Maroie Barkati’s research while affiliated with Centre hospitalier de l'Université de Montréal (CHUM) and other places

What is this page?


This page lists works of an author who doesn't have a ResearchGate profile or hasn't added the works to their profile yet. It is automatically generated from public (personal) data to further our legitimate goal of comprehensive and accurate scientific recordkeeping. If you are this author and want this page removed, please let us know.

Publications (118)


F18-DCFPyL PSMA-PET/CT Versus MRI: Identifying the Prostate Cancer Region Most at Risk of Radiation Therapy Recurrence for Tumor Dose Escalation
  • Article

December 2024

·

5 Reads

·

Mustafa-Karim Benhacene-Boudam

·

·

[...]

·






Figure 2: Primary and secondary outcome measures (A) Metastasis-free survival. (B) Overall survival. (C) Freedom from distant metastasis. (D) Time to non-protocol ADT. Risk tables present the number of participants who, at each timepoint, remain at risk, have been censored, or have had an event. All timepoints add up to the total number of patients. ADT=androgen deprivation therapy.
Primary and secondary outcome measures
Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial
  • Article
  • Full-text available

May 2024

·

668 Reads

·

25 Citations

The Lancet

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society.

Download

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

May 2024

·

478 Reads

·

21 Citations

The Lancet

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society.


FIG 1. Involvement in global oncology projects, as reported by survey respondents. No. of respondents in parentheses (note: values do not add up to 100% because of some respondents selecting multiple answers and some respondents selecting none of the provided answers to this section).
FIG 4. A comparison of involvement of RO and MP survey respondents in different project types. Absolute numbers included above bars. MP, medical physicist; RO, radiation oncologist.
FIG 5. Cancer care domains reported by both RO and MP respondents. MP, medical physicist; RO, radiation oncologist.
FIG 6. A comparison of involvement of RO and MP survey respondents in different cancer care domains. Absolute numbers included above bars. MP, medical physicist; RO, radiation oncologist.
Pan-Canadian Survey of Radiation Oncology Professional Involvement in Global Oncology Initiatives in Low- and Middle-Income Countries

April 2024

·

22 Reads

JCO Global Oncology

PURPOSE Canadian radiation oncology professionals have a strong history of involvement in global oncology initiatives worldwide. This pan-Canadian survey-based study was conducted to determine the current level of engagement of Canadian radiation oncologists (ROs) and medical physicists (MPs) in global oncology initiatives and broaden the development of these activities. MATERIALS AND METHODS This was a cross-sectional study. The survey was designed to characterize current levels of engagement of Canadian ROs and MPs in global oncology initiatives. The survey was open from March 2019 to April 2020. It was disseminated to all Canadian Association of Radiation Oncology and Canadian Organization of Medical Physicists members with two subsequent email reminders. RESULTS Survey responses were received from 40 (93%) of the 43 Canadian cancer treatment centers that offer radiotherapy. At least one RO responded at 34 centers (79%) and one MP from 34 centers (79%) with some overlap. A response was received from a total of 93 participants, 47 ROs and 46 MPs. Of all survey participants, 58% reported some experience with global oncology. Nineteen percent of the participants surveyed were currently directly involved in short- or long-term projects, more than half of which have opportunity for additional staff involvement. The projects spanned 26 countries in South America, Africa, and Asia. Quality improvement and capacity building accounted for 27% and 20% of initiatives, respectively. The most common area of engagement was in direct treatment care, accounting for 56% of the projects. CONCLUSION This study demonstrates the landscape of involvement of Canadian ROs and MPs in global oncology initiatives. The study also highlights areas of opportunity for broadening international participation and collaboration as it relates to global oncology for Canadian radiation oncology professionals.


Noninferiority of Hypofractionated vs Conventional Postprostatectomy Radiotherapy for Genitourinary and Gastrointestinal Symptoms: The NRG-GU003 Phase 3 Randomized Clinical Trial

