Carole Richard

Publications (6)14.62 Total impact

• Article: Neoadjuvant high dose endorectal brachytherapy or short course external beam radiotherapy in resectable rectal cancer.

  Caroline Hesselager, Té Vuong, Lars Påhlman, Carole Richard, Sender Liberman, François Letellier, Joakim Folkesson
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  ABSTRACT: AIM: Total mesorectal excision with preoperative radiotherapy reduces local recurrence in rectal cancer, but radiotherapy increases the risk of complications. The study compared the immediate postoperative outcome after external beam radiotherapy with high dose endorectal brachytherapy (HDREBT). METHOD: Patients (n=318) treated with preoperative HDREBT, (26 Gy over 4 days) followed by surgery after 4-8 weeks were matched with 318 patients from the Swedish Rectal Cancer Register treated with 5 Gy daily over 5 days and surgery in the subsequent week (SCRT) and 318 having surgery alone. All 954 patients were followed for 30 days after surgery. Complications were divided into surgical, cardiovascular and infectious. RESULTS: The SCRT group had fewer cardiovascular complications (3.1%) than HDREBT (9.4%, p=0.002) and RT- (7.2%, p=0.03). Perioperative bleeding was less in HDREBT patients (379.3 ml) than SCRT (947.2 ml; p<0.0001) and RT- (918.9 ml), and the re-intervention rate was lower in HDREBT (4.1%) than SCRT patients (14.2%; p=0.005) and RT- (12.3%; p<0.005). The HDREBT group had fewer R2 resections than the SCRT and RT- groups, but a higher proportion of R0-resections than the RT- group (p=0.03). CONCLUSION: No major differences in postoperative complications were found. HDREBT patients had a higher rate of cardiovascular complications but less perioperative bleeding and fewer re-interventions. A longer interval between radiotherapy and surgery may be beneficial for tumour regression and this could be reflected in the number of radical resections. © 2013 The Authors. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.
  Colorectal Disease 03/2013; · 2.93 Impact Factor
• Article: Local Pelvic Relapses after Neoadjuvant High-dose Rate Endorectal Brachytherapy for Patients with Operable Rectal Cancer

  Té Vuong, Tamim Niazi, Giovanni Artho, Carole Richard, François Letellier, Sender Liberman, Dawn Anderson, Nancy Morin, Slobodan Devic
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  ABSTRACT: This article reports on the pattern of pelvic relapse after targeted radiation therapy to the primary tumor bed using high-dose rate endorectal brachytherapy (HDREBT) for patients with operable rectal cancer. Three hundred twenty-five patients were treated with neoadjuvant HDREBT using 26Gy in four fractions prescribed to the macroscopic disease documented on MRI. Imaging studies including abdominal and pelvic CT scans were performed every 6months during the first 2years, then yearly until year 5. The median follow-up is presently 52months. At 5years, the actuarial local recurrence rate is 4.7%, disease-free survival is 68%, and overall survival is 71%. The primary tumor bed tumor is the dominant pattern compared with nodal relapse in patients treated with HDREBT alone. Our experience suggests that in the era of total mesorectal excision surgery, pelvic nodal relapse is uncommon. KeywordsHDREBT-Rectal cancer-Pattern of relapses
  Current Colorectal Cancer Reports 04/2012; 6(4):228-234.
• Article: The value of Botox-A in acute radiation proctitis: results from a phase I/II study using a three-dimensional scoring system.

  Te Vuong, Kevin Waschke, Tamim Niazi, Carole Richard, Josee Parent, Sender Liberman, Serge Mayrand, Rasmy Loungnarath, Barry Stein, Slobodan Devic
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  ABSTRACT: Acute radiation proctitis (ARP) is a common side effect of pelvic radiotherapy, and its management is challenging in daily practice. The present phase I/II study evaluates the safety and efficacy of the botulinum toxin A (BTX-A) in ARP treatment for rectal cancer patients undergoing neoadjuvant high-dose-rate endorectal brachytherapy (HDREBT). Fifteen patients, treated with neoadjuvant HDREBT, 26-Gy in 4 fractions, received the study treatment that consisted of a single injection of BTX-A into the rectal wall. The injection was performed post-HDREBT and prior to the development of ARP. The control group, 20 such patients, did not receive the BTX-A injection. Both groups had access to standard treatment with hydrocortisone rectal aerosol foam (Cortifoam) and anti-inflammatory and narcotic medication. The ARP was clinically evaluated by self-administered daily questionnaires using visual analog scores to document frequency and urgency of bowel movements, rectal burning/tenesmus, and pain symptoms before and after HDREBT. At the time of this analysis, there was no observed systemic toxicity. Patient compliance with the self-administered questionnaire was 100% from week 1 to 4, 70% during week 5, and 40% during week 6. The maximum tolerated dose was established at the 100-U dose level, and noticeable mean differences were observed in bowel frequency (p = 0.016), urgency (p = 0.007), and pain (p = 0.078). This study confirms the feasibility and efficacy of BTX-A intervention at 100-U dose level for study patients compared to control patients. A phase III study with this dose level is planned to validate these results.
  International journal of radiation oncology, biology, physics 08/2011; 80(5):1505-11. · 4.59 Impact Factor
• Article: A survey of APC mutations in Quebec.

