Laval Grimard

• MD
• Professor (Full) at The Ottawa Hospital

LBA501 Background: Adjuvant breast RT is usually prescribed following BCS to reduce the risk of local recurrence (LR). However, this treatment is inconvenient, costly, and associated with acute and late toxicity. Traditional clinical pathological factors (CPFs) alone are limited in their ability to identify women with a low enough risk of LR to omi...

Background Identification of women with DCIS who have a very low risk of local recurrence risk (LRR) after breast-conserving surgery (BCS) is needed to de-escalate therapy. We evaluated the impact of 10-year LRR estimates after BCS, calculated by the integration of a 12-gene molecular expression assay (Oncotype Breast DCIS Score®) and clinicopathol...

Background: Guidelines recommend that breast radiation (RT) can be omitted for patients with a low risk of local recurrence (LR) after breast-conserving surgery (BCS) for DCIS. The inability to identify women at low risk of LR (<10%) at 10 years after BCS has hampered efforts to de-escalate therapy for DCIS. The Oncotype DX Breast DCIS Score® (DS),...

Background: In Ontario, there is no clearly defined standard of care for staging for distant metastasis in women with newly diagnosed and biopsy-confirmed breast cancer whose clinical presentation is suggestive of early-stage disease. This guideline addresses baseline imaging investigations for women with newly diagnosed primary breast cancer who...

Cranio-spinal irradiation (CSI) treatment of embryonal tumors is associated with long-term endocrine and neuro-cognitive sequelae. As an example, the radiation regiment for standard risk medulloblastoma is 23.4 Grays (Gy) CSI followed by a boost of 30.6Gy to the tumor bed. We hypothesize that a novel CSI technique, which we named "Functional" CSI (...

Objet L’étude visait à déterminer les effets psychologiques et les difficultés que les radiothérapeutes expérimentent lorsqu’ils traitent des patients en pédiatrie. On tente ici de fournir de l’information pour aider les radiothérapeutes dans l’exécution de leurs tâches et pour alimenter la documentation sur le sujet. Méthodologie On a effectué un...

This clinical study was designed to prospectively evaluate the acute and moderately-late cardiac and lung toxicities of intensity modulated radiation therapy delivered by helical tomotherapy (IMRT-HT) for locoregional breast radiation treatment including the internal mammary nodes (IMN). 30 patients with stage III breast cancers have been accrued i...

Context: Pancreatic neuroendocrine tumors (Panc-NETs) are rare and tend to get overshadowed by their more prevalent and aggressive ductal adenocarcinoma counterparts. The biological behavior of PancNETs is unpredictable, and thus management is controversial. However, the new World Health Organization classification has significantly contributed to...

The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Ottawa, Ontario, October 22-23, 2010. Health care professionals involved in the care of patients with colorectal cancer participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement address...

Purpose: To describe results from our comprehensive incident learning system gained over 4 years. Methods: An incident learning system specifically tailored to a radiation treatment program and based on published principles was implemented in our large academic cancer centre in late 2006. In the adopted system, every incident, whether or not there...

To identify the earliest practitioners of prostate brachytherapy. Review of contemporary literature. Radiotherapy has been used for benign prostatic ailments as early as 1902. Prostate cancer was first treated by teletherapy in 1904. Several urologists, in Paris and Vienna, applied intracavitary radium for prostate disease in 1908-1909. We present...

To assess efficacy of an incident learning system in the management of error in radiation treatment. We report an incident learning system implementation customized for radiation therapy where any "unwanted or unexpected change from normal system behaviour that causes or has the potential to cause an adverse effect to persons or equipment" is repor...

The optimal fractionation schedule for whole-breast irradiation after breast-conserving surgery is unknown. We conducted a study to determine whether a hypofractionated 3-week schedule of whole-breast irradiation is as effective as a 5-week schedule. Women with invasive breast cancer who had undergone breast-conserving surgery and in whom resection...

Persistent disease after definitive external beam radiation therapy for head and neck (H&N) malignancies negatively impacts survival. In this series, the effectiveness of low-dose-rate brachytherapy in the management of persistent H&N disease is explored. All patients who received brachytherapy for persistent H&N disease between 1987 and 2002 were...

Squamous carcinoma of the penis is rare but psychologically devastating and potentially fatal. Radiotherapy offers a penile-conserving treatment option without jeopardizing cure. We have used primary penile brachytherapy as the treatment of choice for T1, T2 and selected T3 patients since 1989 and present updated results for 67 patients. Mean age w...

To report long-term results of brachytherapy after local excision (LE) in the treatment of T1 and T2 rectal cancer at risk of recurrence due to residual subclinical disease. Between 1989 and 2007, 32 patients undergoing LE and brachytherapy were followed prospectively for a mean of 6.2 years. Estimates of local recurrence (LR), disease-specific sur...