March 2024

·

82 Reads

·

12 Citations

Importance No prior trial has compared hypofractionated postprostatectomy radiotherapy (HYPORT) to conventionally fractionated postprostatectomy (COPORT) in patients primarily treated with prostatectomy. Objective To determine if HYPORT is noninferior to COPORT for patient-reported genitourinary (GU) and gastrointestinal (GI) symptoms at 2 years. Design, Setting, and Participants In this phase 3 randomized clinical trial, patients with a detectable prostate-specific antigen (PSA; ≥0.1 ng/mL) postprostatectomy with pT2/3pNX/0 disease or an undetectable PSA (<0.1 ng/mL) with either pT3 disease or pT2 disease with a positive surgical margin were recruited from 93 academic, community-based, and tertiary medical sites in the US and Canada. Between June 2017 and July 2018, a total of 296 patients were randomized. Data were analyzed in December 2020, with additional analyses occurring after as needed. Intervention Patients were randomized to receive 62.5 Gy in 25 fractions (HYPORT) or 66.6 Gy in 37 fractions (COPORT). Main Outcomes and Measures The coprimary end points were the 2-year change in score from baseline for the bowel and urinary domains of the Expanded Prostate Cancer Composite Index questionnaire. Secondary objectives were to compare between arms freedom from biochemical failure, time to progression, local failure, regional failure, salvage therapy, distant metastasis, prostate cancer–specific survival, overall survival, and adverse events. Results Of the 296 patients randomized (median [range] age, 65 [44-81] years; 100% male), 144 received HYPORT and 152 received COPORT. At the end of RT, the mean GU change scores among those in the HYPORT and COPORT arms were neither clinically significant nor different in statistical significance and remained so at 6 and 12 months. The mean (SD) GI change scores for HYPORT and COPORT were both clinically significant and different in statistical significance at the end of RT (−15.52 [18.43] and −7.06 [12.78], respectively; P < .001). However, the clinically and statistically significant differences in HYPORT and COPORT mean GI change scores were resolved at 6 and 12 months. The 24-month differences in mean GU and GI change scores for HYPORT were noninferior to COPORT using noninferiority margins of −5 and −6, respectively, rejecting the null hypothesis of inferiority (mean [SD] GU score: HYPORT, −5.01 [15.10] and COPORT, −4.07 [14.67]; P = .005; mean [SD] GI score: HYPORT, −4.17 [10.97] and COPORT, −1.41 [8.32]; P = .02). With a median follow-up for censored patients of 2.1 years, there was no difference between HYPORT vs COPORT for biochemical failure, defined as a PSA of 0.4 ng/mL or higher and rising (2-year rate, 12% vs 8%; P = .28). Conclusions and Relevance In this randomized clinical trial, HYPORT was associated with greater patient-reported GI toxic effects compared with COPORT at the completion of RT, but both groups recovered to baseline levels within 6 months. At 2 years, HYPORT was noninferior to COPORT in terms of patient-reported GU or GI toxic effects. HYPORT is a new acceptable practice standard for patients receiving postprostatectomy radiotherapy. Trial Registration ClinicalTrials.gov Identifier: NCT03274687


Fig. 4. Validation of workflows for 3D Brachy as well as for the end-to-end caps design. IS needle trajectories of replicated caps, TPS pre-plan, and ground truth caps are shown in red, green, and white, respectively End-to-end validation
Comparison of spatial dimensions (mm) between 3D Brachy software files (DICOM RTSS and STL) and 3D-printed prototypes measured with a digital caliper (n = 10)
Material properties and caps production
Spatial deviations as distance-to-agreement (DTA) (mm) at the level of the cervix (z = 0 cm) and a 3 cm needle depth
Deviations in pitch (y, z) and yaw (x, z) angles from the tandem
The Montreal split ring applicator: Towards highly adaptive gynecological brachytherapy using 3D-printed biocompatible patient-specific interstitial caps

December 2023

·

31 Reads

Journal of Contemporary Brachytherapy

Purpose The addition of interstitial (IS) needles to intra-cavitary (IC) brachytherapy applicators is associated with improved outcomes in locally advanced cervical cancers involving parametrial tumor extensions. The purpose of this work was to validate a clinical workflow involving 3D-printed caps for a commercial IC split ring applicator that enable using IS needle trajectories tailored to each treatment. Material and methods A dedicated software module was developed in this work allowing users to design patient-specific IS caps without knowledge of computer-aided design (CAD) software. This software module was integrated to 3D Brachy, a commercial software developed by Adaptiiv Medical Technologies Inc. For validation of the workflow, CAD models of ground truth caps with five IS needle trajectories were designed with Fusion 360™, 3D-printed, assembled with a split ring applicator, and CT-scanned with radio-opaque markers. 3D Brachy was then applied to generate a replica based on trajectories reconstructed from the radio-opaque markers. A comparison between ground truth and replicated IS needle trajectories was done using intersection points with planes at the level of the cervix (z = 0 cm) and a representative needle depth (z = 3 cm). Results Prototypes of interstitial caps 3D-printed in both BioMed Amber and BioMed Clear SLA resins were tested to be functional both pre- and post-sterilization for IS needles with obliquity angles ≤ 45°. Distance-to-agreement at z = 0 cm and 3 cm as well as deviations in pitch and yaw angles of the five IS needle trajectories were found to have mean values of 3.3 ±2.1 mm, 7.3 ±2.0 mm, 2.9° ±2.3°, and 7.0° ±7.0°, respectively. Conclusions The clinical workflow for image-guided adaptive cervical cancer brachytherapy using the Montreal split ring applicator was validated.


Citations (41)


... 23 In the RADICALS-HD trial, however, a short 6-month course of ADT with post-RP SRT did not improve MFS relative to no ADT, but adding 24 months of ADT improved MFS relative to short-course ADT (ISRCTN40814031). 26,27 Ultimately, the decision about whether to add ADT to SRT should be individualized based on clinical features (e.g., genomic classifier scores, the presence of aggressive traits) and patient preferences. 28 ADT-related gynecomastia prophylaxis. ...

