► 3D images of a 1000
μm
3 volume in a Ni-8YSZ cermet have ben reconstructed from FIB tomography. ► Calculation of volume fractions, volumetric connectivity of the individual phases, specific surface ...and interface areas and three-phase boundary length have been performed. ► 3D finite difference method has been used to evaluate the effective thermal, electronic and ionic conductivities as well as of the tortuosity of the solid phases.
The three-dimensional microstructure of an SOFC anode has been characterized using a focused ion beam-scanning electron microscope. The sample preparation and the experimental milling and imaging parameters have been optimized in order to obtain a high-quality 3D reconstruction. Volume fractions and the volumetric connectivity of the individual phases, specific surface and interface areas and the three-phase boundary length have been estimated. Effective thermal, electronic and ionic conductivities of the sample as well as the tortuosity of the solid phases have been evaluated by solving the diffusive transport equation with an implicit 3D finite difference method.
•This is the first European cost-effectiveness analysis of moderately hypofractionated radiotherapy (H-RT) compared to conventional radiotherapy (C-RT).•Using H-RT as a standard treatment for ...intermediate-risk prostate cancer is cost saving.•The economic evidence supporting the shift towards H-RT in France should stimulate reimbursement policy changes.
To evaluate the cost-effectiveness of moderate Hypofractionated Radiotherapy (H-RT) compared to Conventional Radiotherapy (C-RT) for intermediate-risk prostate caner (PCa).
A prospective randomized clinical trial including 222 patients from six French cancer centers was conducted as an ancillary study of the international PROstate Fractionated Irradiation Trial (PROFIT). We carried-out a cost-effectiveness analysis (CEA) from the payer’s perspective, with a time horizon of 48 months.
Patients assigned to the H-RT arm received 6000 cGy in 20 fractions over 4 weeks, or 7800 cGy in 39 fractions over 7 to 8 weeks in the C-RT arm. Patients completed quality of life (QoL) questionnaire: Expanded Prostate Cancer Index Composite (EPIC) at baseline, 24 and 48 months, which were mapped to obtain a EuroQol five-dimensional questionnaire (EQ-5D) equivalent to generate Quality Adjusted Life Years (QALY).
We assessed differences in QALYs and costs between the two arms with Generalized Linear Models (GLMs). Costs, estimated in euro (€) 2020, were combined with QALYs to estimate the Incremental Cost-effectiveness ratio (ICER) with non-parametric bootstrap.
Total costs per patien were lower in the H-RT arm compared to the C-RT arm €3,062 (95 % CI: 2,368 to 3,754) versus €4,285 (95 % CI: 3,355 to 5,215), (p < 0.05). QALY were marginally higher in the H-RT arm, however this difference was not significant: 0.044 (95 % CI: − 0.016 to 0.099).
Treating localized prostate cancer with moderate H-RT could reduce national health insurance spending. Adopting such a treatment with an updated reimbursement tariff would result in improving resource allocation in RT management.
The effectiveness of nonsteroid topical agents for the prevention of acute dermatitis during adjuvant radiotherapy for breast carcinoma has not been demonstrated. The goal of this study was to ...compare the effectiveness of calendula (Pommade au Calendula par Digestion; Boiron Ltd, Levallois-Perret, France) with that of trolamine (Biafine; Genmedix Ltd, France), which is considered in many institutions to be the reference topical agent.
Between July 1999 and June 2001, 254 patients who had been operated on for breast cancer and who were to receive postoperative radiation therapy were randomly allocated to application of either trolamine (128 patients) or calendula (126 patients) on the irradiated fields after each session. The primary end point was the occurrence of acute dermatitis of grade 2 or higher. Prognostic factors, including treatment modalities and patient characteristics, were also investigated. Secondary end points were the occurrence of pain, the quantity of topical agent used, and patient satisfaction.
The occurrence of acute dermatitis of grade 2 or higher was significantly lower (41% v 63%; P <.001) with the use of calendula than with trolamine. Moreover, patients receiving calendula had less frequent interruption of radiotherapy and significantly reduced radiation-induced pain. Calendula was considered to be more difficult to apply, but self-assessed satisfaction was greater. Body mass index and adjuvant chemotherapy before radiotherapy after lumpectomy were significant prognostic factors for acute dermatitis.
Calendula is highly effective for the prevention of acute dermatitis of grade 2 or higher and should be proposed for patients undergoing postoperative irradiation for breast cancer.
