F Lorchel

Hospices Civils de Lyon, Lyons, Rhône-Alpes, France

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Publications (35)43.7 Total impact

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    ABSTRACT: Para mejorar la eficacia de la radioterapia en el tratamiento del cáncer de próstata, se ha propuesto la combinación con hormonoterapia. El objetivo era potenciar el efecto de la radioterapia y proporcionar un tratamiento activo sobre la enfermedad metastásica en paralelo al tratamiento local. En total, cuatro ensayos clínicos aleatorizados (RTOG 86-10, RTOG 94-08, el de D’Amico y TTROG 9601) evaluaron la contribución de una hormonoterapia corta de 4-6 meses (bloqueo androgénico completo) y publicaron el beneficio de esta asociación. Cuatro estudios aleatorizados (EORTC 22863, RTOG 85-31, RTOG 94-13 y el de Granfors et al) evaluaron la contribución de una hormonoterapia de larga duración (2-3 años). Tres mostraron la superioridad de la asociación radioterapia-hormonoterapia larga en comparación con la radioterapia sola, con un beneficio en la supervivencia global en dos estudios (EORTC 22863 y RTOG 85-31). Otros dos (EORTC 22961 y RTOG 92-02) compararon la hormonoterapia corta con una hormonoterapia larga en asociación con radioterapia. Se observó una diferencia en supervivencia global, a favor de la hormonoterapia larga, en el estudio EORTC y en el estudio RTOG para el subgrupo de puntuaciones de Gleason superiores a 7. Tres ensayos clínicos aleatorizados compararon la hormonoterapia sola con la asociación radioterapia-hormonoterapia para formas localmente «muy» avanzadas de cáncer de próstata; se ha observado un beneficio con la realización de la radioterapia.
    EMC - Urología. 06/2014; 46(2):1–8.
  • O Diaz, F Lorchel, C Revault, F Mornex
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    ABSTRACT: The development of accelerators with on-board imaging systems now allows better target volumes reset at the time of irradiation (image-guided radiotherapy [IGRT]). However, these technological advances in the control of repositioning led to a multiplication of tasks for each actor in radiotherapy and increase the time available for the treatment, whether for radiotherapy technicians or radiation oncologists. As there is currently no explicit regulatory framework governing the use of IGRT, some institutional experiments show that a transfer is possible between radiation oncologists and radiotherapy technicians for on-line verification of image positioning. Initial training for every technical and drafting procedures within institutions will improve audit quality by reducing interindividual variability.
    Cancer/Radiothérapie 09/2013; · 1.48 Impact Factor
  • O Chapet, C Enachescu, F Lorchel
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    ABSTRACT: External beam radiotherapy alone is a standard treatment for prostate cancer. According to clinical, histological and biological characteristics of the tumour, lymph node irradiation can be done in combination with irradiation of the prostate. The completion of pelvic irradiation remains controversial and may cause complications by increasing volumes of irradiated healthy tissues. The accuracy of the delineation of lymph node becomes an important issue. This article proposes to take on the characteristics of the pelvic lymph node drainage of the prostate, to review the literature on pelvic irradiation and the definition of volumes to be irradiated.
    Cancer/Radiothérapie 08/2013; · 1.48 Impact Factor
  • O. Diaz, F. Lorchel, C. Revault, F. Mornex
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    ABSTRACT: The development of accelerators with on-board imaging systems now allows better target volumes reset at the time of irradiation (image-guided radiotherapy [IGRT]). However, these technological advances in the control of repositioning led to a multiplication of tasks for each actor in radiotherapy and increase the time available for the treatment, whether for radiotherapy technicians or radiation oncologists. As there is currently no explicit regulatory framework governing the use of IGRT, some institutional experiments show that a transfer is possible between radiation oncologists and radiotherapy technicians for on-line verification of image positioning. Initial training for every technical and drafting procedures within institutions will improve audit quality by reducing interindividual variability.
    Cancer/Radiothérapie 01/2013; 17(s 5–6):383–388. · 1.48 Impact Factor
  • Cancer Radiotherapie - CANCER RADIOTHER. 01/2010; 14(6):586-587.