We have implemented an incident learning system designed for a radiation treatment program where any unwanted or unexpected change from a normal system behavior that causes or has the potential to cause an adverse effect to persons or equipment is reported, investigated and learned from. This system thus captures potential or near-miss in addition...

Based on our demonstration of a circadian rhythm in the human oral mucosa cell cycle, with most cells in the G(1) phase in the morning and M phase at night, we hypothesized that morning radiotherapy (RT) would lead to less oral mucositis than afternoon RT. A total of 216 patients were randomized to morning (8-10 AM) vs. afternoon (4-6 PM) RT and st...

Results: Between April 1993 and September 1996 1,234 women were randomly assigned to treatment (622 in arm A and 612 in arm B). Median follow-up is now 144 months. Risk for local recurrence at 10 years was 6.2% for arm A and 6.7% for arm B (absolute difference = 0.5%, 95% CI 3.5%, 2.5%). At 10 years, 70% of arm A patients had a good or excellent co...

The aim of this study is to quantify the effect of an incident learning system in radiation therapy. The system is designed to detect all occurrences of “an unwanted or unexpected change from a normal system behaviour that causes or has the potential to cause an adverse effect to persons or equipment”. Our application to radiation therapy defines 5...

Rapid delivery of radiation therapy is expected to benefit patients requiring palliation. We investigated the feasibility of employing a helical tomotherapy unit to scan, plan, and deliver a radiation treatment in a single radiation therapy appointment. Eleven patients each had an MVCT scan acquired, a plan created, and delivery completed while the...

Re-treatment for cure of the Head and Neck (H&N) region is therapeutically challenging. In this review we explore the long-term results of Ir(192) low-dose-rate (LDR) brachytherapy in the select subgroup of patients treated for a new H&N malignancy. Thirteen patients received brachytherapy between 1987-2004 for a new primary H&N cancer, six of whom...

Recurrent head and neck malignancies are therapeutically challenging. Brachytherapy is a retreatment alternative to external-beam radiation therapy (EBRT). Patients receiving brachytherapy during 1987–2004 for recurrent head and neck cancer were identified. Tumor and treatment characteristics and toxicities were recorded. Progression-free survival...

Cerebral vascular disease has been reported as a long-term complication of cranial radiotherapy. The purpose of this study was to examine the frequency and risk factors associated with development of cerebral vascular disease in children after cranial radiation. A retrospective chart review of all cancer patients treated between 1985 and 2003 who w...

To report results for 49 men with squamous cell carcinoma (SCC) of the penis treated with primary penile interstitial brachytherapy at one of two institutions: the Ottawa Regional Cancer Center, Ottawa, and the Princess Margaret Hospital, Toronto, Ontario, Canada. From September 1989 to September 2003, 49 men (mean age, 58 years; range, 22-93 years...

Purpose: The purpose of this study is to evaluate the effect of tissue inhomogeneities and surface irregularities on the value of monitor units, MU, calculated for radiotherapytreatments with electron beams of various anatomical sites. Method and Materials: The Monte Carlo software used is the commercial implementation of VMC++ (Nucletron). For eac...

In 2002 we fully implemented clinically a commercial Monte Carlo based treatment planning system for electron beams. The software, developed by MDS Nordion (presently Nucletron), is based on Kawrakow's VMC++ algorithm. The Monte Carlo module is integrated with our Theraplan Plustrade mark treatment planning system. An extensive commissioning proces...

To identify SF2 as a prognostic factor of late complications from radiosurgery in patients treated for AVM. Five patients with AVM treated in three canadian institutions and who suffered clinically significant neurological sequelaes secondary to radiosurgery were identified. Their fibroblasts were cultured and their radiation sensitivity tested to...

Purpose. – To identify SF2 as a prognostic factor of late complications from radiosurgery in patients treated for AVM.Patients and Methods. – Five patients with AVM treated in three canadian institutions and who suffered clinically significant neurological sequelaes secondary to radiosurgery were identified. Their fibroblasts were cultured and thei...

The study objective was to confirm a previous finding that patients with stage III/IV squamous head and neck cancer (SHNC) who smoke during radiotherapy (RT) experience reduced survival. An observational cohort study. Patients' smoking status was assessed weekly by questionnaire plus blood cotinine. Patients were assessed every 3 to 4 months for su...

The survival rate for childhood cancer, including brain tumors, is increasing. As a result, long-term sequelae of chemotherapy and radiotherapy are also increasing. The purpose of this study was to determine the frequency of endocrine complications of therapy for brain tumors in pediatric patients. Endocrinopathy was observed in 19 of 20 (95%) of p...

