Pr. Laure Fournier
Radiologist GU imaging
Dr. Anthony Dohan
Radiologist – Abdominal Imaging
Dr. Myriam Wartski
The adult radiology units of APHP.Centre University of Paris have developed an expertise in oncology imaging, one for each main organ sub specialty.
Imaging of bone and soft tissue sarcomas (Pr Drape and Pr Feydy), imaging of thoracic malignancies (Pr Revel) imaging of liver and gastrointestinal tumors (Pr Soyer, Pr Dohan, Pr Cuenod), neuroendocrine and adrenal tumors (Pr Legmann) part of the RENATEN network, female pelvic malignancies and breast cancer (Pr Fournier, Pr Dion) head and neck malignancies (Dr Gaultier), urologic tumors (Pr Fournier, Pr Correas, Dr Cornud). The radiology units are based on the 3 sites of the Paris Cancer Institute: CARPEM.
The expertise includes diagnostic imaging, for initial staging and follow-up after treatment, using RECIST or iRECIST criteria, as appropriate.
These 6 radiology units are involved in multiple weekly multidisciplinary tumor boards (MDT), following the INCA national guidelines, requiring presence of each actor of cancer diagnosis and treatment. Each week, there are 2 thoracic oncology MDTs, 2 abdominal and pelvic malignancy MDTs, 2 GYN and breast malignancy MDTs, one MDT for hematologic malignancies, one sarcoma MDT, one liver MDT, one urogenital malignancies MDT. There is also a MDT dedicated to bone metastasis.
Each organ-specialized radiologist team also takes in charge biopsy procedures, together with techniques of percutaneous thermal ablation and embolization. There is a dedicated structure for intra-arterial infusion chemotherapy (O. Pellerin).
Radiologists of this program are strongly involved in clinical and translational research
Clinical research is performed in the different fields of oncologic imaging, including renal tumors (1,2) gastro intestinal tumors (3), gynecologic malignancies (4) and lung cancer (5) Our expert radiologists participated in the writing of national guidelines (6), and of the European position statement on lung cancer screening (European Radiology, in press). A strong interaction with on-site physicians regarding the relation between cancer and thrombosis has been developed through several research conducted during last years (7).
Fields of research more specifically include peritoneal carcinomatosis (8), characterization of subsolid lung nodules, of which most represent indolent adenocarcinomas (9) and the radiological evaluation of response to metastatic renal cancers receiving anti-angiogenic treatment or immunotherapy (10).
Translational research is performed to allow for the identification of new imaging biomarkers, using techniques such as shear wave elastography as a way to monitor response to therapy or to characterize tumors of the testis (11,12), Magnetic resonance spectroscopy (13) to detect mutational profiles and MRI based perfusion techniques (14) to quantify tumor vascular heterogeneity. Study of angiogenesis biomarkers is helpful to predict responsiveness to antiangiogenic treatments (15). Machine learning techniques are also developed in the field of oncology to predict treatment efficacy or for prognostic estimation, based on radiomics with texture analysis (16,17). This is in phase with the research about the microenvironment and genomics of the lung tumors including mesothelioma as developed by other researchers of the group who demonstrated that each tumor can be decomposed as a combination of epithelioid-like and sarcomatoid-like components whose proportions are highly associated with the prognosis (18).
- Pr Revel is in charge of a University diploma for thoracic Imaging (72 hours, 120 students) and participates in the Inter University Diploma for thoracic oncology coordinated by F Le Pimpec Barthes and M Wislez (2 hours) and the diploma for Radiotherapists coordinated by Pr Giraud (8 hours)
- Pr Fournier is in charge of the organization of courses in Artificial Intelligence in Radiology for radiology residents (2h for level I, 8h for level II), “Introduction to research in imaging” for radiology residents (8h course), a French workshop on “Tumour Response Evaluation on Imaging” (2018-), co-organizer for European (EORTC-ESOI) workshop on “Tumour Response Evaluation on Imaging” (2016-). She participates 2 classes for Med students, 5 classes for Masters students, 6 classes for residents, 5 classes for continuous medical education focused on cancer imaging, and treatment response.
- Pr Dohan is in charge of the courses of abdominal imaging for radiology residents (8h) and of training in advanced interventional radiology and interventional oncology.
The organization on dedicated organ-specific imaging subspecialties allows providing the most accurate expertise for image reporting, using structured reports such as Lung-Rads, BI-Rads, PI-Rads and others. It also allows using optimized acquisition protocols, which are standardized across the different acquisition units, allowing for data sharing.