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    ABSTRACT: To evaluate the dosimetric impact of breath-hold during radiotherapy of hepatocellular carcinoma (HCC) and to determinate the optimal respiratory phase for treatment (exhale or inhale). Two CT scans were performed in inhale and in exhale in 20 patients with HCC. The GTV was delineated slice by slice on the inspiration breath hold acquisition (GTV(insp)) and on the expiration breath hold acquisition (GTV(exp)). The superposition of two GTV allowed to obtain the global GTV (free respiration). PTV was defined by adding a margin of 1cm around each GTV. The liver, the duodenum, the two kidneys, the stomach and the spinal cord were delineated on each acquisition as organs at risk (OAR). Three dosimetric plans were created on inspiration, expiration and on global PTV. The mean reduction in the volume of PTV with conformal radiation therapy (3D-CRT) in the hold-breath group compared to the free respiration group was of 33.5+/-11.9%. The average difference of V50%, V20, V30, V40 and V50 were around 4% in favor of the breath hold. The average value of NTCP was 8.9% in free respiration, 4.5% in expiration and 3.2% in inspiration. Further improvement in the OARs dosimetric parameters for the breath hold was observed. Compared to the conformal radiotherapy with free respiration, the breath-hold allows reducing the volume of the PTV and the doses to the healthy liver and organs at risk. The use of this modality during different radiotherapy techniques (3D-CRT, IMRT and stereotactic) may be recommended. No difference in dosimetric value has been observed between the breath hold in expiratory and inspiratory phases.
    Cancer/Radiothérapie 01/2009; 13(1):24-9. · 1.48 Impact Factor
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    ABSTRACT: PURPOSE To limit the dose to the liver is a specific challenge in stereotactic radiotherapy of liver tumors due to the low tolerance of this organ. The aim of this study was to define an optimal 7 coplanar fields’ plans in 3 intrahepatic tumor locations. METHOD AND MATERIALS 9 CT scans with tumor located in 3 regions of the liver were used (3 in the left lobe, 3 in each upper and lower right lobe). PTV was defined by adding a margin of 1 cm around the GTV delineated on all CT slices. The dose was 60Gy in 3 fractions, prescribed to the isodose covering 95% of the PTV with energy 16MV. Two methods of optimization were used: the mean dose (MD) and V15 (volume receiving 15Gy) of the liver. The optimization started in each case with a plan of 15 equally spaced coaxial beams. It consisted to select from a plan with ´n´ fields the plan with ´n-1´ fields which provides the lowest V15 or MD for the liver. For each step, a score of 1 was given to the remaining beams. For each case, 8 steps were necessary to obtain 7 fields. In each region, a cumulative score (CS) of 48 was possible for each beam (3 cases with 2 methods: 3•2•8=48). The optimal 7 fields’ plan was defined by the beams with the highest CS. To validate our method, the 7 fields plan was compared with 1 plan generated by 4 physicists in each region. RESULTS For the upper/right lobe, the 7 optimal beams found were 120°, 288° and 312° (CS=48), 264°, 336° (CS=46), 144° (CS=45) and 240° (CS=35). For the right/inferior lobe, the 7 fields were 96°, 240°, 264° (CS=48), 72° (CS=47), 192°, 216° (CS=43) and 120° (CS=41). For the left lobe, the 7 fields were 0°, 24°, 192° (CS=48), 336° (CS=47), 168° (CS=46), 144° (CS=39) and 48° (CS=38).The optimal 7 fields plans provided a lower MD for the liver than the plans created by the physicists. The MD obtained with the optimal 7 fields plan were 11Gy, 9Gy and 10Gy while the average MD obtained with the 4 plans were 15±0.9Gy, 12±0.9Gy and 12±1.4Gy for the same 3 cases. Similar results were observed for the V15. CONCLUSION Using an original method, an optimal plan with 7 coplanar fields was defined, and provides a better liver preservation compared with the plans generated by physicists. CLINICAL RELEVANCE/APPLICATION This original method allows us to optimize the dosimetry for stereotactic radiotherapy of liver tumors.
