequentist one-step model for a simple network meta-analysis of time-to-event data in presence of an effect modifier
- Author
-
Matthieu Faron, Pierre Blanchard, Laureen Ribassin-Majed, Jean-Pierre Pignon, Stefan Michiels, and Gwénaël Le Teuff
- Subjects
Medicine ,Science - Abstract
Introduction Individual patient data (IPD) present particular advantages in network meta-analysis (NMA) because interactions may lead an aggregated data (AD)-based model to wrong a treatment effect (TE) estimation. However, fewer works have been conducted for IPD with time-to-event contrary to binary outcomes. We aimed to develop a general frequentist one-step model for evaluating TE in the presence of interaction in a three-node NMA for time-to-event data. Methods One-step, frequentist, IPD-based Cox and Poisson generalized linear mixed models were proposed. We simulated a three-node network with or without a closed loop with (1) no interaction, (2) covariate-treatment interaction, and (3) covariate distribution heterogeneity and covariate-treatment interaction. These models were applied to the NMA (Meta-analyses of Chemotherapy in Head and Neck Cancer [MACH-NC] and Radiotherapy in Carcinomas of Head and Neck [MARCH]), which compared the addition of chemotherapy or modified radiotherapy (mRT) to loco-regional treatment with two direct comparisons. AD-based (contrast and meta-regression) models were used as reference. Results In the simulated study, no IPD models failed to converge. IPD-based models performed well in all scenarios and configurations with small bias. There were few variations across different scenarios. In contrast, AD-based models performed well when there were no interactions, but demonstrated some bias when interaction existed and a larger one when the modifier was not distributed evenly. While meta-regression performed better than contrast-based only, it demonstrated a large variability in estimated TE. In the real data example, Cox and Poisson IPD-based models gave similar estimations of the model parameters. Interaction decomposition permitted by IPD explained the ecological bias observed in the meta-regression. Conclusion The proposed general one-step frequentist Cox and Poisson models had small bias in the evaluation of a three-node network with interactions. They performed as well or better than AD-based models and should also be undertaken whenever possible.
- Published
- 2021
15. Adjuvant or Salvage Radiation Therapy for Prostate Cancer after Prostatectomy: Current Status, Controversies and Perspectives
- Author
-
Mario Terlizzi, Elaine Johanna Limkin, Yasmina Moukasse, and Pierre Blanchard
- Subjects
prostate cancer ,radiation therapy ,adjuvant ,salvage ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Nearly one-third of the patients who undergo prostatectomy for prostate cancer have a biochemical recurrence (BCR) during follow-up. While several randomized trials have shown that adjuvant radiation therapy (aRT) improves biochemical control, this strategy has not been widely used because of the risk of toxicity and the fear of overtreating patients who would not have relapsed. In addition, the possibility of close PSA monitoring in the era of ultrasensitive assays enables to anticipate early salvage strategies (sRT). Three recent randomized trials and their meta-analysis have confirmed that aRT does not improve event-free survival compared to sRT, imposing the latter as the new standard of treatment. The addition of androgen deprivation therapy (ADT) to RT has been shown to improve biochemical control and metastasis-free survival, but the precise definition of to whom it should be proposed is still a matter of debate. The development of genomic tests or the use of artificial intelligence will allow more individualized treatment in the future. Therapeutic intensification with the combination of new-generation hormone therapy and RT is under study. Finally, the growing importance of metabolic imaging (PET/CT) due to its performance especially for low PSA levels will help in further personalizing management strategies.
- Published
- 2022
- Full Text
- View/download PDF
16. Anaplastic Thyroid Carcinoma: An Update
- Author
-
Arnaud Jannin, Alexandre Escande, Abir Al Ghuzlan, Pierre Blanchard, Dana Hartl, Benjamin Chevalier, Frédéric Deschamps, Livia Lamartina, Ludovic Lacroix, Corinne Dupuy, Eric Baudin, Christine Do Cao, and Julien Hadoux
- Subjects
anaplastic thyroid carcinoma ,chemotherapy ,immune checkpoint inhibitors ,tumors associated macrophages ,radiotherapy ,molecular targeted therapy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Anaplastic thyroid carcinoma (ATC) is a rare and undifferentiated form of thyroid cancer. Its prognosis is poor: the median overall survival (OS) of patients varies from 4 to 10 months after diagnosis. However, a doubling of the OS time may be possible owing to a more systematic use of molecular tests for targeted therapies and integration of fast-track dedicated care pathways for these patients in tertiary centers. The diagnostic confirmation, if needed, requires an urgent biopsy reread by an expert pathologist with additional immunohistochemical and molecular analyses. Therapeutic management, defined in multidisciplinary meetings, respecting the patient’s choice, must start within days following diagnosis. For localized disease diagnosed after primary surgical treatment, adjuvant chemo-radiotherapy is recommended. In the event of locally advanced or metastatic disease, the prognosis is very poor. Treatment should then involve chemotherapy or targeted therapy and decompressive cervical radiotherapy. Here we will review current knowledge on ATC and provide perspectives to improve the management of this deadly disease.
- Published
- 2022
- Full Text
- View/download PDF
17. Leukocytosis, prognosis biomarker in locally advanced head and neck cancer patients after chemoradiotherapy
- Author
-
Antoine Schernberg, Pierre Blanchard, Cyrus Chargari, Dan Ou, Antonin Levy, Philippe Gorphe, Ingrid Breuskin, Sarah Atallah, Alexandre Caula, Alexandre Escande, François Janot, France Nguyen, Stéphane Temam, Eric Deutsch, and Yungan Tao
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Objective: To study the prognostic value of leukocyte increase in a retrospective cohort of locally advanced head and neck squamous cell carcinoma (HNSCC) patients receiving definitive concurrent cisplatin and radiation. Materials and methods: Clinical records of consecutive previously untreated locally advanced HNSCC patients treated in our Institution between March 2006 and October 2012 by concurrent cisplatin (100 mg/m2, every 3 weeks) and radiation (70 Gy in 7 weeks) were collected. The prognostic value of pretreatment leukocyte increase was examined, with focus on patterns of relapse and survival. Leukocytosis and neutrophilia were defined as a leukocyte count or a neutrophils count exceeding 10 and 7.5 G/L, respectively. Results: We identified 193 patients, all treated with concurrent cisplatin-based chemoradiotherapy. Respectively 24% and 20% patients displayed baseline leukocytosis or neutrophilia. Mean leukocyte count were significantly more elevated in current smokers, patients with performance status (PS) >0, T4 and less in HPV + tumor. The 5-year actuarial overall survival (OS) and progression-free survival (PFS) were 56% and 51% respectively. In univariate analysis, both leukocytosis and neutrophilia were strongly associated with worse OS and PFS (p
- Published
- 2018
- Full Text
- View/download PDF
18. Helping patients make informed decisions. Two-year evaluation of the Gustave Roussy prostate cancer multidisciplinary clinic
- Author
-
Anna Patrikidou, Pierre Maroun, Jean-Jacques Patard, Hervé Baumert, Laurence Albiges, Christophe Massard, Yohann Loriot, Bernard Escudier, Mario Di Palma, Julia Arfi-Rouche, Laurence Rocher, Zahira Merabet, Alberto Bossi, Karim Fizazi, and Pierre Blanchard
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Objectives: The initial treatment decision for newly diagnosed non-metastatic prostate cancer is complex. Multiple valid approaches exist, without a clear and absolute consensus for every clinical scenario, and therefore specialist opinions may vary. Multidisciplinary consultations focusing on shared decision-making aim to provide an apposite tool for the initial treatment decision. We have evaluated the first two years of activity of the Gustave Roussy Prostate Cancer Multidisciplinary Clinic (PCMC), dedicated to the initial decision-making for non-metastatic prostate cancer. Methods: PCMC consists of two consecutive specialist consultations with a urological surgeon and a radiation oncologist, followed by a dedicated Tumor Board discussion. A study questionnaire was addressed to all PCMC patients via postal mail. Medical notes and questionnaire responses of 195 eligible patients were analyzed. Results: The questionnaire response rate was 69% (134 patients). Complete satisfaction rate was high (114 of 118 responders, 97%). Patients were offered new treatment options in 55% of cases, and felt better informed in 98% (122 of 125 responders). The double consultation was considered useful (124 of 129 responders, 96%). Reported feeling of active participation was significantly elevated (117 of 131 responders, 89%), while 46% of patients (57 of 125) modified their decision on the management of their prostate cancer following their PCMC consultation. Conclusions: The experience of a multidisciplinary consultation in the initial management of non-metastatic prostate cancer renders high patient satisfaction, improves their appreciation of feeling better informed, promotes active participation and shared decision-making and strongly influences their final decision. Keywords: Prostate cancer, Multidisciplinary, Radiotherapy, Surgery, Shared decision-making
