Julian Biau

Centre Jean Perrin · Department of Radiotherapy

Background and purpose The STEREO POSTOP GORTEC 2017-03 phase 2 trial (NCT03401840) evaluates postoperative stereotactic body radiotherapy (SBRT) in case of high-risk margins for pT1-T2/N0 oropharyngeal and oral cavity tumors. The present ancillary study aimed to compare the dosimetric impact of adding non-coplanar arcs to the volumetric modulated...

Purpose To evaluate potential synergistic effect of pembrolizumab with radiotherapy (RT) compared with a standard of care (SOC) cetuximab-RT in patients with LA-SCCHN. Patients and Methods Patients with non-operated stage III-IV SCC of oral cavity, oropharynx, hypopharynx and larynx and unfit for receiving high-dose cisplatin were enrolled. Patien...

Résumé Objectif de l’étude Les patients atteints d’un cancer de l’oropharynx pris en charge par radiothérapie ou chimioradiothérapie sont à haut risque nutritionnel. L’objectif de l’étude était de définir l’évolution de leur état nutritionnel en fonction de leur statut HPV (papillomavirus humains). Matériels et méthodes Il s’agit d’une étude rétr...

Background The objective of our study was to report predictive factors of local control (LC) and radionecrosis (RN) of brain metastases (BM) of non-small cell lung carcinoma (NSCLC) treated by multifractionated stereotactic radiotherapy (MF-SRT) according to French recommendations. Method From 2012 to 2020, 87 patients with 101 BM were retrospecti...

(1) Background: Glioblastoma multiforme (GBM) shows complex mechanisms of spreading of the tumor cells, up to remote areas, and little is still known of these mechanisms, thus we focused on MRI abnormalities observable in the tumor and the brain adjacent to the lesion, up to the contralateral hemisphere, with a special interest on tensor diffusion...

Intensity-modulated radiotherapy has been widely used routinely in recent past years for post-operative radiotherapy of salivary gland cancers Because of the sharp dose fall off outside of target volumes with IMRT, each volume must be strictly and rigorously defined, as the areas not specifically included in the target volume will not be treated to...

Background To assess the impact of nutritional status on tolerance to induction chemotherapy by docetaxel, cisplatin and 5-fluorouracil (ICT) in head and neck cancer (HNC). Methods Ninety-two HNC patients were included. Toxicity was assessed according to common terminology criteria for adverse events. Nutritional status was assessed by body mass i...

Intensity modulated radiation therapy and brachytherapy are standard techniques of irradiation for the treatment of oral cavity cancers. These techniques are detailed in terms of indication, planning, delineation and selection of the volumes of interest, dosimetry and patients positioning control. This is an update of the guidelines of the French S...

We present the updated recommendations of the French Society for Radiation Oncology on benign intracranial tumours. Most of them are meningiomas, vestibular schwannomas, pituitary adenomas, craniopharyngiomas, and glomus tumours. Some grow very slowly, and can be observed without specific treatment, especially if they are asymptomatic. Symptomatic o...

Nasopharyngeal cancers are a rarity in France. Radiotherapy is the cornerstone of treatment, frequently combined with chemotherapy. The technical modality of radiotherapy is complex in this disease, which is located in the vicinity of numerous organs at risk. In this article, we will present the updated guidelines of the French society for radiatio...

We present the update of the recommendations of the French society of oncological radiotherapy on radiotherapy of laryngeal cancers. Intensity modulated radiotherapy is the standard of care radiotherapy for the management of laryngeal cancers. Early stage T1 or T2 tumours can be treated either by radiotherapy or conservative surgery. For tumours re...

Gliomas are the most frequent primary brain tumour. The proximity of organs at risk, the infiltrating nature, and the radioresistance of gliomas have to be taken into account in the choice of prescribed dose and technique of radiotherapy. The management of glioma patients is based on clinical factors (age, KPS) and tumour characteristics (histology...

We present the update of the recommendations of the French society of oncological radiotherapy on radiotherapy for hypopharynx. Intensity-modulated radiotherapy is the gold standard treatment for hypopharynx cancers. Early T1 and T2 tumors could be treated by exclusive radiotherapy or surgery followed by postoperative radiotherapy in case of high r...

For several years, the use of nanotechnology has been at the heart of research. The use of nanoparticles in oncology opens a vast field of clinical applications. Indeed, nanoparticles have the ability to act as radiosensitizers. They enhance the effectiveness of irradiation in tumor cells, and may represent a promising approach for the local treatm...