    Radiological Society of North America 2008 Scientific Assembly and Annual Meeting; 12/2008
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    ABSTRACT: PURPOSE The low rate of local relapses observed after a selective irradiation for NSCLC can be explained by an incidental irradiation of the non involved lymph node stations (NILNS). The aim of the present dosimetric study was to evaluate the potential impact of multiple fields’ irradiation on this incidental irradiation and lung toxicities. METHOD AND MATERIALS CT scans on inhale and exhale of 10 lung cancer patients were used (5 tumors in each lung). A global GTV was created by fusion of the two GTVs that were limited to the tumor and any lymph node believed to be involved on CT scan (>1cm) or PET scan. The PTV was created by expending the global GTV with 1cm. The main LNS (4R, 4L, 5, 6 7, 10R and 10L) were contoured by 2 radiation oncologists according to the atlas of the University of Michigan. Five plans were generated for each inhale CT scan with: 3 fields (A), 4 opposite fields (B), 4 non-opposite fields (C), 5 fields (D) and 7 fields (E). The PTV was systematically covered by the 95% isodose. The total dose was 70Gy in 35 fractions. Specific constraints were required for the spinal cord (Dmax<45Gy) and lung (V20<30% (volume receiving 20Gy) and V30<20%). To evaluate the dose received incidentally by the NILNS, the D75 (dose received by 75% of each station’s volume) and the mean dose (MD) were used. The dose to the healthy lung was evaluated with the V5, V13, V20 and V30. RESULTS An incidental irradiation was observed in stations 4R, 4L, 5 and 6 with respectively an average MD value above 30Gy, 45Gy, 35Gy and 39Gy in the plans A to E. In stations 7, 10R and 10L, the average MD value remained below 25Gy in all the plans. For the 4R, 4L, 5, 6, 7, 10R and 10L stations, the difference between the 5 plans did not exceed 8Gy in mean D75 values (4.2Gy for 4L to 8Gy for 4R) and 9Gy for MD value (5Gy for 4L to 9Gy for 6). The best values for lung irradiation were obtained with plan B for V5, V13 and MD. There was no significant difference between the plans for V20 and V30. CONCLUSION This study confirms an incidental irradiation of the main NILNS that must be taken into account for the choice of the radiation technique. CLINICAL RELEVANCE/APPLICATION Multiple fields’ irradiation does not reduce incidental irradiation of NILNS but deeply increases the spread of low dose in the lung, associated in some publications to a higher risk of pneumonitis.
    Radiological Society of North America 2008 Scientific Assembly and Annual Meeting; 12/2008
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    ABSTRACT: To evaluate the amplitude of motion and the variations of volume of the tumor, the liver and upper abdominal organs induced by breathing during the irradiation of hepatocellular carcinoma (HCC). Two scanners were performed in inhale and in exhale not forced in 20 patients with a HCC. The liver (left/right lobes), the tumor, the duodenum, the two kidneys and the pancreas were delineated on each acquisition. The superposition of the two spirals made it possible to measure the displacements and variations of volume of these structures in the craniocaudal (CC), lateral (Lat), and anteroposterior (AP) directions. The mean displacement of the tumour in CC, Lat and AP was of 19.7+/-8.3 mm, 4.5+/-2.3 mm, and 8.9+/-6.5 mm. The greatest amplitude of movement was obtained in CC for the right and left hepatic lobes (19+/-6.5 mm, 10+/-5.6 mm), the duodenum(12.6+/-6.4 mm), the kidneys right and left (15.5+/-6.1 mm, 16.2+/-10 mm) and the pancreas (13.2+/-6 mm). No significant variation of volume was observed for these organs. The movements of the tumour, the liver and the abdominal organs, induced by breathing are significant. The respiratory gating appears essential in particular with the development of new techniques of irradiation such as the intensity-modulated radiotherapy (IMRT) or the stereotactic body radiation therapy (SBRT).
    Cancer/Radiothérapie 12/2008; 12(8):768-74. · 1.48 Impact Factor
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    ABSTRACT: Respiration-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast and liver tumors. An increased conformality of irradiation fields leading to decreased complications rates of organs at risk (lung, heart...) is expected. Respiratory gating is in line with the need for improved precision required by radiotherapy techniques such as 3D conformal radiotherapy or intensity modulated radiotherapy. Reduction of respiratory motion can be achieved by using either breath-hold techniques or respiration synchronized gating techniques. Breath-hold techniques can be achieved with active techniques, in which airflow of the patient is temporarily blocked by a valve, or passive techniques, in which the patient voluntarily holds his/her breath. Synchronized gating techniques use external devices to predict the phase of the respiration cycle while the patient breaths freely. This work summarizes the different experiences of the centers of the STIC 2003 project. It describes the different techniques, gives an overview of the literature and proposes a practice based on our experience.