Summary Background & aims Malnutrition is frequent in head and neck (HN) and esophageal cancer patients and aggravated by radiochemotherapy (RCT), increasing morbi-mortality and treatment toxicity. ...Our goal was to investigate the effect of immunonutrition consisting of an arginine, omega-3 fatty acid, nucleotides-enriched diet on nutritional status, and functional capacity in HN or esophageal cancer patients undergoing RCT. Methods 37 patients were randomized in a double-blind clinical trial. 5 days before and until the end of RCT (5–7 weeks), they received either an Immunomodulating Enteral Nutrition (IEN) or an isonitrogenous, isoenergetic Standard Enteral Nutrition (SEN). Anthropometrical parameters, nutritional risk index (NRI), serum albumin, plasma antioxidant capacity, and functional capacity were recorded between the beginning and the end of RCT. Results A significant gain in total body weight (+2.1 ± 3.1 kg) was observed in IEN patients. Albuminemia and NRI were improved concomitantly in IEN malnourished patients. Plasma antioxidant capacity was improved (+100 ± 13 μM Eq Trolox) in IEN patients. Functional capacity measured by WHO Performance Status and Karnofsky index was maintained in IEN patients but significantly reduced in SEN patients. Conclusions These preliminary data show that immunonutrition could improve the nutritional status together with functional capacity in HN and esophageal cancer patients undergoing RCT. Clinical trial registration This clinical trial promoted by the University Hospital Center of Clermont-Ferrand has been registered at ClinicalTrial.gov website under the following reference: NCT00333099.
Best practice in brachytherapy Hannoun-Lévi, J.M.; Chargari, C.; Blanchard, P. ...
Cancer radiothérapie,
February-April 2022, 2022 Feb-Apr, 2022-02-00, 20220201, 2022-02, Letnik:
26, Številka:
1-2
Journal Article
Recenzirano
The 2020 recommendations for good brachytherapy procedures (“Recorad”) are updated based on the 2016 article. This new brachytherapy article took into account recent data published in the literature ...as well as international recommendations. The different brachytherapy steps are successively described from the treatment preparation (brachytherapy technique prescription; procedure and material, dedicated images for planification, dose distribution analysis and validation) to the end of the procedure as well as post-treatment surveillance.
Les recommandations de 2020 pour les bonnes pratiques en curiethérapie (« Recorad ») sont une mise à jour de celles publiées en 2016, prenant en compte les données de la littérature et recommandations internationales. Cet article présente successivement les différentes étapes de la préparation du traitement (prescription de la technique de curiethérapie, réalisation et mise en place du matériel vecteur, mode d’acquisition des images de planification et de distribution de la dose, validation de la dosimétrie), sa délivrance, ainsi que sa surveillance précoce.
External radiotherapy for prostatic cancers de Crevoisier, R.; Supiot, S.; Créhange, G. ...
Cancer radiothérapie,
February-April 2022, 2022 Feb-Apr, 2022-02-00, 20220201, 2022-02, Letnik:
26, Številka:
1-2
Journal Article
Recenzirano
We present the update of the recommendations of the French society of oncological radiotherapy on external radiotherapy of prostate cancer. External radiotherapy is intended for all localized ...prostate cancers, and more recently for oligometastatic prostate cancers. The irradiation techniques are detailed. Intensity-modulated radiotherapy combined with prostate image-guided radiotherapy is the recommended technique. A total dose of 74 to 80Gy is recommended in case of standard fractionation (2Gy per fraction). Moderate hypofractionation (total dose of 60Gy at a rate of 3Gy per fraction over 4 weeks) in the prostate has become a standard of therapy. Simultaneous integrated boost techniques can be used to treat lymph node areas. Extreme hypofractionation (35 to 40Gy in five fractions) using stereotactic body radiotherapy can be considered a therapeutic option to treat exclusively the prostate. The postoperative irradiation technique, indicated mainly in case of biological recurrence and lymph node involvement, is detailed.
Nous présentons la mise à jour des recommandations de la Société française de radiothérapie oncologique sur la radiothérapie externe des cancers de la prostate. La radiothérapie externe s’adresse à tous les cancers prostatiques localisés, et plus récemment, aux cancers prostatiques oligométastatiques. Les techniques d’irradiation sont détaillées. La radiothérapie conformationnelle avec modulation d’intensité guidée par l’image prostatique est la technique recommandée pour ces cancers. Une dose totale de 74 à 80Gy est recommandée en cas de fractionnement standard (par fractions de 2Gy). L’hypofractionnement modéré (dose totale de 60Gy à raison de 3Gy par fraction en 4 semaines) dans la prostate est devenu un standard thérapeutique. Les techniques par boost simultané intégré peuvent être utilisées pour traiter les aires ganglionnaires. L’hypofractionnement extrême (35 à 40Gy en cinq fractions) pour traiter exclusivement la prostate et utilisant une technique stéréotaxique peut être considéré comme une option thérapeutique. La technique d’irradiation postopératoire, indiquée principalement en cas de récidive biochimique et d’atteinte ganglionnaire, est détaillée.
Ethical questions are poorly investigated specifically in radiation oncology. The objective of the study was to identify and understand the main ethical issue in radiation oncology.
A quantitative ...analysis was based on the answers to a questionnaire of 200 professionals from 22 radiation oncology departments. The questionnaire mainly aimed to characterize the main ethical issue. A monocentric qualitative analysis was based on semi-structured interviews focused on the main identified ethical issue, carried out with eight technologists, and 20 patients undergoing radiotherapy.
