Curiethérapie par implants permanents de grains d'Iode 125 (analyse rétrospective des résultats carcinologiques et fonctionnels (urinaires et digestifs) de 748 patients traités de 2000 à 2010 à l'Institut Claudius Regaud et comparaison de 3 techniques successives d'implantation)

TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Apport des marqueurs intra-prostatiques radio-opaques dans l'irradiation conformationnelle des cancers de la prostate

La radiothérapie conformationnelle en 3 dimensions constitue à l'heure actuelle le standard dans l'irradiation des cancers prostatiques. L'implantation de marqueurs radio-opaques au sein de la prostate permet un ciblage plus précis que la seule utilisation de repères cutanés et osseux. Nous avons étudié les conséquences dosimétriques de l'utilisation de cette technique chez 17 patients en réalisant plusieurs Cone Beam Computed Tomographies en cours de radiothérapie. Nous avons dé-montré que le gain de précision permet une réduction des marges d'incertitude de repositionnement autour du volume-cible, d'où une réduction significative de l'irradiation du rectum, principal organe à risque. L'utilisation future de ces marges entraînera donc très probablement une réduction de la toxicité du traitement, et la précision accrue du ciblage, préalable à l'emploi de la modulation d'intensité, pourra améliorer le contrôle local du cancer en augmentant la dose délivrée à la prostate.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Corrélations anatomo-cliniques et prise en charge thérapeutique des tumeurs épithéliales du thymus (à propos d'une série de 54 cas)

TOULOUSE3-BU Santé-Centrale (315552105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

A cost-analysis of image-guided radiation therapy (IGRT) in prostate cancer: results from a phase III clinical trial

International audienc

A cost-analysis of image-guided radiation therapy (IGRT) in prostate cancer: results from a phase III clinical trial

International audienc

Cost of prostate image-guided radiation therapy: results of a randomized trial.

International audiencePURPOSE: This cost analysis aimed to quantify the cost of IGRT in relation to IGRT frequency and modality with Cone Beam Computed Tomography (CBCT) or orthogonal electronic portal imaging with fiducial markers (EPI-FM). MATERIAL AND METHODS: Patients undergoing IGRT for localized prostate cancer were randomized into two prostate control frequencies (daily or weekly). Costs were calculated based on the micro-costing results according to hospitals' perspectives (in Euros, 2009) and the time horizon was radiation therapy. RESULTS: A total of 208 patients were enrolled in seven French cancer centers. A total of 6865 fractions were individually analyzed. The mean total treatment fraction duration was 21.0 min for daily CBCT and 18.3 min for daily EPI-FM. Increasing the control frequency from weekly to daily increased the mean treatment fraction duration by 7.3 min (+53%) for CBCT and 1.7 min (+10%) for EPI-FM (p ≤ 0.01). The mean additional cost per patient of daily controls compared with weekly controls was €679 and €187 for CBCT and EPI-FM, respectively (p<0.0001). CONCLUSIONS: The incremental costs due to different prostate IGRT strategies are relatively moderate, suggesting that daily IGRT combined with intensity-modulated RT (IMRT) could be administered in cases of high-dose radiation delivery to the prostate

Daily versus weekly prostate cancer image-guided radiotherapy Phase 3 multicenter randomized trial

International audiencePurpose - The optimal frequency of prostate cancer image guided radiation therapy (IGRT) has not yet been clearly identified. This study sought to compare the safety and efficacy of daily versus weekly IGRT. Materials and methods - This phase 3 randomized trial recruited patients with N0 localized prostate cancer. The total IGRT doses in the prostate ranged from 70 Gy to 80 Gy, sparing the lymph nodes. Patients were randomly assigned (1:1) to 2 prostate IGRT frequency groups: daily and weekly (ie, on days 1, 2, and 3 and then weekly). The primary outcome was 5-year recurrence-free survival. Secondary outcomes included overall survival and toxicity. Post hoc analyses included biochemical progression-free interval, clinical progression-free interval, and other cancer-free interval. Results - Between June 2007 and November 2012, 470 men from 21 centers were randomized into the 2 groups. Median follow-up was 4.1 years. There was no statistically significant difference in recurrence-free survival between the groups (hazard ratio [HR] = 0.81; P = .330). Overall survival was worse in the daily group than in the weekly group (HR = 2.12 [95% confidence interval (CI), 1.03-4.37]; P = .042). Acute rectal bleeding (grade ≥1) was significantly lower in the daily group (6%) (n = 14) than in the weekly group (11%) (n = 26) (P = .014). Late rectal toxicity (grade ≥1) was significantly lower in the daily group (HR = 0.71 [95% CI, 0.53-0.96]; P = .027). Biochemical progression-free interval (HR = 0.45 [95% CI, 0.25 - 0.80]; P = .007) and clinical progression-free interval (HR = 0.50 [95% CI, 0.24-1.02]; P = .057) were better in the daily group, whereas other cancer-free interval was worse in the daily group (HR = 2.21 [95% CI, 1.10-4.44]; P = .026). Conclusions - Compared with weekly control, daily IGRT control in prostate cancer significantly improves biochemical progression-free and clinical progression-free interval, and rectal toxicity

Évaluation économique prospective de la radiothérapie guidée par l'image des cancers de la prostate dans le cadre du programme national de soutien aux thérapeutiques innovantes et coûteuses. [Prospective economic evaluation of image-guided radiation therapy for prostate cancer in the framework of the national programme for innovative and costly therapies assessment.]

International audiencePurpose The main objective of the economical study was to prospectively and randomly assess the additional costs of daily versus weekly patient positioning quality control in image-guided radiotherapy (IGRT), taking into account the modalities of the 3D-imaging: tomography (CBCT) or gold seeds implants. A secondary objective was to prospectively assess the additional costs of 3D versus 2D imaging with portal imaging for patient positioning controls. Patients and methods Economics data are issued from a multicenter randomized medico-economics trial comparing the two frequencies of patient positioning control during prostate IGRT. A prospective cohort with patient positioning control with PI (control group) was constituted for the cost comparison between 3D (IGRT) versus 2D imaging. The economical evaluation was focused to the radiotherapy direct costs, adopting the hospital's point of view and using a microcosting method applied to the parameters that may lead to cost differences between evaluated strategies. Results The economical analysis included a total of 241 patients enrolled between 2007 and 2011 in seven centres, 183 in the randomized study (128 with CBCT and 55 with fiducial markers) and 58 in the control group. Compared to weekly controls, the average additional cost per patient of daily controls was €847 (CBCT) and €179 (markers). Compared to PI, the average additional cost per patient was €1392 (CBCT) and €997 (fiducial markers) for daily controls; €545 (CBCT) and €818 (markers) in case of weekly controls. Conclusion A daily frequency for image control in IGRT and 3D images patient positioning control (IGRT) for prostate cancer lead to significant additional cost compared to weekly control and 2D imaging (PI). Long-term clinical assessment will permit to assess the medico-economical ratio of these innovative radiotherapy modalities