- Published
- 2018
- Full Text
- View/download PDF
19. Prospective in silico study of the feasibility and dosimetric advantages of MRI-guided dose adaptation for human papillomavirus positive oropharyngeal cancer patients compared with standard IMRT
- Author
-
Abdallah S.R. Mohamed, Houda Bahig, Michalis Aristophanous, Pierre Blanchard, Mona Kamal, Yao Ding, Carlos E. Cardenas, Kristy K. Brock, Stephen Y. Lai, Katherine A. Hutcheson, Jack Phan, Jihong Wang, Geoffrey Ibbott, Refaat E. Gabr, Ponnada A. Narayana, Adam S. Garden, David I. Rosenthal, G. Brandon Gunn, and Clifton D. Fuller
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Purpose: We aim to determine the feasibility and dosimetric benefits of a novel MRI-guided IMRT dose-adaption strategy for human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPC). Materials/methods: Patients with locally advanced HPV+ OPC underwent pre-treatment and in-treatment MRIs every two weeks using RT immobilization setup. For each patient, two IMRT plans were created (i.e. standard and adaptive). The prescription dose for the standard plans was 2.12 Gy/fx for 33 fractions to the initial PTV. For adaptive plans, a new PTVadaptive was generated based on serial MRIs in case of detectable tumor shrinkage. Prescription dose to PTVadaptive was 2.12 Gy/fx to allow for maximum dose to the residual disease. Any previously involved volumes received minimally a floor dose of 50.16 Gy. Uninvolved elective nodal volumes were prescribed 50.16 Gy in 1.52 Gy/fx. Dosimetric parameters of organs at risk (OARs) were recorded for standard vs. adaptive plans. Normal tissue complication probability (NTCP) for toxicity endpoints was calculated using literature-derived multivariate logistic regression models. Results: Five patients were included in this pilot study, 3 men and 2 women. Median age was 58 years (range 45–69). Three tumors originated at the tonsillar fossa and two at the base of tongue. The average dose to 95% of initial PTV volume was 70.7 Gy (SD,0.3) for standard plans vs. 58.5 Gy (SD,2.0) for adaptive plans. The majority of OARs showed decrease in dosimetric parameters using adaptive plans vs. standard plans, particularly swallowing related structures. The average reduction in the probability of developing dysphagia ≥ grade2, feeding tube persistence at 6-month post-treatment and hypothyroidism at 1-year post-treatment was 11%, 4%, and 5%, respectively. The probability of xerostomia at 6-month was only reduced by 1% for adaptive plans vs. standard IMRT. Conclusion: These in silico results showed that the proposed MRI-guided adaptive approach is technically feasible and advantageous in reducing dose to OARs, especially swallowing musculature. Keywords: MRI-guided radiotherapy, Dose adaptation, IMRT, Human papillomavirus positive oropharyngeal cancer, Head and neck cancer, Dysphagia, Normal tissue complication probability
- Published
- 2018
- Full Text
- View/download PDF
20. Anemia and neutrophil-to-lymphocyte ratio are prognostic in p16-positive oropharyngeal carcinoma treated with concurrent chemoradiation
- Author
-
Philippe Gorphe, Younès Chekkoury Idrissi, Yungan Tao, Antoine Schernberg, Dan Ou, Stéphane Temam, Odile Casiraghi, Pierre Blanchard, and Haïtham Mirghani
- Subjects
Infectious and parasitic diseases ,RC109-216 - Abstract
Objectives: We investigated the prognostic value of pre-treatment hematological parameters in patients with p16-positive oropharyngeal squamous-cell carcinoma (OPSCC). Material and methods: Neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), and hemoglobin concentration measurement (Hb), were collected on day one of treatment. Endpoints were overall survival (OS) and progression-free survival (PFS). All patients were planned to receive concurrent chemoradiation. Staging were reviewed according to the recent AJCC 8th edition. Results: We included 167 patients in this study. In multivariate analyses, a smoking history > 30 packyears was associated with decreased OS (p = 0.009; HR, 3.4827) and PFS (p = 0.042; HR, 2.421); Hb < 12 g/dL was associated with impaired OS (p = 0.007; HR, 6.527) and PFS (p = 0.014; HR, 4.092); an NLR > 5 before treatment was associated with decreased OS (p = 0.042; HR, 2.945). Hemoglobin concentration and the NLR were not correlated (p = 0.577), nor anemia and an NLR > 5 (p = 0.167). Patients with an NLR > 5 had a significantly higher rate of disease recurrence (30.8% vs. 8.4%, p = 0.0299, RR = 3.922, 95% CI 1.351–11.386). Discussion: We found hemoglobin level and the NLR to be independent prognostic factors in p16-positive OPSCC patients. This approach is to be considered for further clinical investigations, and its significance in treatment decision-making should be further explored. Keywords: Oropharyngeal carcinoma, P16, Papillomavirus, Smoking, Hemoglobin, Neutrophil-to-lymphocyte ratio
- Published
- 2018
- Full Text
- View/download PDF
21. Lessons from the first 70 patients operated by doppler-guided haemorrhoidal artery ligation with mucopexy in a French team specialising in surgical proctology
- Author
-
Alexia Boukris Toledano, Pierre Blanchard, Annick Zaleski, Paul Benfredj, Nadia Fathallah, Samy Sultan, Elise Pommaret, and Vincent de Parades
- Subjects
Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background: Doppler-guided haemorrhoidal artery ligation with mucopexy is a minimal-invasive surgical technique. It is both effective and less painful than conventional haemorrhoidectomy. Methods: We gathered records on all patients operated on between November 2012 and June 2014. Pre- and postoperative scores were calculated during consultation and then by phone. Unsuccessful surgical treatment was defined by persistent haemorrhoid symptoms within three months following the procedure and relapse defined by recurrent symptoms after the third postoperative month. Results: During the period analysed, 70 patients underwent consecutive surgical procedures for haemorrhoid prolapse (52%), bleeding (29%), or both (17%). Hospitalisation was outpatient or overnight for 87% of patients. There were no complications in 92.7% of cases. The average period away from work was 11 days (± 6.5). The time between the procedure and last postoperative consultation, followed by telephone contact, was respectively 2.7 months (± 5.8) and 16.5 months (± 4.9). At the time of the postoperative telephone call, the Thaha et al. score decreased by 5.6 (p
- Published
- 2018
- Full Text
- View/download PDF
22. Long-term Outcome of a Fissurectomy: A Prospective Single-Arm Study of 50 Operations out of 349 Initial Patients
- Author
-
Jean-David Zeitoun, Pierre Blanchard, Nadia Fathallah, Paul Benfredj, Nicolas Lemarchand, and Vincent de Parades
- Subjects
anal fissure ,fissurectomy ,anal continence ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Purpose The surgical standard of care for patients with chronic anal fissure is still disputed. We aimed to assess the natural course of idiopathic anal fissure and the long-term outcome of a fissurectomy as a surgical treatment. Methods All consecutive patients referred to a single expert practitioner in a tertiary centre were primarily included. A fissurectomy was proposed in cases of refractory symptoms after 4 to 6 weeks of standard medical management. Only patients with idiopathic and noninfected anal fissures were included in this second subsample to undergo surgery. Conventional postoperative management was prescribed for all patients who had undergone surgery. The main outcome measures were the success rate (defined as a combination of wound healing and relief of pain) and postoperative anal continence. Results Three hundred forty-nine patients were primarily recruited. Fifty patients finally underwent surgery for an idiopathic and noninfected fissure. Among them, 47 (94%) were cured at the end of primary follow-up, and 44 of the 47 (93.6%) could be confirmed as being sustainably cured in the longer-term follow-up. The mean time of complete healing was 10.3 weeks (range, 5.7–36.4 weeks). All patients were free of pain at weeks 42. The continence score after surgery was not statistically different from the preoperative score. Conclusion A fissurectomy for the treatment of patients with an idiopathic noninfected fissure is associated with rapid pain relief and a high success rate even though complete healing may often be delayed. Moreover, it appears to have no adverse effect on continence.