The recent association with pathologists, into a common department offers an increased opportunity for improving radiological-pathological confrontation in oncology.
Moreover, nuclear physicians are involved in the same consortium, and benefit from a digital equipment.
Tumor phenotyping will benefit from sharing complex imaging features (field of radiomics) and adding them to the tumor profile, as it is the case for genomics.
There will be an opportunity for developing image datasets combining computed tomography imaging with microscopy, allowing for development of characterization algorithm thanks to deep learning.
The large amount of collected cases at APHP.Centre, in each of the areas of oncology opens new perspectives in the field of artificial intelligence.
The selected following publications highlight the strength of clinical and translational research developed in the imaging program
- Boissier R, Ouzaid I, Nouhaud FX, Khene Z, Dariane C, Chkir S, Chelly S, Giwerc A, Allenet C, Lefrancq JB, Gimel P, Bodin T, Rioux-Leclercq N, Correas JM, Albiges L, Hetet JF, Bigot P, Bernhard JC, Long JA, Mejean A, Bensalah K Long-term oncological outcomes of cystic renal cell carcinoma according to the Bosniak classification AFU Committee of Urological Oncology.
- Cholley I, Correas JM, Masson-Lecomte A, Sanchez S, Champy C, Le Guilchet T, Ariane M, Hurel S, Audenet F, Thiounn N, Fontaine E, Mejean A, Timsit MO. Comparison of operative and oncologic results between partial nephrectomy and radiofrequency ablation for treatment of renal tumors in patients older than 75 . Prog Urol. 2018;28:55-61
- Phelip JM, Tougeron D, Léonard D, Benhaim L, Desolneux G, Dupré A, Michel P, Penna C, Tournigand C, Louvet C, Christou N, Chevallier P, Dohan A, Rousseaux B, Bouché O. Metastatic colorectal cancer (mCRC): French intergroup clinical practice guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFR). Dig Liver Dis. 2019;51:1357-1363
- Lavoue V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze PA, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la Motte Rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lecuru F, Lefrere-Belda MA, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Senechal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Long text of the Joint French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa. Part 1: Diagnostic exploration and staging, surgery, perioperative care, and pathology. J Gynecol Obstet Hum Reprod. 2019;48:369-378
- Chassagnon G, Bennani S, Freche G, Magdeleinat P, Mansuet-Lupo A, Revel MP CT-guided percutaneous core biopsy for assessment of morphologically normal adrenal glands showing high FDG uptake in patients with lung cancer.. Br J Radiol. 2018;91(1092):20180090
- Bensalah K, Albiges L, Bernhard JC, Bigot P, Bodin T, Boissier R, Correas JM, Gimel P, Hetet JF, Long JA, Nouhaud FX, Ouzaïd I, Rioux-Leclercq N, Méjean A. Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : prise en charge du cancer du rein French ccAFU guidelines – Update 2018–2020: Management of kidney cancer- Prog Urol. 2018;28(12S):S3-S31.
- Meyer G, Besse B, Doubre H, Charles-Nelson A, Aquilanti S, Izadifar A, Azarian R, Monnet I, Lamour C, Descourt R, Oliviero G, Taillade L, Chouaid C, Giraud F, Falcoz PE, Revel MP, Westeel V, Dixmier A, Tredaniel J, Dehette S, Decroisette C, Prevost A, Pichon E, Fabre E, Soria JC, Friard S, Stern JB, Jabot L, Dennewald G, Pavy G, Petitpretz P, Tourani JM, Alifano M, Chatellier G, Girard P. Anti-tumour effect of low molecular weight heparin in localised lung cancer: a phase III clinical trial. Eur Respir J. 2018;52(4).
- Dohan A, Hobeika C, Najah H, Pocard M, Rousset P, Eveno C. Preoperative assessment of peritoneal carcinomatosis of colorectal origin. J Visc Surg. 2018;155:293-303.
- Revel MP, Mannes I, Benzakoun J, Guinet C, Léger T, Grenier P, Lupo A, Fournel L, Chassagnon G, Bommart S. Subsolid Lung Nodule Classification: A CT Criterion for Improving Interobserver Agreement. Radiology. 2018;286:316-325.
- Fournier L, Bellucci A, Vano Y, Bouaboula M, Thibault C, Elaidi R, Oudard S, Cuenod C.I maging Response of Antiangiogenic and Immune-Oncology Drugs in Metastatic Renal Cell Carcinoma (mRCC): Current Status and Future Challenges. Kidney Cancer. 2017;1:107-114.