Background Surgery is an important therapeutic option for brain metastases. Currently, postoperative stereotactic radiosurgery (SRT) leads to 6-month and 1-year local control estimated at 70 and 62% respectively. However, there is an increased risk of radio-necrosis and leptomeningeal relapse. Preoperative SRT might be an alternative, providing loc...

Purpose: Endoscopic endonasal surgery (EES) is becoming a standard for most malignant sinonasal tumours. Margin analysis after piecemeal resection is complex and optimally relies on accurate histosurgical mapping. Postoperative radiotherapy may be adapted based on margin assessment mapping to reduce the dose to some sinonasal subvolumes. We assess...

Introduction Head and neck reconstructive surgery using a flap is increasingly common. Best practices and outcomes for postoperative radiotherapy (poRT) with flaps have not been specified. We aimed to provide consensus recommendations to assist clinical decision-making highlighting areas of uncertainty in the presence of flaps. Material and method...

Objectives To determine the importance of nutritional status, social status, and inflammatory status in the prognosis of head and neck cancer. Study Design Single-center retrospective study of prospectively collected data. Setting Tertiary referral center. Methods Ninety-two consecutive patients newly diagnosed for cancer of the upper aerodigest...

Background The rate of toxic deaths related to induction chemotherapy in the treatment of locally advanced head and neck cancers is unacceptable and calls into question this therapeutic strategy, which is however highly effective in terms of rate and speed of response. The purpose of the study was to investigate predictive factors of toxicity of in...

Purpose Stereotactic radiotherapy (SRT) is the standard treatment for brain metastases of non-small-cell lung cancer (NSCLC) and melanoma, mostly in combination with immunotherapy. The objective was to retrospectively evaluate the influence of the time-lapse between immunotherapy and stereotactic radiotherapy on toxicity. Patients and methods From...

Résumé L’identification des différents facteurs de risque d’ostéoradionécrose mandibulaire doit se faire en amont et au décours de la prise en charge des patients atteints d’un cancer des voies aérodigestives supérieures. Différents critères cliniques de cette complication sévère radio-induite sont liés au patient (radiosensibilité intrinsèque, mal...

Intensity modulated radiation therapy for head and neck is a complex technique. Inappropriate delineation and/or dose distribution can lead to recurrences. Analysis of these recurrences should lead to improve clinical practice. For several years, different methods of analysis have been described. The purpose of this review is to describe these diff...

Résumé Il est proposé une délinéation des volumes cibles anatomo-liniques de la tumeur primitive (CTV-P) dans les cancers de l’ethmoïde traités par irradiation postpératoire. Ce concept s’appuie sur la connaissance de la radioanatomie et celle de l’histoire naturelle des cancers. Il repose sur le recalage de la scanographie de planification avec le...

Résumé Les cholangiocarcinomes sont des tumeurs digestives dont l’incidence reste faible et le pronostic sombre. Le bénéfice de la chimioradiothérapie adjuvante et de la radiothérapie n’a jamais été démontré dans un essai contrôlé randomisé de phase III. La chimiothérapie par capécitabine 6 mois est le traitement standard en situation adjuvante. La...

Background Stereotactic radiotherapy (SRT) should be applied with a biologically effective dose with an α/β of 12 (BED12) ≥ 40 Gy to reach a 1-year local control (LC) ≥ 70%. The aims of this retrospective study were to report a series of 81 unresected large brain metastases treated with Linac-based multifraction SRT according to the ICRU 91 and to...

PurposeThe proportion of older populations living with cancer is on the increase. Maintaining or improving their quality of life (QoL) has become an important goal in the treatment of cancer and has become an endpoint in clinical trials. Melatonin regulates a wide variety of physiological functions and is involved in the initiation of sleep and the...

Purpose Stereotactic radiotherapy plays a major role in the treatment of brain metastases (BM). We aimed to compare the dosimetric results of four plans for hypofractionated stereotactic radiotherapy (HFSRT) for large brain metastases. Material and methods Ten patients treated with upfront NovalisTx® non-coplanar multiple dynamic conformal arcs (D...

Introduction et but de l’étude Le consensus international de délinéation des volumes cible anatomocliniques tumoraux des carcinomes épidermoïdes des voies aérodigestives supérieures a proposé l’application de marges d’expansion géométriques autour du volume tumoral macroscopique (5 + 5 mm avec adaptation par localisation) selon le concept du Danish...