- Published
- 2018
- Full Text
- View/download PDF
23. Treatment de-escalation for HPV-driven oropharyngeal cancer: Where do we stand?
- Author
-
Haitham Mirghani and Pierre Blanchard
- Subjects
Human papillomavirus (HPV) ,Oropharynx/oropharyngeal ,Cancer/neoplasm ,Treatment de-escalation/de-intensification ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
HPV-driven oropharyngeal cancers have significantly better survival rates than tobacco and alcohol induced head and neck cancers. As HPV-positive patients are younger, healthier and far more likely to survive their disease, long-term treatment side effects are becoming a major issue. This has led the scientific and medical community to reassess the current treatment protocols in order to develop less toxic strategies while maintaining good oncological outcomes. In this article, we discuss the ongoing treatment de-escalation trials and highlight the issues raised by these studies.
- Published
- 2018
- Full Text
- View/download PDF
24. Prognostic impact of leukocyte counts before and during radiotherapy for oropharyngeal cancer
- Author
-
Garrett L. Jensen, Pierre Blanchard, G. Brandon Gunn, Adam S. Garden, C. David Fuller, Erich M. Sturgis, Maura L. Gillison, Jack Phan, William H. Morrison, David I. Rosenthal, and Steven J. Frank
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Introduction: Peripheral blood count components are accessible and evidently predictive in other cancers but have not been explored in oropharyngeal carcinoma. We examine if there is an association between the use of intensity-modulated radiotherapy (IMRT) or intensity-modulated proton therapy (IMPT) and lymphopenia, as well as if there is an association between baseline neutrophilia, baseline leukocytosis and lymphocyte nadir in oropharyngeal cancer. Materials and Methods: Analysis started with 150 patients from a previous case to case study design, which retrospectively identified adults with oropharyngeal carcinoma, 100 treated with IMRT in 2010-2012 and 50 treated with IMPT in 2011â2014. Pretreatment leukocyte, neutrophil, lymphocyte, and hemoglobin levels were extracted, as were neutrophil and lymphocyte nadir levels during radiotherapy. We retained 137 patients with recorded pre-treatment leukocyte and neutrophil levels for associated analysis and 114 patients with recorded lymphocyte levels during radiation and associated analysis. Multivariate survival analyses were done with Cox regression. Results: The radiotherapy type (IMRT vs. IMPT) was not associated with lymphopenia (grade 3 Pâ¯>â¯.99; grade 4 Pâ¯=â¯.55). In univariate analyses, poor overall survival was associated with pretreatment neutrophilia (hazard ratio [HR] 5.58, 95% confidence interval [CI] 1.99â15.7, Pâ¯=â¯.001), pretreatment leukocytosis (HR 4.85, 95% CI 1.73â13.6, Pâ¯=â¯.003), grade 4 lymphopenia during radiotherapy (HR 3.28, 95% CI 1.14â9.44, Pâ¯=â¯.03), and possibly smoking status >10 pack-years (HR 2.88, 95% CI 1.01â8.18, Pâ¯=â¯.05), but only T status was possibly significant in multivariate analysis (HR 2.64, 95% CI 0.99â7.00, Pâ¯=â¯.05). Poor progression-free survival was associated with pretreatment leukocytosis and T status in univariate analysis, and pretreatment neutrophilia and advanced age on multivariate analysis. Conclusions: Treatment modality did not affect blood counts during radiotherapy. Pretreatment neutrophilia, pretreatment leukocytosis, and grade 4 lymphopenia during radiotherapy were associated with worse outcomes after, but establishing causality will require additional work with increased statistical power. Keywords: Head and neck cancer, Radiotherapy, Proton therapy, Leukocytosis, Lymphopenia
- Published
- 2017
- Full Text
- View/download PDF
25. Pulsed Dose Rate Brachytherapy of Lip Carcinoma: Clinical Outcome and Quality of Life Analysis
- Author
-
Radouane El Ayachy, Roger Sun, Kanta Ka, Adrien Laville, Anne-Sophie Duhamel, Anne Tailleur, Isabelle Dumas, Sophie Bockel, Sophie Espenel, Pierre Blanchard, Yungan Tao, Stéphane Temam, Antoine Moya-Plana, Christine Haie-Meder, and Cyrus Chargari
- Subjects
brachytherapy ,lip cancer ,pulsed dose rate ,quality of life ,radiation therapy ,radiotherapy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Purpose: Lip carcinoma represents one of the most common types of head and neck cancer. Brachytherapy is a highly effective therapeutic option for all stages of lip cancers. We report our experience of pulsed dose rate brachytherapy (PDR) as treatment of lip carcinoma. Methods and Materials: this retrospective single center study included all consecutive patients treated for a lip PDR brachytherapy in our institution from 2010 to 2019. The toxicities and outcomes of the patients were reported, and a retrospective quality of life assessment was conducted by phone interviews (FACT H&N). Results: From October 2010 to December 2019, 38 patients were treated in our institution for a lip carcinoma by PDR brachytherapy. The median age was 73, and the majority of patients presented T1-T2 tumors (79%). The median total dose was 70.14 Gy (range: 60–85 Gy). With a mean follow-up of 35.4 months, two patients (5.6%) presented local failure, and seven patients (19%) had lymph node progression. The Kaplan–Meier estimated probability of local failure was 7.2% (95% CI: 0.84–1) at two and four years. All patients encountered radiomucitis grade II or higher. The rate of late toxicities was low: three patients (8.3%) had grade II fibrosis, and one patient had grade II chronic pain. All patients would highly recommend the treatment. The median FACT H&N total score was 127 out of 148, and the median FACT H&N Trial Outcome Index was 84. Conclusions: This study confirms that an excellent local control rate is achieved with PDR brachytherapy as treatment of lip carcinoma, with very limited late side effects and satisfactory functional outcomes. A multimodal approach should help to improve regional control.
