International audience1. Recherches sur le Fayuan zayuan yuanshi ji de Sengyou (445-518), première anthologie de rites bouddhiques (suite : le contenu des juan 4 et 5) Notre travail de reconstruction du Fayuan zayuan yuanshi ji 法苑雜緣原始集 (Anthologie [pour comprendre] le commencement et l’origine de diverses [pratiques] dans le jardin des devoirs ; ci-après Fayuan) de Sengyou 僧祐 (445-518) nous a amenés cette année à nous pencher sur les 22 premiers titres de la section sur le saṃgha (Sengbao 僧寶, « Le joyau de la Loi ..

Duprez, F.

Daisne, J.

Berwouts, D.

De Gersem, W.

Goethals, I.

Olteanu, A.

Schatteman, J.

Vercauteren, T.

De Neve, W.

International audienceI. Recherches sur le Fayuan zayuan yuanshi ji de Sengyou (445-518), première anthologie de rites bouddhiques (suite) Notre travail de reconstruction du Fayuan zayuan yuanshi ji 法苑雜緣原始集 (Anthologie [pour comprendre] le commencement et l’origine de diverses [pratiques] dans le jardin des devoirs ; ci-après Fayuan) de Sengyou 僧祐 (445-518) nous a amenés cette année à nous pencher sur les 29 titres qui finissent la section sur la Loi (Fabao 法寶, « Le joyau de la Loi ») qui étaient regroupés au troi..

Hureau, Sylvie

Hal-Diderot

Bouddhisme chinois

Archive Ouverte a LUniversite Lyon 2

I. Recherches sur le Fayuan zayuan yuanshi ji de Sengyou (445-518), première anthologie de rites bouddhiques (suite) Notre travail de reconstruction du Fayuan zayuan yuanshi ji 法苑雜緣原始集 (Anthologie [pour comprendre] le commencement et l’origine de diverses [pratiques] dans le jardin des devoirs ; ci-après Fayuan) de Sengyou 僧祐 (445-518) nous a amenés cette année à nous pencher sur les 29 titres qui finissent la section sur la Loi (Fabao 法寶, « Le joyau de la Loi ») qui étaient regroupés au troi..

OpenEdition

French

F. Duprez

J. Daisne

D. Berwouts

W. De Gersem

I. Goethals

A. Olteanu

J. Schatteman

T. Vercauteren

W. De Neve

Crossref

Radiotherapy and Oncology

PO-0638: Adaptive dose painting by numbers for head and neck cancer: interim analysis of a randomised trial

International audienceI. Recherches sur le Fayuan zayuan yuanshi ji de Sengyou (445-518), première anthologie de rites bouddhiques (suite) Poursuivant notre tentative de reconstruction du Fayuan zayuan yuanshi ji 法苑雜緣原始集 (Anthologie [pour comprendre] le commencement et l’origine de diverses [pratiques] dans le jardin des devoirs ; ci-après Fayuan) de Sengyou僧祐 (445-518) à partir de la table des matières qu’en rapporte le Chu sanzang jiji 出三藏記集 (T. 2145), nous nous sommes concentrés sur les 21 premiers titres de la..

1. Recherches sur le Fayuan zayuan yuanshi ji de Sengyou (445-518), première anthologie de rites bouddhiques (suite : le contenu des juan 4 et 5) Notre travail de reconstruction du Fayuan zayuan yuanshi ji 法苑雜緣原始集 (Anthologie [pour comprendre] le commencement et l’origine de diverses [pratiques] dans le jardin des devoirs ; ci-après Fayuan) de Sengyou 僧祐 (445-518) nous a amenés cette année à nous pencher sur les 22 premiers titres de la section sur le saṃgha (Sengbao 僧寶, « Le joyau de la Loi ..