Background: Stereotactic radiosurgery (SRS) is a common treatment option for vestibular schwannomas. Historically, a dose de-escalation of the marginal prescribed dose from 16 Gy to 12-13 Gy has been done to limit toxicity without reducing local control (LC). We aimed to retrospectively report outcomes of Linac-based SRS for vestibular schwannomas...

Background and purpose: This phase 1 trial aimed to determine the maximum tolerated dose (MTD; primary objective) of a p38-MAPK inhibitor, ralimetinib, with radiotherapy (RT) and chemotherapy (TMZ), in the treatment of newly diagnosed glioblastoma (GBM) patients. Materials and methods: The study was designed as an open-label dose-escalation stud...

ESMO Virtual Congress, ELECTR NETWORK, SEP 19-OCT 18, 2020

ESMO Virtual Congress, ELECTR NETWORK, SEP 19-OCT 18, 2020

Background: Primary surgery is usually the mainstay treatment in early-stage oropharyngeal and oral cavity cancer. Typically, neck surgery is performed. Negative tumor margins are recommended (> 5 mm). If feasible, re-resection of any positive margin is preferred. Otherwise, postoperative radiotherapy is required. Adjuvant postoperative radiothera...

Background After stereotactic body radiation therapy (SBRT) for medically inoperable stage I non-small-cell lung cancer (NSCLC), more patients die of comorbidities, particularly severe pulmonary insufficiency, than of tumor progression. The aim of this study was to evaluate correlation between lung biologically effective dose (BED) with an α/β rati...

Résumé Objectif de l’étude Cet article a pour objectif de décrire et de recenser les essais cliniques qui ont changé nos pratiques dans les cancers du sein, les cancers urologiques, les cancers gynécologiques, les cancers des voies aérodigestives supérieures et les cancers digestifs ces dix dernières années. Matériel et méthodes Nous avons répert...

Résumé La chimioradiothérapie concomitante améliore le taux de contrôle des cancers localement évolués des voies aérodigestives supérieures et la chimiothérapie de référence est actuellement le cisplatine. Ces résultats sont obtenus au prix d’une majoration des toxicités. Pour limiter les risques de toxicité, des contraintes de doses dans les organ...

Purpose of review: The role of the immune system is important in both initiation and development of head and neck cancers. Various immune checkpoints have been discovered that can be exploited by cancer to evade immune mediated destruction. Therefore, immune checkpoint inhibitors have been developed to overcome cancer immune-evasion and are curren...

Background Concurrent chemoradiotherapy (CRT) is the standard of care (SoC) in locally advanced (LA) head and neck squamous cell carcinomas (HNSCC). This trial was designed to test whether dose-escalated IMRT and cisplatin could improve locoregional control without increasing complications over 3D-radiotherapy. Methods patients were randomized bet...

Résumé La radiothérapie préopératoire, potentialisée par la chimiothérapie, est un traitement recommandé des cancers du rectum localement évolués. Historiquement, ce traitement est délivré par irradiation conformationnelle tridimensionnelle, généralement avec une bonne tolérance mais avec une toxicité potentielle digestive, urinaire et hématologiqu...

Introduction: Demyelination can occur after brain radiotherapy in tissue adjacent to irradiated tumours. To date, no correlation has been found between conventional-dose radiotherapy and the development of multiple sclerosis, but radiotherapy could be a triggering factor among women with known multiple sclerosis. To the best of our knowledge, this...

Aims Although several studies on outcomes following stereotactic radiosurgery (SRS) for benign meningiomas have been reported, Linac-based SRS outcomes have not been as widely evaluated. The aim of this retrospective institutional single-centre study was to determine long-term outcomes of Linac-based SRS for benign intracranial meningiomas. Materi...

Résumé La radiothérapie stéréotaxique en séance unique ou radiochirurgie cérébrale est une technique non invasive qui permet de créer des lésions focales dans le cerveau de façon très précise et localisée. Elle peut ainsi permettre de traiter des troubles fonctionnels cérébraux en cas d’inefficacité médicamenteuse et d’inopérabilité. L’indication l...