- Published
- 2021
- Full Text
- View/download PDF
26. Clinical relevance of tumor infiltrating lymphocytes, PD-L1 expression and correlation with HPV/p16 in head and neck cancer treated with bio- or chemo-radiotherapy
- Author
-
Dan Ou, Julien Adam, Ingrid Garberis, Pierre Blanchard, France Nguyen, Antonin Levy, Odile Casiraghi, Philippe Gorphe, Ingrid Breuskin, François Janot, Stephane Temam, Jean-Yves Scoazec, Eric Deutsch, and Yungan Tao
- Subjects
biomarker ,cd8 ,head and neck squamous cell carcinoma ,human papillomavirus ,pd-l1 ,tumor-infiltrating lymphocytes ,Immunologic diseases. Allergy ,RC581-607 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
To investigate the prognostic value of tumor infiltrating lymphocytes (TILs: CD8+ and FoxP3+), and PD-L1 expression in patients with head and neck squamous cell carcinoma (HNSCC) treated with radiotherapy combined with cisplatin (CRT) or cetuximab (BRT). Immunohistochemistry for CD8, FoxP3 was performed on pretreatment tissue samples of 77 HNSCC patients. PD-L1 results were evaluable in 38 patients. Cox regression analysis was used to analyze the correlations of these biomarkers expression with clinicopathological characteristics and treatment outcomes. High CD8+ TILs level was identified in multivariate analysis (MVA) as an independent prognostic factor for improved progression-free survival with a non-significant trend for better overall survival (OS). High FoxP3+ TILs and PD-L1+ correlated with a favorable OS in the uni-variate analysis, respectively, but not in the MVA. In subgroup analysis, CD8+TILs appear to play a pivotal role, p16+/high CD8+TILs patients had superior 5-year OS compared with p16+/low CD8+TILs, p16-/ high CD8+TILs, and p16-/ low CD8+TILs patients. p16+/PD-L1+ patients had improved 3-year OS compared with p16+/PD-L1-, p16-/ PD-L1+, and p16-/ PD-L1- patients. In low CD8+ TILs tumors, 5-year loco-regional control of patients treated with CRT was improved vs. those with BRT (p = 0.01) while no significant difference in high CD8+ TILs was observed. CD8+ TILs correlated with an improved clinical outcome in HNSCC patients independent of Human papillomavirus status. The immunobiomarkers may provide information for selecting suitable patients for cisplatin or cetuximab treatment. Additionally, the impact of TILs and PD-L1 of deciphering among the p16+ population a very favorable outcome population could be of interest for patients tailored approaches.
- Published
- 2017
- Full Text
- View/download PDF
27. Clinical and Translational Radiation Oncology, a new player among the radiation oncology journals
- Author
-
Pierre Blanchard
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Published
- 2016
- Full Text
- View/download PDF
28. Les rapports diplomatiques entre la France et le Saint-Siège
- Author
-
Bernard Berthod and Pierre Blanchard
- Subjects
History (General) and history of Europe ,Christianity ,BR1-1725 - Published
- 1999
- Full Text
- View/download PDF
29. A Class of Fast and Accurate Summation Algorithms.
- Author
-
Pierre Blanchard, Nicholas J. Higham, and Théo Mary
- Published
- 2020
- Full Text
- View/download PDF
30. Mixed Precision Block Fused Multiply-Add: Error Analysis and Application to GPU Tensor Cores.
- Author
-
Pierre Blanchard, Nicholas J. Higham, Florent Lopez, Théo Mary, and Srikara Pranesh
- Published
- 2020
- Full Text
- View/download PDF
31. Nonlinear mapping and distance geometry.
- Author
-
Alain Franc, Pierre Blanchard, and Olivier Coulaud
- Published
- 2020
- Full Text
- View/download PDF
32. Role of chemotherapy in patients with nasopharynx carcinoma treated with radiotherapy (MAC-NPC): an updated individual patient data network meta-analysis
- Author
-
Claire Petit, Anne Lee, Jun Ma, Benjamin Lacas, Wai Tong Ng, Anthony T C Chan, Ruey-Long Hong, Ming-Yuan Chen, Lei Chen, Wen-Fei Li, Pei-Yu Huang, Terence Tan, Roger K C Ngan, Guopei Zhu, Hai-Qiang Mai, Edwin P Hui, George Fountzilas, Li Zhang, Alexandra Carmel, Dora L W Kwong, James Moon, Jean Bourhis, Anne Auperin, Jean-Pierre Pignon, Pierre Blanchard, Anne Aupérin, Ellen Benhamou, Somvilai Chakrabandhu, Anthony TC Chan, Qiu-Yan Chen, Yong Chen, Richard J Chappell, Horace Choi, Daniel TT Chua, Melvien Lee Kiang Chua, Julian Higgins, Ming Huang Hong, Edwin Pun Hui, Chin-Fu Hsiao, Michael Kam, Georgia Angeliki Koliou, Shu-Chuan Lai, Ka On Lam, Michael L LeBlanc, Anne WM Lee, Ho Fun Victor Lee, Wen Fei Li, Yoke Lim, Brigette Ma, Frankie Mo, Roger Ngan, Camille Ollivier, Brian O'Sullivan, Sharon X Poh, Gerta Rücker, Jonathan Sham, Yoke Lim Soong, Ying Sun, Lin-Quan Tang, Yuk Tung, Joseph Wee, Xuang Wu, Tingting Xu, and Yuan Zhang
- Subjects
Oncology - Published
- 2023
33. Chapter 10 Indian Ocean Heritage and Sustainable Conservation, from Zanzibar to Kilwa
- Author
-
Stephen Battle and Pierre Blanchard
- Published
- 2023
34. Spatially Addressable Multiplex Biodetection by Calibrated Micro/Nanostructured Surfaces
- Author
-
Serban Dobroiu, Falco C.M.J.M. van Delft, Ayyappasamy Sudalaiyadum Perumal, Shantoshini Dash, Jenny Aveyard, Jeroen van Zijl, Jaap Snijder, Eric van den Heuvel, Jurgen van Berkum, Marie Pierre Blanchard, Cyril Favard, and Dan V. Nicolau
- Subjects
Fluid Flow and Transfer Processes ,Process Chemistry and Technology ,Bioengineering ,Instrumentation - Published
- 2023
35. Parrêsia et processus de véridiction
- Author
-
Pierre BLANCHARD and Pierre BLANCHARD
- Published
- 2019
36. Recommendations for radiation therapy in oligometastatic prostate cancer
- Author
-
Thomas Zilli, Vérane Achard, Alan Dal Pra, Nina Schmidt-Hegemann, Barbara Alicja Jereczek-Fossa, Andrea Lancia, Gianluca Ingrosso, Filippo Alongi, Shafak Aluwini, Stefano Arcangeli, Pierre Blanchard, Antonio Conde Moreno, Felipe Couñago, Gilles Créhange, Piet Dirix, Alfonso Gomez Iturriaga, Matthias Guckenberger, David Pasquier, Paul Sargos, Marta Scorsetti, Stéphane Supiot, Alison C. Tree, Almudena Zapatero, Jennifer Le Guevelou, Piet Ost, Claus Belka, Producción Científica UCH 2022, UCH. Departamento de Medicina y Cirugía, and Guided Treatment in Optimal Selected Cancer Patients (GUTS)
- Subjects
Male ,Consensus ,Prostate cancer ,SBRT ,Delphi Technique ,Radiotherapy ,Elective nodal radiotherapy ,Próstata - Cáncer - Tratamiento ,Prostatic Neoplasms ,Prostate - Cancer - Radiotherapy ,Hematology ,Prostate - Cancer - Treatment ,Oncology ,Próstata - Cáncer - Radioterapia ,ESTRO-ACROP ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Oligometastases ,Retrospective Studies - Abstract
Este artículo se encuentra disponible en la siguiente URL: https://www.sciencedirect.com/science/article/pii/S0167814022044991?via%3Dihub En este artículo de investigación también participan:Gianluca Ingrosso, Filippo Alongi, Shafak Aluwini, Stefano Arcangeli, Pierre Blanchard, Felipe Couñago, Gilles Créhange, Piet Dirix, Alfonso Gomez Iturriaga, Matthias Guckenberger, David Pasquier, Paul Sargos, Marta Scorsetti, Stéphane Supiot, Alison C. Tree, Almudena Zapatero, Jennifer Le Guevelou, Piet Ost y Claus Belka. Background and purpose: Oligometastatic prostate cancer is a new and emerging treatment field with only few prospective randomized studies published so far. Despite the lack of strong level I evidence, metastasis-directed therapies (MDT) are widely used in clinical practice, mainly based on retrospective and small phase 2 studies and with a large difference across centers. Pending results of ongoing prospective randomized trials, there is a clear need for more consistent treatment indications and radiotherapy practices. Material and methods: A European Society for Radiotherapy and Oncology (ESTRO) Guidelines Committee consisting of radiation oncologists’ experts in prostate cancer was asked to answer a dedicated questionnaire, including 41 questions on the main controversial issues with regard to oligometastatic prostate cancer. Results: The panel achieved consensus on patient selection and routine use of prostate-specific membrane antigen positron emission tomography (PSMA PET) imaging as preferred staging and restaging imaging. MDT strategies are recommended in the de novo oligometastatic, oligorecurrent and oligoprogressive disease setting for nodal, bone and visceral metastases. Radiation therapy doses, volumes and techniques were discussed and commented. Conclusion: These recommendations have the purpose of providing standardization and consensus to optimize the radiotherapy treatment of oligometastatic prostate cancer until mature results of randomized trials are available.