Breast irradiation after lumpectomy is an integral component of breast-conserving therapy that reduces the local recurrence of breast cancer. Because an optimal fractionation schedule (radiation dose given in a specified number of fractions or treatment sessions over a defined time) for breast irradiation has not been uniformly accepted, we examine...

A 2-year-old girl who had a stage 2, favorable-histology Wilms tumor diagnosed when she was age 10 months presented with multiple brain metastases at second recurrence. She had been treated with combined radiotherapy, surgery, and chemotherapy; at 2 months after treatment, recurrent disease developed in the central nervous system and she died. Brai...

Interstitial brachytherapy is an effective organ sparing treatment for localized penile squamous cell carcinoma. We report results in 30 patients. From September 1989 to November 2000, 30 men with penile squamous cell carcinoma were treated with primary brachytherapy. Tumor size was 2 to 3 cm. in 8 and greater than 3 cm. in 14 (maximum 5 cm.). Tumo...

To describe a treatment and follow-up protocol for HIV patients with anal dysplasia or warts, which are at risk of malignant change. An ongoing study of highly selected patients referred to a single surgeon. The Colorectal and HIV/AIDS Clinics, University of Ottawa, General Campus. Ninteen young men who presented with suspicious anal lesions and we...

Questions: 1. Does hyperfractionated radiotherapy improve locoregional control or survival as compared with conventionally fractionated radiotherapy in patients with newly diagnosed, locally advanced (stage III-IV) squamous cell carcinoma of the head and neck who are deemed suitable for radiotherapy with curative intent? 2. What is the toxicity ass...

Patients with more than nine ipsilateral lymph node involvement or inflammatory breast cancer have a 5-year survival rate of approximately 50%. We studied the efficacy of high-dose intensification, comparing it with the standard dose chemotherapy for patients with high-risk primary breast cancer. Patients with inflammatory breast cancer or more tha...

A retrospective study of the in vitro radiosensitivity of skin fibroblasts derived from two groups of patients treated by definitive radiotherapy for a variety of tumors who either displayed or did not display severe complications. Seven radiotherapy patients were selected: three were treated for head and neck, prostate and non-Hodgkin lymphoma tum...

Purpose A retrospective study of the in vitro radiosensitivity of skin fibroblasts derived from two groups of patients treated by definitive radiotherapy for a variety of tumors who either displayed or did not display severe complications. Patients and methods Seven radiotherapy patients were selected: three were treated for head and neck, prostat...

Analysis of the results obtained in elderly (75 years and older) included a phase II trial combining intra-arterial cisplatin and concurrent radiation into invasive bladder cancer. Thirty-five patients (28 males and 7 females) were accrued from 1985 to 1996. There were 1 Ta, 4 T2, 11 T3A, 12 T3B, 3 T4A, and 4 T4B patients. Nine had unilateral hydro...

With the increasing survival time of many pediatric patients with malignancies, unexpected symptoms or signs require diligent search for rare complications or second cancers related to the disease or treatment. We recently encountered a patient with extensive glioblastoma multiforme who developed pancytopenia six months after completion of treatmen...

Numerous structures are included in the irradiated volume of patients presenting with head and neck cancer: skin, mucosa, bone, teeth, cartilage, muscles, salivary glands, etc. Curative intent treatment of such tumours requires aggressive approach which can lead to severe sequellae. These sequellae are in most cases dose-dependent and volume-depend...

Numerous structures are included in the irradiated volume of patients presenting with head and neck cancer: skin, mucosa, bone, teeth, cartilage, muscles, salivary glands, etc. Curative intent treatment of such tumours requires aggressive approach which can lead to severe sequellae. These sequellae are in most cases dose-dependent and volume-depend...

Non-small cell lung cancer is the most common cause of cancer death in both males and females. Despite this high incidence and mortality, comparatively little research has addressed the palliative treatment of thoracic symptoms. Until recently, information regarding the indications and effectiveness of radiation in this setting was obtained from re...

A retrospective review was carried out to study children, not more than 16 years old, with a confirmed diagnosis of medulloblastoma, who were residents of the Province of Ontario at the time of diagnosis between 1977 and 1987 inclusive. The provincial tumour registry provided the population database. One hundred and eight children with medulloblast...

A retrospective review was carried out to study children, not more than 16 years old, with a confirmed diagnosis of medulloblastoma, who were residents of the Province of Ontario at the time of diagnosis between 1977 and 1987 inclusive. The provincial tumour registry provided the population database. One hundred and eight children with medulloblast...

From 1987 to 1994, 15 patients with penile saquamous cell carcinoma were referred to the Ottawa Regional Cancer Centre. Seven had already been managed surgically. The other eight were treated with interstitial implantation. Mean age was 58 years (range 39-80). Two patients had previous incomplete local excision and six had biopsy only, with tumor f...