Background: Patterns of nodal involvement in adenoid cystic carcinoma (ACC) of the head and neck have not been sufficiently assessed to guide a decision of prophylactic neck dissection (ND). The objective of this study is to analyse the influence of ND on event-free survival (EFS) for patients with cN0 ACC. Patients and methods: A multicentre pr...

Objectives/hypothesis: PENTOCLO treatment, associating pentoxifylline, tocopherol, and clodronate, resolves radiation-induced fibrosis. The main aim of the present study was to prospectively assess efficacy in mandibular osteoradionecrosis (ORN). Study design: Prospective cohort study. Methods: Twenty-seven patients with mandibular ORN were in...

Radiation therapy (RT) is widely used in cancer care strategies. Its effectiveness relies mainly on its ability to cause lethal damage to the DNA of cancer cells. However, some cancers have shown to be particularly radioresistant partly because of efficient and redundant DNA repair capacities. Therefore, RT efficacy might be enhanced by using drugs...

Introduction et but de l’étude Historiquement, les premiers calculs de dose aux nodules pulmonaires traités par irradiation stéréotaxique utilisaient l’algorithme Pencil Beam. Aujourd’hui, l’algorithme Monte Carlo permet une meilleure évaluation de la dose en prenant en compte les hétérogénéités pulmonaires. L’objectif de l’étude était de quantifie...

Introduction et but de l’étude Il existe un consensus depuis 2004 pour proposer une dose de 12 à 13 Gy sur l’isodose d’enveloppe afin de limiter les taux de complication pour les radiochirurgies stéréotaxiques des schwannomes vestibulaires. L’objectif était d’évaluer rétrospectivement l’efficacité et la toxicité de la radiochirurgie stéréotaxique d...

Introduction et but de l’étude L’évolution métastatique surrénalienne isolée d’un cancer nécessite un changement de traitement systémique ou une radiothérapie stéréotaxique hypofractionnée. L’objectif de cette étude prospective monocentrique était d’étudier l’efficacité et la tolérance de la radiothérapie stéréotaxique hypofractionnée des oligométa...

In cancer cells, aberrant DNA methylation is commonly associated with transcriptional alterations, including silencing of tumor suppressor genes. However, multiple epigenetic mechanisms, including polycomb repressive marks, contribute to gene deregulation in cancer. To dissect the relative contribution of DNA methylation-dependent and -independent...

Résumé Les cancers des voies aérodigestives supérieures correspondent à un ensemble de maladies variées, pour lesquelles les volumes de traitement et la dose prescrite sont à individualiser en fonction de chaque patient. L’objectif de cet article est de passer en revue les principaux facteurs décisionnels concernant la définition des volumes cibles...

Résumé Cet article propose le concept de la sélectivité des zones péritumorales microscopiques à traiter de principe par irradiation pour les tumeurs de la glande sous-mandibulaire en se basant sur le mode d’extension des cancers. Il présente les différentes délimitations des volumes cibles anatomocliniques tumoraux à haut risque et à faible risque...

Résumé Le choix des volumes d’irradiation lors du traitement par radiothérapie externe d’un cancer des voies aérodigestives supérieures, notamment celui des volumes prophylactiques pour couvrir le risque d’extension infraclinique, est difficile. Il repose sur la connaissance de l’histoire naturelle de ces tumeurs mais se heurte à la diversité et la...

Résumé Malgré les progrès dans la prise en charge des carcinomes épidermoïdes des voies aérodigestives supérieures (VADS), de nombreux patients vont développer une récidive en territoire irradié ou un second primitif. Devant la très grande hétérogénéité de ces patients, des facteurs liés à la maladie (localisation, volume, récidive ou second primit...

High grade glioma relapses occur often within the irradiated volume mostly due to a high resistance to radiation therapy (RT). Dbait (which stands for DNA strand break bait) molecules mimic DSBs and trap DNA repair proteins, thereby inhibiting repair of DNA damage induced by RT. Here we evaluate the potential of Dbait to sensitize high grade glioma...

Background and purpose: In 2000, a panel of experts published a proposal for the selection of lymph node target volumes for definitive head and neck radiation therapy (Radiother Oncol, 2000; 56: 135-150). Hereunder, this selection is updated and extended to also cover primary sites not previously covered. Patients and methods: The lymphatic spre...

Résumé Les cancers des glandes parotides sont des tumeurs rares, comprenant une grande diversité de formes histologiques. Cet article propose une synthèse des voies d’extension de ces tumeurs afin de proposer une approche de la délinéation des volumes cibles tumoraux anatomocliniques à haut et faible risques et de la sélections des aires ganglionna...