- Published
- 2022
37. Practice changing data and emerging concepts from recent radiation therapy randomised clinical trials
- Author
-
Sophie Espenel, Cyrus Chargari, Pierre Blanchard, Sophie Bockel, Daphne Morel, Sofia Rivera, Antonin Levy, and Eric Deutsch
- Subjects
Male ,Cancer Research ,Lung Neoplasms ,Oncology ,Head and Neck Neoplasms ,Positron Emission Tomography Computed Tomography ,Humans ,Prostatic Neoplasms ,Radiopharmaceuticals ,Hodgkin Disease ,Randomized Controlled Trials as Topic - Abstract
Oncology treatments are constantly and rapidly evolving. We aimed at highlighting the latest radiation therapy practice changing trials and emerging concepts, through an overview of recent randomised clinical trials (RCTs).Requests were performed in the Medline database to identify all publications reporting radiation therapy RCTs from 2018 to 2021.Recent RCTs sustained the role of newer combinatorial strategies through radioimmunotherapy for early stage or metastatic lung cancer, newer pro-apoptotic agents (e.g. debio 1143 in locoregionally advanced head and neck squamous cell carcinoma) or nanoparticles (e.g. NBTXR3 in locally advanced soft-tissue sarcoma). High-tech radiotherapy allows intensifying treatments and gaining ground in some indications through the development of stereotactic body radiotherapy for example. First randomised evidence on personalised radiation therapy through imaging-based (Radiation therapy is a dynamic field of research, and many RCTs have greatly impacted therapeutic standards over the last years. Investments in radiotherapy research should facilitate the transfer of innovation to clinic.
- Published
- 2022
38. Events prediction after treatment in HPV-driven oropharyngeal carcinoma using machine learning
- Author
-
Adil Dinia, Samy Ammari, John Filtes, Marion Classe, Antoine Moya-Plana, François Bidault, Stéphane Temam, Pierre Blanchard, Nathalie Lassau, and Philippe Gorphe
- Subjects
Machine Learning ,Oropharyngeal Neoplasms ,Cancer Research ,Oncology ,Carcinoma ,Papillomavirus Infections ,Humans ,Neoplasm Recurrence, Local ,Prognosis ,Retrospective Studies - Abstract
Our objective was to develop a predictive model using a machine learning signature to identify patients at high risk of relapse or death after treatment for HPV-positive oropharyngeal carcinoma.Pre-treatment variables of 450 patients with HPV-positive oropharyngeal carcinoma treated with a curative intent comprised clinical items, imaging parameters and histological findings. The events considered were progression or residual disease after treatment, the recurrent disease after a disease-free interval and death. The endpoints were the prediction of events and progression-free survival. After feature Z-score normalisation and selection, random forest classifier models were trained. The best models were evaluated on recall, the F-score, and the ROC AUC metric. The clinical relevance of the best prediction model was evaluated using Kaplan-Meier analysis with a log-rank test.The best random forest model predicted the 5-year risk of relapse-free survival with a recall of 79.1%, an F1-score of 81.08%, and an AUC of the ROC curve of 0.89. The models performed poorly for the prediction of specific events of progression only, recurrence only or death only. The clinical relevance of the model was validated with a 5-year relapse-free survival of high-risk patients versus low-risk patients of 23.5% and 80%, respectively (p 0.0001).Patients with HPV-driven oropharyngeal carcinoma at high risk of relapse-free survival could be identified with a predictive machine learning model using patient data before treatment.
- Published
- 2022
39. Benefit of medial retropharyngeal nodal region sparing in nasopharyngeal carcinoma patients: the final answer?
- Author
-
Roger Sun and Pierre Blanchard
- Subjects
Oncology ,General Medicine - Published
- 2023
40. Accurate Computation of the Log-Sum-Exp and Softmax Functions.
- Author
-
Pierre Blanchard, Desmond J. Higham, and Nicholas J. Higham
- Published
- 2019
41. Efficacy and toxicity following salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after radiotherapy
- Author
-
Manon Kissel, Arthur Pounou, Kanta Ka, Anthony Alexis, Jacques Irani, Barbara Alicja Jereczek-Fossa, Mario Terlizzi, Alberto Bossi, and Pierre Blanchard
- Subjects
Male ,Salvage Therapy ,Brachytherapy ,Prostate ,Prostatic Neoplasms ,Androgen Antagonists ,Radiotherapy Dosage ,Prostate-Specific Antigen ,Oncology ,Recurrence ,Androgens ,Humans ,Radiology, Nuclear Medicine and imaging ,Neoplasm Recurrence, Local ,Retrospective Studies - Abstract
The management of local relapse after prostate cancer radiotherapy is frequently based on androgen deprivation therapy. The aim of the study was to report Gustave Roussy's experience with salvage prostate brachytherapy.All cases of localized prostate cancer presenting in an irradiated area who received salvage high dose rate (HDR) brachytherapy from 2013 to 2020 were retrospectively reviewed.A total of 64 patients were included. Median follow up was 30.5 months. Median initial EBRT dose was 70 Gy [Q1-Q3: 70 - 74]. Median PSA at brachytherapy was 6.8 ng/mL [Q1-Q3: 4.4 - 8.7] with a median interval between first and salvage irradiation of 10 years [Q1-Q3: 6.9 - 12.6]. The modality of the first irradiation was an exclusive EBRT in 73% of the cases, mostly with a 3D technique (82%). Dose prescription was two fractions of 12 Gy or 13 Gy associated with androgen deprivation therapy for 63% of the patients. About 23% of the patients were castrate-resistant. Disease free survival at 2 years was 58% in the whole population and 66% in hormone sensitive patients. The only factors associated with disease free survival on multivariate analysis was a high-risk disease at initial diagnosis (HR = 3.59, IC95 [1.75; 7.39], p = 0.0005). Grade 3 urinary and rectal toxicities occurred in 1.5% and 1.5% of the patients, respectively.HDR salvage brachytherapy seems to be a safe option for patients presenting with an isolated local relapse of prostate cancer.