Reference:

Implementing evidence‐based strategies for men with biochemically recurrent and advanced prostate cancer: Consensus recommendations from the US Prostate Cancer Conference 2024
Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

The Lancet

... However, the MFS benefit should be weighed against the adverse effects of long-course ADT. [1] is a well-conducted, multi-center, randomized trial that compared the efficacy of short-course versus long course ADT in patients requiring adjuvant or salvage radiotherapy following RP. This is the first study in the post-RP settings that contributes level 1 evidence. ...

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

The Lancet

... Although no standard treatment for GEA has been established yet, GEA has been reported as resistant to chemotherapy and radiation [3,5]. Therefore, complete surgical resection based on the accurate preoperative evaluation of its extent might be crucially important as a treatment strategy of GEA [6]. ...

Gastric-type Adenocarcinoma of the Endocervix: Potentially Overcoming Resistant Behavior with Surgery
  • Citing Article
  • October 2023

Gynecologic Oncology Reports

... It is important that there be international multicenter collaboration for prospective studies regarding treatment of POLEmut tumors given their low incidence rate. Future prospective studies to assess de-escalation of treatment in POLEmut tumors including PORTEC-4a (NCT03469674) [10,11] and TAPER [12] are currently open to recruitment. ...

CCTG EN10: A phase II study of tailored adjuvant therapy in POLE -mutated and p53-wildtype/NSMP early-stage endometrial cancer (EC)—RAINBO BLUE and TAPER.
  • Citing Article
  • June 2023

Journal of Clinical Oncology

... Many studies have evaluated an SIB approach to deliver elective pelvic nodal irradiation together with moderate hypofractionation to the prostate [14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. The consistent conclusion from all the published studies is that it is safe with a very acceptable toxicity profile. ...

Hypofractionated, Dose Escalation Radiotherapy for High-Risk Prostate Cancer: the safety analysis of the Prostate Cancer Study-5 (PCS-5), a GROUQ led phase III trial
  • Citing Article
  • May 2023

International Journal of Radiation Oncology*Biology*Physics

... It has proven to be instrumental in elevating the quality of their work and helping them achieve higher levels of excellence. Vaishya et al, 2023 [35] ChatGPT lacks current medical literature knowledge, gives inaccurate data, and inconsistent responses. Limited image presentation hinders comprehensive medical understanding. ...

A Case of Radiation-Induced Aortitis in a Patient With Cervical Cancer

Cureus

... Risk of bias in selection of the reported result 5.1 Were the data that produced this result analysed in accordance with a prespecified analysis plan that was finalized before unblinded outcome data were available for analysis? Petit [22] conducted a recent phase II RCT with a cohort of size 262, which is not specified to be scientifically calculated. A total of 253 patients were divided into four strata, and within each stratum, random selection was done to equally allocate among the intervention (n=125) and the control group (n=128). ...

PSMA-PET/CT guided intensification of radiotherapy for prostate cancer (PSMAgRT): Findings of detection rate, impact on cancer management, and early toxicity from a phase 2 randomised controlled trial
  • Citing Article
  • January 2023

International Journal of Radiation Oncology*Biology*Physics

... We are aware of only one ongoing trial comparing focal HDR-BT boost and whole-gland SBRT with whole-gland HDR-BT boost in terms of cancer control, toxicity, and quality of life. 51 Additionally, there are opportunities to potentially improve outcomes for focal brachytherapy. The consistent use of multi-parametric MRI and saturation biopsies may optimize patient selection and target volume identification. ...

Focal HDR brachytherapy boost to stereotactic radiotherapy (fBTsRT) for prostate cancer: a phase II randomized controlled trial

Radiation Oncology

... Others argued that radiation therapy with systemic therapy should be considered over surgery given the advances in radiation therapy. 16 Results from the PATRON trial will provide insight on the role of PSMA PET/CT in guiding the intensification of therapy in patients at risk of advanced prostate cancer by directly comparing outcomes where treatments were guided by conventional imaging compared to PSMA PET/CT imaging. 17 Use of lutetium-PSMA therapy in chemotherapy-unfit mCRPC patients generated discussion, as physicians noted there is no clear definition for chemotherapy-unfit (e.g., which category do patients who refuse chemotherapy belong in). ...

Conventional vs. Hypofractionated, Radiotherapy for High-Risk Prostate Cancer: 7-Year Outcomes of the Randomized, Non-Inferiority, Phase 3 PCS5 Trial
  • Citing Article
  • November 2022

International Journal of Radiation Oncology*Biology*Physics

... The authors concluded that machine learning could stratify patients based on the MRI characteristics, thereby aiding personalized treatment decisions (Hu et al., 2015). Grajales et al. (2022) proposed an image-guided Raman spectroscopy system for transperineal prostate cancer detection. By combining Raman spectroscopy and multiparametric MRI radiomics, they accurately stratified prostate cancer patients based on their International Society of Urological Pathology (ISUP) grading. ...

Image-guided Raman spectroscopy navigation system to improve transperineal prostate cancer detection. Part 2: in-vivo tumor-targeting using a classification model combining spectral and MRI-radiomics features

Journal of Biomedical Optics