  Jonathan Jarry, Jean-Sébastien Brunet, Rachel Laframboise, Régen Drouin, Jean Latreille, Carole Richard, Jean Gekas, Bruno Maranda, Yury Monczak, Nora Wong, Carly Pouchet, Sonya Zaor, Lidia Kasprzak, Laura Palma, Mona Kay Wu, Marc Tischkowitz, William D Foulkes, George Chong
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  ABSTRACT: This is an 11-year survey of molecular analysis of APC germline mutations for the province of Quebec done at the Molecular Pathology Unit of the Jewish General Hospital which offers genetic testing for hereditary forms of colorectal cancer for the whole of Quebec province. We report on 47 unique mutations seen in 66 families affected with familial adenomatous polyposis. Of these unique mutations, 60% are short indels, 28% are point mutations, and 6% are whole exon deletions. The absence of founder mutations and the variety of mutations encountered reinforce the value of RNA-based testing and the need for gene dosage techniques such as multiplex ligation-dependent probe amplification.
  Familial Cancer 07/2011; 10(4):659-65. · 1.30 Impact Factor
• Article: Risk of hypogonadism from scatter radiation during pelvic radiation in male patients with rectal cancer.

  Ivan Yau, Té Vuong, Aurélie Garant, Thierry Ducruet, Patrick Doran, Sergio Faria, Sender Liberman, Carole Richard, François Letellier, Patrick Charlebois, Rasmy Loungnarath, Barry Stein, Slobodan Devic
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  ABSTRACT: Recent studies have reported fluctuations in sex hormones during pelvic irradiation. The objective of this study was to observe the effects of radiation on hormonal profiles for two treatment modalities: conventional external beam radiotherapy (EBRT) and high-dose-rate brachytherapy (HDRBT) given neoadjuvantly for patients with rectal cancer. Routine serum follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were collected from 119 consecutive male patients receiving either EBRT, using 45.0-50.4 Gy in 25-28 fractions with concurrent 5-fluorouracil chemotherapy or HDRBT using 26 Gy in 4 fractions. Thirty patients with initially abnormal profiles were excluded. Profiles included in this study were collected from 51 patients treated with EBRT and 38 patients treated with HDRBT, all of whom had normal hormonal profiles before treatment. Mean follow-up times were 17 months for the entire patient cohort-14 and 20 months, respectively-for the EBRT and HDRBT arms. Dosimetry results revealed a mean cumulative testicular dose of 1.24 Gy received in EBRT patients compared with 0.27 Gy in the HDRBT group. After treatment, FSH and LH were elevated in all patients but were more pronounced in the EBRT group. The testosterone-to-LH ratio was significantly lower (p = 0.0036) in EBRT patients for tumors in the lower third of the rectum. The 2-year hypogonadism rate observed was 2.6% for HDRBT compared with 17.6% for EBRT (p = 0.09) for tumors in the lower two thirds of the rectum. HDRBT allows better hormonal sparing than EBRT during neoadjuvant treatment of patients with rectal cancer.
  International journal of radiation oncology, biology, physics 02/2009; 74(5):1481-6. · 4.59 Impact Factor
• Article: Transjugular intrahepatic portosystemic shunt before abdominal surgery in cirrhotic patients: a retrospective, comparative study.

  Evelyne Vinet, Pierre Perreault, Louis Bouchard, Denis Bernard, Ramses Wassef, Carole Richard, Richard Létourneau, Gilles Pomier-Layrargues
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  ABSTRACT: Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal hypertension and liver insufficiency. Therefore, preoperative portal decompression is a logical approach to facilitate abdominal surgery and hopefully to improve postoperative survival. The present study evaluated the clinical outcomes of 18 patients (mean age 58 years) with cirrhosis (seven alcoholics and 11 nonalcoholics) who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement before antrectomy (n=5), colectomy (n=10), small-bowel resection (n=1), pancreatectomy (n=1) and nephrectomy (n=1). TIPS was performed a mean (+/-SD) of 72+/-21 days before surgery and induced a marked mean decrease in portohepatic gradient from 21.4+/-3.9 mmHg to 8.4+/-3.4 mmHg. Cirrhotic patients (n=17) who underwent elective abdominal surgery without preoperative TIPS placement were used as the control group. Both groups were matched for age, etiology of cirrhosis, indications for surgery, type of surgery and coagulation parameters. The mean Pugh score was significantly higher in the TIPS group (7.7 versus 6.2). No significant differences were observed for operative blood loss, postoperative complications, duration of hospitalization and one-month (83% versus 88%) or one-year (54% versus 63%) cumulative survival rate. Analysis using the Cox proportional hazards model showed that neither TIPS placement nor preoperative Pugh score were independent predictors for survival. The present study suggests that preoperative TIPS placement does not improve postoperative evolution after abdominal surgery in cirrhotic patients with good or moderately impaired liver function.
  Canadian journal of gastroenterology = Journal canadien de gastroenterologie 07/2006; 20(6):401-4. · 1.21 Impact Factor