Radiotherapy Program
Radiotherapy Program
Board
Pr. Philippe Giraud
Physician
Pr. Catherine Durdux
Physician
Dr. Sarah Kreps
Physician
Dr. Jean- Emmanuel
Physician Bibault
Steering Committee
Radiation therapy department is located at the European Georges Pompidou (HEGP) hospital.
The radiotherapy team includes 4 seniors’ radiotherapy oncologists MD (Pr C. Durdux, head of the unit, Pr Ph. Giraud (MD, PhD), Dr J.E. Bibault (MD, PhD), Dr S. Kreps (MD)). Four fellowships and 5 residents complete the clinical team. The team includes also six senior physicists (5 MS, 1 PhD).
The radiotherapy unit takes care of adult patients with solid tumors (gastrointestinal and urologic cancers, head and neck cancers, lung cancers, breast cancers, gynecological and skin tumors) and Hodgkin lymphomas.
Since its opening in 2000, the radiotherapy unit has been developing innovative techniques in medical imaging, dosimetry and treatment devices: intensity modulated radiotherapy, irradiation with respiratory gating, stereotactic radiotherapy with a Cyberknife® and a Novalis® STX linac. All these various innovations are designed to achieve a high precision radiotherapy to better adapt irradiation fields to the tumor in order to protect organs at risk. Medical, scientific and educational projects fit into the development and assessment of these new technologies as well as in their routine deployment.
The external radiotherapy unit consists of 3 modern Clinac with a multileaf collimator (MLC), portal imaging, including a new generation linac (Novalis® STX) with a dedicated MLC for intensity modulation deliverance or stereotactic radiotherapy and a 3D image guided radiotherapy system, and a dedicated Light Speed RT CT scanner with deep inspiration breath hold techniques or with a 4D synchronized device. A Cyberknife®, an image-guided robotic radiosurgery system, completes the technical offer. The radiotherapy unit has a surgical subunit for high dose rate brachytherapy performed in gynecological and prostate cancers, and all hardware required for prostate brachytherapy with iode125 and implementation of gold markers.
This unit includes a hospitalization unit (8 beds for >24hr-hospitalization) which allow concurrent radiochemotherapy, management of complications and supportive care. Radiochemotherapy is also possible within the mutualized cancer day hospital.
All these activities are structured around multiple weekly cancer multidisciplinary team meetings including systematically at least one radiation oncologist
- 6 in Cochin hospital : Thoracic oncology (Pr C Durdux, Dr S Maaradji), digestive oncology (Dr JE Bibault, Dr A Dautruche), urologic oncology (Pr P Giraud), gynecologic oncology (Pr C Durdux, Dr E Fabiano), Sarcomas (Dr S Kreps, Dr T Feutren), dermatologic oncology (Dr T Feutren)
- 6 in EGP hospital : Thoracic oncology (Pr P Giraud), Senology (Pr C Durdux, Dr A Dautruche), gynecologic oncology (Pr C Durdux, Dr E Fabiano), Head and neck cancers (Dr S Kreps), urologic oncology (Dr JE Bibault, Dr S Maaradji), digestive oncology (Dr T Feutren)
Clinical & translational research
Physicians and Physicists of this program are strongly involved in clinical and translational research in oncology and radiotherapy.
Since the opening of HEGP (2000), 291 papers have been published on indexed journals. Particularly, we coordinate or participate in several innovative technologies projects (National Research Program) and clinical research programs: National STIC (Expensive Diagnostic and Therapeutic Innovation Support Program) on “gated radiotherapy techniques”, INCa national programs on “patient safety during radiotherapy” and “medico-economic evaluation on advanced radiotherapy techniques” (ART-ORL, ART-PELVIS), clinical trials in advanced lung, bladder, head and neck cancers (RTEP7-IFCT 14-01, LUNG ART study, Alimta-RT phase II study, Pravastatine-RT PHRC study, Androgenic alopecia and Prostate Cancer study, A multicentric prospective randomized open-label phase IIB study to evaluate radiofrequency ablation with or without stereotactic radiotherapy for non-operable hepatocellular carcinoma (HCC) INCa study, Amifostine-RT study…).
For 2 years, thanks to the collaboration with the unit of Anita Burgun (Information Science and Personalized Medicine), the service has been implementing several research topics on radiotherapy and artificial intelligence.
The Radiotherapy Program integrates 10 interns and 3 fellows each year. Physicist team will host 2 physicist students (DQPRM) in 2020.
Medical teams are widely involved in the university teaching of various tumor pathologies in Paris University and in several national teaching degrees/master’s degrees in the field of oncology :
- coordination of interns in radiotherapy for Ile-de-France (Pr P Giraud)
- participation in Oncology DES / DESC in oncology
- coordination of DIU of High Technicity Radiotherapy (Pr P Giraud)
- participation in several DIU (thoracic oncology, Pr Le Pimpec-Barthes; digestive oncology, Pr Taieb; gynecological and breast tumors, Pr Lecuru)
- coordination of DU of psycho-oncology (Pr Catherine Durdux).