- Published
- 2022
42. PARP Inhibition, a New Therapeutic Avenue in Patients with Prostate Cancer
- Author
-
Ronan, Flippot, Anna, Patrikidou, Mihaela, Aldea, Emeline, Colomba, Pernelle, Lavaud, Laurence, Albigès, Natacha, Naoun, Pierre, Blanchard, Mario, Terlizzi, Camilo, Garcia, Alice, Bernard-Tessier, Alina, Fuerea, Mario, Di Palma, Bernard, Escudier, Yohann, Loriot, Giulia, Baciarello, and Karim, Fizazi
- Subjects
Male ,Humans ,Prostatic Neoplasms ,Pharmacology (medical) ,Poly(ADP-ribose) Polymerase Inhibitors ,Poly(ADP-ribose) Polymerases - Abstract
Up to 25% of patients with metastatic prostate cancer present with germline or somatic DNA damage repair alterations, some of which are associated with aggressive disease and poor outcomes. New data have brought poly(ADP-ribose) polymerase (PARP) inhibitors into sharp focus in the treatment of metastatic castrate-resistant prostate cancer (mCRPC). Olaparib improved survival after at least one new hormonal therapy (NHT) in a cohort of patients harboring BRCA1, BRCA2 or ATM mutations in the PROfound trial, while rucaparib, talazoparib and niraparib demonstrated compelling activity in phase II trials. While patients with prostate cancer and BRCA1 or BRCA2 mutations may derive greatest benefit of PARP inhibition, the magnitude of benefit seems much lower in the context of most other homologous recombination gene mutations. Several PARP inhibitors are currently developed in combination with conventional therapy, including chemotherapy, NHT, and alpha-particle emitters, at different disease stages. Herein, we review the rationale for PARP inhibition in patients with prostate cancer, discuss the impact of PARP inhibitors on outcomes, and explore underlying challenges for future developments.
- Published
- 2022
43. Correlation between electronic Patient Reported Outcomes and biological markers, key parameter in acute radiation cystitis among prostate cancer patients: The prospective exploratory clinical study RABBIO (Preprint)
- Author
-
Carole Helissey, Sophie CAVALLERO, Nathalie GUITARD, Hélène THERY, Charles PARNOT, Antoine SCHERNBERG, Imen AISSA, Florent RAFFIN, Catherine LE COZ, Stanislas MONDOT, Christos Christopoulos, Karim MALEK, Emmanuelle MALAURIE, Pierre Blanchard, Cyrus CHARGARI, and Sabine FRANCOIS
- Abstract
BACKGROUND Despite advances in radiation techniques, radiation cystitis (RC) remains a significant cause of morbidity from pelvic radiotherapy, which may affect patients' quality of life (QoL). The pathophysiology of RC is not well understood, which limits the development of effective treatments. OBJECTIVE The RABBIO study aims to investigate the correlation between blood and urinary biomarkers and the intensity of acute RC symptoms and QoL in patients undergoing localized prostate cancer radiotherapy. METHODS The study included patients with low or intermediate-risk localized prostate cancer who were eligible for localized radiotherapy. Blood and urinary biomarkers were analyzed before radiotherapy was initiated and at weeks 4 and 12 of radiation therapy. Patients completed questionnaires related to radiation cystitis symptoms and QoL using a digital remote monitoring platform. The information was processed by means of an algorithm which classified patients according to the severity of symptoms and adverse events reported. Levels of blood and urinary biomarkers were correlated with the severity of acute RC symptoms and patient-reported QoL. RESULTS 401 adverse events’ questionnaires were collected over the duration of the study. The most frequently reported adverse events at week 4 were pollakiuria, constipation, and diarrhea. In comparison with baseline, the mean Functional Assessment of Cancer Therapy-Prostate (FACT-P) score decreased at week 4. A significant polarization of M2-phenotype macrophages and increase in serum and urine levels of M-CSF, HGF, and MIP-1α over baseline were observed at week 12. Baseline serum and urine M-CSF concentrations showed a significant negative correlation with FACT–P scores at weeks 4 and 12. CONCLUSIONS The RABBIO study is the first to explore the overexpression of inflammatory proteins in fluid biopsies from patients with symptoms of acute RC. These preliminary findings suggest that serum and urine HGF, M-CSF, MIP-1α, as well as macrophage polarization are potential biomarkers of cystitis after prostate radiotherapy. The elevated M-CSF levels in serum and urine at baseline were associated with the deterioration of QoL during radiotherapy. The results of this study may help to develop mitigation strategies to limit radiation damage to the bladder. CLINICALTRIAL NCT05246774
- Published
- 2023
44. Post-therapeutic surveillance of HPV-driven oropharyngeal cancers: are we ready to change our practices?
- Author
-
Haitham Mirghani, Camille Troux, Charlotte Leroy, Sophie El Bedoui, Anne Aupérin, Florence Garic, Alexandre Bozec, Renaud Schiappa, Pierre Blanchard, Philippe Gorphe, and Dorian Culié