- Chamming’s F, Le-Frère-Belda MA, Latorre-Ossa H, Fitoussi V, Redheuil A, Assayag F, Pidial L, Gennisson JL, Tanter M, Cuénod CA, Fournier LS. Supersonic Shear Wave Elastography of Response to Anti-cancer Therapy in a Xenograft Tumor Model. Ultrasound Med Biol. 2016;42:924-30.
- Rocher L, Criton A, Gennisson JL, Creze M, Albiges L, Ferlicot S, Bellin MF, Izard V, Correas JM.Characterization of Testicular Masses in Adults: Performance of Combined Quantitative Shear Wave Elastography and Conventional Ultrasound. Ultrasound Med Biol. 2019;45:720-731.
- Lussey-Lepoutre C, Bellucci A, Morin A, Buffet A, Amar L, Janin M, Ottolenghi C, Zinzindohoué F, Autret G, Burnichon N, Robidel E, Banting B, Fontaine S, Cuenod CA, Benit P, Rustin P, Halimi P, Fournier L, Gimenez-Roqueplo AP, Favier J, Tavitian B.In Vivo Detection of Succinate by Magnetic Resonance Spectroscopy as a Hallmark of SDHx Mutations in Paraganglioma. Clin Cancer Res. 2016;22:1120-9.
- Thomassin-Naggara I, Soualhi N, Balvay D, Darai E, Cuenod CA.Quantifying tumor vascular heterogeneity with DCE-MRI in complex adnexal masses: A preliminary study. J Magn Reson Imaging. 2017;46:1776-1785.
- Mauge L, Mejean A, Fournier L, Pereira H, Etienne-Grimaldi MC, Levionnois E, Caty A, Abadie-Lacourtoisie S, Culine S, Le Moulec S, Linassier C, Théodore C, Ravaud A, Albiges L, Grine A, Tartour E, Milano G, Gille AS, Verkarre V, Helley D, Oudard S; PREINSUT study group. Sunitinib Prior to Planned Nephrectomy in Metastatic Renal Cell Carcinoma: Angiogenesis Biomarkers Predict Clinical Outcome in the Prospective Phase II PREINSUT Trial. Clin Cancer Res. 2018;24:5534-5542
- Dohan A, Gallix B, Guiu B, Le Malicot K, Reinhold C, Soyer P, Bennouna J, Ghiringhelli F, Barbier E, Boige V, Taieb J, Bouché O, François E, Phelip JM, Borel C, Faroux R, Seitz JF, Jacquot S, Ben Abdelghani M, Khemissa-Akouz F, Genet D, Jouve JL, Rinaldi Y, Desseigne F, Texereau P, Suc E, Lepage C, Aparicio T, Hoeffel C; PRODIGE 9 Investigators and PRODIGE 20 Investigators-Early evaluation using a radiomic signature of unresectable hepatic metastases to predict outcome in patients with colorectal cancer treated with FOLFIRI and bevacizumab. Gut. 2019 May 17
- Durot C, Mulé S, Soyer P, Marchal A, Grange F, Hoeffel C.Metastatic melanoma: pretreatment contrast-enhanced CT texture parameters as predictive biomarkers of survival in patients treated with pembrolizumab. Eur Radiol. 2019;29:3183-3191
- Blum Y, Meiller C, Quetel L, Elarouci N, Ayadi M, Tashtanbaeva D, Armenoult L, Montagne F, Tranchant R, Renier A, de Koning L, Copin MC, Hofman P, Hofman V, Porte H, Le Pimpec-Barthes F, Zucman-Rossi J, Jaurand MC, de Reyniès A, Jean D. Dissecting heterogeneity in malignant pleural mesothelioma through histo-molecular gradients for clinical applications. Nat Commun. 2019 ;10:1333
Annex 1: Main indicators of clinical activities
Annex 2: Ongoing Clinical Trials
|Sponsor Title||Phase||NCT number||Coordinator/Investigator|
|PHRC Simultaneous Portal and Hepatic Vein Versus Portal Vein Embolizations for Hypertrophy of the Future Liver Remnant (HYPER-LIV01)||II||NCT03841305||A Dohan (Investigator)|
|Hospices Civils de Lyon French National Registry of Rare Peritoneal Surface Malignancies (RENAPE)||Patient Registry||NCT02834169||A Dohan (Investigator)|