    Cancer/Radiothérapie 07/2007; 11(4):214-24. · 1.48 Impact Factor
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    ABSTRACT: We performed a retrospective analysis in order to evaluate the compliance with preoperative radiotherapy in patients aged>or=70 with locally advanced resectable rectal cancer, and to evaluate the influence of comorbidities on treatment tolerance and oncological results. From March 1984 to December 2000, 95 patients with T3-T4 N0 M0 rectal cancer received a preoperative radiotherapy in 2 radiotherapy departments. Nineteen patients received concomitant chemotherapy. All patients completed the radiation schedule. Six patients suffered grade 3 acute WHO toxicity. Surgical resection was performed in 87 patients. There were 3 post-operative deaths. Analysis of peri-operative complications showed thromboembolism (4.9%), ileus (9.8%) and diarrhoea (6.1%). After a median follow-up of 29 months, the 3- and 5-year overall survival rates were 65% and 49% respectively. In univariate analysis, a tumour located in the mid part of the rectum, a radiation dose less than 40 Gy, the absence of chemotherapy were significantly associated with a poor prognosis. There was a trend to a better survival for patients with a Charlson score of 0 (P=0.0584). In multivariate analysis, only initial WHO performance status was significant. Compliance with preoperative radiotherapy is good in elderly patients. Toxicity rates are similar to those described in randomised trials in which only younger patients were included. Initial WHO performance status<or=1 is significantly associated with better survival.
    Gastroentérologie Clinique et Biologique 05/2007; 31(4):436-41. · 1.14 Impact Factor
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    ABSTRACT: Background and PurposeThe goal of our study was to quantify the limits of the EUD models for use in score functions in inverse planning software, and for clinical application.Materials and MethodsWe focused on oesophagus cancer irradiation. Our evaluation was based on theoretical dose volume histograms (DVH), and we analyzed them using volumetric and linear quadratic EUD models, average and maximum dose concepts, the linear quadratic model and the differential area between each DVH.ResultsWe evaluated our models using theoretical and more complex DVHs for the above regions of interest. We studied three types of DVH for the target volume: the first followed the ICRU dose homogeneity recommendations; the second was built out of the first requirements and the same average dose was built in for all cases; the third was truncated by a small dose hole. We also built theoretical DVHs for the organs at risk, in order to evaluate the limits of, and the ways to use both EUD(1) and EUD/LQ models, comparing them to the traditional ways of scoring a treatment plan. For each volume of interest we built theoretical treatment plans with differences in the fractionation.ConclusionWe concluded that both volumetric and linear quadratic EUDs should be used. Volumetric EUD(1) takes into account neither hot–cold spot compensation nor the differences in fractionation, but it is more sensitive to the increase of the irradiated volume. With linear quadratic EUD/LQ, a volumetric analysis of fractionation variation effort can be performed.
    Physica Medica 04/2007; · 1.17 Impact Factor
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    ABSTRACT: The European Organization for Research and Treatment of Cancer (EORTC) phase II study No. 22953 demonstrated the feasibility of reducing the overall treatment time of chemoradiation, delivering mitomycin C twice rather than once and fluorouracil during the whole treatment. We tested the feasibility of chemoradiation in anal carcinoma with mitomycin and cisplatin in a phase II study. Twenty-one patients with locally advanced anal carcinoma (15 women, 6 men) were treated. The first sequence of radiotherapy consisted of 36 Gy over four weeks. After a gap interval of 16 days, a second sequence of radiotherapy was given, delivering 23.4 Gy over 2.5 weeks. Mitomycin C was delivered at 10 mg/m(2) day 1 of each sequence and cisplatin was delivered at 25 mg/m(2)/week of each sequence. The compliance rates for the first sequence with radiation, mitomycinm, and cispaltin (dose and timing) were 100 percent. The median duration gap was 16 days (14-30 days). The compliance rates for the second sequence with radiation, mitomycin, and cisplatin (dose and timing) were 100, 76.2, and 85.7 percent, respectively. Grade > or = 2 acute toxicities of 62, 29, 25, and 5 percent were observed for skin, diarrhea, hematologic, and renal toxicities, respectively. Nineteen patients were in complete response (90.5 percent). Combining radiation with mitomycin and cisplatin in patients with locally advanced anal cancer is feasible. The results are promising. The EORTC is currently comparing this combination with mitomycin and 5-fluorouracil in a large phase II-III trial.