- Subjects
Otorhinolaryngology ,General Medicine - Published
- 2023
45. Nonlinear Mapping and Distance Geometry.
- Author
-
Alain Franc, Pierre Blanchard, and Olivier Coulaud
- Published
- 2018
46. Genomic Classifiers in Personalized Prostate Cancer Radiation Therapy Approaches: A Systematic Review and Future Perspectives Based on International Consensus
- Author
-
Simon K.B. Spohn, Cédric Draulans, Amar U. Kishan, Daniel Spratt, Ashley Ross, Tobias Maurer, Derya Tilki, Alejandro Berlin, Pierre Blanchard, Sean Collins, Peter Bronsert, Ronald Chen, Alan Dal Pra, Gert de Meerleer, Thomas Eade, Karin Haustermans, Tobias Hölscher, Stefan Höcht, Pirus Ghadjar, Elai Davicioni, Matthias Heck, Linda G.W. Kerkmeijer, Simon Kirste, Nikolaos Tselis, Phuoc T. Tran, Michael Pinkawa, Pascal Pommier, Constantinos Deltas, Nina-Sophie Schmidt-Hegemann, Thomas Wiegel, Thomas Zilli, Alison C. Tree, Xuefeng Qiu, Vedang Murthy, Jonathan I. Epstein, Christian Graztke, Xin Gao, Anca L. Grosu, Sophia C. Kamran, and Constantinos Zamboglou
- Subjects
Cancer Research ,Radiation ,All institutes and research themes of the Radboud University Medical Center ,Oncology ,Urology ,Radiology, Nuclear Medicine and imaging ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] - Abstract
Current risk-stratification systems for prostate cancer (PCa) do not sufficiently reflect the disease heterogeneity. Genomic classifiers (GC) enable improved risk stratification after surgery, but less data exist for patients treated with definitive radiation therapy (RT) or RT in oligo-/metastatic disease stages. To guide future perspectives of GCs for RT, we conducted (1) a systematic review on the evidence of GCs for patients treated with RT and (2) a survey of experts using the Delphi method, addressing the role of GCs in personalized treatments to identify relevant fields of future clinical and translational research. We performed a systematic review and screened ongoing clinical trials on ClinicalTrials.gov. Based on these results, a multidisciplinary international team of experts received an adapted Delphi method survey. Thirty-one and 30 experts answered round 1 and round 2, respectively. Questions with ≥75% agreement were considered relevant and included in the qualitative synthesis. Evidence for GCs as predictive biomarkers is mainly available to the postoperative RT setting. Validation of GCs as prognostic markers in the definitive RT setting is emerging. Experts used GCs in patients with PCa with extensive metastases (30%), in postoperative settings (27%), and in newly diagnosed PCa (23%). Forty-seven percent of experts do not currently use GCs in clinical practice. Expert consensus demonstrates that GCs are promising tools to improve risk-stratification in primary and oligo-/metastatic patients in addition to existing classifications. Experts were convinced that GCs might guide treatment decisions in terms of RT-field definition and intensification/deintensification in various disease stages. This work confirms the value of GCs and the promising evidence of GC utility in the setting of RT. Additional studies of GCs as prognostic biomarkers are anticipated and form the basis for future studies addressing predictive capabilities of GCs to optimize RT and systemic therapy. The expert consensus points out future directions for GC research in the management of PCa. ispartof: Int J Radiat Oncol Biol Phys vol:116 issue:3 pages:503-520 ispartof: location:United States status: published
- Published
- 2023
47. Management of Patients with Advanced Prostate Cancer. Part I: Intermediate-/High-risk and Locally Advanced Disease, Biochemical Relapse, and Side Effects of Hormonal Treatment: Report of the Advanced Prostate Cancer Consensus Conference 2022
- Author
-
Silke Gillessen, Alberto Bossi, Ian D. Davis, Johann de Bono, Karim Fizazi, Nicholas D. James, Nicolas Mottet, Neal Shore, Eric Small, Matthew Smith, Christopher Sweeney, Bertrand Tombal, Emmanuel S. Antonarakis, Ana M. Aparicio, Andrew J. Armstrong, Gerhardt Attard, Tomasz M. Beer, Himisha Beltran, Anders Bjartell, Pierre Blanchard, Alberto Briganti, Rob G. Bristow, Muhammad Bulbul, Orazio Caffo, Daniel Castellano, Elena Castro, Heather H. Cheng, Kim N. Chi, Simon Chowdhury, Caroline S. Clarke, Noel Clarke, Gedske Daugaard, Maria De Santis, Ignacio Duran, Ros Eeles, Eleni Efstathiou, Jason Efstathiou, Onyeanunam Ngozi Ekeke, Christopher P. Evans, Stefano Fanti, Felix Y. Feng, Valerie Fonteyne, Nicola Fossati, Mark Frydenberg, Daniel George, Martin Gleave, Gwenaelle Gravis, Susan Halabi, Daniel Heinrich, Ken Herrmann, Celestia Higano, Michael S. Hofman, Lisa G. Horvath, Maha Hussain, Barbara Alicja Jereczek-Fossa, Robert Jones, Ravindran Kanesvaran, Pirkko-Liisa Kellokumpu-Lehtinen, Raja B. Khauli, Laurence Klotz, Gero Kramer, Raya Leibowitz, Christopher J. Logothetis, Brandon A. Mahal, Fernando Maluf, Joaquin Mateo, David Matheson, Niven Mehra, Axel Merseburger, Alicia K. Morgans, Michael J. Morris, Hind Mrabti, Deborah Mukherji, Declan G. Murphy, Vedang Murthy, Paul L. Nguyen, William K. Oh, Piet Ost, Joe M. O'Sullivan, Anwar R. Padhani, Carmel Pezaro, Darren M.C. Poon, Colin C. Pritchard, Danny M. Rabah, Dana Rathkopf, Robert E. Reiter, Mark. A. Rubin, Charles J. Ryan, Fred Saad, Juan Pablo Sade, Oliver A. Sartor, Howard I. Scher, Nima Sharifi, Iwona Skoneczna, Howard Soule, Daniel E. Spratt, Sandy Srinivas, Cora N. Sternberg, Thomas Steuber, Hiroyoshi Suzuki, Matthew R. Sydes, Mary-Ellen Taplin, Derya Tilki, Levent Türkeri, Fabio Turco, Hiroji Uemura, Hirotsugu Uemura, Yüksel Ürün, Claire L. Vale, Inge van Oort, Neha Vapiwala, Jochen Walz, Kosj Yamoah, Dingwei Ye, Evan Y. Yu, Almudena Zapatero, Thomas Zilli, Aurelius Omlin, Tampere University, Clinical Medicine, Tays Research Services, Institut Català de la Salut, [Gillessen S] Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland. Università della Svizzera Italiana, Lugano, Switzerland. [Bossi A] Genitourinary Oncology, Prostate Brachytherapy Unit, Gustave Roussy, Paris, France. [Davis ID] Monash University and Eastern Health, Victoria, Australia. [de Bono J] The Institute of Cancer Research, London, UK. Royal Marsden Hospital, London, UK. [Fizazi K] Institut Gustave Roussy, University of Paris Saclay, Villejuif, France. [James ND] The Institute of Cancer Research, London, UK. [Mateo J] Prostate Cancer Translational Research Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. Servei d’Oncologia Mèdica, Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
- Subjects
Neoplasms::Neoplasms by Site::Urogenital Neoplasms::Genital Neoplasms, Male::Prostatic Neoplasms [DISEASES] ,Urology ,3122 Cancers ,Medizin ,Pròstata - Càncer - Diagnòstic ,Salvage therapy ,Behavior and Behavior Mechanisms::Psychology, Social::Group Processes::Consensus [PSYCHIATRY AND PSYCHOLOGY] ,conducta y mecanismos de la conducta::psicología social::procesos de grupo::consenso [PSIQUIATRÍA Y PSICOLOGÍA] ,Prostate-specific membrane antigen positron emission tomography imaging ,Adjuvant therapy ,Locally advanced prostate cancer ,SDG 3 - Good Health and Well-being ,Decisió, Presa de ,Urological cancers Radboud Institute for Molecular Life Sciences [Radboudumc 15] ,Side effects ,Otros calificadores::/terapia [Otros calificadores] ,Salvage radiation therapy ,Prostate cancer ,Next-generation imaging ,Other subheadings::/therapy [Other subheadings] ,Pròstata - Càncer - Tractament ,3126 Surgery, anesthesiology, intensive care, radiology ,3142 Public health care science, environmental and occupational health ,Biochemical recurrence ,neoplasias::neoplasias por localización::neoplasias urogenitales::neoplasias de los genitales masculinos::neoplasias de la próstata [ENFERMEDADES] ,Urological cancers Radboud Institute for Health Sciences [Radboudumc 15] ,Hormonal treatment - Abstract
Contains fulltext : 291600.pdf (Publisher’s version ) (Open Access) BACKGROUND: Innovations in imaging and molecular characterisation and the evolution of new therapies have improved outcomes in advanced prostate cancer. Nonetheless, we continue to lack high-level evidence on a variety of clinical topics that greatly impact daily practice. To supplement evidence-based guidelines, the 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) surveyed experts about key dilemmas in clinical management. OBJECTIVE: To present consensus voting results for select questions from APCCC 2022. DESIGN, SETTING, AND PARTICIPANTS: Before the conference, a panel of 117 international prostate cancer experts used a modified Delphi process to develop 198 multiple-choice consensus questions on (1) intermediate- and high-risk and locally advanced prostate cancer, (2) biochemical recurrence after local treatment, (3) side effects from hormonal therapies, (4) metastatic hormone-sensitive prostate cancer, (5) nonmetastatic castration-resistant prostate cancer, (6) metastatic castration-resistant prostate cancer, and (7) oligometastatic and oligoprogressive prostate cancer. Before the conference, these questions were administered via a web-based survey to the 105 physician panel members ("panellists") who directly engage in prostate cancer treatment decision-making. Herein, we present results for the 82 questions on topics 1-3. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Consensus was defined as ≥75% agreement, with strong consensus defined as ≥90% agreement. RESULTS AND LIMITATIONS: The voting results reveal varying degrees of consensus, as is discussed in this article and shown in the detailed results in the Supplementary material. The findings reflect the opinions of an international panel of experts and did not incorporate a formal literature review and meta-analysis. CONCLUSIONS: These voting results by a panel of international experts in advanced prostate cancer can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers prioritise areas for future research. Diagnostic and treatment decisions should always be individualised based on patient and cancer characteristics (disease extent and location, treatment history, comorbidities, and patient preferences) and should incorporate current and emerging clinical evidence, therapeutic guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2022 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials. PATIENT SUMMARY: The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with health care providers and patients worldwide. At each APCCC, a panel of physician experts vote in response to multiple-choice questions about their clinical opinions and approaches to managing advanced prostate cancer. This report presents voting results for the subset of questions pertaining to intermediate- and high-risk and locally advanced prostate cancer, biochemical relapse after definitive treatment, advanced (next-generation) imaging, and management of side effects caused by hormonal therapies. The results provide a practical guide to help clinicians and patients discuss treatment options as part of shared multidisciplinary decision-making. The findings may be especially useful when there is little or no high-level evidence to guide treatment decisions.
