Clinical Outcomes of Several IMRT Techniques for Patients With Head and Neck Cancer: A Propensity Score-Weighted Analysis.

PURPOSE: The Advanced Radiotherapy Oto-Rhino-Laryngologie (ART-ORL) study (NCT02024035) was performed to prospectively evaluate the clinical and economic aspects of helical TomoTherapy and volumetric modulated arc therapy (RapidArc, Varian Medical Systems, Palo Alto, CA) for patients with head and neck cancer. METHODS AND MATERIALS: Fourteen centers participated in this prospective comparative study. Randomization was not possible based on the availability of equipment. Patients with epidermoid or undifferentiated nasopharyngeal carcinoma or epidermoid carcinoma of the oropharynx and oral cavity (T1-T4, M0, N0-N3) were included between February 2010 and February 2012. Only the results of the clinical study are presented in this report, as the results of the economic assessment have been published previously. Inverse probability of treatment weighting using the propensity score analysis was undertaken in an effort to adjust for potential bias due to nonrandomization. Locoregional control, cancer-specific survival, and overall survival assessed 18 months after treatment, as well as long-term toxicity and salivary function, were evaluated. RESULTS: The analysis included 166 patients. The following results are given after inverse probability of treatment weighting adjustment. The locoregional control rate at 18 months was significantly better in the TomoTherapy group: 83.3% (95% confidence interval [CI], 72.5%-90.2%) versus 72.7% (95% CI, 62.1%-80.8%) in the RapidArc group (P=.025). The cancer-specific survival rate was better in the TomoTherapy group: 97.2% (95% CI, 89.3%-99.3%) versus 85.5% (95% CI, 75.8%-91.5%) in the RapidArc group (P=.014). No significant difference was shown in progression-free or overall survival. TomoTherapy induced fewer acute salivary disorders (P=.012). Posttreatment salivary function degradation was worse in the RapidArc group (P=.012). CONCLUSIONS: TomoTherapy provided better locoregional control and cancer-specific survival than RapidArc treatment, with fewer salivary disorders. No significant difference was shown in progression-free and overall survival. These results should be explored in a randomized trial.

Cost Analysis of Complex Radiation Therapy for Patients With Head and Neck Cancer.

PURPOSE: This cost analysis aimed to prospectively assess differences in costs between TomoTherapy and volumetric modulated arc therapy (VMAT) in patients with head and neck cancer. METHODS AND MATERIALS: Economic data were gathered from a multicenter study. However, randomization was not possible due to the availability of equipment. Costs were calculated using the microcosting technique from the hospital's perspective (in 2013 euros), and the time horizon was radiation therapy. Only resources that entered the hospital production process and which were likely to vary between the strategies being compared were considered. Acute adverse events observed within the time horizon were also assessed. RESULTS: The cost analysis was based on a total of 173 patient treatments given between 2010 and 2012 in 14 French cancer centers: 73 patients were treated with TomoTherapy, 92 with VMAT RapidArc, and 8 with VMAT SmartArc. Estimated costs of SmartArc were removed from the comparison due to the small sample size. The mean ± SD cost per patient of the treatment planning phase was €314 (±€214) for TomoTherapy and €511 (±€590) for RapidArc. Mean costs ± SD per patient of irradiation reached €3144 (±€565) for TomoTherapy and €1350 (±€299) for RapidArc. The most sensitive parameter of irradiation was the annual operating time of accelerators. Ninety-five percent confidence intervals for the mean costs of irradiation were €3016 to €3272 for TomoTherapy and €1281 to €1408 for RapidArc. The number of acute adverse events during radiation therapy was not significantly different between strategies. CONCLUSIONS: TomoTherapy appeared to be more expensive than RapidArc mainly due to the higher price of the accelerator, the higher costs of maintenance, and the longer duration of treatment sessions. Because strategies were not significantly different in clinical effect, RapidArc appeared to be the strategy to be recommended at this stage of knowledge.

[Salvage surgery for upper aerodigestive tract tumours]. / Chirurgie de rattrapage dans les tumeurs des VADS.

Salvage surgeries of head and neck tumors are considered as poor satisfactory either for disease control results or for aesthetic and functional outcomes. Several improvements have been made possible since few years in all fields of oncologic treatments. A new approach must be initiated in that context, moreover since take in charge for head and neck region (exclusive initial medical treatment) let us consider an increasement of clinical situations for which a salvage therapy could be performed. The new surgery techniques have to be considered, reconstructive and guided by systems, which can improve surgical skills (navigation, robotic, sentinel node procedure, nervous detection and so on), the help of reirradiation techniques, the use of medical therapy during surgical procedure, the photodynamic therapy and all the help provided by new medical imaging and modern biology, which can determine more precisely the status of the cancer when it is taken in charge. The mastery of those techniques improvements must follow on an evolution of the concepts in the field of combined salvage treatments performed by multidisciplinary teams. Those treatments have to be realized in structures, which have the techniques and the multiple skills for allowing increasement of outcomes of those severe diseases.

