Showing papers by "Philippe Maingon published in 2005"

Enhanced Tumorocidal Effect of Chemotherapy With Preoperative Radiotherapy for Rectal Cancer: Preliminary Results—EORTC 22921

Abstract: Purpose The European Organisation for Research and Treatment of Cancer (EORTC) trial evaluated the addition of chemotherapy (CT) to preoperative radiation (preop RT) and the value of postoperative CT for improving the survival in patients with T3-4 resectable rectal cancer. Patients were allocated to the following four arms: arm 1, preop RT 45 Gy in 5 weeks; arm 2, preop RT plus two 5-day CT courses (fluorouracil 350 mg/m2/d and leucovorin 20 mg/m2/d) in the first and fifth week of RT; arm 3, preop RT plus four postoperative CT courses; and arm 4, preop RT and CT plus postoperative CT. We investigated the effect of adding CT on the pathologic parameters. Patients and Methods One thousand eleven patients were entered onto the trial; 505 received preop RT (arms 1 and 3), and 506 received preop RT-CT (arms 2 and 4). We analyzed the differences in tumor size, tumor node stage, number of retrieved nodes, and histologic features such as lymphatic, venous, and perineural invasions, tumor differentiation, and tum...

Preoperative radiation (Preop RT) in rectal cancer: Effect and timing of additional chemotherapy (CT) 5-year results of the EORTC 22921 trial

Abstract: 3505 Background: This 2 x 2 factorial trial evaluates the addition of CT to preop RT and that of postop CT vs nil on overall survival (primary end-point) and progression-free survival (secondary end-point). Methods: Eligibility: age 10 cm: 6.6 %. T stage: T3: 90%; T4:10%. The median Fup is 5.4 years. Conservative resection was 55.6% vs 52.4% with preop RT-CT and preop RT, respectively (p = 0.05). One patient in four did not start postop CT due to various reasons....

Intensity modulated radiation therapy in head and neck squamous cell carcinoma: state of the art and future challenges.

Abstract: Intensity-modulated radiation therapy (IMRT) for head and neck (HN) tumors refers to a new approach to the whole treatment procedure from patient immobilization to beam delivery Implementation of IMRT thus requires knowledge of setup uncertainties, adequate selection and delineation of target volumes based on clinical examination and optimal imaging modalities, appropriate specification and dose prescription regarding dose-volume constraints, and ad hoc quality control of both the clinical and physical aspects of the whole procedure A large number of issues still need to be resolved and/or further refined, such as the optimal selection and delineation of the target volume in particular, with the introduction of functional imaging, and a better integration of improved dose distribution into the fractionation strategy IMRT is associated with a potentially increased incidence of carcinogenesis, although in the HN area this risk is relative to the intrinsic risk of co-morbidity and secondary cancer associated with the patient's lifestyle Currently, the implementation of IMRT into routine clinical practice for HN cancers may not be a straightforward matter, and should probably be restricted to selected patients and selected institutions with adequate resources and experience This review emphasizes the above aspects and provides some recommendations for the future use of IMRT in patients with HN tumors

Place de l'association de radiothérapie et d'hormonothérapie dans les cancers de la prostate

Abstract: RTOG and EORTC randomised phase III trials investigated combination of radiation therapy and hormonal treatment in locally advanced prostate cancer T2c-T4 N0-1 M0 (UICC 2002). Complete androgen blockade initiated 2 months prior to starting radiotherapy and stopped at the completion of radiotherapy vs radiation therapy alone, increased overall survival in patients with Gleason score 2-6. Adjuvant androgen suppression started at the end of the radiotherapy and continued indefinitely improved significantly overall survival of patients Gleason score 8 to 10. Complete androgen blockade in two months before and two months during radiation followed by 24 additional months of LHRH analogue alone improved overall survival of patients Gleason score 8-10 with respect to CAB alone. EORTC trial 22861 has shown that androgen suppression with LHRH analogue given during and for 3 years after external irradiation improved overall survival whatever the Gleason score. The role of hormonal treatment is currently assessed in localized prostate cancer (T1-2 N0) with poor prognostic factors: Gleason score 8-10, PSA>20 ng/ml.

La radiothérapie de conformation avec et sans modulation d'intensité dans le traitement du cancer localisé de la prostate

Abstract: Conformal radiation therapy has now to be considered as a standard treatment of localized prostatic adenocarcinomas. Using conformational methods and intensity modulated radiation therapy requires a rigorous approach for their implementation in routine, focused on the reproducibility of the treatment, target volume definitions, dosimetry, quality control, setup positioning. In order to offer to the largest number of patients high-dose treatment, the clinicians must integrate as prognostic factors accurate definition of microscopic extension as well as the tolerance threshold of critical organs. High-dose delivery is expected to be most efficient in intermediary risks and locally advanced diseases. Intensity modulated radiation therapy is specifically dedicated to dose escalation. Perfect knowledge of classical constraints of conformal radiation therapy is required. Using such an approach in routine needs a learning curve including the physicists and a specific quality assurance program.