The Radiotherapy program propose several clinical and research perspectives:
1) Clinical perspectives:
- Development of VMAT in breast cancer
- Development of adaptive radiotherapy
- Development of stereotactic radiotherapy with immunotherapy
- Improvement of Inclusion in therapeutic trials till an inclusion rate to 10% of patients
- Database for stereotactic treatments
2) Research perspectives:
- Industrial research for automatic delineation for organs at risk and GTV (gross tumor volume) in lung stereotactic radiotherapy
- Translational research on additional dose by IGRT in radiotherapy in collaboration with Doseo platform
| Name Surname | Title/Position | Speciality | Research Unit | Resarch Team |
|---|---|---|---|---|
| Catherine Durdux | Full Prof | Radiation Oncologist | HEGP | |
| Philippe Giraud | Full Prof | Radiation Oncologist | HEGP | |
| Sarah Kreps | Full time physician | Radiation Oncologist | HEGP | |
| Jean-Emmanuel Bibault | Full time physician | Radiation Oncologist | UMRS 1138, Centre de Recherche des Cordeliers | Information Science and Personalized Medicine |
| Antoine Dautruche | Full time physician | Radiation Oncologist | HEGP | |
| Emmanuelle Fabiano | Full time physician | Radiation Oncologist | HEGP | |
| Thomas Feutren | Full time physician | Radiation Oncologist | HEGP | |
| Safia Maaradji | Partial time physician | Radiation Oncologist | HEGP | |
| Dupont Stéphane | Full time physicist | Medical Physicist | HEGP | |
| Jaffre Françoise | Full time physicist | Medical Physicist | HEGP | |
| Moreau Damien | Full time physicist | Medical Physicist | HEGP | |
| Om Déborah | Full time physicist | Medical Physicist | HEGP | |
| Scius Maximilien | Full time physicist | Medical Physicist | HEGP | |
| Toublanc Sandra | Full time physicist | Medical Physicist | HEGP |
The selected following publications highlight the strength of clinical and translational research developed in the radiotherapy program:
- Boldrini L ; Bibault JE ; Masciocchi C ; Shen Y ; Bittner MI. Deep Learning: A Review for the Radiation Oncologist, Front Oncol. 2019; 9: 977
- Giraud P, Gasnier A, El Ayachy R, Kreps S, Foy JP, Durdux C, Huguet F, Burgun A, Bibault JE. Radiomics and Machine Learning for Radiotherapy in Head and Neck Cancers. Front Oncol. 2019; 9:174
- Laccourreye O; Marret G, Giraud P. A vicious enemy in head and neck oncology: Delay! Eur Ann Otorhinolaryngol Head Neck Dis. 2019; 136: 61-62
- Zapletal E, Bibault JE, Giraud P, Burgun, A. Integrating Multimodal Radiation Therapy Data into i2b2. Appl Clin Inform. 2018; 9: 377-390
- Foy JP ; Durdux C ; Giraud P ; Bibault JE. The Rise of Radiomics and Implications for Oncologic Management. J Natl Cancer Inst. 2018; 110: 1275-1276
- Bibault JE, Zapletal E, Rance B, Giraud P, Burgun A. Labeling for Big Data in radiation oncology: The Radiation Oncology Structures ontology. PLoS One. 2018 ;13(1) : e0191263
- Meillan N, Bibault JE, Vautier J, Daveau-Bergerault C, Kreps S, Tournat H, Durdux C, Giraud P. Automatic Intracranial Segmentation : Is the Clinician Still Needed ? Technol Cancer Res Treat. 2018;17:1533034617748839.
- Bibault JE, Tinhofer I. The role of Next-Generation Sequencing in tumoral radiosensitivity prediction.Clin Transl Radiat Oncol. 2017. 3:16-20.