    Diseases of the Colon & Rectum 02/2007; 50(1):43-9. · 3.34 Impact Factor
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    ABSTRACT: Respiration-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast and liver tumors. An increased conformality of irradiation fields leading to decreased complications rates of organs at risk (lung, heart…) is expected. Respiratory gating is in line with the need for improved precision required by radiotherapy techniques such as 3D conformal radiotherapy or intensity modulated radiotherapy. Reduction of respiratory motion can be achieved by using either breath-hold techniques or respiration synchronized gating techniques. Breath-hold techniques can be achieved with active techniques, in which airflow of the patient is temporarily blocked by a valve, or passive techniques, in which the patient voluntarily holds his/her breath. Synchronized gating techniques use external devices to predict the phase of the respiration cycle while the patient breaths freely. This work summarizes the different experiences of the centers of the STIC 2003 project. It describes the different techniques, gives an overview of the literature and proposes a practice based on our experience.
    Cancer Radiotherapie - CANCER RADIOTHER. 01/2007; 11(4):214-224.
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    ABSTRACT: The currently used tumor-node metastasis (TNM) staging method is generally not applicable to patients with unresectable esophageal carcinomas. There is a need for both an efficient, easy-to-perform clinical classification and for identification of pretherapeutic prognostic factors that would be useful for oncologists, one of which is tumor volume. Records of 148 patients, admitted to hospital during the period January 1993 to December 2001, were evaluated retrospectively. Median age was 65.7 years (range, 35.5-85.5 years). Most patients had SCC (84.5%). Using the computed tomography (CT) scan classification, tumors were recorded as follows: 1 T1, 42 T2, 93 T3, 6 T4, 2 Nx, 72 N0, 74 N1. Tumor volume from the CT scans was determined as the sum of 2 opposed truncated cones. Median tumor volume was 57.5 cm3 (range, 0.6-288 cm3). Median follow-up was 15.1 month (range, 0.3-82.8 months). Survival rates at 1, 2, and 3 years were 42.5%, 21.6%, and 8%, respectively. Prognostic factors identified by univariate analysis were: dysphagia grade > or =2, other histology than squamous cell, tumor location below the carina, age <65 years and tumor volume > or =100 cm3. Prognostic factors identified with multivariate analysis were: dysphagia grade > or =2 (P = 0.013), weight loss > or =10% (P = 0.047), tumor location below the carina (P = 0.002), and tumor volume > or =100 cm3 (P = 0.041). For patients that the TNM staging system is not applicable, tumor volume is a new powerful determinant of survival. Further clinical trials need to be carried out to validate this prospectively.
    American journal of clinical oncology 12/2006; 29(6):583-7. · 2.21 Impact Factor
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    ABSTRACT: Esophageal cancer has a poor prognosis. Recent epidemiological data has shown a modification of histologic types, as adenocarcinoma represents more than 50% of all patients newly diagnosed. Despite progress of surgery, overall survival at 5 years is still about 20% for resectable tumors, supporting the need for additional therapies. Objectives for neoadjuvant treatments are to increase the rate of resectability R0, to decrease the rate of local failure, to treat precociously the micrometastatic disease especially since adjuvant therapies were inefficient or inapplicable. This work is a review of main data from the literature about preoperative treatments : radiotherapy, chemotherapy and chemoradiotherapy for both adenocarcinoma and squamous cell cancers. New therapeutic strategies are arising in order to optimize these results including new drugs as irinotecan, taxans and targeted therapies. Moreover it is necessary to question the place of surgery in locally advanced but resectable tumors.