Long-term alterations of cytokines and growth factors expression in irradiated tissues and relation with histological severity scoring.

PURPOSE: Beside its efficacy in cancer treatment, radiotherapy induces degeneration of healthy tissues within the irradiated area. The aim of this study was to analyze the variations of proinflammatory (IL-1α, IL-2, IL-6, TNF-α, IFN-γ), profibrotic (TGF-ß1), proangiogneic (VEGF) and stem cell mobilizing (GM-CSF) cytokines and growth factors in an animal model of radiation-induced tissue degeneration. MATERIALS AND METHODS: 24 rats were irradiated unilaterally on the hindlimb at a monodose of 30 Gy. Six weeks (n=8), 6 months (n=8) and 1 year (n=8) after irradiation the mediators expression in skin and muscle were analyzed using Western blot and the Bio-Plex® protein array (BPA) technology. Additional histological severity for fibrosis, inflammation, vascularity and cellularity alterations scoring was defined from histology and immnunohistochemistry analyses. RESULTS: A significant increase of histological severity scoring was found in irradiated tissue. Skin tissues were more radio-sensitive than muscle. A high level of TGF-ß1 expression was found throughout the study and a significant relation was evidenced between TGF-ß1 expression and fibrosis scoring. Irradiated tissue showed a chronic inflammation (IL-2 and TNF-α significantly increased). Moreover a persistent expression of GM-CSF and VEGF was found in all irradiated tissues. The vascular score was related to TGF-ß1 expression and the cellular alterations score was significantly related with the level of IL-2, VEGF and GM-CSF. CONCLUSION: The results achieved in the present study underline the complexity and multiplicity of radio-induced alterations of cytokine network. It offers many perspectives of development, for the comprehension of the mechanisms of late injuries or for the histological and molecular evaluation of the mode of action and the efficacy of rehabilitation techniques.

[Radiotherapy at the Grand Duchy of Luxembourg]. / L'oncologie radiothérapique au Grand-Duché de Luxembourg. Trois premières années de fonctionnement du Centre François Baclesse.

The Centre François Baclesse was created as National Radiotherapy Center in 2000. Oncology Radiotherapy has been developed in Luxembourg in parallel with existing medical and surgical oncology departments. Cancer is a Public Health problem in Luxembourg. More than 1800 new cases of cancer are diagnosed every year, out of wich 70 % will need radiotherapy at the time of the evolution of the disease. Technical platform and Human Resources available at this time are able to deliver high quality treatment. The activity reached a plateau in 2002 with almost 800 patients treated per year, whereas the theorical need for radiation oncology treatment is 1200 patients per year in Luxembourg. A large architectural project will add 2 new linear accelerators and will be finished by 2007-2008. Multidisciplinary oncological network has been developed together with cancer treatment units of 6 luxembourgish hospitals. Clinical Research is one of the missions of the Center. After the achievement of its extension, the Centre François Baclesse will be able to cover the need of the Regional, luxembourgish and cross-boarder patients pool, in line with an European approach in treating cancer.

[Evaluation of results of radiotherapy and localized prostate cancer, Experiences at the Francois Baclesse Center 2000-2001]. / Evaluation des résultats de la radiothérapie dans les cancers localisés de la prostate. Expérience du Centre François Baclesse 2000-2001.

UNLABELLED: The authors report the collegial activity performed during the first two years of François Baclesse Center existence. This experience results from the collaboration between Luxemburgish Urologists and technical and medical staff of the National Radiotherapy Center. 194 new prostate cancer cases have been recorded between 2000 and 2001. 98 of them have been treated by curative three-dimensional conformal radiotherapy. For the 72 Gy level of dose, ilio-obturator curage has been performed in 50% of the patients. 82% of the patients have been treated by concomitant hormotherapy. For the 74 Gy level of dose, 50% of the patients have an ilio-obturator curage and 84% received concomitant hormotherapy. Radiotherapy post-prostatectomy has been done for 7 patients. The subject of the discussion is the respect of Standardized Good Practices as defined in Luxemburg. CONCLUSION: The national strategy instaured since September 2000 has been respected. The Urologists are invited to transmit post-radiotherapy toxicities to the clinical research associate. EORTC 22991 protocol is now initiated. The aim of this study is to demonstrate that combining three-dimensional conformal radiotherapy and adjuvant hormonotherapy can increase survival and reduce metastatic progression risk in localized prostate cancer (T1, T2).