Résumé L’installation et l’utilisation d’un nouvel équipement de radiothérapie requièrent une politique de qualité et de sécurité adaptées. Le processus aboutissant à la mise en service d’un accélérateur suivant la construction d’un bunker comporte, entre autres, l’installation de l’accélérateur, la vérification de la conformité au cahier des charg...

Résumé Objectif de l’étude L’objectif de l’étude était de rechercher des facteurs prédictifs de toxicité de la chimiothérapie d’induction par l'association de docétaxel, platine et 5-fluorouracile (TPF) pour les cancers localement évolués des voies aérodigestives supérieures. Patients et méthodes De juillet 2009 à mars 2015, 57 patients pris en c...

Background: The objective of the study was to evaluate the outcomes in terms of efficacy and safety of a large consecutive series of 362 patients with renal cell carcinoma (RCC) brain metastases treated using stereotactic radiosurgery (SRS) in the tyrosine kinase inhibitor (TKI) era. Patients and methods: From 2005 to 2015, 362 consecutive patie...

Background Aberrant DNA methylation is a cancer cell feature that is commonly associated with transcriptional alterations. However, the primary role of this defect in the genome-wide cancer-associated gene deregulation is not clear. Here, we evaluated the relative contribution of DNA methylation-dependent and -independent mechanisms to transcriptio...

Background Prospective evaluation of the results of volumetric modulated arc therapy (VMAT) for sinonasal cancer compared to 3D conformal radiation therapy (3DCRT). Materials and Methods We prospectively evaluated 34 patients (pts) treated with postoperative VMAT with simultaneous integrated boost (SIB; RapidArc) from 2011 to 2015. These pts were...

Objectif de l’étude Le volume de cerveau recevant plus de 18 Gy (V18) et l’indice de conformité (IC) sont prédictifs de radionécrose après radiothérapie stéréotaxique hypofractionnée des volumineuses métastases cérébrales. L’objectif de l’étude était de comparer les paramètres dosimétriques des métastases cérébrales prises en charge par arcthérapie...

Objectif de l’étude Quinze à 20 % des patients sont atteints de métastases lors du diagnostic initiale de mélanome et le risque de développement de métastases cérébrales augmente avec la durée de la maladie. Nous avons conduit une étude multicentrique rétrospective afin d’évaluer les résultats de la radiothérapie stéréotaxique non fractionnée et de...

Objectif de l’étude Évaluation d’une série rétrospective de patients traités consécutivement avec modulation d’intensité volumétrique (VMAT) pour un carcinome épidermoïde du canal anal. Matériel et méthode Entre 2012 et 2017, 47 patients ont été consécutivement traités pour un carcinome épidermoïde du canal anal localement évolué. L’âge moyen étai...

Objectif de l’étude Analyser l’impact carcinologique du respect des contraintes de l’International Commission on Radiation Units and Measurements (ICRU) D95 ≥ 95 % de la dose prescrite et D98 ≥ 90 % de le dose prescrite pour le volume primitif à haut risque (P) sur le contrôle local. Matériel et méthode Entre 2011 et 2016, les dossiers de 163 pati...

Since decades, stereotactic radiotherapy has spread out worldwide. Published results are very numerous. To clarify obviousness among all the publications, this recommendation review was written. Voluntarily, authors limited analysis of international best evidence literature on malignant tumors of lung, liver, prostate, head and neck, and metastasis...

Purpose: The trigeminal nerve (V) is a major route of tumor spread in several head and neck cancers. However, only limited data are currently available for its precise contouring, although this is absolutely necessary in the era of intensity-modulated radiation therapy (IMRT). The purpose of this article is to present practical clinical guidelines...

The best curative option for locally advanced (stages II–III) squamous-cell carcinomas of the anal canal (SCCAC) is concurrent chemo-radiotherapy delivering 36–45 Gy to the prophylactic planning target volume with an additional boost of 14–20 Gy to the gross tumor volume with or without a gap-period between these two sequences. Although 3-dimension...

Stereotactic radiotherapy is a major issue in the management of brain metastases. Radionecrosis is a major concern, especially for large lesions. Optimizing dosimetric parameters is essential to allow optimal local control rate while minimizing potential toxicity. We report the case of a 30-mm brain metastases treated with stereotactic radiotherapy...