- Giroux M, Ladjal H, Beuve M ; Giraud, P ; Shariat, B. Patient-Specific Biomechanical Modeling of the Lung Tumor for Radiation Therapy. Comput Methods Biomech Biomed Engin. 2017; 20: 95-96
- Bibault JE, Dussart S ; Pommier P ; Morelle M ; Huguet M ; Boisselier P & al. Clinical Outcomes of Several IMRT Techniques for Patients With Head and Neck Cancer: A Propensity Score-Weighted Analysis., Int J Radiat Oncol Biol Phys. 2017; 99: 929-937
- Laccourreye O, Bonfils P, Malinvaud D, Ménard M ; Giraud P , Survival and laryngeal preservation tradeoff in advanced laryngeal cancer: From the otorhinolaryngology patient to the managing physician. Head Neck. 2017; 39: 1984-1989
- Laccourreye O, Castelnau-Marchand P, Rubin F, Badoual C, Halimi P ; Giraud P. The keys to conservative treatment of early-stage squamous cell carcinoma of the tonsillar region., Eur Ann Otorhinolaryngol Head Neck Dis. 2017; 134: 259-264
- Kreps S, Berges O, Belin L; Zefkili S, Petras S, Giraud P. Salivary gland-sparing helical tomotherapy for head and neck cancer: Preserved salivary function on quantitative salivary gland scintigraphy after tomotherapy. Eur Ann Otorhinolaryngol Head Neck Dis. 2016; 133: 257-62
- Bibault JE, Giraud P, Burgun A. Big Data and machine learning in radiation oncology: State of the art and future prospects. Cancer Lett. 2016; 382:110-117
- Garrido P, Engel-Riedel W, Serke M, Giraud P, Ricardi U, Vallejo C & al. Final results from a Phase II study of pemetrexed and cisplatin with concurrent thoracic radiation after Pem-Cis induction in patients with unresectable locally advanced non-squamous non-small cell lung cancer (NSCLC). Lung Cancer. 2015; 88: 160-6
Annex 1: Main indicators of clinical activities in 2018
Number of new patients: 1350
Number of radiotherapy sessions: 27023 (cyberknife: 1518 sessions)
Number of brachytherapy sessions: 368
Number de consultations: about 7500
Number of hospitalization sessions: 298
Number of cancer day sessions : 867
Annex 2: Ongoing Clinical Trials
| Trial Name | Sponsor Title | Principal investigators, sponsors | Radiotherapy Program investigator |
|---|---|---|---|
| RTEP7 | Randomized phase II-III study of personalizedradiotherapy dose redistribution in patients withinoperable stage III non-small cell lung cancerand a persistent FDG uptake at 42 Gy duringconcomitant radio-chemotherapy radiotherapy dose redistribution in patients with inoperable stage III non-small cell lung cancer and a persistent FDG uptake at 42 Gy during concomitant radio-chemotherapy | P. Giraud, P. Ver, IFCT | P. Giraud |
| OSAGE | Phase I-II of chemoradiation in esophagus cancer in elderly | S. Servagi, Vernat, CHRU Besançon | JE Bibault |
| NICOL | A phase-I study of nivolumab in association with radiotherapy and cisplatin in locally advanced cervical cancers followed by adjuvant nivolumab for up to 6 months | E Romano, Curie Institute | C Durdux |
| GETUG V04 | Phase II randomized trial evaluating chemoradiotherapy (cisplatin versus cisplatin plus gemcitabine) as conservative treatment in operable bladder cancer | D. Azria, GETUG | C Durdux |
| GETUG 30 | Post-operative adjuvant radiotherapy in locally advanced bladder cancer : phase II randomized trial | P Sargos, GETUG | S Kreps |
| PEACE 2 | A Phase III of Cabazitaxel and Pelvic Radiotherapy, in localized Prostate Cancer and High-risk Features of relapse | J L Deville, Unicancer | S Kreps, JE Bibault |
| SALTORL | Trial of Laryngeal Preservation Comparing induced CT followed by RT vs CT Concomitant to RT | G Calais, GORTEC | S Kreps |
| ImmuneBOOST | Feasibility and Tolerance of Nivolumab Neoadjuvant immunotherapy in High Risk HPV Driven Oropharynx Cancer | H Mirghani, Unicancer | S Kreps |
| NORAD1 | Phase III randomized trial comparing neoadjuvant chemotherapy to chemoradiation in locally advanced rectal cancers | S Benoist, GRECCAR | E Fabiano |
| PACIFIC4 | Phase III randomised double-blind placebo-controlled multicenter International study of Durvalumab following stereotactic body radiation therapy (SBRT) for the treatment of patients with stage I-II NSCLC | E Fabre, Astra Zeneca | P Giraud |
| KEYNOTE 867 | A Phase 3, Randomized, Placebo-Controlled clinical Study to evaluate the safety and efficacy of Stereotactic Body Radiotherapy (SBRT) with or without Pembrolizumab in participants with Medically Inoperable Stages I or IIA NSCLC (KEYNOTE-867) | M Wislez, Merck | C Durdux, A Dautruche |
| CHECKMATE L73 | A Phase 3, Randomized, Open Label Study to Compare Nivolumab plus Concurrent Chemoradiotherapy (CCRT) followed by Nivolumab plus Ipilimumab or Nivolumab plus CCRT Followed by Nivolumab vs CCRT followed by Durvalumab in Previously Untreated, Locally Advanced Non-small Cell Lung Cancer (LA NSCLC) | M Wislez, BMS | C Durdux, A Dautruche |
| PRISME | Phase II trial evaluating the efficacy of stromal mesenchymal cells in late side effects of pelvic radiotherapy in failure of conventional strategies | M Mohty, APHP | C Durdux |