HAL Descartes

I. Recherches sur le Fayuan zayuan yuanshi ji de Sengyou (445-518), première anthologie de rites bouddhiques (suite) Poursuivant notre tentative de reconstruction du Fayuan zayuan yuanshi ji 法苑雜緣原始集 (Anthologie [pour comprendre] le commencement et l’origine de diverses [pratiques] dans le jardin des devoirs ; ci-après Fayuan) de Sengyou僧祐 (445-518) à partir de la table des matières qu’en rapporte le Chu sanzang jiji 出三藏記集 (T. 2145), nous nous sommes concentrés sur les 21 premiers titres de la..

Elsevier - Publisher Connector 

S298                                                                                                                                                    ESTRO 35 2016 
______________________________________________________________________________________________________ 
studies, topical clonidine shown activity in reducing NF-κB 
activation and incidence of severe OM (SOM). In a randomized 
double blind, placebo-controlled study, a novel 
mucoadhesive buccal tablet (MBT) containing clonidine 
reduced the incidence of SOM in HNC patients being treated 
with CRT. We now report overall survival (OS), tolerability 
and systemic exposure of clonidine of study subjects. 
 
Material and Methods: Clonidine MBT 50µg (n=56), 100µg 
(n=65) or matching placebo (n=62) were applied to the gum 
once daily 1-3 days prior to RT and then daily until the end of 
CRT (1.8-2.2 Gy/d, 5 times/week combined with a platinum 
based CT). AEs, vital signs and gingival tolerance by Silness-
Loe index (global score from 0 to 9) were assessed twice a 
week; xerostomia and sedation (visual scale from 0 to 10) 
were evaluated once a week. Blood and saliva samples for 
clonidine levels were collected Q2 weeks. OS data will be 
collected until 2 years after last patient last visit. Patients 
received a median cumulative radiation dose of 66 Gy [min: 
4; max: 78]. SOM was reported in 60% [95%CI: 47%; 72%] of 
placebo patients, 43% [95%CI: 29%; 57%] in clonidine 50µg 
MBT (p=0.063) and 48 % [95%CI: 35%; 61%] in clonidine 100µg 
MBT (p=0.169). 
 
Results: All grade AE incidence was 91% in clonidine MBT 
groups and 98% in placebo group (p<0.10). No difference in 
heart rate and blood pressure was reported between groups. 
Reversible hypotension AEs were reported in 7% clonidine 
MBT 50µg patients, 6% clonidine MBT 100μg and 2% placebo-
treated patients (p=ns). Sedation score slightly increased in 
all groups between week 1 and week 6 (overall from 1.5 ± 2.3 
to 3.0 ±2.3) and was similar between groups (p=ns). 
Xerostomia grade ≥ 2 increased to 41% in clonidine MBT 50µg, 
31% in clonidine MBT 100µg and 42% in placebo patients 
(p=ns). The mean plasma/saliva concentrations of clonidine 
were 0.087/154.2ng/mL in clonidine MBT 50µg and 
0.134/301.1 ng/mL in clonidine MBT 100µg. With a median 
follow-up of 15 months, the median 1year-OS of 89.3% 
[95%CI: 73.9; 95.8] placebo and 89.7% [95%CI: 80.4; 94.8] 
clonidine MBT. 
 
Conclusion: Clonidine MBT daily applied to the gum 
throughout CRT reduced the incidence of SOM and was well 
tolerated in HNC patients undergoing postoperative CRT. No 
significant systemic effects of clonidine were reported in the 
phase 2 study probably due to its low systemic levels. 
 
PO-0637  
RCT pilot study of Therabite vs wooden spatula in 
amelioration of trismus in H&N cancer patients 
R. Lee
1The Christie, Research and Development, Manchester, 
United Kingdom 
1, S.N. Rogers2, A.L. Caress3, A. Molassiotis4, R. 
Edwards5, D. Ryder1, P. Sanghera6, C. Lunt1, T. Yeo5, N. 
Slevin7 
2University Hospital Aintree, Maxillofacial Unit Directorate, 
Liverpool, United Kingdom 
3University of Manchester, School of Nursing and Midwifery, 
Manchester, United Kingdom 
4The Hong Kong Polytechnic University, Cancer & Supportive 
Care, Hong Kong, China 
5Bangor University, The Bangor Health Economics Unit, 
Bangor, United Kingdom 
6University of Birmingham, Clinical Oncology, Birmingham, 
United Kingdom 
7The Christie, Clinical Oncology, Manchester, United 
Kingdom 
 
Purpose or Objective: Specific objectives of the study were 
(i) to assess whether prophylactic exercise intervention 
prevented the worsening of jaw tightening that would be 
expected following radiotherapy (ii) to assess whether the 
Therabite® or wooden spatulas intervention improved 
patients’ QOL as measured using validated questionnaires; 
(iii) to assess issues around power for sample size 
calculations, compliance and practical aspects of running a 
full RCT in this group of patients and (iv) whether the 
intervention reduced the level of post-treatment clinical 
management/health care utilisation required by mouth 
cancer patients 
 
Material and Methods: All patients had some sense of 
subjective jaw tightening prior to study entry. Measurements 
of jaw opening and QOLs were taken pre and post 
radiotherapy 3 and 6 months. Patients were instructed to 
follow the 5-5-30 regimen daily, for 6 months. (5stretches, 
5times, 30 second hold). 
 
Results: 37 patients with stage 3/4 oral/oropharyngeal 
cancers were randomised to receive the therabite device and 
34 the wooden spatulas for jaw exercises. The study has 
shown that mouth openings had increased on average in both 
groups following the exercise intervention. There was no 
statistically significant difference between the two 
interventions. There were problems with compliance. Lessons 
learnt from the semi structured telephone interviews, (15 
patients) which would aid compliance included: (1) Allow 
patients to have more of a say in the exercise regimen ie 
reduce to 3 times a day. (2) Allow patients to take a variable 
break (up to 6 weeks) from the exercises when side effects of 
radiotherapy are at their worst. Mucositis, soreness and pain 
in mouth being reported during last few weeks and 4 weeks 
post radiotherapy. (3) More regular contact with the patients 
for encouragement and support. The study was designed to 
give an indication about the benefits of exercises and to 
inform feasibility to conduct a larger study 
 
Conclusion: Prophylactic exercises during and after 
radiotherapy treatment can ameliorate trismus for stage 3 
and 4 oral/oropharyngeal cancers. Keyword: Trismus, 
Radiotherapy This abstract presents independent research 
funded by the National Institute for Health Research (NIHR) 
under its Research for Patient Benefit (RfPB) Programme 
(Grant Ref No: PB-PG-0610-22317). The views expressed are 
those of the author(s) and not necessarily those of the NHS, 
the NIHR or the Department of Health. Sponsor: The Christie 
NHS Foundation Trust 
 
PO-0638  
Adaptive dose painting by numbers for head and neck 
cancer: interim analysis of a randomised trial 
F. Duprez
1Universitair Ziekenhuis Gent, Radiotherapy, Gent, Belgium 
1, J. Daisne2, D. Berwouts3, W. De Gersem1, I. 
Goethals3, A. Olteanu1, J. Schatteman3, T. Vercauteren1, W. 
De Neve1 
2Clinique et Maternité Sainte-Elisabeth Namur, 
Radiotherapy, Namur, Belgium 
3Universitair Ziekenhuis Gent, Nuclear Medicine, Gent, 
Belgium 
 
Purpose or Objective: A prospective randomized multi-
centre phase II trial comparing standard IMRT (S-IMRT) to 3-
phase adaptive dose painting by numbers (DPBN) for head 
and neck cancer (HNC) is currently recruiting patients. Unlike 
the fact that the initial dose prescription was derived from a 
phase I trial, we observed an unacceptable rate of late 
mucosal ulceration using this dose prescription in the DPBN 
group. This made us change the dose prescription in two 
steps. This interim analysis reports on acute and late toxicity 
and local (LC), regional (RC) and distant control (DC) in 
almost half of the patients to be included. 
 
Material and Methods: From 2011, Q3 to 2015, Q3 53 
patients received primary radio(chemo)therapy for HNC. We 
report on 45 patients who have ended therapy for ≥ 3 
months. Patient, tumor and treatment characteristics can be 
found in Table 1  
ESTRO 35  2016                                                                                                                                                  S299 
________________________________________________________________________________ 
 
Fig. 1 demonstrates dose prescription protocols (DPP) of the 
DPBN- and S-IMRT group  
 
 
 
Results: As previously reported (ESTRO 2015) we 
unexpectedly observed late grade (G)3 and 4 mucosal ulcers 
in 1/7 and 3/7 DPBN-patients in DPP1, respectively, that 
healed spontaneously (n = 1), after surgical intervention (n = 
2) and is still persisting (n = 1) at 42 months. In order to 
avoid G4 mucosal late toxicity (LT) the DPBN-DPP has been 
adapted in 2 steps (Fig. 1): DPP1 used a median dose 
prescription that can result in increased doses in a GTV with 
> 50% voxels of low-uptake. This median dose prescription 
was abandoned in DPP2. In DPP3 the very-high dose region is 
limited to an absolute volume of 1.75 cc. In DPP2, 1/2 had 
G3 mucosal LT that healed spontaneously. In DPP3, 2/11 and 
1/11 had G3 and G4 mucosal LT, respectively. In S-IMRT, 
there was no G3-4 mucosal LT (n = 20). Late G3 dysphagia 
was seen in 2/18 and 3/20 DPBN and S-IMRT patients at 
month 3, respectively. After 6 months, 6/15 and 2/13 
patients had G≥2 d ysphagia (p = 0.22) and PEG-tube was 
needed in 5/15 and 3/13 patients in DPBN and S-IMRT, 
respectively. G2 xerostomia was present in 6/13 and 7/13 
patients in DPBN and S-IMRT, respectively.  
Median follow-up is 12 (3-45) months. Nine patients 
deceased: 5 DPBN-patients (metastases in 3, complications 
after neck dissection for regional recurrence in 1 and 
unknown cause in 1) and 4 S-IMRT patients (2 metastases, 1 
aspiration pneumonia and 1 cardial event). Local failure was 
seen in 1/21 (5%) and 4/24 (17%) in DPBN and S-IMRT, 
respectively. Regional failure was seen in 2/21 (10%) and 
2/24 (8%) in DPBN and S-IMRT, respectively. Metastases were 
seen in 4/21 (19%) and 5/24 (21%) in DPBN and S-IMRT, 
respectively. At 1 year actuarial LC was 92% and 76% (p = 
0.22), RC 86% and 87% (p = 0.9), DC 76% and 86% (p = 0.9) and 
OS 68% and 90% (p = 0.6) in DPBN and S-IMRT, respectively. 
 
Conclusion: At short term, we did not observe significant 
differences yet in LC, RC, DC or OS in the first 45 patients. 
Due to mucosal LT, the DPBN-DPP has been adapted. Since 
then, G4 mucosal LT was observed in 1/12 patients. Strict 
follow-up of LT is being performed. 
 
PO-0639  
Graves ophthalmopathy: a network meta-analysis of 
treatments 
M.P. Shaikh
1Stritch School of Medicine- Loyola University Chicago, 
Radiation Oncology, Chicago, USA 
1, F. Alite1, M. Wu2, J. Welsh1, B. Emami1, E. 
Melian1, M.M. Harkenrider1 
2Loyola University Chicago, Research Methodology, Chicago, 
USA 
 
Purpose or Objective: Although several treatments have 
been evaluated in randomized clinical trials (RCTs) for Graves 
Ophthalmopathy (GO), many of these treatments have not 
been directly compared against each other and thus the 
relative efficacy among them is unclear. We conducted a 
network meta-analysis (NMA) to compare all regimens 
simultaneously. 
 
Material and Methods: A systematic review was performed 
through MEDLINE, Cochrane Central Register of Controlled 
Trials and meeting abstracts to identify RCTs involving 
treatments for GO. Treatments included: Radiation 10 Gy in 
10 fractions (RT10) or 20 Gy in 10 fraction (RT20), with oral 
glucocorticoid (RT20POGC), with intravenous glucocorticoid 
(RT20IVGC), with retrobulbar glucocorticoid injections 
(RT20RBGC); oral glucocorticoid (POGC); intravenous 
glucocorticoid (IVGC); surgical decompression (Decomp); 
somatostatin analogs i.e., Octreotide or Lanreotide (SSanlg); 
Cyclosporin alone (Cysprn), with oral glucocorticoid 
(CysprnPOGC); Ciamexone (Ciamex); rituximab (Ritux); 
peribulbar orbital glucocorticoid injection (BGCI) or no 
treatment/placebo/sham radiation (NoTx). Success of 
treatment was determined from overall clinical response, 
which was provided by most studies. If this was absent, then 
it was estimated from proportion of patient not needing 
further treatment, improvement in clinical activity score 
(CAS), ophthalmopathy index (OI) or proptosis was used in 
that order. Odds Ratio (OR) was calculated either directly or 
via standardized mean difference (SMD) in measures. A 
frequentist NMA was used to compare treatments. Fixed or 
random effect model was used based on any significant 
variation among ORs. 
 
Results: 27 studies involving 1216 patients were identified, 
with 15 distinct treatments including NoTx. Fixed effect 
model was used, as there was no significant variation among 
ORs. RT20IVGC was significantly better that BGCI (OR 31.4 
[5.1, 195.7]), Ciamex (OR 6.8 [1.4, 33.1]), Cysprn (OR 64.9 
[10.6, 398.5]), Decomp (OR 25.8 [1.7, 392.8]), IVGC (OR 4.1 
[1.5, 11.6]), NoTx (OR 18.9 [5.69, 62.6]), POGC (OR 11.8 
[4.0, 34.6]), RT10 (OR 10.1 [1.9, 52.2]), RT20 (OR 8.4 [2.7, 
25.9]), RT20POGC (OR 4.2 [1.3, 12.9]), RT20RBGC (OR 3.5 
[1.2, 10.2]) and SSanlg (OR 11.1 [3.0, 40.4]), but did not 
reach significance compared to CysprnPOGC (OR 3.7 [0.8, 
17.8]) or Ritux (OR 5.0 [0.9, 28.9]). IVGC was found to be 
significantly better than BGCI (OR 7.6), Cysprn (OR 15.7), 
NoTx (OR 4.6) and POGC (OR 2.9). Also, CysprnPOGC was 
significantly better than BGCI (OR 8.6), Cysprn (OR 17.7), 
NoTx (OR 5.1) and POGC (OR 3.2). RT20, RT20POGC and 
RT20RBGC were all significantly better than Cysprn (ORs 7.7, 
15.6 & 18.6 respectively). RT20 and RT20RBGC were better 


PO-0638: Adaptive dose painting by numbers for head and neck cancer: interim analysis of a randomised trial 

http://journals.openedition.org/asr/pdf/1219

PO-0638: Adaptive dose painting by numbers for head and neck cancer: interim analysis of a randomised trial

Abstract

Similar works

Full text

Available Versions

Hal-Diderot

Archive Ouverte a LUniversite Lyon 2

OpenEdition

Crossref

Hal-Diderot

Archive Ouverte a LUniversite Lyon 2

OpenEdition

HAL Descartes

OpenEdition

Elsevier - Publisher Connector