ABSTRACT
New concepts of medical consultations are currently disrupting the practice of medicine. The use of standardized questionnaires, or patient-reported outcome (PRO and ePRO) has already significantly changed the relationship between the physician and the patient. Telemedicine, or even automatic conversational agents, such as chatbots, are also providing more convenient access to care and medical information for many patients. These tools have a major impact in oncology, precisely because of the rising chronicity of the diseases the radiation oncologists treat. In this article, we provide a detailed analysis of these new concepts.
Subject(s)
Neoplasms/radiotherapy , Radiation Oncology/methods , Remote Consultation , Humans , Patient Reported Outcome Measures , Surveys and QuestionnairesABSTRACT
Stereotactic radiotherapy of oligometastases, mono- or hypofractionated, represents a fundamental change in the practice of the specialty as it was developed for a century. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Four main phase II and III trials are underway in France. Future research concerns the association of stereotactic radiotherapy with immunotherapy or different conventional chemotherapy protocols, the identification of the best clinical presentations, and optimization of fractionation and biological dose for poor prognosis localizations.
Subject(s)
Clinical Trials, Phase II as Topic , Clinical Trials, Phase III as Topic , Neoplasms/radiotherapy , Radiosurgery/methods , Randomized Controlled Trials as Topic , Antibodies, Monoclonal/therapeutic use , Antineoplastic Agents, Immunological/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Neoplasms/radiotherapy , Bone Neoplasms/secondary , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/radiotherapy , Combined Modality Therapy/methods , Forecasting , France , Humans , Immunotherapy , Kidney Neoplasms/drug therapy , Kidney Neoplasms/radiotherapy , Lung Neoplasms/drug therapy , Lung Neoplasms/radiotherapy , Male , Neoplasm Metastasis , Neoplasms/pathology , Neoplasms/therapy , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/radiotherapy , Squamous Cell Carcinoma of Head and Neck/drug therapy , Squamous Cell Carcinoma of Head and Neck/radiotherapyABSTRACT
Stereotactic radiotherapy represents a fundamental change in the practice of radiotherapy of lung cancers. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Stereotactic radiotherapy can be realized either by a dedicated accelerator (CyberKnife®) or by a conventional accelerator associated with specific systems. The two modalities deliver a very precise irradiation whose very good results published to date are similar. Some technical characteristics specific to each type of linear accelerator could guide the choice according to the target volume treated.
Subject(s)
Lung Neoplasms/radiotherapy , Particle Accelerators , Radiosurgery/instrumentation , Humans , Organ Motion , Organs at Risk/radiation effects , Radiosurgery/methods , Respiration , Treatment OutcomeABSTRACT
PURPOSE: We report the patient outcomes of a treatment combining proton therapy and Tomotherapy in sinonasal adenoid cystic carcinoma involving skull base. MATERIALS AND METHODS: We included patients treated at Curie Institute, Paris, France, between March 2010 and February 2014 for an advanced adenoid cystic carcinoma involving skull base. Patients received Tomotherapy, proton therapy or both. We evaluated treatment toxicity (according to CTCAE V4), local control, distant metastasis-free survival and overall survival. RESULTS: Thirteen patients were included, with a median follow-up of 34 months. Radiation therapy followed surgery for 77% of the patients and margins were positive in all those cases. Median dose was 73.8Gy. Local control, distant metastasis-free survival and overall survival at 3 years were respectively 60%, 48% and 60%. One-sided grade 3 hearing impairment occurred in 46% of the patients. CONCLUSION: Combining high-dose proton therapy and Tomotherapy is effective and has moderate toxicity in the treatment of T4 sinonasal adenoid cystic carcinoma involving skull base.
Subject(s)
Carcinoma, Adenoid Cystic/radiotherapy , Paranasal Sinus Neoplasms/radiotherapy , Proton Therapy , Radiotherapy, Conformal , Radiotherapy, Intensity-Modulated , Skull Base Neoplasms/radiotherapy , Carcinoma, Adenoid Cystic/diagnostic imaging , Carcinoma, Adenoid Cystic/mortality , Female , Follow-Up Studies , France/epidemiology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Organs at Risk/diagnostic imaging , Paranasal Sinus Neoplasms/diagnostic imaging , Paranasal Sinus Neoplasms/mortality , Radiotherapy Dosage , Radiotherapy, Adjuvant , Radiotherapy, Image-Guided , Retrospective Studies , Skull Base Neoplasms/diagnostic imaging , Skull Base Neoplasms/mortalityABSTRACT
PURPOSE: To determine the 3 years late toxicity among patients with non-metastatic breast cancer who received concurrent bevacizumab and locoregional radiotherapy. MATERIAL AND METHODS: This is a single-arm, multicentre, prospective study, of the toxicity of adjuvant concomitant association of bevacizumab and radiotherapy in patients with breast cancer. Toxicity was assessed by the Common Terminology Criteria for Adverse Events version 3.0 during the radiotherapy and follow-up clinics at 12 and 36 months after its completion. The study was designed to evaluate the toxicity at one year, 3 years and 5 years. RESULTS: Sixty-four patients were included from October 2007 to August 2010. All of them received concurrent adjuvant radiotherapy and bevacizumab (in 24 cases after primary systemic treatment). All patients received non-fractionated radiotherapy to breast or chest wall with or without irradiation of regional lymph nodes. Early toxicity has been previously reported. Median follow-up was 46.4 months (range: 18-77 months). Median age was 53 years old (range: 23-68 years). The 3-years overall survival was 93% (range: 87-100%). Evaluation of the toxicity at 3 years was available for 67% of the patients. There was a low rate of toxicity: 14% grade 1 pain, 9% grade 1 fibrosis, 2% grade 1 telangiectasia, 2% grade 1 paresis, 7% grade 1 lymphedema and 2% grade 3 lymphedema. No grade 4 toxicity was observed. No patient had a left ventricular ejection fraction below 50% at 3 years. CONCLUSIONS: Concurrent bevacizumab with locoregional radiotherapy is associated with acceptable 3-years toxicity in patients with breast cancer.