- Published
- 2023
48. Twitter as a Medical Media Among French Young Oncologists: Results from a National Survey
- Author
-
Yohann Loriot, Matthieu Roulleaux Dugage, Jean-Charles Soria, Côme Bommier, Marc Hilmi, Pierre Blanchard, Natacha Naoun, and Morgan Michalet
- Subjects
Medical education ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Pharmacology toxicology ,Twitter ,Public Health, Environmental and Occupational Health ,Statistical difference ,Young oncologists ,Medical information ,Article ,Residency ,Social media ,Oncology ,Baseline characteristics ,Pandemic ,Medical continuous education ,Medicine ,business - Abstract
Since its launch in 2006, Twitter has become a commonly used platform for sharing medical information, especially in the field of oncology. However, its role and impact on young oncologists’ education remain unclear. Moreover, COVID-19 and congress virtualization is likely to have modified Twitter use by the medical society. We conducted a national survey (27 questions) in France among medical oncology, hematology, and radiation therapy young doctors to help better understand the role played by Twitter on their medical education. One hundred eighty-three young oncologists participated in our survey. A majority does not use Twitter (72.1%), mostly to reduce their time spent on social media. Participants using Twitter (27.9%) often use it more than once a week, mostly by scrolling on their news feed. Interestingly, they rarely express their own opinion on Twitter: a majority of them (75.5%) tweet less than once a month while the rest of them mostly retweet others’ tweets. They mainly follow English-speaking experts, scientific societies, and medical journals. Pharmaceutical laboratories’ accounts are of less significance. Overall Twitter usage seems increasing since COVID-19 pandemic and the consequent digitalization of congresses. No statistical difference was observed between the baseline characteristics of Twitter users and non-users. This survey shows that Twitter is a relevant mean of continuous medical education used by around a third of French young oncologists, especially since COVID-19 pandemic and the virtualization of congresses. This media should be considered and evaluated for its educational advantages or potential biases. Supplementary Information The online version contains supplementary material available at 10.1007/s13187-021-02119-7.
- Published
- 2021
49. Disease-free time stratification in locally recurrent head and neck carcinoma after definitive radiotherapy or chemoradiotherapy
- Author
-
Philippe Gorphe, Antoine Moya-Plana, Joanne Guerlain, Yungan Tao, France Nguyen, Ingrid Breuskin, Pierre Blanchard, and Stéphane Temam
- Subjects
Oncology ,medicine.medical_specialty ,Prognostic variable ,Squamous Cell Carcinoma of Head and Neck ,business.industry ,Disease free ,Retrospective cohort study ,Chemoradiotherapy ,General Medicine ,Prognosis ,Otorhinolaryngology ,Head and Neck Neoplasms ,Internal medicine ,medicine ,Humans ,Neurosurgery ,Neoplasm Recurrence, Local ,business ,Definitive radiotherapy ,Retrospective Studies ,Head and neck carcinoma - Abstract
There is no standard definition of disease-free interval before local recurrence after treatment in head and neck carcinoma (HNSCC). We evaluated an easy-to-use stratification and its association with survival in a large cohort of patients.We performed a retrospective cohort analysis of prognostic variables in 325 HNSCC patients with a local recurrence after definitive radiotherapy or concurrent chemoradiotherapy. Endpoints were overall survival (OS) and post-recurrence survival (PRS).Variables associated with the survival were the patient age (OS p 0.0001, PRS p 0.0001), the initial disease stage (OS p = 0.24, PRS p = 0.0358), localization (OS p = 0.012, PRS p = 0.0002), a complete initial response to treatment (OS p 0.0001, PRS p = 0.019), synchronous regional or distant metastatic disease (OS p = 0.0094, PRS p 0.0001), a salvage surgery (OS p 0.0001, PRS p 0.0001) and time to recurrence (OS p = 0.0002, PRS p = 0.0029). Time to recurrence could be stratified between specific prognostic time categories that comprised disease persistence, early recurrence ( 12 months), standard recurrence (12 months-5 years) and late recurrence ( 5 years).In HNSCC patients, time to local recurrence is a prognostic variable that can be defined using an easy-to-use stratification.
- Published
- 2021
50. Place de la radiothérapie de la tumeur primitive et/ou des métastases du cancer de la prostate oligométastatique
- Author
-
I. Latorzeff, B. Bataille, B. Vandendorpe, E. Lartigau, David Pasquier, D. Baron, Jean-Michel Hannoun-Levi, T. Le Roy, and Pierre Blanchard
- Subjects
Gynecology ,Stereotactic radiotherapy ,medicine.medical_specialty ,Oncology ,business.industry ,medicine ,Radiology, Nuclear Medicine and imaging ,business - Abstract
Resume Le cancer de la prostate oligometastatique est parmi les cancers oligometastatiques les plus etudies dans la litterature. Malgre cela, a ce jour, nous disposons de peu d’etudes prospectives ayant evalue la radiotherapie stereotaxique des oligometastases du cancer de la prostate. Deux essais randomises de phase II montrent un benefice en termes de survie sans progression en comparaison avec une surveillance simple. Les donnees de registres prospectifs montrent egalement un tres bon taux de controle local et une faible toxicite. L’inclusion dans les essais en cours doit etre fortement encouragee afin de preciser la place de cette irradiation stereotaxique en complement du traitement systemique. La radiotherapie de la tumeur primitive a fait l’objet d’essais randomises, elle apporte un benefice de survie globale chez les patients atteints d’un faible volume tumoral. Le benefice est inversement correle au nombre de lesions osseuses sur l’imagerie classique, jusqu’a trois lesions. La radiotherapie de la tumeur primitive est recommandee par les societes savantes chez les patients atteints d’un faible volume tumoral. Sa place en association avec les hormonotherapies de nouvelle generation doit etre precisee.
- Published
- 2021
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.