Tumors of the posterior pharyngeal wall and nasopharyngeal cancer with retropharyngeal extension can partly encircle the cervical vertebrae. Treating the patient within spinal cord tolerance can cause a geographic miss. A simple technique has been developed to avoid this problem. The standard fields for posterior pharyngeal wall and nasopharyngeal...

Patients presenting with stage II squamous cell carcinomas (SCC) of mobile tongue and floor of mouth can be treated in many ways (Fletcher 1975; Pierquin et al. 1987). The management of these patients in France was routinely by interstitial irradiation to the primary area using iridium-192 and elective supraomohyoid neck dissection or close follow-...

Brachytherapy with iridium 192 was used in 20 patients with recurrent or persistent neck metastases from a primary head and neck carcinoma. Nine patients had intra-operative brachytherapy in combination with a neck dissection. Three patients had an implant as a boost following external beam radiotherapy. Eight patients were treated by brachytherapy...

From 1971 to 1988, 133 T1 and 141 T2 biopsy-proven squamous cell carcinomas of mobile tongue and floor of mouth were definitively managed by Iridium-192. Implantations were performed using either guide gutters or afterloading plastic catheters. The prescribed dose at the reference isodose (85% of the basal dose rate, Paris system) was 60-70 Gy. Tot...

Dose specification in intraluminal brachytherapy varies considerably in the literature. A terminology is proposed, inspired from the Paris System of interstitial brachytherapy, to define some dosimetric guidelines. The dose is specified in the central plane which is a plane perpendicular to the source and passing through its centre. The reference d...

Between December 1982 and October 1986, 131 patients with stage II-III-IV squamous cell carcinoma of the oropharynx or oral cavity were randomized to induction chemotherapy, consisting of bleomycin (10 mg/m2/day in continuous infusion from day 1 to day 5), methotrexate (120 mg/m2 on day 2) followed by folinic acid, 5-fluorouracil (5 FU) (600 mg/m2...

From 1971 to 1988, 134 T1 and 145 T2 biopsy-proven squamous cell carcinomas of mobile tongue and floor of mouth were definitively managed by iridium-192. Implantations were performed using either guide gutters or afterloading plastic catheters. The prescribed dose at the reference isodose (85% of the basal dose rate, Paris system) was 60-70 Gy. Tot...

Brachytherapy is often indicated in the management of primary or recurrent carcinomas of the lip, oral cavity, and oropharynx. It offers the dual advantage over external beam therapy alone of significant sparing of the salivary glands and other peripheral cervicofacial tissues while delivering a high radiation dose to the tumor. Interstitial irradi...

One hundred and ten patients with Stage II epidermoid carcinomas of the mobile tongue were treated by interstitial irradiation (Group I: 85 patients) or external irradiation to the primary and the regional lymphatics followed by an interstitial boost (Group II: 25 patients). The neck was managed by either an elective neck dissection (43 patients) c...

From 1970 to 1986, 117 patients with T1 (47) or T2 (70) epidermoid carcinomas of the floor of the mouth (SCC) were treated by iridium-192 implantation (192 Ir). The dose was prescribed according to the Paris System and varied over those years. Follow-up information was available on 116 patients. There were 46 T1N0, 47 T2N0, and 23 T2N1-3. Neck mana...

Twenty-five patients with invasive adenocarcinoma of the rectum were treated by preoperative external irradiation (35 Gy), local excision, and peroperative placement of a plastic tube loop in the tumor bed for perioperative brachytherapy (20 or 25 Gy). Patients treated were too frail for radical resection (14 patients) or had refused a permanent co...

Between 1980 and 1987, 25 patients with rectal cancer were treated with a combination of preoperative external irradiation of 35 Gy in 15 fractions over 3 weeks which was followed, 6 to 8 weeks later, by a tumorectomy and peroperative placement of a plastic tube loop for post-operative interstitial therapy by iridium-192. This boost dose was 20 Gy...

Radiology became the sole modality of treatment for localized breast cancer in only a few French cancer centers during the 1960s. Although it was possible to completely eradicate localized breast cancer by the use of modern radiotherapy techniques, it was not always possible to obtain agreement from surgeons for this nonsurgical approach. Only a fe...

A retrospective analysis of 343 consecutive patients with histologically proven carcinoma of the cervix, treated at the Ottawa General Hospital, was undertaken to evaluate the prognostic significance of endometrial extension. All these patient had a D + C as part of their work-up. Sixty-seven patients had a (+) D + C: 34/150 (23%) in Stage IB, 21/1...

A review of 197 patients with bone metastases from breast carcinoma was undertaken to assess the effect of adjuvant parasternal irradiation on the distribution of those metastases. A total of 128 patients (Group I) received radiation. The control group consisted of 69 patients (Group II) who did not receive adjuvant radiation. The dose absorbed by...