    Bulletin du cancer 12/2006; 93(11):1107-13. · 0.61 Impact Factor
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    ABSTRACT: To evaluate esophageal tumor and OAR movement during the respiratory cycle in order to obtain optimal values for ITV and PRV. To correlate tumor motion with chest wall displacement - information of value in the free-breathing gating system. Inclusion criteria were: histologically proven squamous-cell carcinoma (SCC) or adenocarcinoma at stage T3 - T4 NX or TX N1 M0 according to the UICC 1997 classification. Two spiral scans were performed with breath-hold respiration under spirometric control: one at end expiration (EBH) and the other at end inspiration (IBH). Displacements between exhalation and inhalation were calculated according to ICRU report 42 recommendations. For the correlation study, CT-scan acquisition was performed at the isocenter over a 20 - 40 s period. After Fourier Transform, frequency spectra for amplitude and phase of tumor and chest wall motions were performed for each patient. Cumulative distribution of CTV motion in absolute values showed that 95% of data ranged from 0 to 1 cm. Cumulative distribution of GTV motion in absolute values showed that 95% of data ranged from 0 to 0.8 cm. The correlation study demonstrated no specific relationship between respiratory and esophageal motions. The ITV margin for 3D conformal radiotherapy in esophageal cancer was 1 cm when 95% of motions were taken into account in this clinical study involving eight patients. Before using a free-breathing gating system, the correlation between external markers and target displacement during irradiation must be established for each patient.
    Radiotherapy and Oncology 10/2006; 80(3):327-32. · 4.52 Impact Factor
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    ABSTRACT: Neoadjuvant chemotherapies for patients with advanced head and neck squamous cell carcinoma have been widely studied for twenty years. Despite a high level of activity on the primary tumor, no study has demonstrated a survival benefit suggesting the use of neoadjvant chemotherapy. One can consider that the only benefit of such strategy is for larynx preservation in patients with operable hypopharnx or larynx cancer. Nevertheless, recently the well established preservation strategy based on induction chemotherapy following according to the activity by radiotherapy has been knocked over by a strategy developed by Forastiere et al. using primary concomitant chemoradiotherapy. However, the lack of benefit reported by neoadjuvant chemotherapy has been thwarted by the recent results provided by the EORTC study which assessed the survival benefit of neoadjuvant chemotherapy by docetaxel-cisplatin-fluorouracile. Interestingly, since 2002 the clearly established strategies for patients with advanced head and neck cancer have been challenged and new options are emerging. This paper reviews the standard strategy of the past and the future proposal emerging from recent studies.
    Bulletin du cancer 08/2006; 93(7):677-82. · 0.61 Impact Factor
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    ABSTRACT: Orchiectomy with adjuvant radiotherapy of retroperitoneal paraaortic and ipsilateral iliac nodes is the standard treatment for localized testicular seminoma (I, IIA, IIB). Post therapeutic follow-up allows to detect local relapse and radio-induced second cancer. Nevertheless, evaluation of risk of second malignancy still remains difficult. We report 2 cases of rectal cancer after radiotherapy for testicular seminoma.
    Cancer/Radiothérapie 06/2006; 10(3):145-7. · 1.48 Impact Factor
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    ABSTRACT: Orchiectomy with adjuvant radiotherapy of retroperitoneal paraaortic and ipsilateral iliac nodes is the standard treatment for localized testicular seminoma (I, IIA, IIB). Post therapeutic follow-up allows to detect local relapse and radio-induced second cancer. Nevertheless, evaluation of risk of second malignancy still remains difficult. We report 2 cases of rectal cancer after radiotherapy for testicular seminoma.
    Cancer Radiotherapie - CANCER RADIOTHER. 01/2006; 10(3):145-147.

Publication Stats

121 Citations
43.70 Total Impact Points

Institutions

  • 2013
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
  • 2010–2013
    • Centre Hospitalier Lyon Sud
      Lyons, Rhône-Alpes, France
  • 2005
    • University of Franche-Comté
      Becoinson, Franche-Comté, France
  • 2002–2004
    • Centre Hospitalier Régional et Universitaire de Besançon
      Becoinson, Franche-Comté, France