The main ethical issue was the understanding and/or acceptance of the treatment by the patients (71 %), which frequently arises (more than once a month) (52 %), and corresponds to an ethical tension between the principles of respect for autonomy and beneficence (the good as viewed by the patient) as defined by Beauchamp and Childress. The technologists, wish the patient to be fully involved in his treatment, with the even possibility of refusing it. However, excluding paternalism and autonomic relentlessness, the technologists have the feeling of acting for the good of the patients by treating them with radiation, even if the patients are not always aware of it, because they are within a situation of vulnerability. If the hierarchy of principles is a compromise alternative, this problem is finally well resolved by the effective implementation of an ethic of consideration and solicitude, restoring the patient capabilities, i.e. the maximum development of his potentialities in his situation of vulnerability. Beyond the legal dimension, patient information is crucial and must consider the specific temporality of the patient.
The main ethical issue in radiation oncology is the understanding and/or acceptance of the treatment involving the development of an ethic of consideration and solicitude.
Prostate cancer is the most common cancer and the third leading cause of cancer mortality in men. Each year, approximately 10% of prostate cancers are diagnosed metastatic at initial presentation. ...The standard treatment option for de-novo metastatic prostate cancer is androgen deprivation therapy with novel hormonal agent or with chemotherapy. Recently, PEACE-1 trial highlighted the benefit of triplet therapy resulting in the combination of androgen deprivation therapy combined with docetaxel and abiraterone. Radiotherapy can be proposed in a curative intent or to treat local symptomatic disease. Nowadays, radiotherapy of the primary disease is only recommended for de novo low-burden/low-volume metastatic prostate cancer, as defined in the CHAARTED criteria. However, studies on stereotactic radiotherapy on oligometastases have shown that this therapeutic approach is feasible and well tolerated. Prospective research currently focuses on the benefit of intensification by combining treatment of the metastatic sites and the primary all together. The contribution of metabolic imaging to better define the target volumes and specify the oligometastatic character allows a better selection of patients. This article aims to define indications of radiotherapy and perspectives of this therapeutic option for de-novo metastatic prostate cancer.
Le cancer de la prostate est le cancer le plus fréquent et la troisième cause de mortalité par cancer chez l’homme. Chaque année, environ 10 % des cancers de prostate diagnostiqués se révèlent d’emblée métastatique. Le traitement standard pour les cancers de prostate métastatiques hormonosensibles est la suppression androgénique associée à une hormonothérapie de nouvelle génération ou à une chimiothérapie. Récemment, l’essai intitulé PEACE-1 a mis en évidence le bénéfice d’une trithérapie résultant de l’association de la suppression androgénique au docétaxel et à l’abiratérone. La radiothérapie peut être proposée dans une approche curative, ou bien à visée palliative pour traiter une maladie symptomatique localement. Aujourd’hui, la radiothérapie locale de la prostate est recommandée dans le cas des cancers de prostate d’emblée métastatiques de faible charge/faible volume tumoral, tels que définis dans les critères de l’essai intitulé CHAARTED. Cependant, des études sur la radiothérapie en conditions stéréotaxiques des oligométastases ont montré que cette approche thérapeutique est réalisable et bien tolérée. Des recherches prospectives s’intéressent actuellement au bénéfice de l’intensification en combinant le traitement des sites métastatiques et du primitif dans le même temps. L’apport de l’imagerie métabolique pour mieux définir les volumes cibles et préciser le caractère oligométastatique permet une meilleure sélection des patients. Cet article vise à définir l’indication de la radiothérapie et les perspectives de cette option thérapeutique dans le cadre de la prise en charge du cancer de la prostate d’emblée métastatique.
Prostate cancer brachytherapy: SFRO guidelines 2021 Pommier, P.; Ferré, M.; Blanchard, P. ...
Cancer radiothérapie,
February-April 2022, 2022 Feb-Apr, 2022-02-00, 20220201, Letnik:
26, Številka:
1-2
Journal Article
Recenzirano
Prostate brachytherapy techniques are described, concerning both permanent seed implant and high dose rate brachytherapy. The following guidelines are presented: brachytherapy indications, implant ...procedure for permanent low dose rate implants and high dose rate with source projector, as well as dose and dose–constraints objectives, immediate postoperative management, post-treatment evaluation, and long-term follow-up.
Les recommandations sur la radiothérapie externe et la curiethérapie (« Recorad ») de 2021 pour la curiethérapie de prostate sont une mise à jour de celles publiées en 2016, prenant en compte les données de la littérature et recommandations internationales. Elles comprennent les indications de curiethérapie, une description des techniques de bas débit de dose par implants permanents et de haut débit de dose par projecteur de source, ainsi que les objectifs dosimétriques, la gestion postopératoire immédiate, l’évaluation et le suivi